ALLIANZ LIFE INSURANCE COMPANY OF NEW YORK
[75 Wall Street,20th Floor]
[New York, New York 10005-2833]
A Stock Company
This is a legal Contract between the Contract Owner (referred to in this
Contract as you and your) and Allianz Life Insurance Company of New York
(Allianz Life of NY) (herein referred to as we, us and our). We will make
Annuity Payments as set forth in this Contract beginning on the Income Date.
This Contract is issued in consideration of any attached application and payment
of the initial Purchase Payment.
READ YOUR CONTRACT CAREFULLY
RIGHT TO EXAMINE: THIS CONTRACT MAY BE RETURNED WITHIN 10 DAYS AFTER YOU RECEIVE
IT. IT CAN BE MAILED OR DELIVERED TO EITHER US OR THE AGENT WHO SOLD IT. RETURN
OF THIS CONTRACT BY MAIL IS EFFECTIVE ON BEING POSTMARKED, PROPERLY ADDRESSED
AND POSTAGE PREPAID. THE RETURNED CONTRACT WILL BE TREATED AS IF WE HAD NEVER
ISSUED IT. WE WILL PROMPTLY REFUND AN AMOUNT EQUAL TO THE SUM OF (I) AND (II),
WHERE (I) IS THE DIFFERENCE BETWEEN THE PURCHASE PAYMENTS, INCLUDING ANY FEES OR
OTHER CHARGES, AND THE AMOUNTS, IF ANY, ALLOCATED TO THE VARIABLE ACCOUNT UNDER
THE CONTRACT, LESS ANY WITHDRAWALS, AND (II) THE CONTRACT VALUE.
This is a Variable Annuity Contract with Annuity Payments and Contract Values
increasing or decreasing depending on the experience of the Variable Account
which is set forth in the Contract Schedule. Annuity Payments and Contract
Values in the Variable Account are not guaranteed as to fixed dollar amounts.
IMPORTANT NOTICE IF THE LIVING GUARANTEES BENEFITS (LGBS) ARE SELECTED:
The Fixed Account will only be available with the selection of the LGB.
Allocations to and from the Fixed Account may only be made by the Company. In
order to provide the Guarantees of your Contract, it is very likely that not all
of your Contract Value will remain in the Investment Options you choose.
Specifically, the Guaranteed Account Value Endorsement gives the Company the
right to transfer Contract Value to the Fixed Account. The amount required to be
in the Fixed Account is determined at the sole discretion of the Company. It is
limited to 50% of your Purchase Payments in the first two Contract Years, but
and there is no limit to the amount that may be in the Fixed Account thereafter.
The amount that is transferred will depend, among other things, on the Contract
Value, the value of all existing guarantees, and the time until those guarantees
are in effect.
Signed for Allianz Life Insurance Company of New York (Allianz of NY) by:
/s/ Xxxxxxx X. Xxxxx /s/ Xxxxxxx Xxxxxxx
Xxxxxxx X. Xxxxx Xxxxxxx Xxxxxxx
Senior Vice President, Secretary Chairman of the Board,
and Chief Legal Officer CEO and President
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
Annuity Payments will not decrease as long as the investment return of the
Variable Account assets equals or exceeds 6.4% (assuming a 5% Assumed Investment
Return) on an annual basis. Variable Account expenses consist of a mortality and
expense risk charge, a contract maintenance charge, and transfer fees. These are
shown on the Contract Schedule Page. The variable provisions can be found on
pages 6, 7 and 13 of this Contract.
L40517-NY
TABLE OF CONTENTS
RIGHT TO EXAMINE...............................................1
CONTRACT SCHEDULE............................................i-v
DEFINITIONS....................................................4
PURCHASE PAYMENTS..............................................5
PURCHASE PAYMENTS.........................................5
CHANGE IN PURCHASE PAYMENTS...............................5
NO DEFAULT................................................5
ALLOCATION OF PURCHASE PAYMENTS...........................5
VARIABLE ACCOUNT...............................................6
THE VARIABLE ACCOUNT......................................6
VALUATION OF ASSETS.......................................6
ACCUMULATION UNITS........................................6
ACCUMULATION UNIT VALUE...................................6
NET INVESTMENT FACTOR.....................................6
MORTALITY AND EXPENSE RISK CHARGE.........................7
MORTALITY AND EXPENSE GUARANTEE...........................7
CONTRACT VALUE.................................................7
CONTRACT MAINTENANCE CHARGE....................................7
TRANSFERS......................................................7
WITHDRAWAL PROVISIONS.........................................8
WITHDRAWALS...............................................8
WITHDRAWAL CHARGE.........................................8
PROCEEDS PAYABLE ON DEATH......................................8
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PHASE.....8
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE........9
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PHASE.......9
DEATH OF CONTRACT OWNER DURING THE ANNUITY PHASE..........9
DEATH OF ANNUITANT........................................9
PAYMENT OF DEATH BENEFIT.................................10
BENEFICIARY..............................................10
CHANGE OF BENEFICIARY....................................10
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION.............10
L40517-NY 2
TABLE OF CONTENTS (CONTINUED)
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS..............11
CONTRACT OWNER...........................................11
JOINT OWNER..............................................11
ANNUITANT................................................11
ASSIGNMENT OF A CONTRACT.................................11
ANNUITY PROVISIONS............................................11
GENERAL..................................................11
FIXED ANNUITY............................................11
VARIABLE ANNUITY.........................................12
INCOME DATE..............................................12
SELECTION OF AN ANNUITY OPTION...........................12
DEFAULT ANNUITY OPTION...................................12
ANNUITY OPTIONS..........................................12
OPTION 1 - LIFE ANNUITY..............................12
OPTION 2 - LIFE ANNUITY WITH MONTHLY
PAYMENTS OVER 5, 10, 15, OR
20 YEARS GUARANTEED..................................13
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY...........13
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY
WITH MONTHLY PAYMENTS OVER
5, 10, 15, OR 20 YEARS GUARANTEED....................13
OPTION 5 - REFUND LIFE ANNUITY.......................13
GENERAL PROVISIONS............................................14
THE CONTRACT.............................................14
NON-PARTICIPATING IN SURPLUS.............................14
MINIMUM VALUES...........................................14
INCONTESTABILITY.........................................14
MISSTATEMENT OF AGE OR SEX...............................14
CONTRACT SETTLEMENT......................................14
REPORTS..................................................14
TAXES....................................................14
EVIDENCE OF SURVIVAL.....................................14
PROTECTION OF PROCEEDS...................................14
MODIFICATION OF CONTRACT.................................14
TABLE OF ANNUITY PAYMENT AMOUNTS.........................14
TABLE.................................................15-18
L40517-NY 3
DEFINITIONS
ACCUMULATION PHASE: The period prior to the Income Date during which you can
make Purchase Payments.
ACCUMULATION UNIT: The units into which we convert amounts invested in
Investment Options during the Accumulation Phase.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax.
This amount is used to determine the death benefit during the Accumulation Phase
or the initial Annuity Payment.
AGE: Age on last birthday unless otherwise specified.
ANNUITANT(S): The natural person(s) upon whose continuation of life any Annuity
Payment involving life contingencies depends. You may change the Annuitant(s) at
any time prior to the Income Date unless the Contract Owner is a non-individual.
On or after the Income Date, any reference to Annuitant shall also include any
Joint Annuitant.
