[INSERT ZURICH LIFE GRAPHIC HERE]
Federal Xxxxxx Life Assurance Company
A Stock Life Insurance Company
0000 XxXxxxxx Xxxxxxx
Xxxxxxxxxx, Xxxxxxxx 00000-0000
(000) 000-0000
RIGHT TO CANCEL - FREE LOOK PROVISION - At any time within 10 days of receiving
this contract You may return it to Us or to the representative through whom it
was purchased. Immediately upon Our receipt, this contract will be voided as if
it had never been in force. All Purchase Payments allocated to the Fixed Account
plus the Separate Account Contract Value computed at the end of the Valuation
Period following Our receipt of this contract will then be refunded within 10
days.
We agree to pay an Annuity to the Owner provided this contract is in force on
the Annuity Date.
We further agree to pay the death benefit prior to the Annuity Date when a death
benefit is payable. Payment will be made upon Our receipt of due proof of death
and the return of this contract.
This contract is issued in consideration of the initial Purchase Payment. The
provisions on this cover and the pages that follow are part of this contract.
Signed for Federal Xxxxxx Life Assurance Company at its home office in
Schaumburg, Illinois.
/s/ Xxxxx X. Xxxxxxx /s/ Xxx X. Xxxxxx
Secretary President
FLEXIBLE PREMIUM, FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
THE INITIAL INTEREST RATE IS GUARANTEED FOR ONLY A LIMITED PERIOD OF TIME.
WITHDRAWALS MAY BE SUBJECT TO A WITHDRAWAL CHARGE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT AND MAY INCREASE OR DECREASE. REFER TO THE VARIABLE ACCOUNT AND
ANNUITY PERIOD PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This a legal contract between the Owner and Federal Xxxxxx Life Assurance
Company
READ YOUR CONTRACT CAREFULLY.
TABLE OF CONTENTS
Page
CONTRACT SCHEDULE Follows Table of Contents
DEFINITIONS 1-2
GENERAL PROVISIONS 3
The Entire Contract 3
Modification of Contract 3
Incontestability 3
Change of Annuity Date 3
Assignment 3
Due Proof of Death 3
Reserves, Contract Values and Death Benefits 3
Non-Participating 3
Reports 3
Premium Taxes 3
Creditors 3
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS 4
Owner 4
Change of Ownership 4
Beneficiary Designation and Change of Beneficiary 4
Death of Beneficiary 4
Annuitant 4
PURCHASE PAYMENT PROVISIONS 5
Purchase Payment Limitations 5
Purchase Payment Bonus 5
Place of Payment 5
FIXED ACCOUNT PROVISIONS 5
Fixed Account Contract Value 5
VARIABLE ACCOUNT PROVISIONS 6-7
Separate Account 6
Liabilities of the Separate Account 6
Subaccounts 6
Fund 6
Rights Reserved by the Company 6
Accumulation Unit Value 6
Investment Experience Factor 7
TRANSFER AND WITHDRAWAL PROVISIONS 7-9
Transfers During the Accumulation Period 7
Withdrawals During the Accumulation Period 8
Withdrawal Charges 8-9
Transfers and Withdrawal Procedures 9
Deferment of Withdrawal or Transfer 9
DEATH BENEFIT PROVISIONS 9-10
Amount Payable Upon Death 9-10
Payment of Death Benefits During the Accumulation Period 10
Spousal Continuation 10
TABLE OF CONTENTS
Page
ANNUITY PERIOD PROVISIONS 11-15
Annuity Options 11
Option 1 Certain Period Annuity 11
Option 2 Life Annuity 11
Option 3 Life Annuity with Installments Guaranteed 11
Option 4 Joint and Survivor Annuity 11
Option 5 Joint and Survivor Annuity with Installments Guaranteed 11
Other Options 11
Election of Annuity Option 11
Electing a Fixed or Variable Annuity Option 11
Fixed Annuity 12
Variable Annuity 12
Annuity Unit Value 12
Basis of Annuity Options 12
Withdrawal Charge Upon Annuitization 12
Transfers Between Subaccounts 13
Conversions from a Fixed Annuity Payment 13-14
Conversions to a Fixed Annuity Payment 14
Payment of Death Benefits During the Annuity Period 14
Disbursement Upon Death of Annuitant: Under Options 1, 3 or 5 15
Supplementary Agreement 15
Date of First Payment 15
Evidence of Age, Sex and Survival 15
Misstatement of Age or Sex 15
ANNUITY OPTION TABLE Follows Page 15
ENDORSEMENTS, if any Follow Annuity Option Table
Contract Schedule
Contract number: [0003251] Issue Date: [May 1, 2003]
Initial Purchase Payment: [$10,000] Type of contract: [Nonqualified]
Owner: [Xxxx Xxx]
Owner date of birth
or trust inception date: [March 04, 1968]
Annuitant: [Xxxx Xxx]
Annuitant gender: [Male]
Annuitant date of birth: [March 04, 1968]
Joint Owner: [None]
Joint Owner date of birth: [N/A]
Joint Annuitant: [None]
Joint Annuitant gender: [N/A]
Joint Annuitant date of birth: [N/A]
Annuity Date: [May 1, 2033]
Maximum Annuity Date: [The oldest owner's or annuitant's 90th birthdate]
Minimum Annuity Date: [The minimum annuity date is one year from the Issue Date]
[Date of Continuance: N/A]
( Optional Enhanced )
( Death Benefit Rider: Zurich Safeguard Not Selected )
( Zurich Safeguard Plus Selected )
( Guaranteed Roll-Up Interest Rate Applicable to Zurich Safeguard: )
( )
( Class 1 Accumulation Options 0.00% )
( Class 2 Accumulation Options 5.00% )
Purchase payment bonus: Contract years 1-15: [4.00%]
Contract years 16 and later: [0.00%]
Agent: [Xxxx Xxxxx]
3257 Page A
Contract Schedule
Beneficiary Information
Primary beneficiary(ies):
[Xxxx Xxx]
Contingent beneficiary(ies):
[Xxxxx Xxx]
Fixed Account
We declare a Fixed account interest rate for each allocation to the Fixed account for an initial period when
the allocation is made and at the start of each subsequent interest period. This initial interest rate will
never be less than the minimum fixed account interest rate.
The initial period is: [Through the end of the calendar month in which the allocation is made and for
12 additional calendar months thereafter.]
