XXXX XXXXXXX LIFE INSURANCE
COMPANY OF NEW YORK [XXXX XXXXXXX(R) LOGO]
HOME OFFICE ANNUITY SERVICE OFFICE
[000 Xxxxxx Xxxx Xxxxx, 0xx Floor [P.O. Box 55230
Valhalla, NY 10595] Boston, MA 02205-5230
0-000-000-0000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
WE AGREE to pay the benefits of this Contract in accordance with its terms.
THIS CONTRACT is issued in consideration of the Payments.
TEN DAY RIGHT TO REVIEW
The Owner may cancel the Contract by returning it to our Annuity Service Office
or agent at any time within 10 days after receipt of the Contract. Within 7 days
of delivery of the Contract to us, we will pay to the Owner an amount equal to
the sum of (i) and (ii), where (i) is the difference between the payments made,
including any fees and deductions, and the amounts, if any, allocated to the
Separate Account under the Contract, (ii) is the Contract Value attributable to
the amounts, if any, allocated to the separate account under the Contract. The
Contract Value will be computed at the end of the Valuation Period during which
the Contract is delivered to us.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this 10 day period, we will return the greater of (i) Contract
Value computed at the end of the Valuation Period during which the Contract is
received by us or (ii) sum of all Payments.
The smallest annual rate of investment return which is required to be earned on
the assets of the separate account so that the dollar amount of variable annuity
payments will not decrease is 4.04%. Explicit annual charges against the assets
of the separate account are as follows:
Contract Asset Fee Charge: Not greater than 0.99%
SIGNED FOR THE COMPANY at its Home Office, Valhalla, New York, on the Contract
Date.
DETAILS OF VARIABLE ACCOUNT PROVISIONS ON PAGE 6.1
DETAILS OF FIXED ACCOUNT PROVISIONS ON PAGE 7.1
/s/ Xxxxx X. Xxxxxxxxx /s/ Xxxxxxx Xxxxx
------------------------------------- ----------------------------------------
President Secretary
Flexible Payment Deferred Combination Fixed* and Variable Annuity
Non-Participating
ANNUITY PAYMENTS, DEATH BENEFITS, SURRENDER VALUES, AND OTHER CONTRACT VALUES
PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE
ACCOUNT, ARE VARIABLE, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE
FLUCTUATIONS IN THE NET INVESTMENT FACTOR, AS APPLICABLE, AND ARE NOT GUARANTEED
AS TO FIXED DOLLAR AMOUNT, UNLESS OTHERWISE SPECIFIED.
* FIXED ACCOUNT(S) MAY NOT BE AVAILABLE AT THIS TIME. PLEASE REVIEW AVAILABLE
INVESTMENT OPTIONS PAGE FOR DETAILS.
INTRODUCTION
This is a flexible payment deferred combination fixed and variable annuity
contract. This Contract provides that prior to the Maturity Date, the Contract
Value will accumulate on either a fixed or variable basis or a combination of
both. After the Maturity Date, annuity payments may be either fixed or variable,
or a combination of fixed and variable.
The variable portion of the Contract will vary with the investment performance
of your Investment Account. The fixed portion of the Contract will accumulate
based on interest rates guaranteed by the Company for the period selected.
If you select annuity payments on a variable basis, the payment amount will vary
with the investment performance of the Variable Account.
You must allocate Payments among one or more Investment Options. The Investment
Options are identified on the Specifications Page.
