THE TRAVELERS LIFE AND ANNUITY COMPANY o [ONE CITYPLACE]
o HARTFORD, CONNECTICUT o [06103-3415]
A STOCK COMPANY
Mailing Address: [Annuity Services]
[ P.O. Box 990009]
Hartford, CT [06199-0009]
We are pleased to provide You the benefits of this Variable Annuity Contract.
Please read Your Contract and all attached forms carefully.
RIGHT TO EXAMINE THIS CONTRACT
IN ORDER TO CANCEL THIS CONTRACT, YOU MUST PROVIDE A WRITTEN REQUEST AND THIS
CONTRACT TO US AT OUR MAILING ADDRESS OR TO OUR AGENT WITHIN 10 CALENDAR DAYS
AFTER ITS DELIVERY TO YOU. WE WILL PAY YOU THE CONTRACT VALUE DETERMINED AS OF
THE NEXT VALUATION DATE AFTER WE RECEIVE THE WRITTEN REQUEST AT OUR OFFICE, PLUS
ANY PREMIUM TAX AND CONTRACT CHARGES PAID, MINUS ANY PURCHASE PAYMENT CREDITS
APPLIED. AFTER THE CONTRACT IS RETURNED, IT WILL BE CONSIDERED AS NEVER IN
EFFECT.
This Contract is issued in consideration of the Purchase Payments. It is subject
to the terms and conditions stated on the attached pages, all of which are parts
of it.
Executed at Hartford, Connecticut
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ /s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇
President Secretary
This is a legal Contract between You and Us. READ YOUR CONTRACT CAREFULLY.
FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE
SEPARATE ACCOUNT, ARE VARIABLE AND MAY INCREASE OR DECREASE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT.
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TABLE OF CONTENTS
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[Right to Examine this Contract Cover Page
Contract Specifications Page 3
Definitions Page 5
Ownership, Beneficiary and Annuitant Provisions Page 7
Purchase Payment and Valuation Provisions Page 8
Death Benefit Provision Page 12
Settlement Provisions Page 13
General Provisions Page 15
Annuity Tables Page 17]
Any Amendments, Riders or Endorsements follow the Annuity Tables.
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CONTRACT SPECIFICATIONS
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CONTRACT NUMBER [SPECIMEN]
MARKET TYPE [NONQUALIFIED]
OWNER [▇▇▇▇ ▇▇▇]
[JOINT OWNER] [ ▇▇▇▇▇ ▇▇▇]
ANNUITANT [▇▇▇▇ ▇▇▇]
[CONTINGENT ANNUITANT] [ ]
CONTRACT DATE [JANUARY 1, 2003]
MATURITY DATE [JANUARY 1, 2015]
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PURCHASE PAYMENTS:
MINIMUM INITIAL PURCHASE PAYMENT: [$5,000]
MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$500]
MAXIMUM SUM OF INITIAL AND SUBSEQUENT PURCHASE PAYMENTS: [$1,000,000]
unless We consent to a larger amount.
PURCHASE PAYMENT CREDIT PERCENTAGE: [4.5%]
The Purchase Payment Credit percentage will be credited to each Purchase Payment
applied through Age [80]. Age is determined based upon the oldest age of the
owner/Annuitant on the date the Purchase Payment is credited to Your Contract.
FIXED ACCOUNT:
MINIMUM GUARANTEED INTEREST RATE: The Minimum Guaranteed Interest Rate for the
Fixed Account is 3%.
GUARANTEED INTEREST PERIODS: The initial interest rate for any Purchase Payment
and associated Purchase Payment Credit allocated to the Fixed Account is
guaranteed for one year from the date it is credited to Your Contract.
Subsequent renewal rates will be guaranteed for a [calendar quarter]. These
guarantees do not apply to any dollar cost averaging program offered by Us, or
to any other administrative program.
TRANSFERS: You may transfer up to [15%] of the Fixed Account value to any of the
Funding Options [twice a year during the 30 days following the semi-annual
Contract Date anniversary.
SEPARATE ACCOUNT:
[TLAC SEPARATE ACCOUNT TWELVE FOR VARIABLE ANNUITIES]
Information about the Separate Account and the Funding Options is provided in
the prospectus for [TLAC Separate Account Twelve for Variable Annuities].
FUNDING OPTIONS DAILY DEDUCTIONS:
The Administrative Charge and the Mortality and Expense Risk Charge result in a
daily deduction of [.00005205] per Funding Option. When expressed on an annual
basis, assuming a 365-day year, the deduction equals [1.90%] per Funding Option.
Administrative Charge: [.15%] on an annual basis
Mortality and Expense Risk Charge: [1.75%] on an annual basis
ANNUAL CONTRACT CHARGE: [$40.00]
This charge will be assessed annually on the [fourth Friday of August].
This charge will not be assessed under the following situations:
(a) if Your Contract value is [$100,000] or greater on the date the
charge is assessed;
(b) from any amount in the Fixed Account;
(c) distribution of proceeds due to death; or
(d) after an Annuity payout has begun.
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CONTRACT SPECIFICATIONS
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WITHDRAWAL CHARGE: The Withdrawal Charge is calculated as a percentage of the
Purchase Payments and associated Purchase Payment Credits withdrawn on a
first-in, first-out basis. For the purpose of determining the withdrawal charge,
the order of withdrawal will be deemed to be taken from (a) any Purchase
Payments and associated Purchase Payment Credits that are not subject to the
withdrawal charge; (b) next from any remaining free withdrawal allowance (as
described below) after the reduction by the amount of (a); (c) next from
Purchase Payments and associated Purchase Payment Credits still subject to a
withdrawal charge (on a first-in, first-out basis); and then from (d) from
Contract earnings. Any free withdrawals taken will not reduce Purchase Payments
and associated Purchase Payment Credits still subject to the withdrawal charge.
NUMBER OF YEARS SINCE A
PURCHASE PAYMENT WAS APPLIED WITHDRAWAL CHARGE PERCENTAGE
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GREATER THAN OR EQUAL TO BUT LESS THAN
------------------------ -------------
0 years 3 years 8%
3 years 4 years 7%
4 years 5 years 6%
5 years 6 years 5%
6 years 7 years 4%
7 years 8 years 3%
8 years 9 years 2%
9+ years 0%
[DEDUCTIONS NOT SUBJECT TO A WITHDRAWAL CHARGE:
We will not deduct a withdrawal charge under this Contract due to:
(a) death of the Contract owner or the Annuitant with no Contingent
Annuitant surviving; or
(b) Minimum Distributions (as defined by the Internal Revenue Code)
taken under Our managed distribution program then in effect if
elected by the owner by a Written Request.]
[FREE WITHDRAWAL ALLOWANCE: [After the first Contract Year], You may withdraw up
to [10 %] of Your Contract value annually without imposition of the withdrawal
charge. If You have Purchase Payments and associated Purchase Payment Credits no
longer subject to the withdrawal charge, the maximum You may withdraw without
the withdrawal charge is the greater of: (a) the free withdrawal allowance; or
(b) the total amount of Purchase Payments and associated Purchase Payment
Credits no longer subject to a withdrawal charge.
NOTE: Any free withdrawal taken will reduce Purchase Payments and associated
Purchase Payment Credits no longer subject to a withdrawal charge. The available
amount will be calculated as of the end of the previous Contract Year. The free
withdrawal amount is not cumulative from year to year. The free withdrawal
allowance applies to any partial withdrawals and to full withdrawals, [except
those transferred directly to annuity contracts issued by unaffiliated carriers
and financial institutions.]
TRANSFER CHARGE: We reserve the right to assess a transfer charge of up to
[$10.00] on transfers exceeding 12 per year. We will notify You In Writing at
Your last known address at least 31 days prior to the imposition of any such
Transfer Charge.
TERMINATION: We reserve the right to terminate this Contract when the Contract
value is less than [$2,000] and Purchase Payments have not been made for at
least two years.
[ASSUMED DAILY NET INVESTMENT FACTOR: Upon annuitization, the Assumed Daily Net
Investment Factor for variable payments is 1.000081 for each Funding Option and
1.000041 for fixed payments. When expressed on an annual basis this equals 3%
for variable payments and 1.5% for fixed payments, assuming a 365-day year.]
