EXHIBIT 4
NATIONAL SECURITY
LIFE AND ANNUITY COMPANY [LOGO WILL PRINT HERE]
-------------------------
WE WILL PAY the benefits of this contract subject to its terms.
Our Home Office is at 000 Xxxxx Xxxxxx, Xxxxxxxxxx, Xxx Xxxx, 00000.
Our Administrative Office is at Xxx Xxxxxxxxx Xxx, Xxxxxxxxxx, Xxxx 00000.
SIGNATURES
[Will print here]
10 DAY RIGHT TO EXAMINE THE CONTRACT: You have a right to cancel this contract
within 10 days after you receive it. You may return it to us or to our agent for
any reason within those 10 days. We will refund an amount equal to the sum of
(1) and (2), where (1) is the difference between the premiums paid, including
any fees or other charges, and the amounts, if any, allocated to any separate
accounts under the contract and (2) is the cash value of the contract, or, if
the contract does not have a cash value, the reserve for the contract, on the
date of surrender attributable to the amounts so allocated.
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT MAY INCREASE OR
DECREASE ACCORDING TO THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT. BENEFITS
ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED-DOLLAR AMOUNT.
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Flexible Purchase Payments
Nonparticipating
Benefits Nontransferable
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 1
POLICY CONTENTS
PAGE
CONTRACT SPECIFICATIONS 3
Investment Subaccounts 4
DEFINITIONS 5
1940 Act 5
Age 5
Annuitant 5
Annuity Payout Date 5
Beneficiary 5
Betterment of Rate Amount 5
Code 5
IRA 5
Proof of Death 6
Subaccount 6
VAA 6
Valuation Period 6
We and You 6
GENERAL PROVISIONS 6
Contract 6
Ownership 7
Nontransferability 7
Beneficiary 7
Change of Beneficiary 8
General Account and VAA 8
Investments of VAA 8
Nonparticipating 8
Evidence of Sex, Age or Survival 8
Misstatement of Age or Sex 8
Incontestability 8
Contract Payments 9
Supplementary Agreement 9
Voting Rights 9
Reports 9
Notice 9
Individual Retirement Annuities 9
PURCHASE PROVISIONS 9
Purchase Payments 9
Allocation of Purchase Payments 10
VALUATION PROVISIONS 10
Contract Value 10
Fixed Accumulation Account 10
Dollar Cost Averaging Account 11
Variable Accumulation Account 11
Net Investment Factor 11
Splitting Units 12
Taxes 12
ACCUMULATION PERIOD PROVISIONS 12
Transfers Among Subaccounts and to
Fixed Accumulation Account 12
Transfers from the Fixed Accumulation
Account to VAA 13
Transfers from the Dollar Cost
Averaging Account 13
Portfolio Rebalancing 13
Surrender 14
Withdrawals 14
Deferral of Payment on Surrender,
Withdrawals and Loans 15
Deferred Premium Tax 15
Contingent Deferred Sales Charge 15
Waiver of Contingent Deferred Sales
Charge 15
Death Benefit During Accumulation
Period 16
Death of the Owner 16
Contract Administration Charge 17
SETTLEMENT PROVISIONS 17
General 17
Elections 17
Pension Plan 17
IRA Restrictions 18
Determination of Amount To Be Applied 18
Effect of Settlement on Accumulation
Units 18
Change of Annuity Payout Date 18
Annuity Payment Amounts 19
Annuity Unit Value 19
Change in Subaccount 19
Limitation on Availability of Options 19
Alternate Annuity Option 19
Betterment of Rate Amount 20
Death Benefit After the Annuity
Payout Date 20
Spendthrift Provision 20
Description of Annuity Options 20
Life Annuity Options 20
Joint and Survivor Life Annuity Options 21
ANNUITY OPTION TABLES 23
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 2
CONTRACT SPECIFICATIONS
Contract Number: [00000000] Contract Date: [05/01/1998 Annuitant's Date of Birth:
[05/01/1948]
Annuitant: [Xxxx Xxx]
Owner: [Xxxx Xxx]
Beneficiary: [Xxxx Xxx]
Contingent Beneficiary: [Xxxxx Xxx]
Initial Payment: [$5,000]
Additional Purchase Payments May Be Made. See PURCHASE PAYMENTS Section.
Annuity Payout Date: First Day of [May, 2010]
Type of Plan: [401(K)]
Riders:
[Optional Minimum Death Benefit Rider:
Charge: ______% Annually]
[Guaranteed Minimum Death Benefit Rider:
Charge: ______% Annually]
Charges:
Annual Contract Administration Charge: $30 (waived on anniversaries
where the Contract Value equals or exceeds $50,000)
Mortality and Expense Risk Charge: 1.15% Annually (.003133% Daily)
Administration Expense Charge: 0.25% Annually (.000684% Daily)
Transfer Fee: $10.00 per transfer (waived for the first 12 transfers in
any contract year)
With the combined annual subaccount charges for mortality and expense
risk assumptions and administration expense of 1.40%, the smallest rate
of investment return required to ensure that the dollar amount of the
variable annuity payments does not decrease is 4.40% for variable
annuity options based on the assumed interest rate (AIR) of 3%.
Table of Contingent Deferred Sales Charge Factors
------------------------ ------------------------
Year of Contingent Deferred
Purchase Payment Sales Charge Factors
------------------------ ------------------------
1st 7%
------------------------ ------------------------
2nd 7%
------------------------ ------------------------
3rd 7%
------------------------ ------------------------
4th and later 0%
------------------------ ------------------------
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 3
INVESTMENT SUBACCOUNTS
[OHIO NATIONAL FUND, INC.
Money Market Portfolio
Equity Portfolio
Bond Portfolio
Omni Portfolio
S&P 500 Index Portfolio
International Portfolio
International Small Company Portfolio
Capital Appreciation Portfolio
Discovery Portfolio
Aggressive Growth Portfolio
Growth & Income Portfolio
Capital Growth Portfolio
High Income Bond Portfolio Equity
Income Portfolio
Blue Chip Portfolio
Core Growth Portfolio
Nasdaq-100 Index Portfolio
XXXXXXX SERIES TRUST
Tactical Allocation Portfolio
XXXXXXX XXXXX VARIABLE INSURANCE TRUST
Xxxxxxx Xxxxx Growth and Income Fund
Xxxxxxx Xxxxx CORE U.S. Equity Fund
Xxxxxxx Xxxxx Capital Growth Fund
JANUS ASPEN SERIES (SERVICE SHARES)
Growth Portfolio
International Growth Portfolio
Worldwide Growth Portfolio
Balanced Portfolio
X. X. XXXXXX SERIES TRUST II
X. X. Xxxxxx Mid Cap Value Portfolio
X. X. Xxxxxx Small Company Portfolio
LAZARD RETIREMENT SERIES, INC.
Small Cap Portfolio
Emerging Markets Portfolio
MFS VARIABLE INSURANCE TRUST (SERVICE
CLASS)
MFS Investors Growth Stock Series
MFS Mid Cap Growth Series
MFS New Discovery Series
MFS Total Return Series
PBHG INSURANCE SERIES FUND
PBHG Technology & Communications
Portfolio
THE PRUDENTIAL SERIES FUND, INC.
Prudential Xxxxxxxx Portfolio
20/20 Focus Portfolio
SALOMON BROTHERS VARIABLE SERIES FUNDS
Capital Fund
Total Return Fund
Investors Fund
STRONG VARIABLE INSURANCE FUNDS
Strong Mid Cap Growth Fund II
Strong Opportunity Fund II
VARIABLE INSURANCE PRODUCTS FUND SERVICE
CLASS 2 (FIDELITY)
VIP Contrafund Portfolio
VIP Mid Cap Portfolio
VIP Growth Portfolio]
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 4
We will pay an Annuity starting on the Annuity Payout Date if the Annuitant is
then living. We will then apply the contract value under the SETTLEMENT
PROVISIONS of this contract.
We will make payments to the Beneficiary if the Annuitant dies while this
contract is in effect and before the Annuity Payout Date in accordance with the
Death Benefit During Accumulation Period provision of this contract.
This contract provides accumulation values and annuity payments on a variable
and/or fixed basis under one or more options as selected by you. The dollar
amount of the variable annuity payments and the variable portion of the contract
value will vary with the investment results of a Separate Account [(VAA)] which
we have established. However, we guarantee that the dollar amount of annuity
payments will not be affected by mortality experience after such payments have
commenced. We also guarantee that the expense charges will not be more than the
charges provided for in this contract. The dollar amount of fixed annuity
payments are guaranteed. In addition, we pay at least the guaranteed minimum
interest rate on the fixed portion of the contract.
Any paid-up annuity, cash surrender, or death benefit that may be payable under
this contract will not be less than the minimum benefits required by law in New
York.
DEFINITIONS
1940 ACT
The Investment Company Act of 1940, as amended, or any similar
successor federal legislation.
AGE
Except as otherwise noted, age shall refer to the person's age as of his or
her last birthday. Age as used in the Annuity Option Tables is age as of
nearest birthday.
ANNUITANT
The person (or persons, if a joint annuitant is chosen) so named on Page 3,
or any other natural person whose length of life measures annuity payments
that involve life contingencies.
ANNUITY PAYOUT DATE
The date shown on Page 3, or the date you later choose under the Change of
Annuity Payout Date provision of this contract, or any other date on which
annuity payments are to start.
BENEFICIARY
The person as designated by the Owner who is entitled to receive the
Contract Value of this contract if the Annuitant dies before the Annuity
Payout Date.
BETTERMENT OF RATE AMOUNT
The greater of the cash surrender benefit or 95% of what the cash surrender
benefit would be if there were no withdrawal charge.
CODE
The Internal Revenue Code as in effect on the Contract Date.
IRA
An Individual Retirement Annuity as defined in the Code.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 5
PROOF OF DEATH
Proof of Death is either:
(1) an original or a copy of a certified death certificate;
(2) an original or a copy of a certified decree of a court of
competent jurisdiction as to the finding of death with
reasonable verification that such certified decree has become
final; or
(3) other written proof satisfactory to us.
SUBACCOUNT
An investment Subaccount may be established within VAA. We reserve the
right to limit the number of Subaccounts in which you may invest provided
that we will not limit the number of Subaccounts in which you may invest to
less than 10 such Subaccounts.
VAA
An account [(Fund Name to be determined)] that consists of assets we have
set aside so that their investment results are kept separate from those of
our general assets.
VALUATION PERIOD
That period of time from one determination of accumulation unit and annuity
unit values to their next determination. Such values will be determined as
often as we choose to do so. This will occur at least once each week or as
often as required by the 1940 Act.
WE AND YOU
"We", "us" and "our" means National Security Life and Annuity Company.
