EX-4.a
XXXXXXX NATIONAL LIFE
[0000 Xxxxxxxxxxx Xxxxxx XXXXXXXXX COMPANY [GRAPHIC OMITTED]
Purchase, New York 10577 OF NEW YORK
xxx.xxxxx.xxx] A STOCK COMPANY
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Thank you for choosing Xxxxxxx National Life Insurance Company of New York,
hereinafter also referred to as "the Company." If You have any questions,
please contact the Company at the Service Center address and telephone
number shown on the Contract Data Page.
THIS ANNUITY CONTRACT IS ISSUED BY THE
COMPANY AND IS AN AGREEMENT BETWEEN THE
OWNER ("YOU") AND XXXXXXX NATIONAL LIFE
INSURANCE COMPANY OF NEW YORK.
READ YOUR CONTRACT CAREFULLY.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE
ACCUMULATION AND ANNUITY PERIODS IS NOT GUARANTEED AND MAY INCREASE OR DECREASE
BASED UPON THE INVESTMENT EXPERIENCE OF THE FUND UNDERLYING THE SEPARATE
ACCOUNT.
IF THE ACTUAL INVESTMENT RATES EXPERIENCED
BY THE SEPARATE ACCOUNT ASSETS ARE LESS
THAN 4.15%, VARIABLE ANNUITY PAYMENTS
WILL DECREASE OVER TIME.
AMOUNTS ALLOCATED TO THE FIXED ACCOUNT(S) WILL EARN INTEREST AT THE
CURRENT INTEREST RATE FOR THE DURATION OF THE FIXED ACCOUNT OPTION
PERIOD. THE INTEREST RATE CREDITED FOR SUBSEQUENT ALLOCATIONS IS SUBJECT
TO CHANGE AS DECLARED BY THE COMPANY.
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NOTICE OF RIGHT TO EXAMINE
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You may return this Contract to the selling producer or Xxxxxxx National Life
Insurance Company of New York within 20 days after You receive it. Upon receipt
of this Contract, the Company will refund the full Premium allocated to the
Fixed Accounts less any withdrawals from the Fixed Account, plus the Separate
Account Contract Value. Upon such refund, this Contract shall be void. The
effective date of the surrender, and the date the funds in the Separate Account
will be valued, will be the date the Contract was mailed to the Company, or
returned to Your selling producer.
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INDIVIDUAL DEFERRED VARIABLE AND THIS CONTRACT IS SIGNED BY THE COMPANY
FIXED ANNUITY CONTRACT (FLEXIBLE
PREMIUM). /s/ Xxxxx X Xxxxxxx
DEATH BENEFIT AVAILABLE.
INCOME OPTIONS AVAILABLE. PRESIDENT AND CHIEF EXECUTIVE
NONPARTICIPATING.
/s/ Xxxxxx X. Xxxxx
SECRETARY
VA410NY
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TABLE OF CONTENTS
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PROVISION PAGE NUMBER
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CONTRACT DATA PAGE 3a
DEFINITIONS 4
GENERAL PROVISIONS 7
ACCUMULATION PROVISIONS 10
WITHDRAWAL PROVISIONS 11
DEATH BENEFIT PROVISIONS 12
INCOME PROVISIONS 15
TABLE OF INCOME OPTIONS 19
VA410NY 2
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CONTRACT DATA PAGE
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Contract Number: 1234567890
Owner: Xxxx Xxx
Owner Issue Age: 35
Joint Owner: Xxxx Xxx
Joint Owner Issue Age: 35
Annuitant: Xxxx Xxx
Annuitant Issue Age: 35
Initial Premium: $50,000.00
Issue Date: 07/01/2004
Issue State: New York
Income Date: 07/01/2034
Fixed Account Minimum Interest Rate: [1.50%]
Initial Current Interest Rate: [3.00%]
Beneficiary(ies): Xxxxx Xxx
VA410NY 3a
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CONTRACT DATA PAGE (CONT'D)
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OPTIONAL BENEFITS ELECTED:
MORTALITY AND EXPENSE On an annual basis, this charge equals
CHARGE: 1.50% of the daily net asset value of the
Investment Divisions.
ADMINISTRATION CHARGE: On an annual basis, this charge equals
0.15% of the daily net asset value
of the Investment Divisions.
TOTAL ASSET BASED CHARGES: ON AN ANNUAL BASIS, THE TOTAL OF ALL ASSET
BASED CHARGES IS EQUAL TO 1.65% OF THE
DAILY NET ASSET VALUE OF THE INVESTMENT
DIVISIONS.
Asset based charges are deducted daily as
part of the Accumulation Unit Value
calculation. Total asset based charges
include the Mortality and Expense Charge,
the Administration Charge and asset based
charges for optional benefits.
VA410NY 3b
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CONTRACT DATA PAGE (CONT'D)
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ANNUAL CONTRACT An annual charge of no more than $30.00
MAINTENANCE CHARGE: will be deducted by the Company from those
Contracts where the Contract Value is less
than $50,000 at the time such charge is
assessed.
TRANSFER/TRANSFER CHARGE: A fee of $25.00 is charged for each
transfer in excess of 15 in any Contract
Year. Any Transfer Charge is deducted
from the amount transferred prior to the
allocation to the new Contract Option.
Transfer Charges will not be applied to
transfers due to automatic transfers from
the Fixed Account Option, dollar cost
averaging or other systematic investment
programs provided by the Company, nor will
these transfers count against the 15 free
transfers allowed in a Contract Year.
Asset allocation service providers must
comply with the Company's administrative
systems, rules, and procedures.
A transfer will be effective as of the end
of the Business Day when the Company
receives a transfer request prior to
market close in Good Order, otherwise the
transfer will be effective as of the end
of the next Business Day.
The Company will not be liable for a
transfer made in accordance with the
Owner's instructions.
FROM INVESTMENT DIVISION TO INVESTMENT
DIVISION. Prior to and after the Income
Date, You may transfer all or a portion of
Your Contract Value in one Investment
Division to any available Investment
Division(s).
FROM INVESTMENT DIVISION TO THE FIXED
ACCOUNT OPTION. Transfers from an
Investment Division to the Fixed Account
Option are not permitted.
