1
EXHIBIT 99.B4(i)
[SENTRY LIFE INSURANCE COMPANY LOGO]
SENTRY LIFE INSURANCE COMPANY, 0000 Xxxxx Xxxxx Xxxxx, Xxxxxxx Xxxxx,
Xxxxxxxxx, ("the Company") will make income payments to the annuitant in
accordance with the terms set forth in this Contract beginning on the Income
Date.
This Contract is issued in consideration of the application, a copy of which is
attached and made a part of the Contract, and of the payment of Purchase
Payments in accordance with the terms and conditions of this Contract.
TEN DAY FREE LOOK
Within ten days of the day the Contract is received, it may be returned to the
Company or to the agent through whom it was purchased. When the Contract is
received by the Company it will be voided as if it had never been in force.
The Purchase Payments paid on it will then be refunded in full.
Signed for the Company.
Xxxxxxxx X. Xxxxxxxx Xxxxx X. Xxxxx
Secretary President
VARIABLE ANNUITY
INDIVIDUAL FLEXIBLE PURCHASE PAYMENT
DEFERRED, NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
FOR DETERMINATION OF VARIABLE BENEFITS PLEASE SEE THE VARIABLE ACCOUNT
PROVISIONS, PAGE 5, AND THE VARIABLE ANNUITY PROVISION, PAGE 8.
2
POLICY INDEX
GENERAL PROVISIONS
The Contract ......................................................... 4
Non-Participation in Surplus ......................................... 4
Incontestability ..................................................... 4
Misstatement of Age .................................................. 4
Contract Settlement .................................................. 4
Reports .............................................................. 4
Taxes ................................................................ 4
Evidence of Survival ................................................. 4
Protection of Proceeds ............................................... 4
Modification of Contract ............................................. 4
OWNERSHIP, ASSIGNMENT PROVISION ......................................... 4
Ownership ............................................................ 4
Assignment ........................................................... 4
BENEFICIARY PROVISIONS .................................................. 5
Beneficiary .......................................................... 5
Change of Beneficiary ................................................ 5
PURCHASE PROVISIONS ..................................................... 5
Purchase Payments .................................................... 5
Net Purchase Payments ................................................ 5
Change in Purchase Payments .......................................... 5
No Default ........................................................... 5
VARIABLE ACCOUNT PROVISIONS ............................................. 5
The Variable Account ................................................. 5
Investments of the Variable Account .................................. 5
Valuation of Assets .................................................. 5
Contract Value ....................................................... 6
Transfers ............................................................ 6
Accumulation Units ................................................... 6
Valuation Periods and Dates .......................................... 7
Mortality and Expense Risk Premium ................................... 7
Mortality and Expense Guarantee ...................................... 7
Annuity Unit ......................................................... 7
CONTRACT MAINTENANCE CHARGE ............................................. 7
Deduction for Contract
Maintenance Charge ................................................. 7
ANNUITY PROVISIONS ...................................................... 7
Income Date and Settlement Option .................................... 7
Change in Income Date ................................................ 7
Change in Settlement Option .......................................... 7
Settlement Options ................................................... 7
Frequency and Amount of Annuity Payment .............................. 8
Variable Annuity ..................................................... 8
Net Investment Factor ................................................ 8
PAYMENTS ................................................................ 9
Payments on the Death of the
Annuitant Prior to the Income Date ................................. 9
Payments on the Death of the
Annuitant After the Income Date .................................... 9
SURRENDER PROVISIONS .................................................... 9
Surrender ............................................................ 9
Calculation of Contingent Deferred
Sales Charge ....................................................... 9
SUSPENSION OF PAYMENTS ................................................. 10
TABLES ................................................................. 11
Life Income ......................................................... 11
Life Income-Joint and Survivor ...................................... 12
Annuity Purchase Rates .............................................. 13
3
CONTRACT DATA PAGE
ANNUITANT: XXXX SENTRY
CONTRACT NUMBER: 378102371
CONTRACT OWNER: XXXX SENTRY
EFFECTIVE DATE: 06/11/1996
INCOME DATE: 02/01/2049
CONTRACT MAINTENANCE CHARGE: GUARANTEED NEVER TO EXCEED $45 PER YEAR.*
*PRIOR TO THE INCOME DATE, THE CONTRACT MAINTENANCE CHARGE IS NOT GUARANTEED
AND MAY BE CHANGED FOR FUTURE YEARS. AFTER THE INCOME DATE, THE AMOUNT OF THE
CONTRACT MAINTENANCE CHARGE WILL NOT BE CHANGED FROM THE AMOUNT OF THE ANNUAL
MAINTENANCE CHARGE IN EFFECT DURING THE CONTRACT YEAR IMMEDIATELY PRECEDING THE
INCOME DATE. AFTER THE INCOME DATE, THE CONTRACT MAINTENANCE CHARGE WILL BE
COLLECTED ON A MONTHLY BASIS.