TABLE OF CONTENTS PAGE
----------------- ----
SPECIFICATIONS PAGE ..................................................... S.1
PART 1 - DEFINITIONS ................................................... 1.1
PART 2 - GENERAL PROVISIONS ............................................ 2.1
PART 3 - OWNERSHIP ..................................................... 3.1
PART 4 - BENEFITS ...................................................... 4.1
PART 5 - PAYMENTS ...................................................... 5.1
PART 6 - VARIABLE ACCOUNT PROVISIONS ................................... 6.1
PART 7 - FIXED ACCOUNT PROVISIONS ...................................... 7.1
PART 8 - ANNUITY PROVISIONS ............................................ 8.1
PART 9 - TRANSFERS ..................................................... 9.1
PART 10 - WITHDRAWAL PROVISIONS ......................................... 10.1
PART 11 - FEES AND DEDUCTIONS ........................................... 11.1
PART 12 - LOAN PROVISIONS ............................................... 12.1
PART 13 - PAYMENT OF CONTRACT BENEFITS .................................. 13.1
TABLE OF ANNUITY PAYMENT RATES .......................................... T.1
SPECIFICATIONS PAGE
TYPE OF CONTRACT: [QUALIFIED]
CONTRACT DATE: [07/25/1997]
INITIAL PAYMENT: [$3,500.00]
OWNER: [COOKIE DOUGH]
CO-OWNER [____________]
ANNUITANT: [COOKIE DOUGH]
CO-ANNUITANT: [____________]
MATURITY DATE: [07/25/2027]
CONTRACT NUMBER: [000000005]
GOVERNING LAW: NY
OWNER'S AGE [46]
CO-OWNER'S AGE [__]
ANNUITANT'S AGE: [46]
CO-ANNUITANT'S AGE [__]
ANNUITY OPTION: [Life 10-Year Certain]
PLAN Venture Freedom
MINIMUM GUARANTEED INTEREST RATE [3.0%] per year
ON FIXED ACCOUNTS
ASSET FEES
CONTRACT ASSET FEE 0.99% years [1+]
[RIDER ASSET FEE(S)] [RIDER FEE PERCENTAGE]
[Enhanced Death Benefit Marketing Name] [0.20%]
TOTAL ASSET FEE PERCENTAGE [0.99%] years [1+]
(CONTRACT ASSET FEE PLUS RIDER FEE(S)):
ANNUAL FEE [$30.00(1)]
[(1) Prior to the Maturity Date,
when the Annual
Administration Fee is to be
assessed, if the sum of all
your Investment Accounts
exceeds $100,000, the
Annual Administration Fee
will be waived.]
[OTHER FEES]
[RIDER] [RIDER FEE PERCENTAGE]
[Guaranteed Minimum Withdrawal Benefit [0.40%]
Marketing Name]
MINIMUM DEATH BENEFIT The sum of all Payments made, less any amount deducted
in connection with partial withdrawals.
For purposes of calculating the Minimum Death Benefit,
the amount deducted in connection with partial
withdrawals will be equal to (i) times (ii), where (i)
is equal to the Minimum Death Benefit prior to the
withdrawal, and (ii) is equal to the partial withdrawal
amount divided by the Contract Value prior to the
partial withdrawal.
[S.1]
PAYMENT LIMITS The initial Payment is shown above. Additional Payments
may be made at any time. However, each additional
Payment must be at least $30. If a Payment would cause
the Contract Value to exceed $1,000,000, or the Contract
Value already exceeds $1,000,000, no additional Payments
will be accepted without our prior approval.
TRANSFER CHARGES AND We reserve the right to impose, upon notice, a
LIMITATIONS - BEFORE transaction charge for transfers. In the event a charge
MATURITY DATE is imposed, it will not exceed the lesser of $25.00 or
2% of the amount of each transfer.
We reserve the right to limit, upon notice, the amount
of the transfer and the maximum number of transfers that
can be made.
You must transfer at least $300 or, if less, the entire
amount in the Investment Account each time you make a
transfer. If, after the transfer, the amount remaining
in the Investment Account from which the transfer is
made is less than $100, then we will transfer the entire
amount instead of the requested amount.
Should we limit the maximum number of transfers that can
be made per Contract Year, that limit will be no less
than one per month or six at any time within a Contract
Year
TRANSFER CHARGES AND We reserve the right to limit, upon notice, the maximum
LIMITATIONS - ON OR number of transfers you may make per Contract Year after
AFTER MATURITY DATE variable annuity payments have begun.
If we limit the maximum number of transfers that can be
made after variable annuity payments have begun, the
maximum number of transfers you may make per Contract
Year shall be no less than 4.
LIMITATIONS ON AMOUNT Any withdrawal from an Investment Account must be at
OF PARTIAL least $300 or the entire balance of the Investment
WITHDRAWALS Account, if less. If after the withdrawal, the amount
remaining in that Investment Account is less than $100,
then we will consider the withdrawal request to be a
request for withdrawal of the entire amount held in the
Investment Account. If a partial withdrawal would reduce
the Contract Value to less than $300, or if the amount
requested is greater than or equal to the amount
available as a total withdrawal, then we will treat the
partial withdrawal request as a total withdrawal of the
Contract Value.
