Settlement Option Tables. 29 Additional benefits or riders, if any, will be listed in the Schedule. The additional provisions will be inserted in the Policy. SCHEDULE (Effective Date: May 1, 1995) POLICY INFORMATION Policy Number 1000540-001 Stated Death Benefit $100,000.00 Insured XXXX XXX Minimum Stated Death Benefit $ 50,000.00 Owner XXXX XXX Three Year Continuation Period Ending Date May 1, 1998 Death Benefit Option Stated Death Benefit Option 1 Three Year Continuation Period Age And Sex 35, Male Minimum Annual Premium $631.62 Premium Class Standard, Non-Smoker Policy Date May 1, 1995 Scheduled Premium $3,000.00 Maturity Date May 15, 2060 Definition of Life Insurance Test Guideline Premium CUSTOMER SERVICE CENTER: P.O. Box 173763, Denver, Colorado 80217- 3763 Coverage may expire prior to the Maturity Date if Scheduled Premiums are paid in a timely manner, coverage may expire prior to the Maturity Date if said premiums are insufficient to continue coverage and the Guarantee Period has ended. Coverage will also be affected by Partial Withdrawals, Policy Loans, changes in the current cost of insurance rates, the actual credited interest rate for the Guaranteed Interest Division and the investment experience of the Variable Account. Form 1195 (VUL) - MD Page 5 SCHEDULE (CONTINUED) BENEFIT PROFILE ------------------------------------------------------------------------------------------------------------------------------------ Initial Segment Age At Guideline Benefit Issue Maturity Effective Annual Target Description Amount Age Date Date Premium Premium ------------------------------------------------------------------------------------------------------------------------------------ Stated Death Benefit (Segment #1) $100,000.00 35 100 May 1, 1995 $1,335.37 $3,680.00 ------------------------------------------------------------------------------------------------------------------------------------ Adjustable Term Insurance Rider $50,000.00 35 100 May 1, 1995 $620.58 (Segment #1) ------------------------------------------------------------------------------------------------------------------------------------ A coverage segment is a block of Death Benefit coverage. The Stated Death Benefit shown on the schedule page at issue is the initial coverage segment. Additional segments are added to the policy after issue to increase the Death Benefit. Each individual coverage segment added to the policy has its own cost of insurance charges and expense loads as shown in the Schedule. Form 1...
Settlement Option Tables. The Option Tables show the payments that we will make at sample payment intervals for each $1,000 applied based on the guaranteed settlement option factors. Amounts may vary with the payment interval and the age of the person on whose life payments are based. Upon request, we will provide information on the payments that we will make for other payment intervals and ages. OPTION A TABLE — INCOME FOR A FIXED PERIOD Payments for fixed number of years for each $1,000 applied. Term of Semi- Years 1 $ [1,010.00] $ [503.74] $ [251.55] $ [83.78] 2 [507.51] [253.12] [126.40] [42.10] 3 [340.02] [169.58] [84.68] [28.20] 4 [256.28] [127.82] [63.83] [21.25] 5 [206.03] [102.76] [51.31] [17.09] 6 [172.54] [86.05] [42.97] [14.31] 7 [148.62] [74.12] [37.01] [12.32] 8 [130.69] [65.18] [32.55] [10.84] 9 [116.74] [58.22] [29.07] [9.68] 10 [105.58] [52.65] [26.29] [8.75] 11 [96.45] [48.10] [24.02] [8.00] 12 [88.84] [44.31] [22.12] [7.37] 13 [82.41] [41.10] [20.52] [6.83] 14 [76.90] [38.35] [19.15] [6.37] 15 [72.12] [35.97] [17.96] [5.98] 16 [67.94] [33.88] [16.92] [5.63] 17 [64.25] [32.04] [16.00] [5.33] 18 [60.98] [30.41] [15.18] [5.05] 19 [58.05] [28.95] [14.45] [4.81] 20 [55.41] [27.63] [13.80] [4.59] The values stated for years 1-4 are available only as a Death Benefit option. AILIC OPTION B TABLE — LIFE ANNUITY Monthly payments by age of the person named for each $1,000 applied. Number of Months Certain Age 0 60 120 180 240 55 $ [3.25] $ [3.24] $ [3.22] $ [3.18] $ [3.12] 56 [3.33] [3.33] [3.30] [3.26] [3.18] 57 [3.42] [3.42] [3.39] [3.34] [3.25] 58 [3.52] [3.51] [3.48] [3.42] [3.32] 59 [3.62] [3.61] [3.58] [3.51] [3.40] 60 [3.73] [3.72] [3.68] [3.60] [3.47] 61 [3.85] [3.83] [3.79] [3.69] [3.54] 62 [3.97] [3.95] [3.90] [3.79] [3.62] 63 [4.10] [4.08] [4.02] [3.89] [3.69] 64 [4.24] [4.22] [4.14] [4.00] [3.77] 65 [4.39] [4.36] [4.27] [4.10] [3.84] 66 [4.55] [4.52] [4.41] [4.21] [3.91] 67 [4.72] [4.68] [4.56] [4.33] [3.99] 68 [4.90] [4.86] [4.71] [4.44] [4.05] 69 [5.10] [5.04] [4.87] [4.55] [4.12] 70 [5.30] [5.24] [5.03] [4.67] [4.18] 71 [5.53] [5.45] [5.21] [4.78] [4.24] 72 [5.77] [5.68] [5.39] [4.89] [4.29] 73 [6.03] [5.92] [5.57] [5.00] [4.34] 74 [6.31] [6.18] [5.76] [5.11] [4.38] 75 [6.61] [6.45] [5.95] [5.21] [4.42] 76 [6.93] [6.74] [6.15] [5.31] [4.45] 77 [7.28] [7.04] [6.35] [5.40] [4.48] 78 [7.66] [7.37] [6.55] [5.48] [4.50] 79 [8.07] [7.71] [6.75] [5.56] [4.52] 80 [8.51] [8.07] [6.94] [5.63] [4.54] AILIC OPTION C TABLE — JOINT AND ONE-HALF SURVIVOR ANNUITY Monthly pay...
Settlement Option Tables. 18 NLIVA99 01-99 2A POLICY DATA PAGE ------------------------------------------------------------------------------------------------------------------- CONTRACT DATE: SEPT 01, 1997 POLICY NUMBER: 00000001 NAME OF ANNUITANT: JXXX XXX INITIAL PREMIUM: 1,000,000.00 NAME OF OWNER: JXXX XXX PLANNED PREMIUM: 100,000.00 ANNUITY DATE: SEPT 01, 2027 MODE: ANNUAL SEPARATE ACCOUNT: [AUL AMERICAN INDIVIDUAL VARIABLE ANNUITY UNIT TRUST] RIDERS ATTACHED: [NONE] MINIMUM PREMIUM ALLOCATION TO ANY INVESTMENT ACCOUNT OR THE FIXED ACCOUNT: [1% of the premium payment] All allocations must be in whole percentages. MINIMUM PREMIUM PAYMENT SUBSEQUENT TO THE INITIAL PREMIUM: [$500 ] MAXIMUM PREMIUM ACCEPTABLE IN A CONTRACT YEAR: [$1,000,000] PREMIUM TAX CHARGE: [ 0%] ANNUAL CONTRACT FEE: [$30, waived for Contracts with Account Value in excess of $50,000] MONTHLY MORTALITY AND EXPENSE RISK CHARGE: 1/12 of the following percentage of the Variable Account Value: [1.00% during the first ten Contract Years] [0.90% thereafter] TRANSFER CHARGE: Current: [$0] Guaranteed: [$0] for the first [12] transfers in any Policy Year [$25] for each subsequent transfer in the Policy Year WITHDRAWAL CHARGES: None INTEREST RATES FOR LOANS (if available): RATE CHARGED ON LOAN BALANCES: [6%] RATE CREDITED TO LOAN ACCOUNT: [4%] MINIMUM TRANSFER AMOUNT: [$500] MINIMUM LOAN AMOUNT: [$1,000] MINIMUM PARTIAL WITHDRAWAL AMOUNT: [$200] ASSUMED DATE OF DELIVERY OF THE POLICY, FOR PURPOSES OF THE TRANSFER AT THE END OF THE RIGHT TO EXAMINE PERIOD: [5] days after the Contract Date NLIVA99 01-99 3A ______________________________________________________________________________