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DEFINITIONS
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ACCUMULATION UNIT - an accounting unit of measure used to calculate the value of
this Contract before annuity payments begin.
AGE - age last birthday.
ANNUITANT - the person on whose life the Maturity Date and annuity payments
depend.
ANNUITY UNIT(S) - an accounting unit of measure used to calculate the value of
annuity payments.
CODE - the Internal Revenue Code of 1986, as amended, and all related laws and
regulations, which are in effect during the term of this Contract.
CONTRACT - a Contract that describes the benefits, rights, and obligations of
the owner and Us.
CONTRACT DATE - the date on which the Contract is issued.
CONTRACT YEARS - twelve-month periods beginning with the Contract Date.
DEATH REPORT DATE - the Valuation Date coincident with or next following the day
on which We have received 1) Due Proof of Death and 2) a Written Request for an
election of a single sum payment or an alternate Settlement Option as described
in the Contract.
DUE PROOF OF DEATH - 1) a copy of a certified death certificate; 2) a copy of a
certified decree of a court of competent jurisdiction as to the finding of
death; 3) a written statement by a medical doctor who attended the deceased; or
4) any other proof satisfactory to Us.
FIXED ACCOUNT(S) - an account that consists of the assets (other than those in a
Separate Account) that are part of the General Account of the Company. The Fixed
Account may not always be available under this Contract.
FUNDING OPTION(S) - that portion of the assets of a division of the Separate
Account, which is allocated to a particular Underlying Fund; also known as a
Sub-Account.
MATURITY DATE - the date on which the annuity payments are to begin.
MINIMUM DISTRIBUTIONS - Minimum amounts that must be distributed each year in
relation to certain qualified plans under the Code.
NONQUALIFIED CONTRACT - a Contract other than a Qualified Contract, funded by
after-tax contributions.
OUR OFFICE - the Home Office of The Travelers Life and Annuity Company or any
other office which We may designate for the purpose of administering this
Contract. All correspondence regarding this Contract should be sent to Our
mailing address stated on the cover page of this Contract.
PREMIUM TAX - the amount of tax, if any, charged by a state or municipality. We
will deduct any applicable Premium Tax from the Contract value either upon
surrender, annuitization, death, or at the time a Purchase Payment is made, but
no earlier than when We have the liability under state law.
PURCHASE PAYMENT(S) - payments of premium You make to Us under this Contract.
QUALIFIED CONTRACT - a Contract used in a retirement plan or program, whereby
the Purchase Payments and any gains are intended to qualify under sections 401,
403, 408, and 457 of the Code.
SETTLEMENT OPTION(S) - an annuity option elected under this Contract.
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SEPARATE ACCOUNT(S) - the Separate Account(s) indicated in the Contract
Specifications, which We established for this class of Contracts and certain
other Contracts.
TERMINATION - discontinuance of this Contract by Us or by Your Written Request.
UNDERLYING FUND(S) - an open-end diversified management investment company,
which serves as a Funding Option under the Separate Account.
VALUATION DATE(S) -a date on which a Funding Option is valued, generally at the
close of business on each day the New York Stock Exchange is open for trading
(except for when trading is restricted due to an emergency as defined by the
Securities and Exchange Commission).
VALUATION PERIOD(S) - the period of time between successive Valuation Dates.
WE, US, OUR - The Travelers Life and Annuity Company
WRITTEN REQUEST - written information including requests for Contract,
beneficiary, ownership, transfers, surrenders or other changes sent to Us in a
form and content satisfactory to Us and received in good order at Our Office.
Requests for changes are subject to any action taken prior to our receipt of the
written information.
YOU, YOUR - the owner, including any joint owner.
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OWNERSHIP, BENEFICIARY AND ANNUITANT PROVISIONS
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OWNERSHIP
This Contract belongs to the owner shown in the Contract Specifications or to
any person subsequently named in a Written Request of "Transfer of Ownership" as
provided below. As owner, You have sole power during the Annuitant's lifetime to
exercise any rights and to receive all benefits given in this Contract, provided
You have not named an irrevocable beneficiary and provided the Contract is not
assigned.
You will be the recipient of all payments while the Annuitant is alive unless
You direct them to an alternate recipient by Written Request. An alternate
recipient does not become the owner. An alternate payment directive is revocable
by You at any time by giving Us 30 days advance notice by Written Request.
JOINT OWNERS
Joint owners may be named in a Written Request prior to the Contract Date. Joint
owners may independently exercise transfers between Funding Options. All other
rights of ownership must be exercised by joint action. Joint owners own equal
shares of any benefits accruing or payments made to them. All rights of a joint
owner end at death if another joint owner survives. The entire interest of the
deceased joint owner in this Contract will pass to the surviving joint owner,
unless the deceased joint owner was also the Annuitant.
If a joint owner dies before payment of an annuity option begins and is survived
by the Annuitant, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the beneficiary named in a Written Request. Upon the death of a joint owner
who is the Annuitant, the entire interest will pass to the beneficiary(ies).
TRANSFER OF OWNERSHIP
You may transfer ownership by Written Request, subject to Our approval. You may
not revoke any transfer of ownership after We receive the Written Request. It
will take effect subject to any payments made or other actions taken by Us
before the Written Request is received.
Until a new beneficiary is designated, a transfer of ownership does not affect
the interest of any beneficiary designated prior to the effective date of the
transfer.
A transfer of ownership may have tax consequences to You; please consult Your
tax advisor.
ASSIGNMENT
To the extent permitted by law, You may collaterally assign ownership of all or
a portion of this Contract by Written Request without the approval of any
beneficiary unless irrevocably named. You may not exercise any rights of
ownership while the assignment remains in effect without the approval of the
collateral assignee. We are not responsible for the validity of any assignment.
Once We record the collateral assignment, it will take effect subject to any
payments made or other actions taken by Us before the Written Request is
recorded.
If a claim is made based on an assignment, We may require proof of interest of
the claimant. An assignment takes precedence over any rights of a beneficiary.
Any amounts due under an assignment will be paid in a single sum.
An assignment may have adverse tax consequences to You; please consult Your tax
advisor.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner or beneficiary
under this Contract shall be subject to the claims of creditors or any legal
process except as may be provided by an assignment.
BENEFICIARY
The beneficiary is the party named by You in a Written Request prior to the
Annuitant's death. If the beneficiary has been irrevocably designated, the
beneficiary cannot be changed without such beneficiary's written consent.
The beneficiary has the right to receive any remaining contractual benefits upon
the death of the Annuitant, or under certain circumstances, upon the death of
the owner. If there is more than one beneficiary surviving, the beneficiaries
will share equally in benefits unless You have indicated different shares in a
Written Request. When the Annuitant dies, if You have not named a beneficiary or
if the named beneficiary is not living, We will pay the death benefit to You or
Your estate.
If a joint owner dies and is survived by the Annuitant before payment of an
annuity option begins, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the beneficiary named in a Written Request.
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ANNUITANT
The Annuitant is the individual shown in the Contract Specifications on whose
life annuity payments are made. The Annuitant may not be changed after the
Contract Date.
CONTINGENT ANNUITANT
You may name one individual as a contingent Annuitant by Written Request prior
to the Contract Date, provided the owner is not a trust. A contingent Annuitant
may not be changed, deleted or added to the Contract after the Contract Date.
If the Annuitant (who is not the owner) dies prior to the Maturity Date while
this Contract is in effect and while the contingent Annuitant is living:
a. the death benefit will not be payable upon the Annuitant's death;
b. the contingent Annuitant becomes the Annuitant; and
c. all other rights and benefits provided by this Contract will
continue in effect.
When a contingent Annuitant becomes the Annuitant, the Maturity Date remains the
same as previously in effect, unless otherwise provided.
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PURCHASE PAYMENT AND VALUATION PROVISIONS
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PURCHASE PAYMENT
PURCHASE PAYMENT
A Purchase Payment is any payment You make to this Contract for the benefits it
provides. An initial lump sum Purchase Payment must be made to the Contract and
is due and payable before the Contract becomes effective. Each Purchase Payment
is payable to Us at Our Office; the minimum and maximum initial and subsequent
Purchase Payment amounts are shown in the Contract Specifications. No additional
Purchase Payments after the initial Purchase Payment is required to keep this
Contract in force, except as provided in the "Termination" provision.
