Exhibit 4
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Financial Group XX-0123456
Lincoln Life & Annuity Company of New York
Home Office Location. ▇▇▇ ▇▇▇▇▇▇▇ ▇▇, ▇▇▇▇▇ ▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇
ANNUITY CONTRACT
Flexible Premium Deferred Variable Annuity or Variable and Fixed Annuity
Benefit Payment Options
Nonparticipating
The Lincoln Life & Annuity Company of New York (LL&A) agrees to provide the
benefits and other rights described in this Contract in accordance with the
terms of this Contract.
NOTICE OF 10-DAY RIGHT TO EXAMINE CONTRACT. Within 10 days after this Contract
is first received, it may be cancelled for any reason without penalty (e.g., no
contingent deferred sales charge will be deducted) by delivering or mailing it
to the representative through whom it was purchased, or to the Servicing Office
of LL&A at ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇.▇. Box 2348, Fort ▇▇▇▇▇, Indiana 46801-
2348. When the Contract is received at the Servicing Office, LL&A will return
the value of the Variable Account and/or the value of the Fixed Account of the
Contract as of the date of cancellation where permitted by law. If this Contract
is issued as an IRA, then the entire amount of Purchase Payments made shall be
returned.
All payments and values provided by this Contract, when based on investment
experience of a separate account, are variable (the amount may increase or
decrease) and are not guaranteed as to fixed dollar amount. See pages 5 and 10.
With a Sub-account charge of 1.25%, the smallest rate of investment return
required to ensure that the dollar amount of variable annuity payments does not
decrease is 5.25% for variable annuity options based on an assumed rate of
return of 4% per year.
Signed for Lincoln Life & Annuity Company of New York at its Servicing Office.
PRESIDENT ASSISTANT SECRETARY
Table of Contents
Article Page
I Definitions................................................... 4
2 Purchase Payments, Options and Benefits....................... 6
3 Annuity Payment Option Benefits............................... 13
4 Beneficiary................................................... 16
5 General Provisions............................................ 17
6 Annuity Purchase Rates Under a Variable Payment Option........ 19
7 Annuity Purchase Rates Under A Fixed Payment Option........... 20
8 Guaranteed Values for Fixed Allocations....................... 21
CONTRACT DATA
Contract Number XX-0123456
Annuitant ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇
Age at Issue 35
Contract Date April 1, 1989
Initial Purchase Payment $1,500.00
Purchase Payment Frequency Monthly
Maturity Date April 1, 2044
Owner
▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇
▇▇▇▇ ▇▇▇▇▇▇▇
▇▇▇▇ ▇▇▇▇▇▇▇
Beneficiary Designation
BENEFICIARY INFORMATION AVAILABLE ON THE NEXT PAGE
FIXED ACCOUNT
Current Interest Rate: [X%]
Minimum Guaranteed Interest Rate: 3%
VARIABLE ACCOUNT
There are currently [eleven] Sub-accounts in the Variable Account available to
the Owner. The Owner may direct Purchase Payments under the Contract to any of
the available Sub-accounts, subject to limitations. The amounts allocated to
each Sub-account will be invested at net asset value in the shares of one of the
Funds of the American Variable Insurance Series (Series). The Funds are:
1. [Growth Fund]
2. [International Fund]
3. [Global Growth Fund]
4. [Growth-income Fund]
5. [Asset Allocation Fund]
6. [High-Yield Bond Fund]
7. [Bond Fund]
8. [U.S. Government/AAA-Rated Securities Fund]
9. [Cash Management Fund]
10. (Global Small Cap Fund]
11. [New World Fund]
See Section 2.03 for provisions governing any limitations, substitution or
elimination of Funds.
Page 3
Sub-Account Charges (as also noted on front page of this Contract):
Mortality and Expense Risk and Administrative Charge: 1.40% on an annual basis,
or 1.25% on an annual basis in any period in which the Enhanced Guaranteed
Minimum Death Benefit is not in effect, of the daily value of the Sub-account
assets.
CONTINGENT DEFERRED SALES CHARGE
Number of complete CDSC as a percentage
Contract Years that of the surrendered
a Purchase Payment or withdrawn
has been invested Purchase Payments
Less than
2 Years 6%
At least
2 Years 5%
At least
3 Years 4%
At least
4 Years 3%
At least
5 Years 2%
At least
6 Years 1%
At least
7+ Years 0%
PREMIUM TAX
State and local government premium tax, if applicable, will be deducted from
Purchase Payments or Contract Value.
This will be deducted when incurred by LL&A or at another time of LL&A's
choosing.
Page 3.1
ARTICLE I
DEFINITIONS
1.01
ACCOUNT or VARIABLE ACCOUNT -- The segregated investment account into which
Lincoln Life & Annuity Company of New York sets aside and invests the variable
assets attributable to this Variable Annuity Contract.
1.02
ACCUMULATION UNIT -- A unit of measure used to calculate the variable Contract
Value during the accumulation period.
1.03
ANNUITANT -- The person upon whose life the annuity benefit payments made after
the Annuity Commencement Date will be based.
1.04
ANNUITY COMMENCEMENT DATE -- The Valuation Date when the funds are withdrawn for
payment of annuity benefits under the Annuity Payment Option selected.
1.05
ANNUITY PAYMENT OPTION -- An optional form of payment of the annuity provided
for under this Contract.
1.06
ANNUITY UNIT - A unit of measure used after the Annuity Commencement Date to
calculate the amount of variable annuity payments.
1.07
BENEFICIARY -- The person or entity designated by the Owner to receive the Death
Benefit, if any, payable upon the death of the Owner.
1.08
CODE - The Internal Revenue Code (IRC) of 1986, as amended.
1.09
CONTINGENT ANNUITANT -- The person named by the Owner that may become the
Annuitant in the event the Annuitant dies prior to the Annuity Commencement
Date.
1.10
CONTINGENT DEFERRED SALES CHARGE (CDSC) -- Charges assessed on premature
surrender of the Contract, calculated according to the Contract provisions.
1.11
CONTRACT -- The agreement, between LL&A and the Owner, providing a variable
annuity.
1.12
CONTRACT VALUE -- The sum of the values of all the Accumulation Units
attributable to this Contract at a given time and the value of monies in the
Fixed Account.
1.13
CONTRACT YEAR -- The period from the anniversary of the date on your Contract
Data Page 3 to the anniversary of the Contract in the following year.
1.14
DEATH BENEFIT -- The amount payable upon death of the Owner or Annuitant.
Page 5
1.15
EARNINGS -- The excess of the Contract Value over Purchase Payments which have
not yet been Withdrawn from this Contract.
1.16
FUND -- Underlying investment options available in the Series.
1.17
FIXED ACCOUNT -- The fixed portion of this Contract which is invested in the
general account of LL&A.
1.18
HOME OFFICE -- The principal office of LL&A located at ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇
▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇, ▇▇▇▇▇.
1.19
LL&A -- Lincoln Life & Annuity Company of New York.
1.20
MATURITY DATE -- The date specified on Page 3 of this Contract. The Maturity
Date may not be deferred past the Annuitant's age 90.
1.21
OWNER -- The individual or entity who exercises rights of ownership under this
contract.
1.22
PURCHASE PAYMENTS - Amounts paid into this Contract.
1.23
QUALIFIED PLAN -- A retirement plan qualified for special tax treatment under
the Internal Revenue Code of 1986, as amended, including Sections 401, 403 and
408. All other plans are considered Non-Qualified.
1.24
SERIES -- American Variable Insurance Series, the mutual fund into which
Purchase Payments allocated to the Variable Account are invested.
