EXHIBIT (4)(A)
--------------
GROUP MASTER POLICY
AND OPTIONAL RIDERS
[LOGO OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
GROUP CONTRACT OWNER: SECURITIES CUSTOMERS DLR INSURANCE TRUST II
GROUP CONTRACT NUMBER: 12345
GROUP CONTRACT DATE: APRIL 1, 1999
WE AGREE
. To provide annuity payments as These agreements are subject to
set forth in Section 10 of this the provisions of this Contract.
Contract, This Contract is issued in
consideration of the
. Or to pay withdrawal benefits in application, if any, and payment
accordance with Section 5 of of the premiums as provided.
this Contract.
This Contract may be applied for
. Or to pay death proceeds in an issued to qualify as a tax-
accordance with Section 9 of qualified annuity under the
this Contract. applicable sections of the
Internal Revenue Code.
Signed for us at our home office.
/S/ Xxxxx X. Xxxxxx /S/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
This Contract is a legal contract between the Contract Owner and the Company.
READ YOUR CONTRACT CAREFULLY
Group Flexible Premium Variable Annuity Contract
Income Payable At Annuity Commencement Date
Benefits Based On The Performance Of The Separate Account
Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
AV432 101 114 199 Non-Participating
SECTION 1
DEFINITIONS
ADJUSTED POLICY VALUE GROUP CONTRACT OWNER
The Policy Value increased or The entity, as shown on the
decreased by any Excess Interest Contract Data Page, which applies
Adjustment for the Group Contract
ANNUITANT INVESTMENT OPTIONS
The Participant to whom annuity Any of the Guaranteed Period
payments will be made, unless Options of the Fixed Account, the
another payee is named. Dollar Cost Averaging Fixed Account
Option, and any of the Subaccounts
ANNUITY COMMENCEMENT DATE of the Separate Account(s).
Date the Annuitant will begin PARTICIPANT
receiving payments from this
annuity, which may not be later A person who makes premium payments
than the last day of the or for whom premium payments are
Certificate month starting after made under the Group Contract
the Annuitant attains age 85,
except as expressly allowed by us, PAYEE
but in no event later than the last
day of the month following the The person to whom annuity payments
month in which the Annuitant will be made.
attains age 95.
PAYMENT OPTIONS
CASH VALUE
Options through which the
Amount defined in Section 5, that distribution of the Adjusted Policy
can be withdrawn if the annuity Value can be directed.
Certificate is surrendered.
POLICY VALUE
CERTIFICATE
The amount (defined in Section 4)
The document issued under the Group applicable under the Certificate
Contract to the eligible that can be used to fund one of the
Participants who apply for Payment Options.
coverage. The Certificate is not a
part of the Group Contract SEPARATE ACCOUNT
CERTIFICATE ANNIVERSARY The separate investment account(s)
established by us, as described in
The anniversary of the Certificate Section 6.
Date for each year this Certificate
remains in force. SUBACCOUNT
CERTIFICATE DATE A division of a Separate Account,
as described in Section 6.
The date shown on page 3 of the
Certificate and the date on which SURRENDER
the Certificate becomes effective.
A partial or full withdrawal of
CERTIFICATE OWNER funds from the Policy Value or Cash
Value.
The owner of the annuity
Certificate. Unless otherwise WITHDRAWAL
specified on the Certificate Data
page, the Annuitant and the A distribution of funds from the
Certificate Owner shall be one and Policy Value or Cash Value.
the same person.
YIELD
CERTIFICATE YEAR
The effective annual interest rate
The 12 month periods following the applicable to the Fixed Account
Certificate Date shown on the
Certificate Data page. The first YOU, YOUR
Certificate Year starts on the
Certificate Date. Each subsequent The owner of this Certificate.
year starts on the anniversary of Unless otherwise specified on the
the Certificate Date. Certificate Data Page, the
Annuitant and the Certificate Owner
DISTRIBUTION shall be one and the same person.
A withdrawal or disbursement of
funds from the Policy Value or Cash
Value.
GROUP CONTRACT
The Contract issued to the Group
Contract Owner, under which
Certificates are issued to eligible
Participants.
AVB432CT
PAGE 2
SECTION 2 - CONTRACT DATA
GROUP CONTRACT NUMBER: [12345]
GROUP CONTRACT DATE: [April 15, 1999]
GROUP CONTRACT OWNER: [Securities Customers DRL Insurance Trust II]
SEPARATE ACCOUNT: [PFL Endeavor Variable Annuity Account]
DCA SUBACCOUNT(S): [Money Market Portfolio,
U.S. Government Securities Portfolio]
PREMIUM PAYMENT MINIMUMS (PER CERTIFICATE)
Initial Premium Payment, Nonqualified: [$5,000.00]
Initial Premium Payment, Qualified*: [$2,000.00]
*Waived for 403(b) annuities
Subsequent Premium Payments: [$50.00]
SERVICE CHARGE: [$40]
Before the Annually Commencement Date:
[5%] Annually Compounding Death Benefit
Mortality and Expense Risk Fee and Administrative Charge: [1.75%]
Step-Up to age 75 Death Benefit
Mortality and Expense Risk Fee and Administrative Charge: [1.75%]
Return of Premium Death Benefit
Mortality and Expense Risk Fee and Administrative Charge: [1.55%]
Distribution Financing Charge [.00%]
After the Annuity Commencement Date: Mortality and Expense Risk Fee and
Administrative Charge: [1.55%]
FIXED ACCOUNT MINIMUM ANNUAL INTEREST RATE: 3%
SURRENDER CHARGE:
Number of Years Since Percentage of
Premium
[Premium Payment Date] Withdrawn
[0 - 1 8%
1 - 2 8%
2 - 3 8%
3 - 4 7%
4 - 5 6%
5 - 6 5%
6 - 7 4%
7 - 8 3%
8 - 9 2%
9 and thereafter 0%]
AV 432 101 114 779 MSP
PAGE 3
SECTION 2 - CONTRACT DATA - CONT
SCHEDULE OF ADDITIONAL BENEFITS:
FORM NO. ADDITIONAL BENEFIT(S)
AE 1051 199 LUMP SUM WITHDRAWAL OPTION
AE 1058 199 GUARANTEED MINIMUM DEATH BENEFIT
AE 1060 199 GUARANTEED MINIMUM DEATH BENEFIT
AE 1061 199 GUARANTEED MINIMUM DEATH BENEFIT
AE 1064 199 SYSTEMATIC PAYOUT OPTION
AE 1074 199 SERVICE CHARGE WAIVER
AE 1075 199 PREMIUM ENHANCEMENT]
AV 432 101 114 779 MSP
PAGE 3(A)
SECTION 3 - PREMIUM PAYMENTS
PAYMENT OF PREMIUMS ALLOCATION OF PREMIUM PAYMENTS
Premium payments may be made any Premium payments may be applied to
time on or after the effective date the various Investment Options
of the Certificate and before the which we make available. The
Annuity Commencement Date. The Certificate Owner must tell us what
Certificate Owner may start or percent of each premium payment to
stop, increase or decrease, or skip allocate to the various Investment
any premium payments. Options. Each percent may be either
zero or any whole number; however,
MAXIMUM AND MINIMUM PREMIUM PAYMENT the allocation among all Investment
Options must total 100%.
The premium payments may not be
more than the amount permitted by CHANGE OF ALLOCATION
law if this is a tax-qualified
annuity. The minimum premium The Certificate Owner may change
payments we will accept are the allocation of premium payments
specified on page 3. The maximum to the various Investment Options.
total premium payments, per The Certificate Owner must tell us
Participant, which we will accept in a signed notice which gives us
without prior Company approval is the facts that we need. Premium
$1,000,000. payments received after the date on
which we receive the notice will be
PREMIUM PAYMENT DATE applied on the basis of the new
allocation.
The premium payment date is the
date on which the premium payment PREMIUM TAXES
is credited to the Certificate. The
initial premium payment less any A state may impose a premium tax.
premium taxes will be credited to It may be imposed when a premium
the Certificate within two business payment is made, or on the Annuity
days of receipt of such payment and Commencement Date, on the date of
the required information. death, or on the date of full
Subsequent additional premium surrender. When permitted by state
payments will be credited to the law, we will not deduct the tax
Certificate as of the business day until the Annuity Commencement
when the premium payment and Date, date of death, or date of
required information are received. full surrender.
A business day is any day on which
the New York Stock Exchange is open
for trading.
SECTION 4 - POLICY VALUE
POLICY VALUE The Adjusted Policy Value may be
used on the Annuity Commencement
On or before the Annuity Date to provide lifetime income or
Commencement Date, the Policy Value income for a period of no less than
of each Certificate is equal to 60 months under the Payment Options
the: in Section 10.
(a) premium payments; minus SERVICE CHARGE
(b) Gross Partial Withdrawals; plus On each Certificate Anniversary and
at the time of surrender during any
(c) interest credited to the Fixed Certificate Year before the Annuity
Account; plus Commencement Date, we reserve the
right to charge an amount up to the
(d) accumulated gains in the amount of the Service Charge shown
Separate Account; minus on page 3 for administration
expenses. It will be deducted from
(e) accumulated losses in the each Investment Option in
Separate Account; minus proportion to the portion of Policy
Value (prior to such charge) in
(f) service charges, premium taxes each Investment Option,
and transfer fees, if any. respectively, on that Certificate
Anniversary, or at the time of
ADJUSTED POLICY VALUE surrender. In no event will the
Service Charge exceed 2% of the
The Adjusted Policy Value is the Policy Value at the time it is
Policy Value increased or decreased deducted.
by any Excess Interest Adjustment
M1016
PAGE 4
SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS
CASH VALUE 4) The Excess Interest Adjustment
may affect the death proceeds
The Cash Value may be partially defined in Section 9;
withdrawn or will be paid in the
event of a full surrender of the 5) If interest rates have decreased
Certificate. We must receive from the time the affected
written withdrawal or surrender Guaranteed Period(s) started
request from the Certificate Owner until the time the transaction
at or before the commencement of occurs, the Excess Interest
annuity payments. Adjustment will result in
additional funds available to
Information on the current amount the Certificate Owner;
of a Certificate's Cash Value is
available upon request The Cash 6) If interest rates have increased
Value is equal to the Adjusted from the time the affected
Policy Value less any Surrender Guaranteed Period(s) started
Charges. There is-no Cash Value until the time the transaction
after annuity payments have occurs, the Excess Interest
commenced. Adjustment will result in a
decrease in the funds available
EXCESS INTEREST ADJUSTMENT to the Certificate Owner.
Full Surrenders, Partial 7) Certain amounts are not subject
Withdrawals, transfers, and amounts to the Excess Interest
applied to a Payment Option from Adjustment as provided in
the Fixed Account Guaranteed Period Sections 5, 7 and 8.
Options described in Section 7 will
be subject to an Excess Interest The formula for determining the
Adjustment except as provided for amount of the Excess Interest
in the Partial Withdrawals Adjustment is as follows:
provision below.
Excess Interest Adjustment = S x (G-
An Excess Interest Adjustment C) x (M/12)
applies in the following
situations: where: S is the gross (that is,
before surrender charges
1) When the Certificate Owner and premium taxes, if any)
withdraws all or any portion of amount being surrendered,
their Cash Value, partially withdrawn,
transferred, or applied to
2) When the Certificate Owner a Payment Option that is
exercises Annuity Payment subject to the Excess
Options, Interest Adjustment
3) When death proceeds are G is the guaranteed interest
calculated. However, death rate for the Guaranteed
proceeds will not be reduced if Period applicable to S.
the Excess Interest Adjustment
is negative. M is the number of months
remaining in the
The Excess Interest Adjustment is Guaranteed Period for S.
only applied to transactions rounded up to the next
affecting the Guaranteed Period higher whole number of
Options of the Fixed Account (see months.
Section 7) and is based on any
change in interest rates from the C is the current guaranteed
time the affected Guaranteed interest rate then being
Period(s) started until the time offered on new Premium
the Excess Interest Adjustment Payments for the next
occurs. The Excess Interest longer Guaranteed Period
Adjustment is applied as follows: than "M". If the
Certificate form or such a
1) The Excess Interest Adjustment Guaranteed Period Option
is only applied when the is no longer offered, "C"
transactions occur prior to the will be the U.S. Treasury
end of any Guaranteed Period rate for the next longer
Option; maturity (in whole years)
than "M" on the 25th day
2) Transfers to the Guaranteed of the previous calendar
Period Options of the Fixed month, plus up to 2%.
Account are considered Premium
Payments for purposes of Upon full surrender, the Excess
determining the Excess Interest Interest Adjustment (EIA) for each
Adjustment; Guaranteed Period Option will not
reduce the Adjusted Policy Value
3) The Excess Interest Adjustment for that Guaranteed Period Option
is distinct from, and is applied below the amount paid into, less
prior to, the Surrender Charge; any prior withdrawals and transfers
from, that Guaranteed Period
Option, plus interest at the 3%
guaranteed effective annual
interest rate.
U1016
PAGE 5
SECTION 5 - CONT
PARTIAL WITHDRAWALS If any Partial Withdrawal reduces
the Cash Value below $500, we
We will pay the Certificate Owner a reserve the right to pay the full
portion of the Cash Value as a Cash Value and terminate the
Partial Withdrawal provided we Certificate.
receive a written request while the
Certificate is in effect and before We may delay payment of the Cash
the Annuity Commencement Date. When Value from the Fixed Account for up
the Certificate Owner requests a to 6 months after we receive the
Partial Withdrawal they must tell request If the Certificate Owner
us how it is to be allocated from dies after we receive the request,
among the Investment Options. If but before ore the request is
the request for a Partial processed, the request will be
Withdrawal from any Investment processed before the death proceeds
Option is less than or equal to the are determined.
Cash Value in that option, or
Subaccount, we will pay the amount Each Partial Withdrawal consists of
of the request However, if the a portion that is subject to
request for a Partial Withdrawal Surrender Charge (that is, the
from any Investment Option is Excess Partial Withdrawal) and a
greater than the Cash Value in that remaining portion that is free from
option, we will pay the Cash Value Surrender Charge (that is, the
of that Investment Option. Surrender Charge-free amount).
