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EX-99.B4
Individual Flexible Purchase Payment Deferred Variable Annuity Contract
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[FIRST VARIABLE LIFE LOGO]
FIRST VARIABLE LIFE INSURANCE COMPANY
LITTLE ROCK, ARKANSAS
FIRST VARIABLE LIFE INSURANCE COMPANY (the "Company") will make Annuity Payments
to the Annuitant starting on the Annuity Date subject to the terms of this
Contract.
This Contract is issued in return for the Application and payment of the initial
Purchase Payment. A copy of the Application is attached to and made a part of
the Contract.
TEN DAY FREE LOOK--Within 10 days of the date of receipt of this Contract by the
Owner, it may be returned by delivering or mailing it to the Company at its
Annuity Service Center or to the agent through whom it was purchased. When this
Contract is received by the Company, it will be voided as if it had never been
in force. The Company will refund the Contract Value computed at the end of the
Valuation Period during which this Contract is received by the Company at its
Annuity Service Center.
Signed for the Company.
/S/ Xxxxxx X. Xxxxxxx /s/ Xxxx X. Xxxxxx
Secretary President
ANNUITY PAYMENTS, WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS
CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE
VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
THE VARIABLE PROVISIONS OF THIS CONTRACT CAN BE FOUND ON PAGES 12 AND 13.
INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT WITH
FLEXIBLE PURCHASE PAYMENTS - NON-PARTICIPATING
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TABLE OF CONTENTS
Contract Data Page.................................................................................................4
Definitions........................................................................................................6
Purchase Payment Provisions........................................................................................7
Purchase Payments..............................................................................................7
Subsequent Purchase Payments...................................................................................7
Allocation of Purchase Payments................................................................................7
No Default.....................................................................................................7
Separate Account Provisions........................................................................................7
The Separate Account...........................................................................................7
Investments of the Separate Account............................................................................7
Valuation of Assets............................................................................................8
Separate Account Management Fee................................................................................8
Accumulation Unit..............................................................................................8
Mortality and Expense Risk Charge..............................................................................8
Administrative Charge..........................................................................................8
Mortality and Expense Guarantee................................................................................8
Contract Value Provision...........................................................................................8
Contract Value.................................................................................................8
Annual Contract Maintenance Charge.................................................................................9
Deduction for Annual Contract Maintenance Charge...............................................................9
Transfer Provisions................................................................................................9
Transfers Prior to the Annuity Date............................................................................9
Transfers During the Annuity Period............................................................................9
Withdrawal Provisions.............................................................................................10
Withdrawal 10
Withdrawal Charge.............................................................................................10
Death Benefits....................................................................................................10
Death of Annuitant............................................................................................10
Death of Owner................................................................................................10
Payment of Death Benefit......................................................................................11
Annuity Provisions................................................................................................11
General.......................................................................................................11
Annuity Date..................................................................................................11
Selection of an Annuity Option................................................................................11
Frequency and Amount of Annuity Payments......................................................................12
Annuity Options ..............................................................................................12
Option A. Life Annuity........................................................................................12
Option B. Life Annuity With Periods Certain of 60, 120, 180 or 240 Months................................12
Option C. Joint and Survivor Annuity.....................................................................12
Option D. Joint and Contingent Annuity...................................................................12
Option E. Fixed Payments for a Period Certain............................................................12
Annuity.......................................................................................................12
Fixed Annuity.................................................................................................12
Variable Annuity..............................................................................................13
Annuity Unit..................................................................................................13
Mortality Tables..............................................................................................13
Supplementary Agreement.......................................................................................14
Suspension or Deferral of Payments................................................................................14
Xxxxxxxxx, Ownership, Assignment Provisions.......................................................................14
Annuitant....................................................................................................14
Owner........................................................................................................14
Joint Owner..................................................................................................14
Assignment...................................................................................................15
Beneficiary Provisions............................................................................................15
Beneficiary..................................................................................................15
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Change of Beneficiary........................................................................................15
General Provisions................................................................................................15
The Contract.................................................................................................15
Misstatement of Age..........................................................................................15
Incontestability.............................................................................................15
Modification.................................................................................................15
Non-Participating............................................................................................15
Evidence of Survival.........................................................................................15
Proof of Age.................................................................................................15
Protection of Proceeds.......................................................................................16
Reports......................................................................................................16
Taxes........................................................................................................16
Transfer by the Company......................................................................................16
Xxxxxxx Option Tables.............................................................................................17
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CAPITAL FIVE VA
CONTRACT DATA PAGE
ANNUITANT: [Xxxx Xxx] AGE AT ISSUE: [35]
OWNER: [XXXX XXX] AGE AT ISSUE: [35]
CONTRACT NUMBER: [12345] ISSUE DATE: [04/01/94]
ANNUITY DATE: [04/01/2023]
PURCHASE PAYMENTS:
[INITIAL PURCHASE PAYMENT: $25,000]
[MINIMUM SUBSEQUENT PURCHASE PAYMENT: $500]
[MAXIMUM SUBSEQUENT PURCHASE PAYMENT: $1 Million]
BENEFICIARY:
As stated in the Application for this Contract unless changed in accordance
with the Contract provisions.
ANNUAL CONTRACT MAINTENANCE CHARGE:
$30.00 each Contract Year. After the Annuity Date, the Annual Contract
Maintenance Charge will be collected on a monthly basis.
MORTALITY AND EXPENSE RISK CHARGE:
Equal on an annual basis to 1.25% of the average daily net asset value of
the Separate Account.
ADMINISTRATIVE CHARGE:
Equal on an annual basis to .15% of the average daily net asset value of the
Separate Account.
TRANSFERS:
FREE TRANSFERS: 12 per Contract Year prior to the Annuity Date; 6 per
Contract Year during the
Annuity Period.
TRANSFER FEE: the lesser of $25 or 2% of the amount transferred.
