EXHIBIT (4)(h)
FORM OF CONTRACT
Home Office: 000 Xxxxxxxxxxxxxx Xxxx
[LOGO] TRANSAMERICA LIFE INSURANCE Purchase, New York 10577-2135
COMPANY OF NEW YORK Administrative Office: 0000 Xxxxxxxx Xx XX
Xxxxx Xxxxxx, Xxxx 00000
CONTRACT NUMBER: 07 - 12345
This is a legal contract between the Owner and Transamerica Life Insurance
Company of New York, a Stock Company (Hereafter called the Company, we, our or
us.) The Company will provide annuities and other benefits as set out in this
annuity contract, subject to its provisions. This annuity contract is delivered
in, and is governed by, the laws of the State of New York.
WE AGREE
.. To provide annuity payments as set forth in Section 10 of this contract,
.. Or to pay Withdrawal benefits in accordance with Section 5 of this contract,
.. Or to pay death proceeds in accordance with Section 9 of this contract.
This contract permits the accumulation of funds on a tax-deferred basis and
provides a periodic annuity payment for the life of the Annuitant or for a
certain period of time. Payments start on the Annuity Commencement Date.
The smallest annual rate of investment return that would have to be earned on
the assets of the Separate Account so that the dollar amount of variable Annuity
Payments will not decrease is 6.25%
Prior to the Annuity Commencement Date, a daily charge corresponding to an
annual charge of 1.45% for the Annual Step-Up death benefit option (1.30% for
the Return of Premium death benefit option), is applied by the Company to the
assets of the Separate Account. The corresponding charge after the Annuity
Commencement Date is 1.25% regardless of death benefit option elected prior to
the Annuity Commencement Date. In addition, a maximum annual Service Charge of
$30 is assessed (prior to the Annuity Commencement Date only) on each Contract
Anniversary if either the sum of premium less Withdrawals is less than $50,000
(or the Account Value is less than $50,000) on the Contract Anniversary.
See the "Service Charge" provision in Section 4 and the "Charges and Deductions"
provision in Section 6 of this contract for more details. These agreements are
subject to the provisions of this contract. This contract is issued in
consideration of the application and payment of the initial premium as provided.
This contract may be applied for and issued to qualify as a tax-qualified
annuity under the applicable sections of the Internal Revenue Code.
20 DAY RIGHT TO CANCEL
You may cancel this contract by delivering or mailing a written notice to us or
Your agent. You must return the contract before midnight of the twentieth day
after the day You receive it. Notice given by mail and return of the contract by
mail are effective upon being mailed, properly addressed and postage prepaid. We
will return the Account Value, including any fees and charges, within 10 days
after we receive notice of cancellation and the returned contract.
If this contract is a replacement of another contract, the Right to Cancel
period is extended to 60 days and we will return the Account Value, including
any fees and charges, for this contract within 10 days after we receive notice
of cancellation and the returned contract.
The value of the Subaccount(s) is based on the value of the Separate Account
assets which are not guaranteed as to fixed dollar amounts and will increase or
decrease in value based on investment results.
Signed for us at our home office.
/s/ Xxx Xxxxxxxxxxx
PRESIDENT
This contract is a legal contract between the contract owner and the Company.
READ YOUR CONTRACT CAREFULLY
Flexible Premium Deferred Variable Annuity, Income Payable At Annuity
Commencement Date
Benefits Based On The Performance Of The Separate Account Are
Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
Non-Participating
WE RESERVE THE RIGHT TO (I) REFUSE PREMIUM PAYMENTS TO THE FIXED ACCOUNT, AND
(II) PROHIBIT TRANSFERS TO THE FIXED ACCOUNT
AV852 101 161 702
SECTION 1 - DEFINITIONS
ACCOUNT VALUE - Amount defined in Section 4, that can be used to fund one of the
Payment Options.
ANNUITANT - The person whose life annuity payments will be based on.
ANNUITY COMMENCEMENT DATE - The Date the Annuitant will begin receiving payments
from this contract. This date may be changed by the owner as described in
Section 11. In no event can this date be later than the last day of the month
following the month in which the Annuitant attains age 90 or 10 years from the
Contract Date if later.
CASH VALUE - Amount, defined in Section 5 that is available for partial or full
Surrenders.
CONTRACT ANNIVERSARY - The anniversary of the Contract Date for each year the
contract remains in force.
CONTRACT DATE - The date shown on the Contract Data page of this contract and
the date on which this contract becomes effective.
CONTRACT YEAR - The 12-month period following the Contract Date shown on the
Contract Data page. The first Contract Year starts on the Contract Date. Each
subsequent year starts on the anniversary of the Contract Date.
CUMULATIVE EARNINGS - An amount equal to the Account Value at the time a lump
sum payout or systematic payout option payout is made, minus the sum of all
premium payments reduced by all prior partial Withdrawals deemed to have been
from premium, if any.
DISTRIBUTION - A Withdrawal or disbursement of funds from the Account Value or
Cash Value. Account Value and Cash Value will be reduced by any Distribution.
GAINS - Cumulative Earnings, if any, in the Account Value.
INVESTMENT OPTIONS - Any of the Guaranteed Period Options of the Fixed Account,
the Dollar Cost Averaging Fixed Account Option, and any of the Subaccounts of
the Separate Account.
MONTHLY ANNIVERSARY - The same date each month as the Contract Date. If there is
no day in the calendar month, which coincides with the Contract Date, the
Monthly Anniversary will be the first day of the next calendar month
PAYEE - The person to whom annuity payments will be made.
PAYMENT OPTIONS - Options through which the distribution of the Account Value
can be directed.
SEPARATE ACCOUNT - The separate investment account(s) established by us, as
described in Section 6. The investment performance of the Separate Account is
independent of the performance of the general assets of the Company.
SUBACCOUNT - A division of the Separate Account, which invests in shares of one
Portfolio. The investment performance of each Subaccount is directly linked to
the investment performance of the corresponding Portfolio, as described in
Section 6.
SURRENDER - A partial or full withdrawal of funds from the Account Value or Cash
Value.
WITHDRAWAL - A distribution of funds from the Account Value or Cash Value.
YOU, YOUR - The owner of this contract. Unless otherwise specified on the
Contract Data page, the Annuitant and the owner shall be one and the same
person. If the owner is a trust and the trust allows any person(s) other than
the trustee to exercise ownership rights under the contract, then such person(s)
must be named as the Annuitant, as applicable. The owner while living, controls
all rights and benefits under the contract. The right of survivorship means that
if a joint owner dies, his or her interest in the contract will pass to the
surviving joint owner in accordance with the Death Provisions (see Section 9).
If a joint owner is named, reference to "You" or "Your" in this contract will
apply to both the owner and joint owner.
This contract may not have joint owners if it is issued in connection with a tax
qualified retirement plan or program.
AVB852 Page 2
SECTION 2 - CONTRACT DATA
CONTRACT NUMBER: 07 - 12345 ANNUITANT: Xxxx Xxx
INITIAL PREMIUM
PAYMENT: $5,000.00 ISSUE AGE/SEX: 35 / Male
CONTRACT DATE: August 10, 2002 OWNER(S): Xxxx Xxx
ANNUITY
COMMENCEMENT GUARANTEED
DATE: March 8, 2051 MINIMUM
DEATH BENEFIT
OPTION: C
BENEFICIARY: Xxxx Xxx
Initial Effective Annual Interest Rate Credited to the Fixed Account [3.50%]
Fixed Account Guaranteed Minimum Effective Annual Interest Rate: 3%
The minimum initial premium payment is $5,000 for nonqualified and $1,000 for
qualified.
The maximum total premium payments, which we will accept without prior approval
is $1,000,000.
Before the Annuity Commencement Date:
SERVICE CHARGE: Annual charge equal to the lesser of 2% of the Account
Value or $30.
Death Benefit Option P - Return of Premium
Mortality and Expense Risk Fee and Administrative Charge: 1.30%
Death Benefit Option C - Annual Step-up to age 86.
Mortality and Expense Risk Fee and Administrative Charge: 1.45%
After the Annuity Commencement Date:
Mortality and Expense Risk Fee and Administrative Charge: 1.25%
SURRENDER CHARGES:
Number of Years Percentage of
Since Premium Payment Date Premium Withdrawn
0-1 7%
1-2 7%
2-3 6%
3-4 6%
4-5 5%
5-6 4%
6-7 3%
7 or more 0%
AV852 101 161 702SP Page 3
SECTION 3 - PREMIUM PAYMENTS
PAYMENT OF PREMIUMS
Premium payments may be made any time while this contract is in force before the
Annuity Commencement Date. You may start or stop, increase or decrease, or skip
any Premium Payments. We reserve the right to prohibit premium payments to any
of the Fixed Account options described in Section 7 if we are crediting an
interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual
Interest Rate of 3% on any of those options. We will provide 30 days advance
written notice of this decision.
MAXIMUM AND MINIMUM PREMIUM PAYMENT
The premium payments may not be more than the amount permitted by law if this is
a tax-qualified annuity. The minimum initial premium payment is $5,000. If this
contract is being used as a tax-qualified annuity, the minimum initial premium
is $1,000, except that no minimum initial premium payment will be required for
403(b) annuities. The minimum subsequent premium payment we will accept is $50.