Either portion may be zero (0)
The Gross Partial Withdrawal is the depending on the Partial Withdrawal
total amount which will be deducted requested and prior amounts
from the Certificate's Policy Value withdrawn.
as a result of each Partial
Withdrawal. The Gross Partial Partial Withdrawals may be made
Withdrawal may be more or less than free from Surrender Charges and
the requested Partial Withdrawal free from Excess Interest
amount, depending on whether Adjustments as follows:
Surrender Charges and/or Excess
Interest Adjustments apply at the MINIMUM REQUIRED DISTRIBUTION
time the Partial Withdrawal is
requested. For tax-qualified plans,
Partial Withdrawals taken to
The Excess Partial Withdrawal satisfy minimum distribution
amount is the portion of the requirements under Section
requested Partial Withdrawal that 401(a)(9) of the Internal
is subject to Surrender Charge Revenue Code (IRC) are
(that is, the portion which is in available with no Surrender
excess of the Surrender Charge-free Charges and no Excess Interest
portion). For example, if the Adjustments. The amount
requested withdrawal amount is $ available from each
1,000, and the Surrender Charge- Certificate with respect to
free amount is $200, then the the minimum distribution
Excess Partial Withdrawal would be requirement is based solely on
$800. Excess Partial Withdrawals this Certificate.
will reduce the Policy Value by an
amount equal to (X-Y+Z) where: The Certificate Owner must be
at least 70 1/2 years old in
X = Excess Partial Withdrawal the calendar year of
A = Amount of Partial withdrawal distribution, must submit a
subject Excess Interest Adjustment written request to us and must
Y = Excess Interest djustment = take the distribution before
(A) x (G-C) x (M/12) where G. year end. If the Certificate
C and M are defined in the Owner attains age 70 1/2 in
Excess Interest Adjustment the calendar year of
provision above, with "A" distribution, a written
substituted for "S" in the request which is postmarked no
definitions of G and M. later than the end of the
Z = Surrender Charge on X minus Y. current calendar year must be
submitted to us.
The formula for determining the
Gross Partial Withdrawal is as Systematic minimum
follows: distributions must be at least
$50 or a lump sum distribution
Gross Partial Withdrawal = R - E + SC is available if minimum
required distributions are
where: R is the requested Partial less than $50
Withdrawal;
Any amount requested in excess
E is the Excess Interest of the IRC minimum required
Adjustment; and distribution will have the
appropriate Surrender Charges
SC is the Surrender Charge on and Excess Interest
(EPW - E); where Adjustments applied, unless
the excess distribution
EPW is the Excess Partial qualifies as Surrender Charge-
Withdrawal amount. free or Excess Interest
Adjustment-free under any
additional options provided.
M1017
PAGE 5(A)
SECTION 5 - CONT
NURSING CARE AND TERMINAL CONDITION Annuitant's, Xxxxxxxxx's
spouse's, Certificate Owner's,
WITHDRAWAL OPTION or Certificate Owner's
spouse's physician. Proof of
Beginning in the first confinement may be a
Certificate Year, if the physician's statement or a
Certificate Owner or statement from a hospital or
Certificate Owner's spouse nursing facility
(annuitant or annuitant's administrator.
spouse if the Certificate
Owner is not a natural person) UNEMPLOYMENT WAIVER
has been 1) confined in a
Hospital or Nursing Facility Beginning in the first
for 30 consecutive days or 2) Certificate Year, the
diagnosed as having a Terminal Certificate Owner may withdraw
Condition, the Certificate all or a portion of the Policy
Owner may elect to withdraw Value free of Surrender
all or a portion of the Policy Charges and free of any Excess
Value without Surrender Interest Adjustment if the
Charges and without Excess Certificate Owner or
Interest Adjustment. The Certificate Owner's spouse
minimum withdrawal under this (annuitant or annuitant's
option is $ 1000. spouse, if the Certificate
Owner is not a natural person)
For Nursing Care, we must becomes unemployed. In order
receive each withdrawal to qualify, the Certificate
request and proof of Owner 1) must have been
eligibility with each request employed full time for at
no later than 90 days least two years prior to
following the date that becoming unemployed, 2) must
confinement has ceased, unless have been employed full time
it can be shown that it was on the Certificate Date, 3)
not reasonably possible to must have been unemployed for
provide the notice and proof at least 60 consecutive days
within the above time period at the time of withdrawal and
and that the notice and proof consist of providing us with a
were given as soon as determination letter from the
reasonably possible. However, applicable State's Department
in no event, except the of Labor which verifies that
absence of legal capacity, the Certificate Owner
shall the notice and proof be qualifies for and is receiving
provided later than one year unemployment benefits at the
following the date that time of withdrawal. The
confinement has ceased. For a determination letter must be
Terminal Condition, we must received by us no later than
receive each withdrawal 15 days following the date of
request and the applicable the withdrawal request.
proof of eligibility no later
than one year following
diagnosis of the Terminal
Condition. Proof of a Terminal
Condition is required only
with the initial withdrawal
request and must be furnished
by the
U1017
PAGE 5(B)
SECTION 5 - CONT
SURRENDER CHARGES purposes, premium payments are
deemed to be withdrawn before
Amounts withdrawn in excess of any earnings.
Surrender Charge-free Partial
Withdrawals are subject to a After all premium payments are
Surrender Charge. If applicable, considered to be withdrawn, the
this charge will either apply for a remaining Adjusted Policy Value may
number of years following each be withdrawn free from any
premium payment date or for a Surrender Charge.
number of years following the
Certificate Date as shown on page GUARANTEED RETURN OF FIXED ACCOUNT
3. The amount of this charge, if PREMIUM PAYMENTS
any, will be a percentage, (as
shown on page 3 of each Upon full surrender of the
Certificate) of the amount of Certificate, the Certificate Owner
premium withdrawn. will always receive at least the
premium payments made to, less
For Surrender Charge purposes, the prior withdrawals and transfers
oldest premium payment is from, the Fixed Account
considered to be withdrawn first If
the amount withdrawn exceeds this, MINIMUM VALUES
the next oldest premium payment is
considered to be withdrawn, and so Benefits available under the
on until the most recent premium Certificate are not less than those
payment is considered to be required by any statute of the
withdrawn. For Surrender Charge state in which the Certificate is
delivered.
SECTION 6 - SEPARATE ACCOUNT
SEPARATE ACCOUNT of the Separate Account in
accordance with a method of
We have established and will valuation which we establish in
maintain one or more Separate good faith. Valuation Period means
Account(s), indicated on the the period of time from one
Certificate Data Page, under the determination of the value of each
laws of the state of Iowa. Any Subaccount to the next. Such
realized or unrealized income, net determinations are made when the
gains and losses from the assets of value of the assets and liabilities
the Separate Account are credited of each Subaccount is calculated.
to or charged against it without This is generally the close of
regard to our other income, gains business on each day on which the
or losses. Assets are put in the New York Stock Exchange is open.
Separate Account for the
Certificates, as well as for other We also reserve the right to
variable annuity policies and transfer assets of the Separate
Certificates. Any Separate Account Account, which we determine to be
may invest assets in shares of one associated with the class of
or more mutual fund portfolios, or Certificates to which the
in the case of a managed Separate Certificate belongs, to another
Account, direct investments in separate account. If this type of
stocks or other securities as transfer is made, the term
permitted by law. Fund Shares refer "Separate Account", as used in this
to shares of underlying mutual contract and in the Certificate,
funds or prorata ownership of the shall then mean the separate
assets held in a Subaccount of a account to which the assets were
managed Separate Account. Fund transferred.
shares are purchased, redeemed and
valued on behalf of the Separate We also reserve the right to:
Account. (a) deregister the Separate Account
under the Investment Company Act o
The Separate Account is divided 1940;
into Subaccounts. Each Subaccount
invests exclusively in shares of (b) manage the Separate Account
one of the portfolios of an under the direction of a
underlying mutual fund. We reserve committee at any time;
the right to add or remove any
Subaccount of the Separate Account. (c) restrict or eliminate any
voting rights of Certificate
The assets of the Separate Account Owners or other persons who
are our property. These assets will have voting rights as to the
equal or exceed the reserves and Separate Account; and
other contract liabilities of the
Separate Account. These assets will (d) combine the Separate Account
not be chargeable with liabilities with one or more other separate
arising out of any other business accounts;
we conduct. We reserve the right,
subject to regulations governing (e) create new Separate Accounts;
the Separate Account, to transfer
assets of a Subaccount, in excess (f) add new Subaccounts to or
of the reserves and other contract remove existing Subaccounts
liabilities with respect to that from the Separate Account, or
Subaccount, to another Subaccount combine Subaccounts;
or to our General Account.
(g) add new underlying mutual
We will determine the fair market funds, remove existing mutual
value of the assets funds, or substitute a new fund
for an existing fund.
P1037
PAGE 6
SECTION 6 - SEPARATE ACCOUNT - CONT
The Net Asset Value of a fund share provide accumulation units in those
is the per-share value calculated Subaccounts. The number of
by the mutual fund or, in the case accumulation units purchased in a
of a managed Separate Account, by Subaccount will be determined by
the Company. The Net Asset Value is dividing the premium payment
computed by adding the value of the allocated to or any amount
Subaccount's investments, cash and transferred to that Subaccount, by
other assets, subtracting its the value of an accumulation unit
liabilities, and then dividing by for that Subaccount on the premium
the number of shares outstanding. payment or transfer date.
Net Asset Values of fund shares
reflect investment advisory fees The number of accumulation units
and other expenses incurred in withdrawn or transferred from the
managing a mutual fund or a managed Subaccounts will be determined by
Separate Account dividing the amount withdrawn or
transferred by the value of an
CHANGE IN INVESTMENT OBJECTIVE OR accumulation unit for that
POLICY OF A MUTUAL FUND Subaccount on the withdrawal or
transfer date.
If required by law or regulation,
an investment policy of the The value of an accumulation unit
Separate Account will only be on any business day is determined
changed if approved by the by multiplying the value of that
appropriate insurance official of unit at the end of the immediately
the state of Iowa or deemed preceding valuation period by the
approved in accordance with such net investment factor for the
law or regulation. If so required, valuation period.
the process for obtaining such
approval is f fled with the The net investment factor used to
insurance official of the state or calculate the value of an
district in which this contract is accumulation unit in each
delivered. Subaccount for the Valuation Period
is determined by dividing (a) by
CHARGES AND DEDUCTIONS (b) and subtracting (c) from the
result, where:
The Mortality and Expense Risk Fee
and the Administrative Charge are (a) is the result of:
each deducted both before and after (1) the net asset value of a
the Annuity Commencement Date to fund share held in that
compensate for changes in mortality Subaccount determined as of
and expenses not anticipated by the the end of the current
mortality and administration valuation period; plus
charges guaranteed in the contract.
(2) the per share amount of any
Any applicable Service Charge is dividend or capital gain
deducted prior to the Annuity distributions made by the
Commencement Date only. fund for shares held in
that Subaccount if the ex-
Any applicable Distribution dividend date occurs during
Financing Charge is deducted prior the valuation period; plus
to the Annuity Commencement Date or minus
only, to compensate f or costs of
distributing the policy. (3) a per share credit or
charge for any taxes
If the Mortality and Expense Risk reserved for, which we
Fee(s) and/or Distribution determine to have resulted
Financing Charges are more than from the investment
sufficient, the Company will retain operations of that
the balance as profit or reduce Subaccount.
these fees and charges in the
future. (b) is the net asset value of a
fund share held in that
ACCUMULATION UNITS Subaccount determined as of the
end of the immediately
The Policy Value in the Separate preceding valuation period.
Account before the Annuity
Commencement Date is represented by (c) is a factor representing the
accumulation units. The dollar Mortality and Expense Risk Fee
value of accumulation units for and Administrative Charge
each Subaccount will change from before the Annuity Commencement
day to day reflecting the Date, plus any applicable
investment experience of the Distribution Financing Charge.
Subaccount. This factor is less than or
equal to, on an annual basis,
Premium payments allocated to and the sum of the applicable
any amounts transferred to the percentages shown on page 3 of
Subaccounts will be applied to the daily net asset value of a
fund share held in that
Subaccount.
Since the net investment factor may
be greater or less than one, the
accumulation unit value may
increase or decrease.
PB1037
PAGE 7
SECTION 7 - FIXED ACCOUNT
FIXED ACCOUNT We reserve the right f or new
premium payments, transfers, or
Premium payments applied to and any rollovers to offer or not to offer
amounts transferred to the Fixed any GPO, except that we will always
Account will reflect a fixed offer at least a one year GPO.
interest rate. The interest rates
we set will be credited for For purposes of crediting interest
increments of at least one year when funds are withdrawn from or
measured from each premium payment transferred into a GPO, the amount
or transfer date. These rates will of the oldest premium payment or
never be less than an effective rollover into that GPO is
annual interest rate of 3%. considered to be withdrawn first If
the amount withdrawn exceeds this
GUARANTEED PERIODS amount, the next oldest premium
payment or rollover is considered
We may offer optional Guaranteed to be withdrawn next, and so on
Period Options, into which premium until the most recent premium
payments may be paid or amounts payment or rollover is considered
transferred. The current interest to be withdrawn (this is a "First-
rate we set for funds entering each In, First-Out" or FIFO procedure).
Guaranteed Period Option (GPO) is Premium payment(s) or rollover(s)
guaranteed until the end of that are deemed to be withdrawn first,
option's Guaranteed Period. At that then credited interest.
time, the premium payment made or
amount transferred into the GPO, Partial withdrawals, Surrenders,
less any withdrawals or transfers transfers, and amounts applied to a
from that GPO, plus accrued Payment Option from the Guarantee
interest, will be rolled into a new Period Option(s) are subject to an
GPO or may be transferred to any Excess Interest Adjustment as
Subaccount(s) within the Separate described in Section 5.
Account(s).