MINIMUM CONTRACT VALUE TO BE TRANSFERRED: $1,000 or the Owner's entire
interest in the Subaccount if less.
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN A SUBACCOUNT AFTER A TRANSFER:
$1,000
SEPARATE ACCOUNT MANAGEMENT FEE: None
WITHDRAWALS:
WITHDRAWAL CHARGE: A withdrawal charge may be deducted in the event of a
withdrawal of all or a portion of the Contract Value. The Withdrawal Charge is
determined by multiplying the excess of the amount withdrawn over the Free
Withdrawal Amount by the applicable percentage or percentages from the Table of
Withdrawal Charges below. The Withdrawal Charge Percentages are based upon the
number of Contract Anniversaries that Purchase Payments have remained in the
Contract before being withdrawn. Purchase Payments are deemed to be withdrawn in
the order in which they are made.
FREE WITHDRAWAL AMOUNT: The annual Free Withdrawal Amount is determined as the
sum of (a) 10% of Purchase Payments still subject to the Withdrawal Charge; plus
(b) the excess of the Contract Value over Purchase Payments not previously
withdrawn; plus (c) any Purchase Payments no longer subject to the Withdrawal
Charge. No Withdrawal Charge will be assessed upon any withdrawal unless the
amount withdrawn exceeds the Free Withdrawal Amount. The cumulative total of all
Withdrawal Charges is guaranteed to never exceed 8 1/2% of the total Purchase
Payments.
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TABLE OF WITHDRAWAL CHARGES:
CONTRACT ANNIVERSARY
SINCE PURCHASE
PAYMENT WITHDRAWAL CHARGE PERCENTAGE
------- ----------------------------
1 7% of the Purchase Payment withdrawn
2 6% of the Purchase Payment withdrawn
3 5% of the Purchase Payment withdrawn
4 4% of the Purchase Payment withdrawn
5 3% of the Purchase Payment withdrawn
6 and after 0%
MINIMUM PARTIAL WITHDRAWAL: $1,000 or the Owner's entire interest in the
Subaccount, if less
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN A SUBACCOUNT AFTER A PARTIAL
WITHDRAWAL: $1,000
INVESTMENT OPTIONS:
VIST Federated Prime Money Fund II Portfolio
VIST U.S. Government Bond Portfolio
VIST High Income Bond Portfolio
VIST Growth Fund Portfolio
VIST Multiple Strategies Portfolio
VIST Matrix Equity Portfolio
VIST World Equity Portfolio
VIST Growth and Income Portfolio
VIST Small Cap Fund Portfolio
General Account
SEPARATE ACCOUNT: Separate Account E
VARIABLE SERVICE CENTER
First Variable Life Insurance Company
Variable Service Center
PO Box 1317
Des Moines, IA 50305-1317
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DEFINITIONS
ACCUMULATION PERIOD: The period during which Purchase Payments may be made prior
to the Annuity Date.
ACCUMULATION UNIT: A unit of measure used to calculate the Contract Value in a
Subaccount of the Separate Account prior to the Annuity Date.
AGE: The Annuitant's age on his/her birthday nearest the date for which age is
being determined.
ANNUITANT: The natural person on whose life Annuity Payments are based.
ANNUITY DATE: The date on which Annuity Payments begin. The Annuity Date is
shown on the Contract Data Page.
ANNUITY PAYMENTS: The series of payments made to the Annuitant after the Annuity
Date under the Option selected.
ANNUITY PERIOD: The period after the Annuity Date during which Annuity Payments
are made.
ANNUITY UNIT: A unit of measure used to calculate Variable Annuity Payments
after the Annuity Date.
BENEFICIARY: The person, persons or entity who will receive the death benefit.
COMPANY: First Variable Life Insurance Company.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date.
CONTRACT VALUE: The sum of the Owner's interest in the Subaccounts of the
Separate Account.
CONTRACT YEAR: One year from the Issue Date and from each Contract Anniversary.
FIXED ANNUITY: A series of payments made during the Annuity Period which are
guaranteed as to dollar amount by the Company.
GENERAL ACCOUNT: The Company's general investment account which contains all the
assets of the Company with the exception of the Separate Account and other
segregated asset accounts.
INVESTMENT OPTION: An investment entity shown on the Contract Data Page.
ISSUE DATE: The date on which the Contract became effective. The Issue Date is
shown on the Contract Data Page.
OWNER: The person, persons or entity entitled to all the ownership rights under
this Contract and in whose name this Contract has been issued.
PORTFOLIO: A segment of an Investment Option which constitutes a separate and
distinct class of shares.
PURCHASE PAYMENT: An amount paid to the Company to provide benefits under this
Contract.
SEPARATE ACCOUNT: A separate investment account of the Company designated on the
Contract Data Page.
SUBACCOUNT: A segment of the Separate Account representing an investment in an
Investment Option or a Portfolio of an Investment Option.
VALUATION DATE: The Separate Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period beginning at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
VARIABLE ANNUITY: A series of payments made during the Annuity Period which vary
in amount with the investment experience of each applicable Subaccount.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS: The initial Purchase Payment is due on the Issue Date. The
minimum and maximum subsequent Purchase Payments are shown on the Contract Data
Page. The Company reserves the right to reject any Application or Purchase
Payment.
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SUBSEQUENT PURCHASE PAYMENTS: Subject to the maximum and minimum shown on the
Contract Data Page, the Owner may make subsequent Purchase Payments and may
increase or decrease or change the frequency of such payments.
ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to the Separate
Account in accordance with the selections made by the Owner. The allocation of
the initial Purchase Payment is made in accordance with the selection made by
the Owner in the Application. Unless otherwise changed by the Owner, subsequent
Purchase Payments are allocated in the same manner as the initial Purchase
Payment. Allocation of the Purchase Payments is subject to the terms and
conditions imposed by the Company.
NO DEFAULT: Unless the Owner makes a total withdrawal, this Contract will remain
in force until the death of the Owner. This Contract will not be in default if
subsequent Purchase Payments are not made.