"You" means the Owner of this contract.
GENERAL PROVISIONS
CONTRACT
Your purchase payment(s) and an application, if required, are the
consideration for this contract. If an application is submitted, a copy of
the application is attached. Your statements are to be considered
representations and not warranties. The contract, any riders, endorsements,
and any application, if applicable, are the entire agreement.
We are not a party to, nor are we bound by, any plan or trust in
conjunction with this contract. This contract is intended to qualify under
the Code for tax favored status. Any reference in this contract to tax laws
or rules is for your information and instruction only and such reference to
tax laws or rules is not subject to approval or disapproval by the state in
which the policy is issued for delivery. We make no representation or
warranty concerning whether this contract will qualify for tax favored
status nor concerning whether, if it does qualify for such tax favored
status, you will derive any tax benefit therefrom. You should ask your tax
advisor if you have any questions as to whether this contract qualifies for
tax favored status and whether, if it does, you derive any benefit
therefrom which would not otherwise be available to you.
This contract cannot be changed, nor our rights waived, except in a writing
signed by our president, vice president or secretary and attached to the
contract. READ YOUR CONTRACT CAREFULLY.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 6
We reserve the right to amend this contract as needed to maintain its
status as an annuity under the Internal Revenue Code. If this contract is
so amended we will send you a copy of the amendment, together with the
applicable regulation, ruling or other requirement imposed by the Internal
Revenue Service which requires such amendment.
OWNERSHIP
The Owner of this contract shall be the person so named on Page 3 of this
contract or the heirs, successors or transferees of such person. Any change
in the Ownership shall take effect on the date the Notice is signed by you
subject to receipt by us.
If a Joint Owner is named, the Joint Owner will possess an undivided
interest in the contract. The exercise of an ownership right in the
contract (including the rights to surrender the contract, to make
withdrawals from the contract or to change the Contract Owner, the
Contingent Owner, the Beneficiary or the Contingent Beneficiary, the
Annuity Payout Date or the Annuity Payout Option) shall require a written
request signed by both Joint Owners. Upon the death of a Joint Owner, the
remaining Joint Owner will become the sole Owner of the contract.
If a Contingent Owner is named, the Contingent Owner shall become the Owner
upon the death of the Owner, or upon the death of both Joint Owners where
there are Joint Owners. If more than one Contingent Owner survives the
Contract Owner, each will share equally unless otherwise specified in the
Contingent Owner designation.
If no Joint Owner or Contingent Owner survives the Contract Owner, all
rights and interests as the Owner of the Contract shall pass to the heirs,
successors or transferees of the last surviving Owner, Joint Owner or
Contingent Owner.
If this contract is an IRA, the Annuitant shall be the Owner while living.
The Annuitant's interest may not then be forfeited. The contract, if an
IRA, is for the sole benefit of the Annuitant and Beneficiaries.
You have the sole right, without the consent of the Beneficiary or any
other person, to exercise all contract rights. If this is a tax-qualified
contract, you can transfer ownership to a successor Owner only if such
successor Owner is (1) the Annuitant, (2) a trustee or successor trustee of
a pension or profit-sharing trust which is qualified under Section 401 of
the Code, or (3) the employer of the Annuitant provided that the contract
after transfer is maintained under the terms of a retirement plan qualified
under Section 403(a) of the Code for the benefit of the Annuitant. Exercise
of any ownership rights under this contract shall not take effect until we
receive notice.
NONTRANSFERABILITY
If this is a tax-qualified contract, you may not sell, assign, discount or
pledge this contract as collateral for a loan or to secure the performance
of any obligation or for any purpose to any person other than to us, to the
Annuitant, or to a trustee or other person exercising ownership rights
solely by reason of the terms of a pension or profit-sharing plan or trust
qualified under the Code.
You may not transfer this contract if it is an IRA, except to your spouse
incident to a divorce.
BENEFICIARY
The Beneficiary and any Contingent Beneficiary are named on Page 3, unless
changed. If the Beneficiary dies prior to the Annuitant's death, the
Contingent Beneficiary becomes the Beneficiary. Unless you have provided
otherwise, if there are two or more Beneficiaries, they will receive equal
shares. If there is no named Beneficiary or Contingent Beneficiary when the
Annuitant has died, you will be deemed to be the Beneficiary.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 7
CHANGE OF BENEFICIARY
Subject to the terms of any assignment, you may name a new Beneficiary or a
new Contingent Beneficiary by notice to us at any time during the lifetime
of the Annuitant. Any change in Beneficiary designation shall take effect
on the date the Notice is signed by you subject to receipt by us. Any new
choice of Beneficiary or Contingent Beneficiary will automatically revoke
any prior choice of Beneficiary or Contingent Beneficiary.
GENERAL ACCOUNT AND VAA
The General Account consists of all our assets other than those we allocate
to separate accounts.
The separate account to which the variable part of contract values and
variable annuity payments under this contract relate is VAA, which we have
established under New York law to provide variable benefits. We shall have
sole and complete ownership and control of all assets in VAA.
A portion of the assets in the VAA, equal to the contract reserves for such
account, shall not be chargeable with liabilities arising out of any other
business we may conduct.
INVESTMENTS OF VAA
All amounts credited to VAA will be used to purchase shares at net asset
value of open-end investment companies registered under the 1940 Act. The
available investment companies are referred to as "Funds" and shares of any
are referred to as "Fund shares". Any and all distributions made by a Fund,
in respect to Fund shares held by VAA, will be reinvested to purchase more
Fund shares in the same Subaccount at net asset value. Deductions and
withdrawals from VAA may be made by redeeming a number of Fund shares, at
net asset value, equal in total value to the amount to be deducted or
withdrawn. If deemed by us to be in the best interest of all contract
owners, VAA may be operated as a management company under the 1940 Act or
it may be deregistered under the 1940 Act if such registration is no longer
required.
If there is a substitution of Fund shares or change in operation of VAA, we
will issue an endorsement for the contract and take such other action as
may be necessary and appropriate to make the substitution or change.
You will be liable for any loss we suffer if we purchase Fund shares at
your direction and, thereafter, we are forced to liquidate such Fund shares
because the check or draft issued by you as a purchase payment is
dishonored by the bank on which it is drawn.
NONPARTICIPATING
This contract is nonparticipating. It will not share in our divisible
surplus.
EVIDENCE OF SEX, AGE OR SURVIVAL
Where any payment under this contract depends on the payee's sex, age or
survival on a given date, we may require proof thereof prior to making such
payment.
MISSTATEMENT OF AGE OR SEX
If the Annuitant's birth date or sex has been misstated, the benefits shall
be such as would have been provided based on the correct birth date and
sex. The amount of any over payments shall be charged against benefits to
be paid after we learn of a misstatement. The amount of any under payments,
accumulated at an annual effective interest rate of 6%, shall be added to
benefits to be paid after we learn of a misstatement.
INCONTESTABILITY
This Contract will not be contestable after it has been inforce, during the
Annuitant's lifetime, for two years from its Contract Date.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 8
CONTRACT PAYMENTS
All sums to be paid by us under this contract are payable at our
Administrative Office. We may require you to send us this contract as a
condition to any payment.
SUPPLEMENTARY AGREEMENT
As of the Annuity Payout Date, we may issue a supplementary agreement that
sets forth the terms of your annuity option.
VOTING RIGHTS
We will seek instructions for the voting of Fund shares held on account of
the variable part of your contract value or held in VAA, which represent
the actuarial liability for variable annuity payments being made. From time
to time, we will send you reports on the Fund, proxy material and a form
with which you may instruct us how to vote Fund shares.
After this contract has been effect for one year, you may also vote at our
annual meeting of policyholders as provided in our code of regulations and
New York law.
REPORTS
At least once each year after the first, we shall send you a statement
reporting the investments held in the separate account as well as amounts
held in the Fixed and Dollar Cost Averaging accounts. At least once each
year after the first contract year and before the Annuity Payout Date, we
shall send you a report of your contract values as of a date not more than
four months prior to the date of the mailing. The report will detail your
beginning and ending accumulation values.
You have the duty to review any confirmations or statements we send you and
to report promptly any discrepancy. We will not be responsible for any
losses or damages attributable to a discrepancy which is reflected on such
confirmations or statements unless you report the discrepancy in writing to
us within 30 days of the date of the confirmation or statement.
NOTICE
Any notice given under this contract must be in writing signed by you. The
notice will take effect when signed, subject to any payment made or action
taken by us before we receive the notice at our Administrative Office.
INDIVIDUAL RETIREMENT ANNUITIES
The Internal Revenue Service has approved the form of this contract as
meeting the Code requirements for an IRA. If this contract is an IRA, we
can change the contract in its approved form so as to keep its approval
under the Code or to comply with any change in the Code or rules under the
Code. Any such change shall be in writing, signed by us and mailed to you
at your address of record in our files. Any terms that relate to this
contract as an IRA shall be of no further effect if the contract is no
longer kept as a qualified IRA under the Code.
PURCHASE PROVISIONS
PURCHASE PAYMENTS
Purchase payments are payable to us at our Administrative Office or, with
respect only to the first purchase payment, to your registered
representative in exchange for a receipt signed by such registered
representative.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 9
The initial purchase payment is due on the contract date. You may make
subsequent purchase payments at any time before the Annuity Payout Date.
Each subsequent purchase payment must be at least $500. We reserve the
right to restrict subsequent purchase payments after the total amount of
all purchase payments exceeds $1,000,000. If this is an IRA, purchase
payments may not be more than the maximum amount allowed by law for an IRA.
We reserve the right to limit the number of purchase payments allocated in
any year to the Dollar Cost Averaging Account.
ALLOCATION OF PURCHASE PAYMENTS
Each purchase payment, less an amount for any applicable premium or similar
tax (net purchase payment), will be allocated to up to ten Subaccounts
within the separate account plus the Fixed Accumulation and Dollar Cost
Averaging Accounts within the General Account in accordance with the
allocation percentages specified by you or as later changed by you.
Such change shall take effect with the first purchase payment received
after the date you ask such change to take effect or, if later, as of the
end of the Valuation Period during which we receive such change request at
our Administrative Office.
VALUATION PROVISIONS
CONTRACT VALUE
The Contract Value for any Valuation Period equals the sum of the Fixed
Accumulation Account and Dollar Cost Averaging Account values as of the end
of the Valuation Period and the Variable Accumulation Account value for the
Valuation Period.
FIXED ACCUMULATION ACCOUNT
The Fixed Accumulation Account is established within the General Account.
