1
EXHIBIT 4(a)
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
Annuitant Age
Contract Date Contract No.
This contract is issued in consideration of the attached application by the
contractholder and payment of the initial purchase payment. The provisions on
this cover and the pages that follow are part of this contract.
We agree to pay an annuity to the annuitant provided the annuitant is living
and this contract is in force on the annuity date. We further agree to pay the
death benefit prior to the annuity date upon the death of an owner or an
annuitant when a death benefit is payable. Payment will be made upon our
receipt of due proof of death and the return of the owner's certificate.
Signed for Xxxxxx Investors Life Insurance Company at its home office in Long
Grove, Illinois.
----------------------- -------------------------
Secretary President
GROUP FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED UPON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED
AS TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD
PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON
GUARANTEE PERIOD VALUES, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE MARKET
VALUE ADJUSTMENT FORMULA STATED IN THE CONTRACT SCHEDULE.
This is a legal contract between the contractholder and Xxxxxx Investors Life
Insurance Company.
READ THIS CONTRACT CAREFULLY
Policy Form No. L-8165
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L-8165
INDEX PAGE
ANNUITY OPTION TABLE........................................Follows Page 9
ANNUITY PERIOD PROVISIONS .............................................6-9
Election Of Annuity Option ......................................6
Xxxxxxx Options ...............................................6-7
Transfers During The Annuity Period ...........................8-9
APPLICATION......................................Follows Contract Schedule
CONTRACT SCHEDULE............................................Follows Index
DEATH BENEFIT PROVISIONS ................................................6
Amount Payable Upon Death .......................................6
Payment Of Death Benefits .......................................6
DEFINITIONS .............................................................1
ENDORSEMENTS, if any..........................Follow Annuity Option Tables
FIXED ACCOUNT PROVISIONS ................................................3
Fixed Account Certificate Value .................................3
GENERAL PROVISIONS ......................................................2
The Contract ....................................................2
Incontestability ................................................2
Assignment ......................................................2
Reports .........................................................2
Premium Taxes ...................................................2
GUARANTEE PERIOD PROVISIONS............................................3-4
Guarantee Period Value...........................................3
MARKET VALUE ADJUSTMENT PROVISION........................................4
OWNERSHIP PROVISIONS ....................................................2
Owner of Contract ...............................................2
Change of Ownership .............................................3
Beneficiary .....................................................3
PURCHASE PAYMENT PROVISIONS .............................................3
TRANSFER AND WITHDRAWAL PROVISIONS ......................................5
Transfers During The Accumulation Period ........................5
Withdrawals During The Accumulation Period ......................5
Withdrawal Charges ..............................................5
Transfer And Withdrawal Procedures ..............................6
Deferment of Withdrawal or Transfer .............................6
VARIABLE ACCOUNT PROVISIONS ...........................................4-5
Separate Account ................................................4
Liabilities Of Separate Account .................................4
Subaccounts .....................................................4
Rights Reserved By The Company ..................................4
Accumulation Unit Value .........................................4
Investment Experience Factor...................................4-5
3
CONTRACT SCHEDULE
DESCRIPTION OF PLAN: GROUP FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND
VARIABLE DEFERRED ANNUITY
GROUP CONTRACT NUMBER: T001 CONTRACT DATE: JANUARY 1, 1997
CONTRACTHOLDER: XYZ GROUP TYPE OF CONTRACT: NONQUALIFIED
STATE OF DELIVERY: THIS CONTRACT IS DELIVERED IN THE STATE WHERE THE
APPLICATION WAS COMPLETED BY THE CONTRACTHOLDER AND IS SUBJECT TO THE LAWS OF
THAT STATE.
INITIAL ALLOCATION OPTIONS:
FIXED ACCUMULATION UNDER:
FIXED ACCOUNT
GUARANTEE PERIOD ACCUMULATION UNDER:
1 YEAR GUARANTEE PERIOD 6 YEAR GUARANTEE PERIOD
2 YEAR GUARANTEE PERIOD 7 YEAR GUARANTEE PERIOD
3 YEAR GUARANTEE PERIOD 8 YEAR GUARANTEE PERIOD
4 YEAR GUARANTEE PERIOD 9 YEAR GUARANTEE PERIOD
5 YEAR GUARANTEE PERIOD 10 YEAR GUARANTEE PERIOD
VARIABLE ACCUMULATION UNDER:
XXXXXX MONEY MARKET SUBACCOUNT
XXXXXX MONEY MARKET II SUBACCOUNT
XXXXXX GOVERNMENT SECURITIES SUBACCOUNT
XXXXXX INVESTMENT GRADE BOND SUBACCOUNT
XXXXXX GLOBAL INCOME SUBACCOUNT
XXXXXX HORIZON 5 SUBACCOUNT
XXXXXX HIGH YIELD SUBACCOUNT
XXXXXX HORIZON 10+ SUBACCOUNT
XXXXXX TOTAL RETURN SUBACCOUNT
XXXXXX HORIZON 20+ SUBACCOUNT
XXXXXX VALUE + GROWTH SUBACCOUNT
XXXXXX BLUE CHIP SUBACCOUNT
XXXXXX INTERNATIONAL SUBACCOUNT
XXXXXX VALUE SUBACCOUNT
XXXXXX SMALL CAP VALUE SUBACCOUNT
XXXXXX SMALL CAP GROWTH SUBACCOUNT
XXXXXX TECHNOLOGY SUBACCOUNT
XXXXXX GROWTH SUBACCOUNT
XXXXXXX GLOBAL DISCOVERY SUBACCOUNT
XXXXXXX GROWTH AND INCOME SUBACCOUNT
XXXXXXX INTERNATIONAL SUBACCOUNT
JANUS ASPEN SERIES GROWTH SUBACCOUNT
JANUS ASPEN SERIES GROWTH AND INCOME SUBACCOUNT
WARBURG PINCUS TRUST EMERGING MARKETS SUBACCOUNT
WARBURG PINCUS TRUST POST-VENTURE CAPITAL SUBACCOUNT
8165
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CONTRACT SCHEDULE
RECORDS MAINTENANCE CHARGE: [$30 PER CERTIFICATE YEAR]
WE WILL ASSESS AN ANNUAL RECORDS MAINTENANCE CHARGE OF [$30] ON EACH
CERTIFICATE ANNIVERSARY AND UPON CERTIFICATE TERMINATION. HOWEVER, IF THE
CERTIFICATE VALUE IS GREATER THAN OR EQUAL TO $50,000 ON A CERTIFICATE
ANNIVERSARY OR DATE OF SURRENDER, WE WILL NOT ASSESS THE RECORDS MAINTENANCE
CHARGE ON THAT CERTIFICATE ANNIVERSARY OR SURRENDER DATE. WE WILL NOT ASSESS
THIS CHARGE AFTER THE ANNUITY DATE.
