Xxxxxx Investors Life Insurance Company [LOGO]
A Stock Life Insurance Company ZURICH
0000 XxXxxxxx Xxxxxxx XXXX
Xxxxxxxxxx, Xxxxxxxx 00000-0000
RIGHT TO CANCEL - FREE LOOK PROVISION - At any time within 10 days of receiving
this Contract You may return it to Us or to the representative through whom it
was purchased. All Purchase Payments allocated to the Fixed Account plus the
Separate Account Contract Value plus Market Adjusted Values computed at the end
of the valuation period following Our receipt of this Contract will then be
refunded within 10 days.
We agree to pay an Annuity to the Owner on the Annuity Date provided this
Contract is in force on the Annuity Date.
We further agree to pay the death benefit prior to the Annuity Date upon the
death of an Owner when a death benefit is payable. Payment will be made upon Our
receipt of due proof of death and the return of this Contract.
This Contract is issued in consideration of the application and payment of a
Purchase Payment. The provisions on this cover and the pages that follow are
part of this Contract.
Signed for Xxxxxx Investors Life Insurance Company at its home office in
Schaumburg, Illinois.
/s/ Xxxxx X. Xxxxxxx /s/ Xxxx X. Xxxxxx
---------------- --------------
Secretary President
FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED ANNUITY
CONTRACT
NON-PARTICIPATING
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD PROVISIONS
FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON GUARANTEE
PERIOD VALUES, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE MARKET VALUE
ADJUSTMENT FORMULA STATED IN THE CONTRACT SCHEDULE.
READ YOUR CONTRACT CAREFULLY.
Form No. L-8825
TABLE OF CONTENTS Page
CONTRACT SCHEDULE Follows Table of Contents
DEFINITIONS 1-3
GENERAL PROVISIONS 3-4
The Entire Contract 3
Modification of Contract 3
Certificates 3
Incontestability 3
Change of Annuity Date 3
Assignment 3
Due Proof of Death 3
Reserves, Contract Values and Death Benefits 3
Non-Participating 3
Reports 3
Net Payments 4
Creditors 4
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS 4-5
Owner 4
Change of Ownership 4
Beneficiary Designation and Change of Beneficiary 4
Death of Beneficiary 4
Annuitant 5
PURCHASE PAYMENT PROVISIONS 5
Purchase Payment Limitations 5
Place of Payment 5
FIXED ACCOUNT PROVISIONS 5
Fixed Account Contract Value 5
GUARANTEE PERIOD PROVISIONS 6
Guarantee Period 6
Guarantee Period Value 6
Market Value Adjustment 6
VARIABLE ACCOUNT PROVISIONS 6-7
Separate Account 6
Liabilities of the Separate Account 6
Subaccounts 6
Fund 7
Rights Reserved by the Company 7
Accumulation Unit Value 7
Investment Experience Factor 7
TRANSFER AND WITHDRAWAL PROVISIONS 8-9
Transfers During the Accumulation Period 8
Withdrawals During the Accumulation Period 8
Withdrawal Charges 8
Transfers and Withdrawal Procedures 9
Deferment of Withdrawal or Transfer 9
L-8825
TABLE OF CONTENTS Page
DEATH BENEFIT PROVISIONS 9-10
Amount Payable Upon Death 9
Payment of Death Benefits During the Accumulation Period 10
Spousal Continuation 10
ANNUITY PERIOD PROVISIONS 10-16
Annuity Options 10
Option 1 Fixed Installment Annuity 10
Option 2 Life Annuity 10
Option 3 Life Annuity with Installments Guaranteed 10
Option 4 Joint and Survivor Annuity 11
Option 5 Joint and Survivor Annuity with Installments Guaranteed 11
Other Options 11
Commutability 11
Election of Annuity Option 11-12
Electing a Fixed or Variable Annuity Option 12
Fixed Annuity 12
Variable Annuity 12-13
Annuity Unit Value 13
Basis of Annuity Options 13
Withdrawal Charge Upon Annuitization 13
Transfers Between Subaccounts 13-14
Conversions from a Fixed Account Payment 14
Conversions to a Fixed Annuity Payment 15
Payment of Death Benefits During the Annuity Period 15-16
Disbursement Upon Death of Annuitant: Under Options 1, 3 or 5 16
Supplementary Agreement 16
Date of First Payment 16
Evidence of Age, Sex and Survival 16
Misstatement of Age or Sex 16
ANNUITY OPTION TABLE Follows Page 16
ENDORSEMENTS, if any Follow Annuity Option Table
L-8825
Contract Schedule
Contract Number: KI10000000 Issue Date: June 1, 2002
Initial Purchase Payment: $10,000.00 Type of Contract Nonqualified
Owner: Xxxx Xxx
Owner Date of Birth: 02/05/67
Joint Owner: Xxxx Xxx
Joint Owner Date of Birth: 05/02/67
Annuitant: Xxxx Xxx
Annuitant Gender: Male Annuitant Date of Birth: 02/05/67
Joint Annuitant: Xxxx Xxx
Joint Annuitant Gender: Female Joint Annuitant Date of Birth: 05/02/67
Representative: Xxxxxxx Xxxxx
ABC Agency Inc.
8825
Contract Schedule
Annuity Date: June 1, 2021
Maximum Annuity Date: Later of the original youngest annuitant's 91 st birthday or 10 years from
issue.
Minimum Annuity Date: The minimum annuity date is two years from the issue date.
[Date of Continuance: NA]
Optional Enhanced Option 1 Yes
Death Benefit rider: Option 2 Not Selected
Guaranteed Roll-up Death Benefit Interest Rate:
Class 1 Accumulations Options 0.00%
Class 2 Accumulation Options 5.00%
Beneficiary(ies):
Primary: Xxxxx Xxx
[Contingent: Xxxx Xxx]
8825
Contract Schedule
Initial Purchase Payment Allocation: Allocation Initial Annual Effective
Percentage Interest Rates*
---------- ---------------
Fixed Account 2% 5.25%
1 Year Guarantee Period Account 2% 5.35%
Xxxxxxx Capital Growth 2%
Xxxxxxx International 2%
SVS Growth and Income 2%
Xxxxxxx Global Blue Chip 2%
SVS Dynamic Growth 2%
Xxxxxxx Contrarian Value 2%
Xxxxxxx Blue Chip 2%
SVS Focus Value+Growth 2%
Xxxxxxx Aggressive Growth 2%
Xxxxxxx Growth and Income 2%
Xxxxxxx High Yield 2%
Xxxxxxx Total Return 2%
SVS Venture Value 2%
Xxxxxxx Investment Grade Bond 2%
Xxxxxxx Government Securities 34%
Money Market 1 32%
* Additional amounts may be credited under a dollar cost averaging program.