Subsequent periods are: [12 calendar months]
The minimum guaranteed fixed account interest rate is:
( Contract Years 1-10 2.00% )
( 11+ 3.00% )
Maximum Total Purchase Payments: [$1,000,000]
Maximum Fixed Account Purchase Payments Per Contract Year: [$100,000]
Maximum Purchase Payment Date: Prior to Oldest owner or Annuitant's
81st birthday
Minimum Initial Account Allocation: [$100]
Minimum Subsequent Account Allocation: [$100]
Minimum Initial Purchase Payment: [$10,000] Nonqualified Plans
[$2,000] Qualified Plans
Minimum amount of Subsequent Purchase Payment: [$100]
Minimum Contract Value remaining after a partial withdrawal: [$500]
3257 Page B
Contract Schedule
Withdrawal Charge:
During Year The Withdrawal
Charge is:
One 8.00%
Two 8.00%
Three 7.00%
Four 6.00%
Five 5.00%
Six 4.00%
Seven 3.00%
Eight 2.00%
Nine and later 0.00%
For purposes of determining the withdrawal charge, year one will elapse on the
last day of the Contract Year in which the Purchase Payment was received.
Subsequent years will elapse on the last day of each subsequent Contract Year.
Purchase Payments received on or after the 15th Contract Annuity are not subject
to withdrawal charges.
Free Withdrawal Allowance:
The Free Withdrawal Allowance is an amount that may be withdrawn without a
withdrawal charge each Contract Year. The Free Withdrawal Allowance is
calculated each time that you make a withdrawal.
The Free Withdrawal Allowance is (a + b) multiplied by 10% - c but not less than
zero, where:
(a) is contract value less Debt prior to the withdrawal;
(b) is previous partial withdrawals made during the Contract Year; and
(c) is previous partial withdrawals made during the Contract Year that
were not subject to withdrawal charges.
A daily equivalent of the following annual charges will be assessed each day on
the subaccounts:
Mortality and Expense Risk Charge: [1.00%]
Administration Charge: Contract years 1 - 15: [.50%]
Contract years 16 and later: [.25%]
[Optional Enhanced Death Benefit rider charge:] Zurich Safeguard [0.20%]
Zurich Safeguard Plus [0.35%]
The Optional Enhanced Death Benefit rider charge applies to the Class 2
accumulation options.
This charge does not apply to the Class 1 accumulation options.
Transfer Charge: We reserve the right to charge $10 for each transfer in excess
of 12 in a contract year.
We will assess a Records Maintenance Charge at the end of each calendar quarter
in which you participate in the Separate Account, upon a full withdrawal, and on
the Annuity Date. This charge will not be assessed after the Annuity Date. This
charge will be deducted on a proportional basis from amounts allocated to the
Subaccounts. We reserve the right to make this deduction from the Fixed Account.
The amount of this charge will depend on the amount of the Contract Value on the
date the change is made:
Amount of Records Maintenance
Contract Value Charge
less than $25,000 $7.50
$25,000 to $49,999.99 $3.75
$50,000 and greater none
Page C
Contract Schedule
Initial Initial Annual Effective Allocation
Allocations Interest Rate(s) Percentage(s)
Janus Aspen Worldwide Growth N/A 80%
Fixed Account 3.0% 20%
Page D
Contract Schedule
Clas 1 Accumulation Options:
Fixed Account Option
--------------------
(Fixed Account)
Separate Account: (FKLA Variable Annuity Separate Account)
Subaccounts available on the Issue Date:
(Xxxxxxx Money Market)
3257 Page E
Contract Schedule
Class 2 Accumulation Options:
Fixed Account Option
--------------------
(None)
Separate Account: (FKLA Variable Annuity Separate Account)
Subaccounts available on the Issue Date:
Xxxxxxx Government Securities
Xxxxxxx High Yield
Xxxxxxx Total Return
Xxxxxxx Growth
Xxxxxxx International Research
Xxxxxxx Small Cap Growth
Xxxxxxx Investment Grade Bond
Xxxxxxx Small Cap Value
Xxxxxxx Contrarian Value
SVS Focus Value + Growth
Xxxxxxx Technology Growth
Xxxxxxx Bond
Xxxxxxx Capital Growth
Xxxxxxxx International
Credit Suisse Warburg Pincus Trust-Emerging Markets
Janus Aspen Balanced
Janus Aspen Growth
Janus Aspen Aggressive Growth
Janus Aspen Worldwide Growth
Pilgrim Emerging Markets Fund, Inc.
Pilgrim Natural Resources Trust
Fidelity VIP II Asset Manager
Fidelity VIP II Index 500
Fidelity VIP II Contrafund (R)
Fidelity VIP Equity-Income
Fidelity VIP Growth
Xxxxx American Growth
Xxxxx American Small Capitalization
Xxxxx American MidCap Growth
American Century VP Income & Growth
American Century VP Value
The Dreyfus Socially Responsible Growth Fund, Inc.
X.X. Xxxxxx Small Company
3257 Page F
DEFINITIONS
ACCUMULATION PERIOD - The period between the
Issue Date and the Annuity Date.
ACCUMULATION UNIT - An accounting unit of measure
used to calculate the value of each Subaccount.
ADMINISTRATION CHARGE - A charge deducted in the
calculation of the Accumulation Unit value and
the Annuity Unit value for a portion of Our
administrative costs.
AGE - The attained age.
ANNIVERSARY VALUE - The Contract Value calculated
on each Contract Anniversary during the
Accumulation Period.
ANNUITANT - The person during whose lifetime the
Annuity is to be paid. Joint Annuitants may be
named under Nonqualified Plans and any reference
to Annuitant shall include Joint Annuitants.
ANNUITY - A series of payments paid in accordance
with this contract which begin on the Annuity
Date.
ANNUITY DATE - The date on which Annuity payments
begin. The original Annuity Date is the maximum
Annuity Date shown in the Contract Schedule. You
may change the Annuity Date as provided in this
contract.
ANNUITY PERIOD - The period that starts on the
Annuity Date.
ANNUITY UNIT - An accounting unit of measure used
to calculate the amount of Variable Annuity
payments after the first Annuity payment.
CONTRACT ANNIVERSARY - An anniversary of the
Issue Date
CONTRACT OWNER, OR OWNER - See "You, Your, Yours"
below
CONTRACT VALUE - The sum of the Fixed Account
Contract Value plus the Separate Account Contract
Value.
CONTRACT YEAR - A one year period starting on the
Issue Date and successive Contract Anniversaries.
DEBT - The principal of any outstanding loan plus
any accrued interest. Loans are available under
certain Qualified Plans.
FIXED ACCOUNT - Our General Account to which an
Owner may allocate all or a portion of Purchase
Payments or Contract Value.
FIXED ACCOUNT CONTRACT VALUE - The value of
amounts allocated under this contract to the
Fixed Account.
FIXED ANNUITY - An Annuity payment plan that does
not vary as to dollar amount.
FREE WITHDRAWAL ALLOWANCE - Amount of Contract
Value that may be withdrawn each Contract Year
without incurring a withdrawal charge as
described in the Contract Schedule.
