1
EXHIBIT 4(c)
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company
0 Xxxxxx Xxxxx
Xxxx Xxxxx, Xxxxxxxx 00000-0000
RIGHT TO CANCEL - FREE LOOK PROVISION - At any time within 10 days of receiving
this contract you may return it to us or to the agent through whom it was
purchased. Immediately upon our receipt, this contract will be voided as if it
had never been in force. All purchase payments allocated to Guarantee Periods
plus the Fixed Account plus the Separate Account contract value computed at the
end of the valuation period following our receipt of this contract will then be
refunded within ten days.
We agree to pay an annuity to the Annuitant provided the Annuitant is living and
this contract is in force on the Annuity Date.
We further agree to pay the death benefit prior to the Annuity Date upon the
death of the Owner or, in certain circumstances, the death of the Annuitant.
Payment will be made upon our receipt of due proof of death and the return of
this contract.
This contract is issued in consideration of the attached application and payment
of the initial purchase payment.
The provisions on this cover and the pages that follow are part of this
contract.
Signed for Xxxxxx Investor Life Insurance Company at its home office in Long
Grove, Illinois.
Xxxxx X. Xxxxxxx Xxxx X. Xxxxxx
Secretary President
INDIVIDUAL FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED
ANNUITY
NON-PARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE SUBACCOUNTS ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR
AMOUNT. WITHDRAWALS AND TRANSFERS FROM THE GUARANTEED PERIOD VALUE BEFORE THE
END OF THE GUARANTEED PERIOD ARE SUBJECT TO A MARKET VALUE ADJUSTMENT.
This is a legal contract between the Owner and Xxxxxx Investors Life Insurance
Company.
READ YOUR CONTRACT CAREFULLY
Policy Form No. L-8589
2
INDEX
Page
ANNUITY OPTION TABLE Follows page 19
ANNUITY PERIOD PROVISIONS 15 - 19
Election of Annuity Option 15 - 16
Annuity Options 16
Transfers During the Annuity Period 18 - 19
APPLICATION Follows Contract Schedule
CONTRACT SCHEDULE Follows Index
DEATH BENEFIT PROVISIONS 14 - 15
Amount Payable Upon Death 14
Payment of Death Benefits 14 - 15
DEFINITIONS 5 - 7
ENDORSEMENT, if any Follows Annuity Option Table
FIXED ACCOUNT PROVISIONS 9
Fixed Account Contract Value 9
GENERAL PROVISIONS 7 - 8
The Contract 7
Incontestability 7
Assignment 7
Reports 7
Premium Taxes 8
GUARANTEE PERIOD PROVISIONS 10
Guarantee Period Value 10
OWNERSHIP PROVISIONS 8 - 9
Owner of Contract 8
Change of Ownership 8
Beneficiary 8 - 9
PURCHASE PAYMENT PROVISIONS 9
Initial Purchase Payment 9
Purchase Payment Limitations 9
TRANSFER AND WITHDRAWAL PROVISIONS 12 - 14
Transfers During the Accumulation Period 12
Withdrawals During the Accumulation Period 13
Transfer and Withdrawal Procedures 13 - 14
VARIABLE ACCOUNT PROVISIONS 10 - 12
Separate Account 10
Liabilities Of Separate Account 10
Subaccounts 11
Rights Reserved By the Company 11
Accumulation Unit Value 12
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CONTRACT SCHEDULE
DESCRIPTION OF PLAN: INDIVIDUAL FLEXIBLE PREMIUM MODIFIED
GUARANTEED, FIXED AND VARIABLE DEFERRED
ANNUITY
THE OWNER(S), BENEFICIARY(IES) AND ANNUITY DATE ARE AS STATED IN THE
APPLICATION FOR THIS CONTRACT UNLESS SUBSEQUENTLY CHANGED IN ACCORDANCE WITH
THE CONTRACT PROVISIONS.
GUARANTEED PERIODS AVAILABLE ON ISSUE DATE:
[ 1 THROUGH 10 ] YEARS
KILICO VARIABLE ANNUITY SEPARATE ACCOUNT
SUBACCOUNTS AVAILABLE ON ISSUE DATE:
[XXXXXX MONEY MARKET
XXXXXX GOVT. SECURITIES
XXXXXX HIGH YIELD
XXXXXX TOTAL RETURN
XXXXXX GROWTH
XXXXXX SMALL CAP GROWTH
XXXXXX INVESTMENT GRADE BOND
KEMPER TECHNOLOGY
XXXXXXX BOND
XXXXXXX CAPITAL GROWTH
XXXXXXX INTERNATIONAL
JANUS ASPEN GROWTH
JANUS ASPEN BALANCED
JANUS ASPEN AGGRESSIVE GROWTH
JANUS ASPEN WORLDWIDE GROWTH
FIDELITY VIP II INDEX 500
FIDELITY VIP EQUITY-INCOME
FIDELITY VIP GROWTH
FIDELITY VIP II CONTRAFUND
XXXXX AMERICAN GROWTH
XXXXX AMERICAN SMALL CAP
XXXXX MID-CAP
AMERICAN CENTURY INCOME & GROWTH
AMERICAN CENTURY VALUE
X.X. XXXXXX SMALL COMPANY
DREYFUS SOCIALLY RESPONSIBLE GROWTH
WARBURG PINCUS EMERGING MARKETS]
L-8589 PAGE 2
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CONTRACT SCHEDULE
CERTIFICATE NUMBER: X00000000 ISSUE DATE: JULY 1, 2000
ANNUITANT: XXXX XXX
SEX: MALE ISSUE AGE: 35
MAXIMUM ANNUITIZATION AGE: 95
QUALIFIED OR NONQUALIFIED TYPE: QUALIFIED
MINIMUM INITIAL PURCHASE PAYMENT: [$25,000]
SUBSEQUENT PURCHASE PAYMENT:
MINIMUM: $100
MAXIMUM: [$1,000,000]
INITIAL PURCHASE PAYMENT RECEIVED: $25,000
SEPARATE ACCOUNT CHARGES:
DEDUCTED DAILY FROM THE SUBACCOUNTS
MORTALITY AND EXPENSE RISK CHARGE:
CURRENT [1.25% ANNUALLY
MAXIMUM 1.40% ANNUALLY]
[RECORD MAINTENANCE CHARGE:
WE WILL ASSESS A RECORDS MAINTENANCE CHARGE AT THE END OF EACH CALENDAR
QUARTER, UPON A FULL WITHDRAWAL, AND ON THE ANNUITY DATE. THIS CHARGE WILL NOT
BE ASSESSED AFTER THE ANNUITY DATE. THIS CHARGE WILL BE DEDUCTED ON A
PROPORTIONAL BASIS FROM AMOUNTS ALLOCATED TO THE SUBACCOUNTS. TO THE EXTENT
NEEDED, IT WILL BE DEDUCTED FROM THE GUARANTEE PERIODS. WE RESERVE THE RIGHT TO
MAKE THIS DEDUCTION FROM THE FIXED ACCOUNT. THE AMOUNT OF THIS CHARGE WILL
DEPEND ON THE SIZE OF THE CONTRACT VALUE ON THE DATE THE CHARGE IS MADE:
AMOUNT OF RECORDS MAINTENANCE
CONTRACT VALUE FEE
LESS THAN $25,000 $7.50
$25,000 TO $49,999.99 $3.75
$50,000 AND OVER NONE]
[TRANSFER CHARGE:
WE RESERVE THE RIGHT TO CHARGE $25 FOR EACH TRANSFER IN EXCESS OF 12 IN A
CONTRACT YEAR.]