A net Purchase Payment is that part of each Purchase Payment applied to the
Contract value. A net Purchase Payment is equal to the Purchase Payment less any
applicable Premium Tax charge.
ALLOCATION OF PURCHASE PAYMENT
We will apply any net Purchase Payment to provide Accumulation Units of selected
Funding Options and/or the Fixed Account (if applicable) of this Contract. The
initial net Purchase Payment will be applied within two business days following
its receipt at Our Office, if the information received is in good order.
Subsequent net Purchase Payments will be applied on the same business day if
received in good order at Our Office on or before 4:00 p.m., Eastern Standard
Time. The net Purchase Payment will be allocated to the Funding Options and/or
the Fixed Account (if applicable) in the proportion specified by You for this
Contract.
PURCHASE PAYMENT CREDIT
We will add a Purchase Payment Credit to this Contract with each Purchase
Payment applied as described in the Contract Specifications. The Purchase
Payment Credit will be equal to the Purchase Payment multiplied by the Purchase
Payment Credit Percentage as shown in the Contract Specifications. Each Purchase
Payment Credit will be applied on a pro rata basis to the Funding Options and/or
the Fixed Account (if applicable) in the same ratio as the applicable Purchase
Payment.
Purchase Payment Credits will be deducted from any refund amount under the
following circumstances:
a) upon return of this Contract during the Right to Examine Period;
b) due to death of the owner or Annuitant (with no Contingent Annuitant
surviving) during the 12 months following the application of any
Purchase Payment Credit; or
c) termination of this Contract during the 12 months following the
application of any Purchase Payment Credit.
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FUNDING OPTION VALUATION
NUMBER OF ACCUMULATION UNITS
The number of Accumulation Units to be credited to each Funding Option once a
Purchase Payment has been received by Us will be determined by dividing the net
Purchase Payment and associated Purchase Payment Credit applied to that Funding
Option by the then Accumulation Unit Value of that Funding Option.
ACCUMULATION UNIT VALUE
We determine the value of an Accumulation Unit in each Funding Option on each
Valuation Date by multiplying the value on the preceding Valuation Date by the
net investment factor for that Funding Option for the Valuation Period just
ended.
The value of an Accumulation Unit on any date other than a Valuation Date will
be equal to its value as of the next Valuation Date.
NET INVESTMENT FACTOR
The net investment factor is a factor applied to measure the investment
performance of a Funding Option from one Valuation Period to the next. The net
investment factor for a Funding Option for any Valuation Period is determined by
dividing A by B and subtracting C where:
A is
1. the Net Asset Value per share of the Underlying Fund held in
the Funding Option as of the Valuation Date; plus
2. the per-share amount of any dividend or capital gain
distribution on shares of the Underlying Fund held by the
Funding Option if the ex-dividend date occurs in the Valuation
Period just ended; plus or minus
3. a per-share charge or credit, as We may determine on the
Valuation Date for tax reserves; and
B is
1. the Net Asset Value per share of the Underlying Fund held in
the Funding Option as of the last prior Valuation Date; plus
or minus
2. the per-share or per-unit charge or credit for tax reserves as
of the end of the last prior Valuation Date; and
C is the applicable Funding Option deduction for the Valuation Period.
Assets in each Funding Option will be valued at fair market value in accordance
with accepted accounting practices and applicable laws and regulations.
All Funding Option deductions related to this Contract are shown in the Contract
Specifications.
FIXED ACCOUNT VALUATION
FIXED ACCOUNT VALUE
Net Purchase Payments are applied to increase the value of the Fixed Account.
The initial value of the Fixed Account will be the net Purchase Payment and
associated Purchase Payment credit allocated to the Fixed Account, or amounts
transferred from the Funding Option(s) to the Fixed Account. On any subsequent
valuation date, the value of the Fixed Account will equal:
1. the value of the Fixed Account on the preceding Valuation Date; plus
2. any net Purchase Payments and associated Purchase Payment Credits or
amounts transferred from the Funding Option(s) applied on that
Valuation Date; minus
3. the dollar value of any transfers, withdrawals, charges or taxes, if
any deducted from the Fixed Account; plus
4. any interest earned.
NUMBER OF ACCUMULATION UNITS
For accounting purposes, upon receipt of each net Purchase Payment allocated to
the Fixed Account, We will convert each Purchase Payment and associated Purchase
Payment Credit to Accumulation Units. We will determine the number of
Accumulation Units to be credited to the Fixed Account by dividing the net
Purchase Payment and associated Purchase Payment Credit allocated to the Fixed
Account by the then dollar value of one Accumulation Unit of the Fixed Account.
ACCUMULATION UNIT VALUE
We determine the value of an Accumulation Unit in the Fixed Account on any day
by multiplying the value on the immediately preceding day by the net interest
factor for the day on which the value is being determined.
NET INTEREST FACTOR
The net interest factor for any day is the guaranteed net interest rate as shown
in the Contract Specifications, plus any additional amounts credited by Us, plus
1.0000. Interest is credited daily. The method of crediting additional interest
will be at Our discretion.
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TRANSFERS AMONG FUNDING OPTIONS AND THE FIXED ACCOUNT
You may transfer all or any part of the Contract value from one Funding Option
to any other Funding Option at any time up to 30 days before the Maturity Date.
Additionally, You may transfer a part of the Fixed Account value (if applicable)
to any of the Funding Options as shown in the Contract Specifications.
Amounts may generally be transferred from the Funding Options to the Fixed
Account (if applicable) at any time up to 30 days before the Maturity Date.
▇▇▇▇▇▇▇ previously transferred from the Fixed Account to the Funding Options may
not be transferred back to the Fixed Account for a period of at least six months
from the date of transfer. We reserve the right to limit the number of transfers
from one Funding Option to any other Funding Option or to the Fixed Account. We
will always allow at least one transfer in any six month period.
Transfers between Funding Options and/or the Fixed Account (if applicable) will
result in the addition or deletion of Accumulation Units having a total value
equal to the dollar amount being transferred to or from a particular Funding
Option and/or the Fixed Account. The number of Accumulation Units will be
determined by using the Accumulation Unit Value of the Funding Options involved
and/or the Fixed Account as of the next valuation after We receive notification
of request for transfer. Transfers will be subject to any applicable Transfer
charge described in the Contract Specifications.
We reserve the right to restrict transfers between Funding Options by any market
timing firm or any other third party authorized to initiate transfers on behalf
of multiple Contract owners. We may not accept, among other things; 1) transfer
instructions of any agent acting under a power of attorney on behalf of more
than one owner, or 2) transfer or exchange instructions of individual owners who
have executed pre-authorized transfer forms which are submitted by market timing
firms or other third parties on behalf of more than one owner. We further
reserve the right to limit transfers by Contract owners, any market timing firm
or any other third party authorized to initiate transfers on behalf of multiple
Contract owners, that We determine, in Our sole discretion, will disadvantage
other Contract owners.
CONTRACT VALUES
CONTRACT VALUE
The Contract value on any date equals the sum of the accumulated values in the
Funding Options and the Fixed Account (if applicable). The accumulated value in
a Funding Option equals the number of outstanding Accumulation Units credited to
that Funding Option, multiplied by the then current Accumulation Unit Value for
that Funding Option.
The Accumulation value of the Fixed Account equals the number of outstanding
Accumulation Units credited to the Fixed Account multiplied by the current
Accumulation Unit Value of the Fixed Account.
The Guaranteed value of the Fixed Account equals the accumulated value of the
Fixed Account calculated by using the guaranteed net interest factor.
CONTRACT CHARGE
A Contract charge in the amount and for the period shown in the Contract
Specifications will be deducted from the Contract value to reimburse Us for
administrative expenses relating to the Contract. The Contract charge will be
deducted by surrendering, on a pro rata basis, Accumulation Units from amounts
allocated to the Funding Options. The Contract charge will not be deducted from
the Fixed Account.
We will deduct the Contract charge on a pro rata basis if the Contract has been
in effect for less than a full period on the date the charge is deducted. The
Contract charge will also be prorated upon full surrender or Termination of the
Contract.
CASH SURRENDER VALUE
The cash surrender value is equal to the Contract value less any applicable
withdrawal charges and fees as shown in the Contract Specifications and less any
taxes deducted upon surrender.