MORTALITY AND EXPENSE RISK PREMIUM: EQUAL ON AN ANNUAL BASIS TO 1.2% OF THE
DAILY NET ASSET VALUE OF THE VARIABLE
ACCOUNT.
TRANSFER FEE: GUARANTEED NEVER TO EXCEED $20.
ELIGIBLE MUTUAL FUNDS: XXXXXXXXX AND XXXXXX ADVISERS MANAGEMENT TRUST
- GROWTH PORTFOLIO
- LIMITED MATURITY BOND PORTFOLIO
- LIQUID ASSET PORTFOLIO
- BALANCED PORTFOLIO
VARIABLE ACCOUNT: SENTRY VARIABLE ACCOUNT II
ANNUITY SERVICE OFFICE: P.O. BOX 867, STEVENS POINT, WISCONSIN 54481
FOR DETERMINATION OF VARIABLE BENEFITS PLEASE SEE THE VARIABLE ACCOUNT
PROVISIONS, PAGE 5, AND THE VARIABLE ANNUITY PROVISION, PAGE 8.
FOR USE WITH SENTRY VARIABLE ACCOUNT II
A SEPARATE INVESTMENT ACCOUNT OF
SENTRY LIFE INSURANCE COMPANY
4
DEFINITIONS
ACCUMULATION UNIT - An accounting unit of measure used to calculate the
Contract Value prior to the Income Date.
ANNUITANT - The person upon whose continuation of life any annuity payment
involving life contingencies depends.
ANNUITY UNIT - An accounting unit of measure used to calculate annuity payments
after the Income Date.
COMPANY - Sentry Life Insurance Company at its Annuity Service Office
designated on the Contract Data Page.
CONTINGENT OWNER - The Contingent Owner, if any, is as named in the
application, unless changed.
CONTRACT ANNIVERSARY - An anniversary of the Effective Date of this Contract.
CONTRACT OWNER - The Contract Owner is named in the application, unless
changed, and has all rights under this contract.
CONTRACT VALUE - The dollar value as of any Valuation Date of all amounts
accumulated under the Contract.
CONTRACT YEAR - Any period of twelve (12) months commencing with the Effective
Date and each Contract Anniversary thereafter.
EFFECTIVE DATE - The date shown as the Effective Date on the Contract Data
Page.
ELIGIBLE MUTUAL FUND(S) - A Mutual Fund designated on the Contract Data Page.
INCOME DATE - The date on which annuity payments are to commence.
PORTFOLIO - A segment of an Eligible Mutual Fund which constitutes a separate
and distinct class of shares.
VALUATION DATE - Each day that the New York Stock Exchange is open for
business.
VALUATION PERIOD - The period commencing at the close of business on the New
York Stock Exchange on each Valuation Date and ending at the close of business
for the next succeeding Valuation Date.
VARIABLE ACCOUNT - A separate investment account of the Company designated on
the Contract Date Page into which net purchase payments will be allocated.
3
5
GENERAL PROVISIONS
THE CONTRACT - The entire Contract consists of this Contract and the
application, a copy of which is attached. This Contract may be changed or
altered only by the President or the Secretary of the Company.
NON-PARTICIPATION IN SURPLUS - This Contract will not share in any distribution
of profits or surplus of the Company.
INCONTESTABILITY - The Company will not contest this Contract from its
Effective Date.
MISSTATEMENT OF AGE - The Company may require proof of age of the Annuitant
before making any life annuity payment provided for by this Contract. If the
age of the Annuitant has been misstated, the amount payable will be the amount
that the purchase payments would have provided at the correct age.
Once monthly life income payments have begun, any underpayments will be made
upon in one sum with the next annuity payment; overpayments will be deducted
from the future annuity payments until the total is repaid.
CONTRACT SETTLEMENT - This Contract must be returned to the Company upon any
settlement. Prior to any settlement as a death claim, due proof of the
Annuitant's death must be submitted to the Company.
REPORTS - The Company will furnish the Contract Owner with a report showing the
Contract Value at least one each calendar year. This report will be sent to
the last known address of the Contract Owner.