WITHDRAWAL/ANNUITIZATION CHARGE TABLE:
YEARS ELAPSED SINCE PURCHASE
PAYMENTS WERE RECEIVED BY THE COMPANY RATE
LESS THAN ONE 7.00%
ONE BUT LESS THAN TWO 6.00%
TWO BUT LESS THAN THREE 5.00%
THREE BUT LESS THAN FOUR 5.00%
FOUR BUT LESS THAN FIVE 4.00%
FIVE BUT LESS THAN SIX 3.00%
SIX BUT LESS THAN SEVEN 2.00%
SEVEN OR MORE 0.00%
THE WITHDRAWAL/ANNUITIZATION CHARGE PERCENTAGES ARE APPLIED AGAINST THE
ORIGINAL AMOUNT OF THE PURCHASE PAYMENTS. A FREE PARTIAL WITHDRAWAL OF THE
GREATER OF 10% OF CERTIFICATE VALUE OR CERTIFICATE VALUE LESS REMAINING
PRINCIPAL IS AVAILABLE EACH YEAR. REMAINING PRINCIPAL FOR THIS PURPOSE IS
TOTAL PREMIUMS SUBJECT TO A WITHDRAWAL CHARGE MINUS WITHDRAWALS PREVIOUSLY
ASSESSED A WITHDRAWAL CHARGE.
8165
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CONTRACT SCHEDULE
FIXED ACCOUNT
THE FIXED ACCOUNT INTEREST RATE IS GUARANTEED THROUGH THE CERTIFICATE
YEAR IN WHICH A PURCHASE PAYMENT IS RECEIVED.
THE SUBSEQUENT FIXED ACCOUNT INTEREST RATE PERIOD IS ONE CERTIFICATE
YEAR.
MINIMUM GUARANTEED INTEREST RATE 3.00%
OTHER CHARGES
MORTALITY AND EXPENSE RISK CHARGE: [1.25% ANNUALLY]
ADMINISTRATION CHARGE: [.15% ANNUALLY]
GUARANTEED RETIREMENT INCOME BENEFIT CHARGE: .25% ANNUALLY.
WE WILL NOT ASSESS THIS CHARGE AFTER THE EARLIER OF CERTIFICATE
ANNUITIZATION OR AGE 90.
THE MORTALITY AND EXPENSE RISK CHARGE AND THE ADMINISTRATION CHARGE, WILL
BE ASSESSED DAILY ON THE SEPARATE ACCOUNT CERTIFICATE VALUE. THE
GUARANTEED RETIREMENT INCOME BENEFIT CHARGE WILL BE ASSESSED AT THE END
OF EACH CALENDAR QUARTER ON THE CERTIFICATE VALUE, BASED ON THE AVERAGE
MONTHLY CERTIFICATE VALUE.
MARKET VALUE ADJUSTMENT FORMULA
THE MARKET VALUE ADJUSTMENT IS DETERMINED BY THE APPLICATION OF THE
FOLLOWING FORMULA: T/365
[(1+I)]
MARKET VALUE ADJUSTMENT = GUARANTEE PERIOD VALUE X ----- -1
[(1+J)]
WHERE,
I IS THE GUARANTEED INTEREST RATE BEING CREDITED TO THE GUARANTEE PERIOD
VALUE SUBJECT TO THE MARKET VALUE ADJUSTMENT.
J IS THE CURRENT INTEREST RATE DECLARED BY THE COMPANY, AS OF THE
EFFECTIVE DATE OF THE APPLICATION OF THE MARKET VALUE ADJUSTMENT, FOR
CURRENT ALLOCATION TO A GUARANTEE PERIOD, THE LENGTH OF WHICH IS EQUAL
TO THE BALANCE OF THE GUARANTEE PERIOD FOR THE GUARANTEE PERIOD VALUE
SUBJECT TO THE MARKET VALUE ADJUSTMENT, ROUNDED TO THE NEXT HIGHER NUMBER
OF COMPLETE YEARS, AND
T IS THE NUMBER OF DAYS REMAINING IN THE GUARANTEE PERIOD.