The guaranteed cash surrender value of the Fixed Account equals the guaranteed
value of the Fixed Account less any applicable charges and fees as shown in the
Contract Specifications, less any taxes deducted upon surrender.
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CASH SURRENDER
You may elect by Written Request to receive the cash surrender value before the
Maturity Date and without the consent of any beneficiary unless irrevocably
named. You may elect either a full or partial surrender of the cash surrender
value. In the case of a full surrender, this Contract will be canceled. In the
case of a partial surrender, We will reduce Your Contract value by surrendering
Accumulation Units on a pro rata basis from amounts allocated to the Funding
Options and from the Fixed Account (if applicable), unless You instruct
otherwise. A partial surrender will result in a reduction of Your Contract value
and death benefit proceeds.
The cash surrender value will be determined as of the next Valuation Date
following receipt of Your Written Request. We may delay payment of the cash
surrender value of the Funding Options for a period of not more than five
business days after Your Written Request is recorded. We may delay payment of
the cash surrender value of the Fixed Account for a period of not more than six
months after We receive Your Written Request.
CONTRACT CONTINUATION
Except as provided in the Termination Provision, this Contract does not require
continuing Purchase Payments and will automatically continue as a paid-up
Contract during the lifetime of the Annuitant, until the Maturity Date, until it
is surrendered or when a death benefit becomes due.
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DEATH BENEFIT PROVISION
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DEATH OF ANNUITANT
A death benefit is payable to the beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a contingent Annuitant. A death
benefit is also payable under those Settlement Options which provide for death
benefits. We will pay the beneficiary the death benefit, determined as of the
Death Report Date, in a single sum or apply it to a Settlement Option. A
beneficiary may request that a death benefit payable under this Contract be
applied to a Settlement Option subject to the provisions of this Contract and
the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the owner is not the Annuitant, and the owner dies (including the first of
joint owners) before the Maturity Date, We will recalculate the value of the
death benefit proceeds under the provisions of Death Benefit Proceeds Prior To
The Maturity Date below, by replacing all references to "Annuitant" with
"owner." The value of the death benefit, as recalculated, will be paid in a
single lump sum or by other election to the party taking proceeds under the
current tax laws.
DEATH BENEFIT PROCEEDS PRIOR TO THE MATURITY DATE
If the Annuitant dies before the Maturity Date, the death benefit payable as of
the Death Report Date will be the greater of a) or b) below, less any applicable
premium tax:
a) the Contract value on the Death Report Date less any Purchase
Payment Credits applied within 12 months of death; or
b) the Adjusted Purchase Payment;
ADJUSTED PURCHASE PAYMENT:
The initial Adjusted Purchase Payment is equal to the initial
Purchase Payment. Whenever any additional Purchase Payment(s) are
made, the Adjusted Purchase Payment is increased by the amount of
the Purchase Payment. Whenever a partial surrender is taken, the
Adjusted Purchase Payment is reduced by a Partial Surrender
Reduction as described below.
PARTIAL SURRENDER REDUCTION
The Partial Surrender Reduction for (b) above is equal to 1) the Adjusted
Purchase Payment in effect immediately prior to the reduction for the partial
surrender, multiplied by 2) the amount of the partial surrender divided by 3)
the Contract value less any Purchase Payment Credits applied within 12 months
immediately prior to the partial surrender.
INTEREST ON DEATH BENEFIT PROCEEDS
Any interest on death proceeds will be paid in accordance with rules in effect
in Your state at the time of death.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
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SETTLEMENT PROVISIONS
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MATURITY DATE
The Maturity Date is shown in the Contract Specifications and must be at least
thirteen months after the Contract Date. Annuity payments will begin under this
Contract on the Maturity Date unless the Contract has been fully surrendered or
the proceeds have been paid to the beneficiary prior to that date. We may
require proof that the Annuitant is alive before annuity payments are made. If
no Maturity Date is specified, the automatic Maturity Date will be the greater
of when the Annuitant reaches age 90 or ten years after the Contract Date, or to
a later date with Our consent.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, You may change the Maturity Date by Written Request to
any time prior to the Annuitant's 90th birthday, or ten years after the Contract
Date, unless You elect a later annuity commencement date, subject to laws and
regulations then in effect and approved by the Company.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, We will pay the amount payable
under this Contract to You in one lump sum or in accordance with an annuity
Option elected by You. While the Annuitant is alive, You may change Your
Settlement Option election by Written Request, but only before the Maturity
Date. We reserve the right to require satisfactory proof of the Age of any
person on whose life annuity payments are based before making the first payment
under any annuity Option.
During the Annuitant's lifetime, if no election has been made by the Maturity
Date, We will pay You the first of a series of periodic annuity payments based
on the life of the Annuitant, in accordance with annuity Option 2, with 120
monthly payments assured.
Once annuity payments have commenced, no election changes are allowed.
MINIMUM AMOUNTS
The minimum amount that can be placed under a Settlement Option is $2,000 unless
We consent to a lesser amount. If any periodic payments due are less than $100,
We reserve the right to make payments at less frequent intervals, resulting in a
payment of at least $100 per year.
ALLOCATION OF ANNUITY
At the time an election of one of the annuity options is made, the person
electing the option may elect to have the cash surrender value applied to
provide a variable annuity, a fixed annuity or a combination of both.
Unless You elect otherwise, the cash surrender value of a Funding Option will be
applied to provide an annuity, which varies with the investment experience of
that same Funding Option. The value of the Fixed Account(if applicable) will be
applied to provide a Fixed Annuity.
You may elect to transfer Contract value from one Funding Option to another, as
described in the provision "Transfers Among Funding Options And The Fixed
Account" in order to reallocate the basis on which annuity payments will be
determined. Once annuity payments start, You may, with Our consent, change the
allocation of Your values in each Funding Option.
VARIABLE ANNUITY
ANNUITY UNIT VALUE
On any Valuation Date, the Annuity Unit Value for a Funding Option equals the
Funding Option Annuity Unit Value on the preceding Valuation Date, multiplied by
the net investment factor for that Funding Option for the Valuation Period just
ended, divided by the Assumed Daily Net Investment Factor. The Assumed Daily Net
Investment Factor is shown in the Contract Specifications. The value of an
Annuity Unit on any date other than a Valuation Date will be equal to its value
as of the next Valuation Date.
NUMBER OF ANNUITY UNITS
We determine the number of Annuity Units credited to this Contract in each
Funding Option by dividing the amount of the first monthly annuity payment
attributable to that Funding Option by the Funding Option's Unit Value as of 14
days before the Maturity Date.
13
AMOUNT OF FIRST PAYMENT
The Life Annuity Tables for Variable Payments are used to determine the first
monthly annuity payment. They show the dollar amount of the first monthly
annuity payment which can be purchased with each $1,000 applied. The amount
applied to a variable annuity will be the cash surrender value allocated to the
variable annuity as of 14 days prior to the Maturity Date. The first monthly
annuity payment is allocated among the Funding Options in the same proportion as
the cash surrender value is allocated among the Funding Options. We reserve the
right to require the satisfactory proof of age of any person on whose life
annuity Payments are based before making the first payment under any of these
options.
AMOUNT OF SECOND AND SUBSEQUENT PAYMENTS
The dollar amount of the second and subsequent payments may change from month to
month. The amount of the annuity payment for each Funding Option is found by
multiplying the number of Annuity Units for that Funding Option by the Annuity
Unit Value for that Funding Option. The total amount of each annuity payment
will be equal to the sum of the payments in each Funding Option.
FIXED ANNUITY
A fixed annuity is an annuity with payments, which remain fixed as to dollar
amount throughout the payment period. The Life Annuity Tables for Fixed Payments
are used to determine the monthly annuity payment. They show the dollar amount
of monthly annuity payment which can be purchased with each $1,000 applied. The
amount applied to the fixed annuity will be equal to the cash surrender value
allocated to the fixed annuity determined as of the date fixed annuity payments
start. If it would produce a larger payment, the fixed annuity payment will be
determined using the Life Annuity Tables in effect on the Maturity Date.