FROM THE FIXED ACCOUNT OPTION TO AN
INVESTMENT DIVISION. Amounts allocated to
the Fixed Account Option will be
automatically transferred to the
Investment Division(s) of Your choice in
regular installments over a 6-month period
from the date of allocation. A
pre-determined amount will be transferred
monthly from the source Fixed Account
Option to the Owner selected Investment
Division(s) such that at the end of the
6-month period all amounts in the Fixed
Account Option have been transferred. The
funds being transferred will be allocated
to the Investment Division(s) elected by
You. You may change Your selected
Investment Division(s) at any time.
Additional transfers from the Fixed
Account Option are permitted at any time.
VA410NY 3c
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CONTRACT DATA PAGE (CONT'D)
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PREMIUM(S): Premiums are flexible. This means that the
Owner may change the amounts, frequency or
timing of Premiums. The initial Premium
must be at least $25,000. Subsequent
Premiums must be at least $5,000 for
Nonqualified Plan Contracts and $2,000 for
Qualified Plan Contracts. Total Premiums
under a Contract may not exceed
$1,000,000. The Company may waive the
minimums or maximums at any time. The
Company reserves the right to refuse any
Premium payment.
The Owner may allocate Premiums among the
Fixed Account Option and Investment
Divisions. Allocations may be made in any
percent from 0% to 100% in whole
percentages. The minimum that may be
allocated to the Fixed Account Option or
an Investment Division is $100. Any
additional Premium will be allocated
according to Your most recent instructions
on file with the Company, provided that
each allocation must meet the minimums and
restrictions described above, regardless
of such instructions.
CONTRACT OPTIONS:
Investment Division(s):
Availability is indicated in the Contract
application, current prospectus and any
supplements.
Fixed Account Option
The Contract Options You have selected, which are specified in the Contract
application, will be detailed in a confirmation sent to You by the Company on or
after the Issue Date.
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Xxxxxxx National Life Insurance Company of New York
[0000 Xxxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxx Xxxx 00000
1/888/965-6569
xxx.xxxxx.xxx]
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Service Centers:
For Contracts purchased through a non-bank Broker/Dealer: For Contracts purchased through a Bank or Financial
[JNL/NY Service Center Institution:
P.O. Box 378002 [JNL/NY IMG Service Center
Denver, CO 80237-8002 P.O. Box 30901
Customer Care: 000-000-0000 Lansing, MI 48909-8401
(9:00 a.m. - 8:00 p.m. ET) Customer Care: 000-000-0000
E-Mail: xxxxxxxxx@xxxxx.xxx] (8:00 a.m. - 8:00 p.m. ET)
E-Mail: xxxxxxxxx@xxxxx.xxx]
VA410NY 3d
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DEFINITIONS
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ACCUMULATION UNIT. A unit of measure used to calculate the value in an
Investment Division prior to the Income Date.
ANNUITANT. The natural person on whose life annuity payments for this Contract
are based. Any reference to the Annuitant includes any Joint Annuitant.
ANNUITY UNIT. A unit of measure used to calculate the amount of a variable
annuity payment.
BASE INTEREST RATE. The rate of interest established by the Company, in its sole
discretion, for a specified Fixed Account Option. In no event will the Base
Interest Rate be less than the Fixed Account Minimum Interest Rate shown on the
Contract Data Page.
BENEFICIARY(IES). The person(s) or entity(ies) designated to receive any
Contract benefits upon the death of the Owner.
BUSINESS DAY. Each day that the New York Stock Exchange is open for business.
All requests for transactions that are received at the Company's Service Center
in Good Order on any Business Day prior to market close, generally 4 P.M.
Eastern Time, will be processed effective the end of that Business Day.
CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract between
You and the Company.
CONTRACT ANNIVERSARY. Each one year anniversary of the Issue Date.
CONTRACT OPTION. One of the allocation options offered by the Company under this
Contract. Each Contract Option is more fully explained in the Accumulation
Provisions.
CONTRACT VALUE. The Contract Value equals the sum of the Separate Account
Contract Value and the Fixed Account Contract Value.
CONTRACT YEAR. The twelve-month period immediately following the Issue Date or
any Contract Anniversary.
CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate
credited by the Company, less any charges due under any optional endorsements to
the Contract. In no event will the Current Interest Rate be less than the Fixed
Account Minimum Interest Rate shown on the Contract Data Page.
FIXED ACCOUNT. Contract Values allocated to the Fixed Account Option under the
Contract. Allocations made to the Fixed Account Option are held under the
general account of the Company. The general account is made up of all general
assets of the Company, other than those in the Separate Account and other
segregated asset accounts.
FIXED ACCOUNT CONTRACT VALUE. The sum of all amounts allocated and credited to
the Fixed Account Option under the Contract, less any amounts canceled or
withdrawn for charges, deductions, withdrawals or transfers.
VA410NY 4
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DEFINITIONS (CONT'D)
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FIXED ACCOUNT OPTION. A Contract Option within the Fixed Account under which the
Current Interest Rate will be credited.
GOOD ORDER. The receipt by the Company of any and all information,
documentation, instructions and/or Premium deemed necessary by the Company, in
its sole discretion, to issue the Contract or execute any transaction pursuant
to the terms of the Contract.
INCOME DATE. The date on which annuity payments are to begin.
INVESTMENT DIVISIONS. Separate and distinct divisions of the Separate Account to
which specific Underlying Mutual Fund shares are allocated and for which
Accumulation Units and Annuity Units are separately maintained. The Contract
Value in the Investment Divisions will go up or down depending on the
performance of the Underlying Mutual Funds. Investment Divisions may also be
referred to as Portfolio(s) or Portfolio Options.
ISSUE DATE. The date the Contract was issued by the Company, as shown on the
Contract Data Page.
JOINT OWNER. If there is more than one Owner, each Owner shall be a Joint Owner
of the Contract. Joint Owners have equal ownership rights and must each
authorize any exercising of those ownership rights under the Contract.