TAXES - Any taxes paid to any governmental entity will be charged against the
Contract Value. The Company will, in its sole discretion, determine when such
taxes have resulted from: the investment experience of the Variable Account;
the receipt by the Company of the purchase payment(s); or commencement of
annuity payments.
EVIDENCE OF SURVIVAL - Where any benefits under this Contract are contingent
upon the recipient being alive on a given date, the Company may require proof
satisfactory to it that such condition has been met.
PROTECTION OF PROCEEDS - No beneficiary may commute, encumber, alienate or
assign any payments under this Contract before they are due. To the extent
permitted by law, no payments shall be subject to the debts, contracts or
engagements of any beneficiary nor to any judicial process to levy upon or
attach the same for payment thereof.
MODIFICATION OF CONTRACT - This Contract may not be modified by the Company
without the consent of the Contract Owner except as may be required by
applicable law.
OWNERSHIP, ASSIGNMENT PROVISION
OWNERSHIP - The Contract Owner has all rights, and may receive all benefits
under this Contract. During the lifetime of the Annuitant and prior to the
Income Date, the Contract Owner shall be the person designated in the
application, unless changed. On and after the Income Date, the Contract Owner
shall be the Annuitant. On and after the death of the Annuitant, the
Beneficiary shall be the Contract Owner.
The Contract Owner may name a Contingent Owner or a new Contract Owner at any
time. If the Contract Owner dies, the Contingent Owner becomes the Contract
Owner. Any new choice of Contract Owner or Contingent Owner will automatically
revoke any prior choice of Contract Owner or Contingent owner. Any request for
change must be: (1) made in writing; and (2) received at the Company. The
change will become effective as of the date the written request is signed. A
new choice of Contract Owner or Contingent Owner will not apply to any payment
made or action taken by the Company prior to the time it was received.
ASSIGNMENT - The Contract Owner may assign this Contract at any time during the
lifetime of the Annuitant prior to the Income Date. The Company will not be
bound by any assignment until written notice is received at the Company. The
Company is not responsible for the validity of any assignment. The Company
shall not be liable as to any payment or other settlement made by the Company
before receipt of the assignment.
If this Contract is issued pursuant to a retirement plan which receives
favorable tax treatment under the provisions of Section 401, 403, 404, 408 or
457 of the Internal Revenue Code, then it may not be assigned, pledged or
otherwise transferred except under such conditions as may be allowed under
applicable law.
4
6
BENEFICIARY PROVISIONS
BENEFICIARY - The Beneficiary, named in the application unless changed, is the
party entitled to receive the benefits to be paid at the death of the
Annuitant.
Unless the Contract Owner provides otherwise, such benefits will be paid in
equal shares or all to the survivor as follows:
(1) to the primary Beneficiaries who survive the Annuitant's death; or, if
there are none,
(2) to the Contingent Beneficiaries who survive the Annuitant's death; or,
if there are none,
(3) to the Contract Owner; or to the estate of the Contract Owner.
CHANGE OF BENEFICIARY - The Contract Owner may change the Beneficiary or
Contingent Beneficiary at any time during the lifetime of the Annuitant. Any
such change must be made in writing on a form acceptable to the Company. The
change will take effect as of the date such notice is signed. But the Company
shall not be liable for any payment made or action taken before it records the
change.
PURCHASE PROVISIONS
PURCHASE PAYMENTS - Subject to the limitations contained herein, purchase
payments are payable according to the frequency and in the amount selected by
the Contract Owner in the application. The initial purchase payment is due on
the Effective Date and must be at least $1,000. Subsequent purchase payments
must be at least $100. In the event that the Contract is issued to retirement
plans which qualify for favorable tax treatment under Section 401, 403, 404,
408, or 457 of the Internal Revenue Code, the amount of the initial purchase
payment must be at least $1,000. Subsequent purchase payments must be at least
$100. The Company reserves the right to reject any application or purchase
payment.
NET PURCHASE PAYMENTS - A net purchase payment is equal to the purchase payment
less any applicable premium taxes.
CHANGE IN PURCHASE PAYMENTS - The Contract Owner may elect to increase or
decrease or to change the frequency of purchase payments.
NO DEFAULT - Unless surrendered for the full Surrender Value, this Contract
remains in force until the Income Date and will not be in default even though
no additional purchase payments are made.