ANNUITY OPTIONS
Subject to conditions stated in Elections Of Settlement Options and Minimum
Amounts, all or any part of the Cash Surrender Value of this Contract may be
paid under one or more of the Annuity Options below. We may offer additional
options.
OPTION 1. LIFE ANNUITY - NO REFUND
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based, ending with the last payment preceding death.
OPTION 2. LIFE ANNUITY WITH 120, 180 OR 240 MONTHLY PAYMENTS ASSURED
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based. If at the death of that person, payments have been
made for less than 120, 180, or 240 months, as elected, We will continue to make
payments to the designated beneficiary during the remainder of the period.
OPTION 3. JOINT AND LAST SURVIVOR LIFE ANNUITY
We will make monthly annuity payments during the Joint lifetime of two persons
on whose lives payments are based and during the lifetime of the survivor. No
more payments will be made after the death of the survivor.
OPTION 4. JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE
We will make monthly annuity payments during the Joint lifetime of two persons
on whose lives payments are based. One of the two persons will be designated as
the primary payee. The other will be designated as the secondary payee. On the
death of the secondary payee, if survived by the primary payee, We will continue
to make monthly annuity payments to the primary payee in the same amount that
would have been payable during the Joint lifetime of the two persons. On the
death of the primary payee, if survived by the secondary payee, We will continue
to make monthly annuity payments to the secondary payee in an amount equal to
50% of the payments, which would have been made during the lifetime of the
primary payee. No further payments will be made following the death of the
survivor.
OPTION 5. PAYMENTS FOR A FIXED PERIOD
We will make monthly payments for the period selected.
OPTION 6. OTHER ANNUITY OPTIONS
We will make any other arrangements for annuity payments as may be mutually
agreed by You and Us.
14
--------------------------------------------------------------------------------
GENERAL PROVISIONS
--------------------------------------------------------------------------------
CONTRACT
The entire Contract between You and Us consists of the Contract, and any
attached amendments, riders, or endorsements.
CONTRACT CHANGES
Upon receiving appropriate state approval, if necessary, We may at any time make
any changes, including retroactive changes to this Contract to the extent that
the change is required to meet the requirements of any federal or state law or
regulation. All Contract changes will be made by a written amendment, rider, or
endorsement and will be signed by Our President, Our Chairman or one of Our home
office authorized officers. Agents do not have authority to alter or modify any
of the terms or conditions of this Contract, or to waive any of its provisions.
Any Contract change will not affect the amount or term of any annuity begun
prior to the change, unless the change is required to conform the Contract to
any federal or state statute and will not affect the method by which the
Contract value is determined.
MINIMUM VALUE
Any paid-up annuity, cash surrender value, or death benefits that are available
under this Contract will not be less than the minimum benefits required by the
statutes of the state in which this Contract is delivered.
INCONTESTABILITY
We will not contest this Contract from the Contract Date.
MISSTATEMENT
If this Contract is issued as a Nonqualified Contract, and the Annuitant's (or,
if applicable, the owner's) sex or date of birth was misstated, the amount of
the annuity payable by Us will be adjusted based on the correct information
without changing the date of the first payment
If this Contract is issued as a Qualified Contract and the Annuitant's date of
birth was misstated, the amount of the annuity payable by Us will be adjusted
based on the correct information without changing the date of the first payment.
If an underpayment has been made under this Contract due to a misstatement as
described above, We will pay the portion due promptly. If an overpayment has
occurred, the amount due Us will be deducted from subsequent annuity payments,
as necessary. No interest will be credited or charged in the event of an
underpayment or overpayment. Proof of the Annuitant's and owner's Age may be
filed at any time at Our Office.
If the age of the Annuitant or owner has been misstated, the amount of any death
benefit payable will be determined based upon the correct age of the Annuitant
or owner.
ADDITION OR DELETION OF SEPARATE ACCOUNT OR FUNDING OPTIONS
If it is not possible to continue to offer a Separate Account or Funding Option
or in Our judgment becomes inappropriate for the purposes of this Contract, We
may substitute another Separate Account or Funding Option without Your consent.
Substitution may be made with respect to both existing investments and
investment of future Purchase Payments. However, no such substitution will be
made without notice to You and without prior approval of the Securities and
Exchange Commission, to the extent required by law. New Funding Options may be
added at any time.
TERMINATION
Prior to annuitization, We reserve the right to terminate this Contract on any
Valuation Date if the Contract value is less than the Termination amount stated
in the Contract Specifications and Purchase Payments have not been made to this
Contract for at least two-years. Termination will not occur until 31 day's after
We have mailed notice of termination to You at Your last known address. If we
terminate this Contract we will pay you the cash surrender value, if any.
REQUIRED REPORTS
We will furnish a report to the Contract owner as often as required by law, but
at least once in each Contract Year before the Maturity Date, reporting the
status of the Contract as of a date not more than four months previous to the
date of the mailing. The report will show the number of Accumulation Units
credited to the Contract in each Funding Option and the Fixed Account (if
applicable) and the corresponding Accumulation Unit Value as of the date of the
report. The report will also show any other information required under state or
federal law.
15
VOTING RIGHTS
If required by federal law, You may have the right to vote at the shareholder
meetings of the Underlying Funds. If You have voting rights, We will send a
notice to You telling You the time and place of a meeting. The notice will also
explain matters to be voted upon and how many votes You may exercise.
If You have voting rights, We will send proxy materials and instructions for You
to vote the shares held for Your account. We will arrange for the handling and
tallying of proxies received from Contract owners. We will vote the Underlying
Fund shares held by Us in accordance with the instructions received from
Contract owners.
In the event that You give no instructions or leave the manner of voting
discretionary, We will vote such shares of the appropriate Underlying Fund in
the same proportion as shares of the Underlying Fund for which instructions have
been received. Also, We will vote the Underlying Fund shares in this
proportionate manner, which are held by Us for Our own account.
If federal law does not require Us to comply with the above, we will vote all
shares in our own right.
MORTALITY AND EXPENSES
Our actual mortality and expense experience will not affect the amount of any
annuity payments or any other values under this Contract.
NON-PARTICIPATING
This Contract does not share in Our surplus earnings, so You will receive no
dividends under it.
CHANGES IN TAXES BASED UPON PREMIUM OR VALUE
If there is a law or change in law assessing taxes against Us based upon the
premium or value of this Contract, We reserve the right to charge You
proportionately for that tax. This would include, but is not limited to, a tax
based upon Our realized net capital gains in the Funding Options and on earnings
in the Fixed Account, on which We are not currently taxed.
EMERGENCY PROCEDURE FOR SUSPENSION OF PAYMENTS
We reserve the right to suspend or postpone the date of any payment of any
benefit or values for the Funding Options for any Valuation Period (1) when the
New York Stock Exchange is closed; (2) when trading on the Exchange is
restricted; (3) when an emergency exists as determined by the Securities and
Exchange Commission so that disposal of the securities held in the Funding
Options is not reasonably practicable or it is not reasonably practicable to
determine the value of the Funding Option's net assets, or (4) during any other
period when the Securities and Exchange Commission, by order, so permits for the
protection of security holders. Any provision of this Contract which specifies a
Valuation Date will be superseded by this Emergency Procedure.
RELATION OF THIS CONTRACT TO THE SEPARATE ACCOUNT AND FUNDING OPTIONS
We will have exclusive and absolute ownership and control of the assets of Our
Separate Account and the Funding Options. That portion of the assets of a
Separate Account or Funding Option equal to the reserves and other Contract
liabilities with respect to such Separate Account or Funding Option shall not be
chargeable with liabilities arising out of any other business We conduct. Our
determination of the value of an Accumulation Unit and an Annuity Unit by the
method described in this Contract will be conclusive.
REDUCTION OR ELIMINATION OF CONTRACT CHARGES
All charges and fees under the Contract may be reduced or eliminated when
certain sales or administration of the Contract result in savings or reduction
of expenses and/or risks.
TRANSFERS TO OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer funds held by You to
another Contract issued by Us or one of Our affiliates, without incurring
charges deducted upon surrender as shown in the Contract Specifications. Once
the transfer is complete and We have established a new Contract at Your
direction, new withdrawal charges or surrender charges may apply to the new
Contract in accordance with the provisions of such Contract.