The maximum total premium payments which we will accept without prior Company
approval is $1,000,000.
If premium payments are discontinued, the Account Value at the cessation of
premium payments will be held by us and the Fixed Account portion of the Account
Value will continue to be credited with at least the guaranteed interest rate
provided in this contract. We may declare a higher rate in advance. On the
Annuity Commencement Date we will distribute the Account Value under one of the
Annuity Payment Options.
PREMIUM PAYMENT DATE
The premium payment date is the date on which the premium payment is credited to
the contract. The initial premium payment less any applicable premium taxes will
be credited to the contract within two business days of receipt of the premium
payment and the information needed. Subsequent additional premium payments will
be credited to the contract as of the business day the premium payment and
required information are received. A business day is any day that the New York
Stock Exchange is open for trading.
ALLOCATION OF PREMIUM PAYMENTS
Premium payments may be applied to various Investment Options, which we make
available. For each premium payment, You must indicate what percentage to
allocate to various Investment Options. Each percent may be either zero or any
whole number; however, the allocation among all accounts must total 100%.
CHANGE OF ALLOCATION
You may change the allocation of premium payments to various Investment Options
by providing us notice containing the facts that we need. Premium payments
received after the date on which we receive Your notice will be applied on the
basis of the new allocation.
PREMIUM TAXES
The insurance laws of the State of New York currently do not allow the
imposition of premium taxes on annuity considerations. Therefore, wherever
reference is made in this annuity contract to the deduction of premium taxes,
such deductions will not be made while the owner is a resident of the State of
New York, unless subsequent changes in New York's insurance laws provide
otherwise. The amount of any applicable premium tax imposed on amounts relating
to this annuity contract may be withdrawn from this annuity contract. For
purposes of this annuity contract, premium taxes include retaliatory taxes or
similar taxes.
SECTION 4 - ACCOUNT VALUE
ACCOUNT VALUE
On or before the Annuity Commencement Date, the Account Value is equal to Your:
(a) premium payments; minus
(b) Gross Partial Withdrawals (as defined in Section 5); plus
(c) interest credited to the Fixed Account (see Section 7); plus
(d) accumulated gains in the Separate Account (see Section 6); minus
(e) accumulated losses in the Separate Account (see Section 6); minus
(f) service charges, premium taxes, rider fees and transfer fees, if any.
You may use the Account Value on the Annuity Commencement Date to provide
lifetime income or income for a period of no less than 60 months under the
General Payment Provisions in Section 10.
SERVICE CHARGE
On each Contract Anniversary during any Contract Year before the Annuity
Commencement Date, we reserve the right to assess a service charge up to $30 for
contract administration expenses. The Service Charge will be deducted from each
Investment Option in proportion to the portion of Account Value (prior to such
charge) in each Investment Option. In no event will the Service Charge exceed 2%
of the Account Value on the Contract.
The Service Charge will not be deducted on a Contract Anniversary if, (1) the
sum of all premium payments less the sum of all Withdrawals taken equals or
exceeds $50,000; or (2) the Account Value equals or exceeds $50,000.
M1407 Page 4
SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS
CASH VALUE
On or before the Annuity Commencement Date, the Cash Value is equal to the
Account Value less any Surrender Charges. Information on the current amount of
Your contract's Cash Value is available upon request. The Cash Value may be
partially withdrawn or will be paid in the event of a full Surrender of the
contract. We must receive Your written partial Withdrawal or Surrender request
before the Annuity Commencement Date.
PARTIAL WITHDRAWALS
We will pay You a portion of the Cash Value as a Partial Withdrawal provided we
receive Your written request while the contract is in effect and before the
Annuity Commencement Date. When You request a Partial Withdrawal You must tell
us how it is to be allocated from among the Investment Options. If no selection
is made, the Partial Withdrawal will be taken prorata from Your Investment
Option. If Your request for a Partial Withdrawal from any Investment Option is
less than or equal to the Cash Value in that option, we will pay the amount of
Your request. However, if Your request for a Partial Withdrawal from any
Investment Option is greater than the Cash Value in that option, we will pay You
the Cash Value of that Investment Option.
The Gross Partial Withdrawal is the total amount which will be deducted from
Your Account Value as a result of each Partial Withdrawal. The Gross Partial
Withdrawal may be more or less than Your requested Partial Withdrawal amount,
depending on whether surrender charges apply at the time You request the Partial
Withdrawal.
The Excess Partial Withdrawal amount is the portion of the requested Partial
Withdrawal that is subject to surrender charge (that is, the portion which is in
excess of the surrender charge-free portion). For example, if the requested
withdrawal amount is $1,000, and the surrender charge-free amount is $200, then
the Excess Partial Withdrawal would be $800. Excess Partial Withdrawals will
reduce the Account Value by an amount equal to (X+Z) where:
X = Excess Partial Withdrawal
Z = Surrender Charge on X.
The formula for determining the Gross Partial Withdrawal is as follows:
Gross Partial Withdrawal = R+ SC, where:
R is the requested Partial Withdrawal; and
SC is the surrender charge on EPW; where
EPW is the Excess Partial Withdrawal Amount (the portion of the requested
Partial Withdrawal that is subject to surrender charge).
If no premium payments have been made for three years and the Account Value is
less than $2,000, we reserve the right to pay the full Account Value and
terminate the contract. We may delay payment of the Account Value from the Fixed
Account for up to 6 months after we receive the request. If payment of the
partial Withdrawal or full Surrender is not made within 10 business days of our
receipt of the request, We will pay interest on that amount from the date of
receipt to the date of payment. The interest rate will be the rate that is
currently paid on Guaranteed Payment Option 1, Interest Payments. If the owner
dies after we receive the request, but before the request is processed, the
request will be processed before the death proceeds are determined.
For interest crediting purposes only, the oldest premium payment is considered
to be withdrawn first, then the interest associated with that premium payment.
If the amount withdrawn exceeds this amount, the next oldest premium payment,
and its associated interest is considered to be withdrawn, and so on until the
most recent premium payment and its associated interest is considered to be
withdrawn (i.e. partial Withdrawals are made on a First-In, First-Out or "FIFO"
basis.)
Each Partial Withdrawal consists of a portion that is subject to a surrender
charge (that is, the Excess Partial Withdrawal) and a remaining portion that is
free from surrender charge (that is, the surrender charge-free amount). Either
portion may be zero (0) depending on the Partial Withdrawal requested and prior
amounts withdrawn.
Amounts withdrawn under one of these options may reduce the amount available
free of surrender charges under another option. Surrender charges may be waived
as described below:
U1407 Page 5
SECTION 5 - CONTINUED
LUMP SUM
Beginning in the second Contract Year, You may withdraw, free from surrender
charges, a lump sum amount equal to the maximum of A or B where:
A is the Cumulative Earnings, if any, in the Account Value and
B is an amount equal to 10% of the premium payments immediately prior to the
partial Withdrawal reduced by all prior partial Withdrawals deemed to have
been from premium, if any.
The minimum partial Withdrawal under this option is $500. This partial
Withdrawal option is available once per Contract Year.
SYSTEMATIC PAYOUT OPTION
Beginning in the first Policy Year, a Systematic Payout Option (SPO) is
available on a monthly, quarterly, semi-annual or annual basis. At the time a
SPO payout is made, such payout must be at least $50 and may not exceed the
maximum of A and B, divided by the number of payouts made per year (e.g. 12 for
monthly).
A is the Cumulative Earnings, if any, in the Account Value and
B is an amount equal to 10% of the premium payments immediately prior to the
partial Withdrawal reduced by all prior partial Withdrawals deemed to have
been from premium, if any.
No surrender charges will apply to the SPO payout. Monthly and quarterly payouts
must be sent through electronic funds transfer directly to a checking or savings
account. You may start or stop SPO payouts at any time; however, 30 days'
written notice is required to stop SPO payouts.
Once You have elected a SPO, You must wait a minimum time before the first SPO
payment: 1 month for monthly, 3 months for quarterly, 6 months for semi-annual,
or 12 months for annual.
MINIMUM REQUIRED DISTRIBUTION
Notwithstanding any other provision of the contract and to the extent required
by Internal Revenue Code Section 408(b)(3) and the rules and regulations issued
thereunder, distribution must be made from the contract in a manner which
satisfies the requirements of Internal Revenue Code Section 401(1)(9) and the
rules and regulations issued thereunder, as follows:
The entire Account Value must be distributed, or must commence to be
distributed, no later than the Required Beginning Date, in equal or
substantially equal amounts over: (a) the life of the owner or over the lives of
the owner and the beneficiary; or (b) a period certain not extending beyond the
life expectancy of the owner or over the lives of the owner, or the joint and
last survivor expectancy of such owner and beneficiary. Such amount must be
distributed periodically at intervals of no longer than one year and must be
either non-increasing or increasing only as provided in Proposed Income Tax
Regulation Section 1.401(a)(9)-1.
All distributions must be made in accordance with the requirements of Internal
Revenue Code Section 401(a)(9), including the incidental death benefit
requirements of Internal Revenue Code Section 402(1)(9)(G), and the regulations
issued thereunder, including the minimum distribution incidental benefit
requirement of Proposed Income Tax Regulation Section 1.401(a)(9)-2.
