EXHIBIT 4(a)
[CUNA MUTUAL LIFE INSURANCE COMPANY LOGO]
A Mutual Insurance Company
0000 Xxxxxxxx Xxx - Xxxxxxx, Xxxx 00000
Phone: 800/000-0000
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
CONTRACT NUMBER: 123456789
READ YOUR CONTRACT CAREFULLY. This is a legal contract between the owner and
CUNA Mutual Life Insurance Company, and hereafter will be referred to as the
contract.
This contract is issued to the owner in consideration of the application and the
initial purchase payment. CUNA Mutual Life Insurance Company will pay the
benefits of this contract, subject to its terms and conditions, which will never
be less than the amount required by state law.
THE DOLLAR AMOUNT OF ANY INCOME PAYMENTS AND OTHER VALUES PROVIDED BY THIS
CONTRACT WILL INCREASE OR DECREASE BASED ON THE INVESTMENT EXPERIENCE OF THE
SUBACCOUNTS SELECTED. THE VARIABLE PROVISIONS ARE DESCRIBED IN SECTION 6.
THIS CONTRACT MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT WHICH CAN RESULT IN
EITHER AN UPWARD OR DOWNWARD ADJUSTMENT UPON SURRENDER OR PARTIAL WITHDRAWAL ON
ANY FIXED ACCOUNT VALUE. SEE THE MARKET VALUE ADJUSTMENT SECTION OF THE FIXED
ACCOUNT ENDORSEMENT, IF INCLUDED IN YOUR CONTRACT.
Signed for CUNA Mutual Life Insurance Company, Waverly, Iowa, on the Contract
Issue Date.
Xxxxxxx X. Xxxxxxx
President
RIGHT TO EXAMINE THIS CONTRACT. IF FOR ANY REASON YOU DECIDE NOT TO KEEP THIS
CONTRACT, YOU MAY RETURN IT TO US WITHIN [10] DAYS AFTER YOU RECEIVE IT. IF THIS
CONTRACT IS A REPLACEMENT FOR AN EXISTING CONTRACT, YOU MAY RETURN IT TO US
WITHIN [30] DAYS AFTER YOU RECEIVE IT. YOU MAY RETURN IT TO EITHER OUR HOME
OFFICE OR TO THE AGENT WHO SOLD IT TO YOU. WE WILL CONSIDER IT VOID FROM THE
BEGINNING AND WILL PAY YOU A REFUND WITHIN 7 DAYS OF RECEIPT OF THE CONTRACT IN
THE HOME OFFICE. WE WILL REFUND ANY NET PURCHASE PAYMENTS ADJUSTED TO REFLECT
GAIN OR LOSS FROM THE DATE OF ALLOCATION TO THE DATE OF CANCELLATION; PLUS ANY
APPLICABLE PREMIUM EXPENSE CHARGES WHICH HAVE BEEN DEDUCTED PRIOR TO ALLOCATION.
IF THIS CONTRACT IS AN INDIVIDUAL RETIREMENT ANNUITY, DURING THE FIRST [10] DAYS
OF YOUR RIGHT TO EXAMINE PERIOD, WE WILL, INSTEAD OF THE FOREGOING, REFUND ANY
PURCHASE PAYMENTS RECEIVED BY US.
Flexible Purchase Payments as Described Herein
Income Payments Starting on the Payout Date
Death Benefit Payable at Death Prior to the Payout Date
Participating
Countersigned by:_______________________________________________________________
Duly Licensed Resident Agent (if required by law)
CONTRACT GUIDE AND INDEX
Data Page
Definitions............................................. Section 1
General Information..................................... Section 2
Owner and Beneficiary................................... Section 3
Accumulation Period..................................... Section 4
Purchase Payments....................................... Section 5
Variable Account........................................ Section 6
Transfer Privilege...................................... Section 7
Contract Value.......................................... Section 8
Withdrawal Provision.................................... Section 9
Death of Xxxxxxxxx and/or Owner......................... Section 10
Death Benefit Proceeds.................................. Section 11
Dividends............................................... Section 12
Payout Period........................................... Section 13
Income Payments......................................... Section 14
Death of Payee.......................................... Section 15
Option Tables........................................... Section 16
Restrictions on Payment of Proceeds..................... Section 17
Additional Benefit Rider(s) and Endorsement(s)
SECTION 1. DEFINITIONS
1.1 WHAT ARE THE MOST ACCUMULATION UNIT - A unit of measure used to
COMMONLY USED calculate variable contract value.
TERMS AND WHAT DO
THEY MEAN? AGE - Age as of last birthday.
ANNUITANT - The person (or persons) whose life (or
lives) determines the income payment benefits
payable under the contract and whose death
determines the death benefit. No more than two
annuitants may be named. References to the death of
an annuitant mean the last surviving annuitant.
BENEFICIARY - The person (or persons) named by the
owner to whom the proceeds payable on the death of
the annuitant will be paid. Prior to the payout
date, if no beneficiary survives the annuitant, you
or your estate will be the beneficiary.
THE CODE - The Internal Revenue Code of 1986, as
amended.
CONTRACT ANNIVERSARY - The same day and month as the
contract issue date for each year the contract
remains in force.
CONTRACT ISSUE DATE - The date shown on the data
page of the contract which is used to determine
contract years and contract anniversaries.
CONTRACT YEAR - A twelve-month period beginning on a
contract anniversary.
CONTRACT VALUE - The total amount invested under the
contract. It is the sum of values in the variable
account and values in all other account(s) provided
for by endorsement.
DUE PROOF OF DEATH - Proof of death satisfactory to
us. Such proof may consist of a certified copy of
the death record, a certified copy of a court decree
reciting a finding of death or any other proof
satisfactory to us.
FUND - Each investment portfolio (sometimes called a
Series) of the Ultra Series Fund or any other
open-end management investment company or unit
investment trust in which a subaccount invests.
GENERAL ACCOUNT - Our assets other than those
allocated to the variable account or any other
separate account of CUNA Mutual Life Insurance
Company.
HOME OFFICE - CUNA Mutual Life Insurance Company,
0000 Xxxxxxxx Xxx, Xxxxxxx, xxxx, 00000.
INCOME UNIT - A unit of measure used to calculate
variable income payments.
INVESTMENT OPTIONS - Choices made available under
the contract for allocation of net purchase
payments, including subaccounts of the variable
account and any other account choices provided by
endorsement. The available investment options as of
the contract issue date are listed on the data page.
NET PURCHASE PAYMENT - A purchase payment less any
deduction for applicable premium expense charges.
OWNER - The person(s) (or entity) who own(s) the
contract and who is entitled to exercise all rights
and privileges provided in the contract. After the
payout date, the payee is the owner.
PAYEE - The person (or entity) receiving income
payments or any successor. The owner is the payee
unless the owner designates another person (or
entity) as payee.
PAYOUT DATE - The date when income payments will
begin, if the annuitant is still living. The
anticipated payout date is shown on the data page.
PREMIUM EXPENSE CHARGE - An amount we deduct from
your purchase payments to cover taxes we are
currently charged by your state of residence. The
initial charge is shown on the data page.
PRO-RATA - A method of distribution of contract
value. The distribution is in the same proportion
that the value in each investment option has to the
total value of the affected investment option(s).
SEC - U.S. Securities and Exchange Commission.
SUBACCOUNT - A subdivision of the variable account,
the assets of which are invested in a corresponding
fund.
SURRENDER VALUE - The contract value, less any
applicable surrender charges, premium expense
charges not previously deducted, the annual contract
fee, and any applicable charge or adjustments for
riders or endorsements.