ANNUITY OPTION: An arrangement under which Annuity Payments are made under this
Contract.
ANNUITY PAYMENTS: The series of payments made to you or any named payee after
the Income Date under the Annuity Option selected.
ANNUITY PHASE: The period of time beginning on the Income Date during which
Annuity Payments are made.
ANNUITY RESERVE: The assets which support the Annuity Option you have selected
during the Annuity Phase.
ANNUITY UNIT: The units into which we convert amounts invested in the Investment
Options during the Annuity Phase.
ASSUMED INVESTMENT RETURN (AIR): The investment return upon which the variable
Annuity Payments in the Contract are based.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Service Center.
BENEFICIARY: The person(s) or entity(ies) who will receive any death benefit
payable under this Contract.
COMPANY: Allianz Life Insurance Company of New York.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date of this Contract.
CONTRACT OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in this Contract. If Joint Owners are named, all references to Contract
Owner shall mean the Joint Owners.
CONTRACT VALUE: The Contract Value for any Valuation Period is equal to the
total dollar value accumulated under this Contract in all of the Investment
Options.
CONTRACT YEAR: Any period of twelve (12) months commencing with the Issue Date
and each Contract Anniversary thereafter.
GENERAL ACCOUNT: Our general investment account which contains all the assets of
the Company with the exception of the Variable Account and other segregated
asset accounts.
L40517-NY 4
INCOME DATE: The date on which you elect to begin receiving Annuity Payments
under the Contract. This date must be the first day of the calendar month.
INVESTMENT OPTION(S): The investment choices available under the Variable
Account. The Investment Options are shown in the Contract Schedule.
ISSUE DATE: The date shown on the Contract Schedule on which the first Contract
Year begins. Contract Anniversaries and Contract Years are measured from the
Issue Date.
JOINT OWNER: If there is more than one Contract Owner, each Contract Owner shall
be a Joint Owner of the Contract. There can only be 2 Joint Owners. Joint Owners
have equal ownership rights and must both authorize any exercising of those
ownership rights unless otherwise allowed by us.
NET ASSET VALUE: The value of a share of the underlying Investment Options, less
any investment management and portfolio administration fees and expenses, as of
the close of trading on a Valuation Date.
PREMIUM TAX: Any premium taxes owed to any governmental entity and assessed
against Purchase Payments, Contract Value, or Annuity Payments.
PURCHASE PAYMENT: A payment made toward this Contract.
SERVICE CENTER: The office indicated on the Contract Schedule of this Contract
to which notices, requests and Purchase Payments must be sent.
VALUATION DATE: The Variable Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period commencing at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account maintained by us in which a portion of our
assets has been allocated for this and certain other contracts. It has been
designated on the Contract Schedule.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: The initial Purchase Payment is due on the Issue Date. The
minimum subsequent Purchase Payment and the maximum total Purchase Payments
allowed is shown on the Contract Schedule.
CHANGE IN PURCHASE PAYMENTS: You may elect to increase or decrease or to change
the frequency of Purchase Payments as set forth in the Contract Schedule.
NO DEFAULT: Unless a full withdrawal is made, this Contract remains in force and
will not be in default if no additional Purchase Payments are made.
ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to one or more
of the Investment Options in accordance with your selection. The allocation of
the initial Purchase Payment is made in accordance with your selection made at
the Issue Date. Unless you inform us otherwise, subsequent Purchase Payments are
allocated in the same manner as the initial Purchase Payment. However, the
Company has reserved the right to allocate the initial Purchase Payment to the
Money Market Investment Option until the expiration of the Right to Examine
period. All allocations of Purchase Payments are subject to the Allocation
Guidelines shown on the Contract Schedule. We guarantee that you will be allowed
to select at least fifteen Investment Options for such allocations. This number
will not decrease after the Issue Date. You will be allowed to choose at least
this number of Investment Options from the Investment Options specified in the
Contract Schedule unless Investment Options are eliminated or substituted.
L40517-NY 5
VARIABLE ACCOUNT
THE VARIABLE ACCOUNT: The Variable Account is designated on the Contract
Schedule. It consists of assets we have set aside and have kept separate from
the rest of our assets and those of our other separate accounts. The assets of
the Variable Account, equal to reserves and other liabilities of your Contract
and those of other Contract Owners, will not be charged with liabilities arising
out of any other business we may conduct.
The Variable Account assets are divided into sub-accounts. Each sub-account
invests exclusively in one Investment Option. The Investment Options are shown
on the Contract Schedule. We may add additional Investment Options in the
future. You may be permitted to transfer your Contract Value or allocate
Purchase Payments to the additional Investment Options.
Should the shares of any sub-account become unavailable for investment by the
Variable Account, or our Board of Directors deems further investment in the
shares inappropriate, we may limit further purchase of such shares or substitute
shares of another sub-account for shares already purchased. No such limitations
will be imposed or substitutions made unless prior approval is obtained from the
New York State Insurance Department.
VALUATION OF ASSETS: Assets of each Investment Option will be valued at its Net
Asset Value on each Valuation Date.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Investment Options of the Variable Account as
a result of Purchase Payments, withdrawals, transfers, or fees and charges. We
will determine the number of Accumulation Units of an Investment Option
purchased or canceled. This will be done by dividing the amount allocated to (or
the amount withdrawn from) the Investment Option by the dollar value of one
Accumulation Unit of the Investment Option as of the end of the Valuation Period
during which the transaction is processed at the Service Center. Purchase
Payments, withdrawals and transfers from or to an Investment Option will result
in the addition of or the cancellation of Accumulation Units in an Investment
Option.
ACCUMULATION UNIT VALUE: The Accumulation Unit value for each Investment Option
was initially arbitrarily set. Subsequent Accumulation Unit values for each
Investment Option are determined by multiplying the Accumulation Unit value for
the immediately preceding Valuation Period by the net investment factor for the
Investment Option for the current period.
The Accumulation Unit value may increase or decrease from Valuation Period to
Valuation Period.
NET INVESTMENT FACTOR: The net investment factor for each Investment Option is
determined by dividing A by B and multiplying by (1 - C) where:
A is (i) the Net Asset Value per share of the Investment Option at
the end of the current Valuation Period; plus
(ii) any dividend or capital gains per share declared on behalf
of such Investment Option that has an ex-dividend date
within the current Valuation Period.
B is the Net Asset Value per share of the Investment Option for
the immediately preceding Valuation Period.
C is (i) the Valuation Period equivalent of the mortality and
expense risk charge, which are shown on the Contract
Schedule; plus
(ii) a charge factor, if any, for any taxes or any tax reserve we
have established as a result of the operation or maintenance
of the Investment Option.
L40517-NY 6
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, we deduct a mortality
and expense risk charge from the Contract Value in the Investment Options which
is equal, on an annual basis, to the amount shown on the Contract Schedule. The
mortality and expense risk charge compensates the Company for assuming the
mortality and expense risks under this Contract.
MORTALITY AND EXPENSE GUARANTEE: We guarantee that the dollar amount of each
Annuity Payment after the first will not be affected by variations in mortality
or expense experience.
CONTRACT VALUE
The Contract Value for any Valuation Period is equal to the total dollar value
accumulated under this Contract in all of the Investment Options. The Contract
Value in an Investment Option of the Variable Account is determined by
multiplying the number of Accumulation Units by the Accumulation Unit value.