Settlement Option Tables. Values for other ages, and for other payment periods, joint life combinations, or assumed investment rates that we offer (Tables below assume 3%) are available on request. Monthly payments are shown for each $1,000 applied. Settlement Option Table for a Fixed Period Monthly Payment Monthly Payment Monthly Payment Fixed Period --------------- Fixed Period --------------- Fixed Period --------------- of Years of Years of Years -------- -------- -------- 11 $8.88 21 $5.33 12 8.26 22 5.16 13 7.73 23 5.00 14 7.28 24 4.85 5 $17.95 15 6.89 25 4.72 6 15.18 16 6.54 26 4.60 7 13.20 17 6.24 27 4.49 8 11.71 18 5.98 28 4.38 9 10.56 19 5.74 29 4.28 10 9.64 20 5.53 30 4.19
Settlement Option Tables. The Option Tables show the payments we will make at sample payment intervals for each $1,000 applied at the guaranteed interest rate. Amounts may vary with the payment interval and the age of the person on whose life payments are based. Upon request, we will provide information on the payments that we will make for other payment intervals and ages. OPTION A TABLE—INCOME FOR A FIXED PERIOD Payments for fixed number of years for each $1,000 applied Term of Payments Annual Semi- Annual Quarterly Monthly Years 1 [$1,010.00 $503.74 $251.55 $83.78 2 507.51 253.12 126.40 42.10 3 340.02 169.58 84.68 28.20 4 256.28 127.82 63.83 21.25 5 206.03 102.76 51.31 17.09 6 172.54 86.05 42.97 14.31 7 148.62 74.12 37.01 12.32 8 130.69 65.18 32.55 10.84 9 116.74 58.22 29.07 9.68 10 105.58 52.65 26.29 8.75 11 96.45 48.10 24.02 8.00 12 88.84 44.31 22.12 7.37 13 82.41 41.10 20.52 6.83 14 76.90 38.35 19.15 6.37 15 72.12 35.97 17.96 5.98 16 67.94 33.88 16.92 5.63 17 64.25 32.04 16.00 5.33 18 60.98 30.41 15.18 5.05 19 58.05 28.95 14.45 4.81 20 55.41 27.63 13.80 4.59] The values stated for years 1-4 are available only as a Death Benefit option. OPTION B TABLES—LIFE ANNUITY WITH PAYMENTS FOR AT LEAST A FIXED PERIOD Monthly payments by age of person named for each $1,000 applied Number of Months Certain Age 0 60 120 180 240 55 [$3.25 $3.24 $3.22 $3.18 $3.12 56 3.33 3.33 3.30 3.26 3.18 57 3.42 3.42 3.39 3.34 3.25 58 3.52 3.51 3.48 3.42 3.32 59 3.62 3.61 3.58 3.51 3.40 60 3.73 3.72 3.68 3.60 3.47 61 3.85 3.83 3.79 3.69 3.54 62 3.97 3.95 3.90 3.79 3.62 63 4.10 4.08 4.02 3.89 3.69 64 4.24 4.22 4.14 4.00 3.77 65 4.39 4.36 4.27 4.10 3.84 66 4.55 4.52 4.41 4.21 3.91 67 4.72 4.68 4.56 4.33 3.99 68 4.90 4.86 4.71 4.44 4.05 69 5.10 5.04 4.87 4.55 4.12 70 5.30 5.24 5.03 4.67 4.18 71 5.53 5.45 5.21 4.78 4.24 72 5.77 5.68 5.39 4.89 4.29 73 6.03 5.92 5.57 5.00 4.34 74 6.31 6.18 5.76 5.11 4.38 75 6.61 6.45 5.95 5.21 4.42 76 6.93 6.74 6.15 5.31 4.45 77 7.28 7.04 6.35 5.40 4.48 78 7.66 7.37 6.55 5.48 4.50 79 8.07 7.71 6.75 5.56 4.52 80 8.51 8.07 6.94 5.63 4.54] OPTION C TABLE—JOINT AND ONE-HALF SURVIVOR ANNUITY Monthly payments by ages of persons named for each $1,000 applied* Secondary Age Primary Age 60 61 62 63 64 65 66 67 68 69 70 60 [$ 3.39 $ 3.42 $ 3.44 $ 3.46 $ 3.48 $ 3.50 $ 3.52 $ 3.54 $ 3.56 $ 3.57 $ 3.59 61 3.47 3.49 3.52 3.54 3.56 3.59 3.61 3.63 3.65 3.66 3.68 62 3.54 3.57 3.59 3.62 3.65 3.67 3.69 3.72 3.74 3.76 3.78 63 3.61 3.64 3.67 3.70 3.73 3.76 3.79 3.81 3.83 3.86 3.88 64 3.69 3.72 3.76 ...