FUND - An investment company or separate series
thereof, in which the Subaccounts of the Separate
Account invest.
GENERAL ACCOUNT - Our assets other than those
allocated to the Separate Account or any other
Separate Account.
Page 1
Page 2
DEFINITIONS (Continued)
MORTALITY AND EXPENSE RISK CHARGE - A charge
deducted in the calculation of the Accumulation
Unit value and the Annuity Unit value. It is for
Our assumption of mortality risks and expense
guarantees. This charge is shown in the Contract
Schedule.
NONQUALIFED PLAN - This contract issued other
than as a Qualified Plan.
PURCHASE PAYMENTS - The dollar amount We receive
in U.S. currency to buy the benefits this
contract provides.
QUALIFIED PLAN - A contract issued under a
retirement plan which qualifies for favorable
income tax treatment under Section 401, 403, 408,
408A, or 457 of the Internal Revenue Code as
amended.
If this contract is issued under a Qualified Plan
additional provisions may apply. The rider or
amendment to this contract used to qualify it
under the applicable section of the Internal
Revenue Code will indicate the extent of change
in the provisions.
RECORDS MAINTENANCE CHARGE - A charge assessed
against Your contract as specified in the
Contract Schedule.
SEPARATE ACCOUNT - A unit investment trust
registered with the Securities and Exchange
Commission under the Investment Company Act of
1940 and identified in the Contract Schedule.
SEPARATE ACCOUNT CONTRACT VALUE - The sum of the
Subaccount Values of this contract on a Valuation
Date.
SUBACCOUNTS - The subdivisions of the Separate
Account, the assets of which consist solely of
shares of the corresponding Fund.
SUBACCOUNT VALUE - The value of Your interest in
each Subaccount.
VALUATION DATE - Each business day that
applicable law requires that We value the assets
of the Separate Account. Currently this is each
day that the New York Stock Exchange is open for
trading.
VALUATION PERIOD - The period that starts at the
close of a Valuation Date and ends at the close
of the next succeeding Valuation Date.
VARIABLE ANNUITY - An Annuity payment plan which
varies as to dollar amount because of Subaccount
investment experience.
WE, OUR, US - Federal Xxxxxx Life Assurance
Company, Schaumburg, Illinois.
YOU, YOUR, YOURS - The party(s) named as Owner
unless later changed as provided in this
contract. Under a Nonqualified Plan when more
than one person is named as Owner, the terms
"You,""Your,""Yours," means joint Owners.
GENERAL PROVISIONS
The Entire Contract This contract, any written application attached
to this contract, and any endorsements and riders
constitute the entire contract between the
parties. All statements made in any attached
application are deemed representations and not
warranties. No statement will void this contract
or be used as a defense of a claim unless it is
contained in an attached application.
Modification of Only Our president, secretary and assistant
Contract secretaries have the power to approve a change or
waive any provisions of this contract. Any such
modifications must be in writing. No agent or
person other than the officers named has the
authority to change or waive the provisions of
this contract.
Upon notice to You, this contract may be modified
by Us as is necessary to comply with any law or
regulation issued by a governmental agency to
which We or the Separate Account is subject or as
is necessary to assure continued qualification of
this contract under the Internal Revenue Code or
other laws relating to retirement plans or
annuities or as otherwise may be in Your best
interest. In the event of a modification, We may
make appropriate endorsement to this and We will
obtain all required regulatory approvals.
Incontestability We cannot contest this contract after it has been
in force for two years from the Issue Date.
Change of Annuity You may write to Us prior to the death of an
Date Owner and the first Annuity payment date and
request a change of the Annuity Date. The new
Annuity Date must not be earlier than the minimum
annuity date or beyond the maximum annuity date
stated in the Contract Schedule.
Assignment No assignment under this contract is binding
unless We receive it in writing. We assume no
responsibility for the validity or sufficiency of
any assignment. The rights of the Owner and
beneficiary are subject to the assignment after
We have recorded it. Any assignment will be
subject to the interest of any previously named
irrevocable beneficiary. Any claim is subject to
proof of interest of the assignee.
Due Proof of Death We must receive written proof of the Owner's
death in the form of a certified death
certificate when a death benefit is payable.
Reserves, Values All reserves are equal to or greater than those
and Benefits required by statute. Any available contract
values and benefit are not less than the minimum
required by the statutes of the state in which
this contract is delivered.
Non-Participating This contract does not pay dividends. It will not
share in Our surplus or earnings.
Reports At least once each Contract Year We will send You
a statement showing Purchase Payments received,
interest credited, investment experience, and
charges made since the last report, as well as
any other information required by statute.
Premium Taxes We will make a deduction for state premium taxes
in certain situations. On any contract subject to
premium tax, as provided under applicable law,
the tax will be deducted from: a. the Purchase
Payments when We receive them; b. the Contract
Value upon total withdrawal; or c. from the total
Contract Value applied to any Annuity option at
the time Annuity payments start. In no event will
an amount be deducted for premium taxes before
the Company has incurred a tax liability under
applicable state law.
Creditors The proceeds of this contract and any payment
under an Annuity option will be exempt from the
claims of creditors and from legal process to the
extent permitted by law.
Page 3
S-3257 Page 4
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
Owner Before the Annuity Date and prior to the death of
an Owner, You may exercise every option and right
conferred by this contract including the right of
assignment. The joint Owners must agree to the
exercise of any option or right if more than one
Owner is named.
Change of Ownership You may change the Owner by written request
before the Annuity Date and prior to the death of
an Owner. You must furnish information sufficient
to clearly identify the new Owner to Us. The
change is subject to any existing assignment of
this contract. After We receive the change, it
will take effect on the date the written notice
is signed. However, any action taken by Us before
the change is recorded by Us remains in effect.
Any change is subject to the payment of any
proceeds. We may require You to return this
contract to Us for endorsement of a change.
Beneficiary The beneficiary initially designated is shown in
Designation and the Contract Schedule. In the case of joint
Change of owners, the surviving joint Owner is
Beneficiary automatically the primary beneficiary of any
death benefit resulting from the death of a joint
Owner. You may change the beneficiary if You send
Us written notice in a form acceptable to Us.
Changes are subject to the following conditions:
1. Prior to the Annuity Date the change must be
filed while You are alive;
2. After the Annuity Date the change must be
filed while You and the Annuitant(s) are
alive;
3. This contract must be in force at the time
You file a change;
4. Such change must not be prohibited by the
terms of an existing assignment, beneficiary
designation or other restriction;
5. After We receive the change, it will take
effect on the date the written notice was
signed. However, any action taken by Us
before the change form is recorded by Us will
remain in effect;
6. The request for change must provide
information sufficient to identify the new
beneficiary; and
7. In the case of joint Owners, the designation
of a beneficiary(ies) other than the
surviving joint Owner will be deemed to be a
contingent beneficiary(ies).