Prior to the Annuity Payout Date, the Fixed Accumulation Account value will
be:
(1) the net purchase payments allocated to the Fixed Accumulation Account;
plus
(2) any amounts, net of fees, transferred from VAA to the Fixed
Accumulation Account; plus
(3) accumulated interest; less
(4) any amounts withdrawn from the Fixed Accumulation Account (along with
any applicable Contingent Deferred Sales Charge) to pay benefits,
contract administration charges and any applicable charges for riders
to this contract; less
(5) any amounts, plus any associated fees, transferred from the Fixed
Accumulation Account to the Variable Accumulation Account; less
(6) any amounts applied to effect an annuity option under the SETTLEMENT
PROVISIONS.
We will declare annual effective interest rates to be applied to purchase
payments and transfers to the Fixed Accumulation Account. No annual
effective interest rate declared by us will be less than 3.00%. Once
established for a purchase payment or transfer, an interest rate shall
remain in effect for a guarantee period which shall not be less than one
year. After a guarantee period expires we will declare an interest rate for
a subsequent guarantee period.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 10
DOLLAR COST AVERAGING ACCOUNT
The Dollar Cost Averaging Account is established within the General
Account.
Prior to the Annuity Payout Date, the Dollar Cost Averaging Account value
will be:
(1) the net purchase payments allocated to the Dollar Cost Averaging
Account; plus
(2) accumulated interest; less
(3) any amounts withdrawn from the Dollar Cost Averaging Account
(along with any applicable Contingent Deferred Sales Charges) to pay
benefits, contract administration charges, and any applicable charges
for riders to this contract; less
(4) any amounts, plus any associated fees, transferred from the
Dollar Cost Averaging Account to the Variable Accumulation Account;
less
(5) any amounts, plus any associated fees, transferred from the
Dollar Cost Averaging Account to the Fixed Accumulation Account;
less
(6) any amounts in the Dollar Cost Averaging Account applied to
effect an annuity option under the SETTLEMENT PROVISIONS.
Relative to each purchase payment allocated to the Dollar Cost Averaging
Account, we will declare an annual effective interest rate that shall remain in
effect for the 12 month averaging period. Such rate shall not be less than
3.00%. In addition, we may declare alternative interest rates for purchase
payments allocated to the Dollar Cost Averaging Account which will remain in
effect for different periods of time.
VARIABLE ACCUMULATION ACCOUNT
We will credit this contract's Variable Accumulation Account with variable
accumulation units in relation to the amount of each net purchase payment
allocated to each Subaccount. To find the number of variable accumulation
units credited to each Subaccount, divide the amount allocated to that
Subaccount by the variable accumulation unit value of that Subaccount for
the Valuation Period during which the purchase payment is received at our
Administrative Office.
The value of each variable accumulation unit was set when the first
purchase payment was allocated to each Subaccount. The value of a variable
accumulation unit for each Subaccount varies for each later Valuation
Period. Such value is found by multiplying the value of a variable
accumulation unit of that Subaccount for the immediately preceding
Valuation Period by the net investment factor for the Subaccount for the
Valuation Period for which the variable accumulation unit value is being
determined. The value of a variable accumulation unit for any Valuation
Period is determined as of the end of such Valuation Period.
The Variable Accumulation Account value for a Valuation Period equals the
number of variable accumulation units credited to the Variable Accumulation
Account multiplied by the value of each such accumulation unit for that
Valuation Period.
NET INVESTMENT FACTOR
The net investment factor for a Subaccount is found by dividing (a) by (b),
then subtracting (c) from the result, where
(a) is
(1) the net asset value of a Fund share in that Subaccount
determined as of the end of a Valuation Period, plus
(2) the per share amount of any dividends or other distribution
declared by the Fund (as of the ex-dividend date, i.e.,
the date as of which dividends on Fund shares have been paid
out to owners of record) during the Valuation Period, adjusted by
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 11
(3) a per share charge or credit with respect to any taxes paid or
reserved for, which we determine to be attributable to the
maintenance or operation of the Subaccount;
(b) is the net asset value of a Fund share in that Subaccount, adjusted
by a per share credit or charge for any taxes reserved for or paid,
determined as of the end of the prior Valuation Period; and
(c) is
(1) a charge for mortality and expense risk assumptions at an
effective rate per year as shown on Page 3, plus
(2) an administration expense charge per year as shown on Page 3 for
the number of days in such Valuation Period.
The total charge for risks and administration expenses is shown on Page 3.
We guarantee that these charges will not be adversely affected by expense
and/or mortality results.
SPLITTING UNITS
We reserve the right to split (or reverse split) the value of the variable
accumulation units or the annuity units. In any such split of unit values,
strict equity will be preserved. Such a split will have no material effect
on the benefits or other terms of this contract. A split may either
increase or decrease the number of such units.
TAXES
Any taxes that pertain to this contract or VAA will be charged against the
contract value when incurred or reserved for by us.
ACCUMULATION PERIOD PROVISIONS
TRANSFERS AMONG SUBACCOUNTS AND TO FIXED ACCUMULATION ACCOUNT
By notice to us, you may transfer the value of any number of accumulation
units from one set of Subaccounts to another set of Subaccounts or to the
Fixed Accumulation Account at any time. The dollar amount transferred from
any Subaccount must be at least $300, but the entire value of a Subaccount
or the Fixed Accumulation Account may be transferred if less than $300.
Such transfers shall be made as of the end of the Valuation Period during
which we receive the request at our Administrative Office or at the end of
any later Valuation Period as you may request. A fee of not more than $10
will be charged for each transfer. The first 12 transfers in any contract
year will not be assessed a transfer fee.
In addition to our other rights to limit the number, frequency, method or
amount of transfers, transfers from any Subaccount on any one day may be
limited to 1% of the previous day's total net assets of that portfolio if
we or the Fund, in the discretion of either or both, believes that the
portfolio might otherwise be damaged.
If and when transfers must be so limited, some transfer requests will not
be granted. In determining which requests will be granted, scheduled
transfers will be made first, followed by mailed written requests in the
order postmarked and lastly, facsimile requests in the order received.
Owners whose requested transfers are not made will be so notified.
Currently The Securities Exchange Commission's (SEC) rules preclude us from
processing at a later date those requested transfers that were not made.
Accordingly, a new transfer request would have to be submitted in order to
make a transfer that was not made because of these limitations.
No transfers are allowed to the Dollar Cost Averaging Account.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 12
The right to make transfers between Subaccounts is subject to modification
if we determine, in our opinion, that exercising that right by one or more
Owners is, or would be, to the disadvantage of other Owners. Any
modification could be applied to transfers to or from some or all of the
Subaccounts and could include, but not be limited to:
(1) the requirement of a minimum time period between each transfer;
(2) not accepting transfer requests of an agent acting under a power
of attorney or on behalf of more than one Owner, or
(3) limiting the dollar amount that may be transferred between the
Subaccounts by an Owner at any one time.
Such restrictions may be applied in any manner reasonably designed to
prevent any use of the transfer right which is considered by us to be to
the disadvantage of other Owners.
TRANSFERS FROM THE FIXED ACCUMULATION ACCOUNT TO VAA
You may transfer account value amounts between the Fixed Accumulation
Account and the Separate Account. Transfers will be effective on the date
we receive your request at our Administrative Office.
With respect to transfers between the Fixed Accumulation Account and the
Separate Account, we reserve the right to impose the following
restrictions:
- For each allocation to the Fixed Accumulation Account, transfers
to the Separate Account may be made only during the 30-day period
following the end of that allocation's interest rate guarantee
period. We may limit the amount that you can transfer during that
time, to 20% of the value of the Fixed Accumulation Account as of
the beginning of the contract year.
- No transfers from the Separate Account to the Fixed Accumulation
Account or the Money Market Subaccount may be made during the
six-month period following the transfer of any amount from the
Fixed Accumulation Account to the Separate Account.
In all other respects, the rules and charges applicable to transfers
between the Subaccounts of the Separate Account will apply to transfers
involving the Fixed Accumulation Account. No transfers to the Dollar Cost
Averaging Account are allowed.
TRANSFERS FROM THE DOLLAR COST AVERAGING ACCOUNT
SCHEDULED TRANSFERS
Relative to each deposit allocated to the Dollar Cost Averaging Account, a
schedule of equal transfers to the available variable Subaccounts will be
set according to your specifications. The schedule will be for no more than
twelve and no less than three transfers (the first occurring one month or
one quarter, as applicable, after the purchase payment).
UNSCHEDULED TRANSFERS
You may make an unscheduled transfer from the Dollar Cost Averaging
Account, but only to the Fixed Accumulation Account, and only for the full
amount in the Dollar Cost Averaging Account.
In all other respects, the rules and charges applicable to transfers
between the Subaccounts of the Separate Account will apply to transfers
involving the Dollar Cost Averaging Account.
PORTFOLIO REBALANCING
The transfer charge does not apply to portfolio rebalancing transactions.
You may have us automatically transfer amounts on a quarterly, semi-annual
or annual basis to maintain a specified percentage (whole percentages only)
of contract value in each of two or more designated Funds. The purpose of a
portfolio
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 13
rebalancing strategy is to maintain, over time, your desired allocation
percentage in the designated Funds having differing investment performance.
Portfolio rebalancing will not necessarily enhance future performance or
protect against future losses.
The transfer charge does not apply to portfolio rebalancing transactions.
These transactions do not count against the free transfer you are allowed
once each calendar month. You may not have portfolio rebalancing for any
Funds that are part of a DCA program.
SURRENDER
You may surrender this contract and receive its surrender value upon notice
received by us at any time at or prior to the earlier of: (1) the Annuity
Payout Date or (2) the death of the Annuitant. The surrender value is the
contract value less: (1) a charge for any applicable premium taxes not
previously deducted, (2) the contract administration charge, (3) any
charges due as the result of riders affecting this contract and (4) the
Contingent Deferred Sales Charge, if any. See DEFERRED PREMIUM TAX. For
this purpose, except as noted below, the Contract Value will be for the
next Valuation Period after we receive the surrender request in good order
at our Administrative Office. At that time, all variable accumulation units
will be cancelled. The surrender value from the Separate Account will be
paid within ten days of the surrender request in good order. We reserve the
right to establish reasonable requirements for what constitutes good order
for purposes of a surrender request.
We reserve the right to defer payment of any surrender proceeds from the
General Account for up to six months from the date we receive the surrender
request in good order. If payment of the surrender proceeds is deferred by
more than ten working days, interest will be paid at an annual rate not
less than our current interest rate.