VARIABLE ACCOUNT PROVISIONS
THE VARIABLE ACCOUNT - The Variable Account is the separate investment account
of the Company. It is named on the Contract Data Page. The Company has
allocated a part of its assets for this and certain other contracts to the
Variable Account. The assets of the Variable Account are the property of the
Company. However, they are not chargeable with the liabilities arising out of
any other business the Company may conduct.
INVESTMENTS OF THE VARIABLE ACCOUNT - Net purchase payments applied to the
Variable Account will be invested in the Eligible Mutual Fund(s) and the
Portfolio(s), if any, within an Eligible Mutual Fund listed on the Contract
Data Page. Such investment will be made in accordance with the selection made
by the Contract Owner in the Application. The selection of investment is
subject to the terms and conditions imposed on such selection by the Company.
The Contract Owner may change such selection prospectively without fee, penalty
or other charge upon written notice to the Company. Such change will be
effective for net purchase payments received after receipt of such notice. The
assets of the Variable Account are segregated by Eligible Mutual Fund(s),
Portfolio(s) within the Eligible Mutual Fund(s) and type of Contract.
Therefore, a series of sub-accounts is established within the Variable Account.
The Company may, from time to time, add additional Eligible Mutual Fund(s) or
Portfolio(s) to those listed on the Contract Data Page. In such an event, the
Contract Owner may be permitted to select such Eligible Mutual Fund(s) or
Portfolio(s) as investments to underlie this Contract. However, the right to
make any such selection will be limited by the terms and conditions imposed on
such transactions by the Company.
5
7
If the shares of any of the Eligible Mutual Funds, or any Portfolio within
these Funds become unavailable for investment by the Variable Account, or the
Company's Board of Directors deems further investment in these shares
inappropriate, the Company may substitute shares of another mutual fund for
fund shares already purchased or to be purchased by Purchase Payments under the
Contract.
CONTRACT VALUE - Net purchase payments are allocated among the various
sub-accounts within the variable account. For each sub-account, the net
purchase payments are converted into Accumulation Units. The number of the
Accumulation Units credited to the Contract is determined by dividing the Net
Purchase Payment allocated to the sub-account by the value of the Accumulation
Unit for the sub-account. The value of the Contract is the sum of the values
for each sub-account. The value of each sub-account is determined by
multiplying the number of Accumulation Units attributable to the sub-account by
the value of an Accumulation Unit for the sub-account.
TRANSFERS - The Contract Owner may, no more frequently than four times in any
one Contract Year prior to the Income Date and no more frequently than one time
in any one Contract Year after the Income Date, direct the transfer of all or
part of the Contract Values between Eligible Mutual Fund(s) or Portfolio(s)
subject to the following conditions:
(a) The Contract Owner will pay to the Company a Transfer Fee for each
transfer as initially shown on the Contract Data Page in effect
at the time of the transfer. The Transfer Fee is not guaranteed and
may be changed by the Company at any time. The Transfer Fee will be
deducted from the amount which is transferred.
(b) The minimum amount which may be transferred from an Eligible Mutual
Fund or Portfolio is (i) $250; or, (ii) if smaller, the remaining value
of the Contract's interest in such Eligible Mutual Fund or Portfolio.
(c) No partial transfer shall be made if the Contract Owner's remaining
Contract Value for each Eligible Mutual Fund or Portfolio will be less
than $250.
(d) Transfers shall be effected during the Valuation Period next following
receipt by the Company of a written transfer direction (containing all
required information). However, no such transfer may be made
effective within seven calendar days of the date on which the first
annuity payment is due; and no initial Purchase Payment nor any amounts
previously transferred including increments thereon, may be transferred
until thirty (30) days after receipt of such initial Purchase Payment;
provided, however, the Contract Owner, during the 30-day period prior
to the date on which the first annuity payment is due, may direct an
additional transfer, to be effective no later than the seventh calendar
day prior to such due date.
(e) Any transfer direction must clearly specify:
(1) the amount which is to be transferred; and
(2) the name(s) of the Eligible Mutual Fund(s) or Portfolio(s) which are
to be affected.
(f) The Company reserves the right at any time and without prior notice to
any party to terminate, suspend or modify the transfer privileges
described above.