SEPARATE ACCOUNT PROVISIONS
THE SEPARATE ACCOUNT: The Separate Account is a separate investment account of
the Company. It is shown on the Contract Data Page. The Company has allocated a
part of its assets for this and certain other contracts to the Separate Account.
The assets of the Separate Account are the property of the Company. However,
they are not chargeable with the liabilities arising out of any other business
the Company may conduct.
INVESTMENTS OF THE SEPARATE ACCOUNT: The Separate Account is segmented into
Subaccounts. Purchase Payments applied to the Separate Account are allocated to
a Subaccount of the Separate Account. The assets of the Subaccount are allocated
to the Investment Option(s) and the Portfolio(s), if any, within an Investment
Option shown on the Contract Data Page. The Company may, from time to time, add
additional Investment Options or Portfolios to those shown on the Contract Data
Page. The Owner may be permitted to transfer Contract Values to the additional
Investment Options or Portfolios. However, the right to make any transfer will
be limited by the terms and conditions imposed by the Company.
If any Investment Option is a separate legal entity issuing shares or other
evidence of ownership and should the shares of any such Investment Option(s) or
any Portfolio(s) within the Investment Option became unavailable for investment
by the Separate Account, or the Company's Board of Directors deems further
investment in these shares inappropriate, the Company may substitute shares of
another Investment Option or Portfolio for shares already purchased under this
Contract.
VALUATION OF ASSETS: Assets of the Separate Account are valued at their fair
market value in accordance with procedures of the Company.
SEPARATE ACCOUNT MANAGEMENT FEE: Any fee deducted by the Company from the
Separate Account for investment management is shown on the Contract Data Page.
ACCUMULATION UNIT: A Purchase Payment when allocated to the Separate Account is
converted into Accumulation Units for the selected Subaccounts. The number of
Accumulation Units in a Subaccount credited to this Contract is determined by
dividing the Purchase Payment allocated to that Subaccount by the Accumulation
Unit Value for that Subaccount as of the Valuation Period during which the
Purchase Payment is allocated to the Subaccount. The Accumulation Unit Value for
each Subaccount was arbitrarily set initially at $10. Subsequent Accumulation
Unit Values are determined by subtracting (2) from (1) and dividing the result
by (3) where:
1. is the net result of:
a. the assets of the Subaccount attributable to Accumulation Units; plus
or minus
b. the cumulative charge or credit for taxes reserved which is
determined by the Company to have resulted from the operation or maintenance of
that Subaccount.
2. is the cumulative unpaid charge for the Mortality and Expense Risk
Charge and for the Administrative Charge, which are shown on the Contract Data
Page; and
3. is the number of Accumulation Units outstanding at the end of the
Valuation Period.
The Accumulation Unit Value may increase or decrease from Valuation Period to
Valuation Period.
MORTALITY AND EXPENSE RISK CHARGE: The Company deducts a Mortality and Expense
Risk Charge from the Separate Account which is equal, on an annual basis, to the
amount shown on the Contract Data Page. The Mortality and Expense Risk Charge
compensates the Company for assuming the mortality and expense risks under this
Contract.
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ADMINISTRATIVE CHARGE: The Company deducts an Administrative Charge from the
Separate Account which is equal, on an annual basis, to the amount shown on the
Contract Data Page. The Administrative Charge compensates the Company for the
costs associated with the administration of this Contract and the Separate
Account.
MORTALITY AND EXPENSE GUARANTEE: The Company guarantees that the dollar amount
of each Annuity Payment after the first Annuity Payment will not be affected by
variations in mortality or expense experience.
CONTRACT VALUE PROVISION
CONTRACT VALUE: Each Purchase Payment is allocated to one or more Subaccounts of
the Separate Account. A Purchase Payment allocated to a Subaccount of the
Separate Account is converted into Accumulation Units. The number of
Accumulation Units in a Subaccount credited to this Contract is determined by
dividing the Purchase Payment allocated to that Subaccount by the Accumulation
Unit Value for that Subaccount.
The Contract Value on any Valuation Date is the sum of the Owner's interest in
the Subaccounts of the Separate Account. The value of the Owner's interest in a
Subaccount is determined by multiplying the number of Accumulation Units
attributable to that Subaccount by the Accumulation Unit Value for that
Subaccount.
Withdrawals will result in the cancellation of Accumulation Units in a
Subaccount.
ANNUAL CONTRACT MAINTENANCE CHARGE
DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE: The Company deducts an Annual
Contract Maintenance Charge from the Contract Value by canceling Accumulation
Units from each applicable Subaccount to reimburse it for expenses relating to
maintenance of this Contract. The Annual Contract Maintenance Charge is shown on
the Contract Data Page. The Annual Contract Maintenance Charge will be deducted
from the Contract Value on each Contract Anniversary while this Contract is in
force.
If a total withdrawal is made on other than a Contract Anniversary, the Annual
Contract Maintenance Charge will be deducted at the time of withdrawal. If the
Annuity Date is not a Contract Anniversary, a pro rata portion of the Annual
Contract Maintenance Charge will be deducted on the Annuity Date. After the
Annuity Date, the Annual Contract Maintenance Charge will be collected on a
monthly basis and will result in a reduction of each Annuity Payment.
TRANSFER PROVISIONS
TRANSFERS PRIOR TO THE ANNUITY DATE: Prior to the Annuity Date, the Owner may
transfer all or part of the Owner's interest in a Subaccount without the
imposition of any fee or charge if there have been no more than the number of
free transfers shown on the Contract Data Page for the Contract Year. All
transfers are subject to the following:
1. if more than the number of free transfers have been made in the Contract
Year, the Company will deduct a Transfer Fee for each subsequent
transfer. The Transfer Fee will be deducted from the Owner's interest in
the Subaccount from which the transfer is made. However, if the Owner's
entire interest in a Subaccount is being transferred, the Transfer Fee
will be deducted from the amount which is transferred.