We may require You to return this contract to Us
for endorsement of a change.
Death of The interest of a beneficiary who dies before the
Beneficiary distribution of the death benefit will pass to
the other beneficiaries, if any, share and share
alike, unless otherwise provided in the
beneficiary designation. If no beneficiary
survives or is named, the distribution will be
made to Your estate when You die.
Annuitant The original Annuitant is shown in the Contract
Schedule. Prior to the Annuity Date, an Annuitant
may be replaced or added unless the Owner is a
non-natural person. At all times there must be at
least one Annuitant. If the Annuitant dies, the
youngest Owner will become the new Annuitant
unless a new Annuitant is otherwise named. Upon
the death of an Annuitant prior to the Annuity
Date, a death benefit is not paid unless the
Owner is a non-natural person.
Any subsequent Annuitant must not have attained
Age 81 prior to the Issue Date.
PURCHASE PAYMENT PROVISIONS
Purchase Payment Purchase payment and allocation limits are shown in the
Limitations Contract Schedule.
We will not apply the maximum fixed account purchase
payments per contract year limit shown in the Contract
Schedule to purchase payment allocations that are part of a
systematic investment program that has been approved by Us,
but reserve the right to apply this or a modified limit to
such allocations.
We will not accept a Purchase Payment received after the
maximum purchase payment date shown in the Contract
Schedule.
We reserve the right: (a) to not accept purchase payment
allocations to the Fixed Account at any time when the
interest rate We declare for the Fixed Account is equal to
or less than an annual rate of 3%; and (b) to not apply this
allocation limitation to Purchase Payments that are part of
a systematic investment program that has been approved by
Us.
We reserve the right to waive or modify these limits. We
reserve the right to not accept any Purchase Payment.
Purchase Payment Subject to the limitation shown below, Purchase Payments
Bonus will be increased by the purchase payments bonus shown on
the Contract Schedule before being allocated to the various
accounts of this contract.
We reserve the right to not increase a Purchase Payment by
the purchase payment bonus if at the time the Purchase
Payment is made the sum of partial withdrawals and loans
made under this contract exceeds the sum of Purchase
Payments and loan repayments.
Place of Payment All Purchase Payments under this contract must be paid to Us
at Our home office or such other location as We may select.
We will notify You and any other interested parties in
writing of such other locations. Purchase Payments received
by an agent will not be considered received by Us.
FIXED ACCOUNT PROVISIONS
Fixed Account The Fixed Account Contract Value includes:
Contract Value
1. Your Purchase Payments allocated to the Fixed Account;
plus
2. amounts transferred to the Fixed Account; plus
3. interest credited; minus
4. withdrawals, previously assessed withdrawal charges and
transfers from the Fixed Account, minus
5. any applicable portion of the Records Maintenance
Charge.
The initial annual effective fixed account interest rate,
initial and subsequent interest rate periods and the minimum
guaranteed fixed account interest rate are shown in the
Contract Schedule.
We reserve the right to declare the Fixed Account current
interest rate(s) based upon the Issue Date, the date We
receive a Purchase Payment or the date of account transfer.
We calculate the interest credited to the Fixed Account by
compounding daily, at daily interest rates, rates that would
produce at the end of 12 months a result identical to the
one produced by applying an annual interest rate.
S-3257 Page 5
S-3257 Page 6
VARIABLE ACCOUNT PROVISIONS
Separate Account The variable benefits under this contract are provided
through the Separate Account identified in the Contract
Schedule. The Separate Account is registered with the
Securities and Exchange Commission as a unit investment
trust under the Investment Company Act of 1940. It is a
separate investment account maintained by Us into which a
portion of Our assets has been allocated for this contract
and may be allocated for certain other contracts and
certificates We issue.
Liabilities of the The assets equal to the reserves and other liabilities of
Separate Account the Separate Account will not be charged with liabilities
arising out of any other business We may conduct. We will
value the assets of the Separate Account on each Valuation
Date.
Subaccounts The Separate Account consists of multiple Subaccounts. We
may from time to time, combine or remove Subaccounts in the
Separate Account and establish additional Subaccounts of the
Separate Account. In such event, We may permit You to select
other Subaccounts under the contract. However, the right to
select any other Subaccount is limited by the terms and
conditions We may impose on such transactions.
Fund Each Subaccount of the Separate Account will buy shares of a
Fund or a separate series of a Fund. Each Fund is registered
under the Investment Company Act of 1940 as an open-end
diversified management investment company. Each series of a
Fund represents a separate investment portfolio that
corresponds to one of the Subaccounts of the Separate
Account.
If We establish additional Subaccounts, each new Subaccount
will invest in a new series of a Fund or in shares of
another investment company. We may also substitute other
investment companies.
Rights Reserved We reserve the right, subject to compliance with the current
by the Company law or as it may be changed in the future:
1. To operate the Separate Account in any form permitted
under the Investment Company Act of 1940 or in any
other form permitted by law;
2. To take any action necessary to comply with or obtain
and continue any exemptions from the Investment Company
Act of 1940 or to comply with any other applicable law;
3. To transfer any assets in any Subaccount to another
Subaccount or to one or more Separate Accounts, or the
General Account, or to add, combine or remove
Subaccounts in the Separate Account;
4. To delete the shares of any of the portfolios of a Fund
or any other open-end investment company and to
substitute, for the Fund shares held in any Subaccount,
the shares of another portfolio of a Fund or the shares
of another investment company or any other investment
permitted by law; and
5. To change the way We assess charges, but not to
increase the aggregate amount above that currently
charged to the Separate Account and the Funds in
connection with this contract.
When required by law, We will obtain Your approval of such
changes and the approval of any regulatory authority.
Accumulation Each Subaccount has an Accumulation Unit value for each
Unit Value combination of charges. When Purchase Payments or other
amounts are allocated to a Subaccount, a number of units are
purchased based on the relevant Accumulation Unit value of
the Subaccount at the end of the Valuation Period during
which the allocation is made. When amounts are transferred
out of or deducted from a Subaccount, units are redeemed in
a similar manner. The value of a Subaccount on any Valuation
Date is the number of units held in the Subaccount times the
relevant Accumulation Unit value on that Valuation Date.
An Accumulation Unit value for each subsequent Valuation
Period is the relevant investment experience factor for that
period multiplied by the Accumulation Unit value for the
period immediately preceding. The Accumulation Unit values
for each Valuation Period are applied to each day in a
Valuation Period. The number of Accumulation Units will not
change as a result of investment experience; however,
adding, deleting or modifying a rider for this contract will
result in a change in the number of Accumulation Units.