Settlement Option Tables. ... 16 Additional benefit provisions or restrictions, if any, and a copy of the application follow page 18. Home Office: 0 Xxxxxx Xxxx Plaza Springfield, Illinois 62715-0001 0-000-000-0000 Individual Deferred Fixed And Variable Retirement Annuity Contract Flexible purchase payments Nonparticipating -- dividends not paid. All payments and values under this contract which are based on investment results of the Separate Account are variable and not guaranteed as to fixed dollar amount. SECTION 1 -- CONTRACT DATA Contract number: XXXXXXXXXX Annuitant: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Contract Date: XXXXXXXXXX Maturity Date: XXXXXXXXXX Renewal Date: XXXXXXXXXX Age at issue: XX Sex: XXXXXX Owner and beneficiary: as stated in the application unless changed.
Settlement Option Tables. Guaranteed Monthly Income Per $1,000 of Proceeds OPTION 1 - Income for Fixed Period Number Monthly Number Monthly of Years Income of Years Income 1 $84.47 11 $8.86 2 42.86 12 8.24 3 28.99 13 7.71 4 22.06 14 7.26 5 17.91 15 6.87 6 15.14 16 6.53 7 13.16 17 6.23 8 11.68 18 5.96 9 10.53 19 5.73 10 9.61 20 5.51 Quarterly Income is 2.993 times the monthly income and annual income is 11.839 times the monthly income. OPTION 2 - Life Annuity The amount of income is based on the adjusted age of the annuitant on the date of the first payment. Adjusted Number of Guaranteed Payments Adjusted Number of Guaranteed Payments Age None 120 Refund* Age None 120 Refund* 55 $4.34 $4.30 $4.17 63 $5.21 $5.10 $4.86 56 4.42 4.38 4.24 64 5.35 5.22 4.96 57 4.52 4.47 4.31 65 5.51 5.35 5.08 58 4.61 4.56 4.39 66 5.67 5.49 5.20 59 4.72 4.65 4.47 67 5.85 5.64 5.33 60 4.83 4.76 4.56 68 6.04 5.80 5.46 61 4.95 4.86 4.66 69 6.24 5.96 5.61 62 5.08 4.98 4.75 70 6.46 6.13 5.76 *The sum of all guaranteed payments will equal the amount applied under this option. OPTION 3 - Survivorship Annuity The amount of income is based on the adjusted age of each of the annuitants on the date of the first payment. 50% to Survivor 100% to Survivor 120 Guaranteed Payments 120 Guaranteed Payments Payee #2 Age Payee #2 Age Payee #1 Payee #1 Age 50 55 60 65 70 Age 50 55 60 65 70 50 $3.95 $4.12 $4.31 $4.55 $4.80 50 $3.56 $3.67 $3.76 $3.83 $3.88 55 4.12 4.30 4.52 4.77 5.05 55 3.67 3.83 3.97 4.08 4.17 60 4.31 4.52 4.76 5.04 5.36 60 3.76 3.97 4.17 4.36 4.51 65 4.55 4.77 5.04 5.35 5.72 65 3.83 4.08 4.36 4.64 4.90 70 4.80 5.05 5.36 5.72 6.13 70 3.88 4.17 4.51 4.90 5.28 Income for other combinations of ages will be furnished on request.
