[Allianz]
Allianz Life Insurance Company of North America
0000 Xxxxxx Xxxxx Xxxxx
Xxxxxxxxxxx, XX 00000-0000
A Stock Company
This is a legal Contract between the Contract Owner (referred to in this
Contract as you and your) and Allianz Life Insurance Company of North America
(herein referred to as we, us and our). We will make Annuity Payments as set
forth in this Contract beginning on the Income Date.
This Contract is issued in consideration of the payment of the initial Purchase
Payment.
READ YOUR CONTRACT CAREFULLY
RIGHT TO EXAMINE: This Contract may be returned within 10 days after you receive
it. It can be mailed or delivered to either us or the agent who sold it. Return
of this Contract by mail is effective on being postmarked, properly addressed
and postage prepaid. The returned Contract will be treated as if we had never
issued it. We will promptly refund the Contract Value in states where permitted.
This may be more or less than the Purchase Payments. We have the right to
allocate payments to the Money Market Investment Option until the expiration of
the Right to Examine period. If we so allocate payments, we will refund the
greater of the Purchase Payments, less any withdrawals, or the Contract Value.
Benefits available under this Contract are not less than those required by
statute of the state in which this Contract is delivered.
This is a Variable Annuity Contract with Annuity Payments and Contract Values
increasing or decreasing depending on the experience of the Variable Account
which is set forth in the Contract Schedule.
Signed for Allianz Life Insurance Company of North America by:
[Signature] [Signature]
Xxxxxxx X. Xxxxx Xxxxxxx Xxxxxxxx
Senior Vice President, Secretary President and Chief Marketing Officer
and Chief Legal Officer
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
L40432 1
TABLE OF CONTENTS
RIGHT TO EXAMINE..............................................................1
CONTRACT SCHEDULE...........................................................i-v
DEFINITIONS...................................................................4
PURCHASE PAYMENTS.............................................................6
PURCHASE PAYMENTS........................................................6
CHANGE IN PURCHASE PAYMENTS..............................................6
NO DEFAULT...............................................................6
ALLOCATION OF PURCHASE PAYMENTS..........................................6
VARIABLE ACCOUNT..............................................................6
THE VARIABLE ACCOUNT.....................................................7
VALUATION OF ASSETS......................................................7
ACCUMULATION UNITS.......................................................7
ACCUMULATION UNIT VALUE..................................................7
NET INVESTMENT FACTOR....................................................7
MORTALITY AND EXPENSE RISK CHARGE........................................7
MORTALITY AND EXPENSE GUARANTEE..........................................7
CONTRACT VALUE................................................................8
CONTRACT MAINTENANCE CHARGE...................................................8
TRANSFERS.....................................................................8
WITHDRAWAL PROVISIONS........................................................9
WITHDRAWALS..............................................................9
WITHDRAWAL CHARGE........................................................9
PROCEEDS PAYABLE ON DEATH.....................................................10
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PHASE....................10
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE.......................10
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PHASE......................10
DEATH OF CONTRACT OWNER DURING THE ANNUITY PHASE.........................11
DEATH OF ANNUITANT.......................................................11
PAYMENT OF DEATH BENEFIT.................................................11
BENEFICIARY..............................................................11
CHANGE OF BENEFICIARY....................................................12
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION..................................12
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS..............................12
CONTRACT OWNER...........................................................12
JOINT OWNER..............................................................12
ANNUITANT................................................................12
ASSIGNMENT OF A CONTRACT.................................................13
ANNUITY PROVISIONS............................................................13
GENERAL..................................................................13
FIXED ANNUITY............................................................13
VARIABLE ANNUITY.........................................................13
INCOME DATE..............................................................14
SELECTION OF AN ANNUITY OPTION...........................................14
DEFAULT ANNUITY OPTION...................................................14
ANNUITY OPTIONS..........................................................14
OPTION 1 - LIFE ANNUITY..............................................14
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15, OR 20
YEARS GUARANTEED.....................................................15
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OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY...........................15
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY
PAYMENTS OVER 5, 10, 15, OR 20 YEARS GUARANTEED......................15
OPTION 5 - REFUND LIFE ANNUITY.......................................16
OPTION 6 - SPECIFIED PERIOD CERTAIN ANNUITY..........................17
GENERAL PROVISIONS............................................................17
THE CONTRACT.............................................................17
NON-PARTICIPATING IN SURPLUS.............................................17
MISSTATEMENT OF AGE OR SEX...............................................17
CONTRACT SETTLEMENT......................................................17
REPORTS..................................................................17
TAXES....................................................................17
EVIDENCE OF SURVIVAL.....................................................18
PROTECTION OF PROCEEDS...................................................18
MODIFICATION OF CONTRACT.................................................18
TABLE OF ANNUITY PAYMENT AMOUNTS.........................................19
L40432 3
CONTRACT SCHEDULE
CONTRACT OWNER: [Xxxx Xxx] CONTRACT NUMBER: [??687456]
JOINT OWNER: [Xxxx Xxx] ISSUE DATE: [04/15/02]
ANNUITANT: [Xxxx Xxx] INCOME DATE: [04/15/15]
PURCHASE PAYMENTS:
MINIMUM INITIAL PURCHASE PAYMENT: [$25,000]
MINIMUM SUBSEQUENT
PURCHASE PAYMENT: .......[$100 if you have selected AIP]
MAXIMUM TOTAL
PURCHASE PAYMENTS: [$1 million; higher amounts may be
accepted with our prior approval]
ALLOCATION GUIDELINES:
[1. Currently, you can select up to 10 of the Investment
Options and/or the Fixed Account.
2. If allocations are made in percentages, whole numbers
must be used.]