8825
Contract Schedule
Class 1 Accumulation Options:
Fixed Accumulation Option
-------------------------
Fixed Account
Market Value Adiustment options:
--------------------------------
1 Year Guarantee Period Account 6 Year Guarantee Period Account
2 Year Guarantee Period Account 7 Year Guarantee Period Account
3 Year Guarantee Period Account 8 Year Guarantee Period Account
4 Year Guarantee Period Account 9 Year Guarantee Period Account
5 Year Guarantee Period Account 10 Year Guarantee Period Account
Variable Subaccount options available on Issue Date:
----------------------------------------------------
Xxxxxxx Money Market I
Xxxxxxx Money Market II
8825
Contract Schedule
Class 2 Accumulation Options:
Fixed Accumulation Option
-------------------------
None
Market Value Adjustment options:
--------------------------------
None
Variable Subaccount options available on Issue Date:
----------------------------------------------------
Xxxxx American Balanced
Xxxxx American Leveraged All Cap
CS Emerging Markets
CS Global Post-Venture Capital
Dreyfus Socially Responsible Fund
Dreyfus VIF Midcap Stock
Xxxxxxx 21st Century Growth
Xxxxxxx Capital Growth
Xxxxxxx Global Discovery
Xxxxxxx Growth and Income
Xxxxxxx Health Sciences
Xxxxxxx International
Xxxxxxx Aggressive Growth
Xxxxxxx Blue Xxxx
Xxxxxxx Contrarian Value
Xxxxxxx Global Blue Xxxx
Xxxxxxx Government Securities
Xxxxxxx Growth
Xxxxxxx High Yield
Xxxxxxx International Select Equity
Xxxxxxx Investment Grade Bond
Xxxxxxx Small Cap Growth
Xxxxxxx Small Cap Value
Xxxxxxx Technology Growth
Xxxxxxx Total Return
SVS Dreman Financial Services
SVS Dreman High Return Equity
SVS Dynamic Growth (Invesco)
SVS Focus Value+Growth
SVS Focused Large Cap Growth
SVS Growth And Income
SVS Growth Opportunities
SVS Index 500
SVS Mid-Cap Growth
SVS Strategic Equity
SVS Venture Value
SVS Dreman Small Cap Value
SVS MFS Strategic Value
8825
Contract Schedule
Minimum Initial Purchase Payment [Non-Qualified $10,000]
[Qualified $2,000]
Minimum Subsequent Purchase Payment: [$500 for nonqualified
Contracts, $50 for all other
Contract types]
[$100 if using Systematic
Accumulation Plan]
Maximum Total Purchase Payments: [$1,000,000]
Minimum Initial Account Allocation: [$500 for each subaccount,
fixed account or each GPA.]
Minimum Subsequent Account Allocation: [$50 for each subaccount or
fixed account. $500 for each
GPA.]
Minimum Contract Value after a Partial Withdrawal: [$5,000]
Withdrawal Charge Table
Years elapsed since purchase
payment was received Withdrawal Charge
-------------------- -----------------
Less than one 7%
One but less than two 6%
Two but less than three 5%
Three but less than four 4%
Four or more 0%
For purposes of determining the withdrawal charge, the first year will elapse on
the last day of the Contract Year in which the Purchase Payment was received.
Subsequent years will elapse on the last day of each subsequent Contract Year.
Free Withdrawal Allowance:
The Free Withdrawal Allowance is an amount that may be withdrawn each Contract
Year without a withdrawal charge. This amount is calculated on the Issue Date
and each Contract Anniversary and is equal to 10% of remaining Purchase Payments
subject to a withdrawal charge. On each Contract Anniversary remaining Purchase
Payments subject to a withdrawal charge are increased by Purchase Payments made
and decreased by Purchase Payments withdrawn and applicable withdrawal charges
since the last Contract Anniversary. During the Contract Year the Free
Withdrawal Allowance is reduced by withdrawals from the Free Withdrawal
Allowance and increased by 10% of Purchase Payments made since the last Contract
Anniversary.
8825
Contract Schedule
Fixed Account
A fixed account will be available for purchase payments and transfers of
existing values. For premiums and transfers allocated to the fixed account,
the initial interest rate is guaranteed through the end of the calendar
month in which the purchase payment or transfer was made and for 12
additional calendar months thereafter. Subsequent fixed account interest
rates are guaranteed for 12 calendar months.
The interest rate will never be less than the minimum guaranteed interest
rate.
Minimum guaranteed interest rate: 3.00%
Charges
Mortality and Expense Risk charge: [1.55%]
Administration charge: [0.15%]
The above annual charges will be assessed as a daily percentage on the
Separate Account Contract Value.
[Optional Enhanced Death Benefit rider charge:] Option 1 [0.20%]
Option 2 [0.35%]
The Optional Enhanced Death Benefit rider charge applies to the Class 2
accumulation options. This charge does not apply to the Class 1 accumulation
options.
Records Maintenance Charge: [$30] per contract year
We will assess an annual records maintenance charge on each Contract
Anniversary and upon total withdrawal. However, if the Contract Value is
greater than or equal to [$50,000] on a Contract Anniversary or date of
total withdrawal, we will not assess the records maintenance charge on that
Contract Anniversary or date of total withdrawal. We will not assess this
charge after the Annuity Date.
8825
Contract Schedule
Market Value Adjustment Formula
The Market Value Adjustment is determined by the application of the
following formula:
Market Value Adjustment = Guarantee Period Value x [[(1+I)/(1+j)]/T/365/-1]
Where,
I is the guaranteed interest rate being credited to the Guarantee Period
Value subject to the Market Value Adjustment.
J is the current interest rate declared by the Company as of the effective
date of the application of the Market Value Adjustment, for current
allocation to a Guarantee Period, the length of which is equal to the
balance of the Guarantee Period for the Guarantee Period Value subject to
the Market Value Adjustment, rounded to the next lower number of complete
years.
T is the number of days remaining in the Guarantee Period.
8825
DEFINITIONS ACCUMULATED GUARANTEE PERIOD VALUE - The sum of the
Guarantee Period Values.
ACCUMULATION PERIOD - The period between the Issue Date and
the Annuity Date.
ACCUMULATION UNIT - An accounting unit of measure used to
calculate the value of each Subaccount. Each Subaccount will
have an Accumulation Unit for each combination of charges.
ADMINISTRATION CHARGE - A charge deducted in the calculation
of the Accumulation Unit value and the Annuity Unit value
for a portion of Our administrative costs.
AGE - The attained age.
ANNIVERSARY VALUE - The Contract Value calculated on each
Contract Anniversary the Accumulation Period.
ANNUITANT - The person during whose lifetime the Annuity is
to be paid. Joint Annuitants may be named under
Non-qualified Certificates and any reference to Annuitant
shall include joint Annuitants.
ANNUITY - A series of payments paid in accordance with this
Contract which begin on the Annuity Date.
ANNUITY DATE - The date on which this Contract matures and
Annuity payments begin. The original Annuity Date is stated
in the Contract Schedule.
ANNUITY PERIOD - The period that starts on the Annuity Date.
ANNUITY UNIT - An accounting unit of measure used to
calculate the amount of Variable Annuity payments after the
first Annuity payment.
CONTRACT ANNIVERSARY - An anniversary of the Issue Date.
CONTRACT OWNER, OR OWNER - See "You, Your, Yours" below.
CONTRACT VALUE - The sum of the Fixed Account Contract Value
plus the Separate Account Contract Value plus the
Accumulated Guarantee Period Value.
CONTRACT YEAR - A one year period starting on the Issue Date
and successive Contract Anniversaries.
DEBT - The principal of any outstanding loan plus any
accrued interest. Loans are available under certain
Qualified Plans.
FIXED ACCOUNT - The General Account of KILICO to which an
Owner may allocate all or a portion of Purchase Payments or
Contract Value.
FIXED ACCOUNT CONTRACT VALUE - The value of amounts
allocated under the Contract to the Fixed Account.
