AMENDMENTS OR ENDORSEMENTS. IF ANY -2- BP 2010P1 -------------------------------------------------------------------------------- CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: CONTRACT NUMBER: OWNER DATE OF BIRTH: CONTRACT DATE: JOINT OWNER NAME: ISSUE DATE: JOINT OWNER DATE OF BIRTH: ANNUITY PAYOUT DATE: ANNUITANT NAME: PLAN: ANNUITANT DATE OF BIRTH: ASSIGNMENT: ANNUITANT GENDER:
AMENDMENTS OR ENDORSEMENTS if any -------------------------------------------------------------------------------- CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: CONTRACT NUMBER: Xxxx Xxx 123456789
AMENDMENTS OR ENDORSEMENTS. IF ANY -------------------------------------------------------------------------------- VARIABLE ANNUITY CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: Xxxx X Xxx CONTRACT NUMBER: Specimen OWNER DATE OF BIRTH: 10-30-1953 CONTRACT DATE: 6-30-1997
AMENDMENTS OR ENDORSEMENTS if any - 2 - 00-00000-00 BP 602PP1 -------------------------------------------------------------------------------- PARKSTONE TRUST VARIABLE ANNUITY POLICY SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: Xxxx X. Xxx OWNER DATE OF BIRTH: 10-30-1953 JOINT OWNER NAME: Xxxx X. Xxx JOINT OWNER DATE OF BIRTH: 7-18-1981 ANNUITANT NAME: Xxxxx X. Xxx ANNUITANT DATE OF BIRTH: 5-13-1987 ANNUITANT SEX: Female PRIMARY BENEFICIARY NAME: Xxxxx X. Xxx CONTRACT NUMBER: Specimen TRUST ACCT. NUMBER: 04201 CONTRACT DATE: 6-30-1993 ISSUE DATE: 6-30-1993 ANNUITY START DATE: 7-1-2052 PLAN: TSA ASSIGNMENT: This Policy may not be assigned See Assignment Provision of your Policy. CONTINGENT BENEFICIARY NAME: Xxxx X. Xxx -------------------------------------------------------------------------------- INITIAL PURCHASE PAYMENT ............................... $500,000 MINIMUM SUBSEQUENT PURCHASE PAYMENTS ................... $5,000 MORTALITY AND EXPENSE RISK CHARGE ...................... 0.65% Annually ADMINISTRATION CHARGE .................................. 0.05% Annually CONTRACT MAINTENANCE CHARGE ............................ $0 WITHDRAWAL CHARGES: .................................... None FREE SYSTEMATIC WITHDRAWAL AVAILABILITY DATE ........... 7-1-1993 MINIMUM GUARANTEED INTEREST RATE ....................... 3.5% ANNUITY OPTION ......................................... Option 2 SUB-ACCOUNTS: Prime Obligations Bond Equity International Discovery Small Capitalization METHOD FOR DEDUCTIONS: Deductions for any Contract Maintenance Charge, any Transfer Charges, any Premium Taxes collected after the Purchase Payments are applied, and any unallocated partial withdrawals will be made sequentially from the Contract Value. In descending order of the Sub-Accounts listed above, the value of each account will be depleted before the next is charged. The Fixed Account is the last account charged. V6020 A (3-93) SBL 20 -------------------------------------------------------------------------------- DEFINITIONS -------------------------------------------------------------------------------- ACCUMULATION UNIT The Accumulation Unit is a unit of measure. It is used to calculate the Variable Account Contract Value prior to the Annuity Start Date. It is also used to calculate the Variable Account Contract Value after the Annuity Start Date for Annuity Options 5 and 6.