L-8589 PAGE 3
5
CONTRACT SCHEDULE
MARKET VALUE ADJUSTMENT FORMULA:
[THIS ADJUSTMENT IS MADE FOR AMOUNTS TRANSFERRED OR WITHDRAWN BEFORE THE END OF
A GUARANTEE PERIOD. THE ADJUSTMENT MAY BE POSITIVE OR NEGATIVE BUT THE DEDUCTION
IS NEVER MORE THAN THE AMOUNT TRANSFERRED OR WITHDRAWN. THE MARKET VALUE
ADJUSTMENT IS SUBTRACTED FROM THE AMOUNT THAT IS WITHDRAWN FROM THE GUARANTEE
PERIOD.
THE MARKET VALUE ADJUSTMENT IS THE PRODUCT OF:
(1) .075
(2) THE NUMBER OF MONTHS (ROUNDED UP) REMAINING IN THE GUARANTEE PERIOD
(3) THE INTEREST RATE BEING GUARANTEED ON NEW ALLOCATIONS TO A GUARANTEE PERIOD
WITH THE PERIOD EQUAL TO THE NUMBER OF YEARS REMAINING IN THE GUARANTEE
PERIOD (ROUNDED UP) LESS THE RATE GUARANTEED ON THE MONEY BEING WITHDRAWN
OR TRANSFERRED.
(4) THE AMOUNT WITHDRAWN OR TRANSFERRED.]
INITIAL ALLOCATION TO GUARANTEE PERIODS:
PERIOD RATE*
5 YRS 6.00%
* STATED AS AN ANNUAL EFFECTIVE RATE
L-8589 PAGE 4
6
DEFINITIONS ACCUMULATION PERIOD: The period between the
Issue Date and the Annuity Date.
ACCUMULATION UNIT: An accounting unit of
measure used to calculate the value of each
Subaccount.
AGE: The attained age of the Annuitant.
ANNUITANT: The person named in the
application during whose lifetime the
Annuity is to be paid. When two people are
named as Joint Annuitants the term
"Annuitant" means the Joint Annuitants or
the survivor. Under qualified plans, only
the spouse may be named as Joint Annuitant.
You may not change the person(s) named as
the Annuitant.
ANNUITY: A series of payments paid in
accordance with this contract which begins
on the Annuity Date.
ANNUITY DATE: The date on which this
Contract matures and Annuity payments begin.
It must be at least one year from the Issue
Date and no later than the maximum age at
annuitization as stated in the Contact
Schedule, unless otherwise agreed. The Owner
may change the Annuity Date, but not beyond
the maximum age.
ANNUITY PERIOD: This is the period that
starts on the Annuity Date.
ANNUITY UNIT: An accounting unit of measure
used to calculate this amount of variable
Annuity payments after the first Annuity
payment.
CONTRACT VALUE: The sum of the Fixed Account
Contract Value plus the Separate Account
Contract Value plus the Guarantee Period
Value.
CONTRACT YEAR: A one-year period starting on
the Issue Date and successive contract
anniversaries
FIXED ACCOUNT: Our assets other than those
allocated to the Separate Account or any
other separate account under which we
guarantee a fixed rate of return.
FIXED ACCOUNT CONTACT VALUE: The Fixed
Account Contract Value is the value of
amounts allocated under this contract to the
Fixed Account.
FIXED ANNUITY: An Annuity payment that does
not vary with investment performance.
FUND: An investment company or separate
series thereof, in which the Subaccounts of
the Separate Account invest.
GUARANTEE PERIOD: A period of time during
which an amount is to be credited with a
guaranteed interest rate, subject to a
Market Value Adjustment prior to the end of
the Guarantee Period. The Guarantee Periods
initially offered are stated in the Contract
Schedule.
GUARANTEE PERIOD VALUE: The (1) Purchase
Payment allocated or the amount transferred
to a Guarantee Period; plus (2) interest
credited; minus (3) withdrawals and
transfers adjusted for (4) any applicable
Market Value Adjustment previously made.
There is a $5000 minimum on the sum of
Purchase Payments and amounts transferred to
any Guarantee Period Value.
ISSUE DATE: The Issue Date is stated in the
Contract Schedule It is the date your
initial Purchase Payment is available for
use and your application has been accepted
by us. It is also the date on which your
Purchase Payment begins to be credited with
interest and/or investment experience.
Policy Form No. L-8589 Page 5
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Policy Form No. L-8589 Page 6
DEFINITIONS (CONTINUED)
MARKET ADJUSTED VALUE: A Guarantee Period
Value adjusted by the Market Value
Adjustment formula prior to the end of a
Guarantee Period.
MARKET VALUE ADJUSTMENT: An adjustment of
Guarantee Period Values in accordance with
the Market Value Adjustment formula prior to
the end of the Guarantee Period. The
adjustment reflects the change in the value
of the Guarantee Period Value due to changes
in interest rates since the date the
Guarantee Period commenced. The Market Value
Adjustment formula is stated in the Contract
Schedule.
MORTALITY AND EXPENSE RISK CHARGE: A charge
deducted in the calculation of the
Accumulation Unit value and the Annuity Unit
value. It is for our assumption of mortality
risks and expense guarantees. The charge is
shown on the Contract Schedule.
NONQUALIFIED: This contract issued to other
than a qualified plan.
OWNER: See "You, Your, Yours" below.
PURCHASE PAYMENTS: The dollar amount we
receive in U.S. currency to buy the benefits
this contract provides.
QUALIFIED PLAN: This contract issued under a
retirement plan which qualifies for
favorable income tax treatment under Section
401, 403, 408 or 457 of the Internal Revenue
Code as amended.