FIXED ANNUITY - An Annuity payment plan that does not vary
as to dollar amount with investment experience.
FREE WITHDRAWAL ALLOWANCE - Amount of Purchase Payments
subject to a withdrawal charge that may be withdrawn each
Contract Year without incurring a withdrawal charge as
described in the Contract Schedule.
FUND - An investment company or separate series thereof, in
which the Subaccounts of the Separate Account invest.
GENERAL ACCOUNT - Our assets other than those allocated to
the Separate Account, the non-unitized separate account or
any other separate account.
L-8825 Page 1
DEFINITIONS(continued)
GUARANTEE PERIOD - A period of time during which an amount
is to be credited with a guaranteed interest rate, subject
to a Market Value Adjustment prior to the end of the
Guarantee Period. The Guarantee Periods initially offered
are stated in the Contract Schedule.
GUARANTEE PERIOD VALUE - The (1) Purchase Payments allocated
or amounts transferred to a Guarantee Period; plus (2)
interest credited; minus (3) withdrawals, previously
assessed withdrawal charges and transfers; adjusted for (4)
any applicable Market Value Adjustment previously made.
ISSUE DATE - The Issue Date stated in the Contract Schedule.
MARKET ADJUSTED VALUE - A Guarantee Period Value adjusted by
the Market Value Adjustment formula prior to the end of a
Guarantee Period.
MARKET VALUE ADJUSTMENT - An adjustment of Guarantee Period
Values in accordance with the Market Value Adjustment
formula prior to the end of the Guarantee Period. The
adjustment reflects the change in the value of the Guarantee
Period Value due to changes in interest rates since the date
the Guarantee Period commenced. The Market Value Adjustment
formula is stated in the Contract Schedule.
MORTALITY AND EXPENSE RISK CHARGE - A charge deducted in the
calculation of the Accumulation Unit value and the Annuity
Unit value. It is for Our assumption of mortality risks and
expense guarantees. This charge is shown in the Contract
Schedule.
NONQUALIFIED - This Contract issued other than as a
Qualified Plan.
XXXXX - A recipient of periodic payments under the Contract.
PURCHASE PAYMENTS - The dollar amount We receive in U.S.
currency to buy the benefits this Contract provides.
QUALIFIED PLAN - A Contract issued under a retirement plan
which qualifies for favorable income tax treatment under
Section 401, 403, 408, 408A, or 457 of the Internal Revenue
Code as amended.
If this Contract is issued under a Qualified Plan additional
provisions may apply. The rider or amendment to this
Contract used to qualify it under the applicable section of
the Internal Revenue Code will indicate the extent of change
in the provisions.
RECORDS MAINTENANCE CHARGE - A charge assessed against Your
Contract as specified in the Contract Schedule.
SEPARATE ACCOUNT - A unit investment trust registered with
the Securities and Exchange Commission under the Investment
Company Act of 1940 known as the KILICO Variable Annuity
Separate Account.
SEPARATE ACCOUNT CONTRACT VALUE - The sum of the Subaccount
Values of this Contract on a Valuation Date.
SUBACCOUNTS - The subdivisions of the Separate Account, the
assets of which consist solely of shares of the
corresponding Fund portfolio.
SUBACCOUNT VALUE - The value of Your interest in each
Subaccount.
VALUATION DATE - Each business day that applicable law
requires that We value the assets of the Separate Account.
Currently this is each day that the New York Stock Exchange
is open for trading.
VALUATION PERIOD - The period that starts at the close of a
Valuation Date and ends at the close of the next succeeding
Valuation Date.
L-8825 Page 2
DEFINITIONS (continued)
VARIABLE ANNUITY - An Annuity payment plan which varies as
to dollar amount because of Subaccount investment
experience.
WE, OUR, US - Xxxxxx Investors Life Insurance Company,
Schaumburg, Illinois.
YOU, YOUR, YOURS - The party(s) named as Owner unless later
changed as provided in this Contract. Under a Nonqualified
Certificate when more than one person is named as Owner, the
terms "You," "Your," "Yours," means joint Owners. The Owner
may be changed during the lifetime of the Owner and prior to
the Annuity Date. The Owner, prior to distribution of any
death benefit, has the exclusive right to exercise every
option and right conferred by this Certificate.
GENERAL PROVISIONS
The Entire Contract
This Contract, any written application attached to this
Contract, and any endorsements and riders constitute the
entire contract between the parties.
Modification of Contract
Only Our president, secretary and assistant secretaries have
the power to approve a change or waive any provisions of
this Contract. Any such modifications must be in writing. No
agent or person other than the officers named has the
authority to change or waive the provisions of this
Certificate.
Upon notice to You, this Contract may be modified by Us as
is necessary to comply with any law or regulation issued by
a governmental agency to which We or the Separate Account is
subject or as is necessary to assure continued qualification
of this Contract under the Internal Revenue Code or other
laws relating to retirement plans or annuities or as
otherwise may be in Your best interest. In the event of a
modification, We may make appropriate endorsement to this
Contract and We will obtain all required regulatory
approvals.
Incontestability We cannot contest this Contract after it has been in force
for two years from the Issue Date.
Change of Annuity Date
You may write to Us prior to the death of an Owner and the
first Annuity payment date and request a change of the
Annuity Date. The new Annuity Date must not be earlier than
the minimum Annuity Date or beyond the maximum Annuity Date
stated in the Contract Schedule.
Assignment No assignment under this Contract is binding unless We
receive it in writing. We assume no responsibility for the
validity or sufficiency of any assignment. The rights of the
Owner, Xxxxxxxxx and beneficiary are subject to the
assignment after it has been recorded by Us. Any claim is
subject to proof of interest of the assignee.
Due Proof of Death We must receive written proof of death of the Owner when a
death benefit is payable. The proof may be a certified death
certificate, or any other proof satisfactory to Us.
Reserves, Contract
Values and Death Benefits
All reserves are equal to or greater than those required by
statute. Any available Contract Value and death benefit are
not less than the minimum benefits required by the statutes
of the state in which the Contract is delivered.
Non-Participating This Contract does not pay dividends. It will not share in
Our surplus or earnings.
Reports At least once each Contract Year We will send You a
statement showing Purchase Payments received, interest
credited, investment experience, and charges made since the
last report, as well as any other information required by
statute.
L-8825 Page 3
GENERAL PROVISIONS (continued)
Premium Taxes We will make a deduction for state premium taxes in certain
situations. On any Contract subject to premium tax, as
provided under applicable law, the tax will be deducted
from: a. the Purchase Payments when We receive them; b. the
Contract Value upon total withdrawal; or c. from the total
Contract Value applied to any Annuity option at the time
Annuity payments start. In no event will an amount be
deducted for premium taxes before the Company has incurred a
tax liability under applicable state law.
Creditors The proceeds of this Contract and any payment under an
Annuity option will be exempt from the claims of creditors
and from legal process to the extent permitted by law.
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
Owner Before the Annuity Date and prior to the death of an Owner,
You may exercise every option and right conferred by this
Contract including the right of assignment. The joint Owners
must agree to the exercise of any option or right if more
than one Owner is named.
Change of Ownership
You may change the Contract Owner by written request before
the Annuity Date and prior to the death of an Owner. You
must furnish information sufficient to clearly identify the
new Owner to Us. The change is subject to any existing
assignment of this Contract. After We receive the change, it
will take effect on the date the written notice is signed.
