Founded in 1867...A Mutual Company...P.O. Xxx 00000,
Xxxxxxxxxx, Xxxx 00000
ANNUITANT: Xxxx Xxx
OWNER: Xxxx Xxx
CONTRACT NUMBER: 012345678
CONTRACT DATE:
WE promise to pay the benefits of this contract in accordance
with its terms.
LOOK AT THE APPLICATION FORMS. This contract is issued based
on payment of the initial premium and the answers in the
application (see copy attached). If all answers are not true
and complete, this contract may be affected.
PLEASE READ THIS CONTRACT CAREFULLY. This is a legal contract
between you and Union Central.
10 DAY RIGHT TO EXAMINE THE CONTRACT. It is important to
Union Central that you are satisfied with this contract. You
have 10 days after you receive it to review the contract. If
this contract is a replacement for an existing contract you
have [20] days after you receive it to review the contract.
If you are not satisfied, you may send it back to us or give
it to our agent. In such case, this contract will be void
from the beginning. We will refund, within 7 days after this
contract is returned, the accumulation value of the contract.
ALL ACCUMULATION VALUES AND ANNUITY PAYMENTS PROVIDED BY THIS
CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A
SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNTS.
Signed for the Company at Cincinnati, Ohio
/s/ Xxxxx X. Xxxxxxxxxx /s/ Xxxx X. Xxxxxx
Secretary President
Flexible Premium Deferred Variable Annuity
Participating
-----------------------
Licensed Resident Agent
UC 8137
INTRODUCTION
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This is a flexible premium deferred variable annuity. This
annuity contract provides that the accumulation value will be
variable, and annuity payments may be either fixed or
variable, or a combination of fixed and variable.
You determine the investment allocation for this annuity. You
may allocate your premiums to the subaccounts of the separate
account. These subaccounts are identified in the contract
application and on the schedule page. Your accumulation value
will vary with the investment performance of the separate
account's subaccounts.
CONTRACT INDEX
Page
Definitions 4
Ownership 5
Benefits 5
Premiums 6
Account Provisions 7
Transfers 8
Surrender Provisions 9
Charges and Deductions 10
General Provisions 10
Payment of Contract Benefits 11
Schedule Page
Initial Allocation of Net Premiums: Money Source
Separate Account: Carillon Account
SUBDIVISIONS OF THE VARIABLE ACCOUNT:
[AIM VI CAP APPRECIATION 0]%
[AIM VI GROWTH 0]
[XXXXX XXXX LEVERG ALLCAP 0]
[XXXXX XXXX MIDCAP GROWTH 0]
[AM CENTURY GROWTH & INC 0]
[AM CENTURY VALUE 0]
[FTVIPT XXXXXXXXX FOREIGN 0]
[MFS EMERGING GROWTH 0]
[MFS INVESTORS TRUST 0]
[MFS HIGH INCOME 0]
[MFS NEW DISCOVERY 0]
[MFS TOTAL RETURN SERIES 0]
[XXXXXXXXX XXXXXX AMT 0]
[XXXXXXXXXXX GLOBAL SEC 0]
[XXXXXXXXXXX MAIN STREET 0]
[XXXXXXX VS I CAP GROWTH 0]
[XXXXXXX VS I MONEY MKT 0]
[XXXXXXX VS I INTERNATL 0]
[XXXXXXXX COMM & INFO 0]
[XXXXXXXX SMALL-CAP VALUE 0]
[SUMMIT BALANCED INDEX 25]
[SUMMIT BOND 25]
[SUMMIT NASDAQ 100 INDEX 0]
[SUMMIT PINN EAFE INTL IND 0]
[SUMMIT PINN LEHMAN AGG BND 0]
[SUMMIT XXXX XXXXXXX 2000 0]
[SUMMIT S&P 500 INDEX 25]
[SUMMIT S&P MIDCAP 400 0]
[SUMMIT ZENITH PORTFOLIO 0]
[UIF CORE PLUS FIXED INCOME 25]
[UIF REAL ESTATE 0]
-------
TOTAL: 100%
Transfer Charge:
Current: [$10]
Maximum: $15
Free Transfers. Notwithstanding the transfer charge described
above, 12 transfers may be made during each Contract Year
without a transfer charge being imposed.