RECORDS MAINTENANCE CHARGE: A charge
assessed against your contract as specified
in the Contract Schedule. We reserve the
right to make this charge against the Fixed
Account Contract Value or the Guarantee
Period Value.
RECEIVED: Received by Xxxxxx Investors Life
Insurance Company at its home office in Long
Grove, Illinois.
SEPARATE ACCOUNT: A unit investment trust
registered with the Securities and Exchange
Commission under the Investment Act of 1940
known as the KILICO Variable Annuity
Separate Account.
SEPARATE ACCOUNT CONTRACT VALUE: The sum of
the Subaccount Values of this contract on
Valuation Date.
SUBACCOUNTS: The Separate Account has
Subaccounts. The Subaccounts initially
available are stated in the contract
schedule.
SUBACCOUNT VALUE: The value of each
Subaccount calculated separately according
to the formulas stated in this contract.
VALUATION DATE: Each business day that
applicable law requires that we value the
assets of the Separate Account. Currently
this is each day that the New York Stock
Exchange is open for trading.
VALUATION PERIOD: The period that starts at
the close of a Valuation Date and ends at
the close of business the next succeeding
Valuation Date.
VARIABLE ANNUITY: An Annuity payment which
varies as to dollar amount because of
Subaccount investment experience.
WE, OUR, US: Xxxxxx Investors Life Insurance
Company, Long Grove, Illinois.
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DEFINITIONS (CONTINUED)
YOU, YOUR, YOURS: The party(ies) named as
Owner in the application unless later
changed as provided in this contract. (See
Change of Ownership.) The Owner is the
Annuitant unless a different Owner is named
in the application. Under a nonqualified
annuity when more than one person is named
as Owner, the terms "you", "your" means
Joint Owners. The Owner may be changed
during the lifetime of the Owner and the
Annuitant. The Owner, prior to the Annuity
Date or any distribution of any death
benefit, has the exclusive right to exercise
every option and right conferred by this
contract.
GENERAL PROVISIONS
THE CONTRACT This contract, any attached endorsements and
the attached application constitute the
entire contract between the parties. All
statements made in the application are
deemed representation and not warranties. No
statement will void this contract or be used
as a defense of a claim unless it is
contained in the application.
MODIFICATION OF CONTRACT Only our president, secretary and assistant
secretaries have the power to approve a
change or waive any provision of this
contract. Any such modifications must be in
writing. No agent or person other than the
officers named has the authority to change
or waive the provisions of this contract.
Upon notice to the Owner or the payees
during the annuity period, the contract may
be modified by us as is necessary to comply
with any law or regulation issued by a
governmental agency to which we or the
Separate Account is subject or as is
necessary to assure continued qualification
of the contract under the Internal Revenue
Code or other laws relating to retirement
plans or annuities or as otherwise may be in
the best interests of the Owners. In the
event of a modification, we may make
appropriate endorsement to the contract and
we will obtain all required regulatory
approvals.
INCONTESTABILITY We cannot contest this contract after it has
been in force for two years from the Issue
Date.
CHANGE OF ANNUITY DATE You may write to us prior to distribution of
a death benefit or the first Annuity payment
date and request a change of the Annuity
Date.
ASSIGNMENT No assignment of this contract is binding
unless we receive it in writing. We assume
no responsibility for the validity or
sufficiency of any assignment. Once filed,
the rights of the Owner, Xxxxxxxxx and
beneficiary are subject to the assignment.
Any claim is subject to proof of interest of
the assignee.
DUE PROOF OF DEATH We must receive written proof upon the death
of the Owner or the Annuitant when a death
benefit is payable. The proof may be a
certified death certificate, the written
statement of a physician, or any other proof
satisfactory to us.
CONTRACT VALUES AND Any available Contract Value and death
DEATH BENEFITS benefit will not be less than the minimum
benefit required by the statutes of the
state in which this contract is delivered.
NON-PARTICIPATING This contract does not pay dividends. It
will not share in our surplus or earnings.
REPORTS At least once each Contract Year we will
send you a statement showing Purchase
Payments received, interest credited,
investment experience, and charges made
since the last report, as well as any other
information required by statute.
Policy Form No. L-8589 Page 7
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Policy Form No. L-8589 Page 8
GENERAL PROVISIONS (CONTINUED)
PREMIUM TAXES We will make a deduction for state premium
taxes in certain situations. On any contract
subject to premium tax, as provided under
applicable law, the tax will be deducted
from: a. The Purchase Payments when we
receive them; b. the Contract Value upon
total withdrawal; or c. from the total
Contract Value applied to an annuity option
at the time Annuity payments start.
QUALIFIED PLANS If this contract is issued under a qualified
plan additional provisions may apply. The
rider or amendment to this contract used to
qualify it under the applicable section of
the Internal Revenue Code will indicate the
extent of change in the provisions.
DETERMINATION The method of determination by us of the
OF VALUES investment experience factor, the number and
value of Accumulation Units, and the number
and value of Annuity Units shall be
conclusive upon the Owner, any Payee, and
any Beneficiary.
GOVERNING LAW The contract will be governed by the laws of
the jurisdiction where the contract is
delivered and interpreted under the laws of
Illinois.
CREDITORS The proceeds of this contract and any
payment under an annuity option will be
exempt from the claim of creditors and from
legal process to the extent permitted by
law.
OWNERSHIP PROVISIONS
OWNER OF CONTRACT The Annuitant is the original Owner unless
otherwise provided in the application.
Before the Annuity Date or any distribution
of death benefit, you have the right to
cancel or amend this contract if we agree.
You may exercise every option and right
conferred by this contract. The Joint Owners
must agree to any change if more than one
Owner is named.
CHANGE OF OWNERSHIP You may change the Owner by written request
at any time while the Owner and Annuitant
are alive. You must furnish information
sufficient to clearly identify the new Owner
to us. The change is subject to any existing
assignment of this contract. When we record
the effective date of the change, it will be
the date the notice was signed except for
action taken by us prior to receiving the
request. Any change is subject to the
payment of any proceeds. We may require you
to return this contract to us for
endorsement of a change.
BENEFICIARY DESIGNATION AND The application for this contract shows the
CHANGE OF BENEFICIARY original beneficiary. You may change the
beneficiary if you send us a written notice
in a form acceptable to us. Changes are
subject to the following conditions:
1. The change must be filed while the
Annuitant is alive;
2. This contract must be in force at the
time you file a change;
3. Such change must not be prohibited by the
terms of an existing assignment,
beneficiary designation or other
restriction;
4. Such change will take effect when we
receive it. After we receive the change,
it will take effect on the date the
change form is signed. However, action
taken by us before the change form was
received will remain in effect; and
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OWNERSHIP PROVISIONS (CONTINUED)
5. The request for change must provide
information sufficient to identify the
new beneficiary.