INVESTMENT OPTIONS:
VARIABLE ACCOUNT: [Allianz Life Variable Account B]
[XXXXX VA FINANCIAL]
[XXXXX VA VALUE]
[DREYFUS SMALL CAP STOCK INDEX]
[DREYFUS STOCK INDEX]
[FRANKLIN GLOBAL COMMUNICATIONS SECURITIES]
[FRANKLIN GROWTH AND INCOME SECURITIES]
[FRANKLIN HIGH INCOME]
[FRANKLIN INCOME SECURITIES]
[FRANKLIN LARGE CAP GROWTH SECURITIES]
[FRANKLIN REAL ESTATE]
[FRANKLIN RISING DIVIDENDS SECURITIES]
[FRANKLIN SMALL CAP]
[FRANKLIN SMALL CAP VALUE SECURITIES]
[FRANKLIN U.S. GOVERNMENT]
[FRANKLIN ZERO COUPON - 2005]
[FRANKLIN ZERO COUPON - 2010]
[XXXXXXXX 20/20 FOCUS]
[MUTUAL DISCOVERY SECURITIES]
[MUTUAL SHARES SECURITIES]
[XXXXXXXXXXX GLOBAL SECURITIES/VA]
[XXXXXXXXXXX HIGH INCOME/VA]
[XXXXXXXXXXX MAIN STREET GROWTH & INCOME/VA]
[PIMCO VIT HIGH YIELD]
[PIMCO VIT STOCKSPLUS GROWTH AND INCOME]
S40252 i
[PIMCO VIT TOTAL RETURN]
[XXXXXXXX SMALL-CAP VALUE]
[XX XXXXXXXX INTERNATIONAL GROWTH]
[SP STRATEGIC PARTNERS FOCUSED GROWTH]
[XXXXXXXXX DEVELOPING MARKETS SECURITIES]
[XXXXXXXXX FOREIGN SECURITIES]
[XXXXXXXXX GROWTH SECURITIES]
[USAZ AIM BASIC VALUE]
[USAZ AIM BLUE CHIP]
[USAZ AIM DENT DEMOGRAPHIC TRENDS]
[USAZ AIM INTERNATIONAL EQUITY]
[USAZ ALLIANCE CAPITAL GROWTH AND INCOME]
[USAZ ALLIANCE CAPITAL LARGE CAP GROWTH]
[USAZ ALLIANCE CAPITAL TECHNOLOGY]
[USAZ MONEY MARKET]
[USAZ XXXXXXXXXXX EMERGING GROWTH]
[USAZ PIMCO GROWTH AND INCOME]
[USAZ PIMCO RENAISSANCE]
[USAZ PIMCO VALUE]
[USAZ XXXXXXXXX DEVELOPED MARKETS]
[USAZ XXX XXXXXX AGGRESSIVE GROWTH]
[USAZ XXX XXXXXX XXXXXXXX]
[USAZ XXX XXXXXX EMERGING GROWTH]
[USAZ XXX XXXXXX GROWTH AND INCOME]
[USAZ XXX XXXXXX GROWTH]
[ALLIANZ LIFE GENERAL ACCOUNT]:
[ALLIANZ LIFE FIXED ACCOUNT]
MORTALITY AND EXPENSE RISK CHARGE: During the Accumulation Phase, the mortality
and expense risk charge is equal on an annual basis to [1.40%] of the average
daily net assets of the Variable Account. During the Annuity Phase, the
mortality and expense risk charge is equal on an annual basis to [1.40%] of the
average daily net assets of the Variable Account.
CONTRACT MAINTENANCE CHARGE: The contract maintenance charge is [$40] each
Contract Year.
During the Accumulation Phase, the contract maintenance charge will be deducted
from the Contract Value the last day of each Contract Year while this Contract
is in force. If a full withdrawal is made on a date other than a Contract
Anniversary and your Contract Value for the Valuation Period during which the
full withdrawal is made is less than [$75,000], the full contract maintenance
charge will be deducted at the time of the withdrawal.
During the Annuity Phase, the contract maintenance charge will be collected
monthly from each Annuity Payment.
If the total Contract Value is at least [$75,000], we will not assess the
contract maintenance charge.
In the event you own more than one Contract of the same type issued by the
Company, we will determine the total Contract Value for all of the Contracts. If
the Contract Owner is a non-individual, we will look to the Annuitant in
determining the foregoing.
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TRANSFERS:
NUMBER OF FREE TRANSFERS PERMITTED: Currently, there are no limits on
the number of transfers that can be made. We reserve the right to
change this, but you will always be allowed at least 12 free transfers
in any Contract Year. Currently, you are allowed [12] free transfers
each Contract Year. This applies to transfers prior to and after the
Income Date.
TRANSFER FEE: For each transfer in excess of the free transfers
permitted, the transfer fee is [$25]. Transfers made at the end of the
Right to Examine period by us, any transfers made pursuant to a
regularly scheduled transfer or other transfers under programs
specifically waiving the transfer fee will not be counted in
determining the application of the transfer fee.
WITHDRAWALS:
WITHDRAWAL CHARGE: During the Accumulation Phase, a withdrawal charge
is assessed against Purchase Payments withdrawn. The charge is
calculated at the time of each withdrawal. The withdrawal charges are
as follows:
[WITHDRAWAL CHARGE - DURING THE ACCUMULATION PHASE:
(as a percentage of total Purchase Payments)
Number of Complete
Years Since Receipt of Purchase Payment Charge
----------------------------------------- ------
0... 8%
1... 8%
2... 7%
3... 6%
4... 5%
5 4%
6... 3%
7 years or more 0%]
PARTIAL WITHDRAWAL PRIVILEGE: Each Contract Year, you can make multiple
withdrawals up to a total of [12%] of Purchase Payments without incurring a
withdrawal charge. Full withdrawals are assessed a withdrawal charge on the full
Withdrawal Charge Basis Amount with no reductions for the Partial Withdrawal
Privilege.
MINIMUM PARTIAL WITHDRAWAL: [None]
MINIMUM CONTRACT VALUE THAT MUST REMAIN IN THE CONTRACT AFTER A PARTIAL
WITHDRAWAL: [None]
S40252 iii
WITHDRAWAL CHARGE APPLICABLE TO ANNUITY OPTION 6: During the Annuity
Phase, under Annuity Option 6, if you choose to make a Liquidation
from Annuity Option 6, your withdrawal charge is as follows:
---------------------------------------- ----------
[Number of Complete Years Withdrawal
Since Receipt of Purchase Payment Charge
---------------------------------------- ----------
0 8%
1 8%
2 7%
3 6%
4 5%
5 4%
6 3%
7 years or more 0%]
---------------------------------------- ----------
NUMBER OF YEARS BEFORE A PARTIAL LIQUIDATION IS AVAILABLE ON ANNUITY OPTION 2
AND 4: [5 years from the Income Date].