1.25
SERVICING OFFICE -- The Servicing Office of LL&A is located at ▇▇▇▇ ▇. ▇▇▇▇▇▇▇
▇▇▇▇▇▇, ▇. ▇. Box 2348, Fort ▇▇▇▇▇, Indiana 46801.
1.26
SUB-ACCOUNT -- That portion of the Variable Account which pertains to
investments in the Accumulation Units and Annuity Units of a particular Fund.
1.27
VALUATION DATE -- Close of the market of each day that the New York Stock
Exchange is open for business.
1.28
VALUATION PERIOD -- The period commencing at the close of business on a
particular Valuation Date and ending at the close of business on the next
succeeding Valuation Date.
1.29
VARIABLE ACCOUNT -- Lincoln Life & Annuity Variable Account H is a segregated
investment account Into which LL&A sets aside and invests the assets
attributable to this variable annuity contract.
Page 6
ARTICLE 2
PURCHASE PAYMENTS, OPTIONS, AND BENEFITS
2.01 WHERE PAYABLE
All Purchase Payments must be made to LL&A or to its designated agent(s).
2.02 AMOUNT AND FREQUENCY
Purchase Payments are made in an amount and at the frequency shown on page 3.
The Owner may change the frequency or amount of Purchase Payments subject to
LL&A's rules described below. No Purchase Payments after the Initial Purchase
Payment are required.
The minimum initial Purchase Payment is $1,500 for Non-Qualified Plans and
$1,000 for Qualified Plans. The minimum annual amount of subsequent Purchase
Payments is $300 for either Non-Qualified Plans or Qualified Plans. The minimum
payment to the Contract at any one time must be at least $25.00 if transmitted
electronically; otherwise the minimum amount is $100.00. LL&A reserves the right
to limit aggregate Purchase Payments to $2 million.
Purchase Payments may be made until the earliest of the Annuity Commencement
Date, the surrender of the Contract, Maturity Date or payment of any Death
Benefit.
2.03 VARIABLE ACCOUNT
Purchase Payments under the Contract may be allocated to the Lincoln Life &
Annuity Variable Annuity Account H (Variable Account) and/or to the Fixed
Account of the Contract. The Variable Account is for the exclusive benefit of
persons entitled to receive benefits under variable annuity contracts. The
Variable Account will not be charged with the liabilities arising from any other
part of LL&A's business. The Owner may direct Purchase Payments under the
Contract to any of the available Sub-accounts subject to the following
limitations. A minimum payment to any one Sub-account must be at least $20. If
the Owner elects to direct Purchase Payments to a new Sub-account not previously
selected, the election must be in writing to LL&A at its Servicing Office. The
amounts allocated to each Sub-account will be invested at net asset value in the
shares of one of the Funds of the American Variable Insurance Series (Series).
The Funds are shown on Page 3 of the Contract.
LL&A reserves the right to eliminate the shares of any Fund and substitute the
securities of a different Fund or investment company or mutual fund if the
shares of a Fund are no longer available for investment, or, if in the judgment
of LL&A, further investment in any Fund should become inappropriate in view of
the purposes of the Contract. LL&A may add a new Sub-account in order to invest
the assets of the Variable Account into a Fund. LL&A shall give the Owner
written notice of the elimination and substitution of any Fund within fifteen
days after such substitution occurs. None of these changes shall take effect
without the prior approval of the New York Superintendent of Insurance.
LL&A shall use each Purchase Payment allocated to the Variable Account by the
Owner to buy Accumulation Units in the Sub-account(s) selected by the Owner. The
number of Accumulation Units bought shall be determined by dividing the amount
directed to the Sub-account by the dollar value of an Accumulation Unit in such
Sub-account as of the point of the next valuation of such Sub-account
immediately following receipt of the Purchase Payment at the Servicing Office of
LL&A. The number of Accumulation Units held for the Variable Account of an Owner
shall not be changed by any change in the dollar value of Accumulation Units in
any Sub-account.
2.04 VALUATION OF ACCUMULATION UNITS
The variable Contract Value of an Owner's Contract at any time prior to the
Annuity Commencement Date equals the sum of the values of the Accumulation Units
credited in the Variable Account under the Contract.
The value of a Sub-account is the number of units in the Sub-account multiplied
by the value of an Accumulation Unit in the sub-account.
Accumulation Units for each Sub-account are valued separately. The Accumulation
Unit value for each Subaccount was or will be arbitrarily established at the
inception of the Sub-account. Thereafter, the value of an Accumulation Unit in
any Sub-account on any Valuation Date equals the value of an Accumulation Unit
in that
Page 7
Sub-account as of the immediately preceding Valuation Date, multiplied by the
"Net Investment Factor" of that Sub-account for the current Valuation Period.
The Net Investment Factor is an index which measures the investment performance
of a Sub-account from one Valuation Period to the next. The Net Investment
Factor for any Sub-account for any Valuation Period is equal to (1) divided by
(2) and subtracting (3) from the result, where:
1. is the result of.
a. the net asset value per share of the Fund held in the Sub-account,
determined at the end of the current Valuation Date; plus
b. the per share amount of any dividend or capital gain distribution made by
the Fund in the Sub-account, if the "ex-dividend" date occurs during the
Valuation Period; plus or minus
c. a per share charge or credit for any taxes reserved for;
2. is the net asset value per share of the Fund held in the Sub-account,
determined at the end of the prior Valuation Date;
3. is a daily factor representing the mortality and expense risk and
administrative charge deducted from the Sub-account adjusted for the number
of days in the Valuation Period. On an annual basis, this charge will not
exceed 1.40%. For any period in which the Enhanced Guaranteed Minimum Death
Benefit (see Section 2.12) is not in effect, this charge will not exceed
1.25% on an annual basis.
The Accumulation Unit value and Annuity Unit value may increase or decrease the
dollar value of benefits under the Contract. The dollar value of benefits will
not be adversely affected by expenses incurred by LL&A.
2.05 FIXED ALLOCATIONS
Purchase Payments under the Contract may be allocated to the Variable Account
and/or to the Fixed Account of the Contract. A minimum allocation to the Fixed
Account must be at least $20.
2.06 CREDITING OF INTEREST ON FIXED ALLOCATIONS
Interest shall be credited daily on all Purchase Payments that are allocated to
the Fixed Account of this Contract.
Prior to: the Maturity Date; the Annuity Commencement Date; payment of any Death
Benefit; or surrender of this Contract; whichever occurs first, LL&A guarantees
that it will credit interest on fixed allocations at an effective annual rate
not less than 3.0% during all years. A table of guaranteed values for the fixed
allocations may be found in Article 8.
LL&A may credit interest at rates in excess of the guaranteed rates at any time.
2.07 AUTOMATIC NONFORFEITURE OPTION
In the event that Purchase Payments are stopped, this Contract will continue as
a paid-up Contract until the earlier of: the Maturity Date, surrender of the
Contract, payment of any Death Benefit, or the Annuity Commencement Date.
Purchase Payments may be resumed at any time prior to: the Maturity Date,
surrender of the Contract, payment of any Death Benefit, or the Annuity
Commencement Date. LL&A reserves the right to surrender this Contract for its
Contract Value in the event that Purchase Payments have stopped for a period of
three full years, and the Contract Value is less than $2,000. By payment of the
Contract Value, LL&A shall be relieved of any further obligation under this
Contract.