We may require you to return this contract
for endorsement of a change.
DEATH OF BENEFICIARY The interest of a beneficiary who dies
before the distribution of the death benefit
will pass to the other beneficiaries, if
any, share and share alike, unless otherwise
provided in the beneficiary designation. If
no beneficiary survives or is named, the
distribution will be made to your estate
when you die, or to the estate of the
annuitant upon the death of the annuitant if
you are not also the Annuitant. If a
beneficiary dies within ten days of the date
of your death, the death benefit will be
paid as if you had survived the beneficiary.
If a beneficiary dies within ten days of the
death of the Annuitant and you are not the
Annuitant, we will pay the death benefit as
if the Annuitant survived the beneficiary.
If you, the Annuitant, and the beneficiary
die simultaneously, we will pay the death
benefit as if you had survived the Annuitant
and the beneficiary.
PURCHASE PAYMENT PROVISIONS
INITIAL PURCHASE PAYMENT The minimum initial Purchase Payment is
shown on the Contract Schedule.
PURCHASE PAYMENT The minimum and maximum Purchase Payments
LIMITATIONS that may be made are shown on the Contract
Schedule. We reserve the right to waive or
modify these limits and to not accept any
Purchase Payment.
Subsequent Purchase Payments will be
allocated according to your most recent
instructions at the time we receive your
Purchase Payment.
PLACE OF PAYMENT All Purchase Payments under this contract
must be paid to us at our home office or
such other location as we may select. We
will notify you and any other interested
parties in writing of such other locations.
Purchase Payments received by an agent will
begin earning interest after we receive it.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT CONTRACT VALUE The Fixed Account Contract Value is
increased by: 1. your Purchase Payment
allocated to the Fixed Account; 2. amounts
transferred from a Guarantee Period or
Subaccount to the Fixed Account at your
request; and 3. the interest credited to
amounts so allocated or transferred.
Transfers, charges, and withdrawals from the
Fixed Account reduce the Fixed Account
Contract Value.
During the Accumulation Period, the Fixed
Account is restricted to allocations that
will be systematically transferred into the
Subaccounts and Guarantee Period Accounts.
At the time that you allocate a Purchase
Payment or transfer money into the Fixed
Account, you must choose a transfer schedule
that is acceptable to us. We will credit
interest at an annual effective interest
rate of at least 3%. At the time of each
allocation, we will guarantee a rate for at
least one year or the period over which the
transfer is to be effected, if less.
Different interest rates may apply to
different allocations. Any rate above 3%
will be at our discretion. We will not
unfairly discriminate between different
classes of contracts.
Policy Form No. L-8589 Page 9
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Policy Form No. L-8589 Page 10
GUARANTEE PERIOD PROVISIONS
GUARANTEE PERIOD We hold all amounts allocated to a Guarantee
Period in a non-unitized separate account.
The assets of this separate account equal to
the reserves and other liabilities of this
separate account will not be charged with
liabilities arising out of any other
business we may conduct. The initial
Guarantee Periods available under the
Contract are shown in the Contract Schedule.
GUARANTEE PERIOD VALUE On any Valuation Date, the Guarantee Period
Value includes:
1. your Purchase Payments or transfers
allocated to the Guarantee Period Value
at the beginning of its Guarantee Period;
plus
2. interest credited; minus
3. withdrawals and transfers; minus
4. any applicable portion of the Records
Maintenance Charge and charges for other
benefits; adjusted for
5. any applicable Market Value Adjustment
previously made.
The Guarantee Period(s) initially elected
and the interest rate(s) initially credited
are shown in the Contract Schedule. The
initial interest rate credited to subsequent
Purchase Payments will be declared at the
time the payment is received.
At the end of a Guarantee Period, the
Guarantee Period Value will be transferred
to a money market Subaccount unless you tell
us to do otherwise.
ACCUMULATED GUARANTEE On any Valuation Date, the Accumulated
PERIOD VALUE Guarantee Period value is the sum of the
Guarantee Period Values. At any time during
the Accumulation Period, the Accumulated
Guarantee Period Value may be allocated to
more than one Guarantee Period with our
agreement.
We calculate the interest credited to the
Guarantee Period Value by compounding daily,
at daily interest rates, rates which would
produce at the end of a Contract Year a
result identical to the one produced by
applying an annual interest rate.
MARKET VALUE ADJUSTMENT The Market Value Adjustment formula is
stated in the Contract Schedule. This
formula is applicable for both an upward or
downward adjustment to a Guarantee Period
Value when, prior to the end of a Guarantee
Period, such value is:
1. taken as a total or partial withdrawal;
2. applied to purchase an Annuity; or
3. transferred to another Guarantee Period,
the Fixed Account or a Subaccount.
VARIABLE ACCOUNT PROVISIONS
SEPARATE ACCOUNT The variable benefits under this contract
are provided through the KILICO Variable
Annuity Separate Account. This is called the
Separate Account. The Separate Account is
registered with the Securities and Exchange
Commission as a unit investment trust under
the Investment Company Act of 1940. It is a
separate investment account maintained by us
into which a portion of the company's assets
have been allocated for this contract and
may be allocated for certain other
contracts.
LIABILITIES OF SEPARATE The assets equal to the reserves and other
ACCOUNT liabilities of the Separate Account will not
be charged with liabilities arising out of
any other business we may conduct.
We will value the assets of the Separate
Account on each Valuation Date.
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VARIABLE ACCOUNT PROVISIONS (CONTINUED)
SEPARATE ACCOUNT CONTRACT On any valuation Date the Separate Account
VALUE Contract Value is the sum of Its Subaccount
values.
SUBACCOUNTS The Separate Account consists of
Subaccounts. The initial Subaccounts
available under this Contract are shown in
the Contract Schedule. We may, from time to
time, combine or remove Subaccounts in the
Separate Account and establish additional
Subaccounts of the Separate Account. In such
event we may permit you to select other
Subaccounts under this contract. However,
the right to select any other Subaccount is
limited by the terms and conditions we may
impose on such transactions.
FUND Each Subaccount of the Separate Account will
buy shares of a separate series of a fund.
Each fund is registered under the Investment
Company Act of 1940 as an open-end
management investment company. Each series
of a fund represents a separate investment
portfolio which corresponds to one of the
Subaccounts of the Separate Account.
If we establish additional Subaccounts each
new Subaccount will invest in a new series
of a fund or in shares of another investment
company. We may also substitute other
investment companies.