VARIABLE ACCOUNT PROVISIONS (Continued)
Investment Each Subaccount has an investment experience factor for each
Experience Factor combination of charges. The investment experience factor of
a Subaccount for a combination of charges for a Valuation
Period is determined by dividing 1. by 2. and subtracting 3.
from the result, where:
1. is the net result of:
a. the net asset value per share of the investment
held in the Subaccount determined at the end of
the current Valuation Period; plus
b. the per share amount of any dividend or capital
gain distributions made by the investments held in
the Subaccount, if the "ex-dividend" date occurs
during the current Valuation Period; plus or minus
c. a credit or charge for any taxes reserved for the
current Valuation Period which We determine
resulted from the investment operations of the
Subaccount;
2. the net asset value per share of the investment held in
the Subaccount, determined at the end of the next
Valuation Period.
3. is the factor representing the sum of the Separate
Account charges currently applicable for the number of
days in the Valuation Period.
TRANSFER AND WITHDRAWAL PROVISIONS
Transfer During Any transfer request must clearly specify:
the Accumulation
Period 1. the amount which is to be transferred; and
2. the names of the accounts which are affected.
We reserve the right at any time and without notice to any
party, to terminate, suspend, or modify the following
transfer provision.
Transfers of Separate Account are subject to the following
conditions:
1. The minimum amount which may be transferred out of or
into a Subaccount is the minimum subsequent account
allocation stated in the Contract Schedule or, if
transfer smaller, the remaining value of the
Subaccount. No partial may be made if the remaining
value of the Subaccount will be less than the minimum
initial account allocation shown in the Contract
Schedule.
2. No transfer may be made within seven calendar days of
the date on which the first Annuity payment is due.
3. We reserve the right to impose a 15 calendar day
waiting period between transfers for any transfer in
excess of 12 in a Contract Year.
4. Total transfers into the Fixed Account that would be
credited an annual current interest rate of 3% or less
in any Contract Year may not exceed 25% of the Contract
Issue Value as of: (a) the prior Contract Anniversary;
or (b) the Date, for transfers made prior to the first
investment Contract Anniversary. Transfers made under a
systematic program that has been approved by Us are not
subject to this limitation but We reserve the right to
apply this or a modified limit to such transfers.
5. We reserve the right: (a) not to allow any transfer
into the Fixed Account if the Fixed Account interest
rate with respect to that transfer would be less than
or equal to an annual rate of 3%; and (b) to not apply
this limitation to transfers made under a systematic
investment program that has been approved by Us.
S-3257 Page 7
S-3257 Page 8
TRANSFER AND WITHDRAWAL PROVISIONS (Continued)
Transfers of Fixed Account Contract Value are subject to the
following conditions:
1. The minimum amount which may be transferred is the
minimum subsequent account allocation stated on the
Contract Schedule or, if smaller, the value of this
contract that remains in the Fixed Account.
2. Total transfers out of the Fixed Account in any Contract
Year may not exceed 25% of the Fixed Account Contract
Value as of: (a) the prior Contract Anniversary; or (b)
the Issue Date, for transfers made prior to the first
Contract Anniversary. The entire Fixed Account Contract
Value may be transferred if the transfer out of the
less than $5,000. Fixed Account would result in a Fixed
Account Contract Value Transfers made under a systematic
investment program that has been approved by Us are not
subject to this limitation but we reserve the right
apply this or a modified limit to such transfers.
3. No transfer may be made within seven calendar days of
the date on which the first Annuity payment is due.
4. We will transfer Purchase Payments and all related
accumulations in the chronological order We received
such Purchase Payments by Contract Year.
Withdrawals During the Accumulation Period, You may withdraw all or part
During the of the Contract Value reduced by any withdrawal charge, Debt
Accumulation and applicable premium taxes.
Period
Withdrawals are subject to all of the following conditions:
1. You must return this contract to Us if You elect a total
withdrawal.
2. Each withdrawal must be at least $500 or the value of
this contract that remains in the Fixed Account or
Subaccount if smaller.
3. The minimum subsequent account allocation stated in the
Contract Schedule must remain in the account after You
make a withdrawal unless the account is eliminated by
such withdrawal.
4. We must receive a written request that indicates the
amount of the withdrawal from the Fixed Account and each
Subaccount.
5. Withdrawals will reduce each investment option on a
proportional basis unless You direct Us otherwise.
6. Withdrawals will first reduce Your Purchase Payments in
the chronological order in which they were received and
then reduce any earnings.
7. If a partial withdrawal would reduce the Contract Value
to less than the minimum contract value after a partial
withdrawal stated in the Contract Schedule, the partial
withdrawal will be processed as a total withdrawal.
Withdrawal Charges 1. All Purchase Payments in a given Contract Year and all
related accumulations are totaled by account and each
total is used separately in computing the withdrawal
charge as stated in the withdrawal charge table shown in
the Contract Schedule.
2. All amounts to be withdrawn and any applicable
withdrawal charges will be charged first against
Purchase Payments and all related accumulations in the
chronological order We received such Purchase Payments
by Contract Year.
TRANSFER AND WITHDRAWAL PROVISIONS (Continued)
3. Any amount withdrawn that is not subject to a withdrawal
charge will be considered a partial free withdrawal.
4. In the event of a partial withdrawal, a partial free
withdrawal is applied against Purchase Payments and all
related accumulations in the chronological order We
received such Purchase Payments by Contract Year even
though the Purchase Payment and related accumulations
are no longer subject to a withdrawal charge.
Transfer and We will withdraw or transfer from the Fixed Account as of
Withdrawal the Valuation Date that follows the date We receive the
Procedures Owner's written or telephone transfer request. To process a
withdrawal, the request must contain all required
information.
We will redeem the necessary number of Accumulation Units to
achieve the dollar amount when the withdrawal or transfer is
made from a Subaccount. We will reduce the number of
Accumulation Units credited in each Subaccount by the number
of Accumulation Units redeemed. The reduction in the number
of Accumulation Units is determined based on the
Accumulation Unit value at the end of the Valuation Period
when We receive the request, provided the request contains
all required information. We will pay the withdrawal amount
within seven calendar days after the date We receive the
request, except as provided below.
Deferment of If the withdrawal or transfer is to be made from a
Withdrawal or Subaccount, We may suspend the right of withdrawal or
Transfer transfer or delay payment more than seven calendar days:
1. during any period when the New York Stock Exchange is
closed other than customary weekend and holiday
closings;
2. when trading in the markets normally utilized is
restricted, or an emergency exists as determined by the
Securities and Exchange Commission, so that disposal of
investments or determination of the Accumulation Unit
value is not practical; or
3. for such other periods as the Securities and Exchange
Commission by order may permit for protection of Owners.