Purchase Payments, withdrawals and transfers from or to an Investment Option
will result in the addition of or the cancellation of Accumulation Units in an
Investment Option.
CONTRACT MAINTENANCE CHARGE
We deduct an annual contract maintenance charge shown on the Contract Schedule.
During the Accumulation Phase, prior to the Income Date, this will be deducted
from the Contract Value. The number of Accumulation Units to be canceled from
each applicable Investment Option is in the ratio that the value of each
Investment Option bears to the total Contract Value.
TRANSFERS
You may transfer all or a part of your interest in an Investment Option to
another Investment Option. We reserve the right to charge for transfers if there
are more than the number of free transfers shown on the Contract Schedule.
Pre-scheduled transfer programs may be available.
All transfers are subject to the following:
1. The deduction of any transfer fee that we may impose as detailed on the
Contract Schedule. We will deduct the transfer fee from the Investment
Options from which you make the transfer. If you transfer the entire
amount in the Investment Options, then we will deduct the transfer fee
from the amount transferred. If you are transferring from multiple
Investment Options, we will treat the transfer as a single transfer and
we will deduct any transfer fee proportionately from the Investment
Options if you transfer less than the entire amount in the Investment
Options.
2. We reserve the right to limit transfers until the expiration of the
Right to Examine period.
3. During the Accumulation Phase, no transfer will be effective within
seven calendar days prior to the date on which the first Annuity
Payment is due.
4. Any transfer direction must clearly specify:
a. the amount you wish to transfer; and
b. the Investment Options which are to be affected.
5. After the Income Date, during the Annuity Phase, transfers may not be
made from a fixed Annuity Option to a variable Annuity Option. After
the Income Date, during the Annuity Phase, you can make transfers from
a variable Annuity Option to a fixed Annuity Option. The number of
Annuity Units canceled from the variable Annuity Option will be equal
in value to the amount of the Annuity Reserve transferred out of the
Variable Account. The Annuity Reserve transferred out of the Variable
Account is defined as the present value of the current variable payment
discounted with mortality at the Assumed Investment Return. The amount
transferred will purchase fixed Annuity Payments at current payout
rates under the Annuity Option in effect and based on the Age and sex
of the Annuitant, where allowed, at the time of the transfer.
L40517-NY 7
6. Restrictions may be applied in any manner reasonably designed to
prevent any use of the transfer right which we consider to be part of a
market- timing program. A market-timing program is one where transfers
are made to or from Investment Options in anticipation of expected
future changes in the performance of the Investment Options. Market-
timing may be characterized by frequent or large trades or a grouping
of trades for multiple Contract Owners.
7. We reserve the right to impose the following modifications and
restrictions on transfers between the Investment Options to prevent
market-timing activities:
a. requiring a minimum time period between each transfer;
b. not accepting a transfer request from a registered representative
acting on behalf of more than one Contract Owner; or
c. limiting the dollar amounts that may be transferred between the
Investment Options at any one time; or
d. not accepting transfer instructions other than by U.S. mail; or
e. prohibiting transfers into specific Investment Options; or
f. rejecting a transfer request or an additional Purchase Payment.
If you elect to use this transfer privilege, we will not be liable for transfers
made in accordance with your instructions. We will determine all amounts and
Accumulation Units as of the end of the Valuation Period during which the
request for transfer is received at the Service Center.
WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Phase, you may make, upon Authorized
Request, a full or partial withdrawal of the Contract Value. Withdrawals will
result in the cancellation of Accumulation Units from each Investment Option in
the ratio that the value of each Investment Option bears to the total Contract
Value in the Investment Options. You must specify, by Authorized Request, which
Accumulation Units are to be canceled if other than the above mentioned method
of cancellation is desired.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
WITHDRAWAL CHARGE: Upon a full or partial withdrawal of this Contract, a
withdrawal charge as set forth on the Contract Schedule may be assessed. Under
certain circumstances, we allow withdrawals without the withdrawal charge as set
forth on the Contract Schedule. The Company will not assess the withdrawal
charge on any payments paid out as Annuity Payments or as death benefits.
PROCEEDS PAYABLE ON DEATH
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PHASE: Upon the death of the
Contract Owner, or any Joint Owner, during the Accumulation Phase, the death
benefit will be paid to the Beneficiary(ies) designated by the Contract 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 time of death will be treated as a contingent Beneficiary. If the
Contract is owned by a non-individual, the death benefit will be paid upon the
death of an Annuitant.
L40517-NY 8
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE: The death benefit will be
the Adjusted Contract Value determined as of the end of the Valuation Period
during which the Company receives both due proof of death and an election for
the payment method.
Any part of the death benefit amount that had been invested in the Variable
Account remains in the Variable Account until distribution begins. From the time
the death benefit is determined until complete distribution is made, any amount
in the Variable Account will be subject to investment risk, which is borne by
the Beneficiary.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PHASE: If the Owner has not
previously designated a death benefit option, a Beneficiary must request that
the death benefit be paid under one of the death benefit options below.
If the Beneficiary is the spouse of the Contract Owner, he or she may elect to
continue the Contract in his or her own name and exercise all the Contract
Owner's rights under the Contract. In this event, the Contract Value for the
Valuation Period during which this election is implemented will be adjusted to
equal the death benefit.
OPTION A - lump sum payment of the death benefit.
OPTION B - the payment of the entire death benefit within 5 years of
the date of the death of the Contract Owner or any Joint Owner; or
OPTION C - payment of the death benefit under an Annuity 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 death of the Contract Owner or any Joint
Owner.
Any portion of the death benefit not applied under any Annuity Option within one
year of the date of the Contract Owner's death must be distributed within five
years of the date of death.
If a lump sum payment is requested, the amount from the Variable Account will be
paid within seven (7) days of receipt of proof of death and the valid election,
including any required governmental forms, unless the Suspension or Deferral of
Payments Provision is in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period after the later of the date of death or the date a death
benefit option election is received by the Company.
DEATH OF CONTRACT OWNER DURING THE ANNUITY PHASE: If you, or any Joint Owner,
dies during the Annuity Phase, and you are not an Annuitant, any remaining
payments under the Annuity Option elected will continue at least as rapidly as
under the method of distribution in effect at such Contract Owner's death. Upon
your death during the Annuity Phase, the Beneficiary becomes the Contract Owner.
DEATH OF ANNUITANT: Upon the death of an Annuitant (or death of both Joint
Annuitants), who is not the Contract Owner, during the Accumulation Phase, you
will become the Annuitant, unless you designate another Annuitant within 30 days
of the death of the Annuitant. If the Contract Owner is a non-individual, the
death of an Annuitant will be treated as the death of the Contract Owner and a
new Annuitant may not be designated.
Upon the death of the Annuitant during the Annuity Phase, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
L40517-NY 9
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death and
payment election and any required governmental forms before any death benefit is
paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the finding
of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments. If there is a delay in the payment of death
benefits, we will pay interest on death benefits from date of death, in
accordance with New York Insurance Law Section 3214.
BENEFICIARY: The Beneficiary designation in effect on the Issue Date will remain
in effect until changed. The Beneficiary is entitled to receive the benefits to
be paid at your death.