DOLLAR COST AVERAGING FIXED ACCOUNT
The Certificate Owner may choose OPTION
the investment Option(s) they want
the funds rolled into by giving us We may offer a Dollar Cost
a written notice within 30 days Averaging (DCA) Fixed Account
before the end of the expiring Option separate from the Guaranteed
option's Guaranteed Period. Period Options. This option will
However, any Guaranteed Period have a one year interest rate
elected may not extend beyond the guarantee. The current interest
maximum Annuity Commencement Date rate we set for the DCA Fixed
defined in Section 11. In the Account may differ from the rates
absence of such election, the funds credited on the one year GPO in the
will be rolled into a new GPO which Fixed Account In addition, the
is the same as the expiring GPO current interest rate we credit may
unless that GPO is no longer vary on different portions of the
offered, in which case, the next DCA Fixed Account The credited
shorter GPO offered will be used. interest rate will never be less
The Certif icate Owner will be than the minimum effective annual
mailed a notice of completion of interest rate of 3%. The DCA Fixed
the rollover with the new interest Account Option will only be
rate applicable. The new GPO will available under a Dollar Cost
be deemed as accepted if we do not Averaging program as described in
receive a written rejection within Section 8.
30 days from the postmark date of
the completion notice.
SECTION 8 - TRANSFERS
A. TRANSFERS BEFORE THE ANNUITY apply to Policy Value transfers at
COMMENCEMENT DATE the end of a Guaranteed Period.
Prior to the Annuity Commencement Transfers of interest credited in
Date, the Certificate Owner may the GPOs to other Investment
transfer the value of the Options are allowed on a "First-In,
accumulation units from one First-Out" basis. Such transfers
Investment Option to another. The may be made monthly, quarterly,
Certificate Owner must sign a semi-annually, or annually. Each
notice to transfer which gives us such transfer must be at least $50
the facts that we need. and will not be subject to an
Excess Interest Adjustment.
Transfers of Policy Value from the
Guaranteed Period Options (GPO) of Transfers of Policy Value from the
the Fixed Account prior to the end Separate Account are subject to a
of that GPO are subject to an minimum of $500, or the entire
Excess Interest Adjustment If the Subaccount Policy Value, if less.
Excess Interest Adjustment at the However, if the remaining
time of such Policy Value transfer Subaccount Policy Value is less
is a negative adjustment, then the than $500, we reserve the right to
maximum Policy Value transfer is include that amount as part of the
25% of that GPO's Policy Value, transfer.
less Policy Values previously
transferred out of that GPO during The Certificate Owner may choose
the current certificate year. If which GPO to transfer to or from,
the Excess Interest Adjustment at however, any GPO elected may not
the time of such Policy Value extend beyond the maximum Annuity
transfer is a positive adjustment, Commencement Date defined in
no maximum will apply to such Section 11.
Policy Values transferred from the
GPO. No Excess Interest Adjustment
will
V1050
PAGE 8
SECTION 8 - CONT
No transfers will be allowed out of guarantee that the Dollar Cost
the Dollar Cost Averaging Fixed Averaging program will result in
Account Option except through the higher Policy Values or will
Dollar Cost Averaging Option. otherwise be successful.
We reserve the right to limit The Dollar Cost Averaging may be
transfers to no more than 12 in any discontinued after satisfying the
one Certificate Year. Any transfers minimum number of required
in excess of 12 per Certificate transfers by sending written notice
Year may be charged a $10 per to us. While Dollar Cost Averaging
transfer fee. Transfers among is in effect, Asset Rebalancing is
multiple Investment Options will be not available.
treated as one transfer in
determining the number of transfers ASSET REBALANCING
that have occurred. We also reserve
the right to prohibit transfer d to Prior to the Annuity Commencement
the Fixed Account if we are Date, the Certificate Owner may
crediting an effective annual instruct us to automatically
interest rate of 3%. transfer amounts among the
Subaccounts of the Separate Account
DOLLAR COST AVERAGING OPTION on a regular basis to maintain a
desired allocation of the Policy
Prior to the Annuity Commencement Value among the various Subaccounts
Date, the Certificate Owner may offered. Rebalancing will occur on
instruct us to automatically a monthly, quarterly, semi-annual
transfer a specified amount from or annual basis, beginning on a
the Dollar Cost Averaging (DCA) date selected. The Certif icate
Fixed Account Option or f from the Owner must select the percentage of
Dollar Cost Averaging the Policy Value desired in each of
Subaccount(s), if any, shown on the various Subaccounts offered
page 3 to any Subaccount(s) of the (totaling 100%). Any amounts in the
Separate Account The automatic Fixed Account are ignored for the
transfers can occur monthly or purposes of asset rebalancing.
quarterly. If the Dollar Cost Rebalancing can be started, stopped
Averaging request is received prior or changed at any time. Asset
to the 28th day of any month, the Rebalancing is not available while
first transfer will occur on the Dollar Cost Averaging is in effect
28th day of that month. If the Rebalancing will cease as soon as
Dollar Cost Averaging request is we receive a request for any other
received on or after the 28th day transfer.
of any month, the first transfer
will occur on the 28th day of the B. TRANSFERS AFTER THE ANNUITY
following month. COMMENCEMENT DATE
Prior to the Annuity Commencement After the Annuity Commencement
Date, no transfers, (except through Date, the Certificate Owner may
Dollar Cost Averaging) will be transfer the value of the variable
allowed from a DCA Fixed Account annuity units from one Subaccount
Transfers will continue until the to another within the Separate
elected Subaccount or DCA Fixed Account or to the Fixed Account. If
Account value is depleted. The the Certificate Owner wants to
amount transferred each time must transfer the value of the variable
be at least $500, All transfers annuity units, the Certificate
from the DCA account will be the Owner must tell us in a signed
same amount as the initial notice which gives us the facts
transfer. Changes to the amount that we need. We reserve the right
transferred will only be allowed to limit transfers between the
when additional premium is Subaccounts or to the Fixed
allocated or a new amount is Accounts to once per Certificate
transferred into the DCA Account Year.
Changes to the Subaccounts to which
these transfers are allocated are The minimum amount which may be
not restricted. Transfers must be transferred is the lesser of $10
scheduled for at least 6 but not monthly income or the entire
more than 24 months or for at least monthly income of the variable
4 but not more than 8 quarters each annuity units in the Subaccount
time the Dollar Cost Averaging from which the transfer is being
program is started or restarted made. If the monthly income of the
following termination of the remaining units in a Subaccount is
program for any reason. less than $10, we have the right to
include the value of those variable
Dollar Cost Averaging results in annuity units as part of the
the purchase of more accumulation transfer.
units when the value of the
accumulation unit is low, and fewer After the Annuity Commencement
accumulation units when the value Date, no transfers may be made from
of the accumulation unit is high. the Fixed Account to any other
However, there is no Investment Options.
VB1050
PAGE 9
SECTION 9 - DEATH PROCEEDS
A. DEATH PROCEEDS PRIOR TO ANNUITY II. Annuitant and Certificate
COMMENCEMENT DATE Owner are different and the
Annuitant dies.
The amount of death proceeds will
be the greater of the Cash Value, When we have due proof that
the Policy Value, or any guaranteed the Annuitant died prior to
minimum death benefit. the Annuity Commencement Date,
the Certificate Owner will
If no payment option is selected by become the new Annuitant and
the date of death, the beneficiary no death proceeds are payable.
may make such election within one If the Certificate Owner is
year of the date we receive due also the deceased Xxxxxxxxx's
proof of death. The beneficiary may surviving spouse, an amount
elect to receive the death proceeds equal to the excess, if any,
as a lump sum payment or may use of any guaranteed minimum
the death proceeds to provide any death benefit over the Policy
of the annuity payment options Value will then be added to
described in Section 10. Interest the Policy Value. This amount
on death proceeds will be paid as will be added only once at the
required by law. time of such election.
Furthermore, all future
B. DEATH PRIOR TO ANNUITY Surrender Charges will be
COMMENCEMENT DATE waived.
Death proceeds are payable However, in lieu of becoming
contingent upon the relationships the new Annuitant, the
between the Certificate Owner, Certificate Owner may elect to
Annuitant, successor Certificate have the death proceeds
Owner and beneficiary as outlined distributed to the beneficiary
below. The Certificate must be on the death of the Annuitant
surrendered upon settlement and This election must be in
will be terminated upon receiving writing and must be received
proof of death. by us prior to the Annuitant's
death. In such case, when we
I. Certificate Owner is also the have due proof that the
Annuitant When we have due Annuitant died prior to the
proof that the Certificate Annuity Commencement Date, we
Owner died before the Annuity will provide the death
Commencement Date, we will proceeds to the beneficiary.
provide the death proceeds to
the beneficiary. a) If the Certificate Owner
has elected to have the
a) Beneficiary is the deceased death proceeds paid as a
Certificate Owner's lump sum, the beneficiary
surviving spouse. The must, within 60 days of our
beneficiary may elect to receipt of due proof of the
continue the Certificate Annuitant's death, either:
rather than receiving the
death proceeds. If the 1) receive the lump sum proceed;
Certificate is continued, or
an amount equal to the 2) elect to receive annuity
excess, if any, of any payments. Such payments
guaranteed minimum death must begin within one
benefit over the Policy year of our receipt of
Value will then be added to due proof of the
the Policy Value. This Xxxxxxxxx's death and
amount will be added only must be made for a
once, at the time of such period certain or for
election. Furthermore, all this beneficiary's
future Surrender Charges lifetime, so long as any
will be waived. period certain does not
exceed this
If this beneficiary elects beneficiary's life
to have the death proceeds expectancy.
paid, the death proceeds
must be distributed: b) Death proceeds which are
not paid to or for the
(1) by the end of 5 years benefit of a natural person
after the date of the must be distributed by the
deceased Certificate end of 5 years after the
Owner's death, or date of the Annuitant's
death.
(2) payments must begin no
later than one year after III. Annuitant and Certificate
the deceased Certificate Owner are different and the
Owner's death and must be Certificate Owner dies.
made for a period certain
or for this beneficiary's If the Certificate Owner dies
lifetime, so long as any prior to the Annuity
period certain does not Commencement Date and before
exceed this beneficiary's the entire interest in the
life expectancy. Certificate is distributed,
the successor Certificate
b) Beneficiary is not the Owner will become the new
deceased Certificate Certificate Owner. The
Owner's surviving spouse. remaining portion of any
The death proceeds must be interest in the policy must be
distributed as provided in distributed to the extent
l.a)(1) or l.a)(2) above. provided below in III.a),
III.b), III.c), or III.d).
c) Death proceeds which are
not paid to or for the a) Successor Certificate Owner
benefit of a natural person is the deceased Certificate
must be distributed by the Owner's surviving spouse.
end of 5 years after the The successor Certificate
date of the deceased Owner may elect to continue
Certificate Owner's death. this Certificate rather
than receive the Adjusted
Policy Value. If the
Certificate is continued,
all future Surrender
Charges will be waived. If
the successor Certificate
Owner elects to receive the
Adjusted Policy Value, the
Adjusted Policy Value must
be distributed:
S961
PAGE 10
SECTION 9 - CONT
(1) by the end of 5 years IV. More than one Certificate
after the date of the Owner. If there is more than
deceased Certificate one Certificate Owner, then
Owner's death, or the death of any Certificate
Owner will be treated the same
(2) payments must begin no as the death of the
later than one year after Certificate Owner.
the deceased Certificate
Owner's death and must be D. DEATH ON OR AFTER THE ANNUITY
made for a period certain COMMENCEMENT DATE
or for the successor
Certificate Owner's The death proceeds on or after the
lifetime, so long as any Annuity Commencement Date depend on
period certain does not the payment option selected. If any
exceed the successor Certificate Owner dies on or after
Certificate Owner's life the Annuity Commencement Date, but
expectancy. before the entire interest in the
Certificate is distributed, the
b) Successor Certificate remaining portion of such interest
Owner is not the deceased in the Certificate will be
Certificate Owner's distributed at least as rapidly as
surviving spouse. The under the method of distribution
Adjusted Policy Value must being used as of the date of that
be distributed as provided Certificate Owner's death.
in III.a)(1) or III.a)(2)
above. E. AN OWNER IS NOT AN INDIVIDUAL
c) Successor Certificate In the case of a non tax-qualified
Owner is not a natural annuity, if any Certificate Owner
person. The Adjusted or beneficial Certificate Owner is
Policy Value must be not an individual, then for
distributed as provided in purposes of the federal income tax
III.a)(1) above. mandatory distribution provisions
in subsection C or D above, (1) the
d) No successor Certificate Annuitant will be treated as the
Owner survives the Certificate Owner of the
deceased Certificate Certificate, and (2) if there is
Owner. The deceased any change in the Annuitant, such a
Certificate Owner's estate change will be treated as the death
will become the new of the Certificate Owner.
Certificate Owner (or the
estate may name a new
Certificate Owner). The
executor or Administrator
must be named in a form
acceptable to us. The
Adjusted Policy Value must
be distributed by the end
of 5 years after the date
of the deceased
Certificate Owner's death.
SECTION 10 - ANNUITY PAYMENTS
A. GENERAL PAYMENT PROVISIONS the adjusted age of the Annuitant.
The adjusted age is the Annuitant's
Payment actual age on the Annuitant's
nearest birthday, at the Annuity
If the Certificate is in force on Commencement Date, adjusted as
the Annuity Commencement Date, we follows:
will use the Fixed Account portion
and/or the Separate Account portion Annuity
of the Adjusted Policy Value to Commencement Date Adjusted Age
make annuity payments to the Payee ----------------- ------------
under Option 3 and/or 3-V, Before 2001 Actual Age minus
respectively, with 10 years 2010 - 2001 Actual Age minus 1
certain, or if elected, under one 2020 - 2011 Actual Age minus 2
or more of the other options 2030 - 2021 Actual Age minus 3
described in this section. However, 2040 - 2031 Actual Age minus 4
the option(s) elected must provide After 2040 Actual Age minus 5
for lifetime income or income for a
period of at least 60 months. The Election of Optional Method of Payment
Certificate Owner will become the
Annuitant at the Annuity Before the Annuity Commencement
Commencement Date. Payments will be Date the Certificate Owner can
made at 1, 3, 6 or 12 month elect or change a payment option.
intervals. We reserve the right to The Certificate Owner may elect, in
change the frequency of payments to a signed notice which gives us the
avoid making payments of less than facts that we need, annuity
$50 payments that may be either
variable, fixed, or a combination
Before the Annuity Commencement of both. If a combination is
Date, if the death proceeds become elected, they must also tell us
payable or if the Certificate is what part of the proceeds on the
surrendered, we will pay any Annuity Commencement Date are to be
proceeds in one sum, or if elected, applied to provide each type of
all or part of these proceeds may payment (It must also specify which
be placed under one or more of the Subaccounts.} The amount of a
options described in this section. combined payment will be the sum of
If we agree, the proceeds may be the variable and fixed payments.
placed under some other method of Payments under a variable payment
payment instead. option will ref lect the investment
performance of the selected
Adjusted Age Subaccount of the Separate Account.