16
LIFE ANNUITY TABLES FOR VARIABLE PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
MALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.59 3.57 3.56 3.53
46 3.64 3.62 3.60 3.57
47 3.69 3.67 3.65 3.62
48 3.75 3.73 3.70 3.67
49 3.81 3.78 3.76 3.71
50 3.87 3.84 3.81 3.77
51 3.93 3.90 3.87 3.82
52 4.00 3.97 3.93 3.87
53 4.07 4.04 3.99 3.93
54 4.15 4.11 4.06 3.99
55 4.23 4.19 4.13 4.05
56 4.32 4.27 4.20 4.11
57 4.41 4.35 4.28 4.17
58 4.50 4.44 4.36 4.24
59 4.61 4.53 4.44 4.31
60 4.72 4.63 4.53 4.37
61 4.83 4.74 4.62 4.44
62 4.96 4.85 4.71 4.51
63 5.09 4.97 4.81 4.58
64 5.24 5.09 4.90 4.65
65 5.39 5.22 5.01 4.72
66 5.56 5.36 5.11 4.79
67 5.73 5.50 5.21 4.86
68 5.92 5.64 5.32 4.93
69 6.12 5.80 5.43 4.99
70 6.34 5.96 5.53 5.05
71 6.56 6.12 5.64 5.11
72 6.81 6.29 5.75 5.16
73 7.07 6.46 5.85 5.21
74 7.35 6.64 5.95 5.26
75 7.64 6.82 6.05 5.30
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based on the Annuity 2000 Table with mortality improvements
based on Projection Scale G. This table assumes a net investment rate of 3% per
Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
17
LIFE ANNUITY TABLES FOR VARIABLE PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
FEMALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.39 3.39 3.38 3.37
46 3.43 3.43 3.42 3.40
47 3.48 3.47 3.46 3.44
48 3.52 3.52 3.50 3.48
49 3.57 3.56 3.55 3.53
50 3.62 3.61 3.60 3.57
51 3.68 3.66 3.65 3.62
52 3.74 3.72 3.70 3.67
53 3.80 3.78 3.76 3.72
54 3.86 3.84 3.81 3.78
55 3.93 3.90 3.88 3.83
56 4.00 3.97 3.94 3.89
57 4.07 4.05 4.01 3.95
58 4.15 4.12 4.08 4.01
59 4.24 4.20 4.15 4.08
60 4.33 4.29 4.23 4.15
61 4.43 4.38 4.32 4.22
62 4.53 4.48 4.40 4.29
63 4.64 4.58 4.49 4.36
64 4.76 4.69 4.59 4.44
65 4.89 4.80 4.69 4.52
66 5.02 4.92 4.79 4.59
67 5.17 5.05 4.89 4.67
68 5.32 5.19 5.00 4.75
69 5.49 5.33 5.12 4.82
70 5.68 5.48 5.23 4.90
71 5.87 5.64 5.35 4.97
72 6.09 5.81 5.47 5.04
73 6.32 5.99 5.59 5.10
74 6.57 6.18 5.71 5.16
75 6.84 6.37 5.83 5.22
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based on the Annuity 2000 Table with mortality improvements
based on Projection Scale G. This table assumes a net investment rate of 3% per
Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
18
LIFE ANNUITY TABLES FOR VARIABLE PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR QUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
UNISEX NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.49 3.48 3.47 3.45
46 3.54 3.53 3.51 3.49
47 3.59 3.57 3.56 3.53
48 3.64 3.62 3.60 3.58
49 3.69 3.68 3.65 3.62
50 3.75 3.73 3.71 3.67
51 3.81 3.79 3.76 3.72
52 3.87 3.85 3.82 3.77
53 3.94 3.91 3.88 3.83
54 4.01 3.98 3.94 3.88
55 4.08 4.05 4.01 3.94
56 4.16 4.12 4.07 4.00
57 4.24 4.20 4.15 4.07
58 4.33 4.28 4.22 4.13
59 4.42 4.37 4.30 4.20
60 4.52 4.46 4.38 4.27
61 4.63 4.56 4.47 4.34
62 4.75 4.67 4.56 4.41
63 4.87 4.78 4.65 4.48
64 5.00 4.89 4.75 4.55
65 5.14 5.01 4.85 4.62
66 5.29 5.14 4.95 4.70
67 5.45 5.28 5.06 4.77
68 5.62 5.42 5.17 4.84
69 5.81 5.57 5.28 4.91
70 6.00 5.72 5.39 4.98
71 6.22 5.89 5.50 5.04
72 6.44 6.06 5.62 5.10
73 6.69 6.23 5.73 5.16
74 6.95 6.41 5.84 5.21
75 7.24 6.60 5.95 5.26
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based upon the Annuity 2000 Table (blended 50%/50%
female/male) with mortality improvements based on Projection Scale G. This table
assumes a net investment rate of 3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
19
LIFE ANNUITY TABLES FOR VARIABLE PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.18 3.27 3.35 3.42 3.47 3.51 3.54
50 3.24 3.36 3.47 3.58 3.66 3.73 3.78
55 3.29 3.43 3.59 3.74 3.87 3.99 4.08
60 3.32 3.49 3.69 3.89 4.09 4.28 4.43
65 3.35 3.54 3.76 4.02 4.31 4.59 4.84
70 3.36 3.57 3.82 4.13 4.49 4.89 5.29
75 3.37 3.59 3.86 4.21 4.63 5.14 5.71
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY MALE DOLLAR AMOUNT
AND SECONDARY FEMALE
45 3.37
50 3.60
55 3.88
60 4.26
65 4.79
70 5.52
75 6.54
Dollar amounts of the monthly annuity payments in the above table and assumes a
year 2000 issue and are based on the Annuity 2000 Table with mortality
improvements based on Projection Scale G. This table assumes a net investment
rate of 3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
20
LIFE ANNUITY TABLES FOR VARIABLE PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR QUALIFIED CONTRACTS.
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
UNISEX
ADJUSTED UNISEX ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.19 3.26 3.33 3.38 3.41 3.44 3.46
50 3.26 3.37 3.46 3.54 3.61 3.66 3.69
55 3.33 3.46 3.60 3.72 3.83 3.91 3.98
60 3.38 3.54 3.72 3.90 4.07 4.22 4.33
65 3.41 3.61 3.83 4.07 4.32 4.56 4.75
70 3.44 3.66 3.91 4.22 4.56 4.91 5.23
75 3.46 3.69 3.98 4.33 4.75 5.23 5.74
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY
AND SECONDARY UNISEX DOLLAR AMOUNT
45 3.34
50 3.55
55 3.82
60 4.19
65 4.70
70 5.40
75 6.40
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based on the Annuity 2000 Table (blended 50%/50%
female/male) with mortality improvements based on Projection Scale G. This table
assumes a net investment rate of 3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
21
LIFE ANNUITY TABLES FOR VARIABLE PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED AND QUALIFIED CONTRACTS.
OPTION 5 - PAYMENTS FOR A FIXED PERIOD
MONTHLY MONTHLY
NUMBER OF PAYMENT NUMBER OF PAYMENT
YEARS AMOUNT YEARS AMOUNT
5 17.91 18 5.96
6 15.14 19 5.73
7 13.16 20 5.51
8 11.68 21 5.32
9 10.53 22 5.15
10 9.61 23 4.99
11 8.86 24 4.84
12 8.24 25 4.71
13 7.71 26 4.59
14 7.26 27 4.47
15 6.87 28 4.37
16 6.53 29 4.27
17 6.23 30 4.18
The dollar amounts of the monthly annuity payments for the fifth option are
based on a net investment rate of 3% per annum, assuming a 365-day year.