ACCUMULATION UNIT - Net Purchase Payments are converted into Accumulation
Units. This is done by dividing each Net Purchase Payment by the value of an
Accumulation Unit for the Valuation Period during which the net Purchase
Payment is allocated to the Variable Account. The Accumulation Unit value for
each sub-account was arbitrarily set initially at $10. The Accumulation Unit
Value for any later Valuation Period is determined by subtracting (b) from (a)
and dividing the result by (c) where:
(a) Is the net result of
(1) The Assets of the sub-account, that is, the aggregate value of the
underlying Fund shares held at the end of such Valuation Period,
plus or minus
(2) The cumulative charge or credit for taxes reserved which is
determined by the Company to have resulted from the investment
operation of the sub-account;
6
8
(b) Is the cumulative unpaid charge for the mortality and expense risks; and
(c) Is the number of Accumulation Units outstanding at the end of such
Valuation Period.
The Accumulation Unit value may increase or decrease from Valuation
Period to Valuation Period.
VALUATION PERIODS AND DATES - A Valuation Period is the period commencing at
the close of business of the New York Stock Exchange for each Valuation Date
and ending at the close of business for the succeeding Valuation Date. A
Valuation Date is each day that the New York Stock Exchange is open for
business.
MORTALITY AND EXPENSE RISK PREMIUM - The Company deducts a Mortality and
Expense Risk Premium equal on an annual basis to the amount set forth on the
Contract Data Page. The Mortality and Expense Risk Premium compensates the
Company for assuming the mortality and expense risks under this Contract. Such
deductions are made daily from the Contract Value.
MORTALITY AND EXPENSE GUARANTEE - The Company guarantees that the dollar amount
of each annuity payment after the first will not be affected by variations in
mortality or expense experience.
ANNUITY UNIT - The value of an Annuity Unit for each sub-account was
arbitrarily set initially at $10. This was done when the first Eligible Mutual
Fund shares were purchased. The value for any later Valuation Period is
determined as follows: the Annuity Unit value for a sub-account for the last
Valuation Period is multiplied by the Net Investment Factor for the sub-account
for the next Valuation period and the result is divided by the assumed
investment factor for that Valuation Period.
CONTRACT MAINTENANCE CHARGE
DEDUCTION FOR CONTRACT MAINTENANCE CHARGE - The Company deducts an annual
Contract Maintenance Charge shown on the Contract Data Page, from the Contract
Value by cancelling Accumulation Units to reimburse it for administration
expenses relating to maintenance of this Contract. The Contract Maintenance
Charge will be deducted from the Contract Value on each Contract Anniversary
this Contract is in force. The number of Accumulation Units to be cancelled
will be from each applicable sub-account in the ratio that the value of each
sub-account bears to the total Contract Value.
When this Contract is surrendered for its full Surrender Value, on other than
the Contract Anniversary, the Contract Maintenance Charge will be deducted at
the time of such surrender. Prior to the Income Date, the Company does not
guarantee the amount of the Contract Maintenance Charge, and there is no
guarantee that it will not be changed in the future. After the Income Date,
the amount of the Contract Maintenance Charge will not be changed from the
amount of the annual Contract Maintenance Charge in effect during the Contract
Year immediately preceding the Income Date. After the Income Date the Contract
Maintenance Charge will be collected on a monthly basis and will result in the
reduction of the monthly benefit.
ANNUITY PROVISIONS
INCOME DATE AND SETTLEMENT OPTION - The Contract Owner selects an Income Date
and Settlement Option at the time of application. Such date must always be the
first day of a calendar month and must be at least one month after the
Effective Date, and may not be later than the first day of the first calendar
month following the Annuitant's 85th birthday.
CHANGE IN INCOME DATE - The Contract Owner may, upon at least thirty (30) days
prior written notice to the Company, change the Income Date. The date to which
such a change may be made shall be the first day of a calendar month. However,
the Income Date may not be deferred beyond the first day of the calendar month
following the Annuitant's 85th birthday.
CHANGE IN SETTLEMENT OPTION - The Contract Owner may, upon at least thirty (30)
days prior written notice to the Company, at any time prior to the Income Date,
elect a different Settlement Option or any other option satisfactory to the
Company and the Contract Owner.
SETTLEMENT OPTIONS - The net proceeds payable upon settlement of this Contract
may be paid under one of the following options or any other option acceptable
to the Company:
Option 1 - LIFE ANNUITY. An annuity payable monthly during the lifetime of
the Annuitant. Payments cease at the death of the Annuitant.