The amount to be distributed each year, beginning with the first Calendar Year
for which distributions are required to begin and then for each year thereafter,
shall not be less than the quotient obtained by dividing the entire Account
Value by the lesser of: (a) the life expectancy of the owner, or the joint life
expectancy of such owner and the beneficiary, whichever is applicable; or (b) if
the owner's spouse is not the beneficiary, the applicable divisor determined
from the table set forth in Proposed Income Tax Regulation Section
1.401(a)(9)-2. Distribution after the death of the owner will be calculated
using the applicable life expectancy as the relevant divisor without regard to
Proposed Income Tax Regulation Section 1.401(a)(9)-2.
Life expectancy of the owner and the joint life expectancy of the owner and the
beneficiary are computed by use of the return multiples contained in Tables V
and VI of Income Tax Regulation Section 1.72-9. Unless otherwise elected by the
owner by the time distributions are required to begin, life expectancies will be
recalculated annually. Such election will be irrevocable as to the owner and
will apply to all subsequent years. The life expectancy of a non-spouse
beneficiary may not be recalculated. Instead, the life expectancy of such
non-spouse beneficiary will be calculated using the attained age of such
non-spouse beneficiary during the Calendar Year in which such non-spouse
beneficiary attains age 70 1/2, and payments for subsequent years will be based
on such life expectancy reduced by one year for each Calendar Year which has
elapsed since the Calendar Year in which the life expectancy of such non-spouse
beneficiary was first calculated.
P1392 Page 6
SECTION 5 - CONTINUED
For tax-qualified plans, partial Withdrawals taken to satisfy minimum
distribution requirements under Section 401(a)(9) of the Internal Revenue Code
(IRC) are available with no surrender charges. The amount available from this
policy with respect to the minimum distribution requirement is based solely on
this contract.
The owner must be at least 70 1/2 years old in the calendar year of
distribution, must submit a written request to us and must take the distribution
before year-end. If the owner attains age 70 1/2 in the calendar year of
distribution, a written request, which is postmarked no later than the end of
the current calendar year, must be submitted to us.
Systematic minimum distributions must be at least $50 or a lump sum distribution
is available if minimum required distributions are less than $50.
Any amount requested in excess of the IRC minimum required distribution will
have the appropriate surrender charges applied, unless the excess Distribution
qualifies as surrender charge-free under any additional options provided.
SURRENDER CHARGES
Amounts withdrawn in excess of the surrender charge-free amount specified in the
Withdrawal provisions above are subject to a surrender charge. The amount of
this charge, if any, will be a percentage, as shown in the table below, of the
amount of premium withdrawn:
Number of Years Percentage of
Since Premium Premium Withdrawn
Payment Date
0-1 7%
1-2 7%
2-3 6%
3-4 6%
4-5 5%
5-6 4%
6-7 3%
7 or more 0%
For surrender charge purposes, all earnings are considered to be withdrawn
first. After all earnings are withdrawn then the oldest premium payment is the
first premium payment considered to be withdrawn. If the amount withdrawn
exceeds this, the next oldest premium payment is considered to be withdrawn, and
so on until the most recent premium payments are deemed to be withdrawn (the
procedure being applied to Withdrawals of premium is a "First-In, First-Out" or
FIFO procedure).
GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS
Upon full Surrender of the contract, You will always receive at least the
premium payments made to, less prior Withdrawals and transfers from, the Fixed
Account.
MINIMUM VALUES
Benefits available under this contract, including any paid up annuity Cash Value
or death benefits that may be available, are not less than those required by the
insurance laws of the State of New York. Such benefits will be increased as
interest is credited to the contract (and decreased by any Withdrawals).
PB1392 Page 7
SECTION 6 - SEPARATE ACCOUNT
SEPARATE ACCOUNT
We have established and will maintain one or more Separate Account(s), under the
laws of the state of New York. Any realized or unrealized income, net gains and
losses from the assets of the Separate Account are credited to or charged
against it without regard to our other income, gains or losses. Assets are put
in the Separate Account for this contract, as well as for other variable annuity
contracts. Any Separate Account may invest assets in shares of one or more
mutual fund portfolio, or in the case of a managed Separate Account, direct
investments in stocks or other securities as permitted by law. Fund shares refer
to shares of underlying mutual funds or prorata ownership of the assets held in
a Subaccount of a managed Separate Account. Fund shares are purchased, redeemed
and valued on behalf of the Separate Account.
The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We reserve
the right to add or remove any Subaccount of the Separate Account.
The Separate Account meets the definition of a "separate account: under rule
0-1(e)(1) of the Investment Company Act of 1940 (the "1940 Act"). The assets of
the Separate Account are our property. These assets will equal or exceed the
reserves and other contract liabilities of the Separate Account. These assets
will not be chargeable with liabilities arising out of any other business we
conduct. We reserve the right, subject to regulations governing the Separate
Account, to transfer assets of a Subaccount, in excess of the reserves and other
contract liabilities with respect to that Subaccount, to another Subaccount or
to our General Account.
We will determine the fair market value of the assets of the Separate Account in
accordance with a method of valuation, which we establish in good faith.
Valuation Period means the period of time from one determination of the value of
each Subaccount to the next. Such determinations are made when the value of the
assets and liabilities of each Subaccount is calculated. This is generally the
close of business on each day on which the New York Stock Exchange is open. In
order to determine the value of an asset on a day that is not a Business Day,
the Company will use the value of that asset as of the end of the next Business
Day on which trading takes place.
The Company will determine the value of the reserves for assets in the Separate
Account at the end of each Business Day. In order to determine the value of
reserves for assets on a day that is not a Business Day, the Company will use
the value of that asset as of the end of the prior Business Day on which trading
took place.
We also reserve the right to transfer assets of the Separate Account, which we
determine to be associated with the class of contracts to which this contract
belongs, to another Separate Account. If this type of transfer is made, the term
"Separate Account", as used in the contract, shall then mean the Separate
Account to which the assets were transferred.
We also reserve the right, when permitted by law to:
(a) deregister the Separate Account under the 1940 Act;
(b) manage the Separate Account under the direction of a committee at any time;
(c) restrict or eliminate any voting rights of contract owners or other persons
who have voting rights as to the Separate Account;
(d) combine the Separate Account with one or more other Separate Accounts;
(e) create new Separate Accounts;
(f) add new Subaccounts to or remove existing Subaccounts from the Separate
Account, or combine Subaccounts; and
(g) add new underlying mutual funds, remove existing mutual funds, or substitute
a new fund for an existing fund.
V1322 Page 8
SECTION 6 - CONTINUED
The Net Asset Value of a fund share is the per-share value calculated by the
mutual fund or, in the case of a managed Separate Account, by the Company. The
Net Asset Value is computed by adding the value of the Subaccount's investments,
cash and other assets, subtracting its liabilities, and then dividing by the
number of shares outstanding. Net Asset Values of fund shares reflect investment
advisory fees and other expenses incurred in managing a mutual fund or a managed
Separate Account.
CHANGE IN INVESTMENT OBJECTIVE OR POLICY OF A MUTUAL FUND
If required by law or regulation, an investment policy of the Separate Account
will only be changed if approved by the appropriate insurance official of the
state of New York or deemed approved in accordance with such law or regulation.
If so required, the process for obtaining such approval is filed with the
insurance official of the state or district in which this contract is delivered.
CHARGES AND DEDUCTIONS
The Mortality and Expense Risk Fee and the Administrative Charge are each
deducted both before and after the Annuity Commencement Date to compensate for
changes in mortality and expenses not anticipated by the mortality and
administration charges guaranteed in the contract.
The service charge is deducted prior to the Annuity Commencement Date only.
If the Mortality and Expense Risk Fee is more than sufficient, the Company will
retain the balance as profit or may reduce this fee in the future.
ACCUMULATION UNITS
The Account Value in the Separate Account before the Annuity Commencement Date
is represented by accumulation units. The dollar value of accumulation units for
each Subaccount will change from business day to business day reflecting the
investment experience of the Subaccount.
Premium payments allocated to and any amounts transferred to the Subaccounts
will be applied to provide accumulation units in those Subaccounts. The number
of accumulation units purchased in a Subaccount will be determined by dividing
the amount allocated to or transferred to that Subaccount, by the value of an
accumulation unit for that Subaccount on the premium payment or transfer date.
The number of accumulation units withdrawn or transferred from the Subaccounts
will be determined by dividing the amount withdrawn or transferred by the value
of an accumulation unit for that Subaccount on the Withdrawal or transfer date.
The value of an accumulation unit on any business day is determined by
multiplying the value of that unit at the end of the immediately preceding
valuation period by the net investment factor for the valuation period.
The net investment factor used to calculate the value of an accumulation unit in
each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the result of:
(1) the net asset value of a fund share held in that Subaccount determined
as of the end of the current valuation period; plus
(2) the per share amount of any dividend or capital gain Distributions made
by the fund for shares held in that Subaccount if the ex-dividend date
occurs during the valuation period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which we
determine to have resulted from the investment operations of that
Subaccount.
(b) is the net asset value of a fund share held in that Subaccount determined as
of the end of the immediately preceding valuation period.