COMMUTATION FEE APPLICABLE TO ANNUITY OPTIONS 2 AND 4: If you elect Annuity
Option 2 or 4 and make a Liquidation [(allowed 5 years after the Income Date)],
a commutation fee will be assessed. The fee is a percentage of the amount
liquidated and is equal to:
--------------------------------- ---------------
[Number of Complete Years Since Commutation Fee
Income Date
--------------------------------- ---------------
5 4%
6 3%
7 2%
8 years or more 1%]
--------------------------------- ---------------
MAXIMUM CUMULATIVE PERCENTAGE FOR PARTIAL LIQUIDATION FOR ANNUITY OPTIONS 2 AND
4: [75% ]
AMOUNT AVAILABLE FOR ANNUITY PAYMENTS: The amount available for Annuity Payments
is your Contract Value less any applicable Premium Tax.
ASSUMED INVESTMENT RETURN: [5%]
[FIXED ACCOUNT GUARANTEED INTEREST RATE: [3%]
We guarantee that the annual interest rate credited on amounts in the
Fixed Account will be at least this rate. Interest rates are
guaranteed for at least one year on any amount in the Fixed Period
Accounts of at least two years. For the one-year Fixed Period Account,
the interest rate is guaranteed for the Contract Year.]
[INITIAL PERIOD WHEN NO MARKET VALUE ADJUSTMENT IS MADE: During the first [0]
months after the Issue Date.]
RIDERS:
[Charitable Remainder Trust Endorsement]
[Enhanced Guaranteed Minimum Death Benefit Endorsement]
S40252 iv
[Group Pension Plan Death Benefit Endorsement]
[Guaranteed Withdrawal Benefit Endorsement]
[Guaranteed Account Value Benefit Endorsement]
[Guaranteed Minimum Income Benefit Endorsement]
[Individual Retirement Annuity Endorsement]
[403(b) Annuity Endorsement]
[Fixed Account with a Market Value Adjustment Endorsement]
[Pension Plan and Profit Sharing Plan Endorsement]
[Xxxx Individual Retirement Annuity Endorsement]
[Traditional Guaranteed Minimum Death Benefit Endorsement]
[Unisex Endorsement]
[Waiver of Withdrawal Charge Endorsement]
SERVICE OFFICE: [USALLIANZ] SERVICE CENTER
[300 Xxxxxx Xxxx
X.X. Xxx 0000
Xxxxxx, XX 00000-0000
000-000-0000]
S40252 v
DEFINITIONS
ACCUMULATION PHASE: The period of time before you elect to begin receiving
Annuity Payments. You may make additional Purchase Payments during this time.
ACCUMULATION UNIT: The units into which we convert amounts invested in
Investment Options during the Accumulation Phase.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax.
AGE: Age on last birthday unless otherwise specified.
ANNUITANT(S): The natural person(s) upon whose continuation of life any Annuity
Payment involving life contingencies depends. You may change the Annuitant(s) at
any time prior to the Income Date unless the Contract Owner is a non-individual.
ANNUITY OPTION: An arrangement under which Annuity Payments are made under this
Contract.
ANNUITY PAYMENTS: The series of payments made to you or any named payee after
the Income Date under the Annuity Option selected.
ANNUITY PHASE: The period of time beginning on the Income Date during which
Annuity Payments are made.
ANNUITY RESERVE: The assets which support the Annuity Option you have selected
during the Annuity Phase.
ANNUITY UNIT: The units into which we convert amounts invested in the Investment
Options during the Annuity Phase.
ASSUMED INVESTMENT RETURN: The investment return upon which the variable Annuity
Payments in the Contract are based.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Service Center.
BENEFICIARY: The person(s) or entity(ies) who will receive any death benefit
payable under this Contract.
COMMUTATION FEE: A fee assessed after the Income Date by the Company equal to
the percentage of the amount liquidated under Annuity Options 2 or 4 as shown on
the Contract Schedule.
COMPANY: Allianz Life Insurance Company of North America.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date of this Contract.
L40432 4
CONTRACT OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in this Contract. If Joint Owners are named, all references to Contract
Owner shall mean the Joint Owners.
CONTRACT VALUE: The Contract Value for any Valuation Period is equal to the
total dollar value accumulated under this Contract in all of the Investment
Options.
CONTRACT YEAR: Any period of twelve (12) months commencing with the Issue Date
and each Contract Anniversary thereafter.
GENERAL ACCOUNT: Our general investment account which contains all the assets of
the Company with the exception of the Variable Account and other segregated
asset accounts.
INCOME DATE: The date on which you elect to begin receiving Annuity Payments
under the Contract. This date must be the first day of the calendar month.
INVESTMENT OPTION(S): The investment choices available under the Variable
Account. The Investment Options are shown in the Contract Schedule.
ISSUE DATE: The date shown on the Contract Schedule on which the first Contract
Year begins. Contract Anniversaries and Contract Years are measured from the
Issue Date.
JOINT OWNER: If there is more than one Contract Owner, each Contract Owner shall
be a Joint Owner of the Contract. Joint Owners have equal ownership rights and
must both authorize any exercising of those ownership rights unless otherwise
allowed by us. Any Joint Owner must be the spouse of the other Contract Owner,
unless limited by state law.
LIQUIDATIONS: Withdrawals made after the Income Date from Annuity Option 2, 4
and 6.
LIQUIDATION VALUE: The present value of the remaining guaranteed number of
variable Annuity Payments, based on their current value, to the end of the
guaranteed period, commuted at the Assumed Investment Return.
NET ASSET VALUE: The value of a share of the underlying Investment Options, less
any investment management and portfolio administration fees and expenses, as of
the close of trading on a Valuation Date.
PREMIUM TAX: Any premium taxes owed to any governmental entity and assessed
against Purchase Payments or Contract Value.
PURCHASE PAYMENT: A payment made toward this Contract.
SERVICE CENTER: The office indicated on the Contract Schedule of this Contract
to which notices, requests and Purchase Payments must be sent.
VALUATION DATE: The Variable Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period commencing at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
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VARIABLE ACCOUNT: A separate account maintained by us in which a portion of our
assets has been allocated for this and certain other contracts. It has been
designated on the Contract Schedule.
WITHDRAWAL CHARGE BASIS AMOUNT: All Purchase Payments less Purchase Payments
previously withdrawn subject to withdrawal charge.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: The initial Purchase Payment is due on the Issue Date. We
reserve the right to decline any Purchase Payment. The minimum subsequent
Purchase Payment and the maximum total Purchase Payments allowed are shown on
the Contract Schedule.
CHANGE IN PURCHASE PAYMENTS: You may elect to increase or decrease or to change
the frequency of Purchase Payments as set forth in the Contract Schedule.