VALUATION DAY - Each day on which valuation of the
assets of a subaccount is required by applicable
law.
VALUATION PERIOD - The period beginning at the close
of the New York Stock Exchange of one valuation day,
and continuing to the close of the New York Stock
Exchange of the next succeeding valuation day.
VARIABLE ACCOUNT - The CUNA Mutual Life Variable
Annuity Account. A segregated investment account of
CUNA Mutual Life Insurance Company into which net
purchase payments may be allocated.
VARIABLE CONTRACT VALUE - The value of the contract
in the variable account.
WE, OUR, US - CUNA Mutual Life Insurance Company.
WRITTEN REQUEST - A signed and dated written notice
in a form satisfactory to us and received in our
home office.
YOU, YOUR - The owner or owners of this contract who
are entitled to exercise all rights and privileges
in the policy.
SECTION 2. GENERAL INFORMATION
2.1 WHAT IS THE This contract form, the data page, any attached
ENTIRE CONTRACT? riders and endorsements, and a copy of the
application, if attached to it, are the entire
contract between you and us. No one except our
president or secretary can change or waive any of
our rights or requirements under this contract. Any
change must be in writing.
2.2 WHEN DOES THIS This contract is incontestable from its contract
CONTRACT BECOME issue date. The statements contained in the
INCONTESTABLE? application (in the absence of fraud) are considered
representations and not warranties.
2.3 WHAT IF THE If an annuitant's date of birth has been misstated,
ANNUITANT'S DATE OF we will adjust the income payments under this
BIRTH OR GENDER HAS contract based on his or her correct date of birth.
BEEN MISSTATED? If an annuitant's gender has been misstated and the
Type A life income rates apply (see the data page
and Section 16), we will adjust the income payments
under this contract based on his or her correct
gender. Any underpayment will be added to the next
payment. Any overpayment will be subtracted from
future payments. No interest will be credited or
charged to any underpayment or overpayment
adjustments.
2.4 WHAT IS THE ANNUAL The maximum annual contract fee is shown on the data
CONTRACT FEE? page. The annual contract fee we charge will never
be greater than the maximum. During the accumulation
period, the contract fee will be deducted pro-rata
from your contract value in the investment options
on each contract anniversary. This contract fee will
also be deducted on the date of any full surrender,
if not on a contract anniversary. During the payout
period, it will be deducted in equal amounts from
any variable income payments made during a contract
year. This fee is to reimburse us for the expense of
maintaining this contract.
2.5 WHEN WILL PREMIUM Any applicable premium expense charge will be
EXPENSE CHARGES BE deducted upon full surrender of the contract,
DEDUCTED? payment of death benefit proceeds or selection of an
income payout option. However, we reserve the right
to charge for the premium expense charge when it is
incurred. The premium expense charge rate for your
state as of the contract issue date is shown on the
data page.
In addition, we reserve the right to deduct certain
other premium expense charges upon full surrender of
the contract, payment of death benefit proceeds or
selection of an income payout option, as
appropriate. Such premium expense charges may
include taxes levied by any government entity which
we, in our sole discretion, determine have resulted
from the establishment or maintenance of the
variable account, or from the receipt by us of
purchase payments, or from the issuance or
termination of this contract, or from the
commencement or continuance of income payments under
this contract.
2.6 WILL ANNUAL REPORTS We will send you a report, without charge, at least
BE SENT? annually which provides information about your
contract required by any applicable law.
2.7 CAN WE MODIFY THE Upon notice to you, we may modify the contract if:
CONTRACT?
a.) necessary to permit the contract or the
variable account to comply with any
applicable law or regulation issued by a
government agency;
b.) necessary to assure continued qualification
of the contract under the code or other
federal or state laws relating to
retirement annuities or variable annuity
contracts;
c.) necessary to reflect a change in the
operation of the variable account; or
d.) the modification provides additional
investment options.
In the event of most such modifications, the company
will make appropriate endorsement to the contract.
SECTION 3. OWNER AND BENEFICIARY
3.1 WHAT ARE YOUR The owner has all rights, title and interest in this
RIGHTS AS OWNER contract during the accumulation period while the
OF THIS CONTRACT? annuitant is living. You may exercise all rights and
options stated in this contract, subject to the
rights of any irrevocable beneficiary. Assignment of
your contract as collateral security will not be
allowed.
3.2 HOW CAN YOU CHANGE You may change the owner or beneficiary of this
THE OWNER OR contract by written request at any time while the
BENEFICIARY OF THIS annuitant is alive. The change will take effect as
CONTRACT? of the date you signed it. We are not liable for any
payment we make or action we take before receiving
any such written request.
If there is more than one owner, the written request
for change must be signed by all persons named as
owner. A request for change of beneficiary must also
be signed by any irrevocable beneficiary.
SECTION 4. ACCUMULATION PERIOD
4.1 WHAT IS THE The accumulation period is the first of two periods
ACCUMULATION PERIOD? of your contract. The accumulation period begins on
the contract issue date stated on the data page.
This period will continue until the payout date
unless the contract is terminated before that date.
SECTION 5. PURCHASE PAYMENTS
5.1 WHEN CAN PURCHASE The initial purchase payment made is shown on the
PAYMENTS BE MADE? data page.
Additional purchase payments may be made to the home
office at any time during the accumulation period.
The minimum additional purchase payment is shown on
the data page.
We may not accept purchase payments beyond the
contract anniversary following the annuitant's 85th
birthday. We reserve the right to decline a purchase
payment in excess of one million dollars.
5.2 ARE ADDITIONAL Additional purchase payments after the initial
PURCHASE PAYMENTS purchase payment are not required.
REQUIRED?
5.3 HOW WILL NET Net purchase payments will be allocated as you
PURCHASE PAYMENTS initially designated. Your initial allocation
BE ALLOCATED? percentage is shown on the data page. This contract
allows you to allocate net purchase payments to any
available investment option.
Net purchase payments allocated to a subaccount
become part of the variable contract value which
fluctuates according to the investment performance
of the selected subaccount(s).
You may change the allocation of subsequent net
purchase payments at any time, without charge, by
written request. The allocation may be 100% to any
available investment option, or may be divided among
any of the investment options in whole percentage
points totaling 100%. The minimum allocation is 1%.
Any change will be effective at the time we receive
your written request.
SECTION 6. VARIABLE ACCOUNT
6.1 WHAT IS THE VARIABLE The variable account is a segregated investment
ACCOUNT? account to which we allocate certain assets and
liabilities related to the contract and to other
variable annuity contracts. The variable account is
registered with the SEC as a unit investment trust
under the Investment Company Act of 1940 (the "1940
Act"). We own the assets of the variable account. We
value the assets of the variable account each
valuation day.
That portion of the assets of the variable account
equal to the reserves and other contract liabilities
of the contracts supported by the variable account
will not be charged with liabilities arising from
any other business that we may conduct. We have the
right to transfer to our general account any assets
of the variable account that are in excess of such
reserves and other contract liabilities. The income,
gains and losses, realized or unrealized, from the
assets allocated to the variable account will be
credited to or charged against the variable account,
without regard to our other income, gains or losses.
The variable account is divided into subaccounts.
The subaccounts as of the contract issue date are
shown on the data page. Each subaccount invests its
assets solely in the shares or units of designated
funds of underlying investment companies. The funds
corresponding to the subaccounts available as of the
contract issue date are shown on the data page. Net
purchase payments allocated and transfers to a
subaccount are invested in the fund supporting that
subaccount.