2. the minimum which can be transferred is shown on the Contract Data Page.
The minimum which must remain is shown on the Contract Data Page.
3. the Company reserves the right, at any time and without prior notice to
any party, to terminate, suspend or modify the transfer privilege
described above.
If the Owner elects to use the transfer privilege, the Company will not be
liable for transfers made in accordance with the Owner's instructions.
TRANSFERS DURING THE ANNUITY PERIOD: During the Annuity Period, the
Owner may make transfers, by written request, as follows:
1. the Owner may make a transfer of Contract Values between Subaccounts as
indicated on the Contract Data Page.
2. the Owner may, once each Contract Year, make a transfer from one or more
Subaccounts to the General Account. The Owner may not make a transfer
from the General Account to the Separate Account.
The amount transferred to the General Account from a Subaccount of the Separate
Account will be equal to the annuity reserves for the Owner's interest in that
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
Owner's interest in the Subaccount per
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Annuity Payment; and (b) is the Annuity Unit Value for the Subaccount; and (C)
is the present value of $1.00 per payment period as of the Age of the
Annuitant at time of transfer for the Annuity Option, determined using the
Mortality Tables used to construct the Annuity Tables contained in this
Contract. Xxxxxxx transferred to the General Account will be applied under the
Annuity Option elected at the Age of the Annuitant at the time of the transfer.
All amounts and Annuity Unit Values will be determined as of the end of the
Valuation Period preceding the effective date of this transfer.
WITHDRAWAL PROVISIONS
WITHDRAWAL: Prior to the Annuity Date, the Owner may, upon written request
received by the Company, make a total or partial withdrawal of the Contract
Withdrawal Value. The Contract Withdrawal Value is:
1. the Contract Value for the Valuation Period next following the Valuation
Period during which a written request for a withdrawal is received at
the Company; less
2. any applicable taxes not previously deducted; less
3. the Withdrawal Charge, if any; less
4. the Annual Contract Maintenance Charge, if any.
A withdrawal will result in the cancellation of Accumulation Units from each
applicable Subaccount in the ratio that the Owner's interest in the Subaccount
bears to the total Contract Value. The Owner must specify in writing in advance
which Subaccount Units are to be canceled if other than the above method is
described.
The Company will pay the amount of any withdrawal within seven (7) days of
receipt of a request in good order unless the Suspension or Deferral of Payments
provision is in effect.
Each partial withdrawal must be for an amount which is not less than the amount
shown on the Contract Data Page. The remaining Contract Value which must remain
in a Subaccount after a partial withdrawal is shown on the Contract Data Page.
WITHDRAWAL CHARGE: A withdrawal charge may be deducted in the event of a
withdrawal of all or a portion of the Contract Value. The Withdrawal Charge and
Free Withdrawal Amounts are set out on the Contract Data Page.
DEATH BENEFITS
DEATH OF ANNUITANT: Upon the death of the Annuitant prior to the Annuity Date,
the Owner must designate a new Annuitant. If no designation is made within 30
days of the death of the Annuitant, the Owner will become the Annuitant. If the
Owner is a non-natural person, the death of the Annuitant will be treated as the
death of the Owner and a new Annuitant may not be designated.
Upon the death of the Annuitant after the Annuity Date, the Death Benefit, if
any, will be as specified in the Annuity Option elected.
DEATH OF OWNER: Upon the death of the Owner prior to the Annuity Date, the Death
Benefit will be paid to the Beneficiary designated by the Owner. The Death
Benefit will be the greater of:
1. the Purchase Payments, less any withdrawals including any applicable
Withdrawal Charges; or
2. the Contract Value.
The Death Benefit will be determined and paid as of the Valuation Period next
following the date of receipt by the Company of both due proof of death and an
election for the payment method. The Beneficiary can elect to have a single lump
sum payment or choose one of the Annuity Options.
If a single sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the election, unless the Suspension or
Deferral of Payments provision is in effect.
Payment to the Beneficiary, other than in a single sum, may only be elected
during the sixty-day period beginning with the date of receipt of proof of
death.
The entire Death Benefit must be paid within five (5) years of the date of death
unless:
1. The Beneficiary elects to have the Death Benefit payable under an
Annuity Option over the life of the Beneficiary or over a period not extending
beyond the life expectancy of the Beneficiary; or
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2. If the Beneficiary is the spouse of the Owner, the Beneficiary may elect
to become the Owner of the Contract and this Contract will continue in effect.
If there are Joint Owners, any references to the death of the Owner shall mean
the first death of an Owner.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death before any
Death Benefit is paid. Due proof of death will be:
1. a certified death certificate;
2. a certified decree of a court of competent jurisdiction as to the
finding of death; or
3. any other proof satisfactory to the Company.
All Death Benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.
ANNUITY PROVISIONS
GENERAL: On the Annuity Date, the Contract Value, less any applicable premium
taxes and Annual Contract Maintenance Charge ("Adjusted Contract Values"), will
be applied under the Annuity Option selected by the Owner. Annuity Payments may
be made on a fixed or variable basis or both.
ANNUITY DATE: The Annuity Date is selected by the Owner at the time of the
Application. The Annuity Date is shown on the Contract Data Page. The Annuity
Date must be the first day of a calendar month and must be at least one month
after the Issue Date. The Annuity Date must not be later than the Annuitant's
85th birthday.
Prior to the Annuity Date, the Owner, subject to the above, may change the
Annuity Date. Any changes shall be in writing in such form as the Company may
require. Any change must be requested at least seven (7) days prior to the new
Annuity Date.