LATEST INCOME DATE. The date on which the Owner attains age 90 under a
Nonqualified Plan Contract, or such earlier date as required by the applicable
Qualified Plan, law or regulation, unless otherwise approved by the Company.
NONQUALIFIED PLAN. A retirement plan which does not qualify for favorable tax
treatment under Section 401, 403, 408 or 408A of the Internal Revenue Code, as
amended.
OWNER ("YOU," "YOUR"). The person or entity shown on the Contract Data Page who
is entitled to exercise all rights and privileges under this Contract. Usually,
but not always, the Owner is the Annuitant. If Joint Owners are named, all
references to Owner shall mean Joint Owner.
PORTFOLIO(S) OR PORTFOLIO OPTION(S). See definition of Investment Division.
PREMIUM(S). Considerations paid into this Contract by or on behalf of the Owner.
QUALIFIED PLAN. A retirement plan which qualifies for favorable tax treatment
under Sections 401, 403, 408 or 408A of the Internal Revenue Code, as amended.
REMAINING PREMIUM. The total Premium paid into this Contract reduced by
withdrawals of Premium. For the purposes of determining Remaining Premium,
withdrawals will be allocated first to earnings and then to Remaining Premium.
SEPARATE ACCOUNT. A segregated asset account established and maintained by the
Company in accordance with applicable law in which a portion of the Company's
assets have been allocated for this and certain other contracts.
VA410NY 5
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DEFINITIONS (CONT'D)
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SEPARATE ACCOUNT CONTRACT VALUE. The current value of the amounts allocated to
the Investment Divisions of this Contract.
SERVICE CENTER. The Company's address and telephone number as specified on the
Contract Data Page or as may be designated by the Company from time to time.
SOURCE FUND. The Investment Division(s) selected by the Owner from which amounts
will be transferred to a Target Fund(s) pursuant to one of the Company's
systematic investment programs.
TARGET FUND(S). The Investment Division(s) selected by the Owner to which
amounts will be transferred from a Source Fund pursuant to one of the Company's
systematic investment programs.
UNDERLYING MUTUAL FUNDS. The registered management investment companies in which
assets of the Investment Divisions of the Separate Account will be invested.
WITHDRAWAL VALUE. The Contract Value, less any tax payable, Annual Contract
Maintenance Charges, and charges due under any optional endorsement to the
Contract.
VA410NY 6
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GENERAL PROVISIONS
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ANNUITANT. The Owner may change the Annuitant at any time prior to the Income
Date, unless the Owner is not a natural person. If the Owner is not a natural
person, the age of the Annuitant will be used in lieu of the Owner's age for all
purposes under this Contract, unless otherwise specified in the Contract.
ASSIGNMENT. The Owner may assign this Contract before the Income Date. An
assignment will take effect when signed by the Owner, subject to action taken by
Us prior to receipt in writing. The Owner may exercise these rights subject to
the interest of any assignee or irrevocable beneficiary. THE COMPANY ASSUMES NO
RESPONSIBILITY FOR THE VALIDITY OR TAX CONSEQUENCES OF ANY ASSIGNMENT. IF YOU
MAKE AN ASSIGNMENT, YOU MAY HAVE TO PAY INCOME TAX. YOU ARE ENCOURAGED TO SEEK
COMPETENT LEGAL AND/OR TAX ADVICE.
BENEFICIARY. The individual(s) or entity(ies) designated by the Owner to receive
any amount payable under this Contract on the Owner's death and on the
Annuitant's death on or after the Income Date pursuant to the terms of this
Contract. (See Income Provision section for details.) The original
Beneficiary(ies) will be shown on the Contract Data Page. If two or more persons
are named, those surviving the Owner will share equally unless otherwise stated.
If there are no surviving Beneficiaries at the death of the Owner, the death
benefit will be paid to the Owner's estate. Upon the death of a Joint Owner, the
surviving Joint Owner, if any, will be treated as the primary Beneficiary and
all other Beneficiaries will be treated as contingent Beneficiaries. The Owner
may change the Beneficiary(ies) by submitting a written request to the Service
Center, unless an irrevocable beneficiary designation was previously filed with
the Company. Any change will take effect on the date the notice is signed by the
Owner subject to any actions taken by the Company prior to the receipt of the
request in writing.
CHARGES AND FEES. The Company may assess charges or fees under the Contract.
Please see the Contract Data Page for more information as to charges or fees.
The Annual Contract Maintenance Charge specified on the Contract Data Page will
be deducted on each Contract Anniversary that occurs on or prior to the Income
Date. It will also be deducted when the Contract Value is withdrawn in full if
the full withdrawal is not on a Contract Anniversary.
CONFORMITY WITH LAWS. This Contract will be interpreted under the law of the
State of New York when it is issued. Any provision which, on the Issue Date, is
in conflict with New York law, is amended to conform to the minimum requirements
of such law.
CONTESTABILITY. The Company will not contest this Contract from its Issue Date,
as shown on the Contract Data Page.
DEFERMENT OF PAYMENTS. The Company may defer making payments from a Fixed
Account Option for up to six months. Interest, pursuant to state law, will be
credited during the deferral period.
ENTIRE CONTRACT. The Contract, and any attached Company forms, applications,
endorsements and amendments together make up the entire Contract.
VA410NY 7
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GENERAL PROVISIONS (CONT'D)
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INCORRECT AGE OR SEX. If the age or sex of the Owner or Annuitant is incorrect,
the payments will be those that the Premiums paid would have purchased at the
correct age and sex. Any underpayments or overpayments will be adjusted
immediately by the Company using an interest rate of 6.00% either as a credit to
or charge against the next succeeding payment by the Company.
MINIMUM BENEFITS. For any paid up annuity option, cash value or death benefit,
the amount available under this Contract will not be less than the minimum
requirements of the state where this Contract was delivered.
MODIFICATION OF CONTRACT. Any change or waiver of the provisions of this
Contract must be in writing and signed by the President, a Vice President, the
Secretary or Assistant Secretary of the Company. No financial representative or
producer has authority to change or waive any provision of this Contract. The
Company may amend or waive any portion of this Contract without notice or
consent if state or federal law permits or so requires.