However, any action taken by Us before the change is
recorded by Us remains in effect. Any change is subject to
the payment of any proceeds. We may require You to return
this Contract to Us for endorsement of a change.
Beneficiary Designation and
Change of Beneficiary
The beneficiary initially designated is shown in the
Contract Schedule. In the case of joint owners, the
surviving joint Owner is automatically the primary
beneficiary of any death benefit resulting from the death of
a joint Owner. You may change the beneficiary if You send Us
written notice in a form acceptable to Us. Changes are
subject to the following conditions:
1. Prior to the Annuity Date the change must be filed while
You are alive;
2. After the Annuity Date the change must be filed while You
and the Annuitant(s) are alive;
3. This Contract must be in force at the time You file a
change;
4. Such change must not be prohibited by the terms of an
existing assignment, beneficiary designation or other
restriction;
5. After We receive the change, it will take effect on the
date the written notice was signed. However, any action
taken by Us before the change form is recorded by Us will
remain in effect;
6. The request for change must provide information
sufficient to identify the new beneficiary; and
7. In the case of joint Owners, the designation of a
beneficiary other than the surviving joint Owner(s) will be
deemed to be a contingent beneficiary(s).
We may require You to return this Contract to Us for
endorsement of a change.
Death of Beneficiary
The interest of a beneficiary who dies before the
distribution of the death benefit will pass to the other
beneficiaries, if any, share and share alike, unless
otherwise provided in the beneficiary designation. If no
beneficiary survives or is named, the distribution will be
made to Your estate when the You die.
L-8825 Page 4
Annuitant The initial Annuitant is shown in the Contract Schedule.
Prior to the Annuity Date, an Annuitant may be replaced or
added unless the Owner is a non-natural person. At all times
there must be at least one Annuitant. If the Annuitant dies,
the youngest Owner will become the new Annuitant unless a
new Annuitant is otherwise named. Upon the death of an
Annuitant prior to the Annuity Date, a death benefit is not
paid unless the Owner is a non-natural person.
PURCHASE PAYMENT PROVISIONS
Purchase Payment The Minimum Initial Purchase Payment, subsequent Purchase
Limitations Payment, and maximum total Purchase Payment limits are shown
in the Contract Schedule.
The minimum initial allocation or transfer to a Guarantee
Period, Fixed Account, or to a Subaccount is shown in the
Contract Schedule.
We reserve the right to waive or modify these limits and to
aggregate multiple Certificates with the same Owner and/or
Annuitants in applying these limits. We also reserve the
right to not accept any Purchase Payment.
Place of Payment All Purchase Payments under this Contract must be paid to Us
at Our home office or such other location as We may select.
We will notify You and any other interested parties in
writing of such other locations. Purchase Payments received
by an agent will not be considered received by Us.
FIXED ACCOUNT PROVISIONS
Fixed Account The Fixed Account Contract Value includes:
Contract Value
1. Your Purchase Payments allocated to the Fixed Account;
plus
2. amounts transferred to the Fixed Account; plus
3. interest credited; minus
4. withdrawals, previously assessed withdrawal charges and
transfers from the Fixed Account, minus
5. any applicable portion of the Records Maintenance Charge.
The initial Fixed Account interest rate credited to the
initial Purchase Payment is shown in the Contract Schedule
and is in effect through the period also shown in the
Contract Schedule. We will declare the Fixed Account
interest rate applicable to the initial Purchase Payment for
each subsequent interest rate period at the beginning of
each subsequent interest rate period shown in the Contract
Schedule.
We will declare the Fixed Account interest rate with respect
to each subsequent Purchase Payment or transfer received.
Any such Purchase Payment or transfer We receive will be
credited that rate through the end of the interest rate
period shown in the Contract Schedule. We will declare the
Fixed Account interest rate applicable to each subsequent
Purchase Payment or transfer for each subsequent interest
rate period at the beginning of each subsequent interest
rate period.
We reserve the right to declare the Fixed Account current
interest rate(s) based upon the Issue Date, the date We
receive a Purchase Payment or the date of account transfer.
We calculate the interest credited to the Fixed Account by
compounding daily, at daily interest rates, rates that would
produce at the end of 12 months a result identical to the
one produced by applying an annual interest rate.
The minimum guaranteed Fixed Account interest rate is shown
in the Contract Schedule.
L-8825 Page 5
GUARANTEE PERIOD PROVISIONS
Guarantee Period We hold all amounts allocated to a Guarantee Period in a
non-unitized separate account. The non-unitized separate
account may also hold amounts from other contracts and
certificates we issue. The assets of this separate account
equal to the reserves and other liabilities of this separate
account will not be charged with liabilities arising out of
any other business we may conduct. The initial Guarantee
Periods available under this Contract are shown in the
Contract Schedule.
Guarantee Period Value
On any Valuation Date, the Guarantee Period Value includes:
1. Your Purchase Payments allocated to the Guarantee Period;
plus
2. amounts transferred to the Guarantee Period; plus
3. interest credited; minus
4. withdrawals, previously assessed withdrawal charges and
transfers from the Guarantee Period; minus
5. any applicable portion of the Records Maintenance Charge;
adjusted for
6. any applicable Market Value Adjustment previously made.
The Guarantee Period(s) initially elected and the interest
rate(s) initially credited are shown in the Contract
Schedule. The initial interest rate credited to subsequent
Purchase Payments or transfers will be declared at the time
the payment is received. At the end of a Guarantee Period,
We will declare a guaranteed interest rate applicable for
the next subsequent Guarantee Period.
We calculate the interest credited to the Guarantee Period
Value by compounding daily, at daily interest rates, rates
which would produce at the end of 12 months a result
identical to the one produced by applying an annual interest
rate.
Market Value The Market Value Adjustment formula is stated in the
Adjustment Contract Schedule. This formula is applicable for both an
upward and downward adjustment to a Guarantee Period Value
when, prior to the end of a Guarantee Period, such value is:
1. taken as a total or partial withdrawal;
2. applied to purchase an Annuity option; or
3. transferred to another Guarantee Period, the Fixed
Account, or a Subaccount.
However, a Market Value Adjustment will not be applied to
any Guarantee Period Value transaction effected within 30
days after the end of the applicable Guarantee Period.
VARIABLE ACCOUNT PROVISIONS
Separate Account The variable benefits under this Contract are provided
through the KILICO Variable Annuity Separate Account. The
Separate Account is registered with the Securities and
Exchange Commission as a unit investment trust under the
Investment Company Act of 1940. It is a separate investment
account maintained by Us into which a portion of Our assets
has been allocated for this Contract and may be allocated
for certain other contracts and certificates we issue.
Liabilities of the The assets equal to the reserves and other liabilities of
Separate Account the Separate Account will not be charged with liabilities
arising out of any other business We may conduct. We will
value the assets of the Separate Account on each Valuation
Date.
Subaccounts The Separate Account consists of multiple Subaccounts. We
may from time to time, combine or remove Subaccounts in the
Separate Account and establish additional Subaccounts of the
Separate Account. In such event, We may permit You to select
other Subaccounts under the Contract. However, the right to
select any other Subaccount is limited by the terms and
conditions We may impose on such transactions.
L-8825 Page 6
VARIABLE ACCOUNT PROVISIONS (continued)
Fund Each Subaccount of the Separate Account will buy shares of a
Fund or a separate series of a Fund. Each Fund is registered
under the Investment Company Act of 1940 as an open-end
diversified management investment company. Each series of a
Fund represents a separate investment portfolio which
corresponds to one of the Subaccounts of the Separate
Account.