8165
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Exhibit 4(d)
[ZURICH XXXXXX LOGO]
GROUP MASTER APPLICATION
XXXXXX INVESTORS LIFE INSURANCE COMPANY (KILICO)
0 Xxxxxx Xxxxx, Xxxx Xxxxx, XX 00000-0001 - 800/621-5001
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APPLICATION
---------------------------------------- -------------------------------------
Application for Name of Product
----------------------------------------
Name of Group
---------------------------------------- ---------------- ----------- --------
Principal Office Street Address City State Zip
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Benefits and payments provided by this contract, when based on Guarantee Period
Values, may increase or decrease in accordance with the Market Value Adjustment
formula stated in the contract schedule.
Benefits, payments and values provided by this contract, when based upon the
investment experience of the subaccounts, are variable and are not guaranteed
as to dollar amount. Refer to the variable account and annuity period
provisions for a determination of any variable benefits.
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SIGNATURES
----------------------------------------
Signature of Authorized Representative
---------------------------------------- ------------------------------------
Typed Name Title
--------------------------------------------------------------------------------
Signed at (City, State and Zip)
----------------------------------------
Date
----------------------------------------
Witnessed by
----------------------------------------
Licensed Agent
page 1 of 1
L-8169
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DEFINITIONS
ACCUMULATED GUARANTEE PERIOD VALUE - The sum of the Guarantee Period Values.
ACCUMULATION PERIOD - The period between the Certificate's Issue Date and the
Annuity Date.
ACCUMULATION UNIT - An accounting unit of measure used to calculate the value
of each Subaccount.
ADMINISTRATION CHARGE - A charge deducted in the calculation of the
accumulation unit value and Annuity Unit Value for a portion of our
administrative costs.
AGE - The attained age of the Annuitant, Payee, or Owner.
ANNIVERSARY VALUE - The Certificate Value calculated on each Certificate
Anniversary during the Accumulation Period.
ANNUITANT - The person during whose lifetime the annuity is to be paid. You may
not change the person named as the Annuitant.
ANNUITY - A series of payments which begins on the Annuity Date.
ANNUITY DATE - The date on which a Certificate matures and annuity payments
begin. The original Annuity Date is stated in the Certificate Schedule. It must
be at least one year from the Issue Date and not later than the maximum age of
annuitization specified on the Certificate schedule. The Owner may change the
Annuity Date, but not beyond the maximum age.
ANNUITY PERIOD - The period that starts on the Annuity Date.
ANNUITY UNIT - An accounting unit of measure used to calculate the amount of
variable annuity payments after the first annuity payment.
ANNUITY UNIT VALUE - The value of an Annuity Unit of a Subaccount determined
for a Valuation Period according to the formula stated in a certificate.
CERTIFICATE - An individual certificate which we issue to each Owner as
evidence of the rights and benefits under the contract.
CERTIFICATE ANNIVERSARY - An anniversary of the Issue Date.
CERTIFICATE OWNER, OR OWNER - See "You, Your, Yours" below.
CERTIFICATE VALUE - The sum of the Fixed Account Certificate Value plus the
Separate Account Certificate Value plus the Accumulated Guarantee Period Value.
CERTIFICATE YEAR - A one year period starting on the Issue Date and successive
Certificate Anniversaries.
CONTINGENT ANNUITANT - The person designated by the owner who becomes the
Annuitant if the Annuitant dies prior to the Annuity Date. A Contingent
Annuitant may not be elected under a qualified plan.
CONTRACT DATE, CONTRACT YEAR - The contract date is stated in the contract
schedule. Subsequent contract years shall begin on anniversaries of the
contract date.
CONTRACTHOLDER - The Contractholder is stated in the contract schedule. It is
the entity to which the contract is issued.
FIXED ACCOUNT - The General Account of KILICO to which an Owner may allocate
all or a portion of Purchase
Payments or Certificate Value.
FIXED ACCOUNT CERTIFICATE VALUE - The value of the Fixed Account of a
certificate on any Valuation Date.
FIXED ANNUITY - An annuity payment plan that does not vary as to dollar amount.
FUND - An investment company or separate series thereof, in which the
Subaccounts of the Separate Account invest.
GENERAL ACCOUNT - Our assets other than those allocated to the Separate Account,
the non-unitized separate account or any other separate account.
GUARANTEE PERIOD - A period of time during which an amount is to be credited
with a guaranteed interest rate, subject to a Market Value Adjustment prior to
the end of the Guarantee Period. The Guarantee Periods initially offered are
stated in the certificate schedule.
GUARANTEE PERIOD VALUE -The (1) Purchase Payment allocated or amount transferred
to a Guarantee Period; plus (2) interest credited; minus (3) withdrawals,
previously assessed withdrawal charges and transfers; adjusted for (4) any
applicable Market Value Adjustment previously made.
ISSUE DATE - The Issue Date stated in the certificate schedule. It is the date
an initial Purchase Payment is available for use and begins to be credited with
interest and/or investment experience. If the normal Issue Date is the 29th,
30th or 31st of the month, the Issue Date will be the 28th day of that month.
MARKET ADJUSTED VALUE - A Guarantee Period Value adjusted by the Market Value
Adjustment formula prior to the end of a Guarantee Period.
MARKET VALUE ADJUSTMENT - An adjustment of Guarantee Period Values in
accordance with the Market Value Adjustment formula prior to the end of the
Guarantee Period. The adjustment reflects the change in the value of the
Guarantee Period Value due to changes in interest rates since the date the
Guarantee Period commenced. The Market Value Adjustment formula is stated in
the certificate schedule.