NONPARTICIPATING. This Contract does not share in the Company's surplus or
earnings.
NOTICE. Information or instructions given to the Company by You must be in a
form satisfactory to the Company, referred to as Good Order. A notice relating
to owner or beneficiary designation changes shall take effect on the date signed
by You once it is received and recorded at the Company's Service Center;
otherwise, any other notice takes effect when the Company accepts it and it is
recorded at the Service Center.
Any notice the Company sends to the Owner will be sent to the Owner's last known
address unless the Owner requests otherwise in writing. Any request or notice
must be sent to the Service Center, unless the Company advises You otherwise.
You are responsible for promptly notifying the Company of any address change.
PROOF OF AGE, SEX OR SURVIVAL. The Company may require satisfactory proof of
correct age or sex at any time. If any payment under this Contract depends on
the Annuitant, Owner or Beneficiary being alive, the Company may require
satisfactory proof of survival.
PROTECTION OF PROCEEDS. Proceeds under this Contract are not assignable by any
Beneficiary prior to the time such proceeds become payable. To the extent
permitted by New York law, proceeds are not subject to the claims of creditors
or to legal process.
REPORTS. The Company will send You a report at least once a year. The Company
will also send You reports as required by law. They shall be addressed to the
last address of the Owner known to the Company.
SUBSTITUTION OF INVESTMENT DIVISION(S). The Company may substitute any
Underlying Mutual Fund(s) with another Underlying Mutual Fund without Your
consent. Substitution would occur if the Company determines that the use of
certain Underlying Mutual Fund(s) is no longer possible or if the Company
determines it is no longer appropriate for the purposes of the Contract. No
substitution will be made without notice to You and without the prior approval
of the New York Insurance Department. Changes of Underlying Mutual Fund(s) are
subject to federal securities laws and the laws of the state of New York. Should
a substitution, addition, or deletion occur, You will be allowed to select from
the then current Investment Divisions and substitution may be made with respect
to both existing Contract Value in that Investment Division(s) and the
allocation of future Premiums.
VA410NY 8
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GENERAL PROVISIONS (CONT'D)
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SUSPENSION OF PAYMENTS. The Company may suspend or postpone any transfers or
payments to or from the Investment Divisions if any of the following occur:
1. The New York Stock Exchange is closed;
2. Trading on the New York Stock Exchange is restricted;
3. An emergency exists such that it is not reasonably practical to dispose of
securities in the Separate Account or to determine the value of its assets;
or
4. The Securities and Exchange Commission, by order, so permits for the
protection of Contract Owners.
The applicable rules and regulations of the Securities and Exchange Commission
will govern whether conditions described in 2. and/or 3. exist.
TAXES. The Company may deduct from the Contract Value any premium taxes or other
taxes payable to a state or other government entity because of this Contract.
Should the Company advance any amount so due, the Company is not waiving any
right to collect such amount at a later date. The Company will deduct any
withholding taxes required by applicable law as a result of any withdrawals or
amounts payable from this Contract.
TRANSFER. The conditions for transfer between Contract Options are explained in
the Contract Data Page. The Company reserves the right to restrict the number of
transfers per year requested by the Owner and to restrict transfers from being
made on consecutive Business Days.
Your ability to make transfers is subject to modification if the Company
determines, in the Company's sole discretion, that the exercise by one or more
owners is, or would be, to the disadvantage of other owners. Restrictions may be
applied in any manner reasonably designed to prevent any use of the transfer
provision which is considered by the Company to be to the disadvantage of other
owners. A modification regarding Your ability to make transfers to or from one
or more of the Investment Divisions could include, but not be limited to: 1. The
requirement of a minimum time period between each transfer; 2. Limiting transfer
requests of an agent acting on behalf of one or more owners or under a power of
attorney on behalf of one or more owners; or 3. Limiting the dollar amount that
may be transferred at any one time.
The Company may provide systematic investment programs that allow You to
transfer funds among the Investment Divisions. These programs may include dollar
cost averaging, portfolio rebalancing, and the automatic transfer of earnings
from the money market Investment Division to a Target Fund(s). You may contact
the Company's Service Center, and the Company will furnish all necessary forms
to request these programs. The Company makes no guarantee that these programs
will result in a profit or protect against loss in a declining market.
In order to participate in a dollar cost averaging program or the automatic
transfer of earnings program, the Contract Value must be at least $15,000. The
Company may waive this requirement at its discretion. For a dollar cost
averaging program, You may authorize the automatic transfer of a fixed dollar
amount or selected percentage of the value of a Source Fund, periodically to one
or more Target Fund(s). The intervals between transfers may be monthly,
quarterly, semi-annually or annually.
VA410NY 9
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ACCUMULATION PROVISIONS
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An Owner may not allocate Contract Values to more than eighteen Contract Options
at any one time. The Company may waive this restriction at its discretion.
SEPARATE ACCOUNT. The Separate Account consists of assets the Company has set
aside and has kept separate from the rest of the Company's general account
assets and those of its other segregated asset accounts. These assets are not
chargeable with liabilities arising out of any other business the Company may
conduct. All the income, gains, and losses resulting from these assets are
credited to or charged against the contracts supported by the Separate Account,
and not against any other contracts the Company may issue. The assets of the
Separate Account will be available to cover the liabilities of the Company's
general account only to the extent that the assets of the Separate Account
exceed the liabilities of the Separate Account arising under the Contracts
supported by the Separate Account. The Separate Account consists of several
Investment Divisions. The assets of the Separate Account shall be valued at
least as often as any benefits of this Contract, but in no event will such
valuation be less frequently than monthly.
ACCUMULATION UNITS. The Separate Account Contract Value will go up or down
depending on the performance of the Investment Divisions. In order to monitor
the Separate Account Contract Value during the accumulation phase, the Company
uses a unit of measure called an Accumulation Unit. The value of an Accumulation
Unit may go up or down from Business Day to Business Day. Adjustments to the
Contract Value, such as withdrawals, transfers, and charges, result in the
redemption of Accumulation Units. However, these adjustments do not affect the
value of the Accumulation Units.