If We establish additional Subaccounts, each new Subaccount
will invest in a new series of a Fund or in shares of
another investment company. We may also substitute other
investment companies.
Rights Reserved by We reserve the right, subject to compliance with the current
the Company law or as it may be changed in the future:
1. To operate the Separate Account in any form permitted
under the Investment Company Act of 1940 or in any other
form permitted by law;
2. To take any action necessary to comply with or obtain and
continue any exemptions from the Investment Company Act of
1940 or to comply with any other applicable law;
3. To transfer any assets in any Subaccount to another
Subaccount or to one or more Separate Accounts, or the
General Account, or to add, combine or remove Subaccounts in
the Separate Account;
4. To delete the shares of any of the portfolios of a Fund
or any other open-end investment company and to substitute,
for the Fund shares held in any Subaccount, the shares of
another portfolio of a Fund or the shares of another
investment company or any other investment permitted by law;
and
5. To change the way We assess charges, but not to increase
the aggregate amount above that currently charged to the
Separate Account and the Funds in connection with this
Contract.
When required by law, We will obtain Your approval of such
changes and the approval of any regulatory authority.
Accumulation Unit Value
Each Subaccount has an Accumulation Unit value for each
combination of charges. When Purchase Payments or other
amounts are allocated to a Subaccount, a number of units are
purchased based on the relevant Accumulation Unit value of
the Subaccount at the end of the Valuation Period during
which the allocation is made. When amounts are transferred
out of or deducted from a Subaccount, units are redeemed in
a similar manner. The value of a Subaccount on any Valuation
Date is the number of units held in the Subaccount times the
relevant Accumulation Unit value on that Valuation Date.
An Accumulation Unit value for each subsequent Valuation
Period is the relevant investment experience factor for that
period multiplied by the Accumulation Unit value for the
period immediately preceding. The Accumulation Unit values
for each Valuation Period are applied to each day in a
Valuation Period. The number of Accumulation Units will not
change as a result of investment experience; however,
adding, deleting or modifying a rider for this Contract will
result in a change in the number of Accumulation Units.
Investment Experience
Factor Each Subaccount has an investment experience factor for each
combination of charges. The investment experience factor of
a Subaccount for a combination of charges for a Valuation
Period is determined by dividing 1. by 2. and subtracting 3.
from the result, where:
1. is the net result of:
a. the net asset value per share of the investment held
in the Subaccount determined at the end of the current
Valuation Period; plus
b. the per share amount of any dividend or capital gain
distributions made by the investments held in the
Subaccount, if the "ex-dividend" date occurs during the
current Valuation Period; plus or minus
c. a credit or charge for any taxes reserved for the
current Valuation Period which We determine resulted
from the investment operations of the Subaccount;
2. is the net asset value per share of the investment held
in the Subaccount, determined at the end of the last
Valuation Period;
3. is the factor representing the sum of the Separate
Account charges currently applicable for the number of days
in the Valuation Period.
L-8825 Page 7
TRANSFER AND WITHDRAWAL PROVISIONS
Transfers During the Transfers may be made among the Subaccounts, Guarantee
Accumulation Period Periods and the Fixed Account subject to the following
conditions:
1. The minimum amount which may be transferred is the
Minimum Subsequent Account Allocation stated in the
Contract Schedule or, if smaller, the remaining
value in the Fixed Account or a Subaccount or
Guarantee Period.
2. No partial transfer will be made if the remaining
value of the Fixed Account, Subaccount, or
Guarantee Period will be less than the Minimum
Initial Account Allocation stated in the Contract
Schedule.
3. No transfer may be made within seven calendar days
of the date on which the first Annuity payment is
due.
4. We reserve the right to impose a 15 calendar day
waiting period between transfers for any transfer
in excess of 12 in a Contract Year.
5. We reserve the right to assess a $ 10.00 charge for
each transfer in excess of 12 in a Contract Year.
6. Any transfer from a Guarantee Period is subject to
a Market Value Adjustment unless the transfer is
effected within thirty days after the end of the
applicable Guarantee Period.
Any transfer request must clearly specify:
1. the amount which is to be transferred; and
2. the names of the accounts which are affected.
For the Fixed Account and Guarantee Period accounts, We
will transfer Purchase Payments and all related
accumulation received in a given Contract Year, in the
chronological order We receive them.
We reserve the right at any time and without notice to
any party, to terminate, suspend, or modify these
transfer rights.
Withdrawals During the During the Accumulation Period, You may withdraw all or
Accumulation Period part of the Contract Value reduced by any withdrawal
charge, Debt and applicable premium taxes, and adjusted
by any applicable Market Value Adjustment.
Withdrawals are subject to all of the following
conditions:
1 You must return the Contract to Us if You elect a
total withdrawal.
2. Each withdrawal must be at least $500 or the value
that remains in the Fixed Account, Subaccount or
Guarantee Period if smaller.
3. The Minimum Subsequent Account Allocation stated
in the Contract Schedule must remain in the
account after You make a withdrawal unless the
account is eliminated by such withdrawal.
4. We must receive a written request that indicates
the amount of the withdrawal from the Fixed Account
and each Subaccount and Guarantee Period.
5. Withdrawals will reduce each investment option on a
proportional basis unless You direct Us otherwise.
6. Withdrawals will first reduce Your Purchase
Payments in the chronological order in which they
were received and then reduce any earnings.
7. If a partial withdrawal would reduce the Contract
Value to less than the Minimum Contract Value after
a Partial Withdrawal stated in the Contract
Schedule, the partial withdrawal will be processed
as a total withdrawal.
L-8825 Page 8
TRANSFER AND WITHDRAWAL PROVISIONS (continued)
Withdrawal Charges Withdrawal charges are shown in the Certificate
Schedule. For purposes of calculating Withdrawal
Charges, We will assume that amounts are withdrawn in
the following order:
1. Purchase Payments no longer subject to a Withdrawal
Charge,
2. Free Withdrawal Allowance,
3. Purchase Payments in chronological order in which
they were received,
4. Earnings.
Transfer and Withdrawal We will withdraw or transfer from the Fixed Account or
Procedures Guarantee Periods as of the Valuation Date that follows
the date We receive the Owner's written or telephone
transfer request. To process a withdrawal, the request
must contain all required information.
We will redeem the necessary number of Accumulation
Units to achieve the dollar amount when the withdrawal
or transfer is made from a Subaccount. We will reduce
the number of Accumulation Units credited in each
Subaccount by the number of Accumulation Units redeemed.
The reduction in the number of Accumulation Units is
determined based on the Accumulation Unit value at the
end of the Valuation Period when We receive the request,
provided the request contains all required information.
We will pay the withdrawal amount within seven calendar
days after the date We receive the request, except as
provided below.
Deferment of Withdrawal If the withdrawal or transfer is to be made from a
or Transfer Subaccount, We may suspend the right of withdrawal or
transfer or delay payment more than seven calendar days:
1. during any period when the New York Stock Exchange is
closed other than customary weekend and holiday
closings;
2. when trading in the markets normally utilized is
restricted, or an emergency exists as determined by
the Securities and Exchange Commission, so that
disposal of investments or determination of the
Accumulation Unit value is not practical; or
3. for such other Periods as the Securities and Exchange
Commission by order may permit for protection of
Owners.