WITHDRAWALS
We have the right to limit you to 12 monthly scheduled, fixed-amount
withdrawals per contract year and/or 2 unscheduled withdrawals of any
amount per contract year. A withdrawal cannot be less than $300 and cannot
be greater than the amount that would cause the contract value to fall
below $5,000. We will pay to you the amount of a withdrawal less the
appropriate Contingent Deferred Sales Charge, if any. Withdrawals will
reduce the contract value by the amount withdrawn including any applicable
Contingent Deferred Sales Charges. Withdrawals from the Dollar Cost
Averaging Account are not allowed. You may tell us how much to deduct from
each Subaccount and the Fixed Accumulation Account. If you do not, the
withdrawal will be deducted from each Subaccount in the same proportion
that the Subaccount's or the Fixed Accumulation Account's value bears to
the total Contract Value on the date we receive your request in our
Administrative Office provided that we will not consider any amount in the
Dollar Cost Averaging Account when allocating a withdrawal among
subaccounts. See DEFERRED PREMIUM TAX.
Withdrawals from the Fixed Accumulation Account will be taken on a
"first-in-first-out" basis. That is, withdrawals will be taken first from
any remaining portion of the total contract value resulting from the
earliest purchase payment. Once the value resulting from any purchase
payment has been reduced to zero, remaining amounts withdrawn shall reduce
the value resulting from the earliest of the remaining purchase payments.
This process shall continue until the withdrawal is completed. The amount
so withdrawn shall be paid within 7 days of receipt of your notice (or
later if allowed by law). For amounts withdrawn from VAA, we will cancel
the number of variable accumulation units from the appropriate Subaccount
which, when multiplied by the corresponding variable accumulation unit
values for the next Valuation Period after the notice was received by us,
equals that portion of the dollar amount of the withdrawal, plus any
applicable Contingent Deferred Sales Charge taken.
If the amount of a requested withdrawal plus any applicable Contingent
Deferred Sales Charge exceeds the values in all other Subaccounts and the
Fixed Accumulation Account other than the Dollar Cost Averaging Account, we
will attempt to contact you to determine whether you wish us to process the
withdrawal as requested and, if so, how you want the contract values in the
Dollar Cost Averaging Account to be reallocated. Prior to such a withdrawal
being processed, all contract values in the Dollar Cost Averaging Account
must be
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 14
transferred to one or more Subaccounts or the Fixed Account. If we are not
able to contact you or you do not indicate to us that you (1) want to
cancel the pending withdrawal, or (2) how you want to reallocate the
contract values in the Dollar Cost Averaging Account, within three business
days of the date of the original withdrawal request, we will allocate all
of the contract values in the Dollar Cost Averaging Account to the
Subaccounts to which such contract values were to be allocated based upon
your pending allocation instructions for the Dollar Cost Averaging Account.
A withdrawal request which requires us to use values in the Dollar Cost
Averaging Account will not be considered in good order until the earlier of
(1) the day we receive instructions from you as to how to reallocate the
contract values in the Dollar Cost Averaging Account or (2) three business
days after we received the withdrawal request. Once the withdrawal request
is in good order, we will allocate the withdrawal amount and any applicable
Contingent Deferred Sales Charge among the account values for the
Subaccounts and the Fixed Account based upon those values as of the next
process date.
We have the right to defer payment of any Surrender or Withdrawal which is
derived from any amount recently paid to us by check or draft until we are
satisfied the check or draft has been paid by the bank on which it is
drawn.
DEFERRAL OF PAYMENT ON SURRENDER, WITHDRAWALS AND LOANS
We may defer the calculation and payment of accumulation values or benefits
if: (1) the New York Stock Exchange is closed or trading on the New York
Stock Exchange is restricted as determined by the Securities and Exchange
Commission; (2) the Commission by order permits postponement for the
protection of contract owners; or (3) an emergency exists, as determined by
the Securities and Exchange Commission, as a result of which disposal of
securities is not reasonably practicable or it is not reasonably
practicable to determine the value of the net assets of VAA.
DEFERRED PREMIUM TAX
If we paid a tax on a purchase payment and did not previously deduct the
tax, then we may deduct it at the time of surrender or on the Annuity
Payout Date.
CONTINGENT DEFERRED SALES CHARGE
We can make a Contingent Deferred Sales Charge if this contract is
surrendered or a withdrawal is made. Withdrawals in a contract year that do
not exceed the free out amount are not subject to a charge. The free out
amount is 10% of the contract value as of the first withdrawal of the
contract year less all amounts previously withdrawn during the contract
year that were not subject to a charge. Withdrawals within a contract year
in excess of the free out amount may be subject to a charge. The amount
subject to a charge is the total purchase payments, less the total of all
withdrawal amounts previously allocated to purchase payments, but not less
than zero.
The Contingent Deferred Sales Charge will be the applicable percentage(s)
of the amount subject to a charge. For purposes of determining the
applicable percentage(s), withdrawal amounts will be allocated to remaining
purchase payments in the order that the purchase payments were received.
Remaining purchase payments are the original purchase payments less the
amount of any withdrawal previously allocated to them. The applicable
percentages for each purchase payment is found on the Contract
Specification page in the Table of Contingent Deferred Sales Charge
Factors. The percentages are based on the duration of the purchase payment
at the time of withdrawal.
WAIVER OF CONTINGENT DEFERRED SALES CHARGE
We will waive the Contingent Deferred Sales Charge otherwise applicable to
a full surrender or one or more withdrawals occurring before income
payments begin if:
(1) the Annuitant is, or has been confined to a state licensed or
legally operated hospital or inpatient nursing facility for at
least 30 consecutive days; and
(2) such confinement begins at least one year after the contract
date; and
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 15
(3) the Annuitant was age 80 or younger on the contract date; and
(4) the request for the surrender or withdrawal, together with proof
of such confinement, is received in the Administrative Office
while the Annuitant is confined or within 90 days after discharge
from the facility.
DEATH BENEFIT DURING ACCUMULATION PERIOD
DEATH BENEFIT ADJUSTMENT
If the Annuitant dies prior to the Annuity Payout Date, while this
contract is in force, we will make the Death Benefit Adjustment, if
any, when we receive Proof of Death. The Death Benefit Adjustment will
be equal to the excess, if any, of the highest guaranteed death benefit
under the contract or any applicable rider as of the Annuitant's death
over the Contract Value as of the next Valuation Period immediately
following the Annuitant's death. On the day of the next Valuation
Period after we receive Proof of Death of the Annuitant, we will add
the amount of the Death Benefit Adjustment to the Contract Value and
purchase units in the Money Market Subaccount with the amount of the
Death Benefit Adjustment, where it will remain until we receive
different investment instructions from the Beneficiary. If the Contract
Value on the actual date of the Annuitant's death exceeds the highest
guaranteed death benefit under the contract or any applicable rider,
then there is no Death Benefit Adjustment.
After we have made the Death Benefit Adjustment, we will not have any
further liability for any guaranteed death benefit under this contract
or any applicable rider, provided that, if the Beneficiary is a spouse
of the Annuitant and he or she elects option (4) described below and,
as a result, continues the contract as the Owner and the Annuitant, the
contract will be eligible for another Death Benefit Adjustment upon
that spouse's death.
SETTLEMENT OPTIONS
The Beneficiary may, by written notice, elect to:
(1) surrender the contract without a Contingent Deferred Sales Charge
within the earlier of 120 days after the Annuitant's death, or 60
days after we receive proof of death; or
(2) surrender the contract for the surrender value within 5 years of
the Annuitant's death; or
(3) settle the contract for annuity payments over the life of the
Beneficiary or over a period not exceeding the Beneficiary's life
expectancy within 12 months of the Annuitant's death; or
(4) continue the contract as the Annuitant and the Owner if the
Beneficiary is the Annuitant's surviving spouse; or
(5) make any other settlement to which we agree.
In the event that the Beneficiary fails to elect any of the
above-described options within 5 years of the Annuitant's death, we
will pay the Surrender Value under option (2) above.
Where there is more than one Beneficiary, all of the Beneficiaries must
agree on the same settlement option. If we do not receive an election
of a settlement option approved by all the beneficiaries before the
earlier of: (1) 121 days after the Annuitant's death or (2) 61 days
after we receive the Proof of Death, the contract will automatically be
surrendered for its surrender value at that time or upon our receipt of
Proof of Death, if later.
Contract riders and any charges therefor terminate upon the Annuitant's
death, except where the Beneficiary is the Annuitant's surviving spouse
and such surviving spouse elects to continue the contract as the
Annuitant and the Owner.
DEATH OF THE OWNER
If you die before the Annuity Payout Date, and before the death of the
Annuitant and there is no Joint Owner living at the time of your death, (or
the Joint Owner is not your surviving spouse) either:
(1) the entire interest in the contract must be distributed within
five years of the date of your death; or
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 16
(2) within 12 months of your death, the Contract Value must be
annuitized over the life expectancy of the person who becomes the
new owner of the contract or over a period not extending beyond
the life expectancy of such person; or
(3) if your surviving spouse becomes the Owner of the contract, the
contract may be continued in the name of the spouse as the
contract Owner.
CONTRACT ADMINISTRATION CHARGE
Prior to the Annuity Payout Date, on each contract anniversary and upon
surrender, we will deduct from the contract value an annual contract
administration charge of $30 to defray our administrative expenses for this
contract if the contract value at that time is less than $50,000. If, on
the anniversary, the contract value equals or exceeds $50,000, we will not
deduct the contract administration charge.
The contract administration charge and any charges for contract riders will
be deducted from the Variable Accumulation Account and the Fixed
Accumulation Account in proportion to the total contract value in those
accounts, respectively. The amount of the charge deducted from the Fixed
Accumulation Account will be made on a "first-in-first-out" basis.
We will cancel the number of variable accumulation units from the
appropriate Subaccounts which, when multiplied by the corresponding
variable accumulation unit values for the valuation period in which the
charge is taken, equals that portion of the charge taken from VAA.
If any portion of the annual contract administration charge is made from
the Fixed Accumulation Account, or Dollar Cost Averaging Account such
portion shall not exceed the sum of (a) and (b), where
(a) is the total amount of net purchase payments allocated to the
account during the contract year; and
(b) is the interest credited to the account during the contract year
that exceeds the minimum guaranteed interest.
SETTLEMENT PROVISIONS
GENERAL
On the Annuity Payout Date, the contract value shall be applied under one
or more of the annuity options shown below or under such other option to
which we may agree.
Unless otherwise specified, the first annuity payment will be apportioned
to the General Account and each Subaccount in the same proportions that
each bears to the total contract value as of the day we credit your annuity
units.
ELECTIONS
You must give us written notice in order to elect an annuity option or
revoke or change such an election. If no such election is in effect on the
Annuity Payout Date, and if the Annuitant is then living, the Contract
Value will be applied under Life Annuity Option (3) as an annuity payable
to the Annuitant. The variable part of the contract value will be used to
provide a variable annuity and the fixed part will provide a fixed annuity
unless you elect otherwise. The Beneficiary will be the payee for any
remaining period certain installments are to be paid after the Annuitant's
death unless this contract is issued pursuant to a tax qualified pension
plan, in which case the following provision will control.