Settlement Option Tables. 18 FPIVA99 01-99 2A POLICY DATA PAGE -------------------------------------------------------------------------------- CONTRACT DATE: SEPT 01, 1997 POLICY NUMBER: 00000001 NAME OF ANNUITANT: JXXX XXX INITIAL PREMIUM: 1000.00 NAME OF OWNER: JXXX XXX PLANNED PREMIUM: 1000.00 ANNUITY DATE: SEPT 01, 2027 MODE: ANNUAL SEPARATE ACCOUNT: [AUL AMERICAN INDIVIDUAL VARIABLE ANNUITY UNIT TRUST] RIDERS ATTACHED: [NONE] MINIMUM PREMIUM ALLOCATION TO ANY INVESTMENT ACCOUNT OR THE FIXED ACCOUNT: [1% of the premium payment] All allocations must be in whole percentages. MINIMUM PREMIUM PAYMENT SUBSEQUENT TO THE INITIAL PREMIUM: [$50 ] MAXIMUM PREMIUM ACCEPTABLE IN A CONTRACT YEAR: [$1,000,000 in the first two Contract Years] [$30,000 in any Contract Year thereafter for Qualified Plans] [$15,000 in any Contract Year thereafter for Non-Qualified Plans] PREMIUM TAX CHARGE: [ 0%]
Settlement Option Tables. Values for other ages, and for other payment periods, joint life combinations, or assumed investment rates that we offer are available on request. Monthly payments are shown for each $1,000 applied. Settlement Option Table for a Fixed Period Income Table for a Fixed Period Variable or Fixed Income Payment (3%) Variable Income Payment Only (5%) Fixed Fixed Fixed Fixed Fixed Fixed Period Monthly Period Monthly Period Monthly Period Monthly Period Monthly Period Monthly Of Income Of Income Of Income Of Income Of Income Of Income -- -- -- -- -- -- Years Payment Years Payment Years Payment Years Payment Years Payment Years Payment ----- -------- ----- ------- ----- ------- ----- ------- ----- ------- ----- ------- 11 $8.88 21 $5.33 11 $9.81 21 $6.36 12 8.26 22 5.16 12 9.19 22 6.19 13 7.73 23 5.00 13 8.67 23 6.04 14 7.28 24 4.85 14 8.23 24 5.91 5 17.95 15 6.89 25 4.72 5 18.82 15 7.85 25 5.78 6 15.18 16 6.54 26 4.60 6 16.05 16 7.52 26 5.67 7 13.20 17 6.24 27 4.49 7 14.08 17 7.23 27 5.56 8 11.71 18 5.98 28 4.38 8 12.61 18 6.97 28 5.47 9 10.56 19 5.74 29 4.28 9 11.46 19 6.74 29 5.38 10 9.64 20 5.53 30 4.19 10 10.55 20 6.54 30 5.30 Settlement Option Table for Life Variable or Fixed Monthly Income Payments Variable Monthly Income Payments Only (3%) (5%) Male/Female Male/Female Male/Female Male/Female Age Male/Female 10 Years 20 Years Male/Female 10 Years 20 Years --- -------- -------- -------- -------- Life Only Certain Certain Life Only Certain Certain --------- ------- ------- --------- ------- ------- 50 $ 4.28 / 3.92 $4.24 / 3.90 $4.10 / 3.84 $ 5.51 / 5.14 $5.44 / 5.11 $5.27 / 5.03 55 4.72 / 4.27 4.64 / 4.24 4.40 / 4.12 5.93 / 5.47 5.82 / 5.42 5.54 / 5.28 60 5.31 / 4.74 5.17 / 4.68 4.73 / 4.45 6.50 / 5.92 6.32 / 5.83 5.83 / 5.58 65 6.13 / 5.38 5.84 / 5.25 5.04 / 4.81 7.33 / 6.55 6.96 / 6.38 6.10 / 5.90 70 7.28 / 6.29 6.65 / 6.00 5.29 / 5.14 8.49 / 7.45 7.33 / 7.09 6.32 / 6.19 75 8.90 / 7.62 7.53 / 6.92 5.43 / 5.37 10.12 / 8.80 8.57 / 7.98 6.46 / 6.40 80 11.19 / 9.62 8.37 / 7.93 5.50 / 5.48 12.45 / 10.83 9.36 / 8.94 6.52 / 6.50 85 14.36 / 12.63 9.00 / 8.77 5.52 / 5.52 15.67 / 13.89 9.95 / 9.74 6.54 / 6.53 Settlement Option Income Table for Joint and Last Survivor Variable or Fixed Variable Only (3%) (5%) Male/Female Monthly Income Monthly Income Age of Each Payee Payment Payment ----------------- ------- ------- 50/50 $3.62 4.83 55/55 3.89 5.07 60/60 4.25 5.40 65/65 4.75 5.87 70/70 5.43 6.53 75/75 6.42 7.50 80/80 7.84 8.92 85/85 9.89 10.98 TABLE OF GUARANTEED MONT...