We may defer the payment of a withdrawal or transfer
from the Fixed Account or Guarantee Periods, for the
period permitted by law. This can never be more than six
months after the Owner sends Us a written request.
During the period of deferral, We will continue to
credit interest, at the then current interest rate(s),
to the Fixed Account Certificate Value and/or each
Guarantee Period Value.
DEATH BENEFIT PROVISIONS
Amount Payable When a death benefit is payable We will pay the greater
Upon Death of 1. or 2. below, less Debt.
1. the Certificate Value, excluding any negative but
including any positive market value adjustment.
2. the total amounts of purchase payments, less previous
Purchase Payments withdrawn and withdrawal charges.
We compute the Certificate Value at the end of the
Valuation Period following our receipt of due proof of
death and the return of this Certificate. We compute 2.
above as of Your date of death.
Payment of Death A death benefit will be paid to the beneficiary upon the
Benefits During the death of the Owner, or a joint Owner, during the
Accumulation Period Accumulation Period. If the Certificate Owner is a
non-natural person, a death benefit will be paid to the
beneficiary upon the death of an Annuitant prior to the
Annuity Date.
We will pay the death benefit to the beneficiary after
We receive due proof of death. We will then have no
further obligation under this Certificate.
L-8825 Page 9
DEATH BENEFIT PROVISIONS (continued)
The entire interest in this Contract must be distributed
within five years from the date of death unless it is
applied under an Annuity Option or the spouse continues
this Contract as described below.
The beneficiary may elect to have the death benefit
distributed as stated in Annuity Period Provisions
Option 1 provided the beneficiary's life expectancy is
not less than 10 years; or Options 2 or 3 as described
in the Annuity Period Provisions of this Contract, based
on the life expectancy of the beneficiary as prescribed
by federal regulations unless You have restricted the
right to make such an election. The beneficiary must
make this choice within sixty days of the time We
receive due proof of death, and distributions must
commence within one year of the date of death.
If the beneficiary is a non-natural person, the
beneficiary must elect that the entire death benefit be
distributed within five years of the date of death.
Spousal Continuation If this Contract was issued as a Nonqualified Plan or an
Individual Retirement Annuity ("IRA") and Your spouse is
the primary beneficiary when You die, Your surviving
spouse may elect to be the successor Owner of this
Contract. This is known as a Spousal Continuation. In
such a case, no death benefit will be payable upon your
death.
Upon Your death, Your surviving spouse may continue
this Contract thereby waiving claim to the death benefit
otherwise payable. Electing to continue this Contract
under the Spousal Continuation provision of this
Contract will affect how the charges and benefits under
this Contract and applicable endorsements are calculated
or determined.
If a Spousal Continuation is elected, the Contract
Value will be adjusted to equal the amount otherwise
payable as a death benefit under this Contract subject
to the following:
A. The Contract Value will be adjusted to equal the
amount of the death benefit. If the death benefit
otherwise payable exceeds the Contract Value one
day prior to the date of continuance, such excess
will be credited to the money market Subaccount
listed in the Contract Schedule. This amount may
subsequently be transferred from the money market
Subaccount to other options under this Contract.
B. Upon the death of Your surviving spouse before the
Annuity Date, the amount of the death benefit
payable will be determined as if: (1) the Contract
was issued on the date of continuance; (2) the
Contract Value applied on the date of continuance
resulted from our receipt of an initial Purchase
Payment,
X. Xxxxxxxxxx charges will not apply to withdrawals
made from the Contract Value credited on the date
of continuance. Withdrawal Charges will apply to
Purchase Payments made after the date of
continuance.
D. This Contract may not be continued under a
subsequent Spousal Continuation.
We may make certain riders available to the surviving
spouse at the time of continuance.
ANNUITY PERIOD PROVISIONS
Annuity Options You may annuitize this Contract under one of the
following Annuity options:
Option 1 We will make monthly payments for 10 years.
Fixed Installment Annuity
Option 2 We will make monthly payments while the Annuitant
Life Annuity is alive.
Option 3 We will make monthly payments for a 10 year
Life Annuity with certain period and thereafter while the Annuitant
Installments Guaranteed is alive.
L-8825 Page 10
ANNUITY PERIOD PROVISIONS (continued)
Option 4 We will pay the full monthly income while both
Joint and Annuitant(s) are alive. Upon the death of either
Survivor Xxxxxxx Xxxxxxxxx, We will continue to pay a percentage of the
original monthly payment. The percentage payable must
be selected at the time the Annuity option is chosen.
The percentages available are 50%, 66 2/3%, 75% and
100%.
Option 5 We will make monthly payments for a 10 year certain
Joint and Survivor period and thereafter while the Annuitants are alive.
Annuity with
Installments Guaranteed
Other Options We may make other Annuity options available.
Commutability For annuitizations under the Fixed and Variable Annuity
options with a 10 year certain period, You may elect a
commutable Annuity option. You must make this election
prior to the Annuity Date. Under the commutable Annuity
option, partial lump sum payments are available during
the certain period.
Lump sum payments are available once each year following
the Annuity Date and may not be elected until 13 months
after annuitization has started.
You may elect to receive a partial lump sum payment of
the present value of the remaining payments in the
period certain subject to the restrictions described
below. If a partial lump sum payment is elected, the
remaining payments in the period certain will be reduced
based on the ratio of the amount of the partial
withdrawal to the amount of the present value of the
remaining installments in the period certain prior to
the withdrawal. If the Annuitant is living after the
period certain is over, payments will resume without
regard to any lump sum payments made during the certain
period.
Each time that a partial lump sum payment is made, We
will determine the percentage that the payment
represents of the present value of the remaining
installments in the period certain. The sum of these
percentages over the life of the Contract cannot exceed
75% for Nonqualified Certificates, or 100% for
Certificates issued under a Qualified Plan.
In determining the amount of the lump sum payment that
is available, the present value of the remaining
installments in the certain period will be calculated
based on the applicable interest rate.
For a Fixed Annuity option the applicable interest rate
is the greater of:
(a) the ten year treasury constant maturity plus 3%, and
(b) the rate used to determine the initial payment
plus 2%.
For a Variable Annuity option the applicable interest
rate is the assumed investment rate plus 2%.
The amount of each payment for purposes of determining
the present value of any variable installments will be
the payment next scheduled after the request for
commutation is received.
The terms for the commutability of an Annuity option
under any Contract rider are specified in the rider.
Election of Annuity We must receive an election of an Annuity option in
Option writing. You may make an election on or before the
Annuity Date provided the Annuitant is alive.
A subsequent change of beneficiary, or an assignment of
this Contract will revoke an election unless the
assignment provides otherwise.
L-8825 Page 11
ANNUITY PERIOD PROVISIONS (continued)
Upon election of an Annuity option, We agree to pay the
Owner on the payment due dates as stated in the
specifications page of the supplementary agreement. The
Owner may direct Us, in writing, to make payments to
another person. An option cannot be changed after the
first Annuity payment is made. If the total Contract
Value is applied under one of the Annuity options, this
Contract must be surrendered to Us.
If an Annuity option is not elected by the Annuity Date,
an Annuity will be paid under Option 3 if there is one
Annuitant on the Annuity Date and Option 5 if there are
joint Annuitants on the Annuity Date.