2.08 TRANSFERS
Prior to the earlier of- the Maturity Date, surrender of the Contract,
termination of Contract upon payment of any Death Benefit, or the Annuity
Commencement Date, the Owner may direct a transfer of assets from one Sub-
account to another Sub-account or to the Fixed Account of the Contract. The
Owner may also direct a transfer of assets from the Fixed Account of the
Contract to one or more Sub-accounts of the Variable Account, subject to the
limitations described below. Such a transfer request must be in writing to LL&A
at its Servicing Office. Amounts transferred to the Sub-account(s) will purchase
Accumulation Units as described in Section 2.03.
Page 8
A transfer will result in the purchase of Accumulation Units in one Sub-account
and the redemption of Accumulation Units in the other Sub-account. Such a
transfer will be accomplished at relative Accumulation Unit values of the
Valuation Date the transfer request is received. The valuation of Accumulation
Units is described in Section 2.04.
LL&A reserves the right to impose a charge in the future for transfers between
Sub-accounts. This charge will not exceed $25 per transfer.
The minimum transfer amount is $300 or the entire amount in the Sub-
account/Fixed Account, whichever is less. If, after the transfer, the amount
remaining under this Contract in the Sub-Account/Fixed Account from which the
transfer is taken is less than $300, the entire amount held in that Sub-
account/Fixed Account will be transferred with the transfer amount.
For transfers between Sub-accounts and from the Sub-account(s) to the Fixed
Account of the Contract, there are no restrictions on the maximum amount which
may be transferred. For transfers from the Fixed Account of the Contract to the
Variable Account, the sum of the percentages of fixed value transferred will be
limited to 25% in any 12 month period.
2.09 WITHDRAWAL OPTION
The Owner may withdraw a part of the surrender value of this Contract, subject
to the Contingent Deferred Sales Charge (CDSC) outlined under Surrender Option
(see Section 2.10). However, the Owner may withdraw up to the Free Amount during
a Contract Year, in up to four withdrawals, without incurring a CDSC. The Free
Amount is equal to the greater of:
a. 10% of the Contract Value, where the percentages are based upon the Contract
Value at the time of the current withdrawal, to the extent that the sum of
the percentages of the Contract Value withdrawn does not exceed the 10%
maximum; or
b. 10% of the total Purchase Payments, where the percentages are based upon the
total Purchase Payments to the Contract at the time of the current
withdrawal, to the extent that the sum of the percentages of the Purchase
Payments withdrawn does not exceed the 10% maximum.
This 10% withdrawal exemption from the CDSC does not apply to a surrender of
this Contract.
For purposes of calculating the CDSC on withdrawals, LL&A assumes that:
a. The Free Amount will be withdrawn from Purchase Payments on a "first in-first
out (FIFO)" basis.
b. Prior to the seventh anniversary of the Contract Date, any amount withdrawn
above the Free Amount during a Contract Year will be withdrawn in the
following order:
1. from Purchase Payments (on a FIFO basis) until exhausted; then
2. from Earnings.
c. On or after the seventh anniversary of the Contract Date, any amount
withdrawn above the Free Amount during a Contract Year will be withdrawn in
the following order:
1. from Purchase Payments (on a FIFO basis) to which a CDSC no longer applies
until exhausted; then
2. from Earnings until exhausted; then
3. from Purchase Payments (on a FIFO basis) to which a CDSC still applies.
A withdrawal will be effective on the Valuation Date on which LL&A receives a
written request for withdrawal at its Home Office.
The remaining value will be subject to the charges as provided under Surrender
Option (see Section 2.10). The request should specify from which Sub-account the
withdrawal will be made. If no Sub-account is specified, LL&A will withdraw, on
a pro-rata basis from each Sub-account, the amount requested.
Any cash payment will be mailed from LL&A's Servicing Office within seven days
after the date of withdrawal; however, LL&A may be permitted to defer such
payment under the Investment Company Act of 1940, as in effect at the time such
request for withdrawal is received in the Servicing Office. The previous
sentence will only apply to any payments from the Variable Account of the Owner.
Any payments made from the Fixed Account of the Owner can be deferred for a
period not to exceed six months after a request is received.
For purposes of this Section, the Fixed Account of the Contract is considered a
Sub-account.
Page 9
The Withdrawal Option is not available after the Annuity Commencement Date.
A partial withdrawal will result in a decrease in the Annuity Account Value by
an amount with an aggregate dollar value equal to the dollar amount of the cash
withdrawal payment, plus or minus any applicable with-drawal charge and premium
taxes. This will also result in a pro rata reduction in any Death Benefit
payable under this Contract.
The minimum withdrawal is $300. LL&A reserves the right to surrender this
Contract for its Contract Value if any withdrawal reduces the Contract Value to
less than $2,000, and Purchase Payments have stopped for a period of three full
years. By payment of the Contract Value, LL&A shall be relieved of any further
obligation under this Contract.
2.10 SURRENDER OPTION
The Owner may surrender this Contract for its surrender value. On surrender,
this Contract terminates. Surrender will be effective on the Valuation Date on
which LL&A receives a written request at its Servicing Office. The surrender
value will be the total Contract Value on the Valuation Date, less a Contingent
Deferred Sales Charge.
Any cash payment will be mailed from LL&A's Servicing Office within seven days
after the date of withdrawal; however, LL&A may be permitted to defer such
payment under the Investment Company Act of 1940, as in effect at the time such
request for withdrawal is received in its Servicing Office. The previous
sentence will only apply to any payments from the Variable Account of the Owner.
Any payments made from the Fixed Account of the Owner can be deferred for a
period not to exceed six months after a request is received.
The Surrender Option is not available after the Annuity Commencement Date.
2.11 CONTINGENT DEFERRED SALES CHARGE
The Contingent Deferred Sales Charge (CDSC) is calculated separately for each
Contract Year's Purchase Payments to which a charge applies. Charges are applied
as follows:
Number of complete CDSC as a percentage
Contract Years that of the surrendered
Purchase Payment or withdrawn
has been invested Purchase Payments
Less than
2 Years 6%
At least
2 Years 5%
At least
3 Years 4%
At least
4 Years 3%
At least
5 Years 2%
At least
6 Years 1%
At least
7 + Years 0%
A CDSC will be waived under certain circumstances (see Section 2.13 for
details).
2.12 DEATH BENEFITS
Before the Annuity Commencement Date
Entitlement
If there is a single Owner, upon the death of the Owner LL&A will pay a Death
Benefit to the designated Beneficiary(s) in accordance with the terms of Article
4. If the designated Beneficiary of the Death Benefit is the surviving spouse of
the deceased Owner, the spouse may elect to continue the contract as the new
Owner. If there are no designated beneficiaries, LL&A will pay a Death Benefit
to the Owner's estate. Upon the death of the spouse who continues the Contract
as the new Owner, LL&A will pay a Death Benefit to the designated Beneficiary(s)
named by the spouse as the new Owner in accordance with Article 4.
If there are Joint Owners, upon the death of the first Joint Owner, LL&A will
pay a Death Benefit to the surviving Joint Owner. If the surviving Joint Owner
is the spouse of the deceased Joint Owner, then the spouse may elect to continue
the Contract as sole Owner. Upon the death of the Joint Owner who continues the
Contract, LL&A will pay a Death Benefit to the designated Beneficiary(s) in
accordance with Article 4.
If the Annuitant is also the Owner or a Joint Owner, then the Death Benefit paid
on the death of the Annuitant will be subject to the Contract provisions
regarding death of Owner. If the surviving spouse of the Owner/▇▇▇▇▇▇▇▇▇ assumes
the contract, the Contingent Annuitant becomes the Annuitant. If no Contingent
Annuitant is named, the surviving spouse becomes the Annuitant.