SELECTION OF AN ANNUITY OPTION: An Annuity Option is selected by the Owner at
the time of the Application. If no Annuity Option is selected, Option B with a
120 month guarantee will automatically be applied. Prior to the Annuity Date,
the Owner can change the Annuity Option selected. Any change shall be in writing
in such form as the Company may require. Any change must be requested at least
seven (7) days prior to the Annuity Date.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS: Annuity Payments are paid in monthly
installments. The Adjusted Contract Value is applied to the Annuity Table for
the Annuity Options selected. If the Adjusted Contract Value to be applied under
an Annuity Option is less than $5,000, the Company reserves the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment would be or
become less than $200 where only a Fixed Annuity Payment or a Variable Annuity
is selected, or if the Annuity Payment would be or become less than $100 on each
basis when a combination of Fixed and Variable Annuities is selected, the
Company will reduce the frequency of payments to an interval which will result
in each payment being at least $200, or $100 on each basis if a combination of
fixed and variable annuities is selected.
ANNUITY OPTIONS: The following Annuity Options or any other Annuity Option
acceptable to the Company may be selected:
OPTION A. LIFE ANNUITY: Monthly Annuity Payments during the life of the
Annuitant.
OPTION B. LIFE ANNUITY WITH PERIODS CERTAIN OF 60,120, 180 OR 240 MONTHS:
Monthly Annuity Payments during the lifetime of the Annuitant and in any
event for sixty (60), one hundred twenty (120), one hundred eighty (180) or
two hundred forty (240) months certain as selected.
OPTION C. JOINT AND SURVIVOR ANNUITY: Monthly Annuity Payments payable
during the joint lifetime of the Annuitant and a designated second person
and then during the lifetime of the survivor at the percentage (100%, 75%,
66 2/3% or 50%) selected.
OPTION D. JOINT AND CONTINGENT ANNUITY: Monthly Annuity Payments during the
Annuitant's lifetime and continuing during the lifetime of a designated
second person after the Annuitant's death at the percentage (either 100%,
75%, 66 2/3% or 50%) selected.
OPTION E. FIXED PAYMENTS FOR A PERIOD CERTAIN: Fixed monthly Annuity
Payments for any specified period (at least five years but not exceeding
thirty years), as selected.
Annuity Options A, B, C and D are available on a Fixed Annuity Basis, a Variable
Annuity basis or a combination of both. Annuity Option E is available on a Fixed
Annuity basis only. Election of a Fixed Annuity or a Variable Annuity
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must be made no later than seven (7) days prior to the Annuity Date. If no
election is made as between a Fixed Annuity and a Variable Annuity, the Variable
Annuity will be the default option.
ANNUITY: If the Owner selects a Fixed Annuity, the Adjusted Contract Value is
allocated to the General Account and the Annuity is paid as a Fixed Annuity. If
the Owner selects a Variable Annuity, the Adjusted Contract Value will be
allocated to the Subaccount of the Separate Account in accordance with the
selection made by the Owner, and the Annuity will be paid as a Variable Annuity.
The Owner can also select a combination of a Fixed and Variable Annuity and the
Adjusted Contract Value will be allocated accordingly.
The Adjusted Contract Value will be applied to the applicable Annuity Table
contained in the Contract based upon the Annuity Option selected by the Owner.
The amount of the first payment for each $1,000 of Adjusted Contract Value is
shown in the Annuity Tables. If, as of the Annuity Date, the current Annuity
Option rates applicable to this class of contracts provide an initial Annuity
Payment greater than guaranteed under the same Annuity Option under this
Contract, the greater payment will be made.
FIXED ANNUITY: The Owner may elect to have the Adjusted Contract Value applied
to provide a Fixed Annuity. The dollar amount of each Fixed Annuity Payment
shall be determined in accordance with Annuity Tables contained in this Contract
which are based on the minimum guaranteed interest rate of 4.0% per year. After
the initial Fixed Annuity Payment, the payments will not change regardless of
investment, mortality or expense experience.
VARIABLE ANNUITY: Variable Annuity Payments reflect the investment performance
of the Separate Account in accordance with the allocation of the Adjusted
Contract Value to the Subaccounts during the Annuity Period. Variable Annuity
Payments are not guaranteed as to dollar amount.
The dollar amount of the first Variable Annuity Payment is determined in
accordance with the description above. The dollar amount of Variable Annuity
Payments for each applicable Subaccount after the first Variable Annuity Payment
is determined as follows:
1. the dollar amount of the first Variable Annuity Payment is divided by
the value of an Annuity Unit for each applicable Subaccount as of the
Annuity Date. This sets the number of Annuity Units for each monthly
payment for the applicable Subaccount. The number of Annuity Units for
each applicable Subaccount remains fixed during the Annuity Period;
2. the fixed number of Annuity Units per payment in each Subaccount is
multiplied by the Annuity Unit Value for that Subaccount for the last
Valuation Period of the month preceding the month for which the payment
is due. This result is the dollar amount of the payment for each
applicable Subaccount.
The total dollar amount of each Variable Annuity Payment is the sum of all
Subaccount Variable Annuity Payments reduced by the applicable portion of the
Annual Contract Maintenance Charge.
ANNUITY UNIT: The value of any Annuity Unit for each Subaccount of the Separate
Account was arbitrarily set initially at $10.
The Subaccount Annuity Unit Value at the end of any subsequent Valuation Period
is determined by subtracting (2) from (1) and dividing the result by (3) and
multiplying the result by a factor which neutralizes the assumed investment rate
of 4% contained in the Annuity Tables where:
1. is the net result of:
a. the assets of the Subaccount attributable to the Annuity Units;
plus or minus
b. the cumulative charge or credit for taxes reserved which is
determined by the Company to have resulted from the operation or
maintenance of the Subaccount;
2. is the cumulative unpaid charge for the Mortality and Expense Risk
Charge and for the Administrative Charge, which are shown on the
Contract Data Page.
3. is the number of Annuity Units outstanding at the end of the Valuation
Period.
The value of an Annuity Unit may increase or decrease from Valuation Period to
Valuation Period.