Electing a Fixed or You may elect a Fixed Annuity, a Variable Annuity or a
Variable Annuity Option combination of both. The portion of the Contract Value
You elect to be paid as a Fixed Annuity, if any, will be
transferred to Our General Account. We must receive your
Fixed and Variable allocation election in writing at
least seven days prior to the Annuity Date. If We do not
receive notification from You, all the Contract Value
will be paid to You as a Fixed Annuity.
If your allocation includes a Variable Annuity payment,
payments will reflect the investment performance of the
Subaccounts in accordance with the allocation on the
Annuity Date. Allocations will not be changed
thereafter, except as provided in the Transfers Between
Subaccounts section.
Payments for all options are derived from the applicable
tables. Current Annuity rates will be used if they
produce greater payments than those quoted in the
Contract. The age in the tables is the Age of the
Annuitant on the last birthday before the first payment
is due.
The option selected must result in a payment that is at
least equal to Our minimum payment, according to Our
rules, at the time the Annuity option is chosen. If at
any time the payment is less than the minimum payment,
We have the right to increase the period between
payments to quarterly, semi-annual or annual so that the
payment is at least equal to the minimum payment or to
make payment in one lump sum.
Xxxxx Xxxxxxx The portion of the Contract Value You elected to have
paid to you as a Fixed Annuity less any withdrawal
charge, charges for other benefits, and Records
Maintenance Charge will be used to determine the Fixed
Annuity monthly payment in accordance with the Annuity
option selected. Any Accumulated Guarantee Period Values
will be adjusted for any applicable Market Value
Adjustment as well.
Variable Annuity The portion of the Contract Value You elect to have paid
to you as a Variable Annuity is first reduced by any
withdrawal charge, charges for other benefits, and
Records Maintenance Charge. The value that remains is
used to determine the first monthly Annuity payment. The
first monthly Annuity payment is based on the guaranteed
Annuity option shown in the Annuity Option Table.
The dollar amount of subsequent payments may increase or
decrease depending on the investment experience of each
Subaccount to which Contract Value is allocated. You may
not have more than three Subaccounts at one time. The
number of Annuity Units per payment will remain fixed
for each Subaccount unless a transfer is made. If a
transfer is made, the number of Annuity Units per
payment will change. Some Annuity options provide for a
reduction in the income level upon the death of an
Annuitant, which will reduce the number of Annuity
units.
L-8825 Page 12
ANNUITY PERIOD PROVISIONS (continued)
The number of Annuity Units for each Subaccount is
calculated by dividing a. by b. where:
a. is the amount of the monthly payment that can be
attributed to that Xxxxxxxxxx; and
b. is the Annuity Unit value for that Subaccount at the
end of the Valuation Period.
The Valuation Period includes the date on which the
payment is made.
Monthly Annuity payments, after the first payment, are
calculated by summing up, for each Subaccount, the
product of a. multiplied by b. where:
a. is the number of Annuity Units per payment in each
Subaccount; and
b. is the Annuity Unit value for that Subaccount at the
end of the Valuation Period.
Annuity Unit Value The Valuation Period includes the date on which the
payment is made. The value of an Annuity Unit for each
Subaccount at the end of any Valuation Period is
determined by the result of a. multiplied by b. by c.
where:
a. is the Annuity Unit value for the immediately
preceding Valuation Period; and
b. is the net investment experience factor for the
Valuation Period for which the Annuity Unit value is
being calculated; and
c. is the interest factor of .99993235 per calendar day
of such subsequent Valuation Period to offset the
effect of the assumed rate of [2.50%] per year used
in the Annuity Option Table. A different interest
rate factor will be used if an assumed rate other
than [2.50%] is used in the Annuity Option Table.
Basis of The guaranteed monthly payments are based on an interest
Annuity Options rate of [2.50%] per year and, where mortality is
involved, the ["Annuity 2000 Table" developed by the
Society of Actuaries projected using Scale G to the year
2015.] We may also make available Variable Annuity
payment options based on assumed investment rates other
than [2.50%], but not greater than 5.00%.
Withdrawal Charge Upon annuitization, a withdrawal charge will be applied
Upon Annuitization as shown in the Contract Schedule after application of
any applicable Market Value Adjustment. The withdrawal
charge is waived when the Owner elects an Annuity option
which provides either an income benefit period of ten
years or more or a benefit under which payment is
contingent on the life of the Annuitant(s).
Transfers Between During the Annuity Period, You may make transfers
Subaccounts between Subaccounts subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. Transfers between Subaccounts are prohibited during
the first year of the Annuity Period; subsequent
transfers are limited to one per year.
3. You may not have more than three Subaccounts at
anytime.
4. At least $5,000 of Annuity Unit value must be
transferred from a Subaccount, unless the transfer
will eliminate Your interest in the Subaccount.
5. At least $5,000 of Annuity Unit value must remain in
the Subaccount after a transfer, unless the transfer
will eliminate Your interest in the Subaccount.
L-8825 Page 13
ANNUITY PERIOD PROVISIONS (continued)
6. If We receive notice of a transfer between
Subaccounts more than seven (7) days before an
Annuity payment date, the transfer is effective
during the Valuation Period after the date We receive
the notice.
7. If We receive notice of a transfer between
Subaccounts less than seven (7) days before an
Annuity Payment date, the transfer is effective
during the Valuation Period after the Annuity Payment
date.
We reserve the right at any time and without notice to
any party to terminate, suspend or modify these transfer
privileges.
When a transfer is made between Subaccounts, the number
of Annuity Units per payment attributable to a
Subaccount to which the transfer is made is equal to
a. multiplied by b. divided by c., where:
a. is the number of Annuity Units per payment in the
Subaccount from which the transfer is being made;
b. is the Annuity Unit value for the Subaccount from
which the transfer is being made; and
c. is the Annuity Unit value for the Subaccount to which
the transfer is being made.
Conversion from a During the Annuity Period, You may convert Xxxxx Xxxxxxx
Xxxxx Xxxxxxx Payment payments to Variable Annuity payments subject to the
following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of annuity reserve value must be
transferred from Our General Account, unless the
transfer will eliminate the annuity reserve value.
3. At least $30,000 of annuity reserve value must remain
in Our General Account after a transfer, unless the
transfer will eliminate the annuity reserve value.
4. Conversions from a Fixed Annuity payment are
available only on an anniversary of the Annuity Date.
5. We must receive notice at least thirty (30) days
prior to the anniversary.
We reserve the right at any time and without notice to
any party to terminate, suspend or modify these
conversion privileges.
When a conversion is made from a Fixed Annuity payment
to a Variable Annuity payment, the number of Annuity
Units per payment attributable to a Subaccount to which
the conversion is made is equal to a. divided by b.
divided by c., where:
a. is the annuity reserve being transferred from Our
General Account;
b. is the Annuity Unit value for the Subaccount to which
the transfer is being made; and
c. is the present value of $1.00 per payment period
using the attained Age(s) of the Annuitant(s) and any
remaining payment that may be due at the time of the
transfer.
The annuity reserve value equals the present value of
the remaining Fixed Annuity payments using the same
interest and mortality basis used to calculate the Fixed
Annuity payments.
Money converted to a Variable Annuity payment will be
applied under the same Annuity option as originally
selected.