Unless you provide otherwise, the death benefit will be paid in equal shares to
the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive your death and/or the
Annuitant's death, as applicable; or if there are none;
2. to the contingent Beneficiary(ies) who survive your death and/or the
Annuitant's death, as applicable; or if there are none
3. to your estate.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), you may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Authorized Request. The change will
take effect as of the date the Authorized Request is signed. If the Authorized
Request reaches our Service Center after the Contract Owner dies but before any
payment is made, the change will be valid. The Company will not be liable for
any payment made or action taken before it receives the change. Such changes
will be effective on the date the Authorized Request is signed subject to any
actions taken by the Company prior to receipt of the Authorized Request.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of the Investment Option
shares held in the Variable Account is not reasonably practicable or it is
not reasonably practicable to determine the value of the Variable Account's
net assets;
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of Contract Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist. Any suspension or postponement of payments will be in accordance with the
deferment provisions of the federal Investment Company Act of 1940, as amended.
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS
CONTRACT OWNER: As the Contract Owner, you have all the interest and rights
under this Contract. The Contract Owner is the person designated as such on the
Issue Date, unless changed.
L40517-NY 10
You may change owners of the Contract at any time by Authorized Request subject
to our approval. However, you must have our consent to name an Owner that is a
non-individual or if the Guaranteed Minimum Death Benefit is greater than the
current Contract Value. A change of Contract Owner will automatically revoke any
prior designation of Contract Owner. The change will become effective on the
date the Authorized Request is signed subject to any actions taken by the
insurer prior to receipt of the Authorized Request. We will not be responsible
for any tax consequences of any change.
JOINT OWNER: Joint Owners (maximum of two) may own a Contract. Upon the death of
either Contract Owner, the surviving Joint Owner will be the primary
Beneficiary. Any other Beneficiary designation will be treated as a contingent
Beneficiary unless otherwise indicated in an Authorized Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by you subject to our underwriting rules
then in effect. The Annuitant may not be changed in a Contract that is owned by
a non-individual.
ASSIGNMENT OF A CONTRACT: An Authorized Request specifying the terms of an
assignment of a Contract must be provided to the Service Center. We will not be
liable for any payment made or action taken before we receive the assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent.
If the Contract is assigned, your rights may only be exercised with the consent
of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Income Date, the Adjusted Contract Value will be applied under
the Annuity Option you have selected. Under Annuity Options 1-5, you may elect
to have the Adjusted Contract Value applied to provide a fixed annuity, a
variable annuity or a combination fixed and variable annuity. If a combination
is elected, you must specify what part of the Adjusted Contract Value is to be
applied to the fixed and variable Annuity Options. If you select a fixed
annuity, the Adjusted Contract Value is allocated to the General Account and the
annuity is paid as a fixed annuity. If you select a variable annuity, the
Adjusted Contract Value will be allocated to the Investment Options of the
Variable Account in accordance with your selection, and the annuity will be paid
as a variable annuity. Unless you designate another payee, you will be the payee
of the Annuity Payments. The Adjusted Contract Value will be applied to current
purchase rates based upon the Annuity Option you have selected. The Annuity
Payments will be at least as favorable as those that would be provided by the
application of the Adjusted Contract Value to purchase any single premium
immediate annuity contract offered by us at the time for the same class of
Annuitants.
We may offer more favorable rates than those guaranteed here at the time your
first Annuity Payment is calculated. Annuity Payments will depend on the Age
and, where permitted, sex of the Annuitant.
If Annuity Payments amount to less than $20, we may change the frequency of the
payments. We will not allow amounts less than $2,000 to be applied under any
Annuity Payment Option. If the Adjusted Contract Value is less than $2,000, we
will pay that amount to you.
FIXED ANNUITY: You may elect to have the Adjusted Contract Value applied to
provide a fixed annuity. The dollar amount of each fixed Annuity Payment is
guaranteed to be at least an amount equal to the Adjusted Contract Value,
divided first by $1000 and then multiplied by the appropriate Annuity Payment
amount for each $1000 of value for the fixed Annuity Option selected. The
guaranteed rates, as set forth in Table A at the end of the Contract, are based
on an interest rate of 1% guaranteed per year and the 1983(a) Individual Annuity
Mortality Table with mortality improvement projected 30 years using Mortality
Projection Scale G.
L40517-NY 11
VARIABLE ANNUITY: You may elect to have the Adjusted Contract Value applied to
provide a variable annuity. Variable Annuity Payments reflect the investment
performance of the Variable Account in accordance with the allocation of the
Adjusted Contract Value to the Investment Options during the Annuity Phase.
Variable Annuity Payments are not guaranteed as to dollar amount.
On the Income Date, Annuity Units will be purchased as follows:
The first Annuity Payment is equal to the Adjusted Contract Value, divided first
by $1000 and then multiplied by the appropriate Annuity Payment amount for each
$1000 of value for the Annuity Option selected as set forth in Table B at the
end of the Contract. In each Investment Option, the number of Annuity Units is
determined by dividing the amount of the initial Annuity Payment determined for
each Investment Option by the Annuity Unit value on the Income Date. Thereafter,
the number of Annuity Units in each Investment Option remains unchanged unless
you elect to transfer between Investment Options. All calculations will
appropriately reflect the Annuity Payment frequency selected.
On each subsequent Annuity Payment date, the total Annuity Payment is the sum of
the Annuity Payments for each Investment Option. The Annuity Payment in each
Investment Option is determined by multiplying the number of Annuity Units then
allocated to such Investment Option by the Annuity Unit value for that
Investment Option.
On each subsequent Valuation Date, the value of an Annuity Unit is determined in
the following way:
First: The net investment factor is determined as described under "Variable
Account - net investment factor" above.
Second: The value of an Annuity Unit for a Valuation Period is equal to:
a. the value of the Annuity Unit for the immediately preceding Valuation
Period;
b. multiplied by the net investment factor for the current Valuation
Period; and
c. divided by the assumed net investment factor (see below) for the
Valuation Period.
The assumed net investment factor is equal to one plus the Assumed Investment
Return (AIR) which is used in determining the basis for the purchase of an
Annuity, adjusted to reflect the particular Valuation Period. The AIR we will
use is 5%. We may agree with you to use a different value, however the AIR may
not exceed 5%.
INCOME DATE: Your Income Date is shown in the Contract Schedule as the latest
date we allow, which is the first day of the calendar month following the
Annuitant's 90th birthday. You may make an Authorized Request for a different
date, however any such request is subject to Company approval. The Income Date
must always be the first day of a calendar month. The earliest Income Date you
can request is a date that is at least thirteen months after the Issue Date. The
Income Date will never be greater than that permitted under state law.
SELECTION OF AN ANNUITY OPTION: You can select an Annuity Option by Authorized
Request. You may, by Authorized Request, at least 30 days prior to the Income
Date, select and/or change the Annuity Option.
DEFAULT ANNUITY OPTION: IF no Annuity Option is selected, variable Annuity
Option 2, which is a life annuity with period certain, 60 Monthly Payments
Guaranteed, will be automatically applied.
ANNUITY OPTIONS: This Contract provides for Annuity Payments under one of the
Annuity Options described below. The Company may make available other payment
options.
OPTION 1 - LIFE ANNUITY. We will make monthly Annuity Payments during the life
of the Annuitant and ceasing with the last Annuity Payment due prior to the
Annuitant's death.
L40517-NY 12
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15 OR 20 YEARS
GUARANTEED. We will make monthly Annuity Payments during the life of the
Annuitant with a guarantee that if, at the Annuitant's death, there have been
less than 60, 120, 180 or 240 monthly Annuity Payments made as selected, monthly
Annuity Payments will continue for the remainder of the guaranteed period.