Payments under Options 3 and 5, and
the first payment under Options 3-V
and 5-V are determined based on
SB961
Page 11
SECTION 10 - ANNUITY PAYMENTS - CONT
Payee when the Certificate Owner elects
this option. The interest rate we
Unless specified otherwise, the declare for this option may be
Payee shall be the Annuitant, or different than the interest rate(s)
the beneficiary as specified in the credited prior to the Annuity
Beneficiary provision. Commencement Date.
Proof of Age Option 2 - Income for a Specified Period
We may require proof of the age of We will make level payments only
any person who has an annuity for the fixed period the
purchased under Options 3, 3-V, 5 Certificate Owner chooses. In the
and 5-V of this section before we event of the death of the person
make the first payment. receiving payments prior to the end
of the fixed period elected,
Minimum Proceeds payments will be continued to that
person's beneficiary or their
If the proceeds are less than present value may be paid in a
$2,000, we reserve the right to pay single sum. No funds will remain at
them out as a lump sum instead of the end.
applying them to a payment option.
Option 3 - Life Income - The
Premium Tax Certificate Owner may choose
between:
We may be required by law to pay
premium tax on the amount applied 1. No Period Certain - We will
to a payment option. If the make level payments only
requirement is applicable to the during the Annuitant's
issue state, we will deduct the lifetime.
premium tax before applying the 2. 10 Years Certain - We will make
proceeds. level payments for the longer
of the Annuitant's lifetime or
B. FIXED ACCOUNT PAYMENTS ten years.
3. Guaranteed Return of Policy
Guaranteed Payment Options Proceeds - We will make level
payments for the longer of the
The fixed account payment is Annuitant's lifetime or until
determined by multiplying each the total dollar amount of
$1,000 of proceeds allocated to a payments we made to the Payee
fixed Payment Option by the amounts equals the amount applied to
shown on page 12 for the option this option.
selected. Options 1, 2 and 4 are
based on a guaranteed interest rate Option 4 - Income of a Specified Amount
of 3%.
Options 3 and 5 are based on a Payments are made for any specified
guaranteed interest rate of 3% and amount until the amount applied to
the "1983 Table a" (male, female, this option, with interest, are
and unisex if required by law) exhausted. This will be a series of
mortality table improved to the level payments followed by a
year 2000 with projection scale G. smaller final payment In the event
(The "1983 Table a" mortality rates of the death of the person
are adjusted based on improvements receiving payments prior to the
in mortality since 1983 to more time proceeds with interest are
appropriately reflect increased exhausted, payments will be
longevity. This is accomplished continued to that person's
using a set of improvement factors beneficiary or their present value
referred to as projection scale G.) may be paid in a single sum.
Option 1 - Interest Payments Option 5 - Joint and Survivor Annuity
We will pay the interest on the Payments are made during the joint
amount we use to provide annuity lifetime of the Payee and a joint
payments in equal payments or this Payee of the Certificate Owner's
amount may be left to accumulate selection. Payments will be made as
for a period of time we and the long as either person is living.
Certificate Owner agree to. We and
the Certificate Owner will agree on Current Payment Options
withdrawal rights
The amounts shown in the tables on
page 12 are the guaranteed amounts.
Current amounts offered to
individuals of the same class may
be obtained from us.
S962
Page 11(A)
SECTION 10 - CONT
C. VARIABLE ACCOUNT PAYMENT OPTIONS the percentage shown on page 3
of the daily net asset value of
Variable Annuity Units a fund share held in the
Separate Account for that
The proceeds chosen by the Subaccount.
Certificate Owner to apply to a
variable payment option will be Determination of the First Variable
used to purchase variable annuity Payment
units in Subaccounts chosen by the
Certificate Owner. The dollar value The amount of the first variable
of variable annuity units in the payment is determined by
chosen Subaccounts will increase or multiplying each $ 1,000 of
decrease reflecting the investment proceeds allocated to a variable
experience of the chosen payment option by the amounts shown
Subaccounts. The value of a on page 13 for the variable option
variable annuity unit in a the Certificate Owner selects. the
particular Subaccount on any tables are based on a 5% effective
business day is equal to (a) annual Assumed Investment Return
multiplied by (b) multiplied by and the "1983 Table a" (male,
(c), where: female, and unisex if required by
law) mortality table improved to
(a) is the variable annuity unit the year 2000 with projection scale
value for that Subaccount on G. (The "1983 Table a" mortality
the immediately preceding rates are adjusted based on
business day; improvements in mortality since
1983 to more appropriately reflect
(b) is the net investment factor increased longevity. This is
for that Subaccount for the accomplished using a set of
Valuation Period; and improvement factors referred to as
projection scale G.)
(c) is the Assumed Investment
Return adjustment factor for Option 3V - Life Income
the Valuation Period.
The Certificate Owner may choose
The Assumed Investment Return between:
adjustment factor for the valuation
period is the product of discount 1. "No Period Certain" - Payments
factors of .99986634 per day to will be made only during the
recognize the 5.0% effective annual lifetime of the Annuitant.
Assumed Investment Return.
2. "10 Years Certain" - Payments
The net investment factor used to will be made for the longer of
calculate the value of a variable the Annuitant's lifetime or ten
annuity unit in each Subaccount for years. In the event of the death
the Valuation Period is determined of the person receiving payments
by dividing (a) by (b) and prior to the end of the period
subtracting (c) from the result, for which the election was made,
where: payments will be continued to
that person's beneficiary or
(a) is the net result of: their present value may be paid
in a single sum.
(1) the net asset value of a
fund share held in that Option 5V - Joint and Survivor Annuity
Subaccount determined as of
the end of the current Payments are made as long as either
valuation period; plus the Payee or the joint Payee is
(2) the per share amount of any living.
dividend or capital gain
distributions made by the Determination of Subsequent Variable
fund for shares held in Payments
that Subaccount if the ex-
dividend date occurs during The amount of each variable annuity
the Valuation Period; plus payment after the first will
or minus increase or decrease according to
(3) a per share credit or the value of the variable annuity
charge for any taxes units which reflect the investment
reserved for, which we experience of the selected
determine to have resulted Subaccounts. Each variable annuity
from the investment payment after the first will be
operations of the equal to the number of variable
Subaccount. annuity units in the selected
Subaccounts multiplied by the
(b) is the net asset value of a variable annuity unit value on the
fund share held in that date the payment is made. The
Subaccount determined as of the number of variable annuity units in
end of the immediately each selected Subaccount is
preceding Valuation Period. determined by dividing the first
variable annuity payment allocated
(c) is a factor representing the to the Subaccount by the variable
Mortality and Expense Risk Fee annuity unit value of that
and Administrative Charge Subaccount on the Annuity
applicable after the Annuity Commencement Date.
Commencement Date. This factor
is less than or equal to, on an
annual basis,
SB962
PAGE 11(B)
GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS
The amounts shown in these tables are the guaranteed amounts for each $1,000 of
the proceeds. Higher current amounts may be available at the time of settlement.
-------------------------------------------------------------------------------------------------------------------------------
Option 2, Table I Option 3, Table II Option 3, Table III Option 3, Table IV
----------------------------- ---------------------------- ---------------------------- ----------------------------
Number Amount of Monthly Installment for life Monthly Installment for life Monthly Installment for Life
Of Years Monthly No Period Certain 10 Years Certain Guaranteed Return of
Payable Installment Proceeds
------------------------------------------------------------------------------------------------
Age* Male Female Unisex Male Female Unisex Male Female Unisex
--------------------------------------------------------------------------------------------------------------------------------
50 $3.87 $3.55 $3.71 $3.84 $3.54 $3.70 $3.73 $3.49 $3.61
51 3.93 3.60 3.77 3.90 3.59 3.75 3.79 3.53 3.66
52 4.00 3.65 3.83 3.97 3.64 3.81 3.84 3.58 3.71
53 4.07 3.71 3.90 4.04 3.70 3.87 3.90 3.63 3.76
5 $17.91 54 4.15 3.77 3.97 4.11 3.75 3.94 3.96 3.68 3.82
6 15.14 55 4.23 3.83 4.04 4.19 3.82 4.01 4.03 3.73 3.88
7 13.16 56 4.32 3.90 4.11 4.27 3.88 4.08 4.10 3.79 3.94
8 11.68 57 4.41 3.97 4.19 4.35 3.95 4.15 4.17 3.85 4.00
9 10.53 58 4.50 4.05 4.28 4.44 4.02 4.24 4.24 3.91 4.07
10 9.61 59 4.61 4.13 4.37 4.53 4.10 4.32 4.32 3.97 4.14
11 8.86 60 4.72 4.21 4.47 4.63 4.18 4.41 4.40 4.04 4.22
12 8.24 61 4.84 4.30 4.57 4.74 4.26 4.51 4.49 4.12 4.30
13 7.71 62 4.96 4.40 4.68 4.85 4.35 4.61 4.58 4.19 4.38
14 7.26 63 5.10 4.50 4.80 4.97 4.45 4.71 4.68 4.28 4.47
15 6.87 64 5.24 4.61 4.93 5.09 4.55 4.83 4.78 4.36 4.56
16 6.53 65 5.40 4.73 5.06 5.22 4.66 4.95 4.88 4.45 4.66
17 6.23 66 5.56 4.85 5.21 5.36 4.77 5.07 4.99 4.55 4.76
18 5.96 67 5.74 4.99 5.36 5.50 4.89 5.20 5.11 4.65 4.87
19 5.73 68 5.93 5.13 5.53 5.65 5.02 5.34 5.24 4.76 4.98
20 5.51 69 6.13 5.29 5.71 5.80 5.15 5.49 5.37 4.87 5.10
70 6.34 5.45 5.90 5.96 5.30 5.64 5.51 4.99 5.23
--------------------------------------------------------------------------------------------------------------------------------
Option 5, Table V
--------------------------------------------------------------------------------------------------------------------------------
Monthly Installment For Joint and Full Survivor
--------------------------------------------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
Xxxx
Xxxxxxxxx* ---------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less Than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
--------------------------------------------------------------------------------------------------------------------------------
50 $2.99 $3.05 $3.11 $3.18 $3.25 $3.32 $3.39
55 3.11 3.19 3.27 3.35 3.44 3.53 3.63
60 3.27 3.37 3.47 3.58 3.70 3.82 3.95
65 3.47 3.60 3.74 3.89 4.05 4.22 4.39
70 3.74 3.91 4.10 4.31 4.53 4.77 5.02
--------------------------------------------------------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor
--------------------------------------------------------------------------------------------------------------------------------
Age of Age of Joint Annuitant*
First
Annuitant* ---------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less Than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
--------------------------------------------------------------------------------------------------------------------------------
50 $3.04 $3.09 $3.15 $3.21 $3.27 $3.33 $3.39
55 3.17 3.24 3.32 3.40 3.48 3.56 3.63
60 3.34 3.44 3.54 3.64 3.75 3.85 3.95
65 3.57 3.70 3.83 3.97 4.11 4.26 4.39
70 3.87 4.04 4.22 4.42 4.62 4.82 5.01
--------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
--------------------------------------------------------------------------------
The annual, semi-annual or quarterly installments under Option 2 shall be the
monthly installment shown multiplied by 11.84, 5.96 or 2.99 respectively, and
for Options 3 and 5 the monthly installment shown multiplied by 11.80, 5.95 or
2.99 respectively.
--------------------------------------------------------------------------------
Dollar amounts of monthly installments not shown in the above tables will be
calculated on the same basis as those shown and may be obtained from the
Company.
T828
PAGE 12
VARIABLE PAYMENT OPTIONS
BASED ON ASSUMED INVESTMENT RETURN
The amounts shown in these tables are the initial payment amounts based on a
5.0% Assumed Investment Return for each $1,000 of the proceeds.
------------------------------------------------------------------------------------------------------------------------------------
Option 3 - V, Table II Option 3 - V, Table III
--------------------------- -------------------------------------------------------------------------------------------
Monthly Installment for Life Monthly Installment for Life
No Period Certain 10 Years Certain
Age* Male Female Unisex Male Female Unisex
------------------------------------------------------------------------------------------------------------------------------------
50 $5.11 $4.81 $4.96 $5.07 $4.79 $4.94
51 5.17 4.85 5.02 5.13 4.83 4.99
52 5.24 4.90 5.07 5.19 4.88 5.04
53 5.31 4.95 5.13 5.25 4.93 5.10
54 5.38 5.01 5.20 5.32 4.98 5.16
55 5.46 5.06 5.26 5.39 5.04 5.22
56 5.54 5.12 5.34 5.47 5.09 5.28
57 5.63 5.19 5.41 5.54 5.16 5.36
58 5.72 5.26 5.49 5.63 5.22 5.43
59 5.82 5.34 5.58 5.72 5.29 5.51
60 5.93 5.42 5.68 5.81 5.37 5.60
61 6.04 5.50 5.78 5.91 5.44 5.69
62 6.17 5.60 5.89 6.02 5.53 5.78
63 6.30 5.69 6.00 6.13 5.62 5.88
64 6.44 5.80 6.13 6.25 5.71 5.99
65 6.60 5.91 6.26 6.37 5.82 6.10
66 6.76 6.04 6.40 6.50 5.92 6.22
67 6.94 6.17 6.56 6.63 6.04 6.35
68 7.13 6.31 6.72 6.77 6.16 6.48
69 7.33 6.46 6.90 6.92 6.29 6.62
70 7.55 6.63 7.09 7.07 6.43 6.76
------------------------------------------------------------------------------------------------------------------------------------
Option 5V, Table V
------------------------------------------------------------------------------------------------------------------------------------
Monthly Installment For Joint and Full Survivor
Age of Age of Female Annuitant*
Male ------------------------------------------------------------------------------------------------------------
Annuitant*
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
-----------------------------------------------------------------------------------------------------------------------------------
50 $4.32 $4.36 $4.41 $4.46 $4.51 $4.57 $4.62
55 4.42 4.47 4.53 4.60 4.67 4.75 4.83
60 4.54 4.62 4.70 4.80 4.90 5.01 5.12
65 4.71 4.82 4.94 5.07 5.22 5.37 5.53
70 4.95 5.10 5.27 5.46 5.67 5.89 6.13
-----------------------------------------------------------------------------------------------------------------------------------
Monthly Installment For Unisex Joint and Full Survivor
-----------------------------------------------------------------------------------------------------------------------------------
Age of Age of Joint Annuitant*
First -----------------------------------------------------------------------------------------------------------
Annuitant*
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
-----------------------------------------------------------------------------------------------------------------------------------
50 $4.40 $4.45 $4.50 $4.55 $4.61 $4.67 $4.72
55 4.52 4.59 4.66 4.73 4.81 4.89 4.96
60 4.69 4.78 4.87 4.97 5.08 5.19 5.29
65 4.91 5.04 5.17 5.31 5.46 5.62 5.77
70 5.22 5.40 5.59 5.79 6.02 6.24 6.47
-----------------------------------------------------------------------------------------------------------------------------------
* Adjusted Age as defined in Section 10.A.