22
LIFE ANNUITY TABLES FOR FIXED PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
MALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 2.73 2.72 2.71 2.69
46 2.79 2.78 2.76 2.74
47 2.84 2.83 2.81 2.79
48 2.90 2.88 2.87 2.84
49 2.96 2.94 2.92 2.89
50 3.02 3.00 2.98 2.94
51 3.09 3.07 3.04 3.00
52 3.16 3.14 3.11 3.06
53 3.23 3.21 3.17 3.12
54 3.31 3.28 3.24 3.18
55 3.39 3.36 3.31 3.25
56 3.48 3.44 3.39 3.31
57 3.57 3.53 3.47 3.38
58 3.66 3.62 3.55 3.45
59 3.77 3.71 3.64 3.52
60 3.88 3.82 3.73 3.59
61 3.99 3.92 3.82 3.67
62 4.12 4.04 3.92 3.74
63 4.25 4.16 4.02 3.82
64 4.40 4.28 4.12 3.89
65 4.55 4.41 4.23 3.97
66 4.71 4.55 4.34 4.04
67 4.89 4.70 4.45 4.12
68 5.07 4.85 4.56 4.19
69 5.27 5.00 4.67 4.25
70 5.48 5.16 4.78 4.32
71 5.70 5.33 4.90 4.38
72 5.95 5.51 5.01 4.44
73 6.20 5.68 5.12 4.49
74 6.48 5.87 5.23 4.54
75 6.77 6.05 5.33 4.59
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based on the Annuity 2000 Table with mortality improvements
based on Projection Scale G. This table assumes a net investment rate of 1.5%
per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
23
LIFE ANNUITY TABLES FOR FIXED PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
FEMALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 2.73 2.72 2.71 2.69
46 2.79 2.78 2.76 2.74
47 2.84 2.83 2.81 2.79
48 2.90 2.88 2.87 2.84
49 2.96 2.94 2.92 2.89
50 3.02 3.00 2.98 2.94
51 3.09 3.07 3.04 3.00
52 3.16 3.14 3.11 3.06
53 3.23 3.21 3.17 3.12
54 3.31 3.28 3.24 3.18
55 3.39 3.36 3.31 3.25
56 3.48 3.44 3.39 3.31
57 3.57 3.53 3.47 3.38
58 3.66 3.62 3.55 3.45
59 3.77 3.71 3.64 3.52
60 3.88 3.82 3.73 3.59
61 3.99 3.92 3.82 3.67
62 4.12 4.04 3.92 3.74
63 4.25 4.16 4.02 3.82
64 4.40 4.28 4.12 3.89
65 4.55 4.41 4.23 3.97
66 4.71 4.55 4.34 4.04
67 4.89 4.70 4.45 4.12
68 5.07 4.85 4.56 4.19
69 5.27 5.00 4.67 4.25
70 5.48 5.16 4.78 4.32
71 5.70 5.33 4.90 4.38
72 5.95 5.51 5.01 4.44
73 6.20 5.68 5.12 4.49
74 6.48 5.87 5.23 4.54
75 6.77 6.05 5.33 4.59
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based on the Annuity 2000 Table with mortality improvements
based on Projection Scale G. This table assumes a net investment rate of 1.5%
per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
24
LIFE ANNUITY TABLES FOR FIXED PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR QUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
UNISEX NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 2.64 2.63 2.62 2.61
46 2.68 2.68 2.67 2.65
47 2.73 2.73 2.71 2.70
48 2.79 2.78 2.76 2.74
49 2.84 2.83 2.82 2.79
50 2.90 2.89 2.87 2.85
51 2.96 2.95 2.93 2.90
52 3.03 3.01 2.99 2.95
53 3.09 3.08 3.05 3.01
54 3.17 3.15 3.12 3.07
55 3.24 3.22 3.19 3.14
56 3.32 3.29 3.26 3.20
57 3.40 3.37 3.33 3.27
58 3.49 3.46 3.41 3.34
59 3.59 3.55 3.49 3.41
60 3.69 3.64 3.58 3.48
61 3.80 3.74 3.67 3.55
62 3.91 3.85 3.76 3.63
63 4.03 3.96 3.86 3.71
64 4.16 4.08 3.96 3.78
65 4.30 4.20 4.07 3.86
66 4.45 4.34 4.17 3.94
67 4.61 4.47 4.29 4.02
68 4.78 4.62 4.40 4.10
69 4.96 4.77 4.52 4.17
70 5.16 4.93 4.63 4.24
71 5.37 5.10 4.75 4.31
72 5.59 5.27 4.87 4.38
73 5.84 5.45 4.99 4.44
74 6.10 5.64 5.11 4.50
75 6.38 5.83 5.22 4.55
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based upon the Annuity 2000 Table (blended 50%/50%
female/male) with mortality improvements based on Projection Scale G. This table
assumes a net investment rate of 1.5% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
25
LIFE ANNUITY TABLES FOR FIXED PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 2.34 2.44 2.52 2.59 2.64 2.67 2.70
50 2.40 2.53 2.66 2.76 2.85 2.91 2.96
55 2.45 2.61 2.78 2.94 3.07 3.19 3.27
60 2.48 2.67 2.88 3.10 3.31 3.49 3.64
65 2.51 2.71 2.96 3.23 3.53 3.81 4.06
70 2.52 2.74 3.01 3.33 3.71 4.11 4.51
75 2.53 2.76 3.05 3.40 3.85 4.37 4.94
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY MALE DOLLAR AMOUNT
AND SECONDARY FEMALE
45 2.52
50 2.76
55 3.05
60 3.44
65 3.97
70 4.70
75 5.72
Dollar amounts of the monthly annuity payments in the above table and assumes a
year 2000 issue and are based on the Annuity 2000 Table with mortality
improvements based on Projection Scale G. This table assumes a net investment
rate of 1.5% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2003-2005 2006-2010 2011-2015 2016-2020
minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
26
LIFE ANNUITY TABLES FOR FIXED PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR QUALIFIED CONTRACTS.
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
UNISEX
ADJUSTED UNISEX ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 2.35 2.43 2.49 2.54 2.57 2.60 2.61
50 2.43 2.54 2.64 2.72 2.79 2.83 2.86
55 2.49 2.64 2.79 2.92 3.02 3.10 3.16
60 2.54 2.72 2.92 3.11 3.28 3.42 3.53
65 2.57 2.79 3.02 3.28 3.54 3.77 3.96
70 2.60 2.83 3.10 3.42 3.77 4.13 4.46
75 2.61 2.86 3.16 3.53 3.96 4.46 4.96
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY
AND SECONDARY UNISEX DOLLAR AMOUNT
45 2.48
50 2.71
55 3.00
60 3.37
65 3.88
70 4.59
75 5.58
Dollar amounts of the monthly annuity payments in the above table assumes a year
2000 issue, and are based on the Annuity 2000 Table (blended 50%/50%
female/male) with mortality improvements based on Projection Scale G. This table
assumes a net investment rate of 1.5% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
27
LIFE ANNUITY TABLES FOR FIXED PAYMENTS
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED AND QUALIFIED CONTRACTS.
OPTION 5 - PAYMENTS FOR A FIXED PERIOD
MONTHLY MONTHLY
NUMBER OF PAYMENT NUMBER OF PAYMENT
YEARS AMOUNT YEARS AMOUNT
5 17.28 18 5.27
6 14.51 19 5.03
7 12.53 20 4.81
8 11.04 21 4.62
9 9.89 22 4.44
10 8.96 23 4.28
11 8.21 24 4.13
12 7.58 25 3.99
13 7.05 26 3.86
14 6.59 27 3.75
15 6.20 28 3.64
16 5.85 29 3.54
17 5.55 30 3.44
The dollar amounts of the monthly annuity payments for the fifth option are
based on a net investment rate of 1.5% per annum, assuming a 365-day year.
28
DEATH BENEFIT ENDORSEMENT I
This endorsement is made part of the Contract on the Contract Date.
The "DEATH BENEFIT PROVISION" section of the Contract is deleted and replaced
with the following:
--------------------------------------------------------------------------------
DEATH BENEFIT PROVISION
--------------------------------------------------------------------------------
DEATH OF ANNUITANT
A death benefit is payable to the beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a contingent Annuitant. A death
benefit is also payable under those Settlement Options which provide for death
benefits. We will pay the beneficiary the death benefit, determined as of the
Death Report Date, in a single sum or apply it to a Settlement Option. A
beneficiary may request that a death benefit payable under this Contract be
applied to a Settlement Option subject to the provisions of this Contract and
the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the owner is not the Annuitant, and the owner dies (including the first of
joint owners) before the Maturity Date, We will recalculate the value of the
death benefit proceeds under the provisions of Death Benefit Proceeds Prior To
The Maturity Date below, by replacing all references to "Annuitant" with
"owner." The value of the death benefit, as recalculated, will be paid in a
single lump sum or by other election to the party taking proceeds under the
current tax laws.