If an Annuitant who is not the Owner or a Joint Owner dies, then the Contingent
Annuitant, if named, becomes the Annuitant and no Death Benefit is payable on
the death of the Annuitant. If no Contingent Annuitant is named, the Owner (or
younger of Joint Owners) becomes the Annuitant. In lieu of continuing the
Contract, a Death Benefit may be paid to the Owner and Joint Owner (in equal
shares if applicable) if the Annuitant named on this Contract has not been
changed, except on death of a prior ▇▇▇▇▇▇▇▇▇, and notification of the election
of the Death Benefit is received by LL&A with 75 days of the death of the
Annuitant. If no Owner is living on the date of death of the Annuitant, the
Death Benefit will be paid to the Beneficiary in accordance with Article 4. This
Contract will terminate when any Death Benefit is paid due to the death of the
Annuitant. A Death Benefit payable on the death of the Annuitant will not be
paid if the Annuitant has been changed subsequent to the effective date of this
Contract unless the change occurred because of the death of a prior Annuitant.
If the Owner is a corporation or other non-individual (non-natural person), the
death of the Annuitant will be treated as the death of the Owner.
The Death Benefit will be paid if LL&A is in receipt of: (1) proof, satisfactory
to LL&A, of the death; (2) written authorization for payment; and (3) all claim
forms, fully completed.
Due proof of death may be a certified copy of a death certificate, a certified
copy of a decree of a court of competent jurisdiction as to the findings of
death, or any other proof of death acceptable to LL&A.
All Death Benefit payments will be subject to the laws and regulations governing
death benefits.
Notwithstanding any provision of this Contract to the contrary, the payment of
Death Benefits provided under this Contract must be made in compliance with Code
Section 72(s) or 401 (a)(9) as applicable, as amended from time to time.
Determination of Amounts
This Contract provides a Death Benefit called the Enhanced Guaranteed Minimum
Death Benefit (EGMDB), if in effect. If the EGMDB was not available at issue or
was terminated, then the Death Benefit is equal to the Guarantee of Principal.
The EGMDB is equal to the greater of:
a. the current Contract Value as of the date on which the death claim is
approved by LL&A for payment; or
b. the highest Contract Value at the time of Fund valuation on any policy
anniversary date (including the inception date) prior to the 81st birthday
of the deceased and prior to the death of the deceased.
The highest Contract Value is increased by Purchase Payments subsequent to such
anniversary date on which the highest Contract Value is obtained. The highest
Contract Value is decreased by partial withdrawals, partial annuitizations, and
premium tax made, effected or incurred subsequent to such anniversary date on
which the highest Contract Value is obtained.
Upon the death of an Owner or Joint Owner of this Contract, if a surviving
spouse continues the Contract, the EGMDB payable on the death of the deceased
spouse is equal to the excess of "b." over "a." (if "a." is greater than "b.",
then no Death Benefit is payable on the first death). This EGMDB will be
credited into the Contract and will only apply one time for each Contract. This
Contract option is not available upon the death of the Annuitant.
The Guarantee of Principal is equal to the greater of:
a. the current Contract Value as of the date on which the death claim is
approved by LL&A for payment; or
Page 10
b. the sum of all Purchase Payments decreased by partial withdrawals, partial
annuitizations, and premium tax made, effected or incurred subsequent to the
inception date.
Upon the death of an Owner or Joint Owner of this Contract, if the surviving
spouse continues the Contract and if the EGMDB is not in effect, the Guarantee
of Principal payable on the death of the deceased spouse is equal to the excess
of "b." over "a." (if "a." is greater than "b.", then no Death Benefit is
payable on the first death). This Guarantee of Principal is credited into the
Contract and will only apply one time for each Contract. This Contract option is
not available upon the death of the Annuitant.
The EGMDB will not be in effect if this Contract is issued to an Owner, Joint
Owner if applicable, and Annuitant with attained ages of 80 or greater at issue.
Under these circumstances, there will be no EGMDB provided and the Death Benefit
is equal to the Guarantee of Principal.
The EGMDB will only be in effect, unless terminated by the Owner, for Non-
Qualified Contracts and Contracts sold as Individual Retirement Annuities (IRA)
under Code Section 408(b) and ▇▇▇▇ Individual Retirement Annuities under Code
Section 408A. For all other Contracts the EGMDB will not be in effect and the
Death Benefit is equal to the Guarantee of Principal.
If the Contract is continued by the surviving spouse, the EGMDB will continue,
if it was in effect at the time of death of the original Owner, unless
subsequently terminated by the surviving spouse. A surviving spouse who
continues the Contract cannot add the EGMDB to the Contract.
At any time prior to the Annuity Commencement Date, an Owner may choose to
terminate the EGMDB by giving written notice to LL&A, and will then have no
EGMDB. The EGMDB will terminate on the next Valuation Date following receipt of
the written notice in the LL&A Servicing Office and the Death Benefit will then
be the Guarantee of Principal. After the termination of the EGMDB by the Owner,
the EGMDB may not be re-selected.
Payment of Amounts
The Death Benefit payable on the death of the Owner, or after the death of the
first Joint Owner, or upon the death of the spouse who continues the Contract,
will be distributed to the designated Beneficiary(s) as follows:
a. the Death Benefit must be completely distributed within five years of the
Owner's date of death; or
b. the designated Beneficiary may elect, within the one year period after the
Owner's date of death, to receive the Death Benefit in substantially equal
installments over the life of such designated Beneficiary or over a period
not extending beyond the life expectancy of such designated Beneficiary;
provided that such distributions begin not later than one year after the
Owner's date of death.
The Death Benefit payable on the death of the Annuitant will be distributed to
the Owner and Joint Owner if applicable in either the form of a lump sum or an
Annuity Payment Option. An Annuity Payment Option must be selected within 60
days after LL&A approves the death claim as discussed previously.
If a lump sum settlement is elected, the proceeds will be mailed within seven
days of approval by LL&A of the claim. This payment may be postponed as
permitted by the Investment Company Act of 1940.
On or after the Annuity Commencement Date
If the Owner dies on or after the Annuity Commencement Date, any remaining
benefits payable will continue to be distributed under the Annuity Payment
Option then in effect. All of the Owner's rights granted by the Contract will
pass to the Joint Owner, if any; otherwise to the Beneficiary.
If there is no named Beneficiary at the time of the Owner's death, then the
Owner's rights will pass to the Annuitant, if still living; otherwise to the
Joint Annuitant, if applicable. If no named Beneficiary, Annuitant, or Joint
Annuitant survives the Owner, any remaining annuity benefit payments will
continue to the Owner's estate.
On receipt of due proof of death, as described above, of the Annuitant or both
Joint Annuitants, any remaining annuity benefit payments under the Annuity
Payment Option will be paid to the Owner if living at the time of death of the
Annuitant(s); otherwise, to the Beneficiary. If there is no Beneficiary, any
remaining benefit payments will continue to the Annuitant's estate.
Page 11
2.13 WAIVER OF CONTINGENT DEFERRED SALES CHARGES
A surrender of this Contract or withdrawal of Contract Value prior to the
Annuity Commencement Date may be subject to a Contingent Deferred Sales Charge
as described in Sections 2.09 and 2.10, except that such charges do not apply
to: (1) the Free Amount as (defined in Section 2.09); (2) a surrender of the
Contract as a result of "permanent and total disability" of the Owner that
prevents the Owner from engaging in any occupation for remuneration or profit
and which has existed continuously for a period of 12 months and begins prior to
the 65th birthday of the Owner provided that written proof of total disability
is sent to LL&A at its Servicing Office; (3) a surrender of the Contract as a
result of the payment of a Death Benefit on the death of the Owner or a Joint
Owner or the Annuitant; (4) annuitization.