6.2 CAN THE VARIABLE Subject to obtaining approval or consent required by
ACCOUNT BE MODIFIED? applicable law, we reserve the right to:
a.) combine the variable account with any of our
other separate accounts;
b.) eliminate or combine any subaccounts and
transfer the assets of any subaccount to any
other subaccount;
c.) add new subaccounts and make such
subaccounts available to any class of
contracts as we deem appropriate;
d.) add new funds or remove existing funds;
e.) substitute a different fund for any existing
fund, if shares or units of a fund are no
longer available for investment or if we
determine that investment in a fund is no
longer appropriate;
f.) deregister the variable account under the
1940 Act if such registration is no longer
required;
g.) operate the variable account as a management
investment company under the 1940 Act
(including managing the variable account
under the direction of a committee) or in
any other form permitted by law;
h.) restrict or eliminate any voting rights of
owners or other persons having such rights
as to the variable account; and
i.) make any other changes to the variable
account or its operations as may be required
by the 1940 Act or other applicable law or
regulations.
In the event of any such substitution or other
change, we may make changes to this and other
contracts as may be necessary or appropriate to
reflect such substitution or other changes.
SECTION 7. TRANSFER PRIVILEGE
7.1 CAN YOU TRANSFER Subject to our right to modify, suspend or terminate
VALUES BETWEEN the transfer privilege, you may transfer contract
INVESTMENT OPTIONS? value between the subaccounts or to any other
available investment option provided by endorsement
as allowed by that endorsement. Transfers are
subject to all of the following:
a.) the transfer request must be by written
request;
b.) the transfer request must be received in our
home office prior to the payout date;
c.) the transfer is to a subaccount or any other
available investment option provided by
endorsement; and
d.) the deduction of any transfer fees that we
may impose. We reserve the right to impose a
transfer fee, not to exceed $10 per
requested transfer. A transfer fee, if
imposed, will be deducted from the
investment option from which the transfer is
made. If a transfer is made from more than
one investment option at the same time, the
transfer fee will be deducted pro-rata from
the value in such investment option(s).
We reserve the right to modify, suspend or terminate
the transfer privilege for any contract or class of
contracts at any time for any reason. We also
reserve the right to impose restrictions on your
ability to transfer contract value between or among
subaccounts. For most classes of contracts, we
anticipate imposing restrictions on the ability to
transfer contract value and reserve the right to
change such restrictions for any class of contracts
at any time. The current prospectus, or other
disclosure statement, will disclose the details of
such restrictions. Such restrictions may include,
but are not limited to, the requirement of a minimum
time period between each transfer or limiting the
dollar amount that can be transferred to and from
the subaccounts at any one time. In addition to such
restrictions, we may impose or collect any fees by a
fund in connection with the redemption of its shares
or otherwise required by applicable law. We reserve
the right to refuse any transfer instructions that,
in our judgement and in our sole discretion, may be
harmful to the separate account, any subaccount or
underlying fund, or to other owners.
SECTION 8. CONTRACT VALUE
8.1 WHAT IS YOUR Your contract value at any time is equal to the sum
CONTRACT VALUE? of values you have in the variable account and
values in all other account(s) provided for by
endorsement.
8.2 HOW IS YOUR VARIABLE Your variable contract value for any valuation
CONTRACT VALUE period is the total of your subaccount values.
DETERMINED? Your value for each subaccount is equal to:
a.) the number of that subaccount's
accumulation units credited to you;
b.) multiplied by the accumulation unit
value for that subaccount at the end of
the valuation period for which the
determination is being made.
8.3 HOW ARE ACCUMULATION The accumulation unit value for each subaccount
UNIT VALUES was arbitrarily set initially at $10. Thereafter,
DETERMINED? the accumulation unit value for each subaccount at
the end of every valuation period is determined by
subtracting (b) from (a) and dividing the result
by (c) (i.e., (a-b)/c), where:
a.) is the net result of:
1.) the net assets of the subaccount
attributable to the accumulation
units (i.e., the aggregate value of
the underlying fund shares held by
the subaccounts) as of the end of
such valuation period;
2.) plus or minus the cumulative credit
or charge with respect to any taxes
reserved for by us during the
valuation period which we determine
to be attributable to the operation
of the subaccount.
b.) is the cumulative unpaid charge for the
mortality and expense risk charge and
administrative expense charge and any
applicable charge for fund redemption
fees. The charge for a valuation period
is equal to the daily charge for the
mortality and expense risk charge and
administrative expense charge and any
applicable charge for fund redemption
fees multiplied by the number of days in
the valuation period.
c.) is the number of accumulation units
outstanding at the end of such valuation
period.
For each subaccount, net purchase payments or
transferred amounts are converted into
accumulation units. The number of accumulation
units credited is determined by dividing the
dollar amount directed to each subaccount by the
value of the accumulation unit for that subaccount
at the end of the valuation period in which the
net purchase payment or amount is received.
Cancellation of the appropriate number of
accumulation units from a subaccount will occur
upon:
a.) a partial withdrawal or surrender;
b.) a transfer from a subaccount;
c.) payment of the death benefit;
d.) the payout date;
e.) the deduction of the annual contract
fee;
f.) the deduction of any transfer fees that
we may impose;
g.) the deduction of any fees imposed by
fund in connection with the redemption
of its shares or otherwise imposed by
applicable law;
h.) the deduction of the applicable charge
for riders, if any; and
i.) the deduction of applicable fees or
charges provided for by any endorsement
attached to your contract.
Accumulation units will be cancelled as of the end
of the valuation period in which we receive notice
of or instructions regarding the event.
SECTION 9. WITHDRAWAL PROVISION
9.1 WHAT ARE THE RULES FOR You may make partial withdrawals during the
A PARTIAL WITHDRAWAL OF accumulation period by written request.
THE SURRENDER VALUE? You must specify the investment option(s) from
which the partial withdrawal is to be made.
We will pay you the amount you request in
connection with a partial withdrawal by canceling
accumulation units from appropriate subaccount(s)
and/or reducing applicable amount(s) from any
other investment option provided for by
endorsement. Partial withdrawals generally will be
effective as of the date we receive written
request.
Any applicable surrender charge will be deducted
from the remaining value in the investment
option(s) from which the partial withdrawal is
being made. If such remaining investment option
values are insufficient for this purpose, the
surrender charge will be deducted pro-rata from
all investment options under the contract based on
the remaining contract value in each investment
option.
If a partial withdrawal would cause the surrender
value to be less than $2,000, we will treat your
request as a full surrender.
9.2 WHAT ARE THE RULES FOR You have the right to surrender this contract
A FULL SURRENDER OF THE during the accumulation period by written request.
CONTRACT? You will be paid the surrender value. The
surrender value is equal to:
a.) the contract value at the end of the
valuation period in which we receive your
request;
b.) minus any applicable surrender charge;
c.) minus the annual contract fee and any
applicable charge for rider(s) if the
surrender does not occur on a contract
anniversary;
d.) minus any applicable premium expense charges
not previously deducted; and
e.) minus any applicable adjustment(s) or
deduction(s) provided for by any endorsement
attached to your contract.
The surrender value will not be less than the
amount required by state law.
Upon payment of the above surrender value, this
contract is terminated and we have no further
obligation under this contract. We may require you
to return your contract to our home office prior
to making payment.
9.3 WHEN WILL A SURRENDER A surrender charge is imposed on withdrawals as
CHARGE BE APPLIED AND described on the contract data page. The surrender
HOW IS IT CALCULATED? charge schedule, description of how a surrender
charge is calculated and free withdrawal amount is
shown on the data page.
9.4 ARE THERE ANY We reserve the right to postpone payment of any
RESTRICTIONS ON partial withdrawal or full surrender from the
PAYMENT OF PARTIAL variable account as described in Section 17.