When You make an allocation to the Investment Divisions, the Company credits
Your Contract with Accumulation Units. The number of Accumulation Units credited
is determined by dividing the amount allocated to any Investment Division by the
Accumulation Unit Value for that Investment Division at the close of the
Business Day when the allocation is made.
ACCUMULATION UNIT VALUE. The Company determines the value of an Accumulation
Unit for each of the Investment Divisions. This is done by:
1. Determining the total amount of money invested in the particular Investment
Division;
2. Subtracting from that amount any Mortality and Expense Charge,
Administration Charge, and any other charge for optional benefits and
taxes;
3. Dividing the remainder by the number of outstanding Accumulation Units.
FIXED ACCOUNT. Amounts allocated to the Fixed Account will earn interest at the
Current Interest Rate. Base Interest Rates on subsequent allocations to the
Fixed Account Option may be higher or lower than the Base Interest Rates
previously declared by the Company.
You may allocate Premiums to the Fixed Account Option at any time prior to the
Income Date, subject to the provisions of this Contract.
FIXED ACCOUNT CONTRACT VALUE. The Fixed Account Contract Value under the
Contract shall be the sum of all monies allocated to the Fixed Account Option,
reduced by any applicable taxes, plus all interest credited to the Fixed Account
Option, adjusted for withdrawals, transfers, and charges.
VA410NY 10
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WITHDRAWAL PROVISIONS
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At or before the Income Date, the Owner may withdraw all or part of the amounts
under this Contract by informing the Company at the Service Center. For full
withdrawal, this Contract, or a completed Lost Contract Affidavit, must be
returned to the Service Center.
Upon full withdrawal, the Owner will receive the Withdrawal Value. The
Withdrawal Value will be based on values at the end of the Business Day in which
the request for withdrawal is received at the Service Center in Good Order. IN
NO EVENT SHALL THE AMOUNT WITHDRAWN, WHETHER A FULL WITHDRAWAL OR PARTIAL
WITHDRAWAL, EXCEED THE WITHDRAWAL VALUE.
Except in connection with a systematic withdrawal program, the minimum partial
withdrawal amount is $500, or if less, the Owner's entire interest in the
Investment Division or Fixed Account Option from which a withdrawal is
requested.
The Owner's interest in the Investment Division or Fixed Account Option from
which the withdrawal is requested must be at least $100 after the withdrawal is
completed if anything is left in that Investment Division or Fixed Account
Option.
Unless otherwise specified, the withdrawal will be made from each Investment
Division and the Fixed Account Option in proportion to their current value.
Withdrawals will be based on values at the end of the Business Day on which the
request for withdrawal is received in Good Order at the Service Center.
You may elect to take a systematic withdrawal by surrendering a specific sum or
a certain percentage on a monthly, quarterly, semiannual or annual basis,
subject to a $50 minimum withdrawal.
VA410NY 11
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DEATH BENEFIT PROVISIONS
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DEATH OF OWNER BEFORE THE INCOME DATE. Upon the Owner's death, or the death of
any Joint Owner, before the Income Date, the death benefit will be paid to the
Beneficiary(ies) designated by the Owner. Upon the death of a Joint Owner, the
surviving Joint Owner, if any, will be treated as the primary Beneficiary. Any
other beneficiary designation on record at the Service Center at the time of
death will be treated as a contingent Beneficiary.
If the Joint Owner, if any, or the Beneficiary is the spouse of the deceased
Owner, he or she may elect to continue the Contract, at the current Contract
Value, in his or her own name and exercise all the Owner's rights under the
Contract.
o DEATH BENEFIT AMOUNT BEFORE THE INCOME DATE. The death benefit is equal to
the greater of:
1. The current Contract Value; or
2. All Premiums (net of any applicable premium tax) paid into the
Contract less any withdrawals incurred since the issuance of the
Contract.
All adjustments will occur at the time of the withdrawal or Premium payment. All
adjustments for amounts withdrawn will reduce the death benefit in the same
proportion that the Contract Value was reduced on the date of such withdrawal.
This amount will be determined as of the end of the Business Day when due proof
of the Owner's death satisfactory to the Company and an election as to the type
of death benefit option is received by the Company at its Service Center in Good
Order.
From the time of death of the Owner until the death benefit amount is
determined, any amount allocated to an Investment Division will be subject to
investment risk. This investment risk is borne by the Beneficiary(ies).
o DEATH BENEFIT OPTIONS BEFORE INCOME DATE. In the event of the Owner's death
or the death of a Joint Owner before the Income Date, a Beneficiary must
request that the death benefit be paid under one of the death benefit
options below unless the Owner did so previously. The following are the
available death benefit options:
1. Option 1 - single lump-sum payment of the death benefit; or
2. Option 2 - payment of the entire death benefit within five years of
the date of the death of the Owner or any Joint Owner; or
3. Option 3 - payment of the death benefit under an income option over
the lifetime of the Beneficiary or over a period not extending beyond
the life expectancy of the Beneficiary, with distribution beginning
within one year of the date of the death of the Owner or Joint Owner.
Any portion of the death benefit not applied under Option 3 within one year of
the date of the Owner's death must be distributed within five years of the date
of the Owner's death.
VA410NY 12
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DEATH BENEFIT PROVISIONS (CONT'D)
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If a single lump-sum payment is requested, the amount will be paid within seven
days of receipt of proof of death and the election in Good Order at the Service
Center, unless either the Suspension of Payments or Deferment of Payments under
the General Provisions is in effect.
Payment to the Beneficiary, other than in a single lump-sum, may only be elected
during the 60-day period beginning with the date of receipt of proof of death in
Good Order by the Service Center.
The settlement of the death proceeds will be made upon receipt of proof of death
and will include any required interest from the date of death until settlement.
SPECIAL SPOUSAL CONTINUATION OPTION. In lieu of taking the death benefit as a
lump-sum payment or continuing the Contract at the then current Contract Value,
if the Beneficiary is the spouse of the Contract Owner, he or she may elect to
continue the Contract at an adjusted Contract Value as described below. The
spouse will then exercise all the Contract Owner's rights under the Contract.
