EXHIBIT 4(a)
THE UNITED STATES LIFE INSURANCE COMPANY
IN THE CITY OF NEW YORK
GROUP ANNUITY MASTER CONTRACT
Unless otherwise directed by a Participant, We will pay a monthly income to each
Annuitant if living on the Annuity Commencement Date. Payment will be made in
accordance with the revisions set forth in each Certificate and this Contract.
ALL PAYMENTS AND VALUES PROVIDED BY EACH CERTIFICATE, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE, MAY INCREASE OR
DECREASE, AND ARE NOT GUARANTEED AS TO AMOUNT. SEE THE "SEPARATE ACCOUNT" AND
"VARIABLE ANNUITY PAYMENTS" REVISIONS IN THE CERTIFICATE.
CANCELLATION RIGHT. THE CONTRACT OWNER MAY RETURN THIS CONTRACT FOR
CANCELLATION TO US OR TO THE SALES REPRESENTATIVE THROUGH WHOM IT WAS PURCHASED,
WITHIN 10 DAYS AFTER DELIVERY. UPON SURRENDER OF THIS CONTRACT WITHIN THE 10
DAY PERIOD, WE WILL REFUND THE SUM OF (1) ANY PURCHASE PAYMENTS ALLOCATED TO A
FIXED ACCOUNT; PLUS (2) ANY SEPARATE ACCOUNT VALUE AS OF THE END OF THE
VALUATION PERIOD IN WHICH THE CANCELLATION REQUEST IS RECEIVED; PLUS (3) ANY
ADDITIONAL AMOUNT DEDUCTED FOR PREMIUM TAXES.
This is a FLEXIBLE PAYMENT VARIABLE AND FIXED GROUP DEFERRED ANNUITY
CONTRACT. NONPARTICIPATING - NOT ELIGIBLE FOR DIVIDENDS.
To ensure that the dollar amount of variable annuity payments do not decrease,
the values in the Separate Account must earn a minimum annual aggregate
investment return of 4.16% for the variable annuity options based on an annual
rate of 3.5% and combined annual Separate Account charges of .66%.
SIGNED AT THE HOME OFFICE ON THE DATE OF ISSUE.
READ YOUR CONTRACT CAREFULLY
Home Office: New York, New York
000 Xxxxxx Xxxx Xxx Xxxx, XX 00000-4992 1-800-246-1924
98506N
INDEX
Account Value 4
Allocation of Net Purchase Payments 8
Annuity Options 20
Annuity Tables 21
Annuity Units 19
Automatic Rebalancing 14
Beneficiary 9
Change of Investment Advisor or Investment Policy 7
Contingent Annuitant 5 Death Proceeds 17
Definitions 4
Division Accumulation Units 12
Divisions 12
Fixed Account 11
General Provisions 6
Guaranteed Interest Rates 12
Guarantee Periods 11
Investment Objectives of the Portfolios 3
Misstatement of Age or Sex (Misstatement of Age if Issued on a Unisex Basis) 21
Net Investment Factor 13
Ownership Provisions 8
Participant 5
Payment and Deferment 15
Payment of Benefits 18
Premium Taxes 9
Purchase Payments 7
Schedule Page 3
Separate Account 12
Surrenders 16
Full Surrender 6
Partial Withdrawals 16
Systematic Withdrawal Plan 16
Tax Charge 17
Transfers 13
Variable Annuity Payments 19
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THE UNITED STATES LIFE INSURANCE COMPANY
SCHEDULE PAGE
INITIAL PURCHASE PAYMENT: $50,000
MINIMUM ADDITIONAL PURCHASE PAYMENTS: $5,000
ADDITIONAL BENEFITS: NONE
MAXIMUM ASSET CHARGE FACTORS (Separate Account Only) ANNUAL RATE: 0.66%
TRANSFER CHARGE After First 12 in a Certificate Year): $ 25
DIVISIONS OF THE SEPARATE ACCOUNT:
Equity Income VIP
Low Duration VIP
LEVCO Equity Value
Navellier Growth
OFFITBANK VIF-Emerging Markets
OFFITBANK VIF-High Yield
OFFITBANK VIF-Total Return
OFFITBANK VIF-U.S. Govt Secur
Royce Premier
Xxxxx Total Return
Xxxxxx lnt'l. Blue Xxxx
Xxxxxx Selected Blue Chip
Money Market
Fixed Account - 1 Year Guarantee Period
GROUP CONTRACT NUMBER: 12345
DATE OF ISSUE: JANUARY 1,1998
JURISDICTION STATE: (STATE NAME)
CONTRACT OWNER: UNITED STATES LIFE GROUP VARIABLE ANNUITY TRUST II
98506N Page 3
INVESTMENT OBJECTIVES OF THE PORTFOLIOS
A brief description of each Portfolio's investment objective follows. However,
no investment allocation should be made without referring to the appropriate
prospectus which describes each portfolio in detail.
THE EQUITY INCOME VIP PORTFOLIO seeks to provide current income and long-term
growth of income accompanied by growth of capital by investing in domestic
equity securities.
THE LOW DURATION VIP PORTFOLIO seeks to maximize total return consistent with
preservation of capital by investing in a diversified portfolio of fixed-income
securities of varying maturities with a portfolio duration of one to three
years.
THE LEVCO EQUITY VALUE FUND seeks long-term growth of capital through an
emphasis on the preservation of capital and an attempt to control volatility as
measured against the Standard Poor's Composite 500 Stock Index. It invests
primarily in common stocks and other securities having equity characteristics.
THE NAVELLIER GROWTH PORTFOLIO seeks long-term growth of capital primarily
through investment in companies with appreciation potential, including equity
securities traded in all U.S. markets and dollar denominated foreign securities
traded in U.S. markets.
THE OFFITBANK VIF - EMERGING MARKETS FUND seeks to provide investors with a
competitive total investment return by focusing on current yield and
opportunities for capital appreciation primarily by investing in corporate and
sovereign debt securities of emerging market countries.
THE OFFITBANK VIF - HIGH YIELD FUND seeks high current income with capital
appreciation as a secondary objective. It invests at least 65% of its total
assets in U.S. Corporate fixed-income securities rated below investment grade
offering potential returns that are sufficiently high to justify the greater
investment risks.
THE OFFITBANK VIF - TOTAL RETURN FUND seeks total return from a combination of
capital appreciation and current income by investing primarily in a portfolio of
fixed-income securities of varying maturities.
THE OFFITBANK VIF - U.S. GOVERNMENT SECURITIES FUND seeks current income
consistent with preservation of capital by investing at least 80% of its total
assets of U.S. Government obligations.
THE ROYCE PREMIER PORTFOLIO seeks primarily long-term growth and secondarily
current income by investing in a limited portfolio of common stocks and
convertible securities of small-cap companies believed to have superior
financial characteristics and/or unusually attractive business prospects.
THE ROYCE TOTAL RETURN PORTFOLIO seeks long-term growth of capital and current
income by investing primarily in a broadly diversified portfolio of dividend-
paying common stocks of small-cap companies selected on a risk averse value
basis.
THE XXXXXX INTERNATIONAL BLUE CHIP PORTFOLIO seeks long-term capital
appreciation by investing primarily in equity securities of well-established,
non-U.S. companies.
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THE XXXXXX SELECTED BLUE CHIP PORTFOLIO seeks long-term capital appreciation
and, as a secondary objective, reasonable current income by investing primarily
in equity securities of well-established U.S. companies.
THE MONEY MARKET FUND seeks protection of capital and high current income by
investing in money-market investments. Investments in the Money Market Fund are
neither insured nor guaranteed by the U.S. Government.