7
9
Option 2 - LIFE ANNUITY WITH 120 MONTHLY PAYMENTS GUARANTEED. An annuity
payable monthly during the lifetime of the Annuitant with the
guarantee that, if at the death of the Annuitant, payments have
been made for less than 120 months, payments will be continued to
the beneficiary for the remainder of the guaranteed period. If
the beneficiary does not desire payments to continue for the
remainder of the guarantee period, he or she may elect to have
the present value of the guaranteed annuity payments remaining,
as of the date notice of death is received by the Company,
commuted at the assumed investment rate, and paid in a single sum
within seven (7) days of receipt of such request.
Option 3 - JOINT AND LAST SURVIVOR ANNUITY. An annuity payable monthly
during the joint lifetime of the Annuitant and a designated
second person and continuing thereafter during the life of the
survivor.
If no settlement option is elected, Option 1 will automatically be applied.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS - Annuity payments will be paid as
monthly installments. However, if the net amount available to apply under any
settlement option is less than $5,000, the Company shall have the right to pay
such amount in one single lump sum. In addition, if the payments provided for
would be or become less than $30, the Company shall have the right to change
the frequency of payments to such intervals as will result in payments of at
least $30.
VARIABLE ANNUITY - A Variable Annuity is an annuity with payments which: (1)
are not predetermined as to dollar amount; and (2) will vary in amount with the
net investment results of the applicable sub-account(s) of the Variable
Account. At the Income Date the sub-account(s) Contract Value will be applied
to the applicable Annuity Tables. The Annuity Table used will depend upon the
Settlement Option chosen. The amount payable for the first payment for each
$1,000 so applied is shown in the Tables on pages 11 and 12. If, as of the
Income Date, the then current settlement option rates applicable to this class
of contracts will provide a larger income than that guaranteed for the same
form of annuity under this Contract, the larger amount will be paid. The
dollar amount of annuity payments after the first is determined as follows:
(1) The dollar amount of the first annuity payment is divided by the value
of an Annuity Unit as of the Income Date. This establishes the number
of Annuity Units for each monthly payment. The number of Annuity
Units remains fixed during the annuity payment period.
(2) The fixed number of Annuity Units is multiplied by the Annuity Unit
value for the last Valuation Period of the month preceding the month
for which the payment is due. This result is the dollar amount of the
payment.
The total dollar amount of each Variable Annuity payment is the sum of all
sub-account Variable Annuity payments reduced by the Contract Maintenance
Charge.
The sub-account Annuity Unit value at the end of any Valuation Period is
determined by multiplying the sub-account Annuity Unit value for the
immediately preceding Valuation Period by the quotient of (a) and (b), where:
(a) is the Net Investment Factor for the Valuation Period for which the
sub-account Annuity Unit value is being determined; and,
(b) is the assumed investment factor for such Valuation Period. The assumed
investment factor adjusts for the interest assumed in determining the
first Variable Annuity payment. Such factor for any Valuation Period
shall be the accumulated value of $1.00 deposited at the beginning of
such period at the Assumed Investment Rate of four (4%) percent.
NET INVESTMENT FACTOR - The Net Investment Factor for any sub-account for any
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 per share of the Eligible Mutual Fund or
Portfolio held in the sub-account determined as of the current
Valuation Period; plus
8
10
(2) the per share amount of any dividend or capital gain distribution
made by the Eligible Mutual Fund or Portfolio held in the sub-
account if the "exdividend" date occurs during the current
Valuation period; plus or minus
(3) a per share charge or credit, which is determined by the Company,
for changes in tax reserves resulting from investment operations of
the sub-account.
(b) is the net result of:
(1) the net asset value per share of the Eligible Mutual Fund or
Portfolio held in the sub-account determined as of the immediately
preceding Valuation Period; plus or minus
(2) the per share charge or credit for any changes in tax reserve for
the immediately preceding Valuation Period.
(c) is the percentage factor representing the Mortality and Expense Risk
Premium.
The Net Investment Factor may be greater or less than one; therefore, Annuity
Unit value may increase or decrease.
PAYMENTS
PAYMENTS ON THE DEATH OF THE ANNUITANT PRIOR TO THE INCOME DATE - In the event
of the death of the Annuitant prior to the Income Date, a death benefit will be
paid to the beneficiary designated by the Contract owner. The value of the
death benefit will be determined as of the Valuation period next following the
date both due proof of death and an election for a single sum payment or
Settlement Option is received by the Company. If a single sum settlement is
requested, the proceeds will be paid within seven (7) days of receipt of such
election and proof of death. If a single sum settlement is not elected and a
Settlement Option is desired, election may be made by the beneficiary during
the ninety-day period commencing with the date of receipt of notification of
death; otherwise a single sum settlement will be made to the beneficiary at the
end of such ninety-day period. The amount of the death benefit will be the
greater of (i) the sum of all Purchase Payments made, less any amount
surrendered, or (ii) the Contract Value. Death benefits will be made in
accordance with any applicable laws or regulations governing payment of death
proceeds.