Alternatively, the Contract Owner may elect to have us make a lump-sum payment
equal to the present value of the guaranteed monthly Annuity Payments remaining,
as of the date proof of the Annuitant's death is received at the Service Center,
commuted at an appropriate rate as defined below. Proof of the Annuitant's death
and return of the Contract are required prior to the payment of any commuted
values. For a fixed Annuity Option, the lump sum payment alternative is not
available. For a variable Annuity Option, the commutation rate will be the
Assumed Investment Return.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. We will make monthly Annuity
Payments during the joint lifetime of the Annuitant and the Joint Annuitant.
Upon the death of the Annuitant, if the Joint Annuitant is then living, Annuity
Payments will continue to be paid during the remaining lifetime of the Joint
Annuitant at a level of 100%, 75% or 50% of the previous level, as selected.
Monthly Annuity Payments cease with the final Annuity Payment due prior to the
last survivor's death.
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15,
OR 20 YEARS GUARANTEED. We will make monthly Annuity Payments during the joint
lifetime of the Annuitant and the Joint Annuitant. Monthly Annuity Payments will
continue to be paid during the remaining lifetime of the Joint Annuitant at 100%
of the previous level. The Company guarantees that if at the last death of the
Annuitant and the Joint Annuitant, there have been less than 60, 120, 180, or
240 monthly Annuity Payments made as selected, monthly Annuity Payments will
continue to be made for the remainder of the guaranteed period. Alternatively,
the Contract Owner may elect to have us make a lump-sum payment equal to the
present value of the guaranteed monthly Annuity Payments remaining, as of the
date proof of the Annuitant's and Joint Annuitant's death is received at the
Service Center, commuted at an appropriate rate as defined below. Proof of death
of the Annuitant and Joint Annuitant and return of this Contract are required
prior to the payment of any commuted values. For a fixed Annuity Option, the
lump sum payment alternative is not available. For a variable Annuity Option,
the commutation rate will be the Assumed Investment Return.
OPTION 5 - REFUND LIFE ANNUITY. We will make monthly Annuity Payments during the
lifetime of the Annuitant ceasing with the last Annuity Payment due prior to the
Annuitant's death. At the Annuitant's death, you may receive a refund. For a
fixed Annuity Option, the amount of the refund will be any excess of the
Adjusted Contract Value applied under this Option over the total of all Annuity
Payments made under this Option. For a variable Annuity Option, the amount of
the refund will depend on the current Investment Option allocation and will be
the sum of refund amounts attributable to each Investment Option. The refund
amount for a given Investment Option is calculated using the following formula:
(1) x {[(2) x (3) x (4)/(5) - [(4) x (6)]}
where:
(1) = Annuity Unit value of that given Investment Option when claim proofs
are received at the Service Center.
(2) = The Adjusted Contract Value on the Income Date.
(3) = Allocation percentage in that given Investment Option (in decimal
form) when claim proofs are received at the Service Center.
(4) = Current number of Annuity Units used in determining each Annuity
Payment attributable to that given Investment Option.
(5) = Dollar value of first Annuity Payment.
(6) = Number of Annuity Payments made since the Income Date.
This calculation will be based upon the allocation of Annuity Units actually
in-force at the time claim proofs are received at the Service Center. There will
be no refund paid if the total refund determined using the above calculations is
less than or equal to zero.
L40517-NY 13
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract and any attached
application, endorsements or riders.
NON-PARTICIPATING IN SURPLUS: This Contract does not share in any distribution
of our profits or surplus.
MINIMUM VALUES: The minimum values for any paid-up annuity, withdrawal value or
death benefit available under the Contract are not less than those required by
the state where the Contract is delivered.
INCONTESTABILITY: We will not contest this Contract from its Issue Date.
MISSTATEMENT OF AGE OR SEX: We may require proof of Age of the Annuitant before
making any life contingent Annuity Payment provided for by this Contract. If the
Age or sex of the Annuitant has been misstated, the amount payable will be the
Adjusted Contract Value would have provided at the true Age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment, and overpayments will be deducted from the future
Annuity Payments until the total is repaid. The annual interest rate to be used
in the calculation of the adjustments for underpayments and overpayments is 5%.
CONTRACT SETTLEMENT: This Contract must be returned to us upon any settlement.
Prior to any settlement as a death claim, due proof of death must be submitted
to us. Any paid-up annuity, cash withdrawal or death benefits that may be
available are not less than the minimum benefits required by statute of the
state in which the Contract is delivered.
REPORTS: We will furnish you with a report showing the number of Accumulation
Units credited to the Contract, the dollar value of each Accumulation Unit, the
Contract Value, and the Adjusted Contract Value, the death benefit, the
available cash withdrawal and any applicable withdrawal charges, transfer fees,
and the contract maintenance charge. This report will be sent to your last known
address.
EVIDENCE OF SURVIVAL: Where any benefits under this Contract are contingent upon
the recipient being alive on a given date, we may require proof satisfactory to
us that the condition has been met.
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under this Contract before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
MODIFICATION OF CONTRACT: This Contract may not be modified by us without your
consent except as may be required by applicable law.
TABLE OF ANNUITY PAYMENT AMOUNTS: Table A below shows the guaranteed amount of
the Annuity Payment for each $1,000 of value applied under a fixed Annuity
Option. Table A is based on an interest rate of 1% guaranteed per year and the
1983(a) Individual Mortality Table with mortality improvement projected 30 years
using Mortality Projection Scale G.
Table B below shows the amount of the first monthly variable Annuity Payment,
based on an Assumed Investment Return of 5%, for each $1,000 of value applied
under a variable Annuity Option.
The amount of such Annuity Payments under Annuity Options 1, 2 and 5 will depend
on the sex and Age of the Annuitant on the Income Date. The amount of such
Annuity Payments under Option 3 and 4 will depend on the Age and sex of the
Annuitant and Joint Annuitant on the Income Date. Any amounts not shown for
Ages, guaranteed periods or other Annuity Options will be provided upon request.