The Contingent Deferred Sales Charge will only be waived if LL&A is in receipt
of proof, satisfactory to LL&A, of the exception.
If a non-natural person is the Owner of the Contract, the Annuitant will be
considered the Owner of the Contract for purposes of this Section 2.13.
2.14 STATE STATUTES
Any benefits paid under this Contract for surrender, withdrawal, or death will
not be less than the minimum benefits required by any statute of the state in
which this Contract is delivered.
2.15 DOLLAR COST AVERAGING PROGRAM
During the lifetime of the Annuitant, the Owner may elect a dollar cost
averaging program by selecting it on the application or by filing a written
request in a form acceptable to LL&A at its Servicing Office. Dollar cost
averaging is the transferring of a designated amount from one of the holding
accounts (Cash Management, U.S. Government/AAA-Rated Securities, or the DCA
Fixed Account) to another Sub-account(s) within the Contract on a monthly basis.
If a dollar cost averaging program is elected, the following provisions apply:
. Only one dollar cost averaging program may exist at any time.
. An Owner currently participating in the cross reinvestment program (See
Section 2.17) may not participate in the dollar cost averaging program.
. The minimum balance in the holding account to establish a dollar cost
averaging program is $10,000.
. Any time frame between 6 to 60 months may be selected for the dollar cost
averaging program.
. The Sub-account selected as the holding account may not be a receiving Sub-
account. Once selected, the holding account cannot be changed unless a new
program is started.
. Statements will be sent to the Owner confirming each dollar cost averaging
transfer.
. A new program does not need to be started if the Owner is changing the
receiving Sub-account(s), or the amounts or percentages to be transferred to
the receiving Sub-account(s), as long as new money is not being added to the
program.
. If additional money is added to the Contract to be dollar cost averaged or
changing the time frame, a new program must be started. Purchase Payments to
the holding account will not automatically be added to the dollar cost
averaging program. Instructions must accompany these additional Purchase
Payments.
. The dollar cost averaging program will be cancelled prematurely if the value
of the holding account drops below the amount required for the transfer.
. The dollar cost averaging program will continue for the specified duration,
or until the Owner terminates the program by sending LL&A, at its Servicing
Office, written notice of such termination.
. The Owner may establish or change a dollar cost averaging program by sending
written notice, in a form acceptable to LL&A, at its Servicing Office.
Page 12
2.16 CROSS REINVESTMENT PROGRAM
During the lifetime of the Annuitant, the Owner may elect a cross reinvestment
program by filing a written request, in a form acceptable to LL&A, at its
Servicing Office. A cross reinvestment program is the transferring, at a
designated frequency (monthly, quarterly, semi-annually or annually), of a Sub-
account value that exceeds a designated baseline amount selected by the Owner,
from the Fixed Account or any of the Variable Subaccounts ("originating Sub-
account") to other investment options within the Contract. If a cross
reinvestment program is elected, the following provisions apply:
. Only one cross reinvestment program may exist at any time.
. Cross reinvestment is not available to those currently participating in:
Dollar cost averaging. Automatic withdrawal service. Automatic bank draft
deposit. Automatic clearinghouse deposit.
. The minimum baseline amount in the originating Sub-account is $10,000.
. The minimum amount that can be transferred is $50.
. At the selected frequency, any Sub-account Value that exceeds the baseline
amount by $50 or more will automatically be transferred to one or more
specified Sub-accounts.
. Transfers will occur on the 20th of the month. If the stock market is closed
on that day, the transfer will occur on the next business day. In order to be
effective by the 20th, a request to establish, change or terminate a cross
reinvestment program must be received by LL&A at its Servicing Office by the
15th of the month.
. Statements will be sent to the Owner confirming each transaction.
. The cross reinvestment program will continue until the Owner authorizes LL&A
to terminate the program.
. The Owner may establish, change or terminate the cross reinvestment program
by sending written notice, in a form acceptable to LL&A, to its Servicing
Office.
. The baseline amount selected will be increased by any additional Purchase
Payments or transfers into the specified originating Sub-account.
ARTICLE 3
ANNUITY PAYMENT OPTION
BENEFITS
3.01 ANNUITY PAYMENTS
An election to receive payments under an Annuity Payment Option must be made by
the Maturity Date.
If an Annuity Payment Option is not chosen prior to the Maturity Date, payments
will commence to the Owner on the Maturity Date under the Annuity Payment Option
providing a Life Annuity with annuity payments guaranteed for 10 years. If no
election is made, the value of the Owner's Variable Account shall be used to
provide a variable annuity payment, and the value of the Owner's Fixed Account
shall be used to provide a fixed annuity payment.
The Maturity Date is set forth on Page 3. Upon written request by the Owner and
any Beneficiary who cannot be changed, the Maturity Date may be deferred.
However, the Maturity Date may not be deferred past the Annuitant's age 90.
Purchase Payments may be made until the new Maturity Date.
Page 13
3.02 CHOICE OF ANNUITY PAYMENT OPTION
By Owner
Prior to the Annuity Commencement Date, the Owner may choose or change any
Annuity Payment Option. In addition, the Owner may select an Annuity Payment
Option as a method of paying the Death Benefit to a Beneficiary. For a 100%
fixed annuity payment, the Annuity Commencement Date must be at least thirty
days prior to the time annuity payments are to begin.
By Beneficiary
At the time proceeds are payable to a Beneficiary, a Beneficiary may choose or
change any Annuity Payment Option that meets the requirements of Code Section
72(s) or 401(a)(9) if proceeds are available to the Beneficiary in a lump sum.
The Beneficiary then becomes the Annuitant.
A choice or change must be in writing to LL&A at its Servicing Office.
After the Annuity Commencement Date, the Annuity Payment Option may not be
changed.
3.03 ANNUITY PAYMENT OPTIONS
a. Life Annuity / Life Annuity with Guaranteed Period -- Payments will be made
for the lifetime of the Annuitant with no certain period, or life and a 10
year certain period, or life and a 20 year certain period.
b. Unit Refund Life Annuity -- Payments will be made for the lifetime of the
Annuitant with the guarantee that upon death a payment will be made of the
value of the number of Annuity Units equal to the excess, if any, of (a) over
(b) where (a) is the total amount applied under the option divided by the
Annuity Unit Value at the Annuity Commencement Date and (b) is the product of
the number of Annuity Units represented by each payment and the number of
payments paid prior to death.
c. Joint Life Annuity / Joint Life Annuity with Guaranteed Period -- Payments
will be made during the joint life of the Annuitant and a Joint Annuitant of
the Owner's choice. Payments will be made for life with no certain period, or
life and a 10 year certain period, or life and a 20 year certain period.
Payments continue for the life of the survivor at the death of the Annuitant
or Joint Annuitant.
d. Other options may be available as agreed upon in writing by LL&A.
At the time an Annuity Payment Option is selected under the provisions of this
Contract, the Owner may elect to have the total Contract Value applied to
provide a variable annuity payment, a fixed annuity payment, or a combination
fixed and variable annuity payment. If no election is made, the value of the
Owner's Variable Account shall be used to provide a variable annuity payment,
and the value of the Owner's Fixed Account shall be used to provide a fixed
annuity payment. If any Annuity Payment Option with a period certain provides
for installment payments of the same amounts at some ages for different periods
certain, LL&A will deem an election to have been made for the longest period
certain which could have been elected for such age and amount.