PAYMENTS ON THE DEATH OF THE ANNUITANT AFTER THE INCOME DATE - If the Annuitant
dies after the Income Date, the death benefit, if any, shall be as specified in
the Settlement Option elected. The Company will require proof of the
Annuitant's death. Death benefits will be made in accordance with any
applicable laws or regulations governing payment of death proceeds.
SURRENDER PROVISIONS
SURRENDER - While this Contract is in force and before the earlier of the
Income Date or the death of the Annuitant, the Company will, upon written
request to the Company by the Contract Owner, allow the surrender of all or a
portion of this Contract for its Surrender Value. Surrenders will result in
the cancellation of Accumulation Units from each applicable sub-account in the
ratio that the value of each sub- account bears to the total Contract Value.
The Contract Owner must specify in writing in advance which units are to be
cancelled if other than the above mentioned method of cancellation is desired.
The Company will pay the amount of any surrender within seven (7) days of
receipt of such request.
The Surrender Value shall be the Contract Value for the Valuation Period next
following the Valuation Period during which the written request to the Company
for surrender is received reduced by the sum of:
(a) the total of any applicable premium taxes not previously deducted;
(b) any applicable Contract Maintenance Charges;
(c) any applicable Contingent Deferred Sales Charge.
9
11
CALCULATION OF CONTINGENT DEFERRED SALES CHARGE - If all or a portion of the
Surrender Value is surrendered, a Contingent Deferred Sales Charge will be
calculated at the time of each such surrender and will be deducted from the
Contract Value. In calculating the Contingent Deferred Sales Charge:
(a) Purchase Payments will be allocated to the amount surrendered on a
first-in, first-out basis;
(b) In no event will the aggregate Contingent Deferred Sales Charges exceed 6%
of the total Purchase Payments made.
The amount of the Contingent Deferred Sales Charge is calculated by:
(a) Allocating Purchase Payments to the amount surrendered; and
(b) Multiplying each such allocated Purchase Payment by the appropriate
percentage determined on the basis of the table below;
(c) Adding the products of each multiplication in (b) above.
TIME BETWEEN RECEIPT OF ALLOCATED
PURCHASE PAYMENT AND DATE OF SURRENDER PERCENTAGE
Less than 1 year 6%
At least 1 year but less than 2 years 5%
At least 2 years but less than 3 years 4%
At least 3 years but less than 4 years 3%
At least 4 years but less than 5 years 2%
At least 5 years but less than 6 years 1%
At least 6 years 0%
For a Partial Surrender, the Contingent Deferred Sales Charge will be deducted
from the remaining Contract Value, if sufficient, otherwise it will be deducted
from the amount surrendered. The amount deducted from the Contract Value will
be determined by cancelling Accumulation Units from each applicable sub-account
in the ratio that the value of each sub-account bears to the total Contract
Value. The Contract Owner must specify in writing in advance which units are
to be cancelled if other than the above method if cancellation is desired.
After the first Contract Anniversary, a Contract Owner may, not more frequently
than once annually on a non-cumulative basis, make a surrender per Contract
Year of up to ten (10%) percent of aggregate Purchase Payments free from
Contingent Deferred Sales Charges provided the contract Value prior to the
surrender exceeds $10,000. The Company may also periodically waive the
contingent Sales Charges under the Company procedures then in effect.
SUSPENSION OF PAYMENTS
The Company reserves the right to suspend or postpone payments hereunder for
any period when:
(1) the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
(2) trading on the Exchange is restricted;
(3) an emergency exists as a result of which disposal of securities held in
the Variable Account is not reasonably practicable or it is not
reasonably practicable to determine the value of the Variable Account's
net assets; or
(4) during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of security holder; provided that
applicable rules and regulations of the Securities and Exchange
Commission shall govern as to whether the conditions described in (2)
and (3) exist.