[S.2]
TABLE OF WITHDRAWAL CHARGES
Number of Complete Years
Payment has been in Withdrawal Charge
Contract Percentage
------------------------ -----------------
0 6%
1 6%
2 5%
3 4%
4 3%
5 2%
6 1%
7+ 0%
Withdrawal charges are applied to liquidated purchase
payments. Purchase payments are liquidated when the
amount of a withdrawal during a Contract Year exceeds
the free withdrawal amount for that year. The amount of
the payments liquidated equals the amount of the
withdrawal in excess of the free withdrawal amount. A
total withdrawal liquidates all unliquidated purchase
payments.
FREE WITHDRAWAL The Free Withdrawal Amount is defined as the greater of:
AMOUNT
(a) the excess of the Contract Value on the date
of withdrawal over the unliquidated Payments,
or
(b) the excess of (i) over (ii), where:
(i) equals 10% times the total Payments; and
(ii) equals 100% of all prior partial
withdrawals, in that Contract Year.
[S.3]
SPECIFICATIONS PAGE (CONTINUED)
[ENHANCED DEATH BENEFIT RIDER MARKETING NAME]
[RIDER DATE:] [07/25/1997]
[RIDER FEE PERCENTAGE:] [0.20%]
[GUARANTEED MINIMUM WITHDRAWAL BENEFIT RIDER MARKETING NAME]
[RIDER DATE] [07/25/1997]
[RIDER FEE PERCENTAGE] [0.40%]
OWNER: [COOKIE DOUGH] OWNER'S AGE [46]
CO-OWNER [____________] CO-OWNER'S AGE [__]
ANNUITANT: [COOKIE DOUGH] ANNUITANT'S AGE: [46]
CO-ANNUITANT: [____________] CO-ANNUITANT'S AGE [__]
BENEFICIAIRY SEE ATTACHED LIST
[S.4]
INITIAL ALLOCATION OF NET PAYMENT: (SEE REVERSE FOR ALL AVAILABLE OPTIONS)
FIXED INVESTMENT OPTIONS:
INITIAL INITIAL GUARANTEE
INTEREST RATE PERIOD EXPIRES
------------- -----------------
[6 MONTH DCA] [25.00%] [3.00%] [01/25/1998]
[12 MONTH DCA] [00.00%] [3.00%] [07/25/1998]
THE INTEREST RATE FOR THE 6 [OR 12] MONTH DCA FIXED ACCOUNT OPTION MAY CONTAIN
AN ENHANCEMENT THAT MAY NOT BE PROVIDED IN SUBSEQUENT GUARANTEE PERIODS [OR IN
THE ONE YEAR FIXED ACCOUNT]
VARIABLE INVESTMENT OPTIONS:
[AMERICAN ASSET ALLOCATION] [75.00%]
TOTAL 100.00%
[THIS PLAN IS INTENDED TO QUALIFY UNDER THE INTERNAL REVENUE CODE FOR
TAX-FAVORED STATUS. LANGUAGE CONTAINED IN THIS CONTRACT REFERRING TO FEDERAL TAX
STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. PLEASE SEEK THE ADVICE OF
YOUR OWN TAX ADVISOR REGARDING YOUR INDIVIDUAL TAX TREATMENT.]
[S.5]
AVAILABLE INVESTMENT OPTIONS
[FIXED INVESTMENT OPTIONS]
6 Month DCA 6 Month DCA Not Currently Available
NO6MODCA03
One Year 1 Year Fixed Not Currently Available
NO1YRFXD03
12 Month DCA 12 Month DCA Not Currently Available
NO12MOCDA03
[VARIABLE INVESTMENT OPTIONS]
[American Asset Allocation]
[Xxxxxxxx Xxxxxxxxx Founding Allocation]
[Money Market]
[Value & Restructuring]
[American Growth]
[International Opportunities]
[International Value]
[Strategic Bond]
[Global Bond]
LIFESTYLE PORTFOLIOS:
[Aggressive]
[Growth]
[Balanced]
[Moderate]
[Conservative]
[S.6]
BENEFICIARY INFORMATION
[Play Dough]
[S.7]
PART 1 DEFINITIONS
------ -----------
WE AND YOU "We", "us" and "our" means Xxxx Xxxxxxx Life
Insurance Company of New York. "You" or "your" means
the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the
value of the variable portion of this Contract
before the Maturity Date.