--------------------------------------------------------------------------------
The annual, semi-annual or quarterly installments shall be the monthly
installment shown for Options 3-V and 5-V multiplied by 11.70, 5.93 or 2.99
respectively.
--------------------------------------------------------------------------------
Dollar amounts of monthly installments not shown in the above tables will be
calculated on the same basis as those shown and may be obtained from the
Company.
TB828
PAGE 13
SECTION 11 - GENERAL PROVISIONS
THE CONTRACT Date.
The entire contract consists of EVIDENCE OF SURVIVAL
this contract, riders, and the
attached application. All We have the right to require
statements in the application or in satisfactory evidence that a person
the enrollment form for a was alive if a payment is based on
Participant Certificate are that person being alive. No payment
representations and not warranties. will be made until we receive the
No statement will cause this evidence.
contract to be void or be used in
defense of a claim unless contained SETTLEMENT
in the application.
Any payment by us under the
PARTICIPANT CERTIFICATES Certificate is payable at our Home
Office.
We will issue a Certificate to each
Participant Such Certificates are RIGHTS OF CERTIFICATE OWNER
not a part of this contract
The Certificate Owner may, while
MODIFICATION OF CONTRACT the Annuitant is living:
No change in this Contract or the 1. Assign the Certificate.
Group Certificate is valid unless 2. Surrender the Certificate to us.
made in writing by us and approved 3. Amend or modify the Certificate
by one of our officers. No with our consent.
registered representative has 4. Receive annuity payments or name
authority to change or waive any a Payee to receive the payments.
provision of the Group Certificate 5. Exercise, receive and enjoy
or this Contract every other right and benefit
contained in the Certificate.
TAX QUALIFICATION
The use of these rights may be
This Contract is intended to subject to the consent of any
qualify as an annuity contract for assignee or irrevocable
federal income tax purposes. The beneficiary; and of the spouse in a
provisions of this Contract are to community or marital property
be interpreted to maintain such state.
qualification. To maintain such tax
qualification, we reserve the right Unless we have been notified of a
to amend this Contract to reflect community or marital property
any clarifications that may be interest in the Certificate, we
needed or are appropriate to will rely on our good faith belief
maintain such tax qualification or that no such interest exists and
to conform this Contract to any will assume no responsibility for
applicable changes in the tax inquiry.
qualification requirements. We will
send the Certificate Owner a copy SUCCESSOR CERTIFICATE OWNER
in the event of any such amendment
If such an amendment is refused, it A successor Certificate Owner can
must be by giving us written be named in any enrollment form, or
notice, and refusal may result in in a notice the Certificate Owner
adverse tax consequences. signs which gives us the facts that
we need. The successor Certificate
NON -PARTICIPATING Owner will become the new
Certificate Owner when the
The Group Contract and Group Certificate Owner dies, if the
Certificates will not share in our Certificate Owner dies before the
surplus earnings. Annuitant If no successor
Certificate Owner survives the
AGE OR SEX CORRECTIONS Certificate Owner and the
Certificate Owner dies before the
If the age or sex of the Annuitant Annuitant, the Certificate Owner's
has been misstated, the benefits estate will become the new
will be those which the premiums Certificate Owner.
paid would have purchased for the
correct age and sex. If required by ANNUITY COMMENCEMENT DATE
law to ignore differences in the
sex of the Annuitant, the payment The Annuity Commencement Date is
options will be determined using the date annuity payments begin.
the unisex factors in Section 10. This date may not be later than the
last day of the Certificate month
Any underpayment made by us will be starting after the Annuitant
paid with the next payment Any attains age 85, except as expressly
overpayment made by us will be allowed by us, but in no event
deducted from future payments. Any later than the last day of the
underpayment or overpayment, will Certificate month following the
include interest at 5% per year, month in which the Annuitant
from the date of the wrong payment attains age 95. The Certificate
to the date of the adjustment Owner may change the Annuity
Commencement Date at any time
INCONTESTABILITY before the Annuity Commencement
Date by giving us 30 days' written
This Contract shall be notice.
incontestable from the Contract
H719
PAGE 14
SECTION 11 - CONT
ASSIGNMENT at the time the death proceeds
become payable. If there is more
(a) In the case of a non-tax than one beneficiary and the
qualified annuity, the Certificate Owner failed to specify
Certificate may be assigned. their interest, they will share
The assignment must be in equally. Payment will be made to
writing and filed with us. the named contingent
beneficiary(ies) only if all
(b) We assume no responsibility for primary beneficiaries have died
the validity of any assignment before the death proceeds become
Any claim made under an payable. If any primary beneficiary
assignment shall be subject to is alive at the time the death
proof of interest and the proceeds become payable, but dies
extent of the assignment. before receiving their payment,
their share will be paid to their
(c) The Certificate may be applied estate.
for and issued to qualify as a
tax-qualified annuity under In cases where the annuitant dies
certain sections of the and the Certificate Owner (who is
Internal Revenue Code. This not the annuitant) elected to
will be specified in the receive the death proceeds in
enrollment form, or information accordance with Section 9, if the
provided in lieu thereof. annuitant's estate has been named
Ownership of the Certificate as beneficiary, then payment will
then is restricted so that it be made to the Certificate Owner.
will comply with provisions of
the Internal Revenue Code. PROTECTION OF PROCEEDS
Assignment of the Certificate may Unless the Certificate Owner so
result in adverse tax consequences. directs by filing written notice
with us, no beneficiary may assign
BENEFICIARY any payments under the Certificate
Death proceeds, when payable in before the same are due. To the
accordance with Section 9, are extent permitted by law, no
payable to the designated payments under the Certificate will
beneficiary or beneficiaries. Such be subject to the claims of
beneficiary(ies) must be named in creditors of the Certificate Owner
the enrollment form, or information or any beneficiary.
provided in lieu thereof, and may
be changed without consent (unless DEFERMENT
irrevocably designated or required
by law) by notifying us in writing We will pay any Partial Withdrawals
on a form acceptable to us. The or surrender proceeds from the
change will take effect upon the Separate Account(s) within 7 days
date signed, whether or not you are after we receive all requirements
living when we receive it The that we need. However, it may
notice must have been postmarked happen that the New York Stock
(or show other evidence of delivery Exchange is closed for trading
that is acceptable to us) on or (other than the usual weekend or
before the date of death. The most holiday closings), or the
recent change of beneficiary notice Securities and Exchange Commission
will replace any prior beneficiary restricts trading or determines
designations. No change will apply that an emergency exists. If so, it
to any payment we made before the may not be practical for us to
written notice was received. If an determine the investment experience
irrevocable beneficiary dies, the of the Separate Account In that
Certificate Owner may designate a case, we may defer transfers among
new beneficiary. the Subaccounts and to the Fixed
Account, and determination or
The Certificate Owner may direct payment of Partial Withdrawals or
that the beneficiary shall not have surrender proceeds.
the right to withdraw, assign or
commute any sum payable under an When permitted by law, we may defer
option. In the absence of such paying any Partial Withdrawals or
election or direction, the surrender proceeds from the Fixed
beneficiary may change the manner Account for up to 6 months from the
of payment or make an election of date we receive the request If the
any option. Certificate Owner dies after the
request is received, but before the
If any primary or contingent request is processed, the request
beneficiary dies before the will be processed before the death
Annuitant* that beneficiary's proceeds are determined. Interest
interest in the Certificate ends will be paid on any amount deferred
with that beneficiary's death. Only for 30 days or more. This rate will
those beneficiaries living at the be computed at the rate of interest
time of the Annuitant's death will currently paid on proceeds left
be eligible to receive their share under the Interest Payments
of the Death Proceeds. In the event Settlement Option.
no contingent beneficiaries have
been named and all primary REPORTS TO OWNER
beneficiaries have died before the
death proceeds become payable, the We will give the Certificate Owner
Certificate Owner(s) will become an annual report at least once each
the beneficiary(ies) unless elected Certificate Year. This report will
otherwise in accordance with show the number and value of the
Section 9. If both primary and accumulation units held in each of
contingent beneficiaries have been the Subaccounts as well as the
named, payment will be made to the value of the Fixed Account. it will
named primary beneficiaries living also give the Death Benefit, Cash
Value, and any other facts required
by law or regulation.
J719
PAGE 15
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [2nd] Certificate Year, amounts $500, minimum)
up to [10%] of the Policy Value immediately prior to the
Partial Withdrawal are available as a Lump Sum Distribution once
per Certificate Year with no Surrender Charges and no Excess
Interest Adjustment.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1051 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
GUARANTEED MINIMUM DEATH BENEFIT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
The Death Proceeds Prior to Annuity Commencement Date Provision in Section 9,
Death Proceeds, is replaced with the following language:
The amount of the death proceeds will be the greatest of (a), (b), or (c),
where:
(a) is the Policy Value on the date we receive due proof of
death and an election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death
and an election of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), plus any
additional premium payments received, less any Gross Partial
Withdrawals from the date of death to the date of payment of
death proceeds.
If no payment option is selected by the date of death, the
beneficiary may make such election within 60 days of the date we
receive due proof of death. The beneficiary may elect to receive
the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity payment options described
in Section 10. Interest on death proceeds will be paid as
required by law.
The Guaranteed Minimum Death Benefit is the [5%] Annually
Compounding Death Benefit The GMDB is equal to the total premiums
paid for the Certificate, less any Adjusted Partial Withdrawals,
accumulated at [5%] interest per annum from the payment or
withdrawal date to the date of death.
The Adjusted Partial Withdrawal is the total amount deducted from
the GMDB as a result of a Partial Withdrawal as used in the GMDB
provision. It is equal to the Gross Partial Withdrawal described
in Section 5, multiplied by an Adjustment Factor. The Adjustment
Factor is equal to the amount of the death proceeds prior to the
Partial Withdrawal divided by the Policy Value prior to the
Partial Withdrawal.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1058 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
GUARANTEED MINIMUM DEATH BENEFIT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
The Death Proceeds Prior to Annuity Commencement Date provision in Section 9,
Death Proceeds, is replaced with the following language:
The amount of the death proceeds will be the greatest of (a),
(b), or (c) where:
(a) is the Policy Value on the date we receive due proof of
death and an election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death
and an election of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), plus any
additional premium payments received, less any Gross Partial
Withdrawals from the date of death to the date of payment of
death proceeds.
If no payment option is selected by the date of death, the
beneficiary may make such election within 60 days of the date we
receive due proof of death. The beneficiary may elect to receive
the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity payment options described
in Section 10. Interest on death proceeds will be paid as
required by law.
The Guaranteed Minimum Death Benefit is the Double Enhanced Death
Benefit The GMDB is the greater of (1) and (2) where:
(1) is a [5%] Annually Compounding Death Benefit, equal to:
a) the total premiums paid for the Certificate; minus
b) Adjusted Partial Withdrawals (as described below);
plus
c) interest accumulated at [5%] per annum from the
payment or withdrawal date to the earlier of the
date of death or the Certificate Owner's [81st]
birthday.
(2) is a Step-Up Death Benefit, equal to:
a) the largest Policy Value on the Certificate Date
or [any] Certificate [Anniversary] prior to the
earlier of the date of death or the Certificate
Owner's [81st] birthday; plus
b) any Premium Payments made since then, minus any
Adjusted Partial Withdrawals made since then.
If the Certificate Owner is a nonnatural person, or if the
Certificate Owner has elected to have the death proceeds paid
upon the death of the annuitant, the Guaranteed Minimum Death
Benefit will be based upon the annuitant's age.
The Adjusted Partial Withdrawal is the total amount deducted
from the GMDB as a result of a Partial Withdrawal as used in
the GMDB provision. It is equal to the Gross Partial Withdrawal
described in Section 5, multiplied by an Adjustment Factor. The
Adjustment Factor is equal to the amount of the death proceeds
prior to the Partial Withdrawal divided by the Policy Value
prior to the Partial Withdrawal.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1060 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
GUARANTEED MINIMUM DEATH BENEFIT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
The Death Proceeds Prior to Annuity Commencement Date Provision in Section 9,
Death Proceeds, is replaced with the following language:
The amount of the death proceeds will be the greatest of (a),
(b), or (c), where:
(a) is the Policy Value on the date we receive due proof of death
and an election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death
and an election of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), plus any
additional premium payments received, less any Gross Partial
Withdrawals from the date of death to the date of payment of
death proceeds.
If no payment option is selected by the date of death, the
beneficiary may make such election within 60 days of the date we
receive due proof of death. The beneficiary may elect to receive
the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity payment options described
in Section 10. Interest on death proceeds will be paid as
required by law.