RIGHTS RESERVED BY THE We reserve the right, subject to compliance
COMPANY with the current law or as it may be changed
in the future:
1. To operate the Separate Account in any
form permitted under the Investment Company
Act of 1940 or in any other form permitted
by law;
2. To take any action necessary to comply
with or obtain and continue any exemptions
from the Investment Company Act of 1940 or
to comply with any other applicable law;
3. To transfer any assets in any Subaccount
to another Subaccount or to one or more
separate accounts, or the General Account,
or to add, combine or remove Subaccounts in
the Separate Account;
4. To delete the shares of any of the
portfolios of a fund or any other open-end
investment company and to substitute, for
the fund shares held in any Subaccount, the
shares of another portfolio of a fund or the
shares of another investment company or any
other investment permitted by law; and
5. To change the way we assess charges, but
not to increase the aggregate amount above
that currently charged to the Separate
Account and the funds in connection with the
contract.
When required by law, we will obtain your
approval of such changes and the approval of
any regulatory authority.
Policy Form No. L-8589 Page 11
13
Policy Form No. L-8589 Page 12
VARIABLE ACCOUNT PROVISIONS (CONTINUED)
ACCUMULATION UNIT VALUE Each Subaccount has an Accumulation Unit
Value. When Purchase Payments or other
amounts are allocated to a Subaccount, a
number of units are purchased based on the
Accumulation Unit Value of the Subaccount at
the end of the Valuation Period during which
the allocation is made. When amounts are
transferred out of or deducted from a
Subaccount, units are redeemed in a similar
manner.
The value of a Subaccount on any Valuation
Date is the number of units held in the
Subaccount times the Accumulation Unit Value
on that Valuation Date.
The Accumulation Unit Value for each
subsequent Valuation Period is the
investment experience factor for that period
multiplied by the Accumulation Unit Value
for the period immediately preceding. Each
Valuation Period has a single Accumulation
Unit Value that is applied to each day in
the period. The number of Accumulation Units
will not change as a result of investment
experience.
INVESTMENT EXPERIENCE Each Subaccount has its own investment
FACTOR experience factor. The investment experience
of the Separate Account is calculated by
applying the investment experience factor to
the value in each Subaccount during a
Valuation Period.
The investment experience factor of a
Subaccount for a Valuation Period is
determined by dividing 1. by 2. and
subtracting 3. from the result, where:
1. is the net result of;
a. the net asset value per share of the
investment held in the Subaccount determined
at the end of the current Valuation Period;
plus
b. the per share amount of any dividend or
capital gain distributions made by the
investments held in the Subaccount, if the
"ex-dividend" date occurs during the current
Valuation Period; plus or minus
c. a charge or credit for taxes reserved for
the current Valuation Period which we
determine resulted from the investment
operations of the Subaccount.
2. is the net asset value per share of the
investment held in the Subaccount,
determined at the end of the last Valuation
Period.
3. is the factor representing the sum of the
Separate Account charges stated in the
Contract Schedule for the number of days in
the Valuation Period.
TRANSFER AND WITHDRAWAL PROVISIONS
TRANSFERS DURING THE All or part of the Separate Account Contract
ACCUMULATION PERIOD Value or a Guarantee Period Value may
transferred to the Fixed Account or to
another Subaccount or Guarantee Period. We
will allow the first transfer at the end of
the free look period.
The Contract Value transferred into or out
of the Guarantee Periods must be at least
$5,000 unless the entire Guarantee Period
Value is transferred. Any transfer from a
Guarantee Period is subject to a Market
Value Adjustment unless the transfer is
effective on the Guarantee Period maturity
date.
14
TRANSFER AND WITHDRAWAL PROVISIONS (CONTINUED)
No transfer may be made within seven
calendar days of the date on which the first
annuity payment is due.
We reserve the right to charge for transfers
as described in the Contract Schedule.
Any transfer request must clearly specify:
1. the amount which is to be transferred;
and 2. the names of the accounts which are
affected. We will only honor a telephone
transfer request if a properly executed
telephone transfer authorization is on file
with us. Such request for a transfer must
comply with the conditions of the
authorization.
We reserve the right at any time and without
notice to any party, to terminate, suspend,
or modify these transfer rights.
WITHDRAWALS DURING THE During the Accumulation Period, you may
ACCUMULATION PERIOD withdraw all or part of the Contract Value
reduced by any applicable premium taxes and
adjusted by any applicable Market Value
Adjustment. The Market Value Adjustment
formula will be applied to the applicable
portion of the total value withdrawn. We
must receive a written request that
indicates the amount of the withdrawal from
the Fixed Account and each Subaccount and
Guarantee Period. You must return the
Contract to us if you elect a total
withdrawal.
Withdrawals are subject to these conditions.
Withdrawals from the Subaccounts will reduce
the amounts in each Subaccount on a
proportional basis, unless you tell us
otherwise.
Each withdrawal from a Guarantee Period must
be at least $5,000 or the value that remains
in the Guarantee Period, if smaller;
The maximum you may withdraw from any
account is the value of the respective
account.
We reserve the right to restrict partial
withdrawals from the Fixed Account in the
first Contract Year.
TRANSFER AND WITHDRAWAL We will withdraw or transfer from the Fixed
PROCEDURES Account or Guarantee Periods as of the
Valuation Date that follows the date we
receive your written or telephone transfer
request. Amounts to be withdrawn or
transferred from the Fixed Account or
Guarantee Periods will be done on a first in
- first out basis, unless you request
otherwise. To process a withdrawal, the
request must contain all required
information.
Policy Form No. L-8589 Page 13
15
Policy Form No. L-8589 Page 14
TRANSFER AND WITHDRAWAL PROVISIONS (CONTINUED)
We will redeem the necessary number of
Accumulation Units to achieve the dollar
amount when the withdrawal or transfer is
made from a Subaccount. We will reduce the
number of Accumulation Units credited in
each Subaccount by the number of
Accumulation Units redeemed. The reduction
in the number of Accumulation Units is
determined on the basis of the Accumulation
Unit Value at the end of the Valuation
Period when we receive the request, provided
the request contains all required
information. We will pay the amount within
seven calendar days after the date we
receive the request, except as provided
below.
DEFERMENT OF WITHDRAWAL If the withdrawal or transfer is to be made
TRANSFER from a Subaccount, we may suspend the right
of withdrawal or transfer or delay payment
more than seven calendar days if: 1. during
any period when the New York Stock Exchange
is closed other than customary weekend and
holiday closings; 2. when trading markets
normally utilized are restricted, or an
emergency exists as determined by the
Securities and Exchange Commission, so that
disposal of investments or determination of
the Accumulation Unit Value is not
practical; or 3. for such other periods as
the Securities and Exchange Commission by
order may permit for protection of Owners.