Mortality and Expense Charge:
Current: [1.20%]
Maximum: 2.00%
Administration Fee:
Current: [0.25%]
Maximum: 0.25%
----------------------
Annuitant: Xxxx Xxx Contract Number: 01234567
Owner: Xxxx Xxx Maturity Date:
Joint Owner: N/A Contract Date:
UC 8137 3
DEFINITIONS
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ACCUMULATION UNIT. Means a unit of measure that is used to
calculate the value of your interest in the separate account
(SA) before the maturity date.
ACCUMULATION VALUE. Means the sum of the values of the
subaccounts credited to this contract.
ANNUITANT. Means the person(s) whose life is used to
determine the duration of any annuity payments involving life
contingencies. The annuitant is named in the application and
on the schedule page.
ANNUITY UNIT. Means a unit of measure that is used to
calculate variable annuity payments.
BENEFICIARY. Means the person(s) designated by you to receive
the death benefits from this contract upon your death.
CALCULATION DATE. Means a date not more than 10 business days
prior to the maturity date.
CONTRACT YEAR. Means a period of 12 consecutive months
beginning on the contract date or any anniversary thereafter.
The contract date is shown on the schedule page.
DUE PROOF OF DEATH. Means one of the following: 1) a
certified copy of a death certificate; 2) a certified copy of
a decree of a court of competent jurisdiction as to the
finding of death; 3) a written statement by a medical doctor
who attended the deceased; and 4) any other proof
satisfactory to us.
FIXED ANNUITY. Means an annuity with payments fixed
throughout the annuity payment period.
HOME OFFICE. Means the home office of The Union Central Life
Insurance Company which is:
0000 Xxxxxxxx Xxxx (X.X. Xxx 00000), Xxxxxxxxxx, Xxxx 00000.
MATURITY DATE. Means the date on which annuity payments will
begin. This date shall be the annuitant's 95th birthday unless
an earlier date is chosen by you.
NOTICE. Means information we have received at our home office
which is written, is signed by you, and is acceptable to us.
PORTFOLIO OR FUND PORTFOLIO. Means a separate portfolio of
one of the mutual funds in which separate account (SA) invests
through its subaccounts, or its successors and assigns.
SCHEDULE PAGE. Means the contract schedule page, or the
supplemental contract schedule page most recently sent to you
by us.
SEPARATE ACCOUNT ("SA"). Means the Carillon Account of The
Union Central Life Insurance Company. The separate account is
divided into several subaccounts.
SUBACOUNT(S). Means one or more of the subaccounts of the
SA. Each subaccount is invested in a different fund
portfolio.
VARIABLE ANNUITY. Means an annuity with payments which: 1.
are not predetermined or guaranteed as to dollar amount; and
2. vary in amount in relation to the investment experience of
one or more specified subaccounts.
WE AND YOU. "We," "us," or "our" means The Union Central Life
Insurance Company. "You" or "your" means the owner of this
contract.
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UC 8137 4
OWNERSHIP
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GENERAL. The owner of this contract shall be the person so
named in the application or the latest change filed with us.
CHANGE OF OWNERSHIP. Prior to the maturity date, you may
assign the ownership of this contract. Such change must be
made by written notice in a form acceptable to us and received
at our home office.
CHANGE OF ANNUITANT. Prior to the maturity date, you may name
a new annuitant. Such change must be made by written notice
in a form acceptable to us and received at our home office.
BENEFITS
----------------------------------------------------
ANNUITY BENEFITS. We will pay an annuity benefit to the
annuitant, if living, on the maturity date. Annuity benefits
will begin on the maturity date and continue while the
annuitant is living, with monthly payments guaranteed for 10
years, unless you elect a different annuity option at least 30
days before the maturity date. If you die after the annuity
benefits have begun, the entire remaining interest will
continue to be distributed to the annuitant at least as
rapidly as under the annuity option being used as of the date
of your death.
We may pay the accumulation value on the maturity date in one
lump sum if it is less than $5,000. We may change the payment
frequency to quarterly, semiannually or annually if the first
monthly annuity payment would be less than $50.
At least 30 days before the maturity date you must select how
the accumulation value will be used to provide the annuity
benefit. Any election must be written in a form satisfactory
to us and received at our home office. If you do not so
select how you wish settlement to be effected, we will provide
a fixed annuity.
If a variable annuity is used, subsequent annuity benefit
payments will vary based on the investment experience of the
subaccount(s) used to effect the annuity. The method used to
calculate the amount of subsequent payments is described in
the Variable Annuity Payments provision.