The Guaranteed Minimum Death Benefit is the Return of Premium
Death Benefit The GMDB is equal to the total premiums paid for
the Certificate, less any Partial Withdrawals, as of the date of
death.
The Adjusted Partial Withdrawal is the total amount deducted from
the GMDB as a result of a Partial Withdrawal as used in the GMDB
provision. It is equal to the Gross Partial Withdrawal described
in Section 5, multiplied by an Adjustment Factor. The Adjustment
Factor is equal to the amount of the death proceeds prior to the
Partial Withdrawal divided by the Policy Value prior to the
Partial Withdrawal.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1061 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
SYSTEMATIC PAYOUT OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [1st] Certificate Year, a Systematic Payout
Option (SPO) is available on a monthly, quarterly, semi-annual or
annual basis. SPO payouts must be at least $50 and may not exceed
10% of the Policy Value at the time a SPO payout is made divided
by the number of payouts made per year (e.g. 12 for monthly). No
Surrender Charges or Excess Interest Adjustment will apply to the
SPO payout Monthly and quarterly payouts must be sent through
electronic funds transfer directly to your checking or savings
account The Certificate Owner may start or stop SPO payouts at
any time; however, 30 days written notice is required to stop SPO
payouts. Once stopped, the Certificate Owner must wait until the
first day of the next Certificate Year to begin a new SPO.
Once the Certificate Owner has elected a SPO, the Certificate
Owner must wait a minimum time before the first SPO payment: one
month for a monthly SPO, three months for quarterly, six months
for semi-annual, or twelve months for annual.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1064 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
SERVICE CHARGE WAIVER
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Service Charge provision in Section 4, Policy Value, is amended to include
the following language:
The Service Charge will not be deducted on a Certificate
Anniversary or at the time of surrender if, at such time, either
(1) the sum of all premium payments made less the sum of all
withdrawals taken equals or exceeds [$50,000] or (2) the Policy
Value equals or exceeds [$50,000]
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1074 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
PREMIUM ENHANCEMENT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 3, Premium Payments, is amended to include the following language:
PREMIUM ENHANCEMENT
When a Premium Payment is paid, a Premium Enhancement Percentage
of [.25%] to [5%] be applied to that Premium Payment and the
resulting amount will be added to t Policy Value. The amount of
the Premium Enhancement is not considered a Premium Payment The
Premium Enhancement Percentage may vary from premium to premium
on subsequent Premium Payments, but will never be less than 0.25%
more than [5%.] The Premium Enhancement Percentage applicable to
the Initial Premium is set forth on the Certificate Data Page. We
will advise You of the amount of the Premium Enhancement
applicable to each subsequent Premium Payment in a confirmation
that We will send to You. No Premium Enhancement will apply if
the Certificate is cancelled pursuant to the Right to Cancel
provision.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1075 199
[LOGO OF PFL LIFE APPEARS HERE]
PFL Life Insurance Company
A Stock Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
(Hereafter called the Company, we, our or us) (000) 000-0000
GUARANTEED MINIMUM INCOME BENEFIT RIDER
This rider provides a Minimum Annuitization Value which can only be used with
the Annuity Factors shown in Schedule I of this rider. This Minimum
Annuitization value is guaranteed by us, regardless of the performance of the
variable annuity's investments.
This rider is attached to and made part of the Contract as of the Contract Date.
This rider may only be terminated as provided herein. This rider is subject to
all of the provisions in the Contract that do not conflict with the provisions
of this rider. The Rider Payment Options provide for variable annuity payments.
Subsequent payments may fluctuate with the investment performance of the
Subaccounts, but will never be less than the initial payment.
DEFINITIONS Election Date
The following definitions used in A date that the Certificate Owner
this Rider are for reference only. elects to begin Guaranteed Minimum
Income Benefit payments. The
Annuitant Election Date must be within 30
days following a Certificate
The Annuitant is designated on the Anniversary. The first and last
Certificate Data Page. The variable dates to elect a Rider Payment
annuity payments are paid to the Option are shown on page one of the
Annuitant (or surviving Joint rider attached to the Certificate.
Annuitant).
Minimum Annuitization Value
Annuity Factor
The amount we will use to determine
A factor for the applicable the Guaranteed Minimum Income
Annuitant age, sex and Rider Benefit payments.
Payment Option is shown in schedule
I or Schedule II of this rider. For Rider Date
the Rider Payment Option chosen,
the Annuity Factor from Schedule I The date that the rider is added to
and the Minimum Annuitization Value the Certificate. This date may only
will be used to determine the be the issue date of the
applicable annuity payments. For Certificate or a Certificate
Annuitants age 85 or older at the Anniversary date. This is also the
time of annuitization, the age 85 Certificate Anniversary that the
Annuity Factor will be used for Certificate Owner most recently
Schedule I. Factors not shown are elected to upgrade the Minimum
available from us upon request Annuitization Value, if applicable.
Schedule I and Schedule II are
based on the "1983 Table a" Supportable Payment
mortality table, improved to the
year 2000 with projection scale G. The Supportable Payment is equal to
the number of variable annuity
units in the selected Subaccounts
multiplied by the variable annuity
unit values in those Subaccounts on
the date the payment is made.
RGMI 4 499
1
GUARANTEED MINIMUM INCOME BENEFIT (C) is the Minimum Annuitization
Value after the current
On the Election Date, the Certificate Year maximum
Certificate Owner may use the annual free amount has been
Minimum Annuitization Value and the withdrawn, but prior to
applicable Annuity Factor to withdrawal of the excess
provide variable payments to the portion.
Annuitant The first variable
payment is determined by For each Certificate Year, the
multiplying each $ 1,000 of Minimum maximum annual free amount is equal
Annuitization Value by the Annuity to the Minimum Annuitization Value,
Factor on Schedule 1. Each as of the beginning of the
subsequent payment will be Certificate Year, multiplied by the
calculated as described in the effective Annual Growth Rate as
Contract, using a 5% Assumed shown on page one of the rider
Investment Return. attached to the Certificate.
Withdrawals during a Certificate
For subsequent payments, an annual Year will reduce the available
Mortality and Expense Risk Fee and maximum annual free amount by the
Administrative Charge (which amount of the Withdrawal.
includes an investment risk fee)
will be charged. This total fee may RIDER FEE
be different than the Mortality and
Expense Risk Fee and Administrative We will deduct a fee from the value
Charge in effect prior to the of the Certificate on each
Election Date. It may also be Certificate Anniversary and on the
different than the Mortality and termination date of this rider. The
Expense Risk Fee and Administrative Rider Fee is the Minimum
Charge for the settlement options Annuitization Value at the time the
shown in the Certificate. fee is deducted, multiplied by the
Rider Fee Percentage shown on the
The subsequent payments may first page of the rider attached to
fluctuate in accordance with the the Certificate. The fee will be
investment performance of the deducted from each Subaccount in
annuity Subaccounts. However, such proportion to the amount of value
payments will never be less than of the Certificate in each
the initial payment. Subaccount. This fee will not be
deducted after the Election Date or
MINIMUM ANNUITIZATION VALUE if the Certificate terminates due
to the death of the Certificate
The Minimum Annuitization Value is Owner.
used to determine the Guaranteed
Minimum Income Benefit payments. WAIVER OF RIDER FEE
On the Rider Date, the Minimum If the value of the Certificate, on
Annuitization Value is the value of a particular Certificate
the Certificate. Thereafter, based Anniversary, exceeds an amount
upon the effective Annual Growth equal to the Rider Fee Waiver
Rate (shown on page one of the Threshold (shown on page one of the
rider attached to the Certificate), rider attached to the Certificate)
it will be the value of the multiplied by the Minimum
Certificate on the Rider Date, plus Annuitization Value, the Rider Fee
any additional payments made after will be waived for that Certificate
the Rider Date, minus policy Anniversary.
Withdrawals (adjusted as described
below), minus any premium taxes. MINIMUM ANNUITIZATION VALUE UPGRADE
Withdrawals The Certificate Owner may elect, in
writing, to upgrade the Minimum
In any Certificate Year, the Annuitization Value to the value of
Minimum Annuitization Value will the Certificate on a Certificate
only be reduced by the actual Anniversary. This may be done
amount of a withdrawal as long as within 30 days immediately
the withdrawal does not exceed a following any Certificate
maximum annual free amount Anniversary, and prior to the Last
Withdrawals in excess of the Date to Upgrade shown on page one
maximum annual free amount will of the rider attached to the
reduce the Minimum Annuitization Certificate.
Value by an amount equal to (A)
divided by (B) multiplied by (C) If an upgrade is elected, the rider
where: attached to the Certificate will
terminate and a new rider will be
(A) is the amount of the excess issued with a new Rider Date,
withdrawal; Election Date and its own
guaranteed benefits. The new annual
(B) is the value of the Rider Fee Percentage may be
Certificate after the different than this rider's, but it
current Certificate Year will never be greater than 0.50%.
maximum annual free amount
has been withdrawn, but
prior to the withdrawal of
the excess portion; and
RGMI 4 499
2
RIDER PAYMENT OPTIONS units as described below. If the
Supportable Payment (at any payment
The Minimum Annuitization Value and date) is less than the stabilized
applicable Annuity Factors from payment for that year, annuity
Schedule I may be applied to the units will be redeemed as described
following payment options: below to fund the deficiency.
Life Income - An election may be Purchase/Redemption of Annuity
made for "No Period Certain" or " Units:
10 Years Certain". In the event
of the death of the person The number of annuity units
receiving payments prior to the purchased or redeemed is equal to
end of the chosen period certain, the annuity income purchased or
the remaining period certain redeemed, respectively, divided
payments will be continued to the by the annuity unit value for
beneficiary. each respective Subaccount
Purchases and redemptions of
Joint and Full Survivor - An annuity income will be allocated
election may be made f or "No to each Subaccount on a
Period Certain" or " 1 0 Years proportionate basis. The amount
Certain". Payments will be made of annuity income purchased or
as long as either the Annuitant redeemed is the difference
or Joint Annuitant is living. In between the Supportable Payment
the event of the death of both and the stabilized payment, times
the Annuitant and the Joint the attained age nearest birthday
Annuitant prior to the end of the Annuity Factors shown in Schedule
chosen period certain, the 11, divided by $ 1,000. These
remaining period certain payments factors will reflect the
will be continued to the remaining certain period, if any,
beneficiary. but will be calculated on the
same basis as the Schedule 11
GUARANTEED MINIMUM PAYMENT factors.
On the Election Date, the The Company bears the risk that it
Certificate Owner will receive will need to make payments if all
guaranteed minimum payments. The annuity units have been redeemed in
annual Mortality and Expense Risk an attempt to maintain the
Fee and Administrative Charge for stabilized payment at the initial
these payments is shown on page one payment level. In such an event,
of the rider attached to the the Company will make all future
Certificate. The percentage shown payments equal to the initial
on page one of the rider attached payment.
to the Certificate also includes a
fee to cover investment risk ASSIGNMENT
associated with guaranteeing a
minimum payment. Payments made under this rider may
not be pledged or assigned.
The first payment is based on the Payments will only be made to the
Annuity Factors in Schedule 1. We Annuitant or Joint Annuitant named
guarantee that each subsequent in the policy.
payment will be equal to or greater
than the initial payment. TERMINATION
During the first Certificate Year This rider will be terminated, with
following annuitization, each respect to each Certificate, upon
payment will be stabilized to equal the earliest of:
the initial payment On each
Certificate Anniversary following a. the Election Date;
annuitization, the stabilized
payment will be increased or b. 30 days after the Last Date to
decreased (but never below the Elect Benefit shown on the
initial payment) and held level for first page of the rider
that Certificate Year. On each attached to the Certificate.
Certificate Anniversary following
annuitization, the stabilized c. the date the Certificate
payment will equal the greater of terminates;
the initial payment or the
Supportable Payment at that time. d. the date the Certificate Owner
elects to apply the value of
If the Supportable Payment (at any the Certificate to annuitize
payment date) is greater than the the Certificate; and
stabilized payment for that year,
the excess will be used to purchase e. the date the Certificate Owner
additional annuity elects to upgrade their Minimum
Annuitization Value.
This rider cannot be terminated
prior to the earliest of the above
dates.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
RGMI 4 499
3
SCHEDULE I - ANNUITY FACTORS
The amounts shown in these tables are the Annuity Factors for each $1,000 of the
Minimum Annuitization Value and assume a 3% Assumed Investment Return.
----------------------------------------------------------------------------------------------------------------------
--------------------------- ---------------------------------------------------------------------------------
Monthly Annuity Factor For Monthly Annuity Factor For
Life With No Period Life With 10 Years
Certain Certain
--------------------------------------------------------------------------------------------
Age* Male Female Unisex Male Female Unisex
----------------------------------------------------------------------------------------------------------------------
50 $3.87 $3.55 $3.71 $3.84 $3.54 $3.70
51 3.93 3.60 3.77 3.90 3.59 3.75
52 4.00 3.65 3.83 3.97 3.64 3.81
53 4.07 3.71 3.90 4.04 3.70 3.87
54 4.15 3.77 3.97 4.11 3.75 3.94
55 4.23 3.83 4.04 4.19 3.82 4.01
56 4.32 3.90 4.11 4.27 3.88 4.08
57 4.41 3.97 4.19 4.35 3.95 4.15
58 4.50 4.05 4.28 4.44 4.02 4.24
59 4.61 4.13 4.37 4.53 4.10 4.32
60 4.72 4.21 4.47 4.63 4.18 4.41
61 4.84 4.30 4.57 4.74 4.26 4.51
62 4.96 4.40 4.68 4.85 4.35 4.61
63 5.10 4.50 4.80 4.97 4.45 4.71
64 5.24 4.61 4.93 5.09 4.55 4.83
65 5.40 4.73 5.06 5.22 4.66 4.95
66 5.56 4.85 5.21 5.36 4.77 5.07
67 5.74 4.99 5.36 5.50 4.89 5.20
68 5.93 5.13 5.53 5.65 5.02 5.34
69 6.13 5.29 5.71 5.80 5.15 5.49
70 6.34 5.45 5.90 5.96 5.30 5.64
----------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Monthly Annuity Factor For Joint and Full Survivor
----------------------------------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
Xxxx
Xxxxxxxxx*
----------------------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
----------------------------------------------------------------------------------------------------------------------
50 $2.99 $3.05 $3.11 $3.18 $3.25 $3.32 $3.39
55 3.11 3.19 3.27 3.35 3.44 3.53 3.63
60 3.27 3.37 3.47 3.58 3.70 3.82 3.95
65 3.47 3.60 3.74 3.89 4.05 4.22 4.39
70 3.74 3.91 4.10 4.31 4.53 4.77 5.02
----------------------------------------------------------------------------------------------------------------------
Monthly Annuity Factor For Joint and Full Survivor with 10 Year Period Certain
----------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
Xxxx
Xxxxxxxxx*
----------------------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
----------------------------------------------------------------------------------------------------------------------
50 $2.99 $3.05 $3.11 $3.18 $3.24 $3.31 $3.38
55 3.11 3.19 3.27 3.35 3.44 3.53 3.63
60 3.27 3.37 3.47 3.58 3.70 3.82 3.95
65 3.47 3.60 3.74 3.89 4.05 4.22 4.39
70 3.74 3.91 4.10 4.30 4.52 4.76 4.99
----------------------------------------------------------------------------------------------------------------------
*Age nearest birthday
----------------------------------------------------------------------------
The annual, semi-annual or quarterly Annuity Factor shall be the monthly
Annuity Factor shown multiplied by 11.80, 5.95 or 2.99 respectively.