(c) is a factor representing the Mortality and Expense Risk Fee and
Administrative Charge before the Annuity Commencement Date. This factor is
less than or equal to, on an annual basis, the percentage shown on the
Contract Data Page of the daily net asset value of a fund share held in that
Subaccount.
Since the net investment factor may be greater or less than one, the
accumulation unit value may increase or decrease.
VB1322 Page 9
SECTION 7 - FIXED ACCOUNT
FIXED ACCOUNT
Premium payments applied to and any amounts transferred to the Fixed Account
will reflect a fixed interest rate. The interest rates we set will be credited
for increments of at least one year measured from each premium payment or
transfer date. These rates will never be less than the Fixed Account Guaranteed
Minimum Effective Annual Interest Rate of 3%.
GUARANTEED PERIODS
We may offer optional Guaranteed Period Options, into which premium payments may
be paid or amounts transferred. The current interest rate we set for funds
entering each Guaranteed Period Option (GPO) is guaranteed until the end of that
option's Guaranteed Period. At that time, the premium payment made or amount
transferred into the GPO, less any Withdrawals or transfers from that GPO, plus
accrued interest, will be rolled into a new GPO or may be transferred to any
Subaccount(s) within the Separate Account(s).
You may choose the Investment Option(s) You want the funds rolled into by giving
us a written notice within 30 days before the end of the expiring option's
Guaranteed Period. However, any Guaranteed Period elected may not extend beyond
the maximum Annuity Commencement Date defined in Section 11. In the absence of
such election, the funds will be rolled into a new GPO which is the same as the
expiring GPO unless that GPO is no longer offered, in which case, the next
shorter GPO offered will be used. We will always offer a GPO with duration of at
least one year. You will be mailed a notice of completion of the rollover with
the new interest rate applicable. The new GPO will be deemed as accepted if we
do not receive a written rejection within 30 days from the postmark date of the
completion notice.
We reserve the right for new premium payments, transfers, or rollovers to offer
or not to offer any GPO. We will provide a 30 day advance written notice if we
decide to no longer accept new premium payments, transfers or rollovers to any
Fixed Account Option.
When funds are withdrawn or transferred from a GPO, the Account Value associated
with the oldest premium payment or rollover is considered to be
withdrawn/transferred first. If the amount withdrawn/transferred exceeds the
Account Value associated with the oldest premium, the Account Value associated
with the next oldest premium payment or rollover is considered to be
withdrawn/transferred next, and so on until the Account Value associated with
the most recent premium payment or rollover is considered to be
withdrawn/transferred (this is a "First-In, First-Out" or FIFO basis).
DOLLAR COST AVERAGING FIXED ACCOUNT OPTION
We may offer a Dollar Cost Averaging (DCA) Fixed Account Option separate from
the Guaranteed Period Options. This option will have a one-year interest rate
guarantee. The current interest rate we set for the DCA Fixed Account may differ
from the rates credited on the one-year GPO in the Fixed Account. In addition,
the current interest rate we credit may vary on different portions of the DCA
Fixed Account. The credited interest rate will never be less than the Fixed
Account Guaranteed Minimum Effective Annual Interest Rate of 3%. The DCA Fixed
Account Option will only be available under a Dollar Cost Averaging program as
described in Section 8.
The DCA Fixed Account Option includes an "enhanced" rate option (either 6 month
or 12 month), and a "regular" (that is, non-enhanced) rate option, where
transfers can be made over periods ranging from six months to twenty four
months. The "enhanced" rate option has a higher interest credited rate than the
"regular" rate option. The enhanced rate will be in excess of the gross
investment earnings rate (less appropriate expense and risk charges). The
enhanced rate applies to all new premiums allocated to the enhanced rate option.
SECTION 8 - TRANSFERS
A. TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE
Prior to the Annuity Commencement Date, You may transfer the value of the
accumulation units from one Investment Option to another by providing us notice
containing the facts that we need.
Transfers of interest credited in the GPOs to other Investment Options are
allowed on a "First-In, First-Out" basis. Such transfers may be made monthly,
quarterly, semi-annually, or annually. Each such transfer must be at least $50.
Transfers of Account Value from the Separate Account are subject to a minimum of
$500 or the entire Subaccount Account Value, if less. However, if the remaining
Subaccount Account Value is less than $500, we reserve the right to include that
amount as part of the transfer.
You may choose which GPO to transfer to or from, however, any GPO elected may
not extend beyond the maximum Annuity Commencement Date defined in Section 11.
L1046 Page 10
SECTION 8 - CONTINUED
We reserve the right to limit transfers to no more than 18 in any one Contract
Year. Any transfers in excess of 18 per Contract Year may be charged a $10 per
transfer fee. Transfers among multiple Investment Options will be treated as one
transfer in determining the number of transfers that have occurred. We also
reserve the right to prohibit transfers to any of the Fixed Account options
described in Section 7 if we are crediting an interest rate equal to the Fixed
Account Guaranteed Minimum Effective Annual Interest Rate of 3% on any of those
options. We will provide you 30 days written notice of this decision.
The contract was not designed for professional market timing organizations or
other persons that use programmed, large, or frequent transfers. The use of such
transfers may be disruptive to an underlying portfolio. We reserve the right to
reject any transfer request from any person in the interest of overall fund
management or, if, in our judgment, an underlying fund would be unable to invest
effectively in accordance with its investment objectives and policies or would
otherwise be potentially adversely affected or if an underlying fund would
reject our purchase order. We also reserve the right to revoke Your fax and
electronic transfer privileges at any time without revoking all owner's fax and
electronic transfer privileges.
DOLLAR COST AVERAGING OPTION
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer a specified amount from the Money Market Subaccount, Quality Bond
Subaccount, Limited Term High Income Subaccount, or the Dollar Cost Averaging
(DCA) Fixed Account Option to any other Subaccount(s) of the Separate Account.
The automatic transfers can occur monthly or quarterly.
Transfers will continue until the elected Subaccount or DCA Fixed Account value
is depleted. The amount transferred each time must be at least $250. All
transfers from the DCA account will be the same amount as the initial transfer.
Changes to the Subaccounts to which these transfers are allocated are not
restricted. Transfers must be scheduled for at least 6, but not more than 24
months or for at least 4, but not more than 8 quarters each time the Dollar Cost
Averaging program is started or restarted following termination of the program
for any reason.
Dollar Cost Averaging results in the purchase of more accumulation units when
the value of the accumulation unit is low, and fewer accumulation units when the
value of the accumulation unit is high. However, there is no guarantee that the
Dollar Cost Averaging program will result in higher Account Values or will
otherwise be successful.
Dollar Cost Averaging may be discontinued by providing notice to us. While
Dollar Cost Averaging is in effect, Asset Rebalancing is not available.
ASSET REBALANCING
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer amounts among the Subaccounts of the Separate Account on a regular
basis to maintain a desired allocation of the Account Value among the various
Subaccounts offered. Rebalancing will occur on a quarterly, semi-annual or
annual basis, beginning on a date selected by You. You must select the
percentage of the Account Value desired in each of the various Subaccounts
offered (totaling 100%). Any amounts in the Fixed Account are ignored for the
purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at
any time. Asset Rebalancing is not available while Dollar Cost Averaging is in
effect. Rebalancing will cease as soon as we receive a request for any other
transfer.
B. TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE
After the Annuity Commencement Date, You may transfer the value of the variable
annuity units from one Subaccount to another within the Separate Account or to
the Fixed Account. If You want to transfer the value of the variable annuity
units, You must provide a signed notice, containing the facts that we need. We
reserve the right to limit transfers between the Subaccounts or to the Fixed
Accounts to once per Contract Year.
The minimum amount which may be transferred is the lesser of $10 monthly income
or the entire monthly income of the variable annuity units in the Subaccount
from which the transfer is being made. If the monthly income of the remaining
units in a Subaccount is less than $10, we have the right to include the value
of those variable annuity units as part of the transfer.
After the Annuity Commencement Date, no transfers may be made from the Fixed
Account to any other Investment Options.
LB1046 Page 11
SECTION 9 - DEATH PROCEEDS
A. DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE
The amount of death proceeds will be the greatest of (a), (b) or (c) where:
(a) is the Account Value on the date we receive due proof of death and an
election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death and an election
of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any additional
premium payments received, less any Gross Partial Withdrawals from the date
of death to the date of payment of death proceeds.
If You have not selected a payment option by the date of death, the beneficiary
may make such election within one year of the date we receive due proof of the
owner's or Xxxxxxxxx's death as described in C below. The beneficiary may elect
to receive the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity Payment Options described in Section 10.
Interest on death proceeds will be paid as required by New York law. Interest
upon the death proceeds paid will be computed daily at the rate of interest
currently paid by us on proceeds left under the Guaranteed Payment Option 1,
Interest Payments, from the date of death, in connection with the death claim of
this contract to the date of payment and will be considered a part of the total
sum paid.
B. GUARANTEED MINIMUM DEATH BENEFIT
The amount of the Guaranteed Minimum Death Benefit (GMDB) is based on the death
benefit option shown on the Contract Data Page. You may not change the GMDB
option after the contract is issued.