MORTALITY AND EXPENSE RISK CHARGE - A charge deducted in the calculation of the
accumulation unit value and the Annuity Unit Value. It is for our assumption of
mortality risks and expense guarantees.
NONQUALIFIED - A Certificate issued other than as a qualified plan.
XXXXX - A recipient of periodic payments under the certificate. This may be an
Annuitant or a beneficiary who becomes entitled to a death benefit payment.
PURCHASE PAYMENTS - The dollar amount we receive in U.S. currency to buy the
benefits a certificate provides.
QUALIFIED PLAN - A certificate issued under a retirement plan which qualifies
for favorable income tax treatment under Section 408 or 408(a) of the Internal
Revenue Code as amended.
RECORDS MAINTENANCE CHARGE - A charge assessed against a certificate as
specified in the certificate schedule.
RECEIVED - Received by Xxxxxx Investors Life Insurance Company at its home
office in Long Grove, Illinois.
Page 1
L-8165
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L-8165 Page 2
SEPARATE ACCOUNT - A unit investment trust registered with the Securities and
Exchange Commission under the Investment Company Act of 1940 known as the
KILICO Variable Annuity Separate Account.
SEPARATE ACCOUNT CERTIFICATE VALUE - The sum of the Subaccount values of the
certificate on a Valuation Date.
SUBACCOUNTS - The Separate Account has several Subaccounts. The Subaccounts
available initially under the certificate are stated in the certificate
schedule.
SUBACCOUNT VALUE - The value of each Subaccount calculated separately according
to the formula stated in the certificate.
VALUATION DATE - Each business day that applicable law requires that we value
the assets of the Separate Account. Currently this is each day that the New
York Stock Exchange is open for trading.
VALUATION PERIOD - The period that starts at the close of a Valuation Date and
ends at the close of the next succeeding Valuation Date.
VARIABLE ANNUITY - An annuity payment plan which varies as to dollar amount
because of Subaccount investment experience.
WE, OUR, US - Xxxxxx Investors Life Insurance Company, Long Grove, Illinois.
YOU, YOUR, YOURS - The party(ies) named as Owner unless later changed as
provided in the certificate. The Owner is the Annuitant unless a different
Owner is named. Under a nonqualified plan when more than one person is named as
Owner, the terms "you," "your," "yours," means joint owners. The Owner may be
changed during the lifetime of the Owner and the Annuitant. The Owner, prior to
the Annuity Date or any distribution of any death benefit, has the exclusive
right to exercise every option and right conferred by this certificate.
GENERAL PROVISIONS
THE CONTRACT - The contract, the attached application, and any endorsements
constitute the entire contract between the parties. All statements made in the
group application and the enrollment application, in the absence of fraud, are
deemed representations and not warranties. No statement will void the contract
or be used as a defense of a claim unless it is contained in the group or
enrollment application.
MODIFICATION OF CONTRACT - Only our president, secretary and assistant
secretaries have the power to approve a change or waive any provisions of the
contract. Any such modifications must be in writing. No agent or person other
than the officers named has the authority to change or waive the provisions of
the contract.
CERTIFICATES - We will issue an individual certificate to each Owner as
evidence of his or her rights and benefits under the contract. This
certificate is not a part of the contract.
SUCCESSOR CONTRACTHOLDER - The Contractholder, with our consent, may at any
time appoint a successor contractholder. The successor Contractholder has all
rights, duties, and obligations of the original Contractholder.
DISCONTINUANCE OF NEW PARTICIPANTS - By giving thirty days prior written notice
to the contractholder, we may limit or discontinue the acceptance of new
applications and the issuance of new certificates under this contract. Such
limitation or discontinuance will have no effect on the rights or benefits of
any owner's certificate issued prior to the effective date of such limitation
or discontinuation.
INCONTESTABILITY - We cannot contest this contract after it has been in force
for two years.
CHANGE OF ANNUITY DATE - The owner may write to us prior to distribution of a
death benefit or the first annuity payment date and request a change of the
Annuity Date.
ASSIGNMENT - No assignment under the contract or certificate is binding unless
we receive it in writing. We assume no responsibility for the validity or
sufficiency of any assignment. Once filed, the rights of the Owner, Xxxxxxxxx
and beneficiary are subject to the assignment. Any claim is subject to proof of
interest of the assignee.
DUE PROOF OF DEATH - We must receive written proof of death of the Owner or the
Annuitant when a death benefit is payable. The proof may be a certified death
certificate, the written statement of a physician, or any other proof
satisfactory to us.
RESERVES, CERTIFICATE VALUES AND DEATH
BENEFITS - All reserves are equal to or greater than those required by statute.
Any available Certificate Value and death benefit are not less than the minimum
benefits required by the statutes of the state in which the certificate is
delivered.
NON-PARTICIPATING - The contract does not pay dividends. It will not share in
our surplus or earnings.
REPORTS - At least once each certificate year we will send you a statement
showing Purchase Payments received, interest credited, investment experience,
and charges made since the last report, as well as any other information
required by statute.
PREMIUM TAXES - We will make a deduction for state premium taxes in certain
situations. On any certificate subject to premium tax, as provided under
applicable law, the tax will be deducted for the total Certificate Value
applied to an annuity option at the time annuity payments start. Premium tax
due and paid by us prior to annuitization will be deducted at the percentage
that was applicable prior to annuitization.