At the time annuity payments commence, they will not be less than those that
would be provided by a specific amount for any single premium immediate annuity
contract offered by LL&A at the time to the same class of annuitants. The
specific amount is the greater of the surrender value or 95% of the accumulation
value.
The amount of annuity payment will depend on the age and sex (except in cases
where unisex rates are required) of the Annuitant as of the Annuity Commencement
Date. A choice may be made to receive payments once each month, four times each
year, twice each year, or once each year. The Contract Value and Annuity Unit
value used to effect benefit payments will be calculated as of the Annuity
Commencement Date.
Article 6 of this Contract illustrates the minimum payment amounts and the age
adjustments which will be used to determine the first monthly payment under a
variable annuity payment option. The tables show the dollar amount of the first
monthly payment which can be purchased with each $1,000 of Contract Value, after
deduction of any applicable premium taxes. Amounts shown in Article 6 use an
Individual Annuity Mortality Table on file with the New York Superintendent of
Insurance, with an assumed rate of return of 4% per year.
Page 14
Article 7 of this Contract illustrates the minimum payment amounts and the age
adjustments which will be used to determine the monthly payments under a fixed
annuity payment option. The tables show the dollar amount of the guaranteed
monthly payments which can be purchased with each $1,000 of Contract Value,
after deduction of any applicable premium taxes. Amounts shown in Article 7 use
an Individual Annuity Mortality Table on file with the New York Superintendent
of Insurance, with an interest rate of 2.75% per year.
The minimum payment amounts shown for Joint and Survivor Annuities under both
Article 6 and Article 7 are for Joint Ages; that is, for a male and a female
both of the same age. Minimum payment amounts for other age and sex combinations
on Joint and Survivor Annuities are available, but are not illustrated in
Article 6 and Article 7.
3.04 DETERMINATION OF THE AMOUNT OF VARIABLE ANNUITY PAYMENTS AFTER THE FIRST
PAYMENT
The first variable annuity payment is sub-divided into components each of which
represents the product of: (a) the percentage elected by the Contract Owner of a
specific Sub-account the performance of which will determine future variable
annuity payments, and (b) the entire first variable annuity payment. Each
variable annuity payment after the first payment attributable to a specific Sub-
account will be determined by multiplying the Annuity Unit value for that Sub-
account for the date each payment is due by a constant number of Annuity Units.
This constant number for each specific Sub-account is determined by dividing the
component of the first payment attributable to such Sub-account as described
above by the Annuity Unit value for that Sub-account on the Annuity Commencement
Date. The total variable annuity payment will be the sum of the payments
attributable to each Sub-account.
The Annuity Unit value for any Valuation Period for any Sub-account is
determined by multiplying the Annuity Unit value for the immediately preceding
Valuation Period by the product of (a) 0.9998926 raised to a power equal to the
number of days in the current Valuation Period and (b) the Net Investment Factor
of the Subaccount for the Valuation Period for which the Annuity Unit value is
being determined.
The valuation of all assets in the Sub-account shall be determined in accordance
with the provisions of applicable laws, rules, and regulations. The method of
determination by LL&A of the value of an Accumulation Unit and of an Annuity
Unit will be conclusive upon the Owner and any Beneficiary.
LL&A guarantees that the dollar amount of each installment after the first shall
not be affected by variations in mortality experience from mortality assumptions
on which the first installment is based nor by expenses actually incurred, other
than taxes on investment income.
After the Annuity Commencement Date, if any portion of the annuity payment is a
variable annuity payment, the Owner may direct a transfer of assets from one
Sub-account to another Sub-account or to a fixed annuity payment. Such transfers
will be limited to three (3) times per Contract Year. Assets may not be
transferred from a fixed annuity payment to a variable annuity payment.
A transfer from one Sub-account to another Sub-account will result in the
purchase of Annuity Units in one Sub-account and the redemption of Annuity Units
in the other Sub-account. Such a transfer will be accomplished at relative
Annuity Unit values as of the Valuation Date the transfer request is received.
The valuation of Annuity Units is described above. A transfer from one Sub-
account to a fixed annuity payment will result in the redemption of Annuity
Units in one Sub-account and the purchase of a minimum fixed annuity payment
based on the tables in Article 7.
3.05 PROOF OF AGE
Payment will be subject to proof of age that LL&A will accept such as a
certified copy of a birth certificate.
3.06 MINIMUM ANNUITY PAYMENT REQUIREMENTS
If the Annuity Payment Option chosen results in payments of less than $50 per
Sub-account, the frequency will be changed so that payments will be at least
$50.
For the purposes of this Section, the fixed annuity payment of the Contract is
considered a Sub-account.
Page 15
3.07 EVIDENCE OF SURVIVAL
LL&A has the right to ask for proof that the person on whose life the payment is
based is alive when each payment is due.
3.08 CHANGE IN ANNUITY PAYMENT OPTION
The Annuity Payment Option may not be changed after the Annuity Commencement
Date.
ARTICLE 4
BENEFICIARY
4.01 DESIGNATION
The Owner may designate a Beneficiary(s). If there is a single Owner, the
designated Beneficiary(s) will receive the Death Benefit proceeds upon the death
of the Owner.
If there are Joint Owners, upon the death of the first Joint Owner, the
surviving Joint Owner will receive the Death Benefit proceeds. The surviving
Joint Owner will be treated as the primary, designated Beneficiary. Any other
Beneficiary designation on record at the time of death will be treated as a
contingent Beneficiary.
If the surviving Joint Owner is the spouse of the deceased Joint Owner and
continues the Contract as the sole Owner, then the designated Beneficiary(s)
move up, in the order of their original designation, to replace the spouse as
original Beneficiary, unless the Beneficiary designation is subsequently changed
by the surviving spouse as the new Owner.
Unless otherwise stated in the Beneficiary designation, if there is more than
one Beneficiary they are presumed to share equally.
If the Annuitant dies and a Death Benefit is paid, the Owner (and Joint Owner if
applicable) will be treated as primary Beneficiary(s). Any other Beneficiary
designation on record at the time of death will be treated as a contingent
Beneficiary.
4.02 CHANGE
The Owner may change any Beneficiary unless otherwise provided in the previous
designation.
A change of Beneficiary will revoke any previous designation.
A change may be made by filing a written request, in a form acceptable to LL&A,
at its Servicing Office. The change will become effective as of the date it was
signed by the Owner upon receipt of the written request by LL&A at its Servicing
Office.
LL&A reserves the right to request the Contract for endorsement of the change.
4.03 DEATH OF BENEFICIARY
Unless otherwise provided in the Beneficiary designation, if any Beneficiary
dies before the Owner, that Beneficiary's interest will go to any other
Beneficiaries named, according to their respective interests. If there are no
Beneficiaries, the Beneficiary's interest will pass to a Contingent
Beneficiary(s), if any. Prior to the Annuity Commencement Date, if no
Beneficiary or Contingent Beneficiary survives the Owner, the Death Benefits
will be paid to the Owner's estate.
Once a Beneficiary is entitled to Death Benefits or other payments, the
Beneficiary may name his or her own Beneficiary(s) to receive any remaining
benefits due under the Contract, should the original Beneficiary die prior to
receipt of all benefits. If no Beneficiary is named or the named Beneficiary
predeceases the original Beneficiary, any remaining benefits will continue to
the original Beneficiary's estate. This designation must be made to the LL&A
Servicing Office.
Page 16
ARTICLE 5
GENERAL PROVISIONS
5.01 THE CONTRACT
The Contract, and any riders attached, together with the application therefor if
a copy of such application is attached to the Contract when issued, constitute
the entire Contract. Only the President, a Vice President, the Secretary or an
Assistant Secretary of LL&A has the power, on behalf of LUA, to change, modify,
or waive any provisions of this Contract.