ANNUITANT Any individual person or persons whose life is used
to determine the duration of annuity payments
involving life contingencies. The Annuitant is as
designated on the Specifications Page, unless changed.
ANNUITY OPTION The method selected by you for annuity payments made
by us.
ANNUITY SERVICE OFFICE Any office designated by us for the receipt of
Payments and processing of Owner requests.
ANNUITY UNIT A unit of measure that is used after the Maturity
Date to calculate Variable Annuity payments.
BENEFICIARY The person, persons or entity to whom certain
benefits are payable following the death of an
Owner, or in certain circumstances, an Annuitant.
CONTRACT ANNIVERSARY The anniversary of the Contract Date.
CONTRACT DATE The date of issue of this Contract as designated on
the Specifications Page.
CONTRACT VALUE The total of your Investment Account Values and, if
applicable, any amount in the Loan Account
attributable to your Contract.
CONTRACT YEAR The period of twelve consecutive months beginning on
the Contract Date or any anniversary thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled
to receive the Contract proceeds if all
Beneficiaries die before the annuitant dies.
DEBT Any amounts in the Loan Account attributable to your
Contract plus any accrued loan interest on that
amount. The loan provision is only available to
certain Qualified Contracts.
DESIGNATED BENEFICIARY For purposes of section 72(s) if the Internal
Revenue Code, the "designated beneficiary" under the
contract shall be the individual who is entitled to
receive the amounts payable on death of an Owner, or
if any Owner is not an individual, on any change in,
or death of, an Annuitant.
ENDORSEMENT An Endorsement modifies the contract to which it is
attached. Endorsements must be signed by an officer
of the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are
predetermined and guaranteed as to dollar amount.
GENERAL ACCOUNT All the assets of Xxxx Xxxxxxx Life Insurance
Company of New York other than assets in separate
accounts.
INTERNAL REVENUE CODE The Internal Revenue Code of 1986, as amended from
(IRC) time to time, and any successor statute of similar
purposes.
INVESTMENT ACCOUNT An account established by us which represents your
interest in an Investment Option prior to the
Maturity Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment
Account.
1.1
INVESTMENT OPTIONS The Investment Options can be either fixed or
variable. The Investment Options available under
this Contract are shown on the Specifications Page.
LOAN ACCOUNT The portion of the General Account that is used for
collateral when a loan is taken.
MATURITY DATE The date on which annuity benefits commence. It is
the date specified on the Specifications Page,
unless changed.
NET PAYMENT The Payment less the amount of premium tax, if any,
deducted from the Payment.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified Plans.
OWNER
The person, persons or entity entitled to the
ownership rights under this Contract. The Owner is
as designated on the Specifications Page, unless
changed.
PORTFOLIO OR TRUST A separate portfolio of Xxxx Xxxxxxx Investment
PORTFOLIO Trust, a mutual fund in which the Variable Account
invests, or a portfolio of any other mutual fund in
which the Variable Account invests.
PAYMENT An amount paid to us by you as consideration for the
benefits provided by this Contract.
RIDER A rider provides an optional benefit, which may
result in an additional charge to the Contract. A
rider supplements the contract to which it is
attached. Riders must be signed by an officer of the
Company in order to be effective.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax
treatment under sections 401, 403, 408 or 457, of
the Internal Revenue Code of 1986, as amended.
SEPARATE ACCOUNT A segregated account of Xxxx Xxxxxxx Life Insurance
Company of New York that is not commingled with our
general assets and obligations.
SUB-ACCOUNT(S) One or more of the Sub-Accounts of the Variable
Account. Each Sub-Account is invested in shares of a
different Trust Portfolio.
VALUATION DATE Any date on which the New York Stock Exchange is
open for business and the net asset value of a Trust
Portfolio is determined.
VALUATION PERIOD Any period from one Valuation Date to the next,
measured from the time on each such date that the
net asset value of each Portfolio is determined.
VARIABLE ACCOUNT Xxxx Xxxxxxx Life Insurance Company of New York
Separate Account A.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount; and
(2) vary in relation to the investment experience of
one or more specified variable Sub-Accounts.