QUALIFIED PLANS - If a certificate is issued under a qualified plan additional
provisions may apply. The rider or amendment to the certificate used to qualify
it under the applicable section of the Internal Revenue Code will indicate the
extent of change in the provisions.
OWNERSHIP PROVISIONS
OWNER - The Annuitant is the original Owner unless otherwise designated
initially. Before the Annuity Date or any distribution of death benefit, the
Owner has the right to cancel or amend the certificate if we agree. The Owner
may exercise every option and right conferred by the contract including the
right of assignment. The joint Owners must agree to any change if more than one
Owner is named.
9
CHANGE OF OWNERSHIP - The Owner may change the certificate Owner by written
request at any time while the Annuitant is alive. The owner must furnish
information sufficient to clearly identify the new Owner to us. The change is
subject to any existing assignment of the certificate. When we record the
effective date of the change, it will be the date the notice was signed except
for action taken by us prior to receiving the request. Any change is subject to
the payment of any proceeds. We may require the return of the certificate to us
for endorsement of a change.
BENEFICIARY DESIGNATION AND CHANGE OF BENEFICIARY - A beneficiary must be
designated initially. The Owner may change the beneficiary by sending us a
written change form. Changes are subject to the following:
1. The change must be filed while the Annuitant is alive and prior to the
Annuity Date;
2. The certificate must be in force at the time the Owner files a change;
3. Such change must not be prohibited by the terms of an existing assignment,
beneficiary designation or other restriction;
4. Such change will take effect when we receive it;
5. After we receive the change, it will take effect on the date the change form
was signed. However, action taken by us before the change form was received
will remain in effect; and
6. The request for change must provide information sufficient to identify the
new beneficiary.
We may require the return of the certificate for endorsement of a change.
The interest of a beneficiary who dies before the distribution of the death
benefit will pass to the other beneficiaries, if any, share and share alike,
unless otherwise provided in the beneficiary designation. If no beneficiary
survives or is named, the distribution will be made to the Owner's estate when
the Owner dies; or to the estate of the Annuitant upon the death of the
Annuitant if the Owner is not also the Annuitant. If a beneficiary dies within
ten days of the date of the Owner's death, the death benefit will be paid as if
the Owner had survived the beneficiary. If a beneficiary dies within ten days of
the death of the Annuitant, and the Owner's the Annuitant, we will pay the death
benefit as if the Annuitant survived the beneficiary. If the Owner, the
Annuitant, and the beneficiary die simultaneously, we will pay the death benefit
as if the Owner had survived the Annuitant and the beneficiary.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENT LIMITATIONS - The minimum and maximum initial and subsequent
Purchase Payment limits are shown in the certificate schedule.
The minimum Purchase Payment allocation to a Guarantee Period, Fixed Account,
or to a Subaccount is $500.
We reserve the right to waive or modify these limits.
PLACE OF PAYMENT - All Purchase Payments under the contract must be paid to us
at our home office or such other location as we may select. We will notify the
Owner and any other interested parties in writing of such other locations.
Purchase Payments received by an agent will begin earning interest only after
we receive it.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT CERTIFICATE VALUE - The Fixed Account Certificate Value includes:
1. Purchase Payments allocated to the Fixed Account; plus
2. amounts transferred from a Subaccount or Guarantee Period to the Fixed
Account at the Owner request; plus
3. interest credited; minus
4. withdrawals, previously assessed withdrawal charges and transfers from
the Fixed Account, minus
5. any applicable portion of the Records Maintenance Charge and charges for
other benefits.
The initial Fixed Account interest rate credited to the initial Purchase
Payment is in effect through the end of the interest rate period and is shown
in the certificate schedule. At the beginning of each subsequent interest rate
period shown in the certificate schedule, we will declare the Fixed Account
interest rate applicable to the initial Purchase Payment for each such
subsequent interest rate period.
We will declare the Fixed Account interest rate with respect to each subsequent
Purchase Payment received. Any such Purchase Payment we receive will be
credited that rate through the end of the interest rate period shown in the
certificate schedule. At the beginning of each subsequent interest rate period,
we will declare the Fixed Account interest rate applicable to each subsequent
Purchase Payment for such interest rate period.
We reserve the right to declare the Fixed Account current interest rate(s)
based upon: the Issue Date; the date we receive a Purchase Payment; or the date
of account transfer.
We calculate the interest credited to the Fixed Account by compounding daily,
at daily interest rates, rates which would produce at the end of a certificate
year a result identical to the one produced by applying an annual interest
rate.
The minimum guaranteed Fixed Account interest rate is stated in the contract
schedule.
GUARANTEE PERIOD PROVISIONS
GUARANTEE PERIOD - We hold all amounts allocated to a Guarantee Period in a
non-unitized separate account. The initial Guarantee Periods available under
the contract are shown in the certificate schedule.
GUARANTEE PERIOD VALUE - On any Valuation Date, the Guarantee Period value
includes
1. Purchase Payments or transfers allocated to the Guarantee Period Value at
the beginning of its Guarantee Period; plus
2. interest credited; minus
3. withdrawals, previously assessed withdrawal charges and transfers; minus
4. any applicable portion of the Records Maintenance Charge and charges for
other benefits; adjusted for
5. any applicable Market Value Adjustment previously made.
L-8165 Page 3
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L-8165 Page 4
The Guarantee Period(s) initially elected and the interest rate(s) initially
credited are shown in the certificate schedule. The initial interest rate
credited to subsequent Purchase Payments will be declared at the time the
payment is received. At the end of an Guarantee Period, we will declare a
guaranteed interest rate applicable for the next subsequent Guarantee Period of
the same duration.