Option C: Annual Step-up Death Benefit
An annual Step-up through age 85 Death Benefit described as follows:
On the Contract Date, the "Stepped-up" Value is the Account Value. At
regular annual intervals (referred to as "determination points") following
the Contract Date, a comparison is made between (1) and (2), where:
(1) = the Account Value at that time
(2) = previous "stepped up" value, plus Premium Payments minus Adjusted
Partial Withdrawals (as described below) made since the preceding
determination point.
The larger of (1) and (2) becomes the new "stepped-up" death benefit value.
This step up process stops at the earlier of the annuitant's date of death
or 86th birthday. The then-current step-up value becomes the final step-up
value, and the most recent determination point will be the final
determination point. The death benefit value at the time of death will be
the final step-up value, plus any premium payments less any Adjusted Partial
Withdrawals made since the final determination point.
Option P: Return of Premium Death Benefit
This GMDB is equal to the total premiums paid for this contract, less any
Adjusted Partial Withdrawals (as described below), as of the date of death.
A partial Withdrawal taken as provided in Section 5 will reduce the Guaranteed
Minimum Death Benefit by an amount referred to as the "Adjusted Partial
Withdrawal". The Adjusted Partial Withdrawal may be a different amount than the
Gross Partial Withdrawal described in Section 5. The Adjusted Partial Withdrawal
is the total amount deducted from the GMDB as a result of a partial Withdrawal
as used in the GMDB provision. It is equal to the Gross Partial Withdrawal
described in Section 5, multiplied by an Adjustment Factor. The Adjustment
Factor is equal to the amount of the death proceeds prior to the partial
Withdrawal divided by the Account Value prior to the partial Withdrawal.
D458 Page 12
SECTION 9 - CONTINUED
C. DEATH PRIOR TO ANNUITY COMMENCEMENT DATE
Death proceeds are payable contingent upon the relationships between the owner,
Xxxxxxxxx, and beneficiary as outlined below. The contract must be surrendered
upon settlement or on proof of death.
If there is a surviving owner(s), the surviving owner(s) automatically takes the
place of any beneficiary designation.
X. Xxxxxxxxx Death
When we have due proof that the Annuitant died before the Annuity
Commencement Date, we will provide the death proceeds to the beneficiary.
Interest upon the death proceeds paid will be computed daily at the rate of
interest currently paid by us on proceeds left under the Guaranteed Payment
Option 1, Interest Payments, from the date of death, in connection with the
death claim of this contract to the date of payment and will be considered
a part of the total sum paid. If no beneficiary is designated, the owner or
owner's estate will become the beneficiary.
a) Beneficiary is the deceased Xxxxxxxxx's surviving spouse. The
beneficiary may elect to continue this contract as owner and Annuitant
rather than receiving the death proceeds. If the contract is
continued, an amount equal to the excess, if any, of the Guaranteed
Minimum Death Benefit over the Account Value will then be added to the
Account Value. This is a one-time only Account Value adjustment
applied at the time the contract is continued, and the Guaranteed
Minimum Death Benefit will continue on as applicable. If the contract
is continued, all current surrender charges will be waived.
If this beneficiary elects to have the death proceeds paid, the death
proceeds must be distributed:
(1) by the end of 5 years after the date of the deceased Xxxxxxxxx's
death, or
(2) payments must begin no later than one year after the deceased
Xxxxxxxxx's death and must be made for a period certain or for
this beneficiary's lifetime, so long as any period certain does
not exceed this beneficiary's life expectancy.
In 1035 exchanges where there are joint Annuitants, the death proceeds will
only be payable upon the death of the surviving Annuitant.
II. Owner or Joint Owner dies.
If an owner or joint owner who is also an Annuitant dies, death proceeds
will be payable according to section I above.
If an owner or joint owner who is not an Annuitant dies prior to the
Annuity Commencement Date and before the entire interest in the contract is
distributed, the Annuitant will become the new owner.
DB458 Page 13
SECTION 9 - CONTINUED
If the new owner is the deceased owner's surviving spouse, the new owner
may elect to continue this contract rather than receiving the Account
Value. If the contract is continued, all current surrender charges will be
waived.
If the new owner is a natural person but is not the sole surviving spouse,
OR if the new owner is the sole surviving spouse but elects to have the
Account Value paid, the Account Value must be distributed by either a) or
b) below:
(a) by the end of 5 years after the date of the deceased owner's death, or
(b) payments must begin no later than one year after the deceased owner's
death and must be made for a period certain or for the new owner's
lifetime, so long as any period certain does not exceed the new
owner's life expectancy.
D. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE The death proceeds on or
after the Annuity Commencement Date depend on the payment option selected. If
any owner dies on or after the Annuity Commencement Date, but before the entire
interest in the contract is distributed, the remaining portion of such interest
in the contract will be distributed to the owner's beneficiary at least as
rapidly as under the method of distribution being used as of the date of that
owner's death.
E. AN OWNER IS NOT AN INDIVIDUAL
In the case of a non tax-qualified annuity, if any owner or beneficial owner is
not an individual, then for purposes of Section 72(s) of the Internal Revenue
Code's mandatory distribution provisions in subsection C or D above, (1) the
primary Annuitant will be treated as the owner of the contract, and (2) if there
is any change in the primary Annuitant, such a change will be treated as the
death of the owner.
SECTION 10 - ANNUITY PAYMENTS
A. GENERAL PAYMENT PROVISIONS
Payment
If this contract is in force on the Annuity Commencement Date, we will use the
Fixed Account portion and/or the Separate Account portion of the Account Value
to make annuity payments to the Payee under Option 3 and/or 3-V, respectively,
with 10 years certain, or if elected, under one or more of the other options
described in this section. However, the option(s) elected must provide for
lifetime income or income for a period of at least 60 months. You will become
the Annuitant at the Annuity Commencement Date. Payments will be made at 1, 3, 6
or 12-month intervals. We reserve the right to change the frequency of payments
to avoid making payments of less than $20.00.
Before the Annuity Commencement Date, if the death proceeds become payable or if
You Surrender this contract, we will pay any proceeds in one sum, or if elected,
all or part of these proceeds may be placed under one or more of the options
described in this section. If we agree, the proceeds may be placed under some
other method of payment instead.
Betterment of Rates
The amounts shown in the tables on page 18 are the guaranteed amounts. Current
amounts offered to individuals of the same class may be obtained from us. Fixed
annuity payments at the time of their commencement will not be less than those
which would be provided by the application of the Account Value to purchase any
single consideration immediate annuity contract (as described in Section 4223
(a)(1)(E) of New York Insurance Law) offered by the Company at the time to the
same class of Annuitant.
Adjusted Age
Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V
are determined based on the adjusted age of the Annuitant. The adjusted age is
the Annuitant's actual age on the Annuitant's nearest birthday, at the Annuity
Commencement Date, adjusted as follows:
Annuity
Commencement Date Adjusted Age
----------------- ------------
Before 2010 Actual Age
2010 - 2019 Actual Age minus 1
2020 - 2026 Actual Age minus 2
2027 - 2033 Actual Age minus 3
2034 - 2040 Actual Age minus 4
After 2040 Determined by us
S1152 Page 14
SECTION 10 - CONTINUED
Election of Optional Method of Payment
Before the Annuity Commencement Date You can elect or change a payment option.
You may elect, in a notice You sign which gives us the facts that we need,
annuity payments that may be either variable, fixed, or a combination of both.
If You elect a combination, You must also tell us what part of the contract
proceeds on the Annuity Commencement Date are to be applied to provide each type
of payment. (You must also specify which Subaccounts.) The amount of a combined
payment will be the sum of the variable and fixed payments. Payments under a
variable payment option will reflect the investment performance of the selected
Subaccount of the Separate Account.
Payee
Unless You specify otherwise, the Payee shall be the Annuitant, or the
beneficiary as defined in the Beneficiary provision in Section 11.
Proof of Age
We may require proof of the age of any person who has an annuity purchased under
Options 3, 3-V, 5 and 5 -V of this section before we make the first payment.
Minimum Proceeds
If the proceeds are less than $2,000, we reserve the right to pay them out as a
lump sum instead of applying them to a payment option.
Premium Tax
The insurance laws of the State of New York currently do not allow the
imposition of premium taxes on the amount applied to a settlement option.
Therefore, such deductions will not be made while the owner is a resident of the
State of New York, unless subsequent changes in New York's insurance laws
provide otherwise. However, if the owner becomes a non-resident of New York or
if New York changes its insurance laws to allow the imposition of premium taxes
on the amount applied to a settlement option, we will deduct the applicable
premium tax before applying the proceeds.
Supplementary Contract
Once proceeds become payable and a payment option has been selected, we will
issue a supplementary contract to reflect the terms of the selected option. The
contract will name the Payee(s) and will describe the payment schedule.
B. FIXED ACCOUNT PAYMENTS
Commutation of Payments after the Annuity Commencement Date
For Options 2,3, and 4, if the present value is paid in a single sum, the
interest rate used for commutation is the interest rate that equated the amount
applied at annuitization to the present value of annuity payments.
Guaranteed Payment Options
The fixed account payment is determined by multiplying each $1,000 of contract
proceeds allocated to a fixed payment option by the amounts shown on page 18 for
the option You select. Options 1, 2 and 4 are based on a guaranteed interest
rate of 3%. Options 3 and 5 are based on a guaranteed interest rate of 3% and
the "Annuity 2000" (male, female, and unisex if required by law) mortality table
projected for improvement using projection scale G (50% of the female scale G
factors were used, while 100% of the male scale factors were used). The rates
were projected dynamically using an assumed Xxxxxxx Commencement Date of 2005.