Settlement Option Tables. (Per $1,000 of Net Proceeds) -------------------------------------------------------------------------- Table 1 - Fixed Period Table 2 - Lifetime Payments ---------------------- -------------------------------------------------- Number Monthly Male Without 10 Year Female Without 10 Year of Years Payment Age Refund Certain Age Refund Certain ---------------------- -------------------------------------------------- 1 $85.12 25 $3.80 $3.80 25 $3.68 $3.68 2 43.39 26 3.82 3.82 26 3.70 3.70 3 29.49 27 3.85 3.84 27 3.72 3.72 4 22.55 28 3.87 3.87 28 3.74 3.74 5 18.38 29 3.90 3.89 29 3.76 3.76 6 15.61 30 3.92 3.92 30 3.78 3.78 7 13.64 31 3.95 3.95 31 3.80 3.80 8 12.16 32 3.98 3.97 32 3.82 3.82 9 11.01 33 4.01 4.01 33 3.85 3.84 10 10.09 34 4.05 4.04 34 3.87 3.87 11 9.34 35 4.08 4.07 35 3.90 3.90 12 8.72 36 4.12 4.11 36 3.93 3.92 13 8.20 37 4.16 4.15 37 3.96 3.95 14 7.75 38 4.20 4.18 38 3.99 3.98 15 7.36 39 4.24 4.23 39 4.02 4.01 16 7.02 40 4.29 4.27 40 4.06 4.05 17 6.73 41 4.33 4.31 41 4.09 4.08 18 6.47 42 4.38 4.36 42 4.13 4.12 19 6.23 43 4.44 4.41 43 4.17 4.16 20 6.02 44 4.49 4.46 44 4.21 4.20 21 5.83 45 4.55 4.52 45 4.26 4.24 22 5.66 46 4.61 4.57 46 4.30 4.29 23 5.51 47 4.67 4.63 47 4.35 4.34 24 5.37 48 4.74 4.70 48 4.40 4.39 25 5.24 49 4.81 4.76 49 4.46 4.44 26 5.12 50 4.88 4.83 50 4.52 4.49 27 5.01 51 4.96 4.90 51 4.58 4.55 28 4.91 52 5.04 4.97 52 4.64 4.61 29 4.82 53 5.13 5.05 53 4.71 4.68 30 4.73 54 5.22 5.13 54 4.78 4.75 55 5.31 5.22 55 4.86 4.82 56 5.42 5.31 56 4.94 4.89 57 5.52 5.41 57 5.03 4.97 58 5.64 5.51 58 5.12 5.06 59 5.76 5.62 59 5.22 5.15 60 5.90 5.73 60 5.32 5.24 61 6.04 5.85 61 5.43 5.34 62 6.19 5.98 62 5.55 5.45 63 6.36 6.11 63 5.68 5.56 64 6.53 6.25 64 5.81 5.68 65 6.72 6.39 65 5.96 5.80 66 6.92 6.54 66 6.11 5.94 67 7.14 6.69 67 6.28 6.08 68 7.37 6.85 68 6.46 6.22 69 7.61 7.01 69 6.65 6.38 70 7.88 7.18 70 6.86 6.54 ---------------------- -------------------------------------------------- We will furnish payments for ages not shown on request. FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY DEATH BENEFITS AND OTHER VALUES PROVIDED BY THIS POLICY, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE. THESE VALUES MAY INCREASE OR DECREASE BASED ON INVESTMENT EXPERIENCE AND ARE NOT GUARANTEED AS TO A FIXED DOLLAR AMOUNT. DEATH BENEFITS ARE PAYABLE BY US TO THE BENEFICIARY UPON THE DEATH OF THE INSURED PRIOR TO MATURITY. THE NET ACCUMULATION VALUE, IF ANY, IS PAYABLE BY US IF THE INSURED IS LIVING UPON MATURITY. FLEXIBLE PREMI...