ACCUMULATED GUARANTEE PERIOD VALUE - On any Valuation Date, the Accumulated
Guarantee Period Value is the sum of the Guarantee Period Values. At any time
during the Accumulation Period, the Accumulated Guarantee Period value may be
allocated to a maximum of forty Guarantee Periods.
We calculate the interest credited to the Guarantee Period Value by compounding
daily, at daily interest rates, rates which would produce at the end of a
certificate year a result identical to the one produced by applying an annual
interest rate.
MARKET VALUE ADJUSTMENT - The Market Value Adjustment formula is stated in the
certificate schedule. This formula is applicable for both an upward or
downward adjustment to a Guarantee Period Value when, prior to the end of a
Guarantee Period, such value is:
(1) taken as a total or partial withdrawal;
(2) applied to purchase an annuity option; or
(3) transferred to another Guarantee Period, the Fixed Account, or a
Subaccount.
However, a Market Value Adjustment shall not be applied to any Guarantee Period
Value transaction effected within 30 days after the end of the applicable
Guarantee Period.
VARIABLE ACCOUNT PROVISIONS
SEPARATE ACCOUNT - The variable benefits under the contract are provided
through the KILICO Variable Annuity Separate Account. This is called the
Separate Account. The Separate Account is registered with the Securities and
Exchange Commission as a unit investment trust under the Investment Company Act
of 1940. It is a separate investment account maintained by us into which a
portion of our assets has been allocated for the contract and may be allocated
for certain other contracts.
LIABILITIES OF SEPARATE ACCOUNT - The assets equal to the reserves and other
liabilities of the Separate Account will not be charged with liabilities arising
out of any other business we may conduct. We will value the assets of the
Separate Account on each Valuation Date.
SEPARATE ACCOUNT CERTIFICATE VALUE - On any Valuation Date, the Separate Account
Certificate Value is the sum of its Subaccount values.
SUBACCOUNTS - The Separate Account consists of several Subaccounts. The initial
Subaccounts available under this contract are shown in the contract schedule.
We may, from time to time, combine or remove Subaccounts in the Separate Account
and establish additional Subaccounts of the Separate Account. In such event, we
may permit you to select other Subaccounts under the contract. However, the
right to select any other Subaccount is limited by the terms and conditions we
may impose on such transactions.
FUND - Each Subaccount of the Separate Account will buy shares of a Fund or a
separate series of a Fund. Each Fund is registered under the Investment Company
Act of 1940 as an open-end diversified management investment company. Each
series of a Fund represents a separate investment portfolio which corresponds
to one of the Subaccounts of the Separate Account.
If we establish additional Subaccounts, each new Subaccount will invest in a
new series of a Fund or in shares of another investment company. We may also
substitute other investment companies.
RIGHTS RESERVED BY THE COMPANY - We reserve the right, subject to compliance
with the current law or as it may be changed in the future:
1. To operate the Separate Account in any form permitted under the Investment
Company Act of 1940 or in any other form permitted by law;
2. To take any action necessary to comply with or obtain and continue any
exemptions from the Investment Company Act of 1940 or to comply with any other
applicable law;
3. To transfer any assets in any Subaccount to another Subaccount or to one or
more separate accounts, or the General Account, or to add, combine or remove
Subaccounts in the Separate Account;
4. To delete the shares of any of the portfolios of a Fund or any other
open-end investment company and to substitute, for the Fund shares held in any
Subaccount, the shares of another portfolio of a Fund or the shares of another
investment company or any other investment permitted by law; and
5. To change the way we assess charges, but not to increase the aggregate
amount above that currently charged to the Separate Account and the Funds in
connection with the contract.
When required by law, we will obtain your approval of such changes and the
approval of any regulatory authority.
ACCUMULATION UNIT VALUE - Each Subaccount has an accumulation unit value. When
Purchase Payments or other amounts are allocated to a Subaccount, a number of
units are purchased based on the Accumulation Unit Value of the Subaccount at
the end of the Valuation Period during which the allocation is made. When
amounts are transferred out of or deducted from a Subaccount, units are
redeemed in a similar manner. The value of a Subaccount on any Valuation Date
is the number of units held in the Subaccount times the accumulation unit value
on that Valuation Date.
The Accumulation Unit Value for each subsequent Valuation Period is the
investment experience factor for that period multiplied by the accumulation
unit value for the period immediately preceding. Each Valuation Period has a
single Accumulation Unit Value that is applied to each day in the period. The
number of Accumulation Units will not change as a result of investment
experience.
INVESTMENT EXPERIENCE FACTOR - Each Subaccount has its own investment experience
factor. The investment experience of the Separate Account is calculated by
applying the investment experience factor to the value in each Subaccount during
a Valuation Period.
11
The investment experience factor of a Subaccount for a Valuation Period is
determined by dividing 1. by 2. and subtracting 3. from the result, where:
1. is the net result of:
a. the net asset value per share of the investment held in the
Subaccount determined at the end of the current Valuation Period; plus
b. the per share amount of any dividend or capital gain distributions
made by the investments held in the Subaccount, if the "ex-dividend"
date occurs during the current Valuation Period; plus or minus
c. a credit or charge for any taxes reserved for the current Valuation
Period which we determine resulted from the investment operations of the
Subaccount;
2. is the net asset value per share of the investment held in the Subaccount,
determined at the end of the last Valuation Period;
3. is the factor representing the sum of the Separate Account charges, stated
in the certificate schedule, for the number of days in the Valuation Period.