We may defer the payment of a withdrawal or transfer from
the Fixed Account for the period permitted by law. This can
never be more than six months after the Owner sends Us a
written request. During the period of deferral, We will
continue to credit interest, at the then current interest
rate(s), to the Fixed Account Contract Value.
DEATH BENEFIT PROVISIONS
Amount Payable If death occurs prior to the oldest Owner's age 75, the
Upon Death death benefit is the greater of the following less Debt:
(a) Contract value; and
(b) Purchase Payment Death Benefit.
If death occurs after the oldest Owner's age 75, the death
benefit is the Contract Value, less debt.
Purchase Payment Death Benefit is the sum of all Purchase
Payments, less premium taxes, reduced by all adjustments for
withdrawals.
Each adjustment for a withdrawal is equal to (1) divided by
(2), with the result multiplied by (3) where:
(1) is the withdrawal and withdrawal charge amount, and
(2) is the Contract Value immediately prior to the
withdrawal, and
(3) is the Purchase Payment Death Benefit immediately prior
to the withdrawal.
S-3257 Page 9
S-3257
Page 10
DEATH BENEFIT PROVISIONS (Continued)
We compute the Contract Value as of the end of
the Valuation Period following Our receipt of due
proof of death, the return of this contract, and
such other information We may require to process
the Death Benefit. We compute the Purchase
Payment Death Benefit as of the date of death.
The amount computed is increased for Purchase
Payments after the date of death and reduced by
all adjustments for withdrawals after the date of
death.
Payment of Death Benefits A death benefit will be paid to the beneficiary
During the Accumulation upon the death of the Owner, or a joint Owner,
Period during the Accumulation Period. If the Contract
Owner is a non-natural person, a death benefit
will be paid to the beneficiary upon the death of
an Annuitant prior to the Annuity Date.
We will pay the death benefit to the beneficiary
after We receive due proof of death. We will then
have no further obligation under this contract.
The entire interest in this contract must be
distributed within five years from the date of
death unless it is applied under an Annuity
option or the spouse continues this contract as
described below.
The beneficiary may elect to have the death
benefit distributed as stated in Annuity Period
Provisions Option 1 provided the beneficiary's
life expectancy is not less than 10 years; or
Options 2 or 3 as described in the Annuity Period
Provisions of this contract, based on the life
expectancy of the beneficiary as prescribed by
federal regulations unless You have restricted
the right to make such an election. The
beneficiary must make this choice within sixty
days of the time We receive due proof of death,
and distributions must commence within one year
of the date of death.
If the beneficiary is a non-natural person, the
beneficiary must elect that the entire death
benefit be distributed within five years of the
date of death.
Spousal Continuation If this contract was issued as a Nonqualified
Plan or an Individual Retirement Annuity ("IRA")
and Your spouse is the primary beneficiary when
You die, Your spouse may elect to be the
successor Owner of this contract. This is known
as a Spousal Continuation. In such a case, no
death benefit will be payable upon Your death.
Upon Your death, Your surviving spouse may
continue this contract thereby waiving claim to
the death benefit otherwise payable. Electing to
continue this contract under the Spousal
Continuation provision of this contract will
affect how the charges and benefits under this
contract, and applicable endorsements are
calculated or determined.
A spousal continuation has the following impact
on this contract:
A. The Contract Value will be adjusted to equal
the amount of the death benefit. If the death
benefit otherwise payable exceeds the
Contract Value one day prior to the date of
continuance, such excess will be credited to
the money market subaccount listed in the
Contract Schedule. This amount may
subsequently be transferred from the money
market subaccount to other options under this
contract.
B. After the spousal continuation, the death
benefit payable will be determined as if:
(1) this contract was issued on the date of
continuance; and (2) the Contract Value
applied on the date of continuance resulted
from our receipt of an initial Purchase
Payment.
X. Xxxxxxxxxx charges will not apply to
withdrawals made from the Contract Value
credited on the date of continuance.
Withdrawal Charges will apply to Purchase
Payments made after the date of continuance.
D. This contract may not be continued under a
subsequent Spousal Continuation.
We may make certain riders available to the
surviving spouse at the time of continuance.
ANNUITY PERIOD PROVISIONS
Annuity Options You may annuitize this contract under one of the
following Annuity options:
Option 1 We will make monthly payments for 10 years.
Certain Period Annuity
Option 2 We will make monthly payments while the Annuitant
Life Annuity is alive.
Option 3 We will make monthly payments for a 10-year
Life Annuity with certain period and thereafter while the Annuitant
Installments Guaranteed is alive.
Option 4 We will pay the full monthly income while both
Joint and Survivor Annuity Annuitant(s) are alive. Upon the death of either
Xxxxxxxxx, We will continue to pay a percentage
of the original monthly payment. The percentage
payable must be selected at the time the Annuity
option is chosen. The percentages available are
50%, 66 2/3%, 75% and 100%.
Option 5 We will make monthly payments for a 10 year
Joint and Survivor Annuity certain period and thereafter while the
with Installments Guaranteed Annuitants are alive.
Other Options We may make other Annuity options available.
Election of Annuity Option We must receive an election of an Annuity option
in writing. You may make an election on or before
the Annuity Date provided the Annuitant is alive.
A subsequent change of beneficiary, or an
assignment of this contract will revoke an
election unless the assignment provides
otherwise.
Upon election of an Annuity option, We agree to
pay the Owner on the payment due dates as stated
in the specifications page of the supplementary
agreement. The Owner may direct Us, in writing,
to make payments to another person. An option
cannot be changed after the first Annuity payment
is made.
If an Annuity option is not elected by the
Annuity Date, an Annuity will be paid under
Option 3 if there is one Annuitant on the Annuity
Date and Option 5 if there are joint Annuitants
on the Annuity Date.
Electing a Fixed or Variable You may elect a Fixed Annuity, a Variable Annuity
Annuity Option or a combination of both. The portion of the
Contract Value You elect to be paid as a Fixed
Annuity, if any, will be transferred to Our
General Account. We must receive your Fixed and
Variable allocation election in writing at least
seven days prior to the Annuity Date. If We do
not receive notification from You, all the
Contract Value will be paid to You as a Fixed
Annuity.
If your allocation includes a Variable Annuity
payment, payments will reflect the investment
performance of the Subaccounts in accordance with
the allocation on the Annuity Date. Allocations
will not be changed thereafter, except as
provided in the Transfers Between Subaccounts
section.
Payments for all options are derived from the
applicable tables. Current Annuity rates will be
used if they produce greater payments than those
quoted in this contract. The age in the tables is
the Age of the Annuitant on the last birthday
before the first payment is due.
The option selected must result in a payment that
is at least equal to Our minimum payment,
according to Our rules, at the time the Annuity
option is chosen. If at any time the payment is
less than the minimum payment, We have the right
to increase the period between payments to
quarterly, semi-annual or annual so that the
payment is at least equal to the minimum payment
or to make payment in one lump sum.