NO DEFAULT: Unless a full withdrawal is made, this Contract remains in force and
will not be in default if no additional Purchase Payments are made.
ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to one or more
of the Investment Options in accordance with your selection. The allocation of
the initial Purchase Payment is made in accordance with your selection made at
the Issue Date. Unless you inform us otherwise, subsequent Purchase Payments are
allocated in the same manner as the initial Purchase Payment. However, the
Company has reserved the right to allocate the initial Purchase Payment to the
Money Market Investment Option until the expiration of the Right to Examine
period. All allocations of Purchase Payments are subject to the Allocation
Guidelines shown on the Contract Schedule. We guarantee that you will be allowed
to select at least five Investment Options for such allocations.
VARIABLE ACCOUNT
THE VARIABLE ACCOUNT: The Variable Account is designated on the Contract
Schedule. It consists of assets we have set aside and have kept separate from
the rest of our assets and those of our other separate accounts. The assets of
the Variable Account, equal to reserves and other liabilities of your Contract
and those of other Contract Owners, will not be charged with liabilities arising
out of any other business we may conduct.
The Variable Account assets are divided into Investment Options as shown on the
Contract Schedule. We may add additional Investment Options to those shown. You
may be permitted to transfer your Contract Value or allocate Purchase Payments
to the additional Investment Options. However, the right to make such transfers
or allocations will be limited by any terms and conditions we may impose.
We may limit further purchase of such shares of an Investment Option or
substitute shares of another Investment Option for shares already purchased,
subject to the requirements of applicable law
L40432 6
VALUATION OF ASSETS: Assets of each Investment Option will be valued at its Net
Asset Value on each Valuation Date.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Investment Options of the Variable Account as
a result of Purchase Payments, withdrawals, transfers, or fees and charges. We
will determine the number of Accumulation Units of an Investment Option
purchased or canceled. This will be done by dividing the amount allocated to (or
the amount withdrawn from) the Investment Option by the dollar value of one
Accumulation Unit of the Investment Option as of the end of the Valuation Period
during which the transaction is processed at the Service Center. Purchase
Payments, withdrawals and transfers from or to an Investment Option will result
in the addition of or the cancellation of Accumulation Units in an Investment
Option.
ACCUMULATION UNIT VALUE: The Accumulation Unit value for each Investment Option
was initially arbitrarily set. Subsequent Accumulation Unit values for each
Investment Option are determined by multiplying the Accumulation Unit value for
the immediately preceding Valuation Period by the net investment factor for the
Investment Option for the current period.
The Accumulation Unit value may increase or decrease from Valuation Period to
Valuation Period.
NET INVESTMENT FACTOR: The net investment factor for each Investment Option is
determined by dividing A by B and multiplying by (1 - C) where:
A is (i) the Net Asset Value per share of the Investment Option at the end
of the current Valuation Period; plus
(ii) any dividend or capital gains per share declared on
behalf of such Investment Option that has an ex-dividend date
within the current Valuation Period.
B is the Net Asset Value per share of the Investment Option for the
immediately preceding Valuation Period.
C is (i) the Valuation Period equivalent of the mortality and expense
risk charge, which are shown on the Contract Schedule; plus
(ii) a charge factor, if any, for any taxes or any tax reserve
we have established as a result of the operation or maintenance of
the Investment Option.
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, we deduct a mortality
and expense risk charge from the Contract Value in the Investment Options which
is equal, on an annual basis, to the amount shown on the Contract Schedule. The
mortality and expense risk charge compensates the Company for assuming the
mortality and expense risks under this Contract.
MORTALITY AND EXPENSE GUARANTEE: We guarantee that the dollar amount of each
Annuity Payment after the first will not be affected by variations in mortality
or expense experience.
L40432 7
CONTRACT VALUE
The Contract Value for any Valuation Period is equal to the total dollar value
accumulated under this Contract in all of the Investment Options. The Contract
Value in an Investment Option of the Variable Account is determined by
multiplying the number of Accumulation Units by the Accumulation Unit value.
CONTRACT MAINTENANCE CHARGE
We deduct an annual contract maintenance charge shown on the Contract Schedule.
Prior to the Income Date, this will be deducted from the Contract Value. The
number of Accumulation Units to be canceled from each applicable Investment
Option is in the ratio that the value of each Investment Option bears to the
total Contract Value. After the Income Date, the contract maintenance charge is
deducted from the Annuity Payment.
TRANSFERS
You may transfer all or a part of your interest in an Investment Option to
another Investment Option. We reserve the right to charge for transfers if there
are more than the number of free transfers shown on the Contract Schedule. All
transfers are subject to the following:
1. The deduction of any transfer fee that may be imposed as shown on the
Contract Schedule. The transfer fee will be deducted from the
Investment Option from which the transfer is made. If the entire
amount in the Investment Option is transferred, then the transfer fee
will be deducted from the amount transferred. If there are multiple
source Investment Options, it will be treated as a single transfer.
Any transfer fee will be deducted proportionally from the source
Investment Options if less than the entire amount in the Investment
Option is transferred.
2. We reserve the right to limit transfers until the expiration of the
Right to Examine period.
3. The minimum amount that can be transferred is shown on the Contract
Schedule.
4. No transfer will be effective within seven calendar days prior to the
date on which the first Annuity Payment is due.
5. Any transfer direction must clearly specify:
a. the amount which is to be transferred; and
b. the Investment Options which are to be affected.
6. After the Income Date, transfers may not be made from a fixed Annuity
Option to a variable Annuity Option.
7. After the Income Date, you can make transfers from a variable Annuity
Option to a fixed Annuity Option. The number of Annuity Units canceled
from the variable Annuity Option will be equal in value to the amount
of the Annuity Reserve transferred out of the Variable Account. The
amount transferred will purchase fixed Annuity Payments under the
Annuity Option in effect and based on the Age and sex of the
Annuitant, where allowed, at the time of the transfer.
L40432 8
8. Your right to make transfers is subject to modification if we
determine in our sole opinion, that the exercise of the right by one
or more Contract Owners is, or would be, to the disadvantage of other
Contract Owners. Restrictions may be applied in any manner reasonably
designed to prevent any use of the transfer right which we consider to
be to the disadvantage of other Contract Owners. A modification could
be applied to transfers to or from one or more of the Investment
Options, and could include, but is not limited to:
a. the requirement of a minimum time period between each transfer;
b. not accepting a transfer request from an agent acting on behalf of
more than one Contract Owner; or
c. limiting the dollar amount that may be transferred between the
Investment Options by a Contract Owner at any one time; or
d. not accepting telephone transfer instructions.