FIXED ANNUITY PAYMENTS. We guarantee the amount of fixed
annuity payments. The payment amount depends only on the
annuity option elected, the age (and possibly sex) of the
annuitant, and the amount applied to purchase the fixed
annuity, in accordance with the Option Tables contained in the
contract.
DEATH BENEFITS. Notwithstanding any provision to the
contrary, death benefits shall always be made in accordance
with the distribution requirements of the Internal Revenue
Code.
If the death benefit is paid before the maturity date, the
death benefit will be the greater of : (a) the accumulation
value on the date that due proof of death is received; or (b)
the adjusted sum of premiums determined as follows: (i) as of
the day a premium is received by us, the sum is increased by
the amount of that premium, and (ii) as of the day that a
partial surrender is made, the sum is decreased by the same
proportion as the accumulation value was decreased by that
surrender.
Death of Owner. If you are an owner and if you die before
the maturity date, the following will apply:
1. If your spouse is not the beneficiary, the death benefit
will be paid to the named beneficiary:
a. upon written request it may be paid under any option
listed in the Payment of Contract Benefits section of this
contract over a period not exceeding the beneficiary's life
expectancy. If the death benefit is paid in installments, the
first installment payment must be made no later than one year
after the date of your death; or
b. in a single sum. The beneficiary has the option to
elect to receive the single sum any time within five years
after the date of your death.
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UC 8137 5
2. If your spouse is the beneficiary, your spouse may elect,
by a written request to us, one of the following options:
a. to continue this contract as the owner; or
b. to receive the death benefit under any option listed
in the Payment of Contract Benefits section of this contract
over a period not exceeding the beneficiary's life expectancy.
If the death benefit is paid in installments, the first
installment payment must be made no later than one year after
the date of your death; or
c. to receive the death benefit in a single sum. Your
spouse may elect to receive the single sum any time within
five years after the date of your death.
If none of these options is elected by your spouse within 45
days after we receive due proof of death, option a. above
shall apply.
3. If no beneficiary is living or if no beneficiary has been
named, at the date of your death, the death benefit will be
paid in a single sum to the executor or administrator of your
estate within five years after the date of your death.
Joint Owners. If this contract is owned jointly, the death of
the first joint owner shall be treated as the death of the
owner.
Death of Annuitant before the Maturity Date. If you, the
owner, are a different person from the annuitant, and the
annuitant dies during your lifetime and before the maturity
date, you will be treated as the annuitant until you choose a
new annuitant.. If you are not a natural person, and the
annuitant dies before the maturity date, we will pay the death
benefit to you in a single sum. You have the option to elect
to receive the single sum any time within five years of the
death of the annuitant.
Death of Annuitant on or after the Maturity Date. If the
annuitant dies on or after the maturity date, the death
benefit, if any, will depend on the annuity option in effect
on the date of the annuitant's death.
Death of Beneficiary. Unless otherwise provided, if any
beneficiary dies before, at the same time as, or within 30
days after your death, that beneficiary will be treated as if
their death occurred before yours.
PREMIUMS
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GENERAL. All premiums under this contract are payable at our
home office or such other place as we may designate.
No premium may be paid under this contract unless it is at
least $50. Premiums may be paid at any time. The amount of
the premium may be increased or decreased any time subject to
the $50 minimum and a maximum of $10,000 per contract year.
We may waive the $10,000 per year maximum, but waiver in one
instance does not constitute waiver for additional premiums.
NET PREMIUM. The net premium is the premium less any premium
tax.
ALLOCATION OF NET PREMIUM. You determine the allocation of
the net premiums among the subaccounts. The minimum amount of
any net premium that you can allocate to any subaccount is
$10. Your accumulation value will be subject to the
investment experience of SA.
When we receive the premiums, the net premiums will be
allocated in accordance with the net premium allocation
percentages shown in the application or as of the most recent
change of allocation received from you. No allocation will be
made prior to the contract date. You may change the
allocation of subsequent premiums at any time, without charge,
by giving us written notice.
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UC 8137 6
ACCOUNT PROVISIONS
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SEPARATE ACCOUNT. The separate account is shown on the
schedule page. It is a unit investment trust registered with
the Securities and Exchange Commission under the Investment
Company Act of 1940. It is established under the laws of
Ohio. The assets in the separate account are kept separate
from our general assets and assets of other separate
accounts.