WITHDRAWALS OR FULL
SURRENDERS?
SECTION 10. DEATH OF ANNUITANT AND/OR OWNER
10.1 WHAT HAPPENS IF THE If the sole annuitant dies during the accumulation
SOLE ANNUITANT DIES period, we will pay the death benefit proceeds to
DURING THE the beneficiary.The beneficiary may elect one of
ACCUMULATION the following options within 60 days of the date
PERIOD? we receive due proof of death:
a.) receive the death benefit in a single sum
within five (5) years of the deceased
annuitant's death;
b.) apply the death benefit proceeds under one
of the income payout options as payee,
provided:
1.) payments under the income payout option
begin within one (1) year of the
deceased annuitant's death; and
2.) payments are made over the life of the
beneficiary, or over a period not
greater than the beneficiary's life
expectancy.
c.) continue the contract, if the beneficiary is
the deceased annuitant's spouse. If the
beneficiary is not the deceased annuitant's
spouse, this option is not available.
10.2 WHAT HAPPENS IF AN If an annuitant dies during the accumulation
ANNUITANT DIES DURING period, and there is a surviving annuitant, no
THE ACCUMULATION death benefit will be paid and the contract will
PERIOD AND THERE IS continue.
A SURVIVING ANNUITANT?
10.3 WHAT HAPPENS IF THE If the sole owner (who is also an annuitant) dies
SOLE OWNER (WHO IS during the accumulation period, one of the
ALSO AN ANNUITANT) following applies:
DIES DURING THE
ACCUMULATION a.) if the deceased owner is also the sole
PERIOD? annuitant, we will pay the death benefit to
the beneficiary, as described in Section
10.1; or
b.) if the deceased owner is an annuitant and
there is a surviving annuitant, no death
benefit will be paid and the contract will
continue. See Section 10.2.
10.4 WHAT HAPPENS IF THE If the sole owner (who is not also an annuitant)
SOLE OWNER (WHO IS dies during the accumulation period, no death
NOT ALSO AN benefit will be paid, and the annuitant becomes
ANNUITANT) DIES the new owner.
DURING THE
ACCUMULATION If the new owner (previously the annuitant) is the
PERIOD? deceased owner's spouse, the contract may be
continued. If the new owner is someone other than
the deceased owner's spouse, the surrender value
(described in Section 9) must be:
a.) distributed in a single sum to the surviving
owner within five (5) years of the deceased
owner's death; or
b.) taken by the surviving owner as payee under
one of the income payment options, provided:
1.) payments under the income payout option
begin within one (1) year of the
deceased owner's death; and
2.) payments are made over the life of the
payee or over a period not greater than
the payee's life expectancy.
10.5 WHAT HAPPENS IF AN If an owner dies during the accumulation period,
OWNER DIES DURING and there is a surviving owner, no death benefit
THE ACCUMULATION and there is a surviving owner, no death benefit
PERIOD, AND THERE IS A will be paid and
SURVIVING OWNER?
a.) if the deceased owner is not the annuitant,
and the surviving owner is the deceased
owner's spouse, he or she will become the
sole owner and the contract will continue;
b.) if the deceased owner is not the annuitant,
and the surviving owner is someone other
than the deceased owner's spouse, the
surrender value (described in Section 9)
must be:
1.) distributed in a single sum to the
surviving owner within 5 years of the
deceased owner's death; or
2.) taken by the surviving owner as payee
under one of the income payment options,
provided:
i.) payments under the income payout
option begin within one (1) year of
the deceased owner's death; and
ii.) payments are made over the life
of the payee or over a period not
greater than the payee's life
expectancy.
c.) if the deceased owner is also the sole
annuitant, we will pay the death benefit to
the beneficiary, as described in
Section 10.2.
SECTION 11. DEATH BENEFIT PROCEEDS
11.1 WHAT AMOUNT WILL BE The amount that will be paid under this contract
PAID AS DEATH BENEFIT as death benefit proceeds is equal to the greater
PROCEEDS DURING THE of a.) or b.) as follows:
ACCUMULATION
PERIOD? a.) The sum of your net purchase payments made
as of the date due proof of death is
received, minus an adjustment for each
partial withdrawal made as of the date due
proof of death is received, equal to (1)
divided by (2), with the result multiplied
by (3), where:
(1) = the partial withdrawal amount;
(2) = the contract value immediately
prior to the partial withdrawal;
and
(3) = the sum of your net purchase
payments immediately prior to the
partial withdrawal, less any
adjustments for prior partial
withdrawals.
b.) The contract value as of the date due proof
of death is received.
The death benefit described above will be reduced
by any applicable premium expense charges not
previously deducted.
SECTION 12. DIVIDENDS
12.1 WILL DIVIDENDS BE We anticipate that no dividends will be payable
PAID? on your contract. However, while your contract
is in force, we will annually determine your
contract's share in our divisible surplus. Your
contract's share, if any, will be paid as a
dividend on your contract anniversary.
You may request that we apply your dividends by:
a.) allocating them to your investment option(s)
in the same proportion as designated for
purchase payments; or
b.) paying them to you in cash.
Unless you tell us otherwise, dividend option
a.) above will be used.
SECTION 13. PAYOUT PERIOD
13.1 WHAT IS THE PAYOUT The payout period is the second of the two
PERIOD? periods of your contract. The payout period
begins on the payout date. It continues until we
make the last payment as provided by the income
payout option chosen.
On the first day of this period, the contract
value (adjusted as described below) will be
applied to the anticipated income payout option
shown on the data page, unless you have selected
another option. Income payments will begin as
provided under that option.
The contract value applied to an income payout
option will be adjusted as follows:
a.) any applicable surrender charge will be
deducted for amounts applied to Option 1 and
Option 2B;
b.) any applicable premium expense charge will
be deducted;
c.) any applicable charge for riders will be
deducted, if the payout date is not on the
contract anniversary;
d.) any other applicable adjustments or
deductions described in any endorsement
attached to your contract will be deducted;
and
e.) if the payout date is not on the contract
anniversary, the annual contract fee will be
deducted on a pro-rated basis.
SECTION 14. INCOME PAYMENTS
14.1 WHEN WILL INCOME The first income payment will be paid as of the
PAYMENTS BEGIN? payout date. The anticipated payout date is
shown on the data page. You may change the
payout date by written request, provided the
request is received at our home office at least
30 days prior to the requested payout date.
Unless otherwise restricted by law or
regulation, the latest payout date is the later
of the contract anniversary following the
annuitant's 85th birthday or 10 years after the
contract issue date.
Unless changed as described above, we will use
the anticipated payout date shown on the data
page.
14.2 WHAT INCOME PAYOUT There are different ways to receive income
OPTIONS ARE AVAILABLE? payments. We call these income payout options.
Seven income payout options are described below.
The terms "payee" and "annuitant", when used in
the income payout descriptions below, include
any beneficiary who elects to apply death
benefit proceeds under an income payout option
as allowed under Section 10.
Options 1 and 2A are available only as a fixed
income payment. Option 2B is available only as a
variable income payment. Options 3A, 3B, 4A and
4B are available in two forms - as a variable
income payment in connection with the variable
account and as a fixed income payment. Other
income payout options may be available with our
consent.
Unless otherwise noted, once an option is
selected, and income payments begin, the value
of any remaining payments can not be surrendered
and paid in one sum.
OPTION 1 - INTEREST OPTION (FIXED INCOME
PAYMENTS ONLY). We will pay interest on the
proceeds which we will hold as a principal sum
during the lifetime of the annuitant. The payee
may choose to receive interest payments either
once a year or once a month. We will determine
the effective rate of interest from time to
time, but it will not be less than an effective
annual interest rate of 2.00%.