9. We reserve the right at any time and without prior notice to any party
to modify the transfer provisions described above. However, if we do
modify these provisions, we guarantee that they will not be any more
restrictive than the above.
If you elect to use this transfer privilege, we will not be liable for transfers
made in accordance with your instructions. All amounts and Accumulation Units
will be determined as of the end of the Valuation Period during which the
request for transfer is received at the Service Center.
WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Phase, you may, upon Authorized Request,
make a full or partial withdrawal of the Contract Value. Withdrawals will result
in the cancellation of Accumulation Units from each Investment Option in the
ratio that the value of each Investment Option bears to the total Contract
Value. You must specify, by Authorized Request, which Accumulation Units are to
be canceled if other than the above mentioned method of cancellation is desired.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
Each partial withdrawal must be for an amount which is not less than the minimum
partial withdrawal amount shown on the Contract Schedule. The minimum Contract
Value, which must remain in the Contract after a partial withdrawal, is shown on
the Contract Schedule.
WITHDRAWAL CHARGE: Upon a full or partial withdrawal of this Contract, a
withdrawal charge as set forth on the Contract Schedule may be assessed. Under
certain circumstances, we allow withdrawals without the withdrawal charge as set
forth on the Contract Schedule. Purchase Payments withdrawn under the partial
withdrawal privilege are still subject to applicable withdrawal charges upon
full withdrawal of the Contract.
L40432 9
PROCEEDS PAYABLE ON DEATH
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PHASE: Upon the death of the
Contract Owner, or any Joint Owner, during the Accumulation Phase, the death
benefit will be paid to the Beneficiary(ies) designated by the Contract Owner.
Upon the death of a Joint Owner, the surviving Joint Owner, if any, will be
treated as the primary Beneficiary. Any other Beneficiary designation on record
at the time of death will be treated as a contingent Beneficiary. If the
Contract is owned by a non-individual, the death benefit will be paid upon the
death of an Annuitant.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE: The death benefit will be
the Adjusted Contract Value determined as of the end of the Valuation Period
during which the Company receives both due proof of death and an election for
the payment method.
If the Beneficiary is the spouse of the Contract Owner, he or she may elect to
continue the Contract in his or her own name and exercise all the Contract
Owner's rights under the Contract. In this event, the Contract Value for the
Valuation Period during which this election is implemented will be adjusted to
equal the death benefit.
Any part of the death benefit amount that had been invested in the Variable
Account remains in the Variable Account until distribution begins. From the time
the death benefit is determined until complete distribution is made, any amount
in the Variable Account will be subject to investment risk, which is borne by
the Beneficiary.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PHASE: If the Owner has not
previously designated a death benefit option, a Beneficiary must request that
the death benefit be paid under one of the death benefit options below. In
addition, if the Beneficiary is the spouse of the Contract Owner, he or she may
elect to continue the Contract in his or her own name and exercise all the
Contract Owner's rights under the Contract.
Option A - lump sum payment of the death benefit. The contract maintenance
charge will not be assessed if the distribution --------- is due to death;
Option B - the payment of the entire death benefit within 5 years of the
date of the death of the Contract Owner or any Joint Owner. The full
contract maintenance charge is assessed to each Beneficiary on each
Contract Anniversary; or
Option C - payment of the death benefit under an Annuity Option over the
lifetime of the Beneficiary or over a period not extending beyond the life
expectancy of the Beneficiary with distribution beginning within one year
of the date of death of the Contract Owner or any Joint Owner. The full
contract maintenance charge will continue to be assessed to each
Beneficiary.
Any portion of the death benefit not applied under any Annuity Option within one
year of the date of the Contract Owner's death must be distributed within five
years of the date of death.
If a lump sum payment is requested, the amount from the Variable Account will be
paid within seven (7) days of receipt of proof of death and the valid election,
including any required governmental forms, unless the Suspension or Deferral of
Payments Provision is in effect.
L40432 10
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period after the day on which such lump sum first became payable
by the Company.
DEATH OF CONTRACT OWNER DURING THE ANNUITY PHASE: If you, or any Joint Owner,
dies during the Annuity Phase, and you are not an Annuitant, any remaining
payments under the Annuity Option elected will continue at least as rapidly as
under the method of distribution in effect at such Contract Owner's death. Upon
your death during the Annuity Phase, the Beneficiary becomes the Contract Owner.
DEATH OF ANNUITANT: Upon the death of an Annuitant (or death of both Joint
Annuitants), who is not the Contract Owner, during the Accumulation Phase, you
will become the Annuitant, unless you designate another Annuitant within 30 days
of the death of the Annuitant. If the Contract Owner is a non-individual, the
death of an Annuitant will be treated as the death of the Contract Owner and a
new Annuitant may not be designated.
Upon the death of the Annuitant during the Annuity Phase, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death and
payment election and any required governmental forms before any death benefit is
paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the finding
of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or
regulations governing death benefit payments.
BENEFICIARY: The Beneficiary designation in effect on the Issue Date will remain
in effect until changed. The Beneficiary is entitled to receive the benefits to
be paid at your death.
Unless you provide otherwise, the death benefit will be paid in equal shares to
the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive your death and/or the Annuitant's
death, as applicable; or if there are none;
2. to the contingent Beneficiary(ies) who survive your death and/or the
Annuitant's death, as applicable; or if there are none
3. to your estate.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), you may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Authorized Request. The change will
take effect as of the date the Authorized Request is signed. If the Authorized
Request reaches our Service Center after the Contract Owner dies but before any
payment is made, the change will be valid. The Company will not be liable for
any payment made or action taken before it records the change.
L40432 11
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of the Investment Option
shares is not reasonably practicable or we cannot reasonably value the
Investment Option shares; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of Contract Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS
CONTRACT OWNER: As the Contract Owner, you have all the interest and rights
under this Contract. The Contract Owner is the person designated as such on the
Issue Date, unless changed.
You may change owners of the Contract at any time by Authorized Request subject
to our underwriting rules then in effect. A change of Contract Owner will
automatically revoke any prior designation of Contract Owner. The change will
become effective as of the date the Authorized Request is signed. We will not be
liable for any payment made or action taken before the change is recorded. We
will not be responsible for any tax consequences of any such change.