L-8825 Page 14
ANNUITY PERIOD PROVISIONS (continued)
Conversion to a During the Annuity Period, You may convert Variable
Fixed Annuity Payment Annuity payments to Fixed Annuity payments subject to
the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of Annuity Unit value must be
transferred to Our General Account from the
Subaccounts.
3. At least $5,000 of Annuity Unit value must remain in
a Subaccount after a transfer, unless the transfer
will eliminate Your interest in the Subaccount.
4. Conversions to a Fixed Annuity payment are available
only on an anniversary of the Annuity Date.
5. We must receive notice at least thirty (30) days
prior to the anniversary.
We reserve the right at any time and without notice to
any party to terminate, suspend or modify these
conversion privileges.
When a conversion is made from a Variable Annuity
payment to a Fixed Annuity payment, the number of
Annuity Units per payment attributable to a Subaccount
from which the conversion is made is the product of
a. multiplied by b. multiplied by x., where:
a. is the number of Annuity Units representing Your
interest in such Subaccount per Annuity payment;
b. is the Annuity Unit value for such Subaccount; and
c. is the present value of $1.00 per payment period
using the attained Age(s) of the Annuitant(s) and any
remaining payment that may be due at the time of the
transfer.
Money converted to a Fixed Annuity payment will be
applied under the same Annuity option as originally
selected.
Payment of Death If an Annuitant dies after the Annuity Date, the death
Benefits During the benefit, if any, will depend on the Annuity option in
Annuity Period effect.
If an Owner, who is nor also an Annuitant, dies after
the Annuity Date, the following provisions apply:
1. If the Owner was the sole Owner, the remaining
Annuity payments will be payable to the beneficiary
in accordance with the Annuity option in effect. The
beneficiary will become the Owner.
2. If the Contract has joint Owners, the Annuity
payments will be payable to the surviving joint Owner
in accordance with the terms of the Annuity option in
effect. Upon the death of the surviving joint Owner,
the beneficiary becomes the Owner.
Disbursement Upon When the Annuitant or surviving joint Annuitant dies, We
Death of Annuitant: will automatically continue any unpaid installments for
Under Options 1, 3 or 5 the remainder of the certain period under Option 1,
Option 3 or Option 5 to the Payee. However, if You
elect within 60 days of Our receipt of due proof of
death, We will pay a commuted value of the remaining
payments of the certain period. In determining the
commuted value, the present value of the remaining
payments in the certain period will be calculated based
on the applicable interest rate.
L-8825 Page 15
ANNUITY PERIOD PROVISIONS (continued)
For a Fixed Annuity option the applicable interest rate
is the greater of:
(a) the ten year treasury constant maturity plus 3%, and
(b) the rate used to determine the initial payment
plus 2%.
For a Variable Annuity option the applicable interest
rate is the assumed investment rate plus 2%:
The amount of each payment for purposes of determining
the present value of any variable installments will be
determined by applying the Annuity Unit value next
determined following Our receipt of due proof of death.
Supplementary A supplementary agreement will be issued to reflect
Agreement payments that will be made under an Annuity option.
Date of First Payment Interest, under an Annuity option, will start to accrue
on the effective date of the supplementary agreement.
The supplementary agreement will provide details on the
payments to be made.
Evidence of Age, Sex We may require satisfactory evidence of the Age, sex and
and Survival the continued survival of any person on whose life the
income is based.
Misstatement of Age If the Age or sex of the Annuitant has been misstated,
or Sex the amount payable under the Contract will be such as
the Purchase Payments sent to Us would have purchased at
the correct Age or sex. Interest not to exceed 6%
compounded each year will be charged to any overpayment
or credited to any underpayment against future payments
We may make under this Contract.
L-8825 Page 16
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
Option One - Fixed Installment Annuity
Number
of years Monthly
selected Payment
10 9.39
Options Two and Three - Life Annuity With Installments Guaranteed
Age of Monthly Payments Guaranteed Age of Monthly Payments Guaranteed
Male Female
Payee None 120 Payee None 120
------ ----- ---- ------ ----- ----
55 4.00 3.96 55 3.71 3.70
56 4.08 4.04 56 3.78 3.76
57 4.17 4.12 57 3.86 3.83
58 4.26 4.21 58 3.93 3.91
59 4.36 4.30 59 4.02 3.99
60 4.46 4.40 60 4.10 4.07
61 4.57 4.50 61 4.20 4.16
62 4.69 4.60 62 4.29 4.25
63 4.81 4.71 63 4.40 4.35
64 4.95 4.83 64 4.51 4.45
65 5.09 4.95 65 4.63 4.56
66 5.24 5.08 66 4.75 4.68
67 5.41 5.22 67 4.89 4.80
68 5.58 5.36 68 5.03 4.93
69 5.76 5.50 69 5.19 5.06
70 5.96 5.65 70 5.36 5.21
71 6.17 5.81 71 5.54 5.36
72 6.39 5.97 72 5.73 5.52
73 6.62 6.13 73 5.94 5.69
74 6.88 6.30 74 6.17 5.86
75 7.14 6.47 75 6.41 6.04
76 7.43 6.65 76 6.68 6.23
77 7.73 6.83 77 6.96 6.42
78 8.06 7.01 78 7.26 6.62
79 8.41 7.18 79 7.59 6.82
80 8.79 7.36 80 7.95 7.02
81 9.19 7.54 81 8.34 7.23
82 9.62 7.71 82 8.76 7.43
83 10.08 7.88 83 9.21 7.62
84 10.57 8.04 84 9.71 7.81
85 11.10 8.20 85 10.24 8.00
Option Four - Joint and 100% Survivor Annuity
Age of Age of Female Payee
Male
Payee 55 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ---- ----
55 3.38 3.53 3.67 3.77 3.86 3.91 3.95
60 3.48 3.68 3.88 4.06 4.20 4.30 4.37
65 3.56 3.81 4.08 4.35 4.59 4.77 4.91
70 3.62 3.92 4.26 4.63 4.99 5.32 5.57
75 3.65 3.99 4.39 4.87 5.39 5.90 6.34
80 3.68 4.03 4.49 5.05 5.73 6.46 7.18
85 3.69 4.06 4.55 5.18 5.99 6.96 8.01
Option Five - Joint and 100% Survivor Annuity with Installments Guaranteed for
10 years
Age of Age of Female Payee
Male
Payee 55 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ---- ----
55 3.38 3.53 3.66 3.77 3.85 3.91 3.94
60 3.48 3.68 3.88 4.05 4.19 4.29 4.35
65 3.56 3.81 4.08 4.34 4.57 4.74 4.86
70 3.61 3.91 4.25 4.61 4.96 5.26 5.46
75 3.65 3.98 4.38 4.84 5.33 5.78 6.13
80 3.67 4.03 4.47 5.01 5.63 6.26 6.78
85 3.69 4.05 4.52 5.12 5.84 6.63 7.34
Rates for ages not shown here will be provided upon request.
L-8825 Page 17
GROUP FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED ANNUITY
CONTRACT
NON-PARTICIPATING
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED
AS TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD PROVISIONS
FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON GUARANTEE
PERIOD VALUES, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE MARKET VALUE
ADJUSTMENT FORMULA STATED IN THE CONTRACT SCHEDULE.
READ YOUR CONTRACT CAREFULLY
Xxxxxx Investors Life Insurance Company
0000 XxXxxxxx Xxxxxxx, Xxxxxxxxxx, Xxxxxxxx 00000-0000
Form No. L-8825