We may defer the payment of a withdrawal or
transfer from the Fixed Account or Guarantee
Periods, for the period permitted by law.
This can never be more than six months after
you send us a written request. During the
period of deferral, we will continue to
credit interest, at the then current
interest rate(s), to the Fixed Account
Contract Value and/or each Guarantee Period
Value.
DEATH BENEFIT PROVISIONS
AMOUNT PAYABLE UPON DEATH We compute the death benefit at the end of
the Valuation Period following our receipt
of due proof of death and the return of this
contract.
If death occurs prior to attaining age 75,
we will pay the greater of: a. the Contract
Value; or b. the total amount of Purchase
Payments, less the aggregate dollar amount
of all previous withdrawals or c. the amount
that would have been payable in the event of
a full surrender. We will pay the larger of
the Contract Value or the amount that would
have been payable in the event of a full
surrender if death occurs at age 75 or
later.
PAYMENT OF DEATH BENEFITS If an Owner or the last surviving annuitant
dies while the contract is in effect and
before the Annuity Date, we will pay a death
benefit. If an Owner is a non-natural
person, the death of an annuitant will be
considered as the death of an Owner for
purposes of this death benefit provision.
If an annuitant dies after the Annuity Date,
the death benefit, if any, will depend on
the Annuity Option in effect. If an Owner
dies after the Annuity Date, income payments
will be made at least as rapidly as under
the method of distribution being used as of
the date of such death.
We will pay the death benefit to the
beneficiary when we receive due proof of
death. We will then have no further
obligation under this contract.
When you die, we will pay the death benefit
in a lump sum. The entire interest in the
contract must be distributed within five
years from the date of death unless it is
16
applied under an Annuity Option or the
spouse continues the contract as described
below.
17
DEATH BENEFIT PROVISIONS (CONTINUED)
Instead of a lump sum payment the
beneficiary may elect to have the death
benefit distributed as stated in Option 1
for a period not to exceed the beneficiary's
life expectancy; or Options 2, or 3 based
upon the life expectancy of the beneficiary
as prescribed by federal regulations. The
beneficiary must make this choice within
sixty days of the time we receive due proof
of death and distribution must commence
within one year of the date of death.
If the beneficiary is not a natural person,
the beneficiary must elect that the entire
death benefit be distributed within five
years of your death.
Distribution of the death benefit must start
within one year after your death. It may
start later if prescribed by federal
regulations.
If the primary beneficiary is the surviving
spouse when you die, the surviving spouse
may elect to be the successor Owner of this
contract, in lieu of receiving a death
benefit. There will be no requirement to
start a distribution of death benefits.
ANNUITY PERIOD PROVISIONS
ELECTION OF ANNUITY OPTION We must receive an election of Annuity
option in writing. You may make an election
before the Annuity Date providing the
Annuitant is alive. The Annuitant may make
an election on the Annuity Date unless you
have restricted the right to make such an
election. The beneficiary may make an
election when we pay the death benefit.
An election will be revoked by 1. a
subsequent change of beneficiary; or 2. an
assignment of this contract unless the
assignment provides otherwise.
Subject to the terms of the death benefit
provision, the beneficiary may elect to have
the death benefit remain with us under one
of the Annuity options.
If an Annuity option is not elected, an
Annuity will be paid under Option 3 for a
guaranteed period of ten years and for as
long thereafter as the Annuitant is alive.
If the total Contract Value is applied under
one of the Annuity options, this contract
must be surrendered to us.
An option cannot be changed after the first
Annuity payment is made.
If, on the seventh calendar day before the
first Annuity payment due date, all the
Contract Value is allocated to the Fixed
Account or Guarantee Periods, the Annuity
will be paid as a Fixed Annuity. The Fixed
Annuity is funded in our General Account,
which consists of our assets other than
those allocated to the Separate Account or
any other separate account. If all of the
Contract Value on such date is allocated to
the Separate Account, the Annuity will be
paid as a Variable Annuity. If the Contract
Value on such date is allocated to both the
Fixed Account or a Guarantee Period and a
Subaccount, then the Annuity will be paid as
a combination of a Fixed and a Variable
Annuity. A Fixed and Variable Annuity
payment will reflect the investment
performance of the Subaccounts in accordance
with the allocation of the Contract Values
existing on such date. Allocations will not
be changed thereafter, except as provided in
the Transfers During the Annuity Period
provision of this contract.
Policy Form No. L-8589 Page 15
18
Policy Form No. L-8589 Page 16
ANNUITY PERIOD PROVISIONS (CONTINUED)
Payments for all options are derived from
the applicable tables. Current Annuity rates
will be used if they produce greater
payments than those quoted in the contract.
The age in the tables is the age of the
payee on the last birthday before the first
payment is due. We reserve the right to
deduct one year from the age for each 10
calendar years that have elapsed since the
year 2000.
The option selected must result in a payment
that is at least equal to our minimum
payment, according to our rules, at the time
the Annuity option is chosen. If at any time
the payments are less than the minimum
payment, we have the right to increase the
period between payment to quarterly,
semi-annual or annual so that the payment is
at least equal to the minimum payment or to
make payment in one lump sum.
OPTION 1
SPECIFIED PERIOD We will make monthly payments for a fixed
number of installments. Payments must be
made for at least 5 years, but not more than
30 years.
OPTION 2
LIFE ANNUITY We will make monthly payments while the
payee is alive.
OPTION 3
LIFE ANNUITY WITH We will make monthly payments for a
INSTALLMENTS GUARANTEED guaranteed period and thereafter while the
payee is alive. The guaranteed period must
be selected at the time the Annuity option
is chosen. The guaranteed periods available
are 5, 10, 15 and 20 years.
OPTION 4
JOINT AND SURVIVOR ANNUITY We will pay the full monthly income while
both payees are alive. Upon the death of
either payee, we will continue to pay the
surviving payee a percentage of the original
monthly payment. The percentage payable to
the surviving payee must be selected at the
time the Annuity option is chosen. The
percentages available are 50%, 66 2/3%, 75%
and 100%.
OTHER OPTIONS We may make other Annuity options available.
Payments are also available on a quarterly,
semi-annual or annual basis.
FIXED ANNUITY The Contract Value allocated to the Fixed
Account or the Guarantee Periods on the
first day preceding the date on which the
first Annuity Payment is due is first
reduced by any premium taxes and charges
that apply. The value that remains will be
used to determine the Fixed Annuity monthly
payment in accordance with the Annuity
option selected.