The payee has the right to surrender the
proceeds applied to this option and to receive
one single sum at any time by written request.
OPTION 2A - INSTALLMENT OPTION (FIXED INCOME
PAYMENTS ONLY). We will pay monthly income
payments to the payee for a chosen number of
years, not less than 5, nor more than 30. If the
original payee dies before income payments have
been made for the chosen number of years: (a)
income payments will be continued for the
remainder of the period to the successor payee;
or (b) the present value of the remaining income
payments, computed at the interest rate used to
create the Option 2A rates, will be paid to the
successor payee or to the last surviving payee's
estate, if there is no successor payee.
Dividends, if any, will be payable as determined
by us. We do not anticipate any dividends will
be paid.
OPTION 2B - INSTALLMENT OPTION (VARIABLE INCOME
PAYMENTS ONLY). We will pay monthly income
payments to the payee for a chosen number of
years, not less than 5, nor more than 30. If the
original payee dies before income payments have
been made for the chosen number of years: (a)
income payments will be continued for the
remainder of the period to the successor payee;
or (b) the present value of the remaining income
payments, computed at the interest rate used to
create the Option 2B rates, will be paid to the
successor payee or to the last surviving payee's
estate, if there is no successor payee.
The payee has the right to surrender the value
of all remaining variable income payments due
under this option and receive one single sum at
any time by written request. The single sum paid
upon surrender will be equal to the present
value of the remaining variable income payments,
computed at the interest rate used to create the
Option 2B rates.
Dividends, if any, will be payable as determined
by us. We do not anticipate any dividends will
be paid.
OPTION 3A - SINGLE LIFE INCOME OPTION -
GUARANTEED PERIOD CERTAIN (FIXED OR VARIABLE
INCOME PAYMENTS). We will pay monthly income
payments to the payee for as long as the
annuitant lives. If the original payee dies
before all of the income payments have been made
for the guaranteed period certain: (a) income
payments will be continued during the remainder
of the guaranteed period certain to the
successor payee; or (b) the present value of the
remaining income payments, computed at the
interest rate used to create the Option 3A
rates, will be paid to the successor payee or to
the last surviving payee's estate, if there is
no successor payee.
The guaranteed period certain choices are:
a.) 5 years;
b.) 10 years;
c.) 15 years; or
d.) 20 years.
Dividends, if any, will be payable as determined
by us. We do not anticipate any dividends will
be paid.
OPTION 3B - SINGLE LIFE INCOME OPTION - LIFETIME
PAYOUT (FIXED OR VARIABLE INCOME PAYMENTS ONLY).
We will pay monthly income payments to the payee
for as long as the annuitant lives.
Dividends, if any, will be payable as determined
by us. We do not anticipate any dividends to be
paid.
OPTION 4A - JOINT AND SURVIVOR LIFE INCOME OPTION
- GUARANTEED PERIOD CERTAIN (FIXED OR VARIABLE
INCOME PAYMENTS). We will pay monthly income
payments to the payee for as long as either of the
co-annuitants is living. If at the death of the
second surviving annuitant, income payments have
been made for less than the guaranteed period
certain: (a) income payments will be continued
during the remainder of the guaranteed period
certain to the successor payee; or (b) the present
value of the remaining income payments, computed
at the interest rate used to create the Option 4A
rates, will be paid to the successor payee or to
the last surviving payee's estate, if there is no
successor payee.
The guaranteed period certain choices are:
a.) 5 years;
b.) 10 years;
c.) 15 years; or
d.) 20 years.
Dividends, if any, will be payable as determined
by us. We do not anticipate any dividends to be
paid.
OPTION 4B - JOINT AND SURVIVOR LIFE INCOME OPTION
- LIFETIME PAYOUT (FIXED OR VARIABLE INCOME
PAYMENTS ONLY). We will pay monthly income
payments to the payee for as long as either of the
co-annuitants is living.
Dividends, if any, will be payable as determined
by us. We do not anticipate any dividends to be
paid.
14.3 WHAT ARE THE We will automatically make income FOR payments
REQUIREMENTS according to a life income payment option with
CHOOSING AN INCOME a guaranteed period certain of 10 years, starting
PAYOUT OPTION? on the payout date, unless you choose another
guaranteed period certain or income payout option.
We will apply your adjusted contract value
(described in Section 13) to purchase a variable
and/or fixed income payment in the same proportion
as your contract value is distributed among the
investment options. You may change the anticipated
income payout option by written request on or
prior to the payout date to an income payout
option that is acceptable to us.
The minimum adjusted contract value which can be
applied under Option 1 is $2,500. If the monthly
interest payment for Option 1 is less than $20, we
reserve the right to pay interest annually.
The minimum adjusted contract value which can be
applied under Options 2A, 2B, 3A, 3B, 4A or 4B is
the greater of $2,500 or the amount required to
provide an initial monthly income payment of $20.
We may require due proof of the age of any
annuitant on whose life an income payout option is
based. For Type A life income rates, we may also
require due proof of the gender of any annuitant
on whose life an income payout option is based.
The payee may name a successor payee to receive
any remaining income payments due after the
payee's death. The payee may exercise any
ownership rights that continue after the payout
date.
14.4 HOW WILL FIXED The minimum dollar amount of each fixed income
INCOME PAYMENT payment will be determined by dividing the amount
VALUES BE applied by $1,000, and multiplying the result by
DETERMINED? applied by $1,000, and multiplying the result by
the applicable option rate shown in Section 16.
Higher current option rates m available on the
payout date and are available upon request to our
home office.
14.5 HOW WILL VARIABLE The dollar amount of the initial variable income
INCOME PAYMENT payment attributable to each subaccount will be
VALUES BE determined by dividing the amount applied by
DETERMINED? $1,000, and multiplying the result by the
applicable option rate shown in Section 16. The
total initial variable income payment is the sum
of the initial variable income payments
attributable to the subaccount(s).
The dollar amount of the subsequent variable
income payments attributable to each subaccount
will be based on the number of income units
credited to the contract for that subaccount and
is determined by multiplying (a) by (b), where:
(a) = the number of subaccount income units; and
(b) = the subaccount income unit value for the
valuation period immediately preceding the
due date of the payment.
The number of income units attributable to each
subaccount remains fixed unless there is an
exchange of income units.
The number of income units is derived by dividing
that portion of the initial variable income
payment attributable to the subaccount by the
subaccount's income unit value for the valuation
period which ends immediately preceding the payout
date.
The income unit value for each subaccount was
arbitrarily set initially at $100. Thereafter, the
income unit value for each subaccount in any
valuation period is determined by dividing (a) by
(b), then multiplying by (c) and adjusting the
result to compensate for the assumed net
investment rate for the option selected, where:
a.) is the accumulation unit value for the
current valuation period;
b.) is the accumulation unit value for the
immediately preceding valuation period; and
c.) is the income unit value for the immediately
preceding valuation period.
Payments after the initial payment may increase,
decrease or remain constant based on whether the
actual annualized investment return of the
selected subaccount(s) is greater or less than the
assumed net investment rate for the option
selected. The option rates used to determine the
initial variable income payment (shown in Section
16) are based on an assumed net investment rate of
3.50% per year.
14.6 CAN VARIABLE ANNUITY The payee may exchange the dollar value of a
UNITS BE EXCHANGED? designated number of income units of a particular
subaccount for an equivalent dollar amount of
income units of another subaccount by written
request. On the date of the exchange, the dollar
amount of an income payment would be unaffected by
the fact of the exchange.