DEFINITIONS
WE, OUR, US, OR COMPANY. The United States Life Insurance Company In the City
of New York.
ACCOUNT. Any of the Divisions of the Separate Account or the Fixed Account.
ACCOUNT VALUE. The sum of the Fixed Account Value and the Separate Account Value
after deduction of any fees.
ACCUMULATION PERIOD. The period during which Net Purchase Payments are allocated
to either the Fixed Account or the Separate Account and held under a
Certificate.
ACCUMULATION UNIT. An accounting unit of measure used to calculate the value of
a Division of a Certificate before annuity payments begin.
ADMINISTRATIVE CENTER. The United States Life Insurance Company (USL) Annuity
Service Center, to which all Purchase Payments, requests, directions and other
communications should be directed. The USL Annuity Service Center is located at
0000-X Xxxxx Xxxxxxx, Xxxxxxx, Xxxxx. (Mailing address P. O. Box 1401, Houston,
Texas 77251-1401.)
AGE. Age of an Annuitant as of his or her last birthday, unless otherwise
stated.
ANNUITANT. The person upon whose date of birth and sex income payments are
based. (Upon whose date of birth income payments are based if issued on a Unisex
basis). The Annuitant's name will be found on page 3 of his or her Certificate.
ANNUITY COMMENCEMENT DATE. The date annuity payments are scheduled to commence.
ANNUITY UNIT. A unit of measure used to calculate variable annuity payments.
BENEFICIARY. The person entitled to receive benefits in the event the
Participant or Annuitant dies. If no named Beneficiary or Contingent Beneficiary
is living at the time any payment is to be made, the Participant shall be the
Beneficiary, or if the Participant is not living, the Participant's estate shall
be the Beneficiary.
CERTIFICATE DATE OF ISSUE. The date on which a Certificate becomes effective as
shown on Page 3 of the Certificate.
CERTIFICATE YEAR. A period of 12 consecutive months beginning on the Certificate
Date of Issue or any anniversary thereof before the Annuity Commencement Date.
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CONTINGENT ANNUITANT. A person named by the Owner of a Non-Qualified Contract to
become the Annuitant if: (1) the Annuitant dies before the Annuity Commencement
Date; and (2) the Contingent Annuitant is then living. A Contingent Annuitant
may not be named except at the time of application. Once named, the choice may
not be revoked or replaced. If a Contingent Annuitant dies, a new Contingent
Annuitant may not be named. After Annuity Payments start, a Contingent Annuitant
may not become the Annuitant.
CONTINGENT BENEFICIARY. A person named by the Participant to receive benefits in
the event designated Beneficiary is not living at the time of the Owner's or
Annuitant's death.
CONTRACT OWNER. The organization named on page 3 as Owner of this Contract.
DATE OF ISSUE. The date on which this Contract becomes effective as shown on
Page 3.
DIVISION. A subdivision of the Separate Account.
FIXED ACCOUNT. An Account which provides interest at a guaranteed fixed rate
for a guaranteed period.
FIXED ANNUITY OPTION. An Annuity Option with payments which do not vary with
investment performance.
GUARANTEED INTEREST RATE. The minimum rate we may use to credit interest on an
effective annual basis during any Guarantee Period.
GUARANTEE PERIOD. The period for which a Guaranteed Interest Rate is credited.
HOME OFFICE. Our office at 000 Xxxxxx Xxxx, Xxx Xxxx, X.X. 10038-4992;
0-000-000-0000.
ISSUE AGE. Age of the Annuitant on the Annuitant's last birthday before the
Certificate Date of Issue. (If the Certificate Date of Issue occurs on the
Annuitant's birthday, "last birthday" will mean the birthday occurring on the
Certificate Date of Issue).
NET ASSET VALUE PER SHARE. The value of the net assets of a Variable Fund
divided by the number of shares in the Variable Fund.
NET PURCHASE PAYMENT. The gross amount of a Purchase Payment less any Premium
Taxes deducted at the time a Purchase Payment is made.
NON-QUALIFIED CONTRACT. A Certificate that does not qualify for special federal
income tax treatment.
PARTICIPANT. (Certificate Owner) The person named in a Certificate who is
entitled to exercise all rights and privileges of ownership under that
Certificate.
PARTICIPANT'S ACCOUNT. An account established for each Participant to which
Purchase Payments are credited.
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PAYEE. A person who is to receive annuity payments, surrender proceeds or death
proceeds under a Certificate.
PAYOUT PERIOD. The period, starting with the Annuity Commencement Date, during
which Annuity Payments are made by the Company.
PREMIUM TAX. The amount of tax, if any, charged by a state or municipality on
Purchase Payments or Certificate Values.
PURCHASE PAYMENT. An amount paid to the Company as consideration for the
benefits described herein.
QUALIFIED CONTRACT. A Certificate that qualifies for special federal income tax
treatment applicable in connection with certain retirement plans.
SEPARATE ACCOUNT. A segregated investment account entitled "Separate Account
USL VA-R" established by the Company to separate the assets funding variable
benefits from the other assets of the Company. That portion of the assets of
the Separate Account equal to the reserves and other liabilities with respect to
the Separate Account shall not be chargeable with liabilities arising out of any
other business We may conduct. Income, gains and losses, whether or not
realized from assets allocable to the Separate Account, are credited to or
charged against such account without regard to our other income gains or losses.
UNIT VALUE. The value of: (1) an Accumulation Unit as described in the
"Division Accumulation Units" provision; or (2) an Annuity Unit as described in
the "Annuity Units" provision.
VALUATION DATE. Any day on which we are open for business except, with respect
to any Division, a day on which the related Variable Fund does not value its
shares.
VALUATION PERIOD. The period that starts at the close of regular trading on the
New York Stock Exchange on a Valuation Date and ends at the close of regular
trading on the Exchange on the next Valuation Date.
VARIABLE ANNUITY OPTION. An Annuity Option under which we promise to pay the
Annuitant or other properly-designated Payee one or more payments which vary in
amount based on the net investment experience of the applicable Divisions
selected to measure the value of a Certificate.
VARIABLE FUND. An individual investment fund or series in which a Division
invests.
WRITTEN, IN WRITING. A written request or notice in acceptable form and
content, which is signed and dated, and received at our Administrative Center.
GENERAL PROVISIONS
ENTIRE CONTRACT. Each Certificate will be attached to and made a part of this
Contract. This Contract, including the Certificate, endorsements if any, and a
copy of the application, if attached, constitute the entire Contract between the
Contract Owner and us. All statements made by the
98506N Page 6
Contract Owner, Participant or Annuitant will be deemed representations and not
warranties. No statement will be used to reduce a claim under this Contract
unless it is in writing and made a part of this Contract. Nothing in this
Contract invalidates or impairs any right granted to the Certificate holder by
Chapter 28, Article 32, Section 3219 of New York Insurance Laws, or the
Certificate.
CONTESTABLE. This Contract is not contestable.
DISCONTINUANCE OF ACCEPTANCE OF NEW PARTICIPANTS. By giving 30 days prior
written notice, we may limit or discontinue the acceptance of new Participants'
applications and the issuance of new Certificates under this Contract. Such
limitation or discontinuance shall have no effect on rights or benefits with
respect to any Certificate issued prior to effective date of such limitation or
discontinuance.
GUARANTEES. Regardless of Our actual mortality experience or the actual
expenses incurred by Us, the Asset Charge Factor will not be increased above the
maximum shown on page 3. Otherwise, Our actual mortality experience and actual
expenses incurred will not affect the dollar amount of variable benefits paid.