19
ANNUITY PERIOD PROVISIONS (CONTINUED)
VARIABLE ANNUITY The Separate Account Contract Value, at the
end of the Valuation period preceding the
Valuation Period that includes the date on
which the first Annuity payment is due, is
first reduced by any Records Maintenance
Charge, charges for other benefits if any
that may be added by a rider to this
Contract and any premium taxes that apply.
The value that remains is used to determine
the first monthly Annuity payment. The first
monthly Annuity payment is based upon the
guaranteed Annuity option shown in the
Annuity Option Table. You may elect any
option available. The dollar amount of
subsequent payments may increase or decrease
depending on the investment experience of
each Subaccount. The number of Annuity Units
per payment will remain fixed for each
Subaccount unless a transfer is made. If a
transfer is made, the number of Annuity
Units per payment will change. Some annuity
options provide for a reduction in the
income level upon the death of an annuitant,
which will reduce the number of Annuity
Units.
The number of Annuity Units for each
Subaccount is calculated by dividing a. by
b. where:
a. is the amount of the monthly payment that
can be attributed to that Xxxxxxxxxx, and
b. is the Annuity Unit Value for that
Subaccount at the end of the Valuation
Period. The Valuation Period includes the
date on which the payment is made.
Monthly Annuity payments, after the first
payment, are calculated by summing up, for
each Subaccount, the product of a. times b.
where:
a. is the number of Annuity Units per
payment in each Subaccount; and
b. is the Annuity Unit Value for that
Subaccount at the end of the Valuation
Period. The Valuation Period includes the
date on which the payment is made.
After the first payment, we guarantee that
the dollar amount of each Annuity payment
will not be affected adversely by actual
expenses or changes in mortality experience
from the expense and mortality assumptions
on which we based the first payment.
ANNUITY UNIT VALUE The value of an Annuity Unit for each
Subaccount, at the end of any subsequent
Valuation Period is determined by
multiplying the result of a. times b. by c.
where:
a. is the Annuity Unit Value for the
immediately preceding Valuation Period; and
b. is the net investment factor for the
Valuation Period for which the Annuity Unit
Value is being calculated; and
c. is the interest factor of .99993235 per
calendar day of such subsequent Valuation
Period to offset the effect of the assumed
rate of 2.50% per year used in the Annuity
Option Table.
Policy Form No. L-8589 Page 17
20
Policy Form No. L-8589 Page 18
ANNUITY PERIOD PROVISIONS (CONTINUED)
THE NET INVESTMENT FACTOR FOR EACH
SUBACCOUNT FOR ANY VALUATION PERIOD IS
DETERMINED BY DIVIDING A. BY B. WHERE:
a. is the value of an Annuity Unit of the
applicable Subaccount as of the end of the
current Valuation Period plus or minus the
per share charge or credit for taxes
reserved.
b. is the value of an Annuity Unit of the
applicable Subaccount as of the end of the
immediately preceding Valuation Period, plus
or minus the per share charge or credit for
taxes reserved.
TRANSFERS DURING THE During the Annuity Period, the payee(s) may
ANNUITY PERIOD not convert Fixed Annuity payment to
Variable Annuity payments. However, during
the Annuity Period, the payee(s), by sending
us a written notice in a form satisfactory
to us, may convert Variable Annuity payments
to Fixed Annuity payments; or have Variable
Annuity payments reflect the investment
experience of other Subaccounts. A transfer
may be made subject to the following:
1. Transfers from a Subaccount to the
General Account can be effective only on an
anniversary of the first Annuity payment
date. We must receive notice of such
transfer at least thirty days prior to the
effective date of the transfer. Unless you
specify otherwise, transfers to the General
Account from the Separate Account will be
proportional among the Subaccounts.
2. Transfers from one Subaccount to another
Subaccount will be effective during the
Valuation Period next succeeding the date
the notice is received by us. However, if
the notice for the transfer is received
within seven days immediately preceding an
Annuity payment date, the transfer will be
effective during the Valuation Period next
succeeding that Annuity payment date.
3. We reserve the right to limit the number
of transfers between Subaccounts to no less
than once each contract year.
4. We reserve the right to limit the number
of Subaccounts that may be used at one time
to no less than 3.
5. Requests for transfers must meet our
current rules and be in a form acceptable to
us.
The number of Annuity Units per payment
attributable to a Subaccount to which
transfer is made is equal to, in the case of
a transfer between Subaccounts, the number
of Annuity Units per payment in the
Subaccount from which transfer is being made
multiplied by the Annuity Unit Value for
that Subaccount divided by the Annuity Unit
Value for the Subaccount to which transfer
is being made.
21
ANNUITY PERIOD PROVISIONS (CONTINUED)
The amount of money allocated to the General
Account in the event of a transfer from a
Subaccount equals the annuity reserve for
the payee's interest in such Subaccount. The
annuity reserve is the product of a.
multiplied by b. multiplied by c. where: a.
is the number of Annuity Units representing
the payee's interest in such Subaccount per
Annuity payment; b. is the Annuity Unit
Value for such Subaccount; and c. is the
present value of $1.00 per payment period
using the attained age(s) of the payee(s)
and any remaining guaranteed payment that
may be due at the time of the transfer. The
fixed monthly payments resulting from the
transfer will not be less than the amount
purchased using the guarantees under this
contract. Money allocated to the General
Account upon such transfer will be applied
under the same Annuity option as originally
elected. Any guaranteed period payments will
be adjusted to reflect the number of
guaranteed payments that have already been
made. If all guaranteed payments have
already been made, no further payments will
be guaranteed.
All amounts and Annuity Unit Values are
determined as of the end of the Valuation
Period which precedes the effective date of
the transfer.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify the transfer privileges.
SUPPLEMENTARY AGREEMENT A supplementary agreement will be issued to
reflect payments that will be made under a
settlement option. If payment is made as a
death benefit distribution, the effective
date will be the date of death. Otherwise
the effective date will be the date chosen
by the Owner.
DATE OF FIRST PAYMENT Interest, under an option, will start to
accrue on the effective date of the
supplementary agreement. The supplementary
agreement will provide details on the
payments to be made.
EVIDENCE OF AGE, SEX We may require satisfactory evidence of the
AND SURVIVAL age, sex and the continued survival of any
person on whose life the income is based.
MISSTATEMENT OF AGE OR SEX If the age or sex of the payee has been
misstated, the amount payable under this
contract will be such as the Purchase
Payments sent to us would have purchased at
the correct age or sex. Interest not to
exceed 6% compounded each year will be
charged to any overpayment or credited to
any underpayment against future payments we
may make under this contract.
BASIS OF ANNUITY OPTIONS The guaranteed monthly payments are based on
an interest rate of 2.50% per year and where
mortality is involved, the A2000 Table
developed by the Society of Actuaries. We
may also make available Variable Annuity
payment options based on assumed investment
rates other than 2.50%.