No more than 4 exchanges of income units may be
made during any contract year.
SECTION 15. DEATH OF PAYEE
15.1 WHAT IF THE PAYEE If the payee dies on or after the payout date, any
DIES DURING remaining proceeds will be distributed at least as
THE PAYOUT PERIOD? rapidly as provided by the income payout option in
effect.
SECTION 16. OPTION TABLES
16.1 WHAT RATES WILL BE The rates shown in the following tables are used
USED TO DETERMINE to determine the minimum payment values for
PAYMENT VALUES monthly fixed income payments. Higher current
rates may be available on the payout date, and are
available upon request to our home office. These
rates are also used to determine the initial
monthly variable income payment amount.
The Option 2A rates are based on 2.00% interest
per year. The Option 2B rates are based on 3.50%
interest per year. The Option 3A, 3B, 4A and 4B
rates are based on the Annuity 2000 Table and with
compound interest at the effective rate of 3.50%
per year.
Rates for ages not shown will be calculated on an
actuarially equivalent basis and will be available
upon request. Rates for initial variable income
payments at an assumed net investment rate other
than 3.50% per year may also be available with our
consent. Other assumed net investment rates that
are made available will be calculated on an
actuarially equivalent basis.
The Type A life income rates for Options 3A, 3B,
4A and 4B are based on the annuitant's age and
gender; or the beneficiary's age and gender if the
beneficiary elects to apply death benefit proceeds
under an income payout option. The Type B life
income rates are based on the annuitant's age; or
the beneficiary's age if the beneficiary elects to
apply death benefit proceeds under an income
payout option. The life income rates type for this
contract is shown on the data page.
OPTION 2A - RATES - FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(FIXED INCOME PAYMENTS ONLY)
YEARS MONTHLY PAYMENT PAYABLE UNDER
PAYABLE OPTION 2 FOR EACH $1,000 APPLIED
------- --------------------------------
5 17.49
10 9.18
15 6.42
20 5.04
25 4.22
30 3.68
OPTION 2B - RATES - FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(VARIABLE INCOME PAYMENTS ONLY)
YEARS MONTHLY PAYMENT PAYABLE UNDER
PAYABLE OPTION 2 FOR EACH $1,000 APPLIED
------- --------------------------------
5 18.12
10 9.83
15 7.10
20 5.75
25 4.96
30 4.45
OPTION 3A - LIFE INCOME RATES - GUARANTEED PERIOD CERTAIN -
FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
AGE - MALE
----------------------------------------------------------------------------------------
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
5 5.24 5.36 5.49 5.62 5.77 5.92 6.08 6.26 6.44 6.64 6.84 7.06 7.28
10 5.16 5.27 5.38 5.50 5.63 5.76 5.90 6.04 6.19 6.34 6.50 6.66 6.82
15 5.02 5.11 5.20 5.30 5.39 5.49 5.59 5.69 5.79 5.89 5.99 6.08 6.18
20 4.82 4.89 4.95 5.02 5.08 5.14 5.20 5.26 5.31 5.37 5.42 5.46 5.50
AGE - MALE
---------------------------------------------------------------------------------------------
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- -----
5 7.53 7.78 8.05 8.33 8.62 8.93 9.25 9.59 9.94 10.29 10.66 11.04 11.43
10 6.99 7.16 7.34 7.51 7.68 7.86 8.03 8.19 8.35 8.51 8.65 8.79 8.92
15 6.27 6.36 6.44 6.52 6.60 6.67 6.73 6.79 6.84 6.88 6.92 6.96 6.99
20 5.54 5.58 5.61 5.63 5.66 5.68 5.69 5.71 5.72 5.73 5.74 5.74 5.75
AGE - FEMALE
----------------------------------------------------------------------------------------
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
5 4.86 4.96 5.07 5.18 5.30 5.43 5.57 5.72 5.88 6.05 6.23 6.43 6.64
10 4.82 4.91 5.01 5.12 5.23 5.35 5.47 5.60 5.74 5.89 6.04 6.21 6.38
15 4.74 4.82 4.91 5.00 5.10 5.20 5.30 5.40 5.51 5.62 5.73 5.84 5.95
20 4.62 4.69 4.76 4.83 4.90 4.97 5.04 5.11 5.18 5.24 5.31 5.37 5.42
AGE - FEMALE
---------------------------------------------------------------------------------------------
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- -----
5 6.86 7.10 7.36 7.63 7.93 8.24 8.57 8.92 9.29 9.68 10.08 10.50 10.94
10 6.55 6.74 6.93 7.12 7.32 7.51 7.71 7.91 8.10 8.29 8.47 8.63 8.79
15 6.06 6.17 6.27 6.37 6.47 6.56 6.64 6.71 6.77 6.83 6.88 6.92 6.96
20 5.47 5.52 5.56 5.59 5.62 5.65 5.67 5.69 5.71 5.72 5.73 5.74 5.74
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
AGE - UNISEX
----------------------------------------------------------------------------------------
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
5 4.93 5.04 5.15 5.26 5.39 5.52 5.67 5.82 5.98 6.15 6.34 6.54 6.75
10 4.88 4.98 5.08 5.19 5.30 5.42 5.55 5.69 5.83 5.97 6.13 6.29 6.46
15 4.79 4.88 4.97 5.06 5.15 5.25 5.35 5.46 5.56 5.67 5.78 5.89 5.99
20 4.66 4.73 4.80 4.87 4.94 5.01 5.07 5.14 5.21 5.27 5.33 5.38 5.44
AGE - UNISEX
----------------------------------------------------------------------------------------------
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- -----
5 6.98 7.22 7.48 7.76 8.05 8.36 8.69 9.03 9.40 9.78 10.18 10.59 11.02
10 6.63 6.81 7.00 7.19 7.38 7.58 7.77 7.96 8.15 8.33 8.50 8.66 8.81
15 6.10 6.20 6.31 6.40 6.49 6.58 6.65 6.72 6.78 6.84 6.89 6.93 6.96
20 5.48 5.53 5.57 5.60 5.63 5.65 5.68 5.69 5.71 5.72 5.73 5.74 5.74
OPTION 3B - SINGLE LIFE INCOME RATES - LIFETIME PAYOUT -
FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
AGE
----------------------------------------------------------------------------
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
------ ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
MALE 5.26 5.39 5.52 5.66 5.81 5.97 6.15 6.33 6.53 6.74 6.96 7.20 7.45
FEMALE 4.87 4.97 5.08 5.20 5.33 5.46 5.60 5.75 5.92 6.10 6.29 6.49 6.72
AGE
-----------------------------------------------------------------------------------
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
------ ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- ----- -----
MALE 7.72 8.01 8.32 8.65 9.00 9.38 9.78 10.21 10.67 11.17 11.69 12.25 12.85
FEMALE 6.96 7.22 7.50 7.81 8.14 8.50 8.89 9.31 9.76 10.26 10.79 11.37 12.00
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
AGE
----------------------------------------------------------------------------------
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
------ ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
UNISEX 4.95 5.05 5.17 5.29 5.42 5.55 5.70 5.86 6.03 6.21 6.41 6.62 6.85
AGE
----------------------------------------------------------------------------------
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
------ ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- ----- -----
UNISEX 7.09 7.36 7.64 7.95 8.29 8.65 9.04 9.46 9.91 10.41 10.94 11.51 12.13