SETTLEMENT. All benefits under Certificates issued under this Contract are
payable from our Administrative Center in Houston, Texas.
NONPARTICIPATING. This Contract is nonparticipating and does not share in our
surplus or earnings.
CHANGE OF INVESTMENT ADVISOR OR INVESTMENT POLICY Unless otherwise required by
law or regulation, the investment advisor or any investment policy may not be
changed without our consent. If required, approval of or change of any
investment policy will be filed with the Insurance Department of the state where
this Contract and the Certificate are delivered. A Participant will be notified
of any material investment policy change which has been approved. Notification
of an investment policy change will be given in advance to those Contract Owners
who have the right to comment on or vote on such change.
Any substitution of the underlying investments of any Division will comply with
all applicable requirements of the Investment Company Act of 1940 and rules
thereunder.
RIGHTS RESERVED BY US. Upon notice to a Participant, a Certificate may be
modified by us, but only if such modification is necessary to:
(1) Operate the Separate Account in any form permitted under the Investment
Company Act of 1940 or in any other form permitted by law;
(2) Transfer any assets in any Division to another Division, or to one or more
other separate accounts, or to the Fixed Account;
(3) Add, combine or remove Divisions in the Separate Account, or combine the
Separate Account with another separate account;
(4) Add, restrict or remove Guarantee Periods of the Fixed Account;
98506N Page 7
(5) Make any new Division available to a Participant on a basis to be
determined by Us;
(6) Substitute for the shares held in any Division, the shares of another
Variable Fund or the shares of another investment company or any other
investment permitted by law;
(7) Make any changes as required by the Internal Revenue Code or by any other
applicable law, regulation or interpretation in order to continue treatment
of a Certificate as an annuity; or
(8) Make any changes required to comply with rules of any Variable Fund.
When required by law, we will obtain a Participant's approval of changes and we
will gain approval from any appropriate regulatory authority.
CHANGING THE TERMS OF THIS CONTRACT OR A CERTIFICATE. Any change in this
Contract or a Certificate must be approved by one of Our officers. No agent has
the authority to make any changes or waive any of the terms of this Contract or
a Certificate.
TERMINATION. Each Certificate will remain in force until surrendered for its
full value, or all annuity payments have been made, or the death proceeds have
been paid, except as follows: If a Participant's Account Value falls below
$10,000 due to Partial Withdrawals, we may cancel the Certificate upon 60 days'
notice to the Participant. Such cancellation would be considered a full
surrender of the Certificate.
This Contract will terminate when all funds from all Certificates are withdrawn.
PURCHASE PAYMENTS
MINIMUM AND MAXIMUM PAYMENTS. The minimum amount acceptable as a Purchase
Payment (after the initial Purchase Payment) is shown on page 3. We reserve the
right to modify the minimum Purchase Payment, but such minimum will never be
greater than $5,000. The maximum amount We will accept during the life of a
Certificate without approval of an officer of the Company is $1,000,000.
ALLOCATION OF NET PURCHASE PAYMENTS. The initial allocation of Net Purchase
Payments is shown on Page 3 of each Certificate and will remain in effect until
changed. The percentage allocation for future Net Purchase Payments may be
changed at any time by written notice provided by the Participant.
Changes in the allocation will be effective on the date We receive the
Participant's notice. The allocation may be 100% to any available Division or
Guarantee Period, or may be divided among the options in whole percentage points
totaling 100%.
An initial Purchase Payment will be credited to the Participant's Account no
more than two Valuation Periods after we receive it, together with all other
required documentation, in good order at the office designated by the Company
for processing of initial Purchase Payments. Subsequent Purchase Payments will
be credited as of the end of the Valuation Period in which they are received. We
reserve the right to limit the total number of Fixed Account Guarantee Periods
and Separate Account Divisions that may be chosen while a certificate remains in
force.
98506N Page 8
PREMIUM TAXES. When applicable, we will deduct an amount to cover premium
taxes. Such education will be made from Purchase Payment(s) when received, or:
(1) From the Participant's Account Value at the time annuity payments are to
commence, or
(2) From the amount of any partial withdrawal; and
(3) From proceeds payable upon termination of a Certificate for any other
reason, including surrender of such Certificate.
If premium tax is paid, the Company may reimburse itself for such tax when
deduction is being made under paragraphs 1, 2 or 3 above calculated by
multiplying the sum of Purchase Payments withdrawn by the applicable premium tax
percentage.
OWNERSHIP PROVISIONS
This Contract is owned by the Organization named on page 3 of this Contract.
The Participant will have the right to exercise all rights and privileges in
connection with such Participant's Certificate. If a Certificate is jointly
owned by more than one Participant, all Participants must join in any request to
exercise the rights or privileges of a Participant.
In any case, such rights and privileges may be exercised without the consent of
the Beneficiary (other than an irrevocably designated Beneficiary) or any other
person. Such rights and privileges may be exercised only during the lifetime of
the Annuitant and prior to the Annuity Commencement Date, except as otherwise
provided in this Contract and the Certificate.
A Payee entitled to benefits upon the death of the Participant or the Annuitant
may thereafter exercise such rights and privileges, if any, of ownership which
continue.
BENEFICIARY. The Participant named the Beneficiary and any Contingent
Beneficiary when applying for the Certificate. By Written notice to Us, a non-
irrevocable Beneficiary or Contingent Beneficiary may be changed by the
Participant prior to the Annuity Commencement Date. The Annuitant or other
properly-designated Payee may change the Beneficiary after the Annuity
Commencement Date by giving Written notice to Us.
CHANGE OF OWNERSHIP. Ownership of a Qualified Contract may not be transferred
except to: (1) the Annuitant; (2) a trustee or successor trustee of a pension or
profit sharing trust which is qualified under Section 401 of the Internal
Revenue Code; (3) the employer of the Annuitant, provided that the Qualified
Contract after transfer is maintained under the terms of a retirement plan
qualified under Section 403(a) of the Internal Revenue Code for the benefit of
the Annuitant; (4) the trustee of an individual retirement account plan
qualified under Section 408 of the Internal Revenue Code; or (5) as otherwise
permitted from time to time by laws and regulations governing the retirement or
deferred compensation plans for which a Qualified Contract may be issued. In no
other case may a Qualified Contract be sold, assigned, transferred, discounted
or pledged as collateral.
The Owner of a Non-Qualified Contract may change the ownership of such Contract.
During the lifetime of the Annuitant and prior to the Annuity Commencement Date,
the Participant may change the ownership interest in the Non-Qualified Contract
as evidenced by the Certificate.
98506N Page 9
A change of ownership will not be binding upon us until we receive Written
notification at Our Administrative Center. When such notification is so
received, the change will be effective as of the date of the signed request for
change, but the change will be without prejudice to Us on account of any payment
made, or any action taken by Us prior to receiving the change, or on account of
any tax consequence.
DEATH OF THE PARTICIPANT PRIOR TO THE ANNUITY DATE NON-QUALIFIED CONTRACTS ONLY.
As used in a Certificate, the term "Non-Qualified Contract" means a Certificate
that does not qualify for the special federal income tax treatment applicable in
connection with retirement plans.
If a Participant (including the first to die in the case of Joint Participants)
under a Non-Qualified Contract dies prior to the Annuitant and before the
Annuity Commencement Date, the death proceeds must be distributed either (1)
with in five years after the date of death of the Participant, or (2) over the
life of or a period not greater than the life or expected life of the Payee,
with annuity payments beginning within one year after the date of death of the
Participant.