JOINT OWNER: A Contract may be owned by Joint Owners. If Joint Owners are named,
any Joint Owner must be the spouse of the other Contract Owner, unless otherwise
provided by state law. Upon the death of either Contract Owner, the surviving
Joint Owner will be the primary Beneficiary. Any other Beneficiary designation
will be treated as a contingent Beneficiary unless otherwise indicated in an
Authorized Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by you subject to our underwriting rules
then in effect. The Annuitant may not be changed in a Contract that is owned by
a non-individual.
ASSIGNMENT OF A CONTRACT: An Authorized Request specifying the terms of an
assignment of a Contract must be provided to the Service Center. We will not be
liable for any payment made or action taken before we record the assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent.
L40432 12
If the Contract is assigned, your rights may only be exercised with the consent
of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Income Date, the amount available for Annuity Payments as
specified in the Contract Schedule will be applied under the Annuity Option you
have selected. You may elect to have the amount available for Annuity Payments
applied to provide a fixed annuity, a variable annuity or a combination fixed
and variable annuity. If a combination is elected, you must specify what part of
the amount available for Annuity Payments is to be applied to the fixed and
variable Annuity Options. If you select a fixed annuity, the amount available
for Annuity Payments is allocated to the General Account and the annuity is paid
as a fixed annuity. If you select a variable annuity, the amount available for
Annuity Payments will be allocated to the Investment Options of the Variable
Account in accordance with your selection, and the annuity will be paid as a
variable annuity. Unless you designate another payee, you will be the payee of
the Annuity Payments. The amount available for Annuity Payments will be applied
to the applicable annuity rate based upon the Annuity Option you have selected.
We may offer more favorable rates than those guaranteed here at the time your
first Annuity Payment is calculated. Annuity Payments will depend on the Age
and, where permitted, sex of the Annuitant.
We will not allow amounts less than $5,000 to be applied under any Annuity
Option.
FIXED ANNUITY: You may elect to have the amount available for Annuity Payments
applied to provide a fixed annuity. The dollar amount of each fixed Annuity
Payment is guaranteed to be at least an amount equal to the amount available for
Annuity Payments, divided first by $1000 and then multiplied by the appropriate
Annuity Payment amount for each $1000 of value for the Annuity Option selected.
The guaranteed rates, as set forth in the tables at the end of the Contract, are
based on an interest rate of 2 1/2% per year and the 1983(a) Individual Annuity
Mortality Table with mortality improvement projected 30 years using Mortality
Projection Scale G.
VARIABLE ANNUITY: You may elect to have the amount available for Annuity
Payments applied to provide a variable annuity. Variable Annuity Payments
reflect the investment performance of the Variable Account in accordance with
the allocation of the amount available for Annuity Payments to the Investment
Options during the Annuity Phase. Variable Annuity Payments are not guaranteed
as to dollar amount.
On the Income Date, Annuity Units will be purchased as follows:
The first Annuity Payment is equal to the amount available for Annuity Payments,
divided first by $1000 and then multiplied by the appropriate Annuity Payment
amount for each $1000 of value for the Annuity Option selected as set forth in
the table at the end of the Contract. In each Investment Option, the number of
Annuity Units is determined by dividing the amount of the initial Annuity
Payment determined for each Investment Option by the Annuity Unit value on the
Income Date. Thereafter, the number of Annuity Units in each Investment Option
remains unchanged unless you elect to transfer between Investment Options. All
calculations will appropriately reflect the Annuity Payment frequency selected.
On each subsequent Annuity Payment date, the total Annuity Payment is the sum of
the Annuity Payments for each Investment Option. The Annuity Payment in each
Investment Option is determined by multiplying the number of Annuity Units then
allocated to such Investment Option by the Annuity Unit value for that
Investment Option.
L40432 13
On each subsequent Valuation Date, the value of an Annuity Unit is determined in
the following way:
First: The net investment factor is determined as described under
"Variable Account - net investment factor" above.
Second: The value of an Annuity Unit for a Valuation Period is equal to:
a. the value of the Annuity Unit for the immediately preceding Valuation
Period;
b. multiplied by the net investment factor for the current Valuation
Period; and
c. divided by the assumed net investment factor (see below) for the
Valuation Period.
The assumed net investment factor is equal to one plus the Assumed Investment
Return which is used in determining the basis for the purchase of an Annuity,
adjusted to reflect the particular Valuation Period. The Assumed Investment
Return that we will use is shown on the Contract Schedule. However, we may agree
with you to use a different value. The Assumed Investment Return will never
exceed 7%.
INCOME DATE: Your Income Date is shown in the Contract Schedule. You may make an
Authorized Request for a different date, however any such request is subject to
Company approval. The Income Date must always be the first day of a calendar
month. The earliest Income Date you can request is a date that is at least two
years after the Issue Date. The Income Date will not be later than the calendar
month following the later of the Annuitant's 90th birthday or 10 years from the
Issue Date, unless approved by the Company. However, the Income Date will never
be greater than that permitted under state law.
SELECTION OF AN ANNUITY OPTION: You can select an Annuity Option by Authorized
Request. You may, by Authorized Request, at least 30 days prior to the Income
Date, select and/or change the Annuity Option.
DEFAULT ANNUITY OPTION: If no Annuity Option is selected, variable Annuity
Option 2, which is a life annuity with period certain, 120 Monthly Payments
Guaranteed, will be automatically applied.
ANNUITY OPTIONS: This Contract provides for Annuity Payments under one of the
Annuity Options described below. The Company may make available other payment
options.
OPTION 1 - LIFE ANNUITY. We will make monthly Annuity Payments during the life
of the Annuitant and ceasing with the last Annuity Payment due prior to the
Annuitant's death.
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15 OR 20 YEARS
GUARANTEED. We will make monthly Annuity Payments during the life of the
Annuitant with a guarantee that if, at the Annuitant's death, there have been
less than 60, 120, 180 or 240 monthly Annuity Payments made as selected, monthly
Annuity Payments will continue for the remainder of the guaranteed period.
L40432 14
Alternatively, the Contract Owner may elect to receive a lump-sum payment equal
to the present value of the guaranteed monthly Annuity Payments remaining, as of
the date proof of the Annuitant's death is received at the Service Center,
commuted at an appropriate rate. Proof of the Annuitant's death and return of
the Contract are required prior to the payment of any commuted values. For a
fixed Annuity Option, the commutation rate will be the Statutory Calendar Year
Interest Rate based on the NAIC Standard Valuation Law for Single Premium
Immediate Annuities corresponding to the Income Date. For a variable Annuity
Option, the commutation rate will be the Assumed Investment Return as shown on
the Contract Schedule. For a variable Annuity Option, the guaranteed monthly
Annuity Payments remaining is based on the current value of the Annuity Units.