AMENDMENTS OR ENDORSEMENTS if any -2- BP 6023P1 -------------------------------------------------------------------------------- VARIABLE ANNUITY CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER: ABC Employer CONTRACT NUMBER: Specimen CONTRACT DATE: 6-30-1996 ASSIGNMENT: This Policy may not be assigned. See Assignment Provision of your Policy. -------------------------------------------------------------------------------- INITIAL PURCHASE PAYMENT ................ $500 MINIMUM SUBSEQUENT PURCHASE PAYMENTS .... $25 MINIMUM SYSTEMATIC WITHDRAWAL ........... $25 MAXIMUM PARTICIPANT AGE ................. 90
AMENDMENTS OR ENDORSEMENTS if any -------------------------------------------------------------------------------- CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: Xxxx X. Xxx CONTRACT NUMBER: Specimen
AMENDMENTS OR ENDORSEMENTS. IF ANY -2- BP 2010Q1 -------------------------------------------------------------------------------- CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: CONTRACT NUMBER: OWNER DATE OF BIRTH: CONTRACT DATE: JOINT OWNER NAME: ISSUE DATE: JOINT OWNER DATE OF BIRTH: ANNUITY PAYOUT DATE: ANNUITANT NAME: PLAN: ANNUITANT DATE OF BIRTH: ASSIGNMENT: ANNUITANT GENDER: SECONDARY BENEFICIARY NAME: See Application or subsequent change form PRIMARY BENEFICIARY NAME: -------------------------------------------------------------------------------- INITIAL PURCHASE PAYMENT ....................
AMENDMENTS OR ENDORSEMENTS if any -2- -------------------------------------------------------------------------------- VARIFLEX LS VARIABLE ANNUITY CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: Xxxx X. Xxx CONTRACT NUMBER: Specimen OWNER DATE OF BIRTH: 10-30-1953 CONTRACT DATE: 6-30-1993 JOINT OWNER NAME: Xxxx X. Xxx ISSUE DATE: 6-30-1993 JOINT OWNER DATE OF BIRTH: 7-18-1981 ANNUITY START DATE: 7-1-2025* ANNUITANT NAME: Xxxxx X. Xxx PLAN: Non-Qualified ANNUITANT DATE OF BIRTH: 5-13-1987 ASSIGNMENT: This policy may be assigned. See Assignment Provision of your Policy.
AMENDMENTS OR ENDORSEMENTS if any -------------------------------------------------------------------------------- CONTRACT SPECIFICATIONS -------------------------------------------------------------------------------- OWNER NAME: IBEW Local Unions Savings & CONTRACT NUMBER: 9000000005 Retirement Plan & Trust CONTRACT DATE: 7-01-1999 PLAN: Non-Qualified ISSUE STATE: Kansas -------------------------------------------------------------------------------- INITIAL PURCHASE PAYMENT............................ $108,351,926 MINIMUM CONTRACT VALUE.............................. $100,000 SEPARATE ACCOUNT.................................... Variable Annuity Account XI
AMENDMENTS OR ENDORSEMENTS. IF ANY -------------------------------------------------------------------------------- DEFINITIONS (Continued) -------------------------------------------------------------------------------- SEPARATE ACCOUNT Variable Annuity Account VIII (the "Separate Account") is a separate account established and maintained by the Company under Kansas law. The Separate Account is registered with the Securities and Exchange Commission under the Investment Company Act of 1940 as a Unit Investment Trust. It was established by the Company to support variable annuity contracts. The Company owns the assets of the Separate Account and maintains them apart from the assets of its general account and its other separate accounts. The assets held in the Separate Account equal to the reserves and other Contract liabilities with respect to the Separate Account may not be charged with liabilities arising from any other business the Company may conduct. Income and realized and unrealized gains and losses from assets in the Separate Account are credited to, or charged against, the Separate Account without regard to the income, gains or losses from the Company's general account or its other separate accounts. The Separate Account is divided into Subaccounts shown on page 3. Income and realized and unrealized gains and losses from assets in each Subaccount are credited to, or charged against, the Subaccount without regard to income, gains or losses in the other Subaccounts. The Company has the right to transfer to its general account any assets of the Separate Account that are in excess of the reserves and other Contract liabilities with respect to the Separate Account. The value of the assets in the Separate Account on each Valuation Date are determined at the end of each Valuation Date.