L40517-NY 14
------------------------------------------------------------------------------------------------------------------------------------
TABLE A (OPTIONS 1, 2 AND 5) - GUARANTEED MONTHLY PAYMENT PER $1,000 OF PROCEEDS
------------------------------------------------------------------------------------------------------------------------------------
FIXED PAYOUTS
------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------
AGE OF ANNUITANT OPTION 1 Option 2
------------------------------------------------------------------------------------------------------------------------------------
NEAREST BIRTHDAY 5 YEARS 10 YEARS 15 YEARS 20 YEARS OPTION 5
WHEN FIRST PAYMENT MINIMUM MINIMUM MINIMUM MINIMUM
-----------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
IS MADE M F M F M F M F M F M F
------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
30 2.01 1.88 2.01 1.88 2.01 1.88 2.01 1.88 2.01 1.88 1.95 1.85
31 2.04 1.90 2.04 1.90 2.04 1.90 2.04 1.90 2.03 1.90 1.97 1.87
32 2.07 1.93 2.07 1.93 2.07 1.93 2.07 1.93 2.06 1.93 2.00 1.89
33 2.10 1.95 2.10 1.95 2.10 1.95 2.10 1.95 2.09 1.95 2.02 1.91
34 2.13 1.98 2.13 1.98 2.13 1.98 2.13 1.98 2.12 1.98 2.05 1.93
35 2.16 2.01 2.16 2.01 2.16 2.01 2.16 2.01 2.15 2.00 2.07 1.96
36 2.20 2.04 2.20 2.04 2.20 2.03 2.19 2.03 2.19 2.03 2.10 1.98
37 2.23 2.06 2.23 2.06 2.23 2.06 2.23 2.06 2.22 2.06 2.13 2.01
38 2.27 2.10 2.27 2.10 2.27 2.09 2.26 2.09 2.26 2.09 2.16 2.04
39 2.31 2.13 2.31 2.13 2.31 2.13 2.30 2.12 2.29 2.12 2.19 2.06
40 2.35 2.16 2.35 2.16 2.35 2.16 2.34 2.16 2.33 2.15 2.22 2.09
41 2.39 2.19 2.39 2.19 2.39 2.19 2.38 2.19 2.37 2.19 2.25 2.12
42 2.44 2.23 2.44 2.23 2.43 2.23 2.42 2.23 2.41 2.22 2.29 2.15
43 2.48 2.27 2.48 2.27 2.48 2.27 2.47 2.26 2.45 2.26 2.32 2.18
44 2.53 2.31 2.53 2.31 2.52 2.30 2.51 2.30 2.50 2.29 2.36 2.21
45 2.58 2.35 2.58 2.35 2.57 2.35 2.56 2.34 2.54 2.33 2.40 2.25
46 2.63 2.39 2.63 2.39 2.62 2.39 2.61 2.38 2.59 2.37 2.43 2.28
47 2.69 2.43 2.68 2.43 2.68 2.43 2.66 2.43 2.64 2.42 2.47 2.32
48 2.74 2.48 2.74 2.48 2.73 2.48 2.72 2.47 2.69 2.46 2.51 2.35
49 2.80 2.53 2.80 2.53 2.79 2.52 2.77 2.52 2.74 2.50 2.56 2.39
50 2.87 2.58 2.86 2.58 2.85 2.57 2.83 2.57 2.80 2.55 2.60 2.43
51 2.93 2.63 2.93 2.63 2.91 2.63 2.89 2.62 2.85 2.60 2.65 2.48
52 3.00 2.69 2.99 2.69 2.98 2.68 2.95 2.67 2.91 2.65 2.70 2.52
53 3.07 2.75 3.07 2.74 3.05 2.74 3.02 2.73 2.97 2.71 2.74 2.56
54 3.15 2.81 3.14 2.81 3.12 2.80 3.09 2.78 3.03 2.76 2.80 2.61
55 3.22 2.87 3.22 2.87 3.20 2.86 3.16 2.85 3.09 2.82 2.85 2.66
56 3.31 2.94 3.30 2.94 3.28 2.93 3.23 2.91 3.16 2.88 2.91 2.71
57 3.40 3.01 3.39 3.01 3.36 3.00 3.31 2.98 3.22 2.94 2.96 2.76
58 3.49 3.09 3.48 3.08 3.45 3.07 3.39 3.05 3.29 3.00 3.02 2.82
59 3.59 3.16 3.58 3.16 3.54 3.15 3.48 3.12 3.36 3.07 3.08 2.87
60 3.69 3.25 3.68 3.24 3.64 3.23 3.56 3.20 3.43 3.14 3.15 2.93
61 3.80 3.34 3.79 3.33 3.75 3.31 3.65 3.28 3.50 3.21 3.22 2.99
62 3.92 3.43 3.91 3.43 3.85 3.40 3.75 3.36 3.57 3.28 3.28 3.05
63 4.05 3.53 4.03 3.52 3.97 3.50 3.84 3.45 3.65 3.35 3.36 3.12
64 4.18 3.64 4.16 3.63 4.09 3.60 3.94 3.54 3.72 3.43 3.43 3.19
65 4.33 3.75 4.30 3.74 4.21 3.71 4.04 3.63 3.79 3.51 3.52 3.27
66 4.48 3.87 4.45 3.86 4.35 3.82 4.15 3.73 3.86 3.59 3.60 3.34
67 4.64 4.00 4.61 3.98 4.48 3.94 4.26 3.84 3.93 3.67 3.69 3.42
68 4.82 4.13 4.77 4.12 4.63 4.06 4.36 3.94 4.00 3.74 3.77 3.51
69 5.00 4.28 4.95 4.26 4.78 4.19 4.47 4.05 4.06 3.82 3.87 3.59
70 5.20 4.44 5.14 4.42 4.93 4.33 4.58 4.17 4.12 3.90 3.97 3.69
71 5.41 4.61 5.33 4.58 5.09 4.48 4.69 4.28 4.18 3.98 4.07 3.78
72 5.63 4.79 5.54 4.76 5.26 4.64 4.80 4.40 4.24 4.05 4.18 3.89
73 5.87 4.99 5.76 4.95 5.43 4.80 4.90 4.53 4.29 4.12 4.30 3.99
74 6.12 5.20 5.99 5.15 5.60 4.97 5.01 4.65 4.34 4.18 4.41 4.11
75 6.39 5.43 6.24 5.37 5.78 5.15 5.11 4.77 4.38 4.25 4.54 4.22
76 6.68 5.67 6.50 5.60 5.96 5.34 5.21 4.89 4.42 4.30 4.67 4.35
77 6.98 5.93 6.77 5.84 6.15 5.53 5.30 5.01 4.45 4.35 4.81 4.48
78 7.32 6.22 7.06 6.11 6.34 5.73 5.39 5.12 4.48 4.40 4.95 4.61
79 7.67 6.52 7.36 6.39 6.52 5.94 5.47 5.23 4.51 4.44 5.10 4.76
80 8.05 6.86 7.68 6.69 6.71 6.15 5.54 5.33 4.53 4.48 5.26 4.91
81 8.46 7.22 8.02 7.01 6.89 6.36 5.61 5.43 4.55 4.51 5.43 5.08
82 8.89 7.61 8.37 7.35 7.08 6.57 5.68 5.52 4.56 4.53 5.61 5.25
83 9.36 8.03 8.73 7.71 7.25 6.78 5.74 5.60 4.57 4.55 5.80 5.44
84 9.86 8.49 9.11 8.09 7.42 6.99 5.79 5.67 4.58 4.56 6.01 5.63
85 10.40 8.99 9.50 8.50 7.59 7.19 5.83 5.74 4.58 4.57 6.23 5.85
86 10.98 9.54 9.91 8.92 7.74 7.38 5.87 5.8 4.59 4.58 6.46 6.07
87 11.61 10.13 10.33 9.36 7.89 7.57 5.9 5.85 4.59 4.59 6.72 6.31
88 12.3 10.78 10.77 9.82 8.03 7.75 5.93 5.88 4.59 4.59 6.99 6.57
89 13.03 11.47 11.21 10.29 8.16 7.92 5.94 5.91 4.59 4.59 7.29 6.85
90 13.82 12.22 11.66 10.77 8.29 8.08 5.96 5.94 4.59 4.59 7.59 7.15
------------------------------------------------------------------------------------------------------------------------------------
L40517-NY 15