TRANSFER AND WITHDRAWAL PROVISIONS
TRANSFERS DURING THE ACCUMULATION PERIOD - The Owner may direct the following
transfers:
1. All or part of the Separate Account Certificate Value or a Guarantee
Period Value may be transferred to the Fixed Account or to another
Subaccount or Guarantee Period.
2. During the thirty days that follow a Certificate Year anniversary, all
or part of the Fixed Account Certificate Value may be transferred to one
or more Subaccounts or Guarantee Periods.
Transfers will also be subject to the following conditions:
1. The minimum amount which may be transferred is $100 or, if smaller, the
remaining value in the Fixed Account or a Subaccount or Guarantee Period.
2. No partial transfer will be made if the remaining Certificate Value of
the Fixed Account or any Subaccount or Guarantee Period will be less than
$500 unless the transfer will eliminate your interest in such account;
3. No transfer may be made within seven calendar days of the date on which
the first annuity payment is due;
4. The Owner may request an additional transfer from the Fixed Account to
one or more Subaccounts during the thirty day period before the date on
which the first annuity payment is due. Such transfer must become
effective no later than the seventh calendar day before such due date;
5. When the Owner requests a transfer from the Fixed Account to a
Subaccount or Guarantee Period, we will limit the amount that can be
transferred to the amount which exceeds withdrawal charge, if any,
applicable to the total Fixed Account Certificate Value for the
certificate year during which the total transfer is made.
6. We reserve the right to charge $25 for each transfer in excess of 12 in a
Certificate Year.
7. Transfers may not be made from any Subaccount or Guarantee Period into
the Fixed Account for the six-month period following any transfer from the
Fixed Account into one or more of the Subaccounts.
Any transfer from a Guarantee Period is subject to a Market Value Adjustment
unless the transfer is effective within thirty days after the end of the
applicable Guarantee Period.
We will transfer amounts attributable to Purchase Payments and all related
accumulations received in a given certificate year, in the chronological order
we received them.
Any transfer request must clearly specify:
1. the amount which is to be transferred; and
2. the names of the accounts which are affected.
We reserve the right at any time and without notice to any party, to terminate,
suspend, or modify these transfer rights.
WITHDRAWALS DURING THE ACCUMULATION PERIOD - During the Accumulation Period, the
Owner may withdraw all or part of the Certificate Value reduced by any
withdrawal charge, applicable premium taxes, and adjusted by any applicable
Market Value Adjustment. The Market Value Adjustment formula will be applied
to the applicable portion of the total value withdrawn unless such withdrawal is
effective within thirty days after the end of the applicable Guarantee Period.
We must receive a written request that indicates the amount of the withdrawal
from the Fixed Account and each Subaccount and Guarantee Period. The Owner must
return the certificate to us if the Owner elects a total withdrawal.
Withdrawals are subject to these conditions:
1. Each withdrawal must be at least $100 or the value that remains in the
Fixed Account, Subaccount or Guarantee Period if smaller.
2. A minimum of $500 must remain in the account after a withdrawal unless
the account is eliminated by such withdrawal;
3. The maximum withdrawal from any account is the value of the respective
account less the amount of any withdrawal charge.
4. Any withdrawal amount will be increased by the withdrawal charge.
5. Partial withdrawals may not be taken from the Fixed Account in the first
Certificate Year.
WITHDRAWAL CHARGES - Withdrawal charges are shown in the certificate schedule
and are calculated as follows:
1. All amounts to be withdrawn and any applicable withdrawal charges will be
charged first against Purchase Payments in the chronological order we received
such Purchase payments.
2. Any amount withdrawn which is not subject to a withdrawal charge will be
considered a "partial free withdrawal".
3. In the event of a partial withdrawal, a "partial free withdrawal" is applied
against Purchase Payments and all related accumulations in the chronological
order we received such Purchase Payments even though the Purchase Payments are
no longer subject to a withdrawal charge.
L-8165 Page 5
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L-8165 Page 6
TRANSFER AND WITHDRAWAL PROCEDURES - We will withdraw or transfer from the
Fixed Account or Guarantee Periods as of the Valuation Date that follows the
date we receive a written or telephone transfer request. To process a
withdrawal, the request must contain all required information.
We will redeem the necessary number of Accumulation units to achieve the dollar
amount when the withdrawal or transfer is made from a Subaccount. We will reduce
the number of Accumulation Units credited in each Subaccount by the number of
Accumulation Units redeemed. The reduction in the number of accumulation units
is determined based on the accumulation unit value at the end of the Valuation
Period when we receive the request, provided the request contains all required
information. We will pay the amount within seven calendar days after the date
we receive the request, except as provided below.
DEFERMENT OF WITHDRAWAL OR TRANSFER - If the withdrawal or transfer is to be
made from a Subaccount, we may suspend the right of withdrawal or transfer or
delay payment more than seven calendar days:
1. during any period when the New York Exchange is closed other than
customary weekend and holiday closings;
2. when trading in the markets normally utilized is restricted, or an
emergency exists as determined by the Securities and Exchange Commission,
so that disposal of investments or determination of the accumulation unit
value is not practical; or
3. for such other periods as the Securities and Exchange Commission by order
may permit for protection of Owners.