SUBACCOUNTS. The separate account is divided into
subaccounts, each of which invests in a different portfolio.
CREDITING OF ACCUMULATION UNITS. We will credit net premiums
allocated in the form of accumulation units. The number of
accumulation units to be credited to this contract for each
subaccount will be determined by dividing the net premium
allocated by the accumulation unit value for the corresponding
subaccount as of the end of the valuation period during which
the premium is received. In the case of the initial premium,
accumulation units will be credited on the later of these
dates: 1) the contract date; or 2) the date we receive the
premium.
Accumulation units are credited when amounts are transferred
into a subaccount. Accumulation units are deducted when the
charges and deductions are assessed or when amounts are
partially surrendered or transferred, including transfer
charges, out of a subaccount.
ACCUMULATION VALUE. At any time prior to the maturity date,
the accumulation value of this contract equals the sum for all
subaccounts of (1) times (2) where: 1. equals the number of
accumulation units credited to a subaccount; and 2. equals
the value of the appropriate accumulation unit.
VALUATION DATE AND VALUATION PERIOD. A valuation date is any
date on which the New York Stock Exchange is open for trading
and we are open for business. The assets of each subaccount
will be valued on each valuation date. A valuation period is
a period beginning with the close of business on a valuation
date and ending at the close of business for the next
valuation date.
ACCUMULATION UNIT. The value of an accumulation unit for each
subaccount was arbitrarily set at $10 when funds were first
credited to the respective subaccount. The accumulation unit
value for any subsequent valuation period is determined by
multiplying the accumulation unit value for the immediately
preceding valuation period by the "net investment factor" for
the valuation period for which the value is being determined.
The value of an accumulation unit may increase or decrease
from one valuation period to the next.
NET INVESTMENT FACTOR. The net investment factor is an index
that measures the investment performance of a subaccount from
one valuation period to the next. The net investment factor
for each subaccount for any 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 a portfolio share
held in the subaccount determined as of the end of the current
valuation period, plus
b. the per share amount of any dividend or capital gain
distributions made by the portfolio on shares held in the
subaccount if the "ex-dividend" date occurs during the current
valuation period, plus or minus
c. a per share charge or credit for any taxes incurred by
or reserved for in the subaccount, which is determined by us
to have resulted from the maintenance of the subaccount; and
2. is the net result of:
a. the net asset value per share of a portfolio share
held in the subaccount determined as of the end of the
immediately preceding valuation period (adjusted for an "ex-
dividend"), plus or minus
b. the per share charge or credit for any taxes reserved
for the immediately preceding valuation period; and
3. is a factor representing the charges deducted from the
subaccounts on a daily basis for administrative expenses and
mortality and expense risks. Such factor is equal on an
annual basis to the amount shown on the schedule page.
VARIABLE ANNUITY PAYMENT. The amount of the first variable
annuity payment is determined by applying the accumulation
value of your contract, measured as of the calculation date
(minus any applicable premium taxes), to the appropriate
Option Table contained in this contract. This is done
separately for each subaccount. We will determine subsequent
payments by dividing the first payment derived from each
subaccount by the annuity unit value determined as of the
calculation date. This number of annuity units is then
multiplied by the annuity unit value for each subsequent
determination date which is a uniformly applied date not more
than 10 business days before payment is due.
ANNUITY UNIT VALUE. The value of an annuity unit for each
subaccount was arbitrarily set at $10 when funds were first
credited to the respective subaccount. Subsequently, the value
of an annuity unit in each subaccount for any valuation period
is determined as follows:
1. the net investment factor for each subaccount for the
valuation period for which the annuity unit value is being
calculated is multiplied by the value of the annuity unit on
the preceding valuation date; and
2. the result is adjusted to compensate for the interest rate
assumed in the Option Tables used to determine the first
variable annuity payment.
The dollar value of annuity units may change from one
valuation period to the next.