DEATH PROCEEDS PRIOR TO THE MATURITY DATE
Upon the death of the Annuitant, the death benefit payable as of the Death
Report Date will be the greatest of a), b) or c) below, less any applicable
premium tax:
c) the Contract value on the Death Report Date less any Purchase Payment
Credits applied within 12 months of death; or
d) the Adjusted Purchase Payment (as described below); or
e) the Step-Up Value (if any, as described below)
ADJUSTED PURCHASE PAYMENT
The initial Adjusted Purchase Payment is equal to the initial Purchase
Payment. Whenever any additional Purchase Payment(s) are made, the
Adjusted Purchase Payment is increased by the amount of the Purchase
Payment. Whenever a partial surrender is taken, the Adjusted Purchase
Payment is reduced by a Partial Surrender Reduction as described below
STEP-UP VALUE
The Step-Value will initially equal the Contract Value on the first
Contract Date anniversary, less any Purchase Payment Credits applied
within the last 12 months. On each subsequent Contract Date anniversary
that occurs before the Annuitant's [80th] birthday and before the
Annuitant's death, if the Contract Value less any Purchase Payment Credits
applied within 12 months is greater than the Step - Up Value, the Step -
Up Value will be increased to equal the Contract Value less any Purchase
Payment Credits applied within the last 12 months. If the Step -Up Value
is greater than the Contract Value less any Purchase Payment Credits
applied within the last 12 months, the Step - Up Value will remain
unchanged. Whenever a Purchase Payment is made, the Step - Up value will
be increased by the amount of that Purchase Payment. Whenever a partial
surrender is taken, the Step - Up Value will be reduced by a partial
Surrender Reduction as described below. The only changes made to the Step
- Up Value on or after the Annuitant's [80th] birthday will be those
related to additional Purchase Payments or partial surrenders as described
below.
PARTIAL SURRENDER REDUCTIONS
ADJUSTED PURCHASE PAYMENT
The Partial Surrender Reduction is equal to 1) the Adjusted Purchase Payment in
effect immediately prior to the reduction for the partial surrender, multiplied
by 2) the amount of the partial surrender divided by 3) the Contract Value less
any Purchase Payment Credits applied within 12 months, immediately prior to the
partial surrender.
29
STEP - UP VALUE
The Partial Surrender Reduction is equal to 1) the Step - Up Value in effect
immediately prior to the reduction for the partial surrender, multiplied by 2)
the amount of the partial surrender divided by 3) the Contract Value less any
Purchase Payment Credits applied within 12 months, immediately prior to the
partial surrender.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
INTEREST ON DEATH PROCEEDS
Any interest on death proceeds will be paid in accordance with rules in effect
in Your state at the time of death.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇
PRESIDENT
30
DEATH BENEFIT ENDORSEMENT II
This endorsement is made part of the Contract on the Contract Date.
The "DEATH BENEFIT PROVISION" section of the Contract is deleted and replaced
with the following:
--------------------------------------------------------------------------------
DEATH BENEFIT PROVISION
--------------------------------------------------------------------------------
DEATH OF ANNUITANT
A death benefit is payable to the beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a contingent Annuitant. A death
benefit is also payable under those Settlement Options which provide for death
benefits. We will pay the beneficiary the death benefit, determined as of the
Death Report Date, in a single sum or apply it to a Settlement Option. A
beneficiary may request that a death benefit payable under this Contract be
applied to a Settlement Option subject to the provisions of this Contract and
the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the owner is not the Annuitant, and the owner dies (including the first of
joint owners) before the Maturity Date, We will recalculate the value of the
death benefit proceeds under the provisions of Death Benefit Proceeds Prior To
The Maturity Date below, by replacing all references to "Annuitant" with
"owner." The value of the death benefit, as recalculated, will be paid in a
single lump sum or by other election to the party taking proceeds under the
current tax laws.
DEATH PROCEEDS PRIOR TO MATURITY DATE
IF THE ANNUITANT DIES BEFORE AGE 80 and before the Maturity Date, the death
benefit payable as of the Death Report Date will be the greatest of a), b), c),
or d) below, less any applicable premium tax:
f) the Contract value on the Death Report Date less any Purchase Payment
Credits applied within 12 months of death; or
g) the Adjusted Purchase Payment (as described below); or
h) the Step-Up Value (if any, as described below); or
i) the roll-up death benefit value (as described below) available at the
Death Report Date
IF THE ANNUITANT DIES ON OR AFTER AGE 80 and before the Maturity Date, the death
benefit payable as of the Death Report Date will be the greatest of a), b), c)
or d) below, less any applicable premium tax:
a) the Contract value on the Death Report Date, less any Purchase Payment
Credits applied within 12 months of death; or
b) the Adjusted Purchase Payments (as described below); or
c) the step-up value (if any, as described below); or
d) the roll-up death benefit value (as described below) available at the
Annuitant's [80th] birthday, plus any additional Purchase Payments and
minus any partial surrender reductions (as described below) which occur
after the Annuitant's [80th] birthday.
ADJUSTED PURCHASE PAYMENT
The initial Adjusted Purchase Payment is equal to the initial Purchase Payment.
Whenever any additional Purchase Payment(s) are made, the Adjusted Purchase
Payment is increased by the amount of the Purchase Payment. Whenever a partial
surrender is taken, the Adjusted Purchase Payment is reduced by a Partial
Surrender Reduction as described below
STEP-UP VALUE
The Step-Value will initially equal the Contract Value on the first Contract
Date anniversary, less any Purchase Payment Credits applied within the last 12
months. On each subsequent Contract Date anniversary that occurs before the
Annuitant's [80th] birthday and before the Annuitant's death, if the Contract
Value less any Purchase payment Credits applied within 12 months is greater than
the Step - Up Value, the Step - Up Value will be increased to equal the Contract
Value less any Purchase Payment Credits applied within the last 12 months. If
the Step -Up Value is greater than the Contract Value less any Purchase Payment
Credits applied within the last 12 months, the Step - Up Value will remain
unchanged. Whenever a Purchase Payment is made, the Step - Up value will be
increased by the amount of that Purchase Payment. Whenever a partial surrender
is taken, the Step - Up Value will be reduced by a partial Surrender Reduction
as described below. The only changes made to the Step - Up Value on or after the
Annuitant's [80th] birthday will be those related to additional Purchase
Payments or partial surrenders as described below.
31
ROLL-UP DEATH BENEFIT VALUE
On the Contract Date, the roll-up death benefit value is equal to the
Purchase Payment. On each Contract Date anniversary, the roll-up death
benefit value will be recalculated to equal a) plus b) minus c), increased
by 5%, where:
a) is the Roll-Up Death Benefit as of the previous Contract Date
anniversary
b) any Purchase Payments made during the previous Contract Year
c) any partial surrender reductions (as described below) during the
previous Contract Year
On dates other than the Contract Date anniversary, the roll-up death benefit
value will equal a) plus b) minus c), where:
a) the roll-up death benefit value on the previous Contract Date
anniversary
b) any Purchase Payments made since the previous Contract Date
anniversary
c) any partial surrender reductions (as described below) since the
previous Contract Date anniversary.
The maximum roll-up death benefit equals 200% of the difference between
all Purchase Payments and all partial surrender reductions (as described
below).
Partial Surrender Reductions
Adjusted Purchase Payment
The Partial Surrender Reduction is equal to 1) the Adjusted Purchase Payment in
effect immediately prior to the reduction for the partial surrender, multiplied
by 2) the amount of the partial surrender divided by 3) the Contract Value less
any Purchase Payment Credits applied within 12 months, immediately prior to the
partial surrender.
Step - Up Value and Roll - Up Value
The Partial Surrender Reduction is equal to 1) the amount of the death benefit
value (Step - Up or Roll - Up Value) in effect immediately prior to the
reduction for the partial surrender, multiplied by 2) the amount of the partial
surrender divided by 3) the Contract Value less any Purchase Payment Credits
applied within 12 months, immediately prior to the partial surrender.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
INTEREST ON DEATH PROCEEDS
Any interest on death proceeds will be paid in accordance with rules in effect
in Your state at the time of death.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇
PRESIDENT
32
This Page Left Blank Intentionally
FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