1.2
PART 2 GENERAL PROVISIONS
------ ------------------
ENTIRE CONTRACT The entire Contract consists of this Contract,
Endorsements and Riders, if any, and the
application, if one is attached to this Contract.
Only the President, a Vice President, or the
Secretary of the Company has authority to agree on
our behalf to any alteration of the Contract or to
any waiver of our rights or requirements. The
change or waiver must be in writing.
The benefits and values available under this
Contract are not less than the minimum required by
any statute of the state in which this Contract is
delivered. We have filed a detailed statement of
the method used to calculate the benefits and
values with the Department of Insurance in the
state in which this Contract is delivered, if
required by law.
MODIFICATION We will not change or modify this Contract without
your consent except as may be required to make it
conform to any applicable law or regulation or any
ruling issued by a government agency.
BENEFICIARY The Beneficiary is as designated on the
Specifications Page, unless changed. However, if
there is a surviving Owner, that person will be
treated as the Beneficiary. If no such
Beneficiary is living, the Beneficiary is the
"Contingent Beneficiary". If no Beneficiary or
Contingent Beneficiary is living, the Beneficiary
is the estate of the deceased Owner.
CHANGE IN MATURITY DATE Prior to the Maturity Date, you may change the
Maturity Date by written request at least one
month before both the previously specified
Maturity Date and the new Maturity Date. Once
elected, the new Maturity Date will become the
Maturity Date. The maximum Maturity Date will be
the later of age 90 or the end of the 10th
Contract Year. Any extension of the Maturity Date
will be subject to the laws and regulations then
in effect and our prior approval.
ASSIGNMENT You may assign this Contract at any time prior to
the Maturity Date. No assignment will be binding
on us unless it is written in a form acceptable to
us and received at our Annuity Service Office. We
will not be liable for any payments made or
actions we take before the assignment is accepted
by us. An absolute assignment will revoke the
interest of any revocable Beneficiary. We will
not be responsible for the validity of any
assignment.
CLAIMS OF CREDITORS To the extent permitted by law, no benefits
payable under this Contract will be subject to the
claims of your, the Beneficiary's, or the
Annuitant's creditors.
MISSTATEMENT AND PROOF We may require proof of age, sex or survival of
OF AGE, SEX OR SURVIVAL 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 which the Payments would have provided for
the correct age and sex. If we have made
incorrect annuity payments, the amount of any
underpayment, adjusted with interest at 3% per
annum, will be paid immediately. The amount of
any overpayment will be deducted from future
annuity payments without adjustment for interest.
2.1
ADDITION, DELETION OR We reserve the right, subject to prior approval of
SUBSTITUTION OF the New York Superintendent of Insurance and in
INVESTMENT compliance with applicable law, to make additions
OPTIONS to, deletions from, or substitutions for the
Portfolio shares that are held by the Variable
Account or that the Variable Account may
purchase. We reserve the right to eliminate the
shares of any of the eligible Portfolios and to
substitute shares of another Portfolio of the
Trust, or of another open-end registered
investment company, if the shares of any 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 Variable Account. We
will not substitute any shares attributable to
your interest in a Sub-Account 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 Variable Account from
purchasing other securities for other series or
classes of contracts, or from effecting a
conversion between shares of another open-end
investment company.
We reserve the right, subject to prior approval of
the New York Superintendent of Insurance and in
compliance with applicable law, to establish
additional Sub-Accounts which would invest in
shares of a new Portfolio of the Trust or in
shares of another open-end investment company. We
also reserve the right to eliminate existing
Sub-Accounts, to combine Sub-Accounts or to
transfer assets in a Sub-Account to another
Separate Account established by us or an
affiliated company. In the event of any such
substitution or change, we may, by appropriate
endorsement, make such changes in this and other
Contracts as may be necessary or appropriate to
reflect such substitutions or change. If deemed
by us to be in the best interests of persons
having voting rights under the Contracts, the
Variable Account may be operated as a management
company under the Investment Company Act of 1940
or it may be de-registered under such Act in the
event such registration is no longer required.
NON-PARTICIPATING Your Contract is non-participating and will not
share in our profits or surplus earnings. We will
pay no dividends on your Contract.