The date that the Company receives the spouse's written request to continue the
Contract, under this Special Spousal Continuation Option, and proof of the death
of the Contact Owner in Good Order will be referred to as the Continuation Date.
The Contract Value for the continuing Contract will be adjusted so that it will
equal the amount of the death benefit that would have been payable as a lump sum
payment at Your death. If the Contract Value on the Continuation Date is less
than the death benefit, an amount will be added to the Contract Value to make up
the difference. This amount is referred to as the Continuation Adjustment. The
Continuation Adjustment will be allocated among the Contract Options in
accordance with the current instructions for the Contract, subject to any
minimum allocation restrictions unless the Company receives other allocation
instructions with the Special Spousal Continuation Option election.
For purposes of determining future death benefits under the continuing Contract,
the Contract Value following the application of any Continuation Adjustment will
be considered as the initial Premium of the continuing Contract. Any future
death benefit, including any enhanced death benefit, will be determined on that
basis and will use the age of the surviving spouse on the Continuation Date.
This Special Spousal Continuation Option can only be exercised one time under
this Contract but may not be available if the Owner elected to pre-select the
death benefit option. Any benefit available under this Special Spousal
Continuation Option will end upon the change of ownership or assignment of the
Contract.
PRE-SELECTED DEATH BENEFIT OPTION ELECTION. Prior to the Income Date the Owner
may designate the option under which the death benefit will be paid. This
designation of the death benefit option must be given in a form acceptable to
the Company, and will take effect only after being recorded by the Company.
VA410NY 13
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DEATH BENEFIT PROVISIONS (CONT'D)
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The Owner may elect any death benefit option described in this Contract, or
other death benefit option, as agreed upon by the Company at the time of
election. Once elected, the designation can only be revoked or changed by the
Owner in a form acceptable to the Company. Upon the death of the Owner, the
Beneficiary may not revoke or modify the death benefit option elected, subject
to the requirements of the Internal Revenue Code. However, at the time of the
Owner's death, the Company reserves the right to change or modify the death
benefit option if the death benefit option previously elected exceeds the life
expectancy of the Beneficiary. If a Pre-selected Death Benefit Option Election
is not made by the Owner prior to the Owner's death, the Beneficiary may request
that the death benefit be paid under any of the death benefit options described
in this Contract, or other death benefit option, as agreed upon by the Company
at the time of request.
If this Pre-selected Death Benefit Option Election is in force at the time of
the Owner's death, the payment of the death benefit may not be postponed, nor
can the Contract be continued under any provisions of this Contract. These
restrictions apply even if the Beneficiary is the spouse of the Owner, unless
such restriction is prohibited by law.
DEATH OF OWNER AFTER THE INCOME DATE. If the Owner or any Joint Owner, who is
not an Annuitant, dies after the Income Date, any remaining payments under the
income option elected will continue at least as rapidly as under the method of
distribution in effect at the Owner's death. Upon the Owner's death after the
Income Date, the Beneficiary becomes the Owner.
DEATH OF ANNUITANT BEFORE INCOME DATE. Upon the death of an Annuitant who is not
an Owner before the Income Date, the Contract remains in force and the Owner
will become the Annuitant. The Owner may designate a new Annuitant, however, if
the Owner is not a natural person, the death of the primary Annuitant will be
treated as the death of the Owner and a new Annuitant may not be designated.
DEATH OF ANNUITANT AFTER INCOME DATE. Upon the death of the Annuitant after the
Income Date, the death benefit, if any, will be as specified in the income
option elected. Death benefits will be paid at least as rapidly as under the
method of distribution in effect at the Annuitant's death.
VA410NY 14
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INCOME PROVISIONS
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The amount applied upon annuitization is the Contract Value.
INCOME DATE. The date on which annuity payments are to begin. The Income Date
may not be sooner than 13 months from the Issue Date of the Contract. If no
Income Date is selected, the Income Date will be the Latest Income Date. At any
time at least seven days prior to the Income Date then indicated on the
Company's records, the Owner may change the Income Date by written notice to the
Service Center.
INCOME OPTIONS. The Owner, or any Beneficiary who is so entitled, may elect to
receive a single lump-sum. However, a single lump-sum distribution will be
deemed to be a withdrawal. Alternatively, an income option may be elected. The
Owner may, upon prior written notice to the Company at its Service Center, elect
an income option at any time prior to the Income Date or change an income option
up to seven days before the Income Date. Unless otherwise designated, the Owner
will be the payee.
If no other income option is elected, monthly annuity payments will be made in
accordance with Option 3 below, a life annuity with 120-month period certain.
Payments will be made in monthly, quarterly, semiannual or annual installments
as selected by the Owner. However, if the amount available to apply under an
income option is less than $5,000, and New York law permits, the Company has the
right to make payments in one single lump-sum. The single lump-sum payment will
not be less than would have been applied under an income option. In addition, if
the first payment provided would be less than $50, and New York law permits, the
Company may require the frequency of payments be at quarterly, semiannual or
annual intervals so as to result in an initial payment of at least $50.
NO WITHDRAWALS OF CONTRACT VALUE ARE PERMITTED DURING THE ANNUITY PERIOD FOR ANY
INCOME OPTION UNDER WHICH PAYMENTS ARE BEING MADE PURSUANT TO LIFE
CONTINGENCIES.
Upon written election filed with the Company at its Service Center, all of the
Contract Value will be applied to provide one of the following income options.
OPTION 1 - LIFE INCOME. An annuity payable monthly during the lifetime of the
Annuitant. Under this income option, no further annuity payments are payable
after the death of the Annuitant, and there is no provision for a death benefit
payable to the Owner. Therefore, it is possible under Option 1 for the Owner to
receive only one monthly annuity payment under this income option if the
Annuitant has an early death. If the Annuitant dies after the Income Date but
prior to the first annuity payment being paid, the amount applied to this income
option will be paid to the Owner or the Owner's beneficiaries.