During the lifetime of the Annuitant and while the number of Annuity Payments
made is less than the guaranteed number of payments elected, the Contract Owner
electing a variable Annuity Option may request a withdrawal (partial
Liquidation). You will be allowed to make a partial Liquidation at least once
per Contract Year beginning no earlier than set forth in the Contract Schedule.
The total of all partial Liquidations, measured as the sum of the percentages of
the total Liquidation Value at the time of each partial Liquidation, cannot
exceed the amount shown on the Contract Schedule. A Commutation Fee will be
subtracted from the amount liquidated before the proceeds are paid out. Partial
Liquidations will be processed on the next Annuity Payment date following your
written request.
After a partial Liquidation, the subsequent monthly Annuity Payments during the
remaining guaranteed period certain will be reduced by the percentage of the
Liquidation Value liquidated, including the Commutation Fee. After the
guaranteed number of payments has been made, the number of Annuity Units used in
calculating the monthly payments will be restored to their original values as if
no Liquidations had taken place.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. We will make monthly Annuity
Payments during the joint lifetime of the Annuitant and the Joint Annuitant.
Upon the death of the Annuitant, if the Joint Annuitant is then living, Annuity
Payments will continue to be paid during the remaining lifetime of the Joint
Annuitant at a level of 100%, 75% or 50% of the previous level, as selected.
Monthly Annuity Payments cease with the final Annuity Payment due prior to the
last survivor's death.
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15,
OR 20 YEARS GUARANTEED. We will make monthly Annuity Payments during the joint
lifetime of the Annuitant and the Joint Annuitant. Monthly Annuity Payments will
continue to be paid during the remaining lifetime of the Joint Annuitant at 100%
of the previous level. The Company guarantees that if at the last death of the
Annuitant and the Joint Annuitant, there have been less than 60, 120, 180, or
240 monthly Annuity Payments made as selected, monthly Annuity Payments will
continue to be made for the remainder of the guaranteed period. Alternatively,
the Contract Owner may elect to receive a lump-sum payment equal to the present
value of the guaranteed monthly Annuity Payments remaining, as of the date proof
of the Annuitant's and Joint Annuitant's death is received at the Service
Center, commuted at an appropriate rate. Proof of death of the Annuitant and
Joint Annuitant and return of this Contract are required prior to the payment of
any commuted values. For a fixed Annuity Option, the commutation rate will be
the Statutory Calendar Year Interest Rate based on the NAIC Standard Valuation
Law for Single Premium Immediate Annuities corresponding to the Income Date. For
a variable Annuity Option, the commutation rate will be the Assumed Investment
Return as shown on the Contract Schedule. For a variable Annuity Option, the
guaranteed monthly Annuity Payments remaining is based on the current value of
the Annuity Payments.
L40432 15
During the lifetime of the Annuitant or Joint Annuitant and while the number of
Annuity Payments made is less than the guaranteed number of payments elected,
the Contract Owner electing a variable Annuity Option may request a withdrawal
(partial Liquidation). You will be allowed to make a partial Liquidation at
least once per Contract Year beginning no earlier than set forth in the Contract
Schedule. The total of all partial Liquidations, measured as the sum of the
percentages of the total Liquidation Value at the time of each partial
Liquidation, cannot exceed the amount shown on the Contract Schedule. A
Commutation Fee will be subtracted from the amount liquidated before the
proceeds are paid out. Partial Liquidations will be processed on the next
Annuity Payment date following your written request.
After a partial Liquidation, the subsequent monthly Annuity Payments during the
remaining guaranteed period certain will be reduced by the percentage of the
Liquidation Value liquidated, including the Commutation Fee. After the
guaranteed number of payments has been made, the number of Annuity Units used in
calculating the monthly payments will be restored to their original values as if
no liquidations had taken place.
OPTION 5 - REFUND LIFE ANNUITY. We will make monthly Annuity Payments during the
lifetime of the Annuitant ceasing with the last Annuity Payment due prior to the
Annuitant's death. At the Annuitant's death, you may receive a refund. For a
fixed Annuity Option, the amount of the refund will be any excess of the amount
available for Annuity Payments applied under this Option over the total of all
Annuity Payments made under this Option. For a variable Annuity Option, the
amount of the refund will depend on the current Investment Option allocation and
will be the sum of refund amounts attributable to each Investment Option. The
refund amount for a given Investment Option is calculated using the following
formula:
(1) x {[(2) x (3) x (4)/(5) - [(4) x (6)]}
where:
(1) = Annuity Unit value of that given Investment Option when claim proofs are
received.
(2) = The amount available for Annuity Payments on the Income Date.
(3) = Allocation percentage in that given Investment Option (in decimal
form) when claim proofs are received.
(4) = Current number of Annuity Units used in determining each Annuity
Payment attributable to that given Investment Option.
(5) = Dollar value of first Annuity Payment.
(6) = Number of Annuity Payments made since the Income Date.
This calculation will be based upon the allocation of Annuity Units actually
in-force at the time claim proofs are received at the Service Center. There will
be no refund paid if the total refund determined using the above calculations is
less than or equal to zero.
OPTION 6 - SPECIFIED PERIOD CERTAIN ANNUITY. Monthly Annuity Payments are paid
for a specified period of time. The Specified Period Certain is elected by the
Contract Owner and must be specified as a whole number of years from 10 to 30.
If at the time of the last death of the Annuitant and any Joint Annuitant, the
Annuity Payments actually made have been for less than the Specified Period
Certain, then Annuity Payments will be continued thereafter to the Contract
Owner for the remainder of the Specified Period Certain.
L40432 16
If you have selected a variable payment option, a Liquidation may be made at
least once per Contract Year up to 100% of the Total Liquidation Value in the
Contract. The Liquidation Value is equal to the present value of the remaining
Annuity Payments based on the Annuity Payment's current value, to the end of the
Specified Period Certain, commuted at the Assumed Investment Return. A
withdrawal charge will be subtracted from the amount liquidated before the
payment is made as shown on the Contract Schedule. The Liquidation will be
processed on the next Annuity Payment Date following your written request. The
Company will require the return of the Contract prior to the payment of the
entire commuted value.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, the Application,
and any attached endorsements or riders. This Contract may be changed or altered
only by our President or Secretary. Any change, modification or waiver must be
made in writing.