REPORTS We will send you reports containing information
required by the Investment Company Act of 1940 and
applicable state law in the time periods required
by such laws.
INSULATION The portion of the assets of the Variable Account
equal to the reserves and other contract
liabilities with respect to such account are not
chargeable with liabilities arising out of any
other business we may conduct. Moreover, the
income, gains and losses, realized or unrealized,
from assets allocated to the Variable Account
shall be credited to or charged against such
account without regard to our other income, gains
or losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets
with a value at least equal to the amounts
accumulated in accordance with the terms of the
applicable agreements with respect to the Separate
Account, and the reserves for annuities, in the
course of payment that vary with the investment
experience of the Separate Account.
CURRENCY AND PLACE OF All payments made to or by us shall be made in the
PAYMENTS lawful currency of the United States of America at
the Annuity Service Office or elsewhere if we
consent.
NOTICES AND ELECTIONS To be effective, all notices and elections you
make under this Contract must be in writing,
signed by you and received by us at the Annuity
Service Office. Unless otherwise provided in this
Contract, all notices, requests and elections will
be effective when received by us at our Annuity
Service Office, complete with all necessary
information and your signature.
GOVERNING LAW This Contract will be governed by the laws of the
jurisdiction indicated on the Specifications Page.
2.2
SECTION 72(S) The provisions of this Contract shall be
interpreted so as to comply with the requirements
of Section 72(s) of the Internal Revenue Code.
2.3
PART 3 OWNERSHIP
------ ---------
GENERAL Before the Maturity Date, the Owner of this
Contract shall be the person, persons or entity
designated on the Specifications Page or the
latest change filed with us. On the Maturity Date
the Annuitant becomes the Owner of this Contract.
If amounts become payable to the Beneficiary under
this Contract, the Beneficiary becomes the Owner
of this Contract.
CHANGE OF OWNER, Subject to the rights of an irrevocable
ANNUITANT, BENEFICIARY Beneficiary, you may change the Owner, Annuitant,
or Beneficiary by written request in a form
acceptable to us and which is received at our
Annuity Service Office. The Annuitant may not be
changed after the Maturity Date. You need not
send us the Contract unless we request it. Any
change must be approved by us. If approved, any
change of Owner, Annuitant, or Beneficiary will
take effect on the date the request is signed. We
will not be liable for any payments or actions we
take before the change is approved.
The substitution or addition of any Owner may
result in the resetting of the Death Benefit to an
amount equal to the Contract Value as of the date
of such change. For purposes of subsequent
calculations of the Death Benefit, described in
Part 4, Benefits, Death Benefit Before Maturity
Date, the Contract Value on the date of the change
will be treated as a Payment made on that date. In
addition, all anniversary values, all Payments
made and all amounts deducted in connection with
partial withdrawals prior to the date of the
change of Owner will not be considered in the
determination of the Death Benefit. This
paragraph will not apply if (a) the individual
whose death will cause the Death Benefit to be
paid is the same after the change of Owner, or (b)
if Ownership is transferred to the Owner's spouse.
If any Annuitant is changed and any Owner is not
an individual, the entire interest in the Contract
must be distributed to the Owner within five years
of the change.
3.1
PART 4 BENEFITS
------ --------
ANNUITY BENEFITS We will pay a monthly income to the Annuitant, if
living, on the Maturity Date. Payments can be
fixed or variable, or a combination of fixed and
variable. Annuity benefits will commence on the
Maturity Date and continue for the period of time
provided for under the Annuity Option indicated on
the Specifications Page. On or before to the
Maturity Date, you may change the Annuity Option.
You may select a Fixed or Variable Annuity.
Unless you indicate otherwise, we will provide
either variable or fixed, or a combination
variable and fixed annuity payments in proportion
to the Investment Account Value of each Investment
Option at the Maturity Date. Once annuity payments
commence, the Annuity Option may not be changed.
The method used to calculate the amount of the
initial and subsequent payments is described under
the Part 8, Annuity Provisions, of this Contract.
We may pay the Contract Value, less Debt, on the
Maturity Date in one lump sum if the monthly
income is less than $20.