OPTION 4A - LIFE INCOME FACTORS - JOINT AND SURVIVOR -
GUARANTEED PERIOD CERTAIN -
FIRST PAYMENT DUE AT BEGINNING OF PERIOD (FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
5 YEAR GUARANTEE PERIOD
----------------------------------------------------
AGE - FEMALE
AGE ----------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.38 4.59 4.79 4.95 5.07 5.15
65 5.52 4.82 5.11 5.38 5.59 5.74
70 4.64 5.01 5.42 5.83 6.19 6.47
75 4.72 5.16 5.69 6.27 6.84 7.32
80 4.78 5.27 5.90 6.65 7.47 8.24
85 4.82 5.35 6.04 6.94 8.01 9.12
10 YEAR GUARANTEE PERIOD
----------------------------------------------------
AGE - FEMALE
AGE ----------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.38 4.59 4.78 4.93 5.04 5.11
65 4.52 4.81 5.09 5.35 5.54 5.66
70 4.63 5.00 5.39 5.78 6.10 6.31
75 4.71 5.14 5.65 6.18 6.66 7.01
80 4.76 5.24 5.83 6.50 7.16 7.68
85 4.79 5.30 5.95 6.72 7.53 8.20
15 YEAR GUARANTEE PERIOD
----------------------------------------------------
AGE - FEMALE
AGE ----------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.37 4.57 4.75 4.88 4.97 5.00
65 4.50 4.78 5.04 5.25 5.39 5.46
70 4.61 4.95 5.30 5.61 5.82 5.93
75 4.67 5.07 5.50 5.91 6.20 6.36
80 4.71 5.14 5.63 6.11 6.47 6.68
85 4.73 5.18 5.70 6.22 6.63 6.86
20 YEAR GUARANTEE PERIOD
----------------------------------------------------
AGE - FEMALE
AGE ----------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.34 4.53 4.67 4.76 4.81 4.82
65 4.46 4.70 4.91 5.05 5.11 5.14
70 4.55 4.84 5.10 5.28 5.37 5.41
75 4.59 4.92 5.22 5.44 5.55 5.60
80 4.62 4.96 5.28 5.52 5.65 5.69
85 4.62 4.97 5.30 5.55 5.68 5.73
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
5 YEAR GUARANTEE PERIOD
-------------------------------------------------
AGE - UNISEX
AGE ----------------------------------------
UNISEX 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ----
60 4.32 4.49 4.64 4.75 4.83 4.88
65 4.49 4.74 4.97 5.17 5.32 5.41
70 4.64 4.97 5.32 5.65 5.92 6.11
75 4.75 5.17 5.65 6.15 6.61 6.98
80 4.83 5.32 5.92 6.61 7.33 7.98
85 4.88 5.41 6.11 6.98 7.98 8.99
10 YEAR GUARANTEE PERIOD
-------------------------------------------------
AGE - UNISEX
AGE ----------------------------------------
UNISEX 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ----
60 4.32 4.49 4.63 4.74 4.81 4.85
65 4.49 4.74 4.96 5.15 5.28 5.36
70 4.63 4.96 5.30 5.61 5.85 6.00
75 4.74 5.15 5.61 6.08 6.48 6.75
80 4.81 5.28 5.85 6.48 7.07 7.52
85 4.85 5.36 6.00 6.75 7.52 8.14
15 YEAR GUARANTEE PERIOD
-------------------------------------------------
AGE - UNISEX
AGE ----------------------------------------
UNISEX 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ----
60 4.32 4.48 4.61 4.70 4.76 4.78
65 4.48 4.71 4.93 5.09 5.18 5.23
70 4.61 4.93 5.23 5.49 5.65 5.74
75 4.70 5.09 5.49 5.85 6.10 6.24
80 4.76 5.18 5.65 6.10 6.44 6.62
85 4.78 5.23 5.74 6.24 6.62 6.84
20 YEAR GUARANTEE PERIOD
-------------------------------------------------
AGE - UNISEX
AGE ----------------------------------------
UNISEX 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ----
60 4.30 4.44 4.55 4.62 4.65 4.66
65 4.44 4.65 4.82 4.93 4.98 5.00
70 4.55 4.82 5.06 5.21 5.29 5.32
75 4.62 4.93 5.21 5.41 5.52 5.56
80 4.65 4.98 5.29 5.52 5.64 5.68
85 4.66 5.00 5.32 5.56 5.68 5.73
OPTION 4B - LIFE INCOME FACTORS - JOINT AND SURVIVOR - LIFETIME PAYOUT -
FIRST PAYMENT DUE AT BEGINNING OF PERIOD (FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
AGE - FEMALE
AGE -----------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- -----
60 4.38 4.59 4.79 4.95 5.07 5.15
65 4.52 4.82 5.11 5.38 5.60 5.75
70 4.64 5.01 5.42 5.84 6.21 6.49
75 4.72 5.17 5.69 6.28 6.87 7.37
80 4.78 5.28 5.91 6.67 7.52 8.33
85 4.82 5.35 6.06 6.97 8.08 9.29
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
AGE - UNISEX
AGE ----------------------------------------
UNISEX 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ----
60 4.32 4.49 4.64 4.75 4.83 4.88
65 4.49 4.74 4.98 5.17 5.32 5.42
70 4.64 4.98 5.33 5.65 5.92 6.12
75 4.75 5.17 5.65 6.16 6.63 7.01
80 4.83 5.32 5.92 6.63 7.37 8.05
85 4.88 5.42 6.12 7.01 8.05 9.13
SECTION 17. RESTRICTIONS ON PAYMENT OF PROCEEDS
17.1 ARE THERE ANY Generally, the amount of any partial withdrawal or
RESTRICTIONS ON full surrender will be paid to you within seven
PAYMENT OF PROCEEDS (7) days after we receive your written request for
FROM THE VARIABLE partial withdrawal or full surrender. Death
ACCOUNT? benefit proceeds are payable upon receipt of due
proof of death in our home office. Income payments
are payable on your payout date and monthly
thereafter.
To the extent permitted by applicable law, we
reserve the right to postpone payment of any
partial withdrawal, full surrender, death benefit
or variable income payment from the variable
account for any period when:
a.) the New York Stock Exchange is closed for
other than customary weekend and holiday
closing or the SEC determines that trading
on the exchange is restricted; or
b.) the SEC issues an order permitting the
postponement for the protection of owners;
or
c.) the SEC determines that an emergency exists
that makes the disposal of securities held
in the variable account, or the
determination of their value, not reasonably
practicable.
FLEXIBLE PREMIUM DEFERRED
VARIABLE ANNUITY
Flexible Purchase Payments as Described Herein
Income Payments Starting on the Payout Date
Death Benefit Payable at Death Prior to the Payout Date
Participating
CUNA MUTUAL LIFE INSURANCE COMPANY
0000 XXXXXXXX XXX, XXXXXXX, XXXX 00000
TELEPHONE: (000) 000-0000
DATA PAGE
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
ANNUITANT: Xxxx Xxx CONTRACT NUMBER: 123456789
CO-ANNUITANT: Xxxx Xxx CONTRACT ISSUE DATE: September 1, 2004
ANTICIPATED INCOME PAYOUT OPTION:10 C & L LIFE INCOME RATES: Type A
ANITICIPATED PAYOUT DATE: September 1, 2054
OWNER(S): Xxxx Xxx Xxxx Xxx
INITIAL PURCHASE PAYMENT: $5,000
See application for allocation of initial purchase payment.
MINIMUM ADDITIONAL PURCHASE PAYMENT: $100
CHARGES AND FEES*:
Variable Account Mortality and Expense Risk Charge: [1.15% per year]
Variable Account Administrative Charge: [.15% per year]
Maximum Contract Fee: $30 per year
Premium Expense Charge on the contract issue date: [0.00%]
Surrender Charges: See the Surrender Charge Schedule Section of the Data
Page
Maximum Transfer Fee: $10
* We reserve the right to reduce or waive any of these charges or fees. Any
reduction or waiver will be administered in a non-discriminatory manner. We
reserve the right to impose or collect any other fees imposed by a fund in
connection with the redemption of its shares or otherwise imposed by
applicable law.