LL&A reserves the right to unilaterally change the Contract for the purpose of
keeping the Contract in compliance with federal or state law, subject to the
prior approval of the Insurance Department where the Contract was delivered.
Any changes, modifications, or waivers must be in writing. No representative or
person other than the above named officers has authority to change or modify
this Contract or waive any of its provisions. All terms used in this Contract
will have their usual and customary meaning except when specifically defined.
5.02 OWNERSHIP
The Owner is the person who has the ability to exercise the rights within this
Contract.
The Owner may name a Joint Owner. Joint Owner(s) shall be treated as having
equal, undivided interests in the Contract, including rights of survivorship.
Either Joint Owner, independently of the other, may exercise any ownership
rights in the Contract.
Any transfer of Ownership, or a revocation of transfer, must be in writing to
LL&A at its Servicing Office. A transfer or a revocation will not take effect
until received in writing at LL&A's Servicing Office. When a transfer or
revocation has been received, it will take effect as of the effective date
specified by the Owner. Any payment made or any action taken or allowed by the
Company before the transfer or the revocation is recorded will be without
prejudice to the Company.
Prior to the Annuity Commencement Date, the Owner has the right to change the
Annuitant at any time by notifying LL&A in writing of the change. The Annuitant
may not be changed in a Contract owned by a nonnatural person. The Owner may
also name a Contingent Annuitant by notifying LL&A in writing. The Contingent
Annuitant designation is no longer applicable after the Annuity Commencement
Date.
5.03 ASSIGNMENTS
During the lifetime of the Annuitant, this Contract may be assigned. LL&A will
not be bound by any assignment unless it is received in writing at LL&A's
Servicing Office in a form acceptable to LL&A. The effective date of the
assignment will be the date it is received by LL&A. LL&A will not be responsible
for the validity of any assignment.
5.04 INCONTESTABILITY
This Contract will not be contested by LL&A.
5.05 MISSTATEMENT OF AGE AND/OR SEX
If the age and/or sex of the Annuitant has been misstated, the benefits
available under this Contract will be those which the Purchase Payments would
have purchased using the correct age and/or sex. Any underpayment already made
by LL&A shall be made up immediately and any overpayments already made by LL&A
shall be charged against the annuity payments failing due after the correction
is made. Any amounts so paid or charged will be adjusted based on an interest
rate of 6% per annum.
5.06 NONPARTICIPATING
The Contract is nonparticipating and will not share in the surplus earnings of
LL&A.
Page 17
5.07 VOTING RIGHTS
The Owner shall have a right to vote at the meetings of the Series. Ownership of
this Contract shall not entitle any person to vote at any meeting of
shareholders of LL&A. Votes attributable to the Contract shall be cast in
conformity with applicable law.
5.08 OWNERSHIP OF THE ASSETS
LL&A shall have exclusive and absolute ownership and control of its assets,
including all assets in the Variable Account.
5.09 REPORTS
Prior to the Annuity Commencement Date, at least once each Contract Year LL&A
shall mail a report to the Owner. The report shall be mailed to the last address
known to LL&A. The report shall include a statement of the number of
Accumulation Units credited to the Variable Account under this Contract and the
dollar value of such units as well as a statement of the value of the Fixed
Account of this Contract. 'The report will also include the total account value,
the cash surrender value and the Death Benefit. Any other information required
by law will also be included in the report. The information in the report shall
be as of a date not more than two months prior to the date of mailing the
report. LL&A shall also mail to the Owner at least once in each Contract Year a
report of the investments held in the Sub-accounts under this Contract.
5.10 PREMIUM TAX
State and local government premium tax, if applicable, will be deducted from
Purchase Payments or Contract Value. This will be deducted when incurred by LL&A
or at another time of LL&A's choosing.
5.11 MAXIMUM ISSUE AGE
The Owner, Joint Owner, and Annuitant must be under the age of 90 when this
Contract is issued.
Page 18
ARTICLE 6
ANNUITY PURCHASE RATES UNDER A VARIABLE PAYMENT OPTION
DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS
PURCHASED WITH EACH $1,000 APPLIED
--------------
SINGLE LIFE ANNUITIES
No Period Certain 120 Months Certain 240 Months Certain Cash Refund
Age Male Female Male Female Male Female Male Female
60 $5.29 $4.78 $5.18 $4.73 $4.83 $4.56 $4.88 $4.56
61 5.41 4.87 5.28 4.81 4.89 4.63 4.96 4.63
62 5.54 4.97 5.39 4.90 4.95 4.69 5.05 4.71
63 5.68 5.07 5.50 5.00 5.01 4.75 5.14 4.78
64 5.82 5.19 5.63 5.10 5.06 4.82 5.23 4.87
65 5.98 5.30 5.75 5.21 5.12 4.88 5.32 4.95
66 6.15 5.43 5.88 5.32 5.17 4.95 5.42 5.04
67 6.33 5.57 6.02 5.44 5.22 5.01 5.53 5.14
68 6.53 5.72 6.16 5.56 5.27 5.08 5.64 5.24
69 6.74 5.88 6.31 5.70 5.32 5.14 5.75 5.34
70 6.96 6.05 6.46 5.84 5.36 5.20 5.87 5.46
71 7.19 6.23 6.61 5.99 5.40 5.26 5.99 5.57
72 7.44 6.44 6.77 6.14 5.44 5.31 6.12 5.69
73 7.71 6.66 6.93 6.30 5.47 5.36 6.25 5.82
74 7.99 6.89 7.09 6.47 5.50 5.40 6.39 5.96
75 8.30 7.15 7.25 6.65 5.53 5.44 6.53 6.10
JOINT AND SURVIVOR ANNUITIES
Joint and Full to Survivor Joint and Two-Thirds Survivor
Certain Period Certain Period
Joint
None 120 240 Age None 120 240
$4.37 $4.37 ????? 60 $4.78 $4.74 $4.57
4.44 4.44 4.40 61 4.88 4.82 4.63
4.52 4.51 4.46 62 4.97 4.91 4.69
4.60 4.59 4.53 63 5.08 5.00 4.76
4.68 4.68 4.60 64 5.19 5.10 4.82
4.77 4.77 4.67 65 5.31 5.21 4.88
4.87 4.86 4.74 66 5.44 5.32 4.95
4.98 4.96 4.82 67 5.57 5.44 5.01
5.09 5.07 4.89 68 5.72 5.56 5.08