DEATH BENEFIT BEFORE A Death Benefit will be determined as of the date
MATURITY DATE on which written notice and proof of death and all
required claim forms are received at the Company's
Annuity Service Office as follows:
The Death Benefit will be determined as the
greater of the Contract Value or the Minimum Death
Benefit described on the Specifications Page.
If there is any Debt, the Death Benefit equals the
amount described above less the Debt under the
Contract.
We will permit the Owner to limit the Death
Benefit option(s) to be offered any named
Beneficiary, if the Owner provides written notice
to the Company prior to death and the desired
option(s) is one provided for in this Contract.
DEATH OF ANNUITANT: On the death of the last
surviving Annuitant, the Owner becomes the new
Annuitant, if the Owner is an individual. If any
Owner is not an individual the death of any
Annuitant is treated as the death of an Owner and
the Death Benefit will be determined by
substituting the Annuitant for the Owner as
described below.
DEATH OF OWNER: We will pay the Death Benefit to
the Beneficiary if any Owner dies prior to the
Maturity Date. The Death Benefit may be taken in
one sum immediately, in which case the Contract
will terminate. If the Death Benefit is not taken
in one sum immediately, the Contract will continue
subject to the following provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit over
the Contract Value will be allocated to and
among the Investment Accounts in proportion
to their values as of the date on which the
Death Benefit is determined.
(c) No additional Payments may be applied to the
Contract.
(d) If the Beneficiary is not the deceased
Owner's spouse, the entire interest in the
Contract must be distributed under one of the
following options:
(i) The entire interest in the Contract must
be distributed over the life of the
Beneficiary, or over a period not
extending beyond the life expectancy of
the Beneficiary, with distributions
beginning within one year of the Owner's
death; or
4.1
(ii)the entire interest in the Contract must
be distributed within 5 years of the
Owner's Death.
If the Beneficiary dies before the
distributions required by (i) or (ii) are
complete, the entire remaining Contract Value
must be distributed in a lump sum immediately.
e) If the Beneficiary is the deceased Owner's
spouse, the Contract will continue with the
surviving spouse as the new Owner. The
surviving spouse may name a new Beneficiary
(and, if no Beneficiary is so named, the
surviving spouse's estate will be the
Beneficiary).
(f) Withdrawal Charges will be waived on any
withdrawals.
If there is more than one Beneficiary, the
foregoing provisions will independently apply to
each Beneficiary, to the extent of that
Beneficiary's share.
DEATH BENEFIT ON OR If annuity payments have been selected based on an
AFTER MATURITY DATE Annuity Option providing for payments for a
guaranteed period, and the Annuitant dies on or
after the Maturity Date, we will make the
remaining guaranteed payments to the Beneficiary.
Any remaining payments will be made as rapidly as
under the method of distribution being used as of
the date of the Annuitant's death. If no
Beneficiary is living, we will commute any unpaid
guaranteed payments to a single sum (on the basis
of the interest rate used in determining the
payments) and pay that single sum to the estate of
the last to die of the Annuitant and the
Beneficiary.
PROOF OF DEATH Proof of death is required upon the death of the
Annuitant or the Owner. Proof of death is one of
the following received at the Annuity Service
Office:
(a) A certified copy of a death certificate.
(b) A certified copy of a decree of a court of
competent jurisdiction as to the finding of
death.
(c) Any other proof satisfactory to us.
4.2
PART 5 PAYMENTS
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GENERAL All Payments under this Contract are payable at
our Annuity Service Office or such other place as
we may designate. Payment Limits are identified
on the Specifications Page.
NONPAYMENT OF PAYMENTS If, prior to the Maturity Date, no Payments have
FOR THREE YEARS been made for three consecutive Contract Years,
and if both:
(a) the total Payments made, less any partial
withdrawals, are less then $2,000; and
(b) the Contract Value at the end of such three
year period is less than $2,000;
We may cancel this Contract and pay you the
Contract Value (measured as of the Valuation
Period during which the cancellation occurs), less
the Debt and Annual Administration Fee. We will
provide you with 31 days prior written notice
before canceling the Contract.
ALLOCATION OF NET When we receive Payments, the Net Payments will be
PAYMENTS allocated among Investment Options in accordance
with the allocation percentages shown on the
Specifications Page. You may change the
allocation of subsequent Net Payments at any time,
without charge, by giving us written notice in a
form acceptable to us.
5.1