OPTIONAL DEATH BENEFIT RIDERS: ANNUAL PERCENTAGE CHARGE
Maximum Anniversary Value Death Benefit Rider [0.15%]
3% Annual Guarantee Death Benefit Rider [0.20%]
Earnings Enhanced Death Benefit Rider [0.30%]
ADDITIONAL BENEFITS (AT NO CHARGE):
Fixed Account Endorsement
Loan Account Endorsement
Additional Income Option Endorsement
Income Payment Increase Endorsement
Waiver of Surrender Charge Endorsement
DATA PAGE (CONTINUED)
INITIAL ALLOCATION OF NET PURCHASE PAYMENTS TO INVESTMENT OPTIONS:
VARIABLE ACCOUNT: CUNA Mutual Life Variable Annuity Account
Subaccounts Fund Percentage
----------- ---- ----------
Mid-Cap Stock Ultra Series 0.00%
Capital Appreciation Stock Ultra Series 0.00%
Growth & Income Stock Ultra Series 15.00%
Balanced Ultra Series 25.00%
Bond Ultra Series 10.00%
Money Market Ultra Series 0.00%
High Income Ultra Series 0.00%
International Stock Ultra Series 0.00%
Multi-Cap Growth Stock Ultra Series 0.00%
Global Securities Ultra Series 0.00%
FIXED ACCOUNT:
Fixed Current Guaranteed
Periods Interest Rate Percentage
------- ------------- ----------
1 Year 3.05% 25.00%
3 Year 3.25% 0.00%
5 Year 3.50% 0.00%
7 Year 3.55% 0.00%
10 Year 3.65% 0.00%
DCA Fixed Periods
1 Year 4.00% 25.00%
FIXED ACCOUNT MINIMUM GUARANTEED INTEREST RATE: [1.00% - 3.00%] as of the
contract issue date. Will be recalculated quarterly (on calendar quarters).
DATA PAGE (CONTINUED)
SURRENDER CHARGE SCHEDULE: Each purchase payment has an individual surrender
charge schedule which begins when the purchase payment is credited to your
contract and continues for 7 years, as shown below. The amount of the surrender
charge is determined separately for each purchase payment and is expressed as a
percentage of the purchase payment as follows:
Number of Years Since Surrender Charge
Purchase Payment was Credited Percent
----------------------------- -------------------
Less than 1 8%
At least 1 but less than 2 7%
At least 2 but less than 3 6%
At least 3 but less than 4 5%
At least 4 but less than 5 4%
At least 5 but less than 6 3%
At least 6 but less than 7 2%
7 or more 0%
These percentages apply to partial withdrawals and full surrender of new
purchase payments in excess of the free withdrawal amount
FREE WITHDRAWAL AMOUNT: The following amounts may be withdrawn without incurring
a surrender charge:
a.) earnings not previously withdrawn;
b.) old purchase payments not previously withdrawn; and
c.) your annual free withdrawal amount described below.
Your annual free withdrawal amount is equal to 10% of new purchase payments at
the time of withdrawal, less free withdrawal amounts previously withdrawn in the
current contract year. Free withdrawal amounts not withdrawn in a contract year
are not carried over to increase the free withdrawal amount in a subsequent
contract year.
DATA PAGE
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
ANNUITANT: Xxxx Xxx CONTRACT NUMBER: 123456789
CO-ANNUITANT: Xxxx Xxx CONTRACT ISSUE DATE: September 1, 2004
ANTICIPATED INCOME PAYOUT OPTION:10 C & L LIFE INCOME RATES: Type A
ANTICIPATED PAYOUT DATE: September 1, 2054
OWNER(S): Xxxx Xxx Xxxx Xxx
INITIAL PURCHASE PAYMENT: $2,000
See application for allocation of initial purchase payment.
MINIMUM ADDITIONAL PURCHASE PAYMENT: $100
CHARGES AND FEES*:
Variable Account Mortality and Expense Risk Charge: [1.15% per year]
Variable Account Administrative Charge: [.15% per year]
Maximum Contract Fee: $30 per year
Premium Expense Charge on the contract issue date: [0.00%]
Surrender Charges: See the Surrender Charge Schedule Section of the
Data Page
Maximum Transfer Fees: $10
* We reserve the right to reduce or waive any of these charges or fees. Any
reduction or waiver will be administered in a non-discriminatory manner. We
reserve the right to impose or collect any other fees imposed by a fund in
connection with the redemption of its shares or otherwise imposed by
applicable law.
OPTIONAL DEATH BENEFIT RIDERS: ANNUAL PERCENTAGE CHARGE
Maximum Anniversary Value Death Benefit Rider [0.15%]
3% Annual Guarantee Death Benefit Rider [0.20%]
Earnings Enhanced Death Benefit Rider [0.30%]
ADDITIONAL BENEFITS (AT NO CHARGE):
Fixed Account Endorsement
Additional Income Option Endorsement
Change of Annuitant Endorsement
Income Payment Increase Endorsement
Waiver of Surrender Charge Endorsement
DATA PAGE (CONTINUED)
INITIAL ALLOCATION OF NET PURCHASE PAYMENTS TO INVESTMENT OPTIONS:
VARIABLE ACCOUNT: CUNA Mutual Life Variable Annuity Account
Subaccounts Fund Percentage
----------- ---- ----------
Mid-Cap Stock Ultra Series 0.00%
Capital Appreciation Stock Ultra Series 0.00%
Growth & Income Stock Ultra Series 15.00%
Balanced Ultra Series 25.00%
Bond Ultra Series 10.00%
Money Market Ultra Series 0.00%
High Income Ultra Series 0.00%
International Stock Ultra Series 0.00%
Multi-Cap Growth Stock Ultra Series 0.00%
Global Securities Ultra Series 0.00%
FIXED ACCOUNT:
Fixed Current Guaranteed
Periods Interest Rate Percentage
------ ------------------ ----------
1 Year 3.05% 25.00%
3 Year 3.25% 0.00%
5 Year 3.50% 0.00%
7 Year 3.55% 0.00%
10 Year 3.65% 0.00%
DCA Fixed Periods
1 Year 4.00% 25.00%
FIXED ACCOUNT MINIMUM GUARANTEED INTEREST RATE: [1.00% - 3.00%] as of the
contract issue date. Will be recalculated quarterly (on calendar quarters).
DATA PAGE (CONTINUED)
SURRENDER CHARGE SCHEDULE: A surrender charge is imposed on partial withdrawals
or upon full surrender during the first seven (7) years following your contract
issue date. The surrender charge (expressed as a percentage) is imposed upon
purchase payments withdrawn in excess of earnings and the free withdrawal amount
described below according the following surrender charge schedule:
Surrender Charge
Contract Year Percent
------------- -------
1 8%
2 7%
3 6%
4 5%
5 4%
6 3%
7 2%
7 or more 0%
The surrender charge amount, if any, is equal to the surrender charge percent
for the current contract year multiplied by the total of:
a.) your contract value, for a full surrender, or the withdrawal amount,
for a partial withdrawal; minus
b.) earnings not previously withdrawn; minus
c.) 10% of the purchase payments being withdrawn.
FREE WITHDRAWAL AMOUNT: The following amounts may be withdrawn without incurring
a surrender charge:
a.) earnings not previously withdrawn; and
b.) 10% of any purchase payments being withdrawn.