MORTALITY TABLES: The Annuity Tables contained in this Contract utilize an
Assumed Investment Rate of 4% for the determination of the initial Variable
Annuity Payment and a minimum guaranteed rate of 4% per year for the
determination of the monthly Fixed Annuity Payment.
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The mortality table used in determining the Annuity Purchase Rates for Options
A, B, C, and D is the 1983 Blended Individual Annuity mortality table with 60%
female and 40% male lives and a pivotal age of 55. In using this mortality
table, Ages of Annuitants will be reduced by one year for Annuity Dates
occurring during the 1990's, reduced two years for Annuity Dates occurring
during the decade 2000-2009, and so on.
The dollar amount of an Annuity Payment for any Age or combination of Ages not
shown in the Tables or for any other form of Annuity Option agreed to by the
Company will be provided by the Company upon request.
SUPPLEMENTARY AGREEMENT: A Supplementary Agreement setting forth the terms of
the Annuity Option selected will be issued at the Annuity Date, at which time
this Contract will be exchanged for the Supplementary Agreement.
SUSPENSION OR DEFERRAL OF PAYMENTS
The Company reserves the right to suspend or postpone payments for a withdrawal
or transfer for any period when:
1. the New York Stock Exchange is restricted;
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held in
the Separate Account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Separate Account's net assets; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated in the Application, unless changed prior
to the Annuity Date. The Annuitant may not be changed in a Contract which is
owned by a non-natural person.
OWNER: The Owner has all rights and may receive all benefits under this
Contract. Prior to the Annuity Date, the Owner is the person designated in the
Application, unless changed. On and after the Annuity Date:
1. the Annuitant is the Owner; and
2. upon the death of the Annuitant, the Beneficiary is the Owner.
The Owner may change the Owner at any time prior to the Annuity Date. A change
of Owner will automatically revoke any prior designation of Owner. A request for
change must be:
1. made in writing; and
2. received by the Company at the Annuity Service Center.
The change will become effective as of the date the written request is signed. A
new designation of Owner will not apply to any payment made or action taken by
the Company prior to the time it was received.
JOINT OWNER: The Contract can be owned by Joint Owners. If Joint Owners are
named, any Joint Owner must be the spouse of the other Owner. Upon the death of
either Owner, the surviving spouse will be the Primary Beneficiary. Any other
Beneficiary designated in the Application or as subsequently changed will be
treated as a Contingent Beneficiary unless otherwise indicated in writing to the
Company.
ASSIGNMENT: The Owner may, at any time during his or her lifetime, assign his or
her rights under this Contract. The Company will not be bound by any assignment
until written notice is received by the Company. The Company is not responsible
for the validity of any assignment. The Company will not be liable as to any
payment or other settlement made by the Company before receipt of the
assignment.
BENEFICIARY PROVISIONS
BENEFICIARY: The Beneficiary is named in the Application, unless changed. The
Beneficiary is entitled to receive the benefits to be paid at the death of the
Owner.
Unless the Owner provides otherwise, the Death Benefit will be paid in equal
shares to the survivor(s) as follows:
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1. to the Primary Beneficiary(ies) who survive the Owner's death; or if
there are none
2. to the Contingent Beneficiary(ies) who survive the Owner's death; or if
there are none
3. to the estate of the Owner.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), the Owner may change the Primary Beneficiary(ies) or
Contingent Beneficiary(ies). A change may be made by filing a written request
with the Company. The change will take effect as of the date the notice is
signed. The Company will not be liable for any payment made or action taken
before it records the change.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of:
1. this Contract;
2. the Application which is attached to this Contract; and
3. any riders or endorsements attached to this Contract.
This Contract may be changed or altered only by the President or Vice President
and the Secretary of the Company. A change or alteration must be made in
writing.
MISSTATEMENT OF AGE: If the Age of the Annuitant, or the Age of any designated
second person, has been misstated, any Annuity benefits payable will be the
Annuity benefits provided by the correct Age. After Annuity Payments have begun,
any underpayments will be made up in one sum with the next Annuity Payment. Any
overpayments will be deducted from future Annuity Payments until the total is
repaid.
INCONTESTABILITY: The Contract will not be contestable after it has been in
force for a period of two years from the Issue Date.
MODIFICATION: This Contract may be modified in order to maintain compliance with
applicable state and federal law.
NON-PARTICIPATING: This Contract will not share in any distribution of
dividends.
EVIDENCE OF SURVIVAL: The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments are based.
PROOF OF AGE: The Company may require evidence of Age of any payee under Annuity
Options A, B, C, and D and of the designated second person under Annuity Options
C and D.
PROTECTION OF PROCEEDS: To the extent permitted by law, Death Benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
if the person is entitled to them under this Contract. No payment and no amount
under this Contract can be taken or assigned in advance of its payment date
unless the Company receives the Owner's written consent.
REPORTS: At least once each calendar year, the Company will furnish the Owner
with a report showing the Contract Value and any other information as may be
required by law. The Company will also furnish an annual report of the Separate
Account. Reports will be sent to the last known address of the Owner.
TAXES: Any taxes paid to any governmental entity relating to this Contract will
be deducted from the Purchase Payment or Contract Value when incurred. The
Company will, in its sole discretion, determine when taxes have resulted from:
the investment experience of the Separate Account; receipt by the Company of the
Purchase Payments; or commencement of Annuity Payments. The Company may, at its
sole discretion, pay taxes when due and deduct that amount from the Contract
Value at a later date. Payment at an earlier date does not waive any right the
Company may have to deduct amounts at a later date. The Company will deduct any
withholding taxes required by applicable law.
TRANSFER BY THE COMPANY: The Company reserves the right to transfer its
obligations hereunder to another qualified life insurance company under an
assumption reinsurance arrangement without the prior consent of the Owner.