S-3257 Page 11
S-3257 Page 12
ANNUITY PERIOD PROVISIONS (Continued)
Xxxxx Xxxxxxx The portion of the Contract Value You elected to
have paid to you as a Fixed Annuity less any
withdrawal charge, charges for other benefits,
and Records Maintenance Charge will be used to
determine the Fixed Annuity monthly payment in
accordance with the Annuity option selected.
Variable Annuity The portion of the Contract Value You elect to
have paid to you as a Variable Annuity is first
reduced by any withdrawal charge, charges for
other benefits, and Records Maintenance Charge.
The value that remains is used to determine the
first monthly Annuity payment. The first monthly
Annuity payment is based on the guaranteed
Annuity option shown in the Annuity Option Table.
The dollar amount of subsequent payments may
increase or decrease depending on the investment
experience of each Subaccount to which Contract
Value is allocated. You may not have more than
three Subaccounts at one time. The number of
Annuity Units per payment will remain fixed for
each Subaccount unless a transfer is made. If a
transfer is made, the number of Annuity Units per
payment will change. Some Annuity options provide
for a reduction in the income level upon the
death of an Annuitant, which will reduce the
number of Annuity units.
The number of Annuity Units for each Subaccount
is calculated by dividing a. by b. where:
a. is the amount of the monthly payment that can
be attributed to that Xxxxxxxxxx; and
b. is the Annuity Unit value for that Subaccount
at the end of the Valuation Period.
The Valuation Period includes the date on which
the payment is made.
Monthly Annuity payments, after the first
payment, are calculated by summing up, for each
Subaccount, the product of a. multiplied by b.
where:
a. is the number of Annuity Units per payment in
each Subaccount; and
b. is the Annuity Unit value for that Subaccount
at the end of the Valuation Period.
Annuity Unit Value The Valuation Period includes the date on which
the payment is made. The value of an Annuity Unit
for each Subaccount at the end of any Valuation
Period is determined by multiplying the result of
a. times b., with the result multiplied by c.,
where:
a. is the Annuity Unit value for the immediately
preceding Valuation Period; and
b. is the net investment experience factor for
the Valuation Period for which the Annuity
Unit value is being calculated; and
c. is the interest factor of .99993235 per
calendar day of such subsequent Valuation
Period to offset the effect of the assumed
rate of 2.50% per year used in the Annuity
Option Table. A different interest rate
factor will be used if an assumed rate other
than 2.50% is used in the Annuity Option
Table.
Basis of Annuity Options The guaranteed monthly payments are based on an
interest rate of 2.50% per year and, where
mortality is involved, the "Annuity 2000 Table"
developed by the Society of Actuaries projected
using Scale G to the year 2015. We may also make
available Variable Annuity payment options based
on assumed investment rates other than 2.50%, but
not greater than 5.00%.
Withdrawal Charge Upon annuitization, a withdrawal charge will be
Upon Annuitization applied as shown in the Contract Schedule. The
withdrawal charge is waived when the Owner elects
an Annuity option which provides either an income
benefit period of ten years or more or a benefit
under which payment is contingent on the life of
the Annuitant(s).
ANNUITY PERIOD PROVISIONS (Continued)
Transfers Between Subaccounts During the Annuity Period, You may make transfers
between Subaccounts subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. Transfers between Subaccounts are prohibited
during the first year of the Annuity Period;
subsequent transfers are limited to one per
year.
3. You may not have more than three Subaccounts
at any time.
4. At least $5,000 of Annuity Unit value must be
transferred from a Subaccount, unless the
transfer will eliminate Your interest in the
Subaccount.
5. At least $5,000 of Annuity Unit value must
remain in the Subaccount after a transfer,
unless the transfer will eliminate Your
interest in the Subaccount.
6. If We receive notice of a transfer between
Subaccounts more than seven (7) days before
an Annuity payment date, the transfer is
effective during the Valuation Period after
the date We receive the notice.
7. If We receive notice of a transfer between
Subaccounts less than seven (7) days before
an Annuity Payment date, the transfer is
effective during the Valuation Period after
the Annuity Payment date.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these transfer privileges.
When a transfer is made between Subaccounts, the
number of Annuity Units per payment attributable
to a Subaccount to which the transfer is made is
equal to a. multiplied by b. divided by c.,
where:
a. is the number of Annuity Units per payment in
the Subaccount from which the transfer is
being made;
b. is the Annuity Unit value for the Subaccount
from which the transfer is being made; and
c. is the Annuity Unit value for the Subaccount
to which the transfer is being made.
Conversion from a Fixed During the Annuity Period, You may convert Fixed
Annuity Payment Annuity payments to Variable Annuity payments
subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of annuity reserve value
must be transferred from Our General Account,
unless the transfer will eliminate the
annuity reserve value.
3. At least $30,000 of annuity reserve value
must remain in Our General Account after a
transfer, unless the transfer will eliminate
the annuity reserve value.
4. Conversions from a Fixed Annuity payment are
available only on an anniversary of the
Annuity Date.
5. We must receive notice at least thirty (30)
days prior to the anniversary.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these conversion privileges.
When a conversion is made from a Fixed Annuity
payment to a Variable Annuity payment, the number
of Annuity Units per payment attributable to a
Subaccount to which the conversion is made is
equal to a. divided by b. divided by c., where:
S-3257 Page 13
Page 14
ANNUITY PERIOD PROVISIONS (Continued)
a. is the annuity reserve being transferred
from Our General Account;
b. is the Annuity Unit value for the Subaccount
to which the transfer is being made; and
c. is the present value of $1.00 per payment
period using the attained Age(s) of the
Annuitant(s) and any remaining payment that
may be due at the time of the transfer.
The Annuity reserve value equals the present
value of the remaining Fixed Annuity payments
using the same interest and mortality basis used
to calculate the Fixed Annuity payments.
Money converted to a Variable Annuity payment
will be applied under the same Annuity option as
originally selected.
Conversion to a During the Annuity Period, You may convert
Fixed Annuity Payment Variable Annuity payments to Fixed Annuity
payments subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of Annuity Unit value must
be transferred to Our General Account from
the Subaccounts.
3. At least $5,000 of Annuity Unit value must
remain in a Subaccount after a transfer,
unless the transfer will eliminate Your
interest in the Subaccount.
4. Conversions to a Fixed Annuity payment are
available only on an anniversary of the
Annuity Date.
5. We must receive notice at least thirty
(30) days prior to the anniversary.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these conversion privileges.