VA410NY 15
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INCOME PROVISIONS (CONT'D)
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OPTION 2 - JOINT AND SURVIVOR. An annuity payable monthly while both the
Annuitant and a designated second person are living. Upon the death of either
person, the monthly annuity payments will continue during the lifetime of the
survivor at either the full amount previously payable or as a percentage (either
one-half or two-thirds) of the full amount, as chosen at the time of election of
the income option. If a reduced annuity payment to the survivor is desired,
variable annuity payments will be determined using either one-half or two-thirds
of the number of each type of Annuity Unit credited. Fixed annuity payments will
be equal to either one-half or two-thirds of the fixed annuity payment payable
during the joint life of the Annuitant and the designated second person.
Annuity payments terminate automatically and immediately upon the death of the
surviving person without regard to the number or total amount of payments
received. There is no minimum number of fixed annuity payments, and it is
possible to have only one monthly annuity payment if both the Annuitant and the
designated second person die before the due date of the second payment. If both
Annuitants die after the Income Date but prior to the first annuity payment
being paid, the amount applied to this income option will be paid to the Owner
or the Owner's beneficiary.
OPTION 3 - LIFE ANNUITY WITH 120 OR 240 MONTHLY PERIODS GUARANTEED. An annuity
payable monthly during the lifetime of the Annuitant with the guarantee that if,
at the death of the Annuitant, payments have been made for fewer than the
guaranteed 120 or 240 monthly periods, as elected, the balance of the guaranteed
number of payments will continue to be made to the Owner as scheduled. In the
event the Owner dies before the specified number of guaranteed payments has been
made, the Beneficiary(ies) may elect to continue receiving the fixed and
variable payments according to the terms of this Contract or may alternatively
elect to receive the present value of any remaining guaranteed payments in a
single lump-sum, the amount of which is calculated by the Company. The present
value of any remaining guaranteed payments will be based on the total annuity
payment as of the date of the calculation.
OPTION 4 - INCOME FOR A SPECIFIED PERIOD. Under this income option, the Owner
can elect monthly payments for any number of years from 5 to 30. This election
must be made for full 12-month periods. In the event the Owner dies before the
specified number of payments has been made, the Beneficiary(ies) may elect to
continue receiving the fixed and variable payments according to the terms of
this Contract or may alternatively elect to receive the present value of any
remaining guaranteed payments in a single lump-sum, the amount of which is
calculated by the Company. The present value of any remaining guaranteed
payments will be based on the total annuity payment as of the date of the
calculation.
ADDITIONAL OPTIONS. The Company may make other income options available
including income options for longer periods.
VA410NY 16
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INCOME PROVISIONS (CONT'D)
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FIXED ANNUITY PAYMENTS. To the extent a fixed income option has been elected,
the Contract Value allocated to the fixed annuity payment option, less any
applicable taxes and Contract charges, shall be applied to the payment of the
income option elected at whichever of the following is more favorable to the
Owner:
1. the annuity rates based upon the Table of Income Options specified in the
Contract; or
2. the then current rates provided by the Company on contracts of this type on
the Income Date.
In no event will the fixed payments be changed once they begin.
VARIABLE ANNUITY PAYMENT. The initial variable annuity payment is determined by
taking the Contract Value allocated to that Investment Division, less any tax
and any applicable Contract charges, and then applying it to the Table of Income
Options specified in the Contract.
The first variable annuity payment is divided by the value of an Annuity Unit as
of the Income Date to establish the number of Annuity Units representing each
variable annuity payment. The number of Annuity Units determined for the first
variable annuity payment remains constant for the second and subsequent variable
annuity payments, assuming that no reallocation of Contract Values is made.
The amount of the second and each subsequent variable annuity payment is
determined by multiplying the number of Annuity Units by the Annuity Unit Value
as of the Business Day next preceding the date on which each payment is due.
ANNUITY UNIT VALUE. The initial value of an Annuity Unit of each Investment
Division was set when the Investment Divisions were established. The value may
increase or decrease from one Business Day to the next. The Table of Income
Options contained in the Contract is based on the assumed net investment rates
described in the Basis of Computation provision. If the actual net investment
rate experienced by an Investment Division exceeds the assumed net investment
rate, variable annuity payments will increase over time. Conversely, if the
actual net investment rate is less than the assumed net investment rate,
variable annuity payments will decrease over time. If the actual net investment
rate equals the assumed net investment rate, the variable annuity payments will
remain constant.
The value of a fixed number of Annuity Units will reflect the investment
performance of the Investment Divisions, and the amount of each payment will
vary accordingly.
For each Investment Division, the value of an Annuity Unit for any Business Day
is determined by multiplying the Annuity Unit Value for the immediately
preceding Business Day by the net investment factor for the Business Day for
which the Annuity Unit Value is being calculated. The result is then multiplied
by a second factor which offsets the effect of the assumed net investment rate.
The net investment factor, which reflects changes in the net asset value of
Investment Divisions, is determined by dividing 1. by 2., and then subtracting
3. from the result, where: 1.
VA410NY 17
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INCOME PROVISIONS (CONT'D)
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1. Is the net result of:
a. the net asset value of an Investment Division determined as of the end
of the Business Day, plus
b. the per share amount of any dividend or other distribution declared by
the Investment Division if the "ex-dividend" date occurs on the
Business Day, plus or minus
c. a per share credit or charge with respect to any taxes paid or
reserved for by the Company which are determined by the Company to be
attributable to the operation of the Investment Division (no federal
income taxes are applicable under present law);
2. Is the net asset value of the Investment Division determined as of the end
of the preceding Business Day; and
3. Is the asset charge factor determined by the Company for the Business Day
to reflect the Mortality and Expense Charge and the Administration Charge.
Neither expenses actually incurred, other than taxes on the investment return,
nor mortality actually experienced, shall adversely affect the dollar amount of
variable annuity payments after such payments have been commenced.
VA410NY 18
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TABLE OF INCOME OPTIONS
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The following table is for this Contract whose net proceeds are $1,000, and will
apply pro rata to the amount payable under this Contract.