PENSION PLAN
If: (a) this contract is issued pursuant to a tax qualified pension plan;
(b) no election is in effect on the Annuity Payout Date; and (c) the
Annuitant is living on the Annuity Payout Date, then the Contract Value
will be applied as follows:
(1) If the Annuitant is married as of the Annuity Payout Date, the
Contract Value will be applied to provide equal payments under
Joint and Survivor Life Annuity Option (2) with the Annuitant's
spouse as the Joint Annuitant.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 17
(2) If the Annuitant is not married as of the Annuity Payout Date,
the Contract Value will be applied under Life Annuity Option (3)
and paid to the Annuitant with the Beneficiary as payee for any
period certain payments to be made after the Annuitant's death.
IRA RESTRICTIONS
If this contract is an IRA, the Annuitant's entire interest will be paid to
him or her (1) not later than the close of the tax year in which the
Annuitant attains age seventy and one-half years, or (2) in installments
that are equal except for any adjustments due to earnings or losses in the
contract. Such installments will be made (a) for the life of the Annuitant,
(b) for a term certain period that does not last past the life expectancy
of the Annuitant (and the Annuitant's spouse, if applicable) determined
under Regulations issued by the Internal Revenue Service or (c) in
installments recalculated annually according to Regulations issued by the
Internal Revenue Service. If the Annuitant's entire interest is to be
distributed in installments beginning in the year the Annuitant attains age
seventy and one-half years, then the annual payments must be at least the
lesser of: (a) the balance of the Annuitant's interest or (b) an amount
determined by dividing (i) the Annuitant's entire interest at the beginning
of each year (including amounts not in the IRA at the beginning of the year
because they have been withdrawn so as to make a rollover contribution to
another IRA) by (ii) the life expectancy of the Annuitant (or of the
Annuitant and his or her spouse, if applicable) as of the date the
Annuitant attains age seventy, such expectancy being reduced by the number
of whole years that have elapsed since the Annuitant attained age seventy
and one-half years.
If the Annuitant dies while there are additional amounts due under the
contract, or if payments have begun to the Annuitant's surviving spouse and
such spouse dies while there are additional amounts due under the contract,
the entire interest (or any such interest that is left if payments have
begun) will, within 5 years after the Annuitant's death (or the death of
the surviving spouse) be (a) paid to the Beneficiary or Beneficiaries, (b)
be applied to purchase an immediate annuity for the Beneficiary or
Beneficiaries, or (c) be paid in annual distributions over the life
expectancy or in installments payable over a term certain period that does
not last past the life expectancy of the Beneficiary or Beneficiaries
determined under Regulations issued by the Internal Revenue Service. Any
immediate annuity will be payable for the life of the Beneficiary or
Beneficiaries (or for a term that does not last beyond their life
expectancy). This paragraph does not apply if term certain payments began
before the Annuitant's death and the term certain is for a period allowed
in the prior paragraph.
Notwithstanding the foregoing, Internal Revenue Service Regulations
regarding aggregation of IRAs for purposes of minimum required distribution
calculations shall be applicable to this contract.
DETERMINATION OF AMOUNT TO BE APPLIED
The Contract Value to be applied to provide an annuity shall be determined
at the end of a Valuation Period, selected by us and uniformly applied,
which is not more than 10 Valuation Periods before the Annuity Payout Date.
The fixed part of the contract value used to provide a fixed annuity will
be determined as of the Annuity Payout Date. Any applicable premium tax
will be deducted at this time, if it was not deducted earlier.
EFFECT OF SETTLEMENT ON ACCUMULATION UNITS
When this contract is settled, its Variable Accumulation Units will be
cancelled.
CHANGE OF ANNUITY PAYOUT DATE
You may change the annuity payout at any time prior to the earlier of (1)
the Annuitant's death or (2) the Annuity Payout Date by notice to us. But,
unless we agree, the Annuity Payout Date may not be later than the first
day of the month following the Annuitant's 90th birthday. In any event, the
Annuity Payout Date must be the first day of a month and must be at least
30 days after the date we receive notice of a change of date.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 18
ANNUITY PAYMENT AMOUNTS
VARIABLE ANNUITIES
The dollar amount of the first periodic variable annuity payment shall
be derived from the annuity option tables in this contract or any other
option table to which both we and the Annuitant agree for the sex(es)
and age(s) of the Annuitant and Joint Annuitant, if any, on the Annuity
Payout Date. The dollar amount of each variable annuity payment after
the first will be measured by annuity units. The number of annuity
units of each Subaccount to be credited to this contract is determined
by dividing that part of the first variable annuity payment apportioned
to each Subaccount by the annuity unit value of that Subaccount for the
Valuation Period used to determine the contract value for settlement of
this contract under these SETTLEMENT PROVISIONS. The dollar amount of
each variable annuity payment after the first is equal to the number of
annuity units credited to this contract multiplied by the annuity unit
value of the applicable Subaccount for the Valuation Period, selected
by us and uniformly applied, which is not more than 10 Valuation
Periods before the due date of each such payment.
FIXED ANNUITIES
The dollar amount of each periodic fixed annuity payment shall be
derived from the annuity option tables for the sex(es) and age(s) of
the Annuitant and Joint Annuitant, if any, on the Annuity Payout Date.
ANNUITY UNIT VALUE
The value of an Annuity Unit for each Subaccount was set when the first
annuity payment was made from each Subaccount for this class of contracts.
To determine the Annuity Unit value for each later Valuation Period, (a)
multiply the Annuity Unit value for that Subaccount for the immediately
prior Valuation Period by the Net Investment Factor for that Subaccount for
such later Valuation Period, and then (b) multiply the product by a factor
to neutralize the annual interest rate assumed in the annuity option tables
used. For an assumed interest rate of 3%, the factor for a one-day
Valuation Period is .9999190.
CHANGE IN SUBACCOUNT
After variable annuity payments have been made for at least 12 months, you
may, no more than once each 12 months, change all or part of the investment
upon which your variable annuity payments are based from one Subaccount to
another. To do this, we will convert the number of Annuity Units being
changed to the number of Annuity Units of the Subaccount to which you are
changing so as to result in the next variable annuity payment being of the
same amount that it would have been without the change. After that,
variable annuity payments will reflect changes in the values of your new
Annuity Units. You must give us notice at least 30 days before the due date
of the first variable annuity payment to which the change will apply.
LIMITATION ON AVAILABILITY OF OPTIONS
If the Joint Annuitant is not related to the Annuitant, you may not elect
Joint and Survivor Life Annuity Option 2 unless we consent and then only
if, based upon life expectancies, less than 50% of the amount so applied
would accrue to the Joint Annuitant.
If the amount to be applied under any annuity option is less than $2,000,
such option shall not be available. Settlement shall than be in a single
sum. If the first periodic payment to a payee would be less than $20, we
may pay less often so that such payment will be at least $20.
ALTERNATE ANNUITY OPTION
Instead of the variable annuities provided under this contract, you may
choose an alternate amount and type of periodic installments for fixed
annuity payments. Such alternate annuity options shall be based on the
rates for fixed dollar Single Premium Immediate Annuities being issued by
us on the Annuity Payout Date. They may only be elected within 30 days
before that date.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 19
Any withdrawal of part or all of the contract value for settlement under an
alternate annuity option will be exempt from any otherwise applicable
Contingent Deferred Sales Charge if at least one of the following
conditions is met:
(1) If withdrawal is before the end of the second contract year, the
annuity income must be payable for the lifetime of the Annuitant
and Joint Annuitant, if any.
(2) If withdrawal is during the third through fifth contract years,
the annuity income must be payable over a period of not less than
ten years, or payable over the lifetime of the Annuitant and Joint
Annuitant, if any.
(3) If withdrawal is after the fifth contract year, the annuity income
must be payable over a period of not less than five years or
payable over the lifetime of the Annuitant and Joint Annuitant, if
any.
BETTERMENT OF RATE AMOUNT
The annuity benefits, at the time of their commencement, will not be less
than those that would be provided by the application of the Betterment of
Rates Amount to purchase any single consideration immediate annuity
contract offered by us at the time of the same class of annuitants.
DEATH BENEFIT AFTER THE ANNUITY PAYOUT DATE
If the Annuitant dies after the Annuity Payout Date, any death benefit
payable will be in accordance with the annuity option chosen.
SPENDTHRIFT PROVISION
Except as otherwise provided in this contract (or in any supplementary
contract issued in exchange for it), an Annuitant or Beneficiary may not
commute, anticipate, assign or otherwise encumber any amounts to be paid in
settlement of this contract. To the extent allowed by law, no such amount
shall be subject to any legal process in payment of any claim against an
Annuitant or Beneficiary.
DESCRIPTION OF ANNUITY OPTIONS
All of these options may be on a fixed or variable annuity basis or both.
LIFE ANNUITY OPTIONS
(1) NONREFUND. We will make payments during the lifetime of the
Annuitant. No payments are due after the death of the Annuitant.
(2) 5-YEARS CERTAIN. We will make payments for 5 years and after that
during the lifetime of the Annuitant. No payments are due after
the death of the Annuitant or, if later, the end of the 5-year
period certain.
In the event that payments under the Settlement Options are the
same for different periods certain than the longest period
certain with the payment amount will be deemed to have been
chosen. If no Settlement Option has been chosen, the 5-Years
Certain Option will be applied by default.
(3) 10-YEARS CERTAIN. We will make payments for 10 years and after
that during the lifetime of the Annuitant. No payments are due
after the death of the Annuitant or, if later, the end of the
10-year period certain.
(4) INSTALLMENT REFUND. We will make payments for a period certain
and after that during the lifetime of the Annuitant. No payments
are due after the death of the Annuitant or, if later, the end of
the period certain. The number of period certain payments is
equal to the amount applied under this installment refund option
divided by the amount of the first annuity payment; provided,
however, that the amount of the final period certain payment
shall be multiplied by that part of the preceding quotient which
is not an integer.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 20
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 22
JOINT AND SURVIVOR LIFE ANNUITY OPTIONS
(1) JOINT AND SURVIVOR NONREFUND. We will make payments during the
joint lifetime of the Annuitant and Joint Annuitant. Payments
will then continue during the remaining lifetime of the survivor
of them. No payments are due after the death of the last survivor
of the Annuitant and Joint Annuitant.