The Beneficiary of a Participant (other than a Joint Participant) will be the
person or persons designated as Beneficiary in the application for a
Certificate, or as later changed prior to the death of such Participant. If a
Joint Participant dies, death proceeds will be paid to the surviving Joint
Participant, if living; otherwise death proceeds will be paid to the person
designated as Beneficiary.
These mandatory distribution requirements will not apply upon the death of a
Participant if the spouse of a deceased Participant elects to continue the
Certificate in the spouse's own name, as Participant. The spouse may make such
election if: (1) the spouse is the designated Beneficiary of a deceased
Participant (other than a Joint Participant); or (2) the spouse is the sole
surviving Joint Participant.
The Beneficiary (including a Joint Participant receiving death proceeds) will be
considered the designated beneficiary for the purposes of Section 72(s) of the
Internal Revenue Code. In all cases, any such designated beneficiary will not
be entitled to exercise any rights prohibited by applicable federal income tax
law.
If the Payee under a Non-Qualified Contract dies after the Annuity Commencement
Date and before all of the payments under the Annuity Option have been
distributed, the remaining amount payable must be distributed at least as
rapidly as under the method of distribution then in effect.
If the Participant prior to the Annuity Commencement Date, or the Payee
thereafter, is not a natural person, then the foregoing distribution
requirements shall apply upon the death of the primary Annuitant within the
meaning of the Internal Revenue Code.
PERIODIC REPORTS. During the Accumulation Period We will send to each
Participant, at least once during each Certificate Year, a statement showing the
following amounts as of a date not more than two months prior to the date of
mailing:
(1) The number of Accumulation Units credited to the Participant's Account; and
(2) The dollar value of each Accumulation Unit;
(3) The total value of the Participant's Account;
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(4) The Cash Surrender Value of the Participant's Account; and
(5) The Death Benefit.
We will also send such statements as may be required by applicable state and
federal laws, rules and regulations.
PARTICIPANT'S ACCOUNT. We will establish a Participant's Account for the
Participant under a Certificate and will maintain such account during the
Accumulation Period. The Participant's Account Value for any Valuation Period
will be equal to the Participant's Separate Account Value, if any, plus the
Participant's Fixed Account Value, if any, for that Valuation Period.
FIXED ACCOUNT
FIXED ACCOUNT VALUE. We will credit to the Guarantee Period(s) selected that
portion of each Net Purchase Payment allocated to the Fixed Account. The value
in any one Guarantee Period on a Valuation Date is:
(1) The accumulated value of the Net Purchase Payments, renewals or transfers
allocated to the Guarantee Period at the Guaranteed Interest Rate; less
(2) The Accumulated Value of surrenders and transfers out of that Guarantee
Period at the Guaranteed Interest Rate.
GUARANTEE PERIODS. A one year Guarantee Period will always be available, and
additional Guarantee Periods may be added from time to time. If more than one
Guarantee Period is available, the Participant may select more than one. The
Guarantee Period selected will determine the Guaranteed Interest Rate(s).
The Net Purchase Payment or the portion thereof (or amount transferred in
accordance with the transfer privilege provision described below) allocated to a
particular Guarantee Period will earn interest at the Guaranteed Interest Rate
during the Guarantee Period. Guarantee Periods begin on the date as of which we
credit a Participant's Account Value to that Guarantee Period or, in the case of
a transfer, on the effective date of the transfer. The Guarantee Period is the
number of years We credit the Guaranteed Interest Rate. The expiration date of
any Guarantee Period is the last day of the Guarantee Period. Subsequent
Guarantee Periods begin on the first day following the expiration date. As a
result of Guarantee Period renewals, additional Purchase Payments and transfers
of portions of the Participant's Account Value, Guarantee Periods of the same
duration may have different expiration dates and Guaranteed Interest Rates.
We will notify the Participant in writing at least 15, and not more than 45 days
prior to the expiration date of any Guarantee Period. A new Guarantee Period of
the same duration as the previous Guarantee Period will begin automatically
unless we receive Written notice to the contrary from the Participant at least 3
Valuation Dates prior to the end of such Guarantee Period. The Participant may
elect to change to another Guarantee Period or Division which We offer at such
time.
98506N Page 11
If the amount of the Participant's Account Value in a Guarantee Period is less
than $500 at the end of such Guarantee Period, We reserve the right to transfer
such amount, without charge, to the Money Market Division of the Separate
Account. However, We will transfer such amount to another available Division at
the Participant's request.
GUARANTEED INTEREST RATES. We will periodically establish an applicable
Guaranteed Interest Rate for each Guarantee Period We offer. These rates will
be guaranteed for the duration of the respective Guarantee Periods. The
Guarantee Periods that We make available at any time will be determined at Our
discretion. No Guaranteed Interest Rate shall be less than an effective annual
rate of 3.0%.
INTEREST RATE LOCK ON 1035 EXCHANGES OR OTHER QUALIFIED ROLLOVERS AND TRANSFERS.
This provision will apply if:
(1) Proceeds are being transferred to us under Internal Revenue Code (IRC
Section 1035 (a 1035 Exchange), or under another rollover of values
qualified for special tax treatment under the IRC; and
(2) All, or a part of the resulting Net Purchase Payments are to be allocated
to the Fixed Account.
If proceeds from such Exchange, Rollover or Transfer are received by the Company
within 60 days following the date of application for a Certificate, interest to
be credited to the Fixed Account during the Guarantee Period will be calculated
at a rate which is the higher of: (1) the current interest rate being used by
the Company on the date of the application for the Guarantee Period selected; or
(2) the current interest rate being used by the Company on the date of receipt
of proceeds. Proceeds received more than 60 days after the date the application
is signed will receive interest at the rate in effect on the date of receipt of
such proceeds.
Interest will be credited to the Fixed Account as of the date of receipt of such
proceeds, and the interest rate used to calculate such interest will remain in
effect for the duration of the Guarantee Period.
SEPARATE ACCOUNT
DIVISIONS. The Separate Account has several Divisions, each investing in a
corresponding Variable Fund. Net Purchase Payments will be allocated to the
Divisions and the Fixed Account as shown on page 3 of the Certificate unless the
Participant changes the allocation. A list of the Divisions of the Separate
Account and the Initial Allocation of Purchase Payments appear on page 3 of each
Certificate. A brief description of each Division will be found on page 3A.
We will use the Net Purchase Payments and any transferred amounts to purchase
Variable Fund shares applicable to the Divisions at their net asset value. We
will be the owner of all Variable Fund shares purchased with the Net Purchase
Payments or transferred amounts.
DIVISION ACCUMULATION UNITS. Net Purchase Payments and transferred amounts
allocated to the Separate Account will be credited to the Participant's account
in the form of Division Accumulation Units. The number of Division Accumulation
Units will be determined by dividing the amount allocated to a Division by the
Division Accumulation Unit value as of the end of the Valuation Period
98506N Page 12
as of which the transaction is credited. The value of each Division
Accumulation Unit is arbitrarily set as of the date the Division first purchases
Variable Fund shares. Subsequent Accumulation Unit values on any Valuation Date
are equal to the previous Division Accumulation Unit value times the Net
Investment Factor for the Valuation Period ending on that Valuation Date.
NET INVESTMENT FACTOR. The Net Investment Factor is an index applied to measure
the investment performance of a Division from one Valuation Period to the next.
The Net Investment Factor may be greater than, less than or equal to one;
therefore, the value of an Accumulation Unit may increase, decrease or remain
the same.