----------------------------------------------------------------------------
Annuity Factors not shown in the above tables will be calculated on the same
basis as those shown and may be obtained from the Company.
RGMI 4 499
SCHEDULE II - ANNUITY FACTORS
The amounts shown in these tables are the Annuity Factors for each $1,000 of the
Minimum Annuitization Value and assume a 5% Assumed Investment Return.
----------------------------------------------------------------------------------------------------------------------
--------------------------- ---------------------------------------------------------------------------------
Monthly Annuity Factor Monthly Annuity Factor For
Life With No Period Certain Life With 10 Years Certain
--------------------------- ------------------------------------------------------------------------------------------
Age* Male Female Unisex Male Female Unisex
----------------------------------------------------------------------------------------------------------------------
50 $5.14 $4.83 $4.99 $5.09 $4.80 $4.95
51 5.20 4.87 5.04 5.15 4.85 5.00
52 5.27 4.92 5.10 5.21 4.89 5.05
53 5.34 4.98 5.16 5.27 4.94 5.11
54 5.41 5.03 5.22 5.34 4.99 5.17
55 5.49 5.09 5.29 5.41 5.05 5.23
56 5.57 5.15 5.36 5.48 5.11 5.30
57 5.66 5.22 5.44 5.56 5.17 5.37
58 5.75 5.29 5.52 5.65 5.24 5.45
59 5.85 5.37 5.61 5.74 5.31 5.53
60 5.96 5.45 5.71 5.83 5.38 5.61
61 6.08 5.53 5.81 5.93 5.46 5.70
62 6.20 5.63 5.92 6.04 5.55 5.80
63 6.34 5.73 6.04 6.15 5.64 5.90
64 6.48 5.83 6.16 6.27 5.73 6.01
65 6.64 5.95 6.30 6.39 5.84 6.12
66 6.81 6.07 6.44 6.52 5.94 6.24
67 6.99 6.21 6.60 6.66 6.06 6.37
68 7.18 6.35 6.77 6.80 6.18 6.50
69 7.39 6.51 6.95 6.94 6.31 6.64
70 7.61 6.68 7.14 7.09 6.45 6.78
----------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Monthly Annuity Factor For Joint and Full Survivor
----------------------------------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
Xxxx
Xxxxxxxxx*
--------------------- ------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
----------------------------------------------------------------------------------------------------------------------
50 $4.34 $4.38 $4.43 $4.48 $4.53 $4.59 $4.65
55 4.43 4.49 4.55 4.62 4.70 4.77 4.85
60 4.56 4.64 4.73 4.82 4.92 5.03 5.15
65 4.74 4.84 4.96 5.10 5.24 5.40 5.56
70 4.98 5.13 5.30 5.49 5.70 5.93 6.17
----------------------------------------------------------------------------------------------------------------------
Monthly Annuity Factor For Joint and Full Survivor with 10 Year Period Certain
----------------------------------------------------------------------------------------------------------------------
Age of Age of Female Annuitant*
Xxxx
Xxxxxxxxx*
----------------------------------------------------------------------------------------------------------------------
15 Years 12 Years 9 Years 6 Years 3 Years 3 Years
Less than Less Than Less Than Less Than Less Than Same As More Than
Male Male Male Male Male Male Male
----------------------------------------------------------------------------------------------------------------------
50 $4.34 $4.38 $4.43 $4.48 $4.53 $4.59 $4.65
55 4.43 4.49 4.55 4.62 4.70 4.77 4.85
60 4.56 4.64 4.72 4.82 4.92 5.03 5.14
65 4.73 4.84 4.96 5.09 5.24 5.39 5.55
70 4.97 5.12 5.29 5.48 5.69 5.91 6.14
----------------------------------------------------------------------------------------------------------------------
*Age nearest birthday
--------------------------------------------------------------------------------
The annual, semi-annual or quarterly Annuity Factor shall be the monthly
Annuity Factor shown multiplied by 11.70, 5.93 or 2.99 respectively.
--------------------------------------------------------------------------------
Annuity Factors not shown in the above tables will be calculated on the same
basis as those shown and may be obtained from the Company.
RGMI 4 499
PFL Life Insurance Company
Home Office located at 0000 Xxxxxxxx Xxxx X.X., Xxxxx Xxxxxx, Xxxx 00000
[LOGO OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
Group Flexible Premium Variable Annuity Contract
Income Payable At Annuity Commencement Date
Benefits Based On The Performance Of The Separate Account
Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and
10C.)
Non -Participating
INDEX
Page Page
Accumulation Units............................. 7 Guaranteed Period.............................. 8
Adjusted Age (Settlement Options).............. 7 Incontestability............................... 14
Age or Sex Corrections......................... 14 Modification of Contract....................... 14
Annuity Commencement Date...................... 14 Nonparticipation............................... 14
Annuity Payments............................... 11, 11(A) Nursing Care and Terminal Condition
Assignment..................................... 15 Withdrawal Option.............................. 5(B)
Beneficiary.................................... 15 Partial Withdrawals............................ 5, 6
Cash Value..................................... 5, 6 Payee.......................................... 11(A)
Certificate Data Page.......................... 3 Payment Option Tables.......................... 12, 13
Death Proceeds................................. 10, 11 Policy Value................................... 4
Definitions.................................... 2 Premium Payments............................... 4
Dollar Cost Averaging.......................... 9 Proof of Age................................... 11(A)
Excess Interest Adjustment..................... 5 Protection of Proceeds......................... 15
Evidence of Survival........................... 14 Right to Cancel................................ 1
Fixed Account.................................. 8 Separate Account............................... 6, 7
Guaranteed Return of Fixed Account Service Charge................................. 4
Premium Payments............................... 6 Settlement..................................... 14
Surrender Charges.............................. 6
Transfers...................................... 9
Unemployment Waive............................. 5(B)
Y576
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the
following language:
Beginning in the [ xth ] Certificate Year, the Certificate Owner may
withdraw, free from Surrender Charges, and free from Excess Interest
Adjustment, an amount equal to the Cumulative Earnings, if any, in the Policy
Value. The Cumulative Earnings is an amount equal to the Policy Value at the
time a Lump Sum payout is made, minus the sum of all premium payments reduced
by all prior Partial Withdrawals, if any. The minimum Partial Withdrawal
under this option is $500. This Partial Withdrawal option is available once
per Certificate Year.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1052 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on
the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, the Certificate Owner may
withdraw an amount ($500 minimum) free from Surrender Charges and free from
Excess Interest Adjustment up to the Cumulative Free Percentage (CFP) times
the Policy Value immediately prior to the Partial Withdrawal. On the
Certificate Date the CFP is [ 10% ]. Thereafter, [ 10% ] will be added to
the CFP on each Certificate Anniversary. The unused portion of the CFP in
any Certificate Year will be carried forward at each successive Certificate
Anniversary. Any portion of the CFP previously taken will reduce the CFP
currently available. Any Partial Withdrawals will reduce the CFP by the
ratio of the requested Partial Withdrawal amount to the Policy Value
immediately prior to the Partial Withdrawal. The maximum CFP will be [ 100%
] beginning in the [ yth ] Certificate Year, and will never be less than
zero.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1053 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
MORTALITY AND EXPENSE RISK FEE AND ADMINISTRATIVE CHARGE REDUCTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 6, Separate Account - Charges and Deductions, is amended to include the
following language:
MORTALITY AND EXPENSE RISK FEE AND ADMINISTRATIVE CHARGE REDUCTION
The Mortality and Expense Risk Fee and Administrative Charge (before the
Annuity Commencement Date) as shown on the Certificate Data Page will be
reduced to [ x ] % if, at the time such fees are deducted, either
(1) the sum of all premium payments less the sum of all partial
withdrawals is at least $ [ y ]
or
(2) the Policy Value is at least $ [ y ].
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1054 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, the Certificate Owner may
withdraw, free from Surrender Charges, and free from Excess Interest
Adjustment, an amount equal to the accumulated interest in the Fixed Account,
during the prior [ 12 ] months, or since the last Partial Withdrawal, if
later. The minimum Partial Withdrawal under this option is $500. This Partial
Withdrawal option is available once per Certificate Year.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to ail the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1056 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, the Certificate Owner may withdraw
an amount ($500 minimum) free from Surrender Charges, and free from Excess
Interest Adjustment up to the Cumulative Free Percentage (CFP) times the
cumulative premium payments immediately prior to the Partial Withdrawal. On
the Certificate Date the CFP is [ 10% ] . Thereafter, [ 10% ] will be added
to the CFP on each Certificate Anniversary. The unused portion of the CFP in
any Certificate Year will be carried forward at each successive Certificate
Anniversary. Any portion of the CFP previously taken will reduce the CFP
currently available. Any Partial Withdrawals will reduce the CFP by the ratio
of the requested Partial Withdrawal amount to the cumulative premium payments
immediately but prior to, the Partial Withdrawal. The maximum CFP will be
[100%] beginning in the [ yth ] Certificate Year and will never be less than
zero.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1057 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, the Certificate Owner may
withdraw, free from Surrender Charges, and free from Excess Interest
Adjustment, an amount equal to the earnings, if any, in the Policy Value,
during the prior [ 12 ] months, or since the last Partial Withdrawal, if
later. The amount of earnings is equal to the Policy Value at the time a Lump
Sum payout is made, minus the Policy Value at the later of the date of the
last Partial Withdrawal or the date [ 12 ] months prior to the Lump Sum
payout, minus the premiums paid during the corresponding time period. The
minimum Partial Withdrawal under this option is $500. This Partial Withdrawal
option is available once per Certificate Year.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1059 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
GUARANTEED MINIMUM DEATH BENEFIT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
The Death Proceeds Prior to Annuity Commencement Date Provision in Section 9,
Death Proceeds is replaced with the following language:
The amount of the death proceeds will be the greatest of (a), (b), or (c),
where:
(a) is the Policy Value on the date we receive due proof of death and an
election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death and an
election of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), plus any additional
premium payments received, less any Gross Partial Withdrawals from the date
of death to the date of payment of death proceeds.
If no payment option is selected by the date of death, the beneficiary may
make such election within 60 days of the date we receive due proof of death.
The beneficiary may elect to receive the death proceeds as a lump sum payment
or may use the death proceeds to provide any of the annuity payment options
described in Section 10. Interest on death proceeds will be paid as required
by law.
The Guaranteed Minimum Death Benefit is the Step-Up Death Benefit. The GMDB
is equal to the largest Policy Value on the Certificate Date or on [
any/every ] [ xth ] Certificate [ Anniversary/Monthiversary ] prior to the
earlier of the date of death or the Certificate Owner's [ yth ] birthday,
plus any Premium Payments made since then, minus any Adjusted Partial
withdrawals made since then.
If the Certificate Owner is a nonnatural person, or if the Certificate Owner
has elected to have the death proceeds paid upon the death of the annuitant,
the Guaranteed Minimum Death Benefit will be based upon the annuitant's age.
The Adjusted Partial Withdrawal is the total amount deducted from the GMDB as
a result of a Partial Withdrawal as used in the GMDB provision. It is equal
to the Gross Partial Withdrawal described in Section 5, multiplied by an
Adjustment Factor. The Adjustment Factor is equal to the amount of the death
proceeds prior to the Partial Withdrawal divided by the Policy Value prior to
the Partial Withdrawal.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1062 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
GUARANTEED MINIMUM DEATH BENEFIT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
The Death Proceeds Prior to Annuity Commencement Date Provision in Section 9,
Death Proceeds, is replaced with the following language:
The amount of the death proceeds will be the greatest of (a), (b), or (c),
where:
(a) is the Policy Value on the date we receive due proof of death and an
election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death and an
election of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), plus any additional
premium payments received, less any Gross Partial Withdrawals from the date
of death to the date of payment of death proceeds.
If no payment option is selected by the date of death, the beneficiary may
make such election within 60 days of the date we receive due proof of death.
The beneficiary may elect to receive the death proceeds as a lump sum payment
or may use the death proceeds to provide any of the annuity payment options
described in Section 10. Interest on death proceeds will be paid as required
by law.
The Guaranteed Minimum Death Benefit is [ x ] % Annually Compounding Death
Benefit The GMDB is equal to the total premiums paid for the Certificate,
less any Adjusted Partial Withdrawals, accumulated at [ x ] % interest per
annum from he payment or withdrawal date to the earlier of the date of death
or the Certificate Owner's [ yth ] birthday.
If the Certificate Owner is a nonnatural person, or if the Certificate Owner
has elected to have the death proceeds paid upon the death of the annuitant,
the Guaranteed Minimum Death Benefit will be based upon the annuitant's age.