(2) JOINT AND SURVIVOR WITH 10-YEARS CERTAIN. We will make payments
for 10 years and after that during the joint lifetime of the
Annuitant and Joint Annuitant. Payments will then continue during
the remaining lifetime of the survivor of them. No payments are
due after the death of the survivor of the Annuitant and Joint
Annuitant or, if later, the end of the 10-year period certain.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 21
ANNUITY OPTION TABLES
Date of Birth
(1939 and Before)
Installments shown are for a monthly payment for each $1,000 of Contract Value
applied under an option. Age, as used in these tables, is age as of nearest
birthday. Rates of monthly payments for ages and periods certain not shown, if
allowed by us, will be based on an actuarially equivalent basis. To determine
annual, semi-annual, or quarterly installments, multiply the amounts shown by
11.64, 5.92 or 2.98; respectively.
OPTION 1: LIFE INCOME
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
AGE AND SEX AGE AND SEX
OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT
MALE REFUND CERTAIN CERTAIN REFUND FEMALE REFUND CERTAIN CERTAIN REFUND
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
51 $4.15 $4.14 $4.11 $3.99 51 $3.89 $3.88 $3.87 $3.79
52 4.22 4.21 4.18 4.05 52 3.95 3.94 3.93 3.84
53 4.30 4.29 4.25 4.11 53 4.01 4.01 3.99 3.90
54 4.38 4.37 4.33 4.18 54 4.08 4.08 4.06 3.96
55 4.46 4.45 4.41 4.25 55 4.15 4.15 4.13 4.02
56 4.55 4.54 4.49 4.32 56 4.23 4.22 4.20 4.08
57 4.65 4.63 4.58 4.39 57 4.31 4.30 4.28 4.15
58 4.75 4.73 4.68 4.47 58 4.40 4.39 4.36 4.22
59 4.86 4.84 4.78 4.55 59 4.49 4.48 4.45 4.30
60 4.98 4.95 4.88 4.64 60 4.59 4.58 4.54 4.38
61 5.10 5.07 4.99 4.73 61 4.69 4.68 4.63 4.46
62 5.23 5.20 5.10 4.83 62 4.80 4.79 4.73 4.55
63 5.37 5.34 5.23 4.93 63 4.92 4.90 4.84 4.64
64 5.52 5.48 5.35 5.04 64 5.04 5.02 4.95 4.74
65 5.69 5.64 5.48 5.15 65 5.18 5.15 5.07 4.84
66 5.86 5.80 5.62 5.27 66 5.32 5.29 5.20 4.95
67 6.04 5.97 5.77 5.39 67 5.47 5.44 5.33 5.06
68 6.24 6.16 5.92 5.52 68 5.64 5.60 5.47 5.18
69 6.45 6.35 6.07 5.66 69 5.82 5.77 5.62 5.31
70 6.67 6.56 6.23 5.80 70 6.01 5.95 5.78 5.45
71 6.90 6.77 6.39 5.95 71 6.21 6.15 5.94 5.59
72 7.16 7.00 6.56 6.11 72 6.44 6.36 6.11 5.74
73 7.43 7.24 6.73 6.28 73 6.68 6.58 6.29 5.91
74 7.71 7.50 6.90 6.45 74 6.94 6.83 6.48 6.08
75 8.02 7.77 7.08 6.63 75 7.22 7.08 6.67 6.26
76 8.35 8.05 7.25 6.83 76 7.52 7.36 6.86 6.45
77 8.70 8.34 7.43 7.03 77 7.85 7.65 7.06 6.65
78 9.08 8.65 7.61 7.24 78 8.21 7.97 7.26 6.87
79 9.48 8.98 7.78 7.47 79 8.60 8.30 7.46 7.10
80 9.91 9.31 7.95 7.70 80 9.02 8.65 7.66 7.34
81 10.37 9.66 8.11 7.95 81 9.47 9.02 7.86 7.59
82 10.86 10.02 8.27 8.21 82 9.96 9.41 8.05 7.86
83 11.38 10.39 8.42 8.48 83 10.50 9.81 8.23 8.14
84 11.94 10.77 8.56 8.77 84 11.07 10.24 8.40 8.44
85 12.54 11.16 8.69 9.07 85 11.69 10.67 8.55 8.75
86 13.17 11.55 8.81 9.38 86 12.36 11.11 8.70 9.09
87 13.85 11.95 8.92 9.71 87 13.08 11.55 8.83 9.43
88 14.56 12.34 9.02 10.06 88 13.84 11.99 8.95 9.78
89 15.32 12.73 9.12 10.43 89 14.65 12.43 9.05 10.16
90 16.12 13.12 9.20 10.80 90 15.50 12.85 9.15 10.55
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 23
OPTION 2: JOINT & SURVIVOR LIFE INCOME
(a) Nonrefund
---------------- -----------------------------------------------------------------------------------------
AGE OF
AGE FEMALE JOINT ANNUITANT
OF MALE ----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
------------------------------------------------------------------------------------------------------------
55 $3.61 $3.77 $3.94 $4.08 $4.21 $4.30 $4.37 $4.41 $4.43
60 3.68 3.88 4.10 4.32 4.51 4.68 4.79 4.87 4.92
65 3.73 3.97 4.25 4.55 4.84 5.11 5.32 5.47 5.57
70 3.76 4.04 4.36 4.74 5.16 5.57 5.94 6.22 6.41
75 3.79 4.08 4.45 4.90 5.43 6.02 6.60 7.10 7.46
80 3.80 4.11 4.50 5.01 5.64 6.41 7.25 8.07 8.72
85 3.81 4.13 4.54 5.08 5.79 6.71 7.82 9.02 10.11
90 3.82 4.14 4.56 5.12 5.88 6.91 8.26 9.86 11.48
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
(b) With 10 Years Certain
---------------- -----------------------------------------------------------------------------------------
AGE OF
AGE FEMALE JOINT ANNUITANT
OF MALE ----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
------------------------------------------------------------------------------------------------------------
55 $3.61 $3.77 $3.94 $4.08 $4.20 $4.29 $4.35 $4.39 $4.40
60 3.67 3.88 4.10 4.31 4.51 4.66 4.77 4.83 4.86
65 3.73 3.97 4.24 4.54 4.83 5.08 5.27 5.39 5.45
70 3.76 4.03 4.36 4.73 5.13 5.52 5.84 6.05 6.16
75 3.78 4.07 4.43 4.87 5.38 5.92 6.41 6.76 6.95
80 3.80 4.10 4.49 4.97 5.57 6.25 6.91 7.43 7.74
85 3.81 4.12 4.51 5.03 5.68 6.46 7.28 7.96 8.38
90 3.81 4.12 4.53 5.06 5.74 6.59 7.51 8.30 8.81
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
Actuarial Basis - Installments shown in these tables are based on the Annuity
2000 Mortality Table with compound interest at the effective rate of 3% per
year.
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 24
ANNUITY OPTION TABLES
(1940-1959)
Installments shown are for a monthly payment for each $1,000 of Contract Value
applied under an option. Age, as used in these tables, is age as of nearest
birthday. Rates of monthly payments for ages and periods certain not shown, if
allowed by us, will be based on an actuarially equivalent basis. To determine
annual, semi-annual, or quarterly installments, multiply the amounts shown by
11.64, 5.92 or 2.98; respectively.
OPTION 1: LIFE INCOME
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
AGE AND SEX AGE AND SEX
OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT
-------------------- ------------------
MALE REFUND CERTAIN CERTAIN REFUND FEMALE REFUND CERTAIN CERTAIN REFUND
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
51 $4.08 $4.07 $4.05 $3.93 51 $3.83 $3.82 $3.81 $3.74
52 4.15 4.14 4.11 3.99 52 3.89 3.88 3.87 3.79
53 4.22 4.21 4.18 4.05 53 3.95 3.94 3.93 3.84
54 4.30 4.29 4.25 4.11 54 4.01 4.01 3.99 3.90
55 4.38 4.37 4.33 4.18 55 4.08 4.08 4.06 3.96
56 4.46 4.45 4.41 4.25 56 4.15 4.15 4.13 4.02
57 4.55 4.54 4.49 4.32 57 4.23 4.22 4.20 4.08
58 4.65 4.63 4.58 4.39 58 4.31 4.30 4.28 4.15
59 4.75 4.73 4.68 4.47 59 4.40 4.39 4.36 4.22
60 4.86 4.84 4.78 4.55 60 4.49 4.48 4.45 4.30
61 4.98 4.95 4.88 4.64 61 4.59 4.58 4.54 4.38
62 5.10 5.07 4.99 4.73 62 4.69 4.68 4.63 4.46
63 5.23 5.20 5.10 4.83 63 4.80 4.79 4.73 4.55
64 5.37 5.34 5.23 4.93 64 4.92 4.90 4.84 4.64
65 5.52 5.48 5.35 5.04 65 5.04 5.02 4.95 4.74
66 5.69 5.64 5.48 5.15 66 5.18 5.15 5.07 4.84
67 5.86 5.80 5.62 5.27 67 5.32 5.29 5.20 4.95
68 6.04 5.97 5.77 5.39 68 5.47 5.44 5.33 5.06
69 6.24 6.16 5.92 5.52 69 5.64 5.60 5.47 5.18
70 6.45 6.35 6.07 5.66 70 5.82 5.77 5.62 5.31
71 6.67 6.56 6.23 5.80 71 6.01 5.95 5.78 5.45
72 6.90 6.77 6.39 5.95 72 6.21 6.15 5.94 5.59
73 7.16 7.00 6.56 6.11 73 6.44 6.36 6.11 5.74
74 7.43 7.24 6.73 6.28 74 6.68 6.58 6.29 5.91
75 7.71 7.50 6.90 6.45 75 6.94 6.83 6.48 6.08
76 8.02 7.77 7.08 6.63 76 7.22 7.08 6.67 6.26
77 8.35 8.05 7.25 6.83 77 7.52 7.36 6.86 6.45
78 8.70 8.34 7.43 7.03 78 7.85 7.65 7.06 6.65
79 9.08 8.65 7.61 7.24 79 8.21 7.97 7.26 6.87
80 9.48 8.98 7.78 7.47 80 8.60 8.30 7.46 7.10
81 9.91 9.31 7.95 7.70 81 9.02 8.65 7.66 7.34
82 10.37 9.66 8.11 7.95 82 9.47 9.02 7.86 7.59
83 10.86 10.02 8.27 8.21 83 9.96 9.41 8.05 7.86
84 11.38 10.39 8.42 8.48 84 10.50 9.81 8.23 8.14
85 11.94 10.77 8.56 8.77 85 11.07 10.24 8.40 8.44
86 12.54 11.16 8.69 9.07 86 11.69 10.67 8.55 8.75
87 13.17 11.55 8.81 9.38 87 12.36 11.11 8.70 9.09
88 13.85 11.95 8.92 9.71 88 13.08 11.55 8.83 9.43
89 14.56 12.34 9.02 10.06 89 13.84 11.99 8.95 9.78
90 15.32 12.73 9.12 10.43 90 14.65 12.43 9.05 10.16
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 23
OPTION 2: JOINT & SURVIVOR LIFE INCOME
(a) Nonrefund
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
55 $3.56 $3.72 $3.87 $4.01 $4.13 $4.22 $4.28 $4.32 $4.35
60 3.63 3.82 4.03 4.23 4.42 4.57 4.68 4.76 4.80
65 3.67 3.90 4.17 4.45 4.72 4.97 5.18 5.32 5.41
70 3.71 3.97 4.27 4.63 5.02 5.40 5.75 6.02 6.20
75 3.73 4.01 4.35 4.78 5.27 5.82 6.37 6.84 7.18
80 3.75 4.04 4.41 4.88 5.47 6.18 6.97 7.73 8.35
85 3.76 4.06 4.44 4.95 5.61 6.46 7.49 8.62 9.65
90 3.76 4.07 4.46 4.99 5.70 6.65 7.90 9.39 10.93
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
(b) With 10 Years Certain
----------------------------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
55 $3.56 $3.72 $3.87 $4.01 $4.12 $4.21 $4.27 $4.30 $4.32
60 3.63 3.82 4.03 4.23 4.41 4.56 4.66 4.73 4.76
65 3.67 3.90 4.16 4.44 4.71 4.95 5.14 5.25 5.31
70 3.71 3.96 4.27 4.62 5.00 5.36 5.67 5.88 5.99
75 3.73 4.00 4.34 4.76 5.24 5.75 6.21 6.56 6.76
80 3.74 4.03 4.39 4.85 5.41 6.06 6.70 7.22 7.54
85 3.75 4.05 4.42 4.91 5.52 6.27 7.07 7.76 8.21
90 3.76 4.05 4.44 4.94 5.58 6.39 7.30 8.11 8.67
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
Actuarial Basis - Installments shown in these tables are based on the Annuity
2000 Mortality Table (set back one year) with compound interest at the effective
rate of 3% per year.