The Net Investment Factor for a Division is determined by dividing (1) by (2),
and then subtracting (3) from the result, where:
(1) Is the sum of:
(a) The Net Asset Value Per Share of the Variable Fund shares held in the
Division, determined at the end of the current Valuation Period; plus
(b) The per share amount of any dividend or capital gain distributions
made on the Variable Fund shares held in the Division during the
current Valuation Period;
(2) Is the Net Asset Value Per Share of the Variable Fund shares held in the
Division, determined at the beginning of the current Valuation Period; and
(3) Is the daily asset charge factor representing the mortality and expense
risks, and administrative expense charge. We may change the daily asset
charge factor, but in no event may it exceed the Maximum Asset Charge
Factor as specified on Page 3.
SEPARATE ACCOUNT VALUE. Separate Account Value for any Valuation Period is the
total of the values in each Division credited to a Participant's account for
such Valuation Period. The value for each Division will be equal to:
(1) The number of Division Accumulation Units; multiplied by
(2) The Division Accumulation Unit Value for the Valuation Period.
The Separate Account value will vary from Valuation Date to Valuation Date
reflecting the total value in the Divisions.
If a Participant's Account Value in any Division (except the Money Market
Division) falls below $500, we reserve the right to transfer the remaining
balance without charge to the Money Market Division.
TRANSFERS
Transfers may be made at any time during the Accumulation Period after the first
30 days following the Certificate Date of Issue. A transfer will be effective
at the end of the Valuation Period in which We receive a Participant's Written
request for a transfer. Transfers will be subject to the following
restrictions:
98506N Page 13
(1) Prior to the Annuity Commencement Date, the Participant may make up 12
transfers each Certificate Year without charge.
(2) There will be a charge of $25.00 for each transfer in excess of 12 in a
Certificate Year.
(3) Transfers under the Automatic Rebalancing or Dollar Cost Averaging programs
will not count towards the 12 free transfers each Certificate Year. The $25
charge will not apply to transfers made through Automatic Rebalancing or
Dollar Cost Averaging. Transfers under any other asset management
arrangement approved by the Company may be subject to the $25 charge and
may count towards the 12 free transfers.
(4) The amount of Account Value that may be transferred each year from a Fixed
Account Guarantee Period to a Separate Account Division is limited. The
limit will be based on the Guarantee Period account balance at the
beginning of the Guarantee Period. Not more than 25% of such account
balance may be transferred to a Separate Account Division during each
Certificate Year. The 25% limit does not apply to:
(a) Funds transferred from a Guarantee Period as a result of Dollar Cost
Averaging; or
(b) Transfers within 15 days before or after the end of the applicable
Guarantee Period; or
(c) A renewal at the end of a Guarantee Period to the same Guarantee
Period.
(5) If a transfer would cause the Account Value in any Division or Guarantee
Period to fall below $500, We reserve the right to also transfer the
remaining balance in that Division or Guarantee Period in the same
proportions as the transfer request.
(6) We reserve the right to defer any transfer from the Fixed Account to the
Variable Divisions for up to 6 months.
We may not unilaterally terminate or discontinue transfer privileges. However,
We reserve the right to suspend such privileges for a reasonable period. Any
such suspension will be administered in a nondiscriminatory manner.
After the Annuity Commencement Date, a Participant may make six transfers during
any Certificate Year. There will be no charge for such transfers. After the
Annuity Commencement Date, a Participant may not make transfers from the Fixed
Account.
AUTOMATIC REBALANCING. "Automatic Rebalancing" occurs when funds are
transferred by the Company between the Separate Account Divisions so that the
values in each Division match the percentage allocation then in effect.
Automatic Rebalancing of the Separate Account Divisions will occur periodically:
(1) If a Participant's Account Value is equal to or greater than $25,000; and
(2) If such Participant has selected Automatic Rebalancing.
98506N Page 14
A Participant may select Automatic Rebalancing when applying for a Certificate,
or it may be selected at a later date. We reserve the right to increase or
lower the Minimum Account Value required for Automatic Rebalancing. Automatic
Rebalancing is only available prior to the Annuity Commencement Date.
DOLLAR COST AVERAGING. Dollar Cost Averaging is an automatic transfer of funds
over a stated period prior to the Annuity Commencement Date in accordance with
the Transfers provision and instructions from a Participant. The periods
available for automatic transfers will be determined by the Company. There will
always be at least one period of 12 months or more during which Dollar Cost
Averaging may be made. The minimum automatic transfer which may be made will be
$1,000, or a lesser amount as determined by the Company.
PAYMENT AND DEFERMENT
SURRENDERS. The amount surrendered will normally be paid to a Participant within
5 Valuation Dates following Our receipt of:
(1) The Participant's Written request on a form acceptable to Us; and
(2) The Certificate, if required.
DEATH PROCEEDS. If we do not receive a Written request as to the manner of
payment within 60 days after death proceeds become payable, any death benefit
proceeds will be paid as a lump sum, normally within 7 calendar days after the
end of the Valuation Period that contains the last day of said 60 day period.
FIXED ACCOUNT. We reserve the right to defer payment or transfers of amounts out
of the Fixed Account for up to 6 months from the date We receive the request.
ACCOUNT VALUE BASED ON PURCHASE PAYMENT MADE BY CHECK. We reserve the right to
defer payment of that portion of a Participant's Account Value that is based on
a Purchase Payment made by check for a period not to exceed 15 days.
OTHER. We may defer payment of any portion of the variable account value if:
(1) The New York Stock Exchange is closed (other than customary weekend and
holiday closings) or trading on the New York Stock Exchange is restricted.
(2) An emergency exists, as a result of which disposal of securities is not
practicable, or it is not reasonably practicable to fairly determine the
variable account value.
(3) The Securities and Exchange Commission by order permits delay for the
protection of Participants. Transfer and allocations of Account Value among
the Divisions and the Fixed Account may also be postponed under these
circumstances.
98506N Page 15
SURRENDERS
FULL SURRENDER. At any time prior to the Annuity Commencement Date, and during
the lifetime of the Annuitant, a Participant may surrender his or her
Certificate by sending us a Written request. The amount payable on surrender is:
(1) The Participant's Account Value at the end of the Valuation Period in which
We receive the Participant's request on a form acceptable to Us;
(2) Minus any applicable premium tax.
The amount payable upon surrender will not be less than the amount required by
state law.
Upon payment of the surrender amount, the Certificate will terminate and We will
have no further obligation to the Participant.
All collateral assignees must consent to any surrender or partial withdrawal.
We may require that the Certificate be returned to Our Administrative Center
prior to making payment.
PARTIAL WITHDRAWALS. A portion of the Participant's Account Value may be
withdrawn at any time prior to the Annuity Commencement Date. The Participant
must send us a Written request specifying the Divisions or Guarantee Periods
from which the Partial Withdrawal is to be made. However, in cases where the
Participant does not so specify, or the withdrawal cannot be made in accordance
with the Participant's specifications, We reserve the right to implement the
withdrawal prorata from each Division and Guarantee Period based on the Account
Value in each. Partial Withdrawals will be made effective at the end of the
Valuation Period in which We receive the Written request. Partial Withdrawals
will be subject to the following guidelines:
(1) The Partial Withdrawal amount must be at least $ 100 or, if less, the
Participant's entire Account Value;
(2) If a Partial Withdrawal would cause the Participant's Account Value in any
Division or Guarantee Period (except the Money Market Division) to fall
below $500, We reserve the right to transfer the remaining balance without
charge to the Money Market Division.
(3) A request for a Partial Withdrawal may not be honored if it would reduce
the Participant's Account Value to an amount less than $ 10,000.