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ANNUITY OPTION TABLES
OPTIONS A AND B - LIFETIME PAYMENT OPTION
MINIMUM MONTHLY PAYMENT RATES FOR EACH $1,000 APPLIED
Payments Guaranteed For Payments Guaranteed For
Adjusted Life Only 5 Years 10 Years 20 Years Adjusted Life Only 5 Years 10 Years 20 Years
-------- --------- ------- -------- -------- -------- --------- ------- -------- --------
Age Age
50 4.64 4.63 4.60 4.50 70 7.16 7.05 6.73 5.68
51 4.70 4.69 4.66 4.55 71 7.40 7.275 6.90 5.73
52 4.77 4.76 4.73 4.50 72 7.66 7.51 7.07 5.77
53 4.85 4.83 4.80 4.66 73 7.94 7.76 7.25 5.81
54 4.92 4.91 4.87 4.71 74 8.24 8.02 7.43 5.84
55 5.01 4.99 4.95 4.77 75 8.56 8.31 7.61 5.87
56 5.09 5.08 5.03 4.83 76 8.91 8.60 7.80 5.90
57 5.19 5.17 5.11 4.89 77 9.29 8.92 7.98 5.92
58 5.29 5.27 5.20 4.95 78 9.70 9.25 8.17 5.94
59 5.39 5.37 5.30 5.02 79 10.14 9.60 8.35 5.95
60 5.50 5.48 5.40 5.08 80 10.61 9.97 8.53 5.97
61 5.62 5.60 5.51 5.15 81 11.12 10.35 8.70 5.98
62 5.75 5.72 5.62 5.21 82 11.67 10.75 8.86 5.98
63 5.89 5.85 5.73 5.28 83 12.27 11.16 9.01 5.99
64 6.04 5.99 5.86 5.34 84 12.90 11.58 9.15 5.99
65 6.20 6.14 5.99 5.40 85 13.59 12.00 9.28 6.00
66 6.36 6.30 6.12 5.46
67 6.54 6.47 6.27 5.52
68 6.74 6.65 6.41 5.58
69 6.94 6.85 6.57 5.63
Monthly payment rates for all other ages will be furnished on request. For
quarterly payments, multiply the monthly payment rate by 2.99. For semi-annual
payments, multiply by 5.95. For annual payment, multiply by 11.78.
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OPTIONS C AND D - JOINT LIFETIME PAYMENT
MINIMUM MONTHLY PAYMENT RATES FOR EACH $1,000 APPLIED PAYMENTS FOR TWO
LIVES ONLY
ANNUITANTS' AGES PERCENTAGE OF PAYMENT PAYABLE TO
SURVIVING
ANNUITANT IS:
PRIMARY JOINT 50% 66 2/3% 75% 100%
(A) Payments reduce upon the death of either the Annuitant or the Joint Annuitant:
50 50 4.64 4.47 4.39 4.18
50 55 4.81 4.62 4.53 4.28
55 55 5.01 4.80 4.70 4.43
55 60 5.24 5.00 4.88 4.57
60 60 5.50 5.24 5.11 4.77
60 65 5.83 5.51 5.36 4.96
65 65 6.20 5.84 5.68 5.24
65 70 6.65 6.21 6.02 5.50
(B) Payments reduce only upon the death of the Annuitant (ERISA Joint and
Survivor Annuity Option):
50 50 4.39 4.32 4.28 4.18
50 55 4.45 4.39 4.37 4.28
55 50 4.62 4.50 4.44 4.28
55 55 4.70 4.61 4.56 4.43
55 60 4.78 4.71 4.67 4.57
60 55 4.99 4.84 4.77 4.57
60 60 5.11 4.99 4.93 4.77
60 65 5.22 5.13 5.09 4.96
65 60 5.51 5.31 5.22 4.96
65 65 5.68 5.52 5.45 5.24
65 70 5.83 5.71 5.66 5.50
70 65 6.22 5.96 5.84 5.50
Monthly payment rates for other age combinations will be furnished on request.
For quarterly payments, multiply the monthly payment rate by 2.99. For
semi-annual payments, multiply by 5.95. For annual payment, multiply by 11.78.
OPTION E - FIXED TIME PAYMENT
MINIMUM MONTHLY PAYMENT RATES FOR EACH $1,000 APPLIED
YEARS MONTHLY PAYMENT YEARS MONTHLY PAYMENT YEARS MONTHLY PAYMENT
1 Not Available 11 $9.31 21 $5.81
2 Not Available 12 8.69 22 5.64
3 Not Available 13 8.17 23 5.49
4 Not Available 14 7.72 24 5.35
5 18.32 15 7.34 25 5.22
6 15.56 16 7.00 26 5.10
7 13.59 17 6.71 27 5.00
8 12.12 18 6.44 28 4.90
9 10.97 19 6.21 29 4.80
10 10.06 20 6.00 30 4.72
For quarterly payments, multiply the monthly payment rate by 2.99. For
semi-annual payments, multiply by 5.95. For annual payment, multiply by 11.78.
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FIRST VARIABLE LIFE
FIRST VARIABLE LIFE INSURANCE COMPANY
LITTLE ROCK, ARKANSAS
ENHANCED DEATH BENEFIT RIDER
This Rider is part of the Contract to which it is attached and is effective upon
issuance. The Contract is amended as follows:
ENHANCED DEATH BENEFIT. Upon the death of the Owner prior to the Annuity
Date, the Death Benefit will be paid to the Beneficiary designated by the
Owner. The Death Benefit will be the greater of:
1. the Purchase Payments, less any withdrawals including any
applicable withdrawal charges; or
2. the Contract Value; or
3. the Contract Value as of the first day of the current five
Contract Year period plus any Purchase Payments made since that
day and less any amounts withdrawn since that day.