The "Annuity 2000" mortality rates are adjusted based on improvements in
mortality since 2000 to more appropriately reflect increased longevity. This is
accomplished using a set of improvement factors referred to as projection scale
G.
Option 1 - Interest Payments
We will pay the interest on the amount we use to provide annuity payments in
equal payments or this amount may be left to accumulate for a period of time we
and You agree to. We and You will agree on Withdrawal rights when You elect this
option. The interest rate we declare for this option may be different than the
interest rate(s) credited prior to the Annuity Commencement Date.
Option 2 - Income for a Specified Period
We will make level payments only for the fixed period You choose. In the event
of the death of the person receiving payments prior to the end of the fixed
period elected, payments will be continued to that person's beneficiary or their
present value may be paid in a single sum. No funds will remain at the end.
Option 3 - Life Income - You may choose between:
1. No Period Certain - We will make level payments only during the Annuitant's
lifetime.
2. 10 Years Certain - We will make level payments for the longer of the
Annuitant's lifetime or ten years.
3. Guaranteed Return of Contract Proceeds - We will make level payments for
the longer of the Annuitant's lifetime or until the total dollar amount of
payments we made to You equals the amount applied to this option.
SB1152 Page 15
SECTION 10 - CONTINUED
Option 4 - Income of a Specified Amount
Payments are made for any specified amount until the amount applied to this
option, with interest, is exhausted. This will be a series of level payments
followed by a smaller final payment. In the event of the death of the person
receiving payments prior to the time proceeds with interest are exhausted,
payments will be continued to that person's beneficiary or their present value
may be paid in a single sum.
Option 5 - Joint and Survivor Annuity
Payments are made during the joint lifetime of the Payee and a joint Payee of
Your selection. Payments will be made as long as either person is living.
Current Payment Options
The amounts shown in the tables on page 18 are the guaranteed amounts. Current
amounts offered to individuals of the same class may be obtained from us. Any
rates not shown in the Tables contained in this annuity contract will be
provided by the Company upon request.
C. VARIABLE ACCOUNT PAYMENT OPTIONS
Variable Annuity Units
The contract proceeds You tell us to apply to a variable payment option will be
used to purchase variable annuity units in Your chosen Subaccounts. The dollar
value of variable annuity units in Your chosen Subaccounts will increase or
decrease reflecting the investment experience of Your chosen Subaccounts. The
value of a variable annuity unit in a particular Subaccount on any business day
is equal to (a) multiplied by (b) multiplied by (c), where:
(a) is the variable annuity unit value for that Subaccount on the immediately
preceding business day;
(b) is the net investment factor for that Subaccount for the Valuation Period;
and
(c) is the Assumed Investment Return adjustment factor for the Valuation
Period.
The Assumed Investment Return adjustment factor for the valuation period is the
product of discount factors of .99986634 per day to recognize the 5.0% effective
annual Assumed Investment Return.
The net investment factor used to calculate the value of a variable annuity unit
in each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the net result of:
(1) the net asset value of a fund share held in that Subaccount determined
as of the end of the current valuation period; plus
(2) the per share amount of any dividend or capital gain Distributions
made by the fund for shares held in that Subaccount if the ex-dividend
date occurs during the Valuation Period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which we
determine to have resulted from the investment operations of the
Subaccount.
(b) is the net asset value of a fund share held in that Subaccount determined
as of the end of the immediately preceding Valuation Period.
(c) is a factor representing the Mortality and Expense Risk Fee and
Administrative Charge applicable after the Annuity Commencement Date. This
factor is less than or equal to, on an annual basis, the percentage shown
on the Contract Data Page of the daily net asset value of a fund share held
in the Separate Account for that Subaccount.
Determination of the First Variable Payment
The amount of the first variable payment is determined by multiplying each
$1,000 of contract proceeds allocated to a variable payment option by the
amounts shown on page 20 for the variable option You select. The tables are
based on a 5% effective annual Assumed Investment Return and the "Annuity 2000"
(male, female, and unisex if required by law) mortality table projected for
improvement using projection scale G (50% of the female scale G factors were
used, while 100% of the male scale factors were used). The rates were projected
dynamically using an assumed Xxxxxxx Commencement Date of 2005. The "Annuity
2000" mortality rates are adjusted based on improvements in mortality since 2000
to more appropriately reflect increased longevity. This is accomplished using a
set of improvement factors referred to as projection scale G.
C886 Page 16
SECTION 10 - CONTINUED
Option 3-V - Life Income - You may choose between:
1. No Period Certain - Payments will be made during the lifetime of the
Annuitant.
2. 10 Years Certain - Payments will be made for the longer of the Annuitant's
lifetime or ten years. In the event of the death of the person receiving
payments prior to the end of the guarantee period for which the election
was made, payments will be continued to that person's beneficiary or their
present value may be paid in a single sum.
Option 5-V - Joint and Survivor Annuity
Payments are made as long as either the Annuitant or the joint Annuitant is
living.
Determination of Subsequent Variable Payments
The amount of each variable annuity payment after the first will increase or
decrease according to the value of the variable annuity units which reflect the
investment experience of the selected Subaccounts. Each variable annuity payment
after the first will be equal to the number of variable annuity units in the
selected Subaccounts multiplied by the variable annuity unit value on the date
the payment is made. The number of variable annuity units in each selected
Subaccount is determined by dividing the first variable annuity payment
allocated to the Subaccount by the variable annuity unit value of that
Subaccount on the Annuity Commencement Date. Once Annuity Payments begin,
neither expenses actually incurred other than taxes on the investment return,
nor mortality actually experienced by the Company, shall adversely affect the
dollar amount of Variable Annuity Payments to any Payee for whom such payments
have commenced.
CB886 Page 17
GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS
The amounts shown in these tables are the guaranteed amounts for each 1,000
of the proceeds. Higher current amounts may be available at the time of
settlement.
-------------------------------------------------------------------------------------------------------------------------------
Option 2, Table I Option 3, Table II Option 3, Table III Option 3, Table IV
-------------------------------------------------------------------------------------------------------------------------------
Number Amount of
of Monthly Monthly Installment For Life No Monthly Installment For Life Monthly Installment For Life
Years Installment Period Certain 10 Years Certain Guaranteed Return Of
Payable Proceeds
-------------------------------------------------------------------------------------------------------------------------------
Age Male Female Unisex Male Female Unisex Male Female Unisex
*
-------------------------------------------------------------------------------------------------------------------------------
50 $3.82 $3.70 $3.74 $3.80 $3.69 $3.72 $3.70 $3.62 $3.65
51 3.89 3.76 3.80 3.86 3.74 3.78 3.75 3.67 3.70
52 3.95 3.81 3.86 3.92 3.80 3.84 3.81 3.72 3.75
53 4.02 3.88 3.92 3.99 3.86 3.90 3.87 3.78 3.80
5 17.91 54 4.10 3.94 3.99 4.06 3.92 3.96 3.93 3.83 3.86
6 15.14 55 4.18 4.01 4.06 4.13 3.99 4.03 3.99 3.89 3.92
7 13.16 56 4.26 4.08 4.14 4.21 4.06 4.10 4.06 3.95 3.98
8 11.68 57 4.35 4.16 4.22 4.29 4.13 4.18 4.13 4.02 4.05
9 10.53 58 4.44 4.24 4.30 4.38 4.21 4.26 4.20 4.08 4.12
10 9.61 59 4.54 4.33 4.39 4.47 4.29 4.35 4.27 4.16 4.19
11 8.86 60 4.64 4.42 4.49 4.57 4.38 4.44 4.36 4.23 4.27
12 8.24 61 4.76 4.52 4.59 4.67 4.47 4.53 4.44 4.31 4.35
13 7.71 62 4.88 4.63 4.70 4.78 4.57 4.63 4.53 4.39 4.43
14 7.26 63 5.01 4.74 4.82 4.89 4.67 4.74 4.62 4.48 4.52
15 6.87 64 5.15 4.86 4.94 5.01 4.78 4.85 4.72 4.57 4.62
16 6.53 65 5.30 4.98 5.08 5.14 4.89 4.97 4.83 4.67 4.72
17 6.23 66 5.46 5.12 5.22 5.27 5.02 5.09 4.94 4.78 4.82
18 5.96 67 5.63 5.27 5.37 5.41 5.14 5.22 5.05 4.89 4.94
19 5.73 68 5.81 5.42 5.54 5.55 5.28 5.36 5.17 5.00 5.05
20 5.51 69 6.00 5.59 5.71 5.70 5.42 5.51 5.30 5.13 5.18
70 6.21 5.78 5.90 5.86 5.58 5.66 5.43 5.26 5.31
71 6.43 5.97 6.11 6.02 5.74 5.82 5.58 5.39 5.45
72 6.66 6.19 6.33 6.18 5.90 5.99 5.72 5.54 5.59
73 6.91 6.42 6.56 6.35 6.08 6.16 5.88 5.70 5.75
74 7.18 6.67 6.82 6.53 6.26 6.34 6.05 5.86 5.92
75 7.46 6.94 7.09 6.70 6.45 6.53 6.22 6.04 6.09
76 7.77 7.23 7.39 6.88 6.65 6.72 6.40 6.22 6.27
77 8.10 7.55 7.71 7.07 6.85 6.91 6.60 6.42 6.47
78 8.45 7.89 8.05 7.25 7.05 7.11 6.80 6.63 6.68
79 8.83 8.26 8.43 7.43 7.26 7.31 7.01 6.85 6.90
80 9.23 8.66 8.83 7.61 7.46 7.51 7.24 7.08 7.13
81 9.66 9.10 9.27 7.79 7.66 7.70 7.47 7.33 7.37
82 10.13 9.57 9.74 7.97 7.86 7.89 7.72 7.59 7.63
83 10.62 10.09 10.24 8.13 8.05 8.07 7.98 7.86 7.90
84 11.15 10.64 10.79 8.29 8.23 8.25 8.26 8.15 8.18
85 11.72 11.24 11.38 8.44 8.40 8.41 8.55 8.45 8.48
86 12.32 11.89 12.02 8.59 8.56 8.56 8.85 8.77 8.80
87 12.97 12.59 12.70 8.72 8.70 8.71 9.17 9.11 9.12
88 13.65 13.33 13.42 8.84 8.83 8.83 9.50 9.45 9.47
89 14.38 14.11 14.19 8.95 8.95 8.95 9.85 9.82 9.83
90 15.16 14.94 15.00 9.06 9.05 9.05 10.22 10.19 10.20
91 15.97 15.80 15.85 9.15 9.15 9.15 10.61 10.59 10.59
92 16.84 16.70 16.74 9.23 9.23 9.23 11.01 11.00 11.00
93 17.75 17.63 17.67 9.31 9.31 9.31 11.45 11.42 11.43
94 18.72 18.60 18.64 9.37 9.37 9.37 11.92 11.88 11.89
95 19.77 19.62 19.66 9.43 9.43 9.43 12.42 12.36 12.38
-------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
Dollar amounts of monthly, quarterly, semi-annual, and annual
installments not shown in the above tables will be calculated on the same
basis as those shown and may be obtained from the Company.