When a conversion is made from a Variable Annuity
payment to a Fixed Annuity payment, the number of
Annuity Units per payment attributable to a
Subaccount from which the conversion is made is
the product of a. multiplied by b. multiplied by
x., where:
a. is the number of Annuity Units representing
Your interest in such Subaccount per Annuity
payment;
b. is the Annuity Unit value for such
Subaccount; and
c. is the present value of $1.00 per payment
period using the attained Age(s) of the
Annuitant(s) and any remaining payment that
may be due at the time of the transfer.
Money converted to a Fixed Annuity payment will
be applied under the same Annuity option as
originally selected.
Payment of Death If an Annuitant dies after the Annuity Date, the
Benefits During the death benefit, if any, will depend on the
Annuity Period Annuity option in effect.
If an Owner, who is not also an Annuitant, dies
after the Annuity Date, the following provisions
apply:
1. If the Owner was the sole Owner, the
remaining Annuity payments will be payable
to the beneficiary in accordance with the
Annuity option in effect. The beneficiary
will become the Owner.
2. If the contract has joint Owners, the
Annuity payments will be payable to the
surviving joint Owner in accordance with the
terms of the Annuity option in effect. Upon
the death of the surviving joint Owner, the
beneficiary becomes the Owner.
ANNUITY PERIOD PROVISIONS (Continued)
Disbursement Upon Death When the Annuitant or surviving joint Annuitant
of Annuitant: Under Options dies, We will automatically continue any unpaid
1, 3 or 5 installments for the remainder of the certain
period under Option 1, Option 3 or Option 5 to
the Owner. However, if You elect within 60 days
of Our receipt of due proof of death, We will pay
a commuted value of the remaining payments of the
certain period. In determining the commuted
value, the present value of the remaining
payments in the certain period will be calculated
based on the applicable interest rate.
For a Fixed Annuity option the applicable
interest rate is the greater of:
(a) the ten year treasury constant maturity plus
3%, and
(b) the rate used to determine the initial
payment plus 2%.
For a Variable Annuity option the applicable
interest rate is the assumed investment rate
plus 2%.
The amount of each payment for purposes of
determining the present value of any variable
installments will be determined by applying the
Annuity Unit value next determined following Our
receipt of due proof of death.
Supplementary Agreement A supplementary agreement will be issued to
reflect payments that will be made under an
Annuity option.
Date of First Payment Interest, under an Annuity option, will start to
accrue on the effective date of the supplementary
agreement. The supplementary agreement will
provide details on the payments to be made.
Evidence of Age, Sex and We may require satisfactory evidence of the Age,
Survival sex and the continued survival of any person on
whose life the income is based.
Misstatement of Age or Sex If the Age or sex of the Annuitant has been
misstated, the amount payable under the contract
will be such as the Purchase Payments sent to Us
would have purchased at the correct Age or sex.
Interest not to exceed 6% compounded each year
will be charged to any overpayment or credited to
any underpayment against future payments We may
make under this contract.
Page 15
S-3257 Page 16
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
Option One - Certain Period Annuity
Number
of years Monthly
selected Payment
10 9.39
Options Two and Three - Life Annuity and Life Annuity With Installments
Guaranteed
Age of Monthly Payments Guaranteed Age of Monthly Payments Guaranteed
Male Female
Annuitant None 120 Annuitant None 120
55 4.00 3.96 55 3.71 3.70
56 4.08 4.04 56 3.78 3.76
57 4.17 4.12 57 3.86 3.83
58 4.26 4.21 58 3.93 3.91
59 4.36 4.30 59 4.02 3.99
60 4.46 4.40 60 4.10 4.07
61 4.57 4.50 61 4.20 4.16
62 4.69 4.60 62 4.29 4.25
63 4.81 4.71 63 4.40 4.35
64 4.95 4.83 64 4.51 4.45
65 5.09 4.95 65 4.63 4.56
66 5.24 5.08 66 4.75 4.68
67 5.41 5.22 67 4.89 4.80
68 5.58 5.36 68 5.03 4.93
69 5.76 5.50 69 5.19 5.06
70 5.96 5.65 70 5.36 5.21
71 6.17 5.81 71 5.54 5.36
72 6.39 5.97 72 5.73 5.52
73 6.62 6.13 73 5.94 5.69
74 6.88 6.30 74 6.17 5.86
75 7.14 6.47 75 6.41 6.04
76 7.43 6.65 76 6.68 6.23
77 7.73 6.83 77 6.96 6.42
78 8.06 7.01 78 7.26 6.62
79 8.41 7.18 79 7.59 6.82
80 8.79 7.36 80 7.95 7.02
81 9.19 7.54 81 8.34 7.23
82 9.62 7.71 82 8.76 7.43
83 10.08 7.88 83 9.21 7.62
84 10.57 8.04 84 9.71 7.81
85 11.10 8.20 85 10.24 8.00
Option Four - Joint and 100% Survivor Annuity
Age of Age of Female Annuitant
Male
Annuitant 55 60 65 70 75 80 85
55 3.38 3.53 3.67 3.77 3.86 3.91 3.95
60 3.48 3.68 3.88 4.06 4.20 4.30 4.37
65 3.56 3.81 4.08 4.35 4.59 4.77 4.91
70 3.62 3.92 4.26 4.63 4.99 5.32 5.57
75 3.65 3.99 4.39 4.87 5.39 5.90 6.34
80 3.68 4.03 4.49 5.05 5.73 6.46 7.18
85 3.69 4.06 4.55 5.18 5.99 6.96 8.01
Option Five - Joint and Survivor Annuity with Installments Guaranteed for 10
years
Age of Age of Female Annuitant
Male
Annuitant 55 60 65 70 75 80 85
55 3.38 3.53 3.66 3.77 3.85 3.91 3.94
60 3.48 3.68 3.88 4.05 4.19 4.29 4.35
65 3.56 3.81 4.08 4.34 4.57 4.74 4.86
70 3.61 3.91 4.25 4.61 4.96 5.26 5.46
75 3.65 3.98 4.38 4.84 5.33 5.78 6.13
80 3.67 4.03 4.47 5.01 5.63 6.26 6.78
85 3.69 4.05 4.52 5.12 5.84 6.63 7.34
Rates for ages not shown here will be provided upon request.
FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
THE INITIAL INTEREST RATE IS GUARANTEED FOR ONLY A LIMITED PERIOD OF TIME.
WITHDRAWALS MAY BE SUBJECT TO A WITHDRAWAL CHARGE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT AND MAY INCREASE OR DECREASE. REFER TO THE VARIABLE ACCOUNT AND
ANNUITY PERIOD PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This a legal contract between the Owner and Federal Xxxxxx Life Assurance
Company
READ YOUR CONTRACT CAREFULLY.
Federal Xxxxxx Life Assurance Company
0000 XxXxxxxx Xxxxxxx, Xxxxxxxxxx, Xxxxxxxx 00000-0000