The first five Contract Year period begins on the Issue Date, the second five
Contract Year period begins on the fifth Contract Anniversary, and so forth. If
the Beneficiary is the spouse of the Owner and elects to continue the Contract,
the Contract Value remains unchanged and no determination of the Death Benefit
is made at that time.
s/Xxxxxx X. Xxxxxxx s/Xxxx X. Xxxxxx
Secretary President
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FIRST VARIABLE LIFE
FIRST VARIABLE LIFE INSURANCE COMPANY
LITTLE ROCK, ARKANSAS
GENERAL ACCOUNT RIDER
ONE YEAR INTEREST GUARANTEE PERIOD
This Rider is part of the Contract to which it is attached and is effective upon
issuance. The Contract is amended as follows:
DEFINITIONS
CONTRACT VALUE -- The sum of the Owner's interest in the Subaccounts of the
Separate Account and in the General Account.
GENERAL ACCOUNT VALUE -- The Owner's interest in the General Account.
VARIABLE ACCOUNT VALUE -- The Owner's interest in the Subaccounts of the
Separate Account.
PURCHASE PAYMENT PROVISIONS
ALLOCATION OF PURCHASE PAYMENTS -- The Purchase Payments for the General Account
Rider shall be allocated to the General Account. The minimum and maximum
subsequent Purchase Payments are shown on the Contract Data Page.
CONTRACT VALUE PROVISION
CONTRACT VALUE -- The Purchase Payments for this General Account Rider shall be
allocated to the General Account.
The Contract Value on any Valuation Date is the sum of the Owner's interest in
the Subaccounts of the Separate Account and in the General Account. The General
Account Value at any time is equal to the sum of the Purchase Payments allocated
to the General Account, amounts transferred to the General Account and interest
credited to the General Account less amounts transferred from the General
Account, any partial withdrawals, Withdrawal Charges, Contract Maintenance
Charges, Transfer Fees and applicable taxes.
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ANNUAL CONTRACT MAINTENANCE CHARGE
DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE - This charge is deducted from
the General Account Value and the Separate Account Value by subtracting values
from the General Account Value and/or canceling Accumulation Units from each
applicable Subaccount in the ratio that the value of each account bears to the
total Contract Value.
TRANSFER PROVISIONS
The Transfers Prior to the Annuity Date section is replaced in its entirety by
the following provisions:
TRANSFERS PRIOR TO THE ANNUITY DATE - Prior to the Annuity Date, the Owner may
transfer all or a part of the Owner's interest in a Subaccount or the General
Account without the imposition of any fee or charge if there have been no more
than the number of free transfers shown on the Contract Data Page for the
Contract Year.
All transfers are subject to the following:
(1) if more than the number of free transfers have been made in the Contract
Year, the Company will deduct a Transfer Fee. The Transfer Fee is shown
on the Contract Data Page. The Transfer Fee will be deducted from the
Account from which the transfer is made. However, if the entire interest
in an Account is being transferred, the Transfer Fee will be deducted
from the amount which is transferred.
(2) the minimum amount which may be transferred and which must remain in the
Account is shown on the Contract Data Page.
(3) any transfer direction must clearly specify: (A) the amount which is to
be transferred; and (B) the Accounts which are to be affected.
(4) the Company reserves the right at any time and without prior notice to
any party to terminate, suspend or modify the transfer privileges
described above.
(5) all Purchase Payments and transfers allocated to the General Account
must remain in the General Account for one year prior to any transfer
from the General Account.
If the Owner elects to use the transfer privilege, the Company will not be
liable for transfers made in accordance with the Owner's instruction.
INTEREST CREDITS
INTEREST TO BE CREDITED - The Company guarantees that the interest rate credited
to the General Account Value will not be less than the minimum Guaranteed
Interest Rate equal to: an effective rate of 3% per year. The Company may credit
additional interest in its sole discretion. The Initial Guaranteed Interest Rate
shall be as set forth on the Contract Data Page for the Initial Interest
Guarantee Period which shall be for one year from the date the Purchase Payment
is allocated to the General Account. Upon the expiration of the Initial Interest
Guarantee Period, the Company will in its discretion determine the Guaranteed
Interest Rate for each subsequent Interest Guarantee Period. Such subsequent
Interest Guarantee Period shall be for successive one year periods after the
expiration of the Initial Interest Guarantee Period. The Guaranteed Interest
Rate for any subsequent Purchase Payments allocated to the General Account shall
be that rate in effect at the time of the allocation or transfer to the General
Account. Interest will be credited daily to the General Account Value.
WITHDRAWAL PROVISIONS
A withdrawal will result in the cancellation of Accumulation Units for each
applicable Subaccount of the Separate Account or a reduction in the General
Account Value in the ratio that the Subaccount Value and/or the General Account
Value bears to the Contract Value. The Owner must specify in writing in advance
if other than the above method of cancellation and reduction is to be used.
SUSPENSION OR DEFERRAL OF PAYMENTS
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The Company reserves the right to defer payment for a withdrawal or transfer
from the General Account for the period permitted by law but not for more than
six months after written election is received by the Company.
s/Xxxxxx X. Xxxxxxx s/Xxxx X. Xxxxxx
Secretary President
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[FIRST VARIABLE LIFE INSURANCE COMPANY LOGO]
FIRST VARIABLE LIFE INSURANCE COMPANY
LITTLE ROCK, ARKANSAS
ANNUITIZATION BONUS RIDER
This Rider is made part of the Contract to which it is attached, and is
effective upon the Issue Date:
The ANNUITY PROVISIONS of the Contract is amended to include the following:
ANNUITIZATION BONUS: The Company will increase the Contract Value on the Annuity
Date if Contract Value is applied to an Annuity Option. The increase in Contract
Value will be calculated by the Company with respect to Contract Value as of the
immediately preceding Business Day, using the percentage shown on the Contract
Data Page. The increase in Contract Value will be allocated pro-rata to the
Investment Options to which Contract Value is then allocated.
s/Xxxx X. Xxxxxx s/Xxxxxx X. Xxxxxxx
President Secretary
First Variable Life Insurance Company
Little Rock, Arkansas
INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT WITH
FLEXIBLE PURCHASE PAYMENTS
NON-PARTICIPATING
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