ADDITION, DELETION, OR SUBSTITUTION OF INVESTMENTS. We
reserve the right, subject to compliance with applicable law,
to make additions to, deletions from, or substitution for the
portfolio shares that are held by the separate account or that
the separate account may purchase. We reserve the right to
eliminate the shares of any of the eligible portfolios and to
substitute shares of another portfolio, or of another open-
end, registered investment company, if the shares of an
eligible portfolio are no longer available for investment, or
if in our judgment further investment in any eligible
portfolio should become inappropriate in view of the purposes
of the separate account. We will not substitute any shares
attributable to your interest in a subaccount without notice
to you and prior approval of the Securities and Exchange
Commission, to the extent required by the Investment Company
Act of 1940. Nothing contained herein shall prevent the
separate account from purchasing other securities for other
series or classes of policies, or from effecting a conversion
between series or classes of policies on the basis of requests
made by owners.
We reserve the right to establish additional subaccounts, each
of which would invest in a new portfolio, or in shares of
another open-end investment company. We also reserve the
right to eliminate existing subaccounts.
In the event of any such substitution or change, we may, by
appropriate endorsement, make such changes in this and other
policies as may be necessary or appropriate to reflect such
substitution or change. If deemed by us to be in the best
interest of persons having voting rights under the policies,
the separate account may be operated as a management company
under the Investment Company Act of 1940 or it may be
deregistered under such Act in the event such registration is
no longer required.
The investment contract of the separate account will not be
changed without the approval of the Insurance Commissioner of
the State of Ohio. If required, the approval process is on
file with the Commissioner of the state in which this contract
is issued.
TRANSFERS
------------------------------------------------------------
TRANSFERS BEFORE MATURITY DATE. Before the maturity date you
may transfer amounts among the subaccounts. You are subject
to the terms and conditions stated by each subaccount in its
prospectus. These terms and conditions may contain
restrictions on how often you can move in or out of the
subaccount in a given period. Such restrictions protect the
subaccounts and the participating contract owners from an
activity known as "day trading." We will help the subaccounts
enforce such restrictions by notifying you if you violate a
subaccount's transfer restrictions and, if necessary,
requiring you to submit transfer requests via regular United
States mail. Transfers from subaccounts will be made based on
the accumulation unit values at the end of the valuation
period during which we receive the request for transfer. You
must transfer at least $300 or, if less, the entire amount in
the subaccount each time you make a transfer. If after the
transfer the amount remaining in the subaccount from which the
transfer is made is less than $25, then we will transfer the
entire amount instead of the requested amount. A transfer
charge as shown on the schedule page will be imposed for each
transfer. The charge will be deducted from the account from
which the transfer is made.
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UC 8137 8
TRANSFERS AFTER MATURITY DATE. After annuity payments have
been made for at least 12 months, you may, no more than once
each 12 months, change all or part of the investment upon
which your annuity payments are based from one subaccount to
another. After your death, the annuitant assumes this right.
To do this, we will convert the number of annuity units being
changed to the number of annuity units of the subaccount to
which you are changing so as to result in the next annuity
payment being of the same amount that it would have been
without the change. After that, annuity payments will reflect
changes in the values of your new annuity units. You must
give us notice at least 30 days before the due date of the
first annuity payment to which the change will apply.
No transfers may be made with respect to fixed annuity
payments.
SURRENDER PROVISIONS
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PAYMENT OF SURRENDERS. You may totally or partially surrender
the contract and receive all of the accumulation value at any
time before the earlier of the death of the annuitant or the
maturity date, by sending us a written request. We will pay
all surrenders within seven days of receipt of the written
request, subject to postponement for any period during which
the New York Stock Exchange is closed for trading (except for
normal holiday closing) or when the Securities and Exchange
Commission has determined that a state of emergency exists or
when required to withhold the surrender by any other
applicable law or regulation.
PARTIAL SURRENDER. If you are partially surrendering the
contract, you should specify the amounts that should be
withdrawn from each subaccount. If you do not so specify, the
requested amount will be withdrawn from each subaccount in
which you have an interest, in the same proportion that your
interest therein bears to the accumulation value. You may
pre-authorize periodic surrenders by entering into a separate
agreement with us. Under this agreement, you may withdraw
part of your accumulation value at a regular interval chosen
by you. You may choose to withdraw a level dollar amount or a
percentage of your accumulation value. If you choose the
latter, the accumulation value for the first year you choose
to make these withdrawals is set on the date we approve your
request. In later years, the accumulation value is set on the
first day of the contract year. These surrenders may be
subject to the 10% federal tax on early withdrawals.
DOLLAR COST AVERAGING. You have the option to elect the
Dollar Cost Averaging Plan. This Plan enables you to
automatically transfer specified dollar amounts from a
subaccount you specify to other subaccounst.