5.21 5.19 4.96 69 5.87 5.69 5.14
5.34 5.31 5.04 70 6.04 5.83 5.20
5.47 5.44 5.11 71 6.22 5.97 5.25
5.62 5.58 5.18 72 6.42 6.12 5.31
5.78 5.73 5.24 73 6.62 6.28 5.36
5.96 5.88 5.30 74 6.85 6.44 5.40
6.14 6.05 5.36 75 7.09 6.61 5.44
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
Before 1920 + 2 1970-1979 - 4
1920-1929 + 1 1980-1989 - 5
1930-1939 0 1990-1999 - 6
1940-1949 - 1 2000-2009 - 7
1950-1959 - 2 2010-2019 - 8
1960-1969 - 3 After 2019 - 9
19
ARTICLE 7
ANNUITY PURCHASE RATES UNDER A FIXED PAYMENT OPTION
DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS
PURCHASED WITH EACH $1,000 APPLIED
----------------------------------
SINGLE LIFE ANNUITIES
No Period Certain 120 Months Certain 240 Months Certain Cash Refund
Age Male Female Male Female Male Female Male Female
60 $4.91 $4.37 $4.81 $4.33 $4.47 $4.17 $4.47 $4.13
61 5.03 4.47 4.92 4.42 4.53 4.24 4.56 4.21
62 5.17 4.58 5.04 4.52 4.60 4.31 4.65 4.29
63 5.32 4.69 5.16 4.62 4.67 4.38 4.75 4.38
64 5.48 4.81 5.30 4.73 4.73 4.46 4.85 4.46
65 5.64 4.94 5.43 4.85 4.80 4.53 4.95 4.56
66 5.82 5.08 5.58 4.97 4.86 4.61 5.06 4.66
67 6.01 5.22 5.72 5.10 4.92 4.68 5.18 4.76
68 6.22 5.38 5.88 5.24 4.97 4.75 5.30 4.87
69 6.44 5.55 6.04 5.39 4.03 4.82 5.43 4.98
70 6.68 5.73 6.20 5.54 5.08 4.89 5.56 5.11
71 6.92 5.93 6.37 5.70 5.12 4.95 5.70 5.23
72 7.18 6.14 6.54 5.87 5.16 5.02 5.84 5.37
73 7.47 6.38 6.72 6.04 5.20 5.07 6.00 5.51
74 7.77 6.63 6.90 6.23 5.23 5.12 6.16 5.66
75 8.09 6.90 7.08 6.42 5.26 5.17 6.32 5.82
JOINT AND SURVIVOR ANNUITIES
Joint and Full to Survivor Joint and Two-Thirds Survivor
Certain Period Certain Period
Joint
None 120 240 Age None 120 240
$3.96 $3.95 $3.98 60 $4.38 $4.34 $4.22
4.03 4.08 4.05 61 4.48 4.47 4.29
4.12 4.16 4.12 62 4.58 4.57 4.36
4.21 4.25 4.19 63 4.69 4.67 4.43
4.30 4.34 4.26 64 4.81 4.78 4.50
4.40 4.43 4.34 65 4.94 4.89 4.57
4.51 4.54 4.42 66 5.08 5.01 4.64
4.62 4.64 4.50 67 5.22 5.13 4.71
4.74 4.76 4.58 68 5.38 5.27 4.78
4.87 4.88 4.66 69 5.55 5.41 4.85
5.01 5.01 4.74 70 5.73 5.55 4.91
5.16 5.15 4.82 71 5.92 5.70 4.98
5.32 5.30 4.89 72 6.12 5.86 5.03
5.49 5.45 4.96 73 6.34 6.03 5.09
5.68 5.62 5.03 74 6.58 6.20 5.14
5.88 5.79 5.09 75 6.84 6.38 5.18
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
Before 1920 + 2 1970-1979 - 4
1920-1929 + 1 1980-1989 - 5
1930-1939 0 1990-1999 - 6
1940-1949 - 1 2000-2009 - 7
1950-1959 - 2 2010-2019 - 8
1960-1969 - 3 After 2019 - 9
20
ARTICLE 8
GUARANTEED ACCUMULATED VALUES AND SURRENDER VALUES
FOR FIXED ALLOCATIONS*
$1,000 Annual Contribution
Guaranteed Guaranteed
End of Accumulated Surrender
Year Value Value
1 $ 1,030.00 $ 970.00
2 2,090.90 1,970.90
3 3,183.63 3,013.63
4 4,309.14 4,099.14
5 5,468.41 5,228.41
6 6,662.46 6,402.46
7 7,892.34 7,622.34
8 9,159.11 8,889.11
9 10,463.88 10,193.88
10 11,807.80 11,537.80
11 13,192.03 12,922.03
12 14,617.79 14,347.79
13 16,086.32 15,816.32
14 17,598.91 17,328.91
15 19,156.88 18,886.88
16 20,761.59 20,491.59
17 22,414.44 22,144.44
18 24,116.87 23,846.87
19 25,870.37 25,600.37
20 27,676.49 27,406.49
21 29,536.78 29,266.78
22 31,452.88 31,182.88
23 33,426.47 33,156.47
24 35,459.26 35,189.26
25 37,553.04 37,283.04
26 39,709.63 39,439.63
27 41,930.92 41,660.92
28 44,218.85 43,948.85
29 46,575.42 46,305.42
30 49,002.68 48,732.68
31 51,502.76 51,232.76
32 54,077.84 53,807.84
33 56,730.18 56,460.18
34 59,462.08 59,192.08
35 62,275.94 62,005.94
36 65,174.22 64,904.22
37 68,159.45 67,889.45
38 71,234.23 70,964.23
39 74,401.26 74,131.26
40 77,663.30 77,393.30
41 81,023.20 80,753.20
42 84,483.89 84,213.89
43 88,048.41 87,778.41
44 91,719.86 91,449.86
45 95,501.46 95,231.46
$100 Monthly Contribution
Guaranteed Guaranteed
End of Accumulated Surrender
Year Value Value
1 $ 1,219.41 $ 1,147.41
2 2,475.41 2,331.41
3 3,769.08 3,565.08
4 5,101.56 4,849.56
5 6,474.02 6,186.02
6 7,887.66 7,575.66
7 9,343.70 9,019.70
8 10,843.42 10,519.42
9 12,388.14 12,064.14
10 13,979.19 13,655.19
11 15,617.98 15,293.98
12 17,305.93 16,981.93
13 19,044.52 18,720.52
14 20,835.27 20,511.27
15 22,679.74 22,355.74
16 24,579.54 24,255.54
17 26,536.34 26,212.34
18 28,551.84 28,227.84
19 30,627.81 30,303.81
20 32,766.06 32,442.06
21 34,968.45 34,644.45
22 37,236.91 36,912.91
23 39,573.43 39,249.43
24 41,980.05 41,656.05
25 44,458.86 44,134.86
26 47,012.04 46,688.04
27 49,641.81 49,317.81
28 52,350.48 52,026.48
29 55,140.41 54,816.41
30 58,014.03 57,690.03
31 60,973.86 60,649.86
32 64,022.49 63,698.49
33 67,162.58 66,838.58
34 70,396.87 70,072.87
35 73,728.18 73,404.18
36 77,159.44 76,835.44
37 80,693.64 80,369.64
38 84,333.86 84,009.86
39 88,083.29 87,759.29
40 91,945.20 91,621.20
41 95,922.96 95,598.96
42 100,020.07 99,696.07
43 104,240.08 103,916.08
44 108,586.69 108,262.69
45 113,063.71 112,739.71
* Guaranteed Values are based on the guaranteed interest rate of 3.0%.
Guaranteed Accumulated Values and Guaranteed Surrender
Values may be more or less than shown in the table because of the variable of
the day of receipt of the Purchase Payment at the Servicing Office from period
to period and the crediting of interest to the Annuitant's account on a daily
basis. Values shown are based upon contributions equally spaced with interest
occurring at the beginning of the year. These values do not take into
consideration premium taxes (if any), or any withdrawals and/or transfers of
assets from the fixed account.
21
ANNUITY
CONTRACT
Deferred Variable Annuity or Variable and Fixed Annuity
Benefit Payment Options
Nonparticipating
If you have any questions concerning
this Contract, please
contact your LL&A
representative or the Servicing Office of I-L&A.
LINCOLN LIFE & ANNUITY
COMPANY OF NEW YORK
Home Office:
▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇ ▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇
▇▇▇-▇▇▇-▇▇▇▇
Servicing Office:
▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇▇▇▇
P. 0. Box 2348
Fort ▇▇▇▇▇, IN 46801-2348
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