The Adjusted Partial Withdrawal is the total amount deducted from the GMDB as
a result of a Partial Withdrawal as used in the GMDB provision. It is equal
to the Gross Partial Withdrawal described in Section 5, multiplied by an
Adjustment Factor. The Adjustment Factor is equal to the amount of the death
proceeds prior to the Partial Withdrawal divided by the Policy Value prior to
the Partial Withdrawal.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1063 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
SYSTEMATIC PAYOUT OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, a Systematic Payout Option (SPO)
is available on a monthly, quarterly, semi-annual or annual basis. At the
time a SPO payout is made, such payout must be at least $50 and may not
exceed [ 10% ] of the cumulative premium payments immediately prior to the
Partial Withdrawal, divided by the number of payouts made per year (e.g. 12
for monthly). No Surrender Charges or Excess Interest Adjustment will apply
to the SPO payout. Monthly and quarterly payouts must be sent through
electronic funds transfer directly to a checking or savings account. The
Certificate Owner may start or stop SPO payouts at any time; however, 30 days
written notice is required to stop SPO payouts. Once stopped, the Certificate
Owner must wait until the first day of the next Certificate Year to begin a
new SPO.
Once the Certificate Owner has elected a SPO, the Certificate Owner must wait
a minimum time before the first SPO payment: one month for a monthly SPO,
three months for quarterly, six months for semi-annual, or twelve months for
annual.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1065 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
SYSTEMATIC PAYOUT OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, a Systematic Payout Option (SPO)
is available on a monthly, quarterly, semiannual or annual basis. At the time
a SPO payout is made, such payout must be at least $50 and may not exceed the
Cumulative Earnings, if any, in the Policy Value, divided by the number of
payouts made per year (eg. 12 for monthly). The Cumulative Earnings is an
amount equal to the Policy Value at the time a SPO payout is made, minus the
sum of all premium payments reduced by all prior Partial Withdrawals, if any.
No Surrender Charges or Excess Interest Adjustment will apply to the SPO
payout. Monthly and quarterly payouts must be sent through electronic funds
transfer directly to a checking or savings account. The Certificate Owner may
start or stop SPO payouts at any time; however, 30 days written notice is
required to stop SPO payouts. Once stopped, the Certificate Owner must wait
until the first day of the next Certificate Year to begin a new SPO.
Once the Certificate Owner has elected a SPO, the Certificate Owner must wait
a minimum time before the first SPO payment: one month for a monthly SPO,
three months for quarterly, six months for semi-annual, or twelve months for
annual.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1066 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
SYSTEMATIC PAYOUT OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, a Systematic Payout Option (SPO) is
available on a monthly, quarterly, semi-annual or annual basis. At the time a
SPO payout is made, such payout must be at least $50 and may not exceed the
earnings, if any, in the Policy Value during the prior [ 12 ] months or since
the last Partial Withdrawal, if later, divided by the number of payouts made
per year (e.g. 12 for monthly). The amount of earnings is equal to the Policy
Value at the time a SPO payout is made, minus the Policy Value at the later of
the date of the last Partial Withdrawal or the date [ 12 ] months prior to the
SPO payout, minus the premiums paid during the corresponding time period. No
Surrender Charges or Excess Interest Adjustment will apply to the SPO payout.
Monthly and quarterly payouts must be sent through electronic funds transfer
directly to a checking or savings account. The Certificate Owner may start or
stop SPO payouts at any time; however, 30 days written notice is required to
stop SPO payouts. Once stopped, the Certificate Owner must wait until the
first day of the next Certificate Year to begin a new SPO.
Once the Certificate Owner has elected a SPO, the Certificate Owner must wait
a minimum time before the first SPO payment: one month for a monthly SPO,
three months for quarterly, six months for semi-annual, or twelve months for
annual.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1067 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
SYSTEMATIC PAYOUT OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value-and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year, a Systematic Payout Option (SPO)
is available on a monthly, quarterly, semi-annual or annual basis. At the
time a SPO payout is made, such payout must be at least $50 and may not
exceed the accumulated interest in the Fixed Account during the prior [ 12 ]
months, or since the last Partial Withdrawal, if later, divided by the number
of payouts made per year (e.g. 12 for monthly). No Surrender Charges or
Excess Interest Adjustment will apply to the SPO payout. Monthly and
quarterly payouts must be sent through electronic funds transfer directly to
a checking or savings account. The Certificate Owner may start or stop SPO
payouts at any time; however, 30 days written notice is required to stop SPO
payouts. Once stopped, the Certificate Owner must wait until the first day of
the next Certificate Year to begin a new SPO.
Once the Certificate Owner has elected a SPO, the Certificate Owner must wait
a minimum time before the first SPO payment: one month for a monthly SPO,
three months for quarterly, six months for semi-annual, or twelve months for
annual.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1068 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
LUMP SUM PARTIAL WITHDRAWAL OPTION
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate Data page.
The Partial Withdrawals provision in Section 5, Cash Value and Partial
Withdrawals, is amended to include the following language:
Beginning in the [ xth ] Certificate Year amounts ($500 minimum) up to
[ 10% ] of the Cumulative Premium Payments immediately prior to the Partial
Withdrawal are available as a Lump Sum distribution once per Certificate Year
with no Surrender Charges and no Excess Interest Adjustment
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1069 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
PREMIUM ENHANCEMENT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 3, Premium Payments, is amended to include the following language:
PREMIUM ENHANCEMENT
If the Cumulative Premium Payments less partial withdrawals are less than
$ [ x ] when a Premium Payment is paid, then a Premium Enhancement Percentage
of [ a to b ] % will be applied to that Premium Payment and the resulting
amount will be added to the Policy Value. If the Cumulative Premium Payments
less partial withdrawals are greater than or equal to $ [ x ] when a Premium
Payment is paid, then a Premium Enhancement Percentage of [ a to b ] % will
be applied to that Premium Payment and the resulting amount will be added to
the Policy Value. The amount of the Premium Enhancement is not considered a
Premium Payment
The Premium Enhancement Percentage may vary from premium to premium on
subsequent Premium Payments, but will never be less than .25% nor more than
[ b ]%. The Premium Enhancement Percentage applicable to the Initial
Premium is set forth on the Certificate Data Page. We will advise You of the
amount of the Premium Enhancement applicable to each subsequent Premium
Payment in a confirmation that We will send to You. No Premium Enhancement
will apply if the Certificate is cancelled pursuant to the Right to Cancel
provision.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1073 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
PREMIUM ENHANCEMENT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 3, Premium Payments, is amended to include the following language:
PREMIUM ENHANCEMENT
If the Cumulative Premium Payments less partial withdrawals are less than
$ [ x ] when a Premium Payment is paid, then a Premium Enhancement Percentage
of [ a to b ] % will be applied to that Premium Payment and the resulting
amount will be added to the Policy Value. If the Cumulative Premium Payments
less partial withdrawals are greater than or equal to $ [ x ] and less than
$ [ y ] when a Premium Payment is paid, then a Premium Enhancement Percentage
of [ a to b ] % will be applied to that Premium Payment and the resulting
amount will be added to the Policy Value. If the Cumulative Premium Payments
less partial withdrawals are greater than or equal to $ [ y ] when a Premium
Payment is paid, then a Premium Enhancement Percentage of [ a to b ] % will
be applied to that Premium Payment and the resulting amount will be added to
the Policy Value. The amount of the Premium Enhancement is not considered a
Premium Payment.
The Premium Enhancement Percentage may vary from premium to premium on
subsequent Premium Payments, but will never be less than .25% nor more than
[ b ] %. The Premium Enhancement Percentage applicable to the Initial Premium
is set forth on the Certificate Data Page. We will advise You of the amount
of the Premium Enhancement applicable to each subsequent Premium Payment in a
confirmation that We will send to You. No Premium Enhancement will apply if
the Certificate is cancelled pursuant to the Right to Cancel provision.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1076 199
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
GUARANTEED MINIMUM DEATH BENEFIT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
The Death Proceeds Prior to Annuity Commencement Date Provision in Section 9,
Death Proceeds, is replaced with the following language:
The amount of the death proceeds will be the greatest of (a), (b), or (c),
where:
(a) is the Policy Value on the date we receive due proof of death and an
election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death and an
election of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), plus any additional
premium payments received, less any Gross Partial Withdrawals from the date
of death to the date of payment of death proceeds.
If no payment option is selected by the date of death, the beneficiary may
make such election within 60 days of the date we receive due proof of death.
The beneficiary may elect to receive the death proceeds as a lump sum payment
or may use the death proceeds to provide any of the annuity payment options
described in Section 10. Interest on death proceeds will be paid as required
by law.
The Guaranteed Minimum Death Benefit is the Return of Premium Death Benefit.
The GMDB is equal to the total premiums paid for the Certificate, less any
Adjusted Partial Withdrawals, as of the date of death.
The Adjusted Partial Withdrawal is the total amount deducted from the GMDB as
a result of a Partial Withdrawal as used in the GMDB provision. It is equal
to the Gross Partial Withdrawal described in Section 5, multiplied by an
Adjustment Factor. The Adjustment Factor is equal to the amount of the death
proceeds prior to the Partial Withdrawal divided by the Policy Value prior to
the Partial Withdrawal.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1127 799
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
PREMIUM ENHANCEMENT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 3, Premium Payments, is amended to include the following language:
PREMIUM ENHANCEMENT
If the Cumulative Premium Payments less requested partial withdrawals amounts
are less than $ [ x ] when a Premium Payment is paid, then a Premium
Enhancement Percentage of [ a to b ] % will be applied to that Premium
Payment and the resulting amount will be added to the Policy Value. If the
Cumulative Premium Payments less requested partial withdrawals amounts are
greater than or equal to $ [ x ] when a Premium Payment is paid, then a
Premium Enhancement Percentage of [ a to b ] % will be applied to that
Premium Payment and the resulting amount will be added to the Policy Value.
The Premium Enhancement Percentage may also vary depending on Your attained
age at the time a Premium Payment is made. However, the Premium Enhancement
Percentage applicable to Premium Payments made at attained ages less than age
[ z ] will be at least as great as the corresponding percentage applicable at
attained ages [ z ] and above. The Premium Enhancement will be applied using
the same allocation as the corresponding Premium Payment. The amount of the
Premium Enhancement is not considered a Premium Payment.
The Premium Enhancement Percentage may vary from premium to premium on
subsequent Premium Payments, but will never be less than [ a ] % nor more
than [ b ] %. The Premium Enhancement Percentage applicable to the Initial
Premium Payment is set forth on the Certificate Data Page. We will advise
You of the amount of the Premium Enhancement applicable to each subsequent
Premium Payment in a confirmation that We will sent to You. No Premium
Enhancement will apply if the Certificate is cancelled pursuant to the Right
to Cancel provision.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1128 799
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
PREMIUM ENHANCEMENT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 3, Premium Payments, is amended to include the following language:
PREMIUM ENHANCEMENT
When a Premium Payment is paid, a Premium Enhancement Percentage of
[ x to y ] % will be applied to that Premium Payment and the resulting amount
will be added to the Policy Value. The Premium Enhancement Percentage may
also vary depending on Your attained age at the time of a Premium Payment is
made. However, the Premium Enhancement Percentage applicable to Premium
Payments made at attained ages less than age [ z ] will be at least as great
as the corresponding percentage applicable at attained ages [ z ] and above.
The amount of the Premium Enhancement is not considered a Premium Payment.
The Premium Enhancement Percentage may vary from premium to premium on
subsequent Premium Payments, but will never be less than [ x ] % nor more
than [ y ] %. The Premium Enhancement Percentage applicable to the Initial
Premium Payment is set forth on the Certificate Data Page. We will advise You
of the amount of the Premium Enhancement applicable to each subsequent
Premium Payment in a confirmation that We will send to You. The Premium
Enhancement will be applied using the same allocation as the corresponding
Premium Payment. No Premium Enhancement will apply if the Certificate is
cancelled pursuant to the Right to Cancel provision.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1129 799
[LETTERHEAD OF PFL LIFE INSURANCE COMPANY APPEARS HERE]
PREMIUM ENHANCEMENT
This Rider is a part of the Contract/Certificate if it is shown in the Schedule
of Additional Benefits section on the Contract/Certificate page.
Section 3, Premium Payments, is amended to include the following language:
PREMIUM ENHANCEMENT
If the Cumulative Premium Payments less requested partial withdrawals are
less than $ [ x ] when a Premium Payment is paid, then a Premium Enhancement
Percentage of [ a to b ] % will be applied to that Premium Payment and the
resulting amount will be added to the Policy Value. If the Cumulative Premium
Payments less requested partial withdrawals are greater than or equal to
$ [ x ] and less than $[y] when a Premium Payment is paid, then a Premium
Enhancement Percentage of [ a to b ] % will be applied to that Premium
Payment and the resulting amount will be added to the Policy Value. If the
Cumulative Premium Payments less requested partial withdrawal amounts are
greater than or equal to $ [ y ] when a Premium Payment is paid, then a
Premium Enhancement Percentage of [ a to b ] % will be applied to that
Premium Payment and the resulting amount will be added to the Policy Value.
The Premium Enhancement Percentage may also vary depending on Your attained
age at the time a Premium Payment is made. However, the Premium Enhancement
Percentage applicable to Premium Payments made at attained ages less than age
[ z ] will be at least as great as the corresponding percentage applicable at
attained ages [ z ] and above. The Premium Enhancement will be applied using
the same allocation as the corresponding Premium Payment. The amount of the
Premium Enhancement is not considered a Premium Payment
The Premium Enhancement Percentage may vary from premium to premium on
subsequent Premium Payments, but will never be less than .[ a ] % nor more
than [ b ] %. The Premium Enhancement Percentage applicable to the Initial
Premium is set forth on the Certificate Data Page. We will advise You of the
amount of the Premium Enhancement applicable to each subsequent Premium
Payment in a confirmation that We will send to You. No Premium Enhancement
will apply if the Certificate is cancelled pursuant to the Right to Cancel
provision.
This Rider takes effect and expires concurrently with the Contract/Certificate
to which it is attached and is subject to all the terms and conditions of the
Contract/Certificate not inconsistent herewith.
Signed for us at our home office.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx
SECRETARY PRESIDENT
AE 1130 799