TABLE A (OPTIONS 3 AND 4) - GUARANTEED MONTHLY PAYMENT PER $1,000 OF PROCEEDS
FIXED PAYOUTS
OPTION 3
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
---------------------------------------------------------------------
30 1.77 1.88 1.95 1.99 2.00 2.01 2.01
40 1.83 2.01 2.17 2.27 2.32 2.34 2.35
50 1.86 2.10 2.36 2.60 2.75 2.83 2.85
60 1.87 2.14 2.49 2.91 3.30 3.55 3.65
70 1.88 2.15 2.55 3.11 3.85 4.56 4.99
80 1.88 2.16 2.57 3.20 4.21 5.65 7.03
90 1.88 2.16 2.58 3.24 4.37 6.42 9.46
---------------------------------------------------------------------
OPTION 4
5 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
---------------------------------------------------------------------
30 1.77 1.88 1.95 1.99 2.00 2.01 2.01
40 1.83 2.01 2.17 2.27 2.32 2.34 2.35
50 1.86 2.10 2.36 2.60 2.75 2.83 2.85
60 1.87 2.14 2.49 2.91 3.30 3.55 3.65
70 1.88 2.15 2.55 3.11 3.85 4.56 4.98
80 1.88 2.16 2.57 3.20 4.21 5.63 6.96
90 1.88 2.16 2.58 3.23 4.37 6.37 9.16
---------------------------------------------------------------------
OPTION 4
10 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
---------------------------------------------------------------------
30 1.77 1.88 1.95 1.99 2.00 2.01 2.01
40 1.83 2.01 2.17 2.27 2.32 2.34 2.35
50 1.86 2.10 2.36 2.60 2.75 2.82 2.85
60 1.87 2.14 2.49 2.91 3.29 3.54 3.63
70 1.88 2.15 2.55 3.11 3.84 4.52 4.87
80 1.88 2.16 2.57 3.20 4.18 5.49 6.47
90 1.88 2.16 2.57 3.22 4.31 6.04 7.75
---------------------------------------------------------------------
OPTION 4
15 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
---------------------------------------------------------------------
30 1.77 1.88 1.95 1.99 2.00 2.01 2.01
40 1.83 2.01 2.17 2.27 2.32 2.34 2.34
50 1.86 2.10 2.36 2.60 2.75 2.81 2.83
60 1.87 2.13 2.49 2.90 3.28 3.50 3.56
70 1.88 2.15 2.54 3.10 3.79 4.37 4.57
80 1.88 2.16 2.56 3.18 4.09 5.07 5.52
90 1.88 2.16 2.57 3.19 4.16 5.32 5.91
---------------------------------------------------------------------
OPTION 4
20 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
---------------------------------------------------------------------
30 1.77 1.88 1.95 1.99 2.00 2.01 2.01
40 1.83 2.01 2.17 2.27 2.31 2.33 2.33
50 1.86 2.10 2.36 2.59 2.74 2.79 2.80
60 1.87 2.13 2.48 2.89 3.24 3.41 3.43
70 1.88 2.15 2.54 3.07 3.68 4.06 4.12
80 1.88 2.15 2.55 3.13 3.88 4.42 4.53
90 1.88 2.15 2.55 3.14 3.90 4.48 4.59
---------------------------------------------------------------------
L40517-NY 16
------------------------------------------------------------------------------------------------------------------------------------
TABLE B (OPTIONS 1, 2 AND 5) - GUARANTEED INITIAL MONTHLY PAYMENT PER
$1,000 OF PROCEEDS VARIABLE PAYOUTS BASED ON 5.00% AIR
------------------------------------------------------------------------------------------------------------------------------------
Age of Option
Annuitant 2
----------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------
Nearest Option 1 5 Years 10 Years 15 Years 20 years Option 5
birthday
When First Minimum Minimum Minimum Minimum
Payment
--------------------------------------- ------------
--------------- -----------------------------------------
Is Made M F M F M F M F M F M F
------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------
30 4.46 4.36 4.46 4.36 4.46 4.35 4.45 4.35 4.45 4.35 4.44 4.35
31 4.48 4.37 4.48 4.37 4.48 4.37 4.47 4.37 4.46 4.36 4.46 4.36
32 4.50 4.39 4.50 4.39 4.50 4.38 4.49 4.38 4.48 4.38 4.48 4.38
33 4.53 4.40 4.52 4.40 4.52 4.40 4.51 4.40 4.50 4.39 4.50 4.39
34 4.55 4.42 4.55 4.42 4.54 4.42 4.54 4.42 4.53 4.41 4.52 4.41
35 4.57 4.44 4.57 4.44 4.57 4.44 4.56 4.43 4.55 4.43 4.55 4.43
36 4.60 4.46 4.60 4.46 4.59 4.46 4.59 4.45 4.57 4.45 4.57 4.44
37 4.63 4.48 4.63 4.48 4.62 4.48 4.61 4.47 4.60 4.47 4.60 4.46
38 4.66 4.50 4.66 4.50 4.65 4.50 4.64 4.49 4.62 4.49 4.62 4.48
39 4.69 4.53 4.69 4.52 4.68 4.52 4.67 4.52 4.65 4.51 4.65 4.51
40 4.72 4.55 4.72 4.55 4.71 4.55 4.70 4.54 4.68 4.53 4.68 4.53
41 4.76 4.58 4.76 4.57 4.75 4.57 4.73 4.56 4.71 4.55 4.71 4.55
42 4.80 4.60 4.79 4.60 4.78 4.60 4.77 4.59 4.74 4.58 4.74 4.58
43 4.84 4.63 4.83 4.63 4.82 4.63 4.80 4.62 4.77 4.61 4.77 4.60
44 4.88 4.66 4.87 4.66 4.86 4.66 4.84 4.65 4.81 4.63 4.81 4.63
45 4.92 4.70 4.92 4.69 4.90 4.69 4.88 4.68 4.84 4.66 4.85 4.66
46 4.97 4.73 4.96 4.73 4.95 4.72 4.92 4.71 4.88 4.69 4.89 4.69
47 5.02 4.77 5.01 4.76 4.99 4.76 4.96 4.74 4.92 4.73 4.93 4.73
48 5.07 4.80 5.06 4.80 5.04 4.79 5.01 4.78 4.96 4.76 4.97 4.76
49 5.12 4.85 5.11 4.84 5.09 4.83 5.05 4.82 5.00 4.79 5.02 4.80
50 5.18 4.89 5.17 4.88 5.14 4.87 5.10 4.86 5.04 4.83 5.06 4.83
51 5.24 4.93 5.23 4.93 5.20 4.92 5.15 4.90 5.09 4.87 5.11 4.87
52 5.30 4.98 5.29 4.98 5.26 4.96 5.21 4.94 5.14 4.91 5.16 4.92
53 5.37 5.03 5.35 5.03 5.32 5.01 5.26 4.99 5.18 4.95 5.22 4.96
54 5.44 5.09 5.42 5.08 5.38 5.07 5.32 5.04 5.23 5.00 5.28 5.01
55 5.51 5.14 5.50 5.14 5.45 5.12 5.38 5.09 5.29 5.04 5.34 5.06