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 24
ANNUITY OPTION TABLES
(1960-1979)
Installments shown are for a monthly payment for each $1,000 of Contract Value
applied under an option. Age, as used in these tables, is age as of nearest
birthday. Rates of monthly payments for ages and periods certain not shown, if
allowed by us, will be based on an actuarially equivalent basis. To determine
annual, semi-annual, or quarterly installments, multiply the amounts shown by
11.64, 5.92 or 2.98; respectively.
OPTION 1: LIFE INCOME
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
AGE AND SEX AGE AND SEX
OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT
-------------------- ------------------
MALE REFUND CERTAIN CERTAIN REFUND FEMALE REFUND CERTAIN CERTAIN REFUND
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
51 $4.01 $4.01 $3.98 $3.88 51 $3.77 $3.77 $3.76 $3.69
52 4.08 4.07 4.05 3.93 52 3.83 3.82 3.81 3.74
53 4.15 4.14 4.11 3.99 53 3.89 3.88 3.87 3.79
54 4.22 4.21 4.18 4.05 54 3.95 3.94 3.93 3.84
55 4.30 4.29 4.25 4.11 55 4.01 4.01 3.99 3.90
56 4.38 4.37 4.33 4.18 56 4.08 4.08 4.06 3.96
57 4.46 4.45 4.41 4.25 57 4.15 4.15 4.13 4.02
58 4.55 4.54 4.49 4.32 58 4.23 4.22 4.20 4.08
59 4.65 4.63 4.58 4.39 59 4.31 4.30 4.28 4.15
60 4.75 4.73 4.68 4.47 60 4.40 4.39 4.36 4.22
61 4.86 4.84 4.78 4.55 61 4.49 4.48 4.45 4.30
62 4.98 4.95 4.88 4.64 62 4.59 4.58 4.54 4.38
63 5.10 5.07 4.99 4.73 63 4.69 4.68 4.63 4.46
64 5.23 5.20 5.10 4.83 64 4.80 4.79 4.73 4.55
65 5.37 5.34 5.23 4.93 65 4.92 4.90 4.84 4.64
66 5.52 5.48 5.35 5.04 66 5.04 5.02 4.95 4.74
67 5.69 5.64 5.48 5.15 67 5.18 5.15 5.07 4.84
68 5.86 5.80 5.62 5.27 68 5.32 5.29 5.20 4.95
69 6.04 5.97 5.77 5.39 69 5.47 5.44 5.33 5.06
70 6.24 6.16 5.92 5.52 70 5.64 5.60 5.47 5.18
71 6.45 6.35 6.07 5.66 71 5.82 5.77 5.62 5.31
72 6.67 6.56 6.23 5.80 72 6.01 5.95 5.78 5.45
73 6.90 6.77 6.39 5.95 73 6.21 6.15 5.94 5.59
74 7.16 7.00 6.56 6.11 74 6.44 6.36 6.11 5.74
75 7.43 7.24 6.73 6.28 75 6.68 6.58 6.29 5.91
76 7.71 7.50 6.90 6.45 76 6.94 6.83 6.48 6.08
77 8.02 7.77 7.08 6.63 77 7.22 7.08 6.67 6.26
78 8.35 8.05 7.25 6.83 78 7.52 7.36 6.86 6.45
79 8.70 8.34 7.43 7.03 79 7.85 7.65 7.06 6.65
80 9.08 8.65 7.61 7.24 80 8.21 7.97 7.26 6.87
81 9.48 8.98 7.78 7.47 81 8.60 8.30 7.46 7.10
82 9.91 9.31 7.95 7.70 82 9.02 8.65 7.66 7.34
83 10.37 9.66 8.11 7.95 83 9.47 9.02 7.86 7.59
84 10.86 10.02 8.27 8.21 84 9.96 9.41 8.05 7.86
85 11.38 10.39 8.42 8.48 85 10.50 9.81 8.23 8.14
86 11.94 10.77 8.56 8.77 86 11.07 10.24 8.40 8.44
87 12.54 11.16 8.69 9.07 87 11.69 10.67 8.55 8.75
88 13.17 11.55 8.81 9.38 88 12.36 11.11 8.70 9.09
89 13.85 11.95 8.92 9.71 89 13.08 11.55 8.83 9.43
90 14.56 12.34 9.02 10.06 90 13.84 11.99 8.95 9.78
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 23
(a) Nonrefund
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
55 $3.52 $3.67 $3.81 $3.94 $4.05 $4.14 $4.20 $4.24 $4.27
60 3.58 3.76 3.96 4.15 4.33 4.47 4.58 4.65 4.70
65 3.62 3.84 4.09 4.35 4.61 4.85 5.04 5.17 5.26
70 3.66 3.90 4.19 4.53 4.89 5.25 5.57 5.83 6.00
75 3.68 3.94 4.27 4.66 5.12 5.64 6.15 6.59 6.92
80 3.69 3.97 4.32 4.76 5.31 5.97 6.70 7.42 8.01
85 3.70 3.99 4.35 4.82 5.44 6.23 7.19 8.24 9.22
90 3.71 4.00 4.37 4.86 5.52 6.41 7.57 8.95 10.41
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
(b) With 10 Years Certain
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
----------------------------------------------------------------------------------------------------------
55 $3.52 $3.67 $3.81 $3.94 $4.05 $4.13 $4.19 $4.23 $4.24
60 3.58 3.76 3.96 4.15 4.32 4.46 4.56 4.62 4.66
65 3.62 3.84 4.09 4.35 4.60 4.83 5.01 5.12 5.18
70 3.66 3.90 4.19 4.52 4.87 5.22 5.51 5.72 5.84
75 3.68 3.94 4.26 4.65 5.10 5.58 6.03 6.37 6.58
80 3.69 3.96 4.31 4.74 5.27 5.87 6.50 7.02 7.35
85 3.70 3.98 4.33 4.79 5.37 6.08 6.86 7.55 8.02
90 3.70 3.99 4.35 4.82 5.43 6.20 7.08 7.92 8.51
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
Actuarial Basis - Installments shown in these tables are based on the Annuity
2000 Mortality Table (set back two years) with compound interest at the
effective rate of 3% per year.
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 24
ANNUITY OPTION TABLES
(1980-1999)
Installments shown are for a monthly payment for each $1,000 of Contract Value
applied under an option. Age, as used in these tables, is age as of nearest
birthday. Rates of monthly payments for ages and periods certain not shown, if
allowed by us, will be based on an actuarially equivalent basis. To determine
annual, semi-annual, or quarterly installments, multiply the amounts shown by
11.64, 5.92 or 2.98; respectively.