You must specify a fixed dollar amount in the subaccount from
which transfers will be made. The minimum amount of this type
of transfer is $100.00 and a $25.00 minimum to each
subaccount.
Once elected, transfers from the subaccount will be processed
monthly until the number of designated transfers has been
completed, or the value of the subaccount is completely
depleted, or you send us notice instructing us to cancel the
transfers.
We also reserve the right to alter the terms or suspend or
eliminate the availability of this option at any time. Any
transfers made under this plan will not count towards the
number of free transfers permitted in a policy year.
PORTFOLIO REBALANCING. If you have at least $5,000 in your
variable annuity, you may elect to have the accumulated
balance of each subaccount periodically redistributed to equal
the allocation percentages you specified in the election form.
Transfers pursuant to this provision will continue until you
send us notice to stop or the policy terminates. This option
is not available if Dollar Cost Averaging Plan is in effect.
We also reserve the right to alter the terms or suspend or
eliminate the availability of this option at any time. Any
transfers made under this plan will not count towards the
number of free transfers permitted in a policy year.
FREQUENCY AND AMOUNT OF SURRENDERS. You may make as many
partial surrenders as you wish. Any surrender from a
subaccount must be at least $100 or the entire balance of the
subaccount. If, after the surrender, the amount remaining in
a subaccount is less than $25, then we may consider the
surrender request to be a request for surrender of the entire
amount held in that subaccount. If a partial surrender would
reduce the accumulation value to less than $100, then we may
treat the partial surrender request as a total surrender of
the contract.
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UC 8137 9
CHARGES AND DEDUCTIONS
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MORTALITY AND EXPENSE RISK CHARGE. To compensate us for
assuming the mortality and expense risks, we deduct a charge
each valuation period. The current charge is shown on the
schedule page as is the maximum charge that can be charged.
We will deduct the charge from each subaccount in the same
proportion that the value of each subaccount bears to the
accumulation value.
SURRENDER CHARGE. A surrender charge will never be imposed on
total or partial surrenders of this contract.
ADMINISTRATION FEE. We deduct a charge each valuation period
to partially defray the expenses of maintaining the contract.
The current charge is shown on the schedule page as is the
maximum charge that can be charged.
TAXES. We will charge certain taxes against your premiums,
accumulation value, or annuity payments, when incurred. These
taxes include any premium taxes or other taxes levied by any
government entity which we, in our sole discretion, determine
have resulted from:
1. the establishment or maintenance of the accumulation
value; or
2. the investment experience of the accumulation value; or
3. the receipt by us of the premium; or
4. the issuance of this contract, or
5. the commencement or continuance of annuity payments
under this contract.
GENERAL PROVISIONS
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ENTIRE CONTRACT. This contract is a legal contract that you
have entered into with us. The entire contract consists of
this contract, any endorsements, schedule pages, amendments,
and the attached copy of the application and supplemental
applications. Any change in the contract must be written and
signed by our President, one of our Vice Presidents, our
Secretary or Assistant Secretary. No agent or person other
than the above-named has the authority to change or modify
this policy or waive any of its provisions. Words that can be
interpreted as singular or plural shall mean both singular and
plural.
BENEFICIARY. The primary and any contingent beneficiaries of
this contract are named in the application. If changed, the
beneficiary is as shown in the latest change. Unless the
beneficiary designation provides otherwise, any death benefits
will be divided equally among beneficiaries of the same class.
The contingent beneficiary will receive the death benefits if
no primary beneficiary is living at the time of the event
giving rise to the benefit payment. Prior to the maturity
date, if no beneficiary survives you, your estate will be the
beneficiary. The interest of any beneficiary is subject to
that of any assignee.
CHANGE OF BENEFICIARY. You may change the beneficiary, unless
an irrevocable designation has been made. Any such change
must be made by written notice in a form acceptable to us and
received at our home office. If you die after the maturity
date, the annuitant may change the beneficiary unless an
irrevocable designation has been made.
CHANGE IN MATURITY DATE. Prior to the maturity date, you may
change the maturity date by written request at least 30 days
before the previously specified maturity date. After the
election, the new maturity date will become the maturity date.