10
12
DOLLAR AMOUNT OF THE FIRST MONTHLY
VARIABLE ANNUITY PAYMENT PER $1,000
UNISEX
ADJUSTED LIFE LIFE & 10 YRS
AGE ONLY CERTAIN
40 4.19 4.18
41 4.24 4.22
42 4.28 4.27
43 4.33 4.31
44 4.38 4.36
45 4.43 4.41
46 4.49 4.46
47 4.55 4.52
48 4.61 4.58
49 4.67 4.64
50 4.74 4.70
51 4.81 4.77
52 4.89 4.83
53 4.97 4.91
54 5.05 4.99
55 5.14 5.07
56 5.23 5.15
57 5.33 5.24
58 5.44 5.34
59 5.55 5.44
60 5.68 5.55
61 5.81 5.66
62 5.95 5.78
63 6.10 5.90
64 6.26 6.03
65 6.43 6.17
66 6.61 6.31
67 6.81 6.46
68 7.01 6.61
69 7.24 6.77
70 7.48 6.94
71 7.74 7.11
72 8.02 7.28
73 8.32 7.46
74 8.64 7.63
75 8.98 7.81
The Settlement Rates given in the above table are based on the 1983 Individual
Annuitant Mortality Table (a) assuming an interest rate of 4.0% per year
compounded annually. Settlement rates for any age not shown above will be
calculated on the same basis as those rates in the table above. Such rates
will be furnished upon request.
11
13
DOLLAR AMOUNT OF THE FIRST MONTH
VARIABLE ANNUITY PAYMENT PER $1,000
JOINT & SURVIVOR LIFE INCOME
UNISEX
ANNUITANT SPOUSE ADJUSTED AGE MINUS ANNUITANT ADJUSTED AGE
ADJUSTED -10 -5 +0 +5 +10
AGE ------------------------------------------------
40 3.73 3.80 3.87 3.94 4.00
41 3.75 3.83 3.90 3.87 4.04
42 3.78 3.85 3.93 4.01 4.07
43 3.80 3.88 3.96 4.04 4.11
44 3.82 3.91 4.00 4.08 4.15
45 3.85 3.94 4.03 4.12 4.20
46 3.88 3.97 4.07 4.16 4.24
47 3.91 4.01 4.11 4.21 4.29
48 3.94 4.04 4.15 4.25 4.34
49 3.97 4.08 4.19 4.30 4.40
50 4.00 4.12 4.24 4.35 4.45
51 4.04 4.16 4.29 4.41 4.51
52 4.07 4.20 4.34 4.46 4.58
53 4.11 4.25 4.39 4.53 4.65
54 4.15 4.30 4.45 4.59 4.72
55 4.20 4.35 4.51 4.66 4.79
56 4.24 4.41 4.57 4.73 4.88
57 4.29 4.46 4.64 4.81 4.96
58 4.34 4.53 4.71 4.90 5.06
59 4.40 4.59 4.79 4.98 5.15
60 4.45 4.66 4.87 5.08 5.26
61 4.51 4.73 4.96 5.18 5.37
62 4.58 4.81 5.06 5.29 5.49
63 4.65 4.90 5.16 5.41 5.62
64 4.72 4.98 5.26 5.53 5.76
65 4.79 5.08 5.38 5.66 5.91
66 4.88 5.18 5.50 5.80 6.07
67 4.96 5.29 5.63 5.95 6.23
68 5.06 5.40 5.77 6.12 6.42
69 5.15 5.53 5.92 6.29 6.61
70 5.26 5.66 6.08 6.48 6.82
71 5.27 5.80 6.25 6.68 7.04
72 5.49 5.95 6.44 6.90 7.28
73 5.62 6.12 6.64 7.13 7.54
74 5.76 6.29 6.85 7.38 7.82
75 5.91 6.48 7.08 7.65 8.11
The Settlement Rates given in the above table are based on the 1983 Individual
Annuitant Mortality Table (a) assuming an interest rate of 4.0% per year
compounded annually. Settlement rates for any age not shown above will be
calculated on the same basis as those rates in the table above. Such rates
will be furnished upon request.
12
14
ANNUITY PURCHASE RATES
ADJUSTED AGE
CALENDAR YEAR WHEN INCOME
PAYMENTS COMMENCE ADJUSTED AGE
1984-1989 Actual Age minus 1
1990-1999 minus 2
2000-2009 minus 3
2010-2019 minus 4
2020-2024 minus 5
2025-2029 minus 6
2030-2934 minus 7
2035-2039 minus 8
13
15
[SENTRY LIFE INSURANCE COMPANY LOGO]
VARIABLE ANNUITY
INDIVIDUAL FLEXIBLE PURCHASE PAYMENT
DEFERRED, NON-PARTICIPATING