DISBURSEMENT OF FUNDS When the payee dies, the value of any unpaid
UPON DEATH OF PAYEE: installments will be paid in one sum, to the
UNDER OPTIONS 1 OR 3 estate of the payee unless otherwise
provided in the agreement. The commuted
value for fixed installments based upon a
minimum interest rate of not less than 2.50%
will be paid. The commuted value of any
variable installments will be determined by
applying the Annuity Unit Value next
determined following our receipt of due
proof of death and will be based on the
Assumed Investment Return.
PROTECTION OF BENEFITS Unless otherwise provided in the
supplementary agreement, the payee may not
commute, anticipate, assign, alienate or
otherwise hinder the receipt of any payment.
Policy Form No. L-8589 Page 19
22
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
OPTION ONE - SPECIFIED PERIOD
Number Number Number Number
of years Monthly of years Monthly of years Monthly of years Monthly
selected Payment selected Payment selected Payment selected Payment
5 17.69 12 8.01 19 5.48 26 4.33
6 14.92 13 7.48 20 5.27 27 4.22
7 12.94 14 7.03 21 5.08 28 4.11
8 11.46 15 6.64 22 4.90 29 4.02
9 10.31 16 6.29 23 4.74 30 3.92
10 9.39 17 5.99 24 4.59
11 8.64 18 5.72 25 4.46
OPTION TWO AND THREE - LIFE ANNUITY WITH INSTALLMENTS GUARANTEED
Age of Monthly Payments Guaranteed Age of Monthly Payments Guaranteed
Male Female
Payee NONE 60 120 180 240 Payee NONE 60 120 180 240
55 4.17 4.16 4.13 4.06 3.96 55 3.87 3.86 3.84 3.81 3.75
56 4.27 4.25 4.21 4.14 4.03 56 3.95 3.94 3.92 3.88 3.82
57 4.36 4.35 4.30 4.22 4.09 57 4.03 4.02 4.00 3.95 3.88
58 4.46 4.45 4.40 4.30 4.16 58 4.11 4.11 4.08 4.03 3.95
59 4.57 4.55 4.50 4.39 4.22 59 4.21 4.20 4.17 4.11 4.01
60 4.69 4.67 4.60 4.48 4.29 60 4.30 4.29 4.26 4.19 4.08
61 4.81 4.79 4.71 4.57 4.36 61 4.41 4.40 4.35 4.28 4.15
62 4.94 4.92 4.83 4.66 4.43 62 4.52 4.50 4.46 4.37 4.23
63 5.09 5.05 4.95 4.76 4.49 63 4.64 4.62 4.56 4.46 4.30
64 5.24 5.20 5.08 4.86 4.56 64 4.76 4.74 4.68 4.56 4.37
65 5.40 5.35 5.21 4.96 4.62 65 4.90 4.87 4.80 4.66 4.45
66 5.57 5.52 5.35 5.06 4.69 66 5.04 5.01 4.93 4.77 4.52
67 5.75 5.69 5.49 5.17 4.75 67 5.19 5.16 5.06 4.87 4.59
68 5.95 5.87 5.64 5.27 4.81 68 5.36 5.32 5.20 4.98 4.66
69 6.15 6.07 5.80 5.37 4.86 69 5.53 5.49 5.35 5.10 4.73
70 6.38 6.27 5.96 5.48 4.91 70 5.72 5.68 5.51 5.21 4.80
71 6.61 6.49 6.12 5.58 4.96 71 5.93 5.87 5.67 5.33 4.86
72 6.86 6.72 6.29 5.68 5.00 72 6.15 6.08 5.85 5.44 4.92
73 7.13 6.96 6.47 5.77 5.04 73 6.39 6.31 6.03 5.56 4.97
74 7.42 7.21 6.64 5.86 5.08 74 6.65 6.55 6.21 5.67 5.02
75 7.72 7.48 6.82 5.95 5.11 75 6.93 6.81 6.41 5.78 5.06
76 8.05 7.76 7.00 6.03 5.14 76 7.24 7.08 6.60 5.88 5.10
77 8.40 8.06 7.18 6.11 5.17 77 7.57 7.38 6.80 5.98 5.13
78 8.77 8.37 7.35 6.18 5.19 78 7.92 7.69 7.01 6.07 5.16
79 9.18 8.69 7.53 6.25 5.20 79 8.31 8.02 7.21 6.15 5.18
80 9.60 9.03 7.70 6.31 5.22 80 8.72 8.37 7.41 6.23 5.20
81 10.06 9.38 7.86 6.36 5.23 81 9.17 8.74 7.61 6.30 5.22
82 10.55 9.74 8.02 6.41 5.24 82 9.66 9.13 7.80 6.35 5.23
83 11.07 10.12 8.17 6.45 5.25 83 10.20 9.54 7.98 6.41 5.24
84 11.63 10.50 8.32 6.49 5.26 84 10.77 9.96 8.15 6.45 5.25
85 12.22 10.89 8.45 6.52 5.26 85 11.39 10.40 8.31 6.49 5.26
23
ANNUITY OPTION TABLE
(CONTINUED)
OPTION FOUR - JOINT AND 100% SURVIVOR ANNUITY
Age of Age of Female Payee
Male
Payee 55 60 65 70 75 80 85
55 3.49 3.66 3.81 3.93 4.02 4.08 4.12
60 3.61 3.83 4.05 4.24 4.40 4.52 4.59
65 3.69 3.97 4.28 4.57 4.84 5.05 5.20
70 3.76 4.09 4.47 4.89 5.31 5.67 5.95
75 3.80 4.17 4.63 5.16 5.75 6.34 6.83
80 3.83 4.23 4.73 5.37 6.14 6.99 7.80
85 3.84 4.26 4.80 5.51 6.44 7.55 8.75
Rates for ages not shown here will be provided upon request.
24
INDIVIDUAL FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED
ANNUITY
NON-PARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE SUBACCOUNTS ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR
AMOUNT. WITHDRAWALS AND TRANSFERS FROM THE GUARANTEED PERIOD VALUE BEFORE THE
END OF THE GUARANTEED PERIOD ARE SUBJECT TO A MARKET VALUE ADJUSTMENT.
This is a legal contract between the Owner and Xxxxxx Investors Life Insurance
Company.
READ YOUR CONTRACT CAREFULLY
XXXXXX INVESTORS LIFE INSURANCE COMPANY
A Stock Life Insurance Company
0 Xxxxxx Xxxxx, Xxxx Xxxxx, Xxxxxxxx 00000-0000
Policy Form No. L-8589