------------------- --------------------------------------------------------------------------------------------------------
UNDER OPTION 4 MONTHLY INSTALLMENT UNDER OPTIONS 1 OR 3
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---------- -------- ------ ----------------- ------- ------------------ ------- ----------------- ------- ------------------
No. of
Monthly Monthly Age of Age of Age of Age of
Install- Install- Annui- No. of Mos. Annui- No. of Mos. Annui- No. of Mos. Annui- No. of Mos.
ments ments tant Certain tant Certain tant Certain tant Certain
---------- -------- ------ ----------------- ------- ------------------ ------- ----------------- ------- ------------------
------ ----- ----- ----- ------- ------ ----- ----- ------- ----- ----- ----- ------- ------ ----- -----
Male Life 120 240 Male Life 120 240 Female Life 120 240 Female Life 120 240
---------- -------- ------ ----- ----- ----- ------- ------ ----- ----- ------- ----- ----- ----- ------- ------ ----- -----
---------- -------- ------ ----- ----- ----- ------- ------ ----- ----- ------- ----- ----- ----- ------- ------ ----- -----
60 17.73 40 3.25 3.25 3.22 70 6.42 5.99 4.93 40 3.09 3.09 3.07 70 5.76 5.54 4.82
72 14.96 41 3.30 3.29 3.26 71 6.66 6.16 4.98 41 3.13 3.12 3.11 71 5.97 5.71 4.88
84 12.98 42 3.35 3.34 3.30 72 6.91 6.33 5.02 42 3.17 3.16 3.14 72 6.20 5.88 4.94
96 11.49 43 3.39 3.38 3.34 73 7.19 6.50 5.06 43 3.21 3.20 3.18 73 6.44 6.06 4.99
108 10.34 44 3.45 3.43 3.38 74 7.48 6.68 5.10 44 3.25 3.24 3.22 74 6.70 6.25 5.04
120 9.41 45 3.50 3.48 3.43 75 7.79 6.86 5.13 45 3.30 3.29 3.26 75 6.99 6.44 5.08
132 8.66 46 3.56 3.54 3.48 76 8.12 7.04 5.16 46 3.34 3.33 3.30 76 7.30 6.64 5.12
144 8.03 47 3.61 3.59 3.53 77 8.48 7.21 5.18 47 3.39 3.38 3.35 77 7.63 6.84 5.15
156 7.50 48 3.67 3.65 3.58 78 8.86 7.39 5.20 48 3.44 3.43 3.39 78 7.99 7.05 5.18
168 7.05 49 3.74 3.71 3.63 79 9.27 7.57 5.22 49 3.50 3.49 3.44 79 8.38 7.25 5.20
180 6.65 50 3.81 3.78 3.68 80 9.70 7.74 5.24 50 3.55 3.54 3.49 80 8.80 7.45 5.22
192 6.31 51 3.88 3.85 3.74 81 10.17 7.90 5.25 51 3.61 3.60 3.54 81 9.26 7.65 5.24
204 6.01 52 3.95 3.92 3.80 82 10.67 8.06 5.26 52 3.68 3.66 3.60 82 9.76 7.84 5.25
216 5.74 53 4.03 3.99 3.86 83 11.20 8.21 5.27 53 3.74 3.72 3.65 83 10.31 8.02 5.26
228 5.50 54 4.11 4.07 3.92 84 11.77 8.36 5.27 54 3.81 3.79 3.71 84 10.89 8.19 5.27
240 5.29 55 4.20 4.15 3.98 85 12.38 8.49 5.28 55 3.89 3.86 3.77 85 11.52 8.35 5.27
252 5.09 56 4.29 4.23 4.04 86 13.03 8.61 5.28 56 3.97 3.94 3.83 86 12.21 8.50 5.28
264 4.91 57 4.39 4.32 4.11 87 13.72 8.73 5.28 57 4.05 4.02 3.90 87 12.94 8.63 5.28
276 4.75 58 4.49 4.42 4.18 88 14.45 8.83 5.28 58 4.14 4.10 3.96 88 13.72 8.75 5.28
288 4.61 59 4.60 4.52 4.24 89 15.23 8.92 5.28 59 4.23 4.19 4.03 89 14.54 8.86 5.28
300 4.47 60 4.72 4.62 4.31 90 16.06 9.01 5.28 60 4.33 4.28 4.10 90 15.42 8.95 5.28
312 4.35 61 4.84 4.74 4.38 91 16.93 9.08 5.29 61 4.43 4.38 4.17 91 16.33 9.03 5.29
324 4.23 62 4.97 4.85 4.45 92 17.87 9.15 5.29 62 4.54 4.48 4.25 92 17.28 9.11 5.29
336 4.13 63 5.12 4.98 4.51 93 18.85 9.21 5.29 63 4.66 4.59 4.32 93 18.27 9.17 5.29
348 4.03 64 5.27 5.10 4.58 94 19.91 9.26 5.29 64 4.79 4.70 4.39 94 19.30 9.22 5.29
360 3.94 65 5.43 5.24 4.64 95 21.04 9.30 5.29 65 4.93 4.83 4.47 95 20.38 9.27 5.29
66 5.60 5.38 4.71 96 22.27 9.33 5.29 66 5.07 4.95 4.54 96 21.52 9.31 5.29
67 5.79 5.52 4.77 97 23.60 9.36 5.29 67 5.22 5.09 4.61 97 22.75 9.34 5.29
68 5.99 5.68 4.83 98 25.10 9.38 5.29 68 5.39 5.23 4.69 98 24.10 9.37 5.29
69 6.20 5.83 4.88 99 26.78 9.39 5.29 69 5.57 5.38 4.75 99 25.63 9.39 5.29
---------- -------- ------ ----- ----- ----- ------- ------ ----- ----- ------- ----- ----- ----- ------- ------ ----- -----
NOTE: Due to the length of the information, the Table for Option 2 is
available from the Service Center upon Your request.
BASIS OF COMPUTATION. The actuarial basis for the Table of Income Options shall
be the Annuity 2000 Mortality Table, with an assumed net investment rate of
2.50%. The interest rate used in the present value calculation referred to in
Options 3 and 4 will be determined by the Company, but in no instance will it be
greater than the rate used to calculate the initial payment. The Table of Income
Options does not include any applicable tax. The benefits of this Contract will
not vary due to expense and/or mortality results.
VA410NY 19