ASSIGNMENT. You may assign this contract. No assignment will
be binding on us unless it is written in a form acceptable to
us and received at our home office. We will not be
responsible for the validity of any assignment. We will not
be liable for any payments we make or actions we take before
we receive notice of an assignment.
CLAIMS OF CREDITORS. Any accumulation value, before paid,
under this contract, will not be subject to the claims of a
beneficiary's creditors, except as required by law.
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UC 8137 10
MISSTATEMENT AND PROOF OF AGE, SEX OR SURVIVAL. We may
require proof of age, sex, or survival of any person upon
whose age, sex, or survival any payments depend.
If the age or sex of the annuitant has been misstated, the
benefits will be those that the premiums would have provided
for the correct age and sex. If we have made incorrect
annuity payments, we will adjust future payments. The
adjustments will reflect any overpayment or underpayment.
DIVIDEND. As long as this contract is in force, you will
receive any dividends declared by us. It is anticipated that
no dividends will be declared.
You have these options:
1. take the dividends in cash; or
2. use the dividends to be credited as additional
accumulation units.
You may choose either option or change options by notice to
us. If none is chosen, the second option will be used.
REPORTS. At least once a year we will send you a report
showing:
1. the accumulation unit value as of the beginning date of
the report;
2. the accumulation unit value as of the ending date of the
report;
3. the total number of accumulation units as of the ending
date of the report;
4. the value of each subaccount on the beginning date of
the report;
5. the value of the subaccount on the ending date of the
report; and
6. the gain or loss for each subaccount.
For the column headings within the report, the accumulation
unit is referred to as "unit."
INSULATION. The assets of SA are not chargeable with
liabilities arising out of any other business we may conduct.
OWNERSHIP OF ASSETS. We shall have exclusive and absolute
ownership and control of our assets, including the assets of
SA.
MODIFICATION OF CONTRACT. We may not modify this contract
without your consent except:
1. to make the contract meet the requirements of the
Investment Company Act of 1940;
2. to make the contract comply with any changes in the
Internal Revenue Code; or
3. as required by any other applicable law in order to
continue treatment of the contract as an annuity.
INCONTESTABILITY. We cannot contest this contract after it
has been in force during the lifetime of the annuitant for a
period of two years from the date of issue.
PAYMENT OF CONTRACT BENEFITS
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GENERAL. Annuity benefits under this contract are payable in
accordance with the Option Tables given below or under such
other annuity options to which we may agree.
ALTERNATE ANNUITY OPTIONS. Instead of an annuity in
accordance with the Option Tables given below, you may choose
an alternate type of fixed annuity payment. Such alternate
annuity option shall be based on rates at least as favorable
as those for fixed dollar single premium immediate annuities
being issued by us on the maturity date. Such election may
only be made within 30 days before that date.
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DESCRIPTION OF ANNUITY OPTIONS.
Option 1: Life Annuity
1. Nonrefund. We will make payments during the lifetime of
the annuitant. No payments are due after the death of the
annuitant.
2. 5-Years Certain. We will make payments for 5 years and
after that during the lifetime of the annuitant. No payments
are due after the death of the annuitant or, if later, the end
of the 5-year period certain.
3. 10-Years Certain. We will make payments for 10 years and
after that during the lifetime of the annuitant. No payments
are due after the death of the annuitant or, if later, the end
of the 10-year period certain.
4. Installment Refund. We will make payments for a period
certain and after that during the lifetime of the annuitant.
No payments are due after the death of the annuitant or, if
later, the end of the period certain. The number of period
certain payments is equal to the amount applied under this
Installment Refund Option divided by the amount of the first
annuity payment; provided, however, that the amount of the
final period certain payment shall be multiplied by that part
of the preceding quotient which is not an integer.
Option 2: Joint and Survivor Life Annuity
1. Joint and Survivor Nonrefund. We will make payments
during the joint lifetime of the annuitant and contingent
annuitant. Payments will then continue during the remaining
lifetime of the survivor of them. No payments are due after
the death of the last survivor of the annuitant and contingent
annuitant.
2. Joint and Survivor with 10-Years Certain. We will make
payments for 10 years and after that during the joint lifetime
of the annuitant and contingent annuitant. Payments will then
continue during the remaining lifetime of the survivor of
them. No payments are due after the death of the survivor of
the annuitant and contingent annuitant or, if later, the end
of the 10-year period certain.
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Flexible Premium Deferred Variable Annuity
Participating
UC 8137