SYSTEMATIC WITHDRAWAL PLAN
The Systematic Withdrawal Plan (the "Plan") allows Partial Withdrawals to be
made at periodic intervals while the Certificate remains in force. The Plan is
available immediately after the Date of Issue of the Certificate with
withdrawals beginning as early as 30 days after the Date of Issue. Additional
Purchase Payments will be accepted by the Company while withdrawals are being
made under the Plan. Withdrawals are automatic. Once Withdrawals have been
started under the Plan, the Company will continue distribution unless the
Participant has provided otherwise. The Participant under a Certificate may
stop withdrawals under the Plan at any time.
98506N Page 16
The Plan is subject to the following guidelines:
(1) The Annuity Date of a Certificate must be at least one year later than the
date of the first withdrawal;
(2) Each withdrawal must be $100.00 or more;
(3) The Participant may request distributions to be made on an annual, semi-
annual, quarterly or monthly basis;
(4) After withdrawals are stopped under the Plan, withdrawals may be started
again at a later date subject to the same guidelines that applied to the
initial series of withdrawals.
The Systematic Withdrawal Plan will terminate at the Annuity Date at which time
the Certificate must annuitize.
TAX CHARGE
RIGHT TO IMPOSE. We reserve the right to impose additional charges or establish
reserves for any federal or local taxes incurred or that may be incurred by us,
and that may be deemed attributable to a Certificate.
DEATH PROCEEDS
DEATH PROCEEDS BEFORE THE ANNUITY COMMENCEMENT DATE. If the Annuitant dies
before the Annuity Commencement Date, and is survived by a Contingent Annuitant,
the Certificate will be continued with the Contingent Annuitant being named the
Annuitant. If the Certificate is a Non-Qualified Contract, it may qualify for
continuation under the "Death of the Participant Prior to the Annuity Date -
Non-Qualified Contracts Only" provision Otherwise, death proceeds will be paid
as follows (unless the Participant has specified in writing the death proceeds
are to be paid in a different manner):
(1) If the Annuitant dies, and no Contingent Annuitant survives, death proceeds
will be paid to the Beneficiary designated by the Participant to receive
proceeds.
(2) If a Participant (other than a Joint Participant) dies, and the Certificate
is not being continued under the "Death of the Participant Prior to the
Annuity Date - Non-Qualified Contracts Only" provision, death proceed will
be paid to the Beneficiary designated by the Participant to receive
proceeds.
(3) If a Joint Participant dies, death proceeds will be paid to the surviving
Joint Participant, if living; otherwise death proceeds will be paid to the
person designated as Beneficiary if:
(a) The Certificate is not being continued under the "Death of the
Participant Prior to the Annuity Date - Non-Qualified Contracts Only"
provision; and
(b) Joint Participants have not specified in writing the death proceed are
to be paid in a different manner.
98506N Page 17
If the Annuitant or a Participant dies before the deceased's Age 81, the amount
of the death proceeds will be the greater of the following amounts less any
applicable Premium Tax:
(1) The sum of all Net Purchase Payments less any prior Partial Withdrawals; or
(2) The Participant's Account Value as of the end of the Valuation Period in
which We receive proof of the Annuitant's or such Participant's death and a
Written request from the Beneficiary as to the form of payment.
If the Annuitant or Participant dies on or after the deceased's attainment of
Age 81, the amount of the death proceeds will be the Participant's Account Value
as of the end of the Valuation Period in which We receive proof of the
Annuitant's or such Participant's death and a Written request from the
Beneficiary as to the form of payment.
The death proceeds will not be less than the amount payable on a full surrender
at the date used to value the death benefit. The death proceeds will become
payable when We receive:
(1) Proof of the Participant's or Annuitant's Death; and
(2) A Written request from the Beneficiary for either a single sum or payment
under an Annuity Option.
If the Annuitant dies, and a Contingent Annuitant was named but pre deceased the
Annuitant, We will require proof of the Contingent Xxxxxxxxx's death in addition
to proof of the death of the Annuitant. We will pay a single sum to the
Beneficiary unless an Annuity Option is chosen.
DEATH PROCEEDS AFTER THE ANNUITY COMMENCEMENT DATE. If the Annuitant dies on or
after the Annuity Commencement Date, the Beneficiary will receive the death
proceeds, if any, as provided by the payment contract.
PROOF OF DEATH. We accept any of the following as proof of the Annuitant's or
Participant's death:
(1) A copy of a certified death Certificate;
(2) A copy of a certified decree of a court of competent jurisdiction as to the
finding of death;
(3) A written statement by a medical doctor who attended the deceased a the
time of death; or
(4) Any other proof satisfactory to Us.
PAYMENT OF BENEFITS
APPLICATION OF ACCOUNT VALUE. Unless directed otherwise, We will apply the
Fixed Account Value to provide a Fixed Annuity, and the Separate Account Value
to provide a Variable Annuity. A Participant must tell us in Writing at least
30 days prior to the Annuity Commencement Date if Fixed and Separate Account
values are to be applied in different proportions. Transfers and partial
withdrawals will be permitted within the 30-day period.
98506N Page 18
ANNUITY COMMENCEMENT DATE. The Annuity Commencement Date (Annuity Date) is
shown on page 3 of the Certificate. The Participant of a Qualified Contract may
be required to receive distributions after the Annuitant's 70th birthday to
comply with certain federal tax requirements. The Annuity Date may be changed
by Written notice from the Participant, subject to our approval.
OPTIONS AVAILABLE TO A PARTICIPANT. A Participant may elect to have annuity
payments made beginning on the Annuity Commencement Date under any one of the
Annuity Options described in his or her Certificate. We will notify the
Participant 60 to 90 days prior to the scheduled Annuity Date that the
Certificate is scheduled to mature, and request that an Annuity Option be
selected. If the Participant has not selected an Annuity Option ten days prior
to the Annuity Commencement Date, We will proceed as follows:
(1) If the scheduled Annuity Commencement Date is any date prior to the
Annuitant's 90th birthday, We will extend the Annuity Commencement Date to
the Annuitant's 90th birthday.
(2) If the scheduled Annuity Commencement Date is the Annuitant's 90th
birthday, the Account Value less any premium taxes will be paid in one sum
to the Participant.
OPTIONS AVAILABLE TO A BENEFICIARY. A Participant may elect, in lieu of payment
in one sum, that any amount or part thereof due under the Certificate be applied
under any of the options described in the Certificate. Within 60 days after the
death of the Annuitant or Participant, the Beneficiary may make such election if
the Participant has not done so. In such case, the Beneficiary thereafter shall
have all the rights and options of the Participant.
The first annuity payment under any option shall be made on the first day of the
second month after approval of the claim for settlement. Subsequent payments
shall be made periodically in accordance with the manner of payment elected.
PAYMENT CONTRACT. At such time as one of these options becomes effective, the
Certificate shall be surrendered to the Company in exchange for a payment
contract providing for the option elected.
FIXED ANNUITY PAYMENTS. Fixed Annuity Payments start on the Annuity
Commencement Date. The amount of the first monthly payment for the annuity
selected will be at least as favorable as that produced by the applicable
annuity table of the Certificate.
The dollar amount of any payments after the first payment is specified during
the entire period of annuity payments according to the provisions of the Annuity
Option elected.
VARIABLE ANNUITY PAYMENTS
ANNUITY UNITS. We convert the Division Accumulation Units into Division Annuity
Units at the values determined at the end of the Valuation Period which contains
the tenth day prior to the Annuity Commencement Date. The number of Division
Annuity Units is obtained by dividing the first monthly payment by the Division
Annuity Unit Value determined at the end of the Valuation Period. (See following
paragraph). The first monthly payment is determined by applying the dollar
value of the Division Accumulation Units to the applicable Annuity Table. The
number of Division Annuity Units remains constant as long as an annuity remains
in force and allocation among the Divisions has not changed.