56 5.59 5.21 5.57 5.20 5.53 5.18 5.45 5.14 5.34 5.09 5.40 5.11
57 5.68 5.27 5.66 5.26 5.60 5.24 5.52 5.20 5.39 5.14 5.47 5.17
58 5.77 5.34 5.74 5.33 5.68 5.30 5.59 5.26 5.45 5.19 5.55 5.23
59 5.86 5.41 5.84 5.40 5.77 5.37 5.66 5.32 5.51 5.25 5.62 5.29
60 5.96 5.49 5.94 5.48 5.86 5.45 5.74 5.39 5.56 5.31 5.70 5.36
61 6.07 5.57 6.04 5.56 5.96 5.52 5.82 5.46 5.62 5.36 5.78 5.42
62 6.19 5.66 6.16 5.65 6.06 5.61 5.90 5.53 5.68 5.42 5.87 5.50
63 6.32 5.76 6.28 5.74 6.17 5.69 5.98 5.61 5.74 5.49 5.97 5.58
64 6.45 5.86 6.41 5.84 6.28 5.79 6.07 5.69 5.80 5.55 6.07 5.66
65 6.60 5.97 6.55 5.95 6.40 5.88 6.16 5.77 5.86 5.61 6.17 5.75
66 6.75 6.09 6.70 6.06 6.52 5.99 6.25 5.86 5.91 5.68 6.28 5.84
67 6.92 6.21 6.85 6.18 6.65 6.10 6.34 5.95 5.97 5.74 6.39 5.94
68 7.10 6.35 7.02 6.31 6.79 6.22 6.44 6.05 6.02 5.81 6.51 6.05
69 7.29 6.49 7.19 6.46 6.92 6.34 6.53 6.14 6.08 5.87 6.64 6.16
70 7.49 6.65 7.38 6.61 7.07 6.47 6.62 6.25 6.13 5.94 6.77 6.27
71 7.71 6.82 7.58 6.77 7.22 6.61 6.72 6.35 6.17 6.00 6.91 6.40
72 7.93 7.00 7.78 6.94 7.37 6.76 6.81 6.45 6.22 6.06 7.06 6.54
73 8.18 7.20 8.00 7.13 7.53 6.91 6.90 6.56 6.26 6.12 7.21 6.67
74 8.44 7.42 8.23 7.33 7.69 7.07 6.99 6.67 6.30 6.17 7.38 6.82
75 8.71 7.65 8.47 7.55 7.85 7.24 7.07 6.77 6.33 6.22 7.54 6.98
76 9.01 7.91 8.73 7.78 8.01 7.41 7.16 6.88 6.36 6.27 7.73 7.15
77 9.33 8.18 8.99 8.02 8.18 7.59 7.23 6.98 6.39 6.31 7.92 7.33
78 9.67 8.47 9.28 8.28 8.35 7.78 7.31 7.07 6.42 6.35 8.11 7.51
79 10.03 8.78 9.57 8.56 8.52 7.97 7.38 7.17 6.44 6.38 8.32 7.72
80 10.42 9.12 9.89 8.86 8.68 8.16 7.44 7.26 6.46 6.41 8.54 7.94
81 10.84 9.49 10.21 9.18 8.85 8.35 7.50 7.34 6.47 6.44 8.78 8.16
82 11.29 9.89 10.55 9.51 9.01 8.54 7.56 7.42 6.48 6.46 9.03 8.40
83 11.77 10.33 10.90 9.87 9.17 8.74 7.61 7.49 6.49 6.48 9.28 8.66
84 12.28 10.81 11.26 10.24 9.32 8.92 7.65 7.55 6.50 6.49 9.57 8.92
85 12.83 11.32 11.64 10.64 9.46 9.10 7.69 7.61 6.50 6.50 9.86 9.20
86 13.42 11.88 12.02 11.05 9.60 9.28 7.72 7.66 6.51 6.50 10.16 9.50
87 14.06 12.49 12.42 11.47 9.73 9.44 7.75 7.70 6.51 6.51 10.49 9.82
88 14.76 13.16 12.83 11.91 9.86 9.60 7.77 7.73 6.51 6.51 10.84 10.16
89 15.50 13.87 13.24 12.36 9.98 9.75 7.79 7.76 6.51 6.51 11.22 10.52
90 16.30 14.63 13.66 12.81 10.08 9.89 7.80 7.78 6.51 6.51 11.63 10.92
------------------------------------------------------------------------------------------------------------------------------------
L40517-NY 17
TABLE B (OPTIONS 3 AND 4) - GUARANTEED INITIAL MONTHLY PAYMENT PER $1,000 OF
PROCEEDS VARIABLE PAYOUTS BASED ON 5.00% AIR
OPTION 3
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
-------------------------------------------------------------------
30 4.27 4.33 4.38 4.42 4.44 4.45 4.46
40 4.30 4.41 4.51 4.60 4.66 4.70 4.72
50 4.33 4.47 4.65 4.85 5.00 5.10 5.15
60 4.34 4.51 4.76 5.10 5.46 5.74 5.89
70 4.35 4.53 4.83 5.30 5.96 6.67 7.18
80 4.35 4.54 4.86 5.41 6.34 7.72 9.16
90 4.36 4.55 4.88 5.46 6.54 8.54 11.54
-------------------------------------------------------------------
OPTION 4
5 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
-------------------------------------------------------------------
30 4.27 4.33 4.38 4.42 4.44 4.45 4.46
40 4.30 4.41 4.51 4.60 4.66 4.70 4.72
50 4.33 4.47 4.65 4.85 5.00 5.10 5.15
60 4.34 4.51 4.76 5.10 5.46 5.74 5.88
70 4.35 4.53 4.83 5.30 5.95 6.67 7.16
80 4.35 4.54 4.86 5.41 6.33 7.70 9.04
90 4.36 4.55 4.88 5.46 6.53 8.47 11.16
-------------------------------------------------------------------
OPTION 4
10 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
-------------------------------------------------------------------
30 4.27 4.33 4.38 4.42 4.44 4.45 4.46
40 4.30 4.41 4.51 4.60 4.66 4.70 4.71
50 4.33 4.47 4.65 4.84 5.00 5.10 5.14
60 4.34 4.51 4.76 5.10 5.45 5.72 5.84
70 4.35 4.53 4.83 5.29 5.94 6.60 6.98
80 4.35 4.54 4.86 5.40 6.29 7.50 8.43
90 4.35 4.54 4.87 5.44 6.45 8.04 9.58
-------------------------------------------------------------------
OPTION 4
15 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
-------------------------------------------------------------------
30 4.27 4.33 4.38 4.42 4.44 4.45 4.45
40 4.30 4.41 4.51 4.60 4.66 4.69 4.70
50 4.33 4.47 4.65 4.84 4.99 5.08 5.10
60 4.34 4.51 4.76 5.09 5.43 5.66 5.73
70 4.35 4.53 4.82 5.28 5.88 6.41 6.61
80 4.35 4.54 4.85 5.37 6.16 7.02 7.42
90 4.35 4.54 4.86 5.39 6.24 7.24 7.76
-------------------------------------------------------------------
OPTION 4
20 YEARS MINIMUM
FEMALE AGE 30 40 50 60 70 80 90
MALE AGE
-------------------------------------------------------------------
30 4.27 4.33 4.38 4.41 4.44 4.44 4.45
40 4.30 4.41 4.51 4.60 4.65 4.68 4.68
50 4.33 4.47 4.65 4.84 4.98 5.04 5.04
60 4.34 4.50 4.75 5.07 5.38 5.54 5.56
70 4.35 4.52 4.81 5.24 5.74 6.07 6.13
80 4.35 4.53 4.83 5.30 5.91 6.37 6.46
90 4.35 4.53 4.83 5.31 5.94 6.41 6.51
-------------------------------------------------------------------
L40517-NY 18
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
L40517-NY 19