OPTION 1: LIFE INCOME
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
AGE AND SEX AGE AND SEX
OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT
-------------------- ------------------
MALE REFUND CERTAIN CERTAIN REFUND FEMALE REFUND CERTAIN CERTAIN REFUND
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
51 $3.95 $3.94 $3.92 $3.82 51 $3.72 $3.71 $3.71 $3.65
52 4.01 4.01 3.98 3.88 52 3.77 3.77 3.76 3.69
53 4.08 4.07 4.05 3.93 53 3.83 3.82 3.81 3.74
54 4.15 4.14 4.11 3.99 54 3.89 3.88 3.87 3.79
55 4.22 4.21 4.18 4.05 55 3.95 3.94 3.93 3.84
56 4.30 4.29 4.25 4.11 56 4.01 4.01 3.99 3.90
57 4.38 4.37 4.33 4.18 57 4.08 4.08 4.06 3.96
58 4.46 4.45 4.41 4.25 58 4.15 4.15 4.13 4.02
59 4.55 4.54 4.49 4.32 59 4.23 4.22 4.20 4.08
60 4.65 4.63 4.58 4.39 60 4.31 4.30 4.28 4.15
61 4.75 4.73 4.68 4.47 61 4.40 4.39 4.36 4.22
62 4.86 4.84 4.78 4.55 62 4.49 4.48 4.45 4.30
63 4.98 4.95 4.88 4.64 63 4.59 4.58 4.54 4.38
64 5.10 5.07 4.99 4.73 64 4.69 4.68 4.63 4.46
65 5.23 5.20 5.10 4.83 65 4.80 4.79 4.73 4.55
66 5.37 5.34 5.23 4.93 66 4.92 4.90 4.84 4.64
67 5.52 5.48 5.35 5.04 67 5.04 5.02 4.95 4.74
68 5.69 5.64 5.48 5.15 68 5.18 5.15 5.07 4.84
69 5.86 5.80 5.62 5.27 69 5.32 5.29 5.20 4.95
70 6.04 5.97 5.77 5.39 70 5.47 5.44 5.33 5.06
71 6.24 6.16 5.92 5.52 71 5.64 5.60 5.47 5.18
72 6.45 6.35 6.07 5.66 72 5.82 5.77 5.62 5.31
73 6.67 6.56 6.23 5.80 73 6.01 5.95 5.78 5.45
74 6.90 6.77 6.39 5.95 74 6.21 6.15 5.94 5.59
75 7.16 7.00 6.56 6.11 75 6.44 6.36 6.11 5.74
76 7.43 7.24 6.73 6.28 76 6.68 6.58 6.29 5.91
77 7.71 7.50 6.90 6.45 77 6.94 6.83 6.48 6.08
78 8.02 7.77 7.08 6.63 78 7.22 7.08 6.67 6.26
79 8.35 8.05 7.25 6.83 79 7.52 7.36 6.86 6.45
80 8.70 8.34 7.43 7.03 80 7.85 7.65 7.06 6.65
81 9.08 8.65 7.61 7.24 81 8.21 7.97 7.26 6.87
82 9.48 8.98 7.78 7.47 82 8.60 8.30 7.46 7.10
83 9.91 9.31 7.95 7.70 83 9.02 8.65 7.66 7.34
84 10.37 9.66 8.11 7.95 84 9.47 9.02 7.86 7.59
85 10.86 10.02 8.27 8.21 85 9.96 9.41 8.05 7.86
86 11.38 10.39 8.42 8.48 86 10.50 9.81 8.23 8.14
87 11.94 10.77 8.56 8.77 87 11.07 10.24 8.40 8.44
88 12.54 11.16 8.69 9.07 88 11.69 10.67 8.55 8.75
89 13.17 11.55 8.81 9.38 89 12.36 11.11 8.70 9.09
90 13.85 11.95 8.92 9.71 90 13.08 11.55 8.83 9.43
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 23
OPTION 2: JOINT & SURVIVOR LIFE INCOME
(a) Nonrefund
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
55 $3.48 $3.62 $3.76 $3.88 $3.98 $4.07 $4.12 $4.16 $4.19
60 3.53 3.71 3.89 4.08 4.24 4.38 4.48 4.55 4.59
65 3.58 3.78 4.02 4.26 4.51 4.73 4.91 5.04 5.12
70 3.61 3.84 4.11 4.43 4.77 5.10 5.41 5.65 5.81
75 3.63 3.88 4.19 4.56 4.99 5.46 5.94 6.36 6.67
80 3.64 3.91 4.23 4.65 5.16 5.78 6.46 7.13 7.69
85 3.65 3.92 4.27 4.71 5.29 6.02 6.91 7.89 8.81
90 3.66 3.93 4.29 4.75 5.36 6.19 7.26 8.55 9.92
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
(b) With 10 Years Certain
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
55 $3.48 $3.62 $3.75 $3.88 $3.98 $4.06 $4.12 $4.15 $4.17
60 3.53 3.71 3.89 4.07 4.24 4.37 4.47 4.53 4.56
65 3.58 3.78 4.01 4.26 4.50 4.72 4.89 5.00 5.06
70 3.61 3.84 4.11 4.42 4.75 5.08 5.36 5.56 5.68
75 3.63 3.88 4.18 4.54 4.97 5.42 5.85 6.19 6.40
80 3.64 3.90 4.23 4.63 5.13 5.70 6.30 6.81 7.15
85 3.65 3.92 4.25 4.68 5.23 5.90 6.65 7.34 7.83
90 3.65 3.92 4.27 4.71 5.29 6.02 6.87 7.71 8.34
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
Actuarial Basis - Installments shown in these tables are based on the Annuity
2000 Mortality Table (set back three years) with compound interest at the
effective rate of 3% per year.
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FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 24
ANNUITY OPTION TABLES
(2000 +)
Installments shown are for a monthly payment for each $1,000 of Contract Value
applied under an option. Age, as used in these tables, is age as of nearest
birthday. Rates of monthly payments for ages and periods certain not shown, if
allowed by us, will be based on an actuarially equivalent basis. To determine
annual, semi-annual, or quarterly installments, multiply the amounts shown by
11.64, 5.92 or 2.98; respectively.
OPTION 1: LIFE INCOME
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
AGE AND SEX AGE AND SEX
OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT OF ANNUITANT NON- 5 YEARS 10 YEARS INSTALLMENT
-------------------- ------------------
MALE REFUND CERTAIN CERTAIN REFUND FEMALE REFUND CERTAIN CERTAIN REFUND
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
51 $3.89 $3.88 $3.87 $3.77 51 $3.67 $3.66 $3.66 $3.60
52 3.95 3.94 3.92 3.82 52 3.72 3.71 3.71 3.65
53 4.01 4.01 3.98 3.88 53 3.77 3.77 3.76 3.69
54 4.08 4.07 4.05 3.93 54 3.83 3.82 3.81 3.74
55 4.15 4.14 4.11 3.99 55 3.89 3.88 3.87 3.79
56 4.22 4.21 4.18 4.05 56 3.95 3.94 3.93 3.84
57 4.30 4.29 4.25 4.11 57 4.01 4.01 3.99 3.90
58 4.38 4.37 4.33 4.18 58 4.08 4.08 4.06 3.96
59 4.46 4.45 4.41 4.25 59 4.15 4.15 4.13 4.02
60 4.55 4.54 4.49 4.32 60 4.23 4.22 4.20 4.08
61 4.65 4.63 4.58 4.39 61 4.31 4.30 4.28 4.15
62 4.75 4.73 4.68 4.47 62 4.40 4.39 4.36 4.22
63 4.86 4.84 4.78 4.55 63 4.49 4.48 4.45 4.30
64 4.98 4.95 4.88 4.64 64 4.59 4.58 4.54 4.38
65 5.10 5.07 4.99 4.73 65 4.69 4.68 4.63 4.46
66 5.23 5.20 5.10 4.83 66 4.80 4.79 4.73 4.55
67 5.37 5.34 5.23 4.93 67 4.92 4.90 4.84 4.64
68 5.52 5.48 5.35 5.04 68 5.04 5.02 4.95 4.74
69 5.69 5.64 5.48 5.15 69 5.18 5.15 5.07 4.84
70 5.86 5.80 5.62 5.27 70 5.32 5.29 5.20 4.95
71 6.04 5.97 5.77 5.39 71 5.47 5.44 5.33 5.06
72 6.24 6.16 5.92 5.52 72 5.64 5.60 5.47 5.18
73 6.45 6.35 6.07 5.66 73 5.82 5.77 5.62 5.31
74 6.67 6.56 6.23 5.80 74 6.01 5.95 5.78 5.45
75 6.90 6.77 6.39 5.95 75 6.21 6.15 5.94 5.59
76 7.16 7.00 6.56 6.11 76 6.44 6.36 6.11 5.74
77 7.43 7.24 6.73 6.28 77 6.68 6.58 6.29 5.91
78 7.71 7.50 6.90 6.45 78 6.94 6.83 6.48 6.08
79 8.02 7.77 7.08 6.63 79 7.22 7.08 6.67 6.26
80 8.35 8.05 7.25 6.83 80 7.52 7.36 6.86 6.45
81 8.70 8.34 7.43 7.03 81 7.85 7.65 7.06 6.65
82 9.08 8.65 7.61 7.24 82 8.21 7.97 7.26 6.87
83 9.48 8.98 7.78 7.47 83 8.60 8.30 7.46 7.10
84 9.91 9.31 7.95 7.70 84 9.02 8.65 7.66 7.34
85 10.37 9.66 8.11 7.95 85 9.47 9.02 7.86 7.59
86 10.86 10.02 8.27 8.21 86 9.96 9.41 8.05 7.86
87 11.38 10.39 8.42 8.48 87 10.50 9.81 8.23 8.14
88 11.94 10.77 8.56 8.77 88 11.07 10.24 8.40 8.44
89 12.54 11.16 8.69 9.07 89 11.69 10.67 8.55 8.75
90 13.17 11.55 8.81 9.38 90 12.36 11.11 8.70 9.09
-------------------- -------- ---------- ----------- ------------ ------------------ ---------- ---------- ------------ ------------
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 23
OPTION 2: JOINT & SURVIVOR LIFE INCOME
(a) Nonrefund
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
----------------------------------------------------------------------------------------------------------
55 $3.44 $3.57 $3.70 $3.82 $3.92 $4.00 $4.05 $4.09 $4.12
60 3.49 3.66 3.83 4.00 4.16 4.29 4.39 4.46 4.50
65 3.53 3.73 3.95 4.18 4.41 4.62 4.79 4.91 4.99
70 3.56 3.78 4.04 4.33 4.65 4.97 5.25 5.48 5.64
75 3.58 3.82 4.11 4.46 4.86 5.30 5.75 6.14 6.44
80 3.60 3.84 4.16 4.54 5.02 5.60 6.23 6.85 7.38
85 3.61 3.86 4.19 4.60 5.14 5.82 6.65 7.56 8.42
90 3.61 3.87 4.20 4.64 5.22 5.98 6.97 8.17 9.45
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
(b) With 10 Years Certain
---------------- -----------------------------------------------------------------------------------------
AGE OF
FEMALE JOINT ANNUITANT
AGE
OF MALE -----------------------------------------------------------------------------------------
ANNUITANT 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
55 $3.44 $3.57 $3.70 $3.82 $3.92 $3.99 $4.05 $4.08 $4.10
60 3.49 3.66 3.83 4.00 4.16 4.28 4.38 4.44 4.47
65 3.53 3.73 3.95 4.18 4.40 4.61 4.77 4.88 4.94
70 3.56 3.78 4.04 4.33 4.64 4.95 5.22 5.41 5.53
75 3.58 3.82 4.10 4.45 4.84 5.27 5.68 6.01 6.22
80 3.59 3.84 4.15 4.53 5.00 5.54 6.11 6.61 6.95
85 3.60 3.85 4.17 4.58 5.10 5.73 6.44 7.12 7.63
90 3.61 3.86 4.19 4.61 5.16 5.85 6.67 7.50 8.15
---------------- --------- --------- --------- --------- --------- --------- --------- --------- ---------
Actuarial Basis - Installments shown in these tables are based on the Annuity
2000 Mortality Table (set back four years) with compound interest at the
effective rate of 3% per year.
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 24
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 25
NATIONAL SECURITY
LIFE AND ANNUITY COMPANY
------------------------
Our Home Office is at 000 Xxxxx Xxxxxx, Xxxxxxxxxx, Xxx Xxxx, 00000.
Our Administrative Office is at Xxx Xxxxxxxxx Xxx, Xxxxxxxxxx, Xxxx, 00000.
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
FLEXIBLE PURCHASE PAYMENTS
NONPARTICIPATING
BENEFITS NONTRANSFERABLE
--------------------------------------------------------------------------------
FORM NS-02-VA-07.1 NATIONAL SECURITY LIFE AND ANNUITY COMPANY PAGE 26