T933 Page 18
Option 5V, Table IV
-------------------
Monthly Installment For Joint and Full Survivor
--------------------------------------------------------------------------------
Age of Female Annuitant*
---------------------------------------------------------------------
Age of 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Male Less Than Less Than Less Than Less Than Less Than Male More Than
Annuitant* Male Male Male Male Male Male
--------------------------------------------------------------------------------
50 $3.06 $3.12 $3.19 $3.25 $3.31 $3.38 $3.44
55 3.20 3.27 3.35 3.44 3.52 3.61 3.69
60 3.37 3.47 3.57 3.68 3.79 3.91 4.02
65 3.59 3.72 3.86 4.01 4.16 4.32 4.47
70 3.88 4.06 4.25 4.45 4.67 4.89 5.11
--------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor
--------------------------------------------------------------------------------
Age of Joint Annuitant*
---------------------------------------------------------------------
Age of 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
First Less Than Less Than Less Than Less Than Less Than First More Than
Annuitant* First First First First First First
--------------------------------------------------------------------------------
50 $3.07 $3.13 $3.19 $3.25 $3.31 $3.37 $3.43
55 3.20 3.28 3.36 3.44 3.52 3.60 3.67
60 3.38 3.48 3.58 3.68 3.79 3.89 4.00
65 3.61 3.73 3.87 4.01 4.16 4.30 4.44
70 3.90 4.07 4.26 4.46 4.66 4.86 5.05
--------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A
--------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
TB933 Page 19
VARIABLE PAYMENT OPTIONS
BASED ON ASSUMED INVESTMENT RETURN
The amounts shown in these tables are the initial payment amounts based on a
5.0% Assumed Investment Return for each $1,000 of the proceeds.
---------------------------------------------------------------------------------------------
Option 3-V, Table II Option 3-V, Table III
---------------------------------------------------------------------------------------------
Monthly Installment for Life Monthly Installment for Life
No Period Certain 10 Years Certain
---------------------------------------------------------------------------------------------
Age* Male Female Unisex Male Female Unisex
50 $5.07 $4.93 $4.98 $5.04 $4.92 $4.95
51 5.13 4.99 5.03 5.09 4.96 5.00
52 5.19 5.04 5.08 5.15 5.01 5.05
53 5.26 5.10 5.14 5.21 5.07 5.11
54 5.33 5.16 5.21 5.27 5.12 5.17
55 5.40 5.22 5.27 5.34 5.18 5.23
56 5.48 5.29 5.35 5.41 5.25 5.30
57 5.57 5.36 5.42 5.49 5.32 5.37
58 5.66 5.44 5.50 5.57 5.39 5.44
59 5.75 5.52 5.59 5.66 5.47 5.52
60 5.85 5.61 5.68 5.75 5.55 5.61
61 5.97 5.70 5.78 5.85 5.63 5.70
62 6.09 5.81 5.89 5.95 5.72 5.79
63 6.21 5.91 6.00 6.06 5.82 5.89
64 6.35 6.03 6.13 6.17 5.92 6.00
65 6.50 6.16 6.26 6.29 6.03 6.11
66 6.66 6.29 6.40 6.42 6.15 6.23
67 6.83 6.43 6.55 6.55 6.27 6.36
68 7.01 6.59 6.71 6.69 6.40 6.49
69 7.21 6.76 6.89 6.83 6.54 6.63
70 7.41 6.94 7.08 6.98 6.69 6.77
71 7.63 7.14 7.28 7.13 6.84 6.93
72 7.87 7.35 7.50 7.28 7.00 7.09
73 8.12 7.58 7.74 7.45 7.17 7.25
74 8.39 7.83 8.00 7.61 7.34 7.42
75 8.68 8.11 8.28 7.78 7.52 7.60
76 8.99 8.40 8.58 7.95 7.71 7.78
77 9.32 8.72 8.90 8.12 7.90 7.97
78 9.68 9.07 9.25 8.29 8.09 8.16
79 10.06 9.45 9.63 8.47 8.29 8.34
80 10.47 9.85 10.04 8.64 8.48 8.53
81 10.91 10.30 10.48 8.80 8.67 8.71
82 11.38 10.78 10.96 8.97 8.86 8.89
83 11.88 11.30 11.47 9.12 9.04 9.06
84 12.42 11.87 12.03 9.27 9.21 9.23
85 12.99 12.48 12.63 9.41 9.37 9.38
86 13.60 13.13 13.27 9.54 9.51 9.52
87 14.26 13.84 13.96 9.67 9.65 9.65
88 14.95 14.59 14.70 9.78 9.77 9.77
89 15.69 15.39 15.48 9.89 9.88 9.88
90 16.47 16.23 16.30 9.98 9.98 9.98
91 17.29 17.10 17.16 10.07 10.07 10.07
92 18.16 18.01 18.05 10.15 10.15 10.15
93 19.07 18.95 18.98 10.22 10.22 10.22
94 20.05 19.92 19.96 10.28 10.28 10.28
95 21.09 20.94 20.99 10.34 10.33 10.33
---------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
H1108 Page 20
Option 5V, Table IV
-------------------
Monthly Installment For Joint and Full Survivor
--------------------------------------------------------------------------------
Age of Female Annuitant*
---------------------------------------------------------------------
Age of 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
Male Less Than Less Than Less Than Less Than Less Than Male More Than
Annuitant* Male Male Male Male Male Male
--------------------------------------------------------------------------------
50 $4.37 $4.42 $4.46 $4.51 $4.56 $4.62 $4.67
55 4.48 4.54 4.60 4.67 4.74 4.81 4.88
60 4.62 4.70 4.79 4.88 4.98 5.08 5.18
65 4.81 4.92 5.04 5.17 5.31 5.46 5.61
70 5.07 5.23 5.40 5.59 5.79 6.00 6.22
--------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor
--------------------------------------------------------------------------------
Age of Joint Annuitant*
---------------------------------------------------------------------
Age of 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years
First Less Than Less Than Less Than Less Than Less Than First More Than
Annuitant* First First First First First First
--------------------------------------------------------------------------------
50 $4.38 $4.42 $4.47 $4.51 $4.56 $4.61 $4.66
55 4.48 4.54 4.60 4.67 4.73 4.80 4.87
60 4.63 4.70 4.79 4.88 4.97 5.07 5.16
65 4.82 4.93 5.05 5.17 5.30 5.44 5.57
70 5.09 5.24 5.41 5.59 5.78 5.97 6.16
--------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A
--------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.
J1108 Page 21
SECTION 11 - GENERAL PROVISIONS
THE ENTIRE CONTRACT
The entire contract consists of this contract, the Contract Data page,
endorsements, and riders, if any and the application signed by you, a copy of
which is attached hereto. No insertion in or other alteration of any written
application can be made by any person other than the owner without his or her
written consent, except that insertions may be made by the Company for
administrative purposes only in such manner as to clearly indicate that the
insertions are not to be ascribed to the owner. All statements in the
application are representations and not warranties. Nothing is incorporated by
reference, unless a copy is endorsed upon or attached to the contract. Nothing
in the contract or any attached endorsements or riders thereto invalidates or
impairs any right granted to the owner by New York law or this contract.