98506N Page 19
Each Division Annuity Unit Value is arbitrarily set when the Division first
converts Division Accumulation Units into Division Annuity Units. Subsequent
values on any Valuation Date are equal to (1) times (2) divided by (3) where:
(1) is the previous Division Annuity Unit Value (2) is the Net Investment Factor
for that Division for the Valuation Period ending on that Valuation Date; and
(3) is the value of $1.00 accumulated with interest at the effective annual rate
of 3 1/2% from the end of the previous Valuation Date to the end of the current
Valuation Date.
Variable Annuity Payments start on the Annuity Commencement Date. Payments will
vary in amount and are determined at the end of the Valuation Period that
contains the tenth day prior to each payment. If the monthly payment under the
annuity option selected is based on a single Division, the monthly payment is
found by multiplying the Division Annuity Unit Value on said date by the number
of Division Annuity Units.
If the monthly payment under the annuity option selected is based upon more than
one Division, the above procedure is repeated for each applicable Division. The
sum of these payments is the Variable Annuity Payment.
ANNUITY OPTIONS
FIRST OPTION - LIFE ANNUITY - An annuity payable monthly during the lifetime of
the Annuitant.
SECOND OPTION - LIFE ANNUITY WITH 120, 180 OR 240 MONTHLY PAYMENTS GUARANTEED -
An annuity payable monthly during the lifetime of the Annuitant, including the
guarantee that if, at the death of the Annuitant, payments have been made for
less than 120 months, 180 months or 240 months (as selected), payments shall be
continued during the remainder of the selected period.
THIRD OPTION - JOINT AND LAST SURVIVOR LIFE ANNUITY - An annuity payable monthly
during the joint lifetime of the Annuitant, and a secondary Annuitant and
thereafter during the remaining lifetime of the survivor, ceasing with the last
payment prior to the death of the survivor. This option is available only if
one person is Adjusted Age 70 or less.
FOURTH OPTION - PAYMENTS FOR A DESIGNATED PERIOD - An amount payable monthly for
the number of years selected which may be from 5 to 40 years. If this option is
selected on a variable basis, the number of years may not exceed the life
expectancy of the Annuitant or other properly-designated Payee.
FIFTH OPTION - PAYMENTS OF A SPECIFIC DOLLAR AMOUNT - The amount due may be paid
in equal monthly installments of a designated dollar amount until the remaining
balance is less than the amount of one installment. Payments under this option
are available on a fixed basis only. To determine the remaining balance at the
end of any month, such balance at the end of the previous month is decreased by
the amount of any installment paid during the month and the result will be
accumulated at an interest rate not less than 3.5% compounded annually. If the
remaining balance at any time is less than the amount of one installment, such
balance will be paid and will be the final payment under the option.
In lieu of monthly payments, payments may be elected on a quarterly, semi-annual
or annual basis, in which cases the amount of each annuity payment will be
determined on a basis consistent with that described in the Certificate for
monthly payments.
98506N Page 20
No election of any Annuity Option may be made if the accumulated value is less
than $2,000, or if the initial annuity payment will be less than $20 per month.
If the minimum is not met, the Company will make a lump-sum payment of the
Account Value (less any applicable premium tax) to the Annuitant or other
properly-designated Payee.
MISSTATEMENT OF AGE OR SEX (MISSTATEMENT OF AGE IF ISSUED ON A UNISEX BASIS).
If the: (1) age or sex of the Annuitant (if the Certificate was issued on a Sex
Distinct basis); or (2) age of the Annuitant (if the Certificate was issued on a
Unisex basis) has been misstated to Us, any amount payable will be that which
would have been payable had the misstatement not occurred. We will deduct any
overpayment from the next payment or payments due and add any under payments to
the next payment due. Interest at an effective annual rate of 3 1/2% will be
added to any such adjustment.
ANNUITY TABLES. The tables that follow show the dollar amount of the first
monthly payment for each $1,000 applied under the options. If issued on a Sex
Distinct basis, tables are based on the 1983a Male or Female Tables adjusted by
projection scale G for 9 years, with interest at the rate of 3 1/2% per year.
Under the First or Second Options, the amount of each payment will depend upon
the sex of the Annuitant and the Annuitant's adjusted age at the time the first
payment is due. Under the Third Option, the amount of each payment will depend
upon the sex of both Annuitants and their adjusted ages at the time the first
payment is due. If issued on a Unisex basis, tables are based on the 1983a Male
or Female Tables, adjusted by projection scale G for 9 years, with unisex rates
based on 60% female and 40% male, and interest at the rate of 3 1/2% per year.
Under the First or Second Options, the amount of each payment will depend upon
the Annuitant's adjusted age at the time the first payment is due. Under the
Third Option, the amount of each payment will depend upon both Xxxxxxxxx's
adjusted ages at the time the first payment is due.
ADJUSTED AGE. In using the table of annuity payment rates, the ages of the
Annuitants must be reduced by one year for Annuity Commencement Dates occurring
during the decade 2000-2009, reduced two years for Annuity Commencement Dates
occurring during the decade 2010-2019, and reduced an additional year for each
decade that follows. The age 70 rate is also used for ages above 70.
ALTERNATE AMOUNT OF INSTALLMENT UNDER FIXED LIFE INCOME OPTIONS. If a fixed
life income option is elected, the Participant (or, if the Participant has not
elected a payment option, the Beneficiary) may elect life income payment equal
to those provided by those fixed single premium immediate annuity option rates
offered to the same class of annuitants by the Company when annuity payments
begin.
98506N Page 21
ANNUITY TABLES
AMOUNT OF MONTHLY PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE
Options 1 and 2 - Life Annuities
Adjusted Age Monthly Payments Guaranteed
of Male Option l* Option 2 Option 2 Option
None 120 180 240
50 4.37 4.33 4.28 4.21
51 4.44 4.40 4.34 4.26
52 4.52 4.47 4.40 4.32
53 4.59 4.54 4.47 4.37
54 4.68 4.62 4.54 4.43
55 4.77 4.70 4.61 4.49
56 4.86 4.78 4.69 4.55
57 4.96 4.87 4.76 4.61
58 5.06 4.97 4.84 4.67
59 5.18 5.07 4.93 4.73
60 5.30 5.17 5.01 4.79
61 5.42 5.28 5.10 4.86
62 5.56 5.40 5.20 4.92
63 5.71 5.52 5.29 4.98
64 5.87 5.65 5.38 5.04
65 6.04 5.79 5.48 5.10
66 6.22 5.92 5.58 5.15
67 6.41 6.07 5.68 5.21
68 6.62 6.22 5.77 5.26
69 6.84 6.37 5.87 5.30
70 7.07 6.53 5.96 5.35
71 N/A 6.70 6.07 5.40
72 N/A 6.87 6.16 5.44
73 N/A 7.04 6.24 5.47
74 N/A 7.21 6.32 5.50
75 N/A 7.38 6.40 5.52
76 N/A 7.55 6.47 5.55
77 N/A 7.72 6.54 5.57
78 N/A 7.89 6.60 5.58
79 N/A 8.05 6.66 5.60
80 N/A 8.21 6.71 5.61
81 N/A 8.36 6.75 5.62
82 N/A 8.50 6.79 5.62
83 N/A 8.64 6.82 5.63
84 N/A 8.76 6.85 5.63
85 N/A 8.88 6.88 5.64
PAGE 22
98506N
Adjusted Age Monthly Payments Guaranteed
of Female Option l* Option 2 Option 2 Option 2
None 120 180 240
50 4.05 4.03 4.01 3.97
51 4.10 4.09 4.06 4.02
52 4.17 4.14 4.12 4.07
53 4.23 4.21 4.17 4.12
54 4.30 4.27 4.23 4.18
55 4.37 4.34 4.30 4.23
56 4.44 4.41 4.36 4.29
57 4.52 4.48 4.43 4.35
58 4.61 4.56 4.50 4.41
59 4.70 4.65 4.58 4.48
60 4.79 4.74 4.66 4.54
61 4.89 4.83 4.74 4.61
62 5.00 4.93 4.83 4.67
63 5.12 5.03 4.92 4.74
64 5.24 5.14 5.01 4.81
65 5.38 5.26 5.11 4.88
66 5.52 5.38 5.20 4.95
67 5.67 5.51 5.31 5.01
68 5.83 5.65 5.41 5.08
69 6.01 5.79 5.52 5.14
70 6.20 5.94 5.62 5.20
71 N/A 6.11 5.74 5.27
72 N/A 6.27 5.85 5.32
73 N/A 6.45 5.96 5.37
74 N/A 6.63 6.06 5.41
75 N/A 6.81 6.16 5.45
76 N/A 7.00 6.26 5.49
77 N/A 7.20 6.35 5.52
78 N/A 7.39 6.44 5.54
79 N/A 7.59 6.52 5.56
80 N/A 7.78 6.59 5.58
81 N/A 7.97 6.65 5.60
82 N/A 8.15 6.70 5.61
83 N/A 8.32 6.75 5.62
84 N/A 8.49 6.79 5.62
85 N/A 8.64 6.83 5.63
* Not available above Adjusted Age 70.