NON-PARTICIPATING IN SURPLUS: This Contract does not share in any distribution
of our profits or surplus.
MISSTATEMENT OF AGE OR SEX: We may require proof of Age of the Annuitant before
making any life contingent Annuity Payment provided for by this Contract. If the
Age or sex of the Annuitant has been misstated, the amount payable will be the
amount that the amount available for Annuity Payments would have provided at the
true Age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment, and overpayments will be deducted from the future
Annuity Payments until the total is repaid.
CONTRACT SETTLEMENT: This Contract must be returned to us upon any settlement.
Prior to any settlement as a death claim, due proof of death must be submitted
to us. Any paid-up annuity, cash withdrawal or death benefits that may be
available are not less than the minimum benefits required by statute.
REPORTS: We will furnish you with a report showing the Contract Value at least
once each calendar year. This report will be sent to your last known address.
TAXES: Any taxes paid to any governmental entity will be charged against the
Contract Value. We will, in our sole discretion, determine when taxes have
resulted from: the investment experience of the Variable Account; receipt by us
of the Purchase Payment(s); or commencement of Annuity Payments. We may, at our
discretion, pay taxes when due and deduct that amount from the Contract Value at
a later date. Payment at an earlier date does not waive any right we may have to
deduct amounts at a later date. We reserve the right to establish a provision
for federal income taxes if we determine, in our sole discretion, that we will
incur a tax as a result of the operation of the Variable Account. We will deduct
for any income taxes incurred by it as a result of the operation of the Variable
Account whether or not there was a provision for taxes and whether or not it was
sufficient. We will deduct any withholding taxes required by applicable law.
EVIDENCE OF SURVIVAL: Where any benefits under this Contract are contingent upon
the recipient being alive on a given date, we may require proof satisfactory to
us that the condition has been met.
L40432 17
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under this Contract before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
MODIFICATION OF CONTRACT: This Contract may be modified by us in order to
maintain compliance with state and federal law. This Contract may be changed or
altered only by our President or our Secretary. A change or alteration will be
made in writing.
L40432 18
TABLE OF ANNUITY PAYMENT AMOUNTS: Table A below shows the guaranteed amount of
the Annuity Payment for each $1,000 of value applied under a fixed Annuity
Option. Table A is based on an interest rate of 2 1/2% per year and the 1983(a)
Individual Mortality Table with mortality improvement projected 30 years using
Mortality Projection Scale G.
Table B below shows the amount of the first monthly variable Annuity Payment,
based on an Assumed Investment Return of 5%, for each $1,000 of value applied
under a variable Annuity Option.
The amount of such Annuity Payments under Annuity Options 1, 2 and 5 will depend
on the sex and Age of the Annuitant on the Income Date. The amount of such
Annuity Payments under Option 3 and 4 will depend on the Age and sex of the
Annuitant and Joint Annuitant on the Income Date. Any amounts not shown for
Ages, guaranteed periods or other Annuity Options will be provided upon request.
-----------------------------------------------------------------------------------------------------------------------------
Table A - Guaranteed Monthly Annuity Payments Per $1,000 of Value
-----------------------------------------------------------------------------------------------------------------------------
Fixed Annuity Options
-----------------------------------------------------------------------------------------------------------------------------
Age of Annuitant Option 1 Option 2 Option 3 Option 4 Option 5
Nearest Birthday -------------- ----------------------------- --------------- ----------- ----------------
When First
Payment Is Made
-----------------------------------------------------------------------------------------------------------------------------
Guaranteed Guaranteed 100% Joint and Guaranteed
Period of Period of Last Survivor Period of
10 Years 20 Years 10 Years
-----------------------------------------------------------------------------------------------------------------------------
Male Female Male Female Male Female Male & Female Male & Female Male Female
Same Age Same Age
-----------------------------------------------------------------------------------------------------------------------------
30 2.85 2.72 2.84 2.72 2.84 2.71 2.61 2.61 2.81 2.70
40 3.17 2.97 3.16 2.97 3.14 2.96 2.82 2.82 3.10 2.94
50 3.67 3.38 3.65 3.37 3.58 3.34 3.14 3.14 3.51 3.29
60 4.50 4.03 4.43 4.01 4.18 3.90 3.67 3.67 4.13 3.84
70 6.03 5.23 5.70 5.10 4.83 4.62 4.59 4.58 5.11 4.72
80 8.92 7.68 7.43 6.88 5.21 5.16 6.40 6.21 6.66 6.18
90 14.75 13.12 8.94 8.74 5.27 5.27 10.23 8.42 9.39 8.81
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Table B - Guaranteed Initial Monthly Annuity Payment Per $1,000 of Proceeds
-----------------------------------------------------------------------------------------------------------------------------
Variable Annuity Option Based on 5% Assumed Investment Return
-----------------------------------------------------------------------------------------------------------------------------
Age of Annuitant Option 1 Option 2 Option 3 Option 4 Option 5
Nearest Birthday -------------- ----------------------------- ---------------- ------------- ----------------
When First
Payment Is made
-----------------------------------------------------------------------------------------------------------------------------
Guaranteed Guaranteed 100% Joint and Guaranteed
Period of Period of Last Survivor Period of
10 Years 20 Years 10 Years
-----------------------------------------------------------------------------------------------------------------------------
Male Female Male Female Male Female Male & Female Male & Female Male Female
Same Age Same Age
-----------------------------------------------------------------------------------------------------------------------------
30 4.46 4.36 4.46 4.35 4.45 4.35 4.27 4.27 4.44 4.35
40 4.72 4.55 4.71 4.55 4.68 4.53 4.41 4.41 4.68 4.53
50 5.18 4.89 5.14 4.87 5.04 4.83 4.65 4.65 5.06 4.83
60 5.96 5.49 5.86 5.45 5.56 5.31 5.10 5.10 5.70 5.36
70 7.49 6.65 7.07 6.47 6.13 5.94 5.96 5.94 6.77 6.27
80 10.42 9.12 8.68 8.16 6.46 6.41 7.72 7.50 8.54 7.94
90 16.30 14.63 10.08 9.89 6.51 6.51 11.54 9.58 11.63 10.92
-----------------------------------------------------------------------------------------------------------------------------
L40432 19
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
L40432 20