MODIFICATION OF CONTRACT
No change in this contract is valid unless made in writing by us and approved by
one of our officers. No Registered Representative has authority to change or
waive any provision of Your contract.
TAX QUALIFICATION
This contract is intended to qualify as an annuity contract for federal income
tax purposes. The provisions of this contract are to be interpreted to maintain
such qualification, notwithstanding any other provisions to the contrary. To
maintain such tax qualification, we reserve the right to amend this contract to
reflect any clarifications that may be needed or are appropriate to maintain
such tax qualification or to conform this contract to any applicable changes in
the tax qualification requirements. We will send You a copy in the event of any
such amendment. If You refuse such an amendment it must be by giving us written
notice, and Your refusal may result in adverse tax consequences.
NON-PARTICIPATING
This contract will not share in our surplus earnings.
AGE OR SEX CORRECTIONS
If the age or sex of the Annuitant has been misstated, the benefits will be
those, which the premiums paid, would have purchased for the correct age and
sex. If required by law to ignore differences in the sex of the Annuitant, the
annuity payments will be determined using the unisex factors in Section 10.
Any underpayment made by us will be paid with the next payment. Any overpayment
made by us will be deducted from future payments. Any underpayment or
overpayment, will include interest at 5% per year, from the date of the wrong
payment to the date of the adjustment.
INCONTESTABILITY
This contract shall be incontestable from the Contract Date.
EVIDENCE OF SURVIVAL
We have the right to require satisfactory evidence that a person was alive if a
payment is based on that person being alive. No payment will be made until we
receive the evidence.
SETTLEMENT
Any payment by us under this contract is payable by our Home Office.
RIGHTS OF OWNER
The owner may, while the Annuitant is living:
1. Assign this contract.
2. Surrender the contract to us.
3. Amend or modify the contract with our consent.
4. Receive annuity payments or name a Payee to receive the payments.
5. Exercise, receive and enjoy every other right and benefit contained in the
contract.
The use of these rights may be subject to the consent of any assignee or
irrevocable beneficiary; and of the spouse in a community or marital property
state.
Unless we have been notified of a community or marital property interest in this
contract, we will rely on our good faith belief that no such interest exists and
will assume no responsibility for inquiry.
CHANGE OF OWNERSHIP
In the case of a non-tax-qualified annuity, You can change the owner of this
contract, from yourself to a new owner, in a notice You sign which gives us the
facts that we need. When this change takes effect, all rights of ownership in
this contract will pass to the new owner.
A change of owner will not be effective until it is received by Us. After it has
been so received, the change will take effect as of the date You signed the
notice. However, if the Annuitant dies before the notice has been so received,
it will not be effective as to those proceeds we have paid before the change was
received by Us.
We may require that the change be endorsed in the contract. Changing the owner
does not change the beneficiary or the Annuitant.
A change of ownership may result in adverse tax consequences.
ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is the date annuity payments begin. This date is
generally no later than the last day of the contract month starting after the
Annuitant attains age 85. In no event can this date be later than the last day
of the month following the month in which the Annuitant attains age 90 or 10
years from the Contract Date, if later. You may change the Annuity Commencement
Date at any time before the Annuity Commencement Date by giving us 30 days'
written notice. The revised Annuity Commencement Date may not be earlier than
the first day of the calendar month coinciding with or next following the first
Contract Anniversary.
R200 Page 22
SECTION 11 - CONTINUED
ASSIGNMENT
(a) In the case of a non tax-qualified annuity, this Contract may be assigned.
The assignment must be in writing and filed with us.
(b) We assume no responsibility for the validity of any assignment. Any claim
made under an assignment shall be subject to proof of interest and the
extent of the assignment.
(c) This contract may be applied for and issued to qualify as a tax-qualified
annuity under certain sections of the Internal Revenue Code. Ownership of
this contract is then restricted so that it will comply with provisions of
the Internal Revenue Code.
Assignment of this contract may result in adverse tax consequences.
BENEFICIARY
Death proceeds, when payable in accordance with Section 9, are payable to the
designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and
may be changed without consent (unless irrevocably designated or required by
law) by notifying us in writing on a form acceptable to us. The change will take
effect upon the date You sign it, whether or not You are living when we receive
it. The notice must have been postmarked (or show other evidence of delivery
that is acceptable to us) on or before the date of death. Your most recent
change of beneficiary notice will replace any prior beneficiary designations. No
change will apply to any payment we made before the written notice was received.
If an irrevocable beneficiary dies, You may designate a new beneficiary.
You may direct that the beneficiary shall not have the right to withdraw, assign
or commute any sum payable under an option. In the absence of such election or
direction, the beneficiary may change the manner of payment or make an election
of any option.
If any primary or contingent beneficiary dies before the Annuitant, that
beneficiary's interest in this contract ends with that beneficiary's death. Only
those beneficiaries living at the time of the Annuitant's death will be eligible
to receive their share of the death proceeds. In the event no primary or
contingent beneficiaries have been named and all primary beneficiaries have died
before the death proceeds become payable, the owner(s) will become the
beneficiary(ies) unless elected otherwise in accordance with Section 9. If both
primary and contingent beneficiaries have been named, payment will be made to
the named primary beneficiaries living at the time the death proceeds become
payable. If there is more than one beneficiary and You failed to specify their
interest, they will share equally. Payment will be made to the named contingent
beneficiary(ies) only, if all primary beneficiaries have died before the death
proceeds become payable. If any primary beneficiary is alive at the time the
death proceeds become payable, but dies before receiving their payment, their
share will be paid to their estate.
PROTECTION OF PROCEEDS
Unless You so direct by filing written notice with us, no beneficiary may assign
any payments under this contract before the same are due. To the extent
permitted by law, no payments under this contract will be subject to the claims
of creditors of any beneficiary.
DEFERMENT
We will pay any Partial Withdrawals or Surrender proceeds from the Separate
Account within 7 days after we receive all requirements that we need. However,
it may happen that the New York Stock Exchange is closed for trading (other than
the usual weekend or holiday closings), or the Securities and Exchange
Commission restricts trading or determines that an emergency exists. If so, it
may not be practical for us to determine the investment experience of the
Separate Account. In that case, we may defer transfers among the Subaccounts and
to the Fixed Account, and determination or payment of Partial Withdrawals or
Surrender proceeds.
When permitted by law, we may defer paying any Partial Withdrawals or Surrender
proceeds from the Fixed Account for up to 6 months from the date we receive Your
request. If the owner dies after the request is received, but before the request
is processed, the request will be processed before the death proceeds are
determined. The interest rate will be the rate that is currently paid on
Guaranteed Payment Option 1, Interest Payments.
REPORTS TO OWNER
We will give You an annual report at least once each Contract Year. This report
will show the number and value of the accumulation units held in each of the
Subaccounts as well as the value of the Fixed Account. It will also give You the
Surrender Charges, Death Benefit and method of determining the Cash Value, and
any other facts required by law or regulation.
RB200 Page 23
Home Office: 000 Xxxxxxxxxxxxxx Xxxx
[LOGO] TRANSAMERICA LIFE INSURANCE Purchase, New York 10577-2135
COMPANY OF NEW YORK Administrative Office: 0000 Xxxxxxxx Xx XX
Xxxxx Xxxxxx, Xxxx 00000
INDEX
Page
Account Value ...................................................... 4
Accumulation Units ................................................. 9
Age or Sex Corrections ............................................. 22
Annuity Commencement Date .......................................... 22
Annuity Payments ................................................... 14
Account Value ...................................................... 4
Assignment ......................................................... 23
Beneficiary ........................................................ 23
Cash Value ......................................................... 5
Contract ........................................................... 22
Contract Data Page ................................................. 3
Death Proceeds ..................................................... 12
Definitions ........................................................ 2
Dollar Cost Averaging Option ....................................... 11
Evidence of Survival ............................................... 22
Fixed Account ...................................................... 10
Guaranteed Minimum Death Benefit ................................... 12
Guaranteed Return of Fixed Account Premium Payments ................ 8
Guaranteed Periods ................................................. 10
Incontestability ................................................... 22
Modification of Contract ........................................... 22
Non-participating .................................................. 22
Option to Change Annuity Commencement Date ......................... 22
Partial Withdrawals ................................................ 6
Payee .............................................................. 15
Payment of Premiums ................................................ 4
Payment Option Tables .............................................. 18, 19, 20, 21
Proof of Age ....................................................... 15
Protection of Proceeds ............................................. 23
Right to Cancel .................................................... 1
Rights of Owner .................................................... 22
Separate Account ................................................... 8
Service Charge ..................................................... 4
Settlement ......................................................... 22
Surrender Charges .................................................. 8
Transfers .......................................................... 10
Flexible Premium Deferred Variable Annuity, Income Payable At Annuity
Commencement Date
Benefits Based On The Performance Of The Separate Account Are
Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
Non-Participating
WE RESERVE THE RIGHT TO (I) REFUSE PREMIUM PAYMENTS TO THE FIXED ACCOUNT,
AND (II) PROHIBIT TRANSFERS TO THE FIXED ACCOUNT
Y851