98506N Page 23
Option 3 - Joint and Last Survivor Life Annuity (Available only if one person is
Adjusted Age 70 or less)
Adjusted Age Adjusted Age of Secondary Annuitant
of Annuitant Female
Male F50 F55 F60 F65 F70
50 3.76 3.89 4.01 4.11 4.19
55 3.84 4.01 4.18 4.33 4.46
60 3.90 4.11 4.33 4.56 4.77
65 3.95 4.19 4.47 4.78 5.09
70 3.99 4.25 4.58 4.96 5.39
Adjusted Age
of Annuitant Adjusted Age of Secondary Annuitant
Male
Female M50 M55 M60 M65 M70
50 3.76 3.84 3.90 3.95 3.99
55 3.89 4.01 4.11 4.19 4.25
60 4.01 4.18 4.33 4.47 4.58
65 4.11 4.33 4.56 4.78 4.96
70 4.19 4.46 4.77 5.09 5.39
Option 4 - Payments for a Designated Period
Years of Amount of Monthly Years of Amount of Monthly
Payment Payment Payment Payment
5 $18.12 23 $5.24
6 15.35 24 5.09
7 13.38 25 4.96
8 11.90 26 4.84
9 10.75 27 4.73
10 9.83 28 4.63
11 9.09 29 4.53
12 8.46 30 4.45
13 7.94 31 4.37
14 7.49 32 4.29
15 7.10 33 4.22
16 6.76 34 4.15
17 6.47 35 4.09
18 6.20 36 4.03
19 5.97 37 3.98
20 5.75 38 3.92
21 5.56 39 3.88
22 5.39 40 3.83
98506N Page 24
ANNUITY TABLES
AMOUNT OF MONTHLY PAYMENT
FOR EACH 1,000 OF ANNUITY VALUE
Options 1 and 2 - Life Annuities
Adjusted Unisex Monthly Payments Guaranteed
Age
Option 1* Option 2 Option 2 Option 2
None 120 180 240
50 4.18 4.15 4.12 4.07
51 4.24 4.21 4.18 4.12
52 4.31 4.28 4.24 4.17
53 4.38 4.34 4.30 4.23
54 4.45 4.41 4.36 4.28
55 4.53 4.48 4.43 4.34
56 4.61 4.56 4.50 4.40
57 4.70 4.64 4.57 4.46
58 4.79 4.73 4.65 4.52
59 4.89 4.82 4.72 4.59
60 5.00 4.91 4.81 4.65
61 5.11 5.02 4.89 4.71
62 5.23 5.12 4.98 4.78
63 5.36 5.23 5.07 4.85
64 5.49 5.35 5.17 4.91
65 5.64 5.48 5.26 4.98
66 5.80 5.61 5.36 5.04
67 5.96 5.74 5.46 5.10
68 6.14 5.88 5.57 5.16
69 6.34 6.03 5.67 5.21
70 6.54 6.19 5.77 5.27
71 N/A 6.36 5.88 5.33
72 N/A 6.52 5.98 5.37
73 N/A 6.69 6.08 5.41
74 N/A 6.87 6.18 5.45
75 N/A 7.05 6.27 5.49
76 N/A 7.23 6.35 5.51
77 N/A 7.42 6.44 5.54
78 N/A 7.60 6.51 5.56
79 N/A 7.78 6.58 5.58
80 N/A 7.96 6.64 5.59
81 N/A 8.13 6.69 5.61
82 N/A 8.30 6.74 5.62
83 N/A 8.46 6.78 5.62
84 N/A 8.60 6.82 5.63
85 N/A 8.74 6.85 5.63
98506UN Page 25
Option 3 - Joint and Last Survivor Life Annuity (Available only if one person
is Adjusted Age 70 or less)
Adjusted Age Adjusted Age of Secondary Annuitant
of Annuitant
Unisex 50 55 60 65 70
50 3.75 3.85 3.94 4.01 4.07
55 3.85 4.00 4.13 4.24 4.33
60 3.94 4.13 4.32 4.49 4.65
65 4.01 4.24 4.49 4.75 5.00
70 4.07 4.33 4.65 5.00 5.36
*Not available above Adjusted Unisex Age 70.
Option 4 - Payments for a Designated Period
Years of Amount of Monthly Years of Amount of Monthly
Payment Payment Payment Payment
5 $18.12 23 $5.24
6 15.35 24 5.09
7 13.38 25 4.96
8 11.90 26 4.84
9 10.75 27 4.73
10 9.83 28 4.63
11 9.09 29 4.53
12 8.46 30 4.45
13 7.94 31 4.37
14 7.49 32 4.29
15 7.10 33 4.22
16 6.76 34 4.15
17 6.47 35 4.09
18 6.20 36 4.03
19 5.97 37 3.98
20 5.75 38 3.92
21 5.56 39 3.88
22 5.39 40 3.83
98506UN Page 26
THE UNITED STATES LIFE INSURANCE COMPANY
IN THE CITY OF NEW YORK
This is a FLEXIBLE PAYMENT VARIABLE and FIXED GROUP DEFERRED ANNUITY CONTRACT
NONPARTICIPATING - NOT ELIGIBLE FOR DIVIDENDS.
ALL PAYMENTS AND VALUES PROVIDED BY EACH CERTIFICATE, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE, MAY INCREASE OR
DECREASE, AND ARE NOT GUARANTEED AS TO AMOUNT. SEE THE "SEPARATE ACCOUNT" AND
"VARIABLE ANNUITY PAYMENTS" PROVISIONS IN THE CERTIFICATE.
For Information, Service or to make a Complaint
Contact our Registered Representative or The United States Life Annuity Service
Center
THE UNITED STATES LIFE INSURANCE COMPANY
ANNUITY SERVICE CENTER
0000-X XXXXX PARKWAY
P. 0. BOX 1401
HOUSTON, TEXAS 77251-1401
0-000-000-0000
98506N