We may defer the payment of a withdrawal or transfer from the Fixed Account or
Guarantee Periods, for the period permitted by law. This can never be more than
six months after you send us a written request. During the period of deferral,
we will continue to credit interest, at the then current interest rate(s), to
the Fixed Account Certificate Value and/or each Guarantee Period Value.
DEATH BENEFIT PROVISIONS
AMOUNT PAYABLE UPON DEATH - We compute the death benefit at the end of the
Valuation Period following our receipt of due proof of death and the return of
the certificate.
If death occurs prior to the deceased attaining age 91, we will pay the greater
of:
(1) the total amount of Purchase Payments less withdrawals,
(2) the Certificate Value,
(3) the total amount of Purchase Payments less withdrawals accumulated at
5.00% per annum to the earlier of age 80 or date of death, increased by
Purchase Payments made from age 80 to the date of death and decreased by
any withdrawals from age 80 to the date of death, or
(4) the greatest Anniversary Value immediately preceding the earlier of age
81 or date of death, increased by Purchase Payments made since the date of
the greatest Anniversary Value, and decreased by any withdrawals since
that date.
We will pay the Certificate Value if death occurs at age 91 or later.
CONTINGENT ANNUITANT - If a Contingent Annuitant is named, the Contingent
Annuitant will become the Annuitant on the death of the Annuitant. If the
Contingent Annuitant is not alive at the date of the Annuitant's death, or if
the Contingent Annuitant dies within ten days of the Annuitant's death, this
Contingent Annuitant provision will not apply.
PAYMENT OF DEATH BENEFITS - A death benefit will be paid to the designated
Beneficiary upon any of the following events during the Accumulation Period:
1. the death of the Owner, or a joint Owner,
2. the death of the Annuitant if no Contingent Annuitant is named or if
the Contingent Annuitant does not survive the Annuitant, or
3. if a Contingent Annuitant is named and survives the Annuitant, the
death of the Contingent Annuitant.
We will pay the death benefit to the beneficiary when we receive due proof of
death. We will then have no further obligation under this certificate.
We will pay the death benefit in a lump sum. This sum may be deferred for up to
five years from the date of death.
Instead of a lump sum payment the beneficiary may elect to have the death
benefit distributed as stated in Option 1 for a period not to exceed the
beneficiary's life expectancy; or Options 2 or 3 based upon the life expectancy
of the beneficiary as prescribed by federal regulations. The beneficiary must
make this choice within sixty days of the time we receive due proof of death,
and distribution must commence within one year of the date of death.
If the beneficiary is not a natural person, the beneficiary must elect that the
entire death benefit be distributed within five years of the Owner's death.
Distribution of the death benefit must start within one year after the Owner's
death. It may start later if prescribed by federal regulations.
If the primary beneficiary is the surviving spouse when the Owner dies, the
surviving spouse may elect to be the successor Owner of the certificate, and
shall become the Annuitant if no Annuitant or Contingent Annuitant is living at
the time of the Owner's death. There will be no requirement to start a
distribution of death benefits.
ANNUITY PERIOD PROVISIONS
ELECTION OF ANNUITY OPTION - We must receive an election of an annuity option
in writing. The Owner may make an election before the Annuity Date providing the
Annuitant is alive. The Annuitant may make an election on the Annuity Date
unless the Owner has restricted the right to make such an election. The
beneficiary may make an election when we pay the death benefit.
An election will be revoked by:
1. a subsequent change of beneficiary; or
2. an assignment the certificate unless the assignment provides otherwise.
Subject to the terms of the death benefit provision, the beneficiary may elect
to have the death benefit remain with us under one of the annuity options.
If an annuity option is not elected, an annuity will be paid under Option 3 for
a guaranteed period of ten years and for as long thereafter as the Annuitant is
alive.
13
If the total Certificate Value is applied under one of the annuity options,
this certificate must be surrendered to us.
An option can not be changed after the first annuity payment is made.
If, on the seventh calendar day before the first annuity payment due date, all
the Certificate Value is allocated to the Fixed Account or Guarantee Periods,
the annuity will be paid as a Fixed Annuity. If all of the Certificate Value on
such date is allocated to the Separate Account, the annuity will be paid as a
Variable Annuity. If the Certificate Value on such date is allocated to a
combination of the Fixed Account, Guarantee Periods and Subaccounts, then the
annuity will be paid as a combination of a Fixed and Variable annuity. A Fixed
and Variable annuity payment will reflect the investment performance of the
Subaccounts in accordance with the allocation of the Certificate Values existing
on such date. Allocations will not be changed thereafter, except as provided in
the Transfers During The Annuity Period provision of the contract.
Payments for all options are derived from the applicable tables. Current
annuity rates will be used if they produce greater payments than those quoted in
the contract. The age in the tables is the age of the Payee on the last birthday
before the first payment is due.
The option selected must result in a payment that is at least equal to our
minimum payment, according to our rules, at the time the annuity option is
chosen. If at any time the payments are less than the minimum payment, we have
the right to increase the period between payments to quarterly, semi-annual or
annual so that the payment is at least equal to the minimum payment or to make
payment in one lump sum.
ANNUITIZATION CHARGE - An withdrawal charge shall be applied as shown in the
certificate schedule after application of any applicable Market Value
Adjustment. The annuitization charge is waived when the Owner elects an annuity
option which provides either an income benefit period of five years or more or a
benefit under which payment is contingent on the life of the Payee(s).
OPTION 1
FIXED INSTALMENT ANNUITY - We will make monthly payments for a fixed number of
instalments. Payments must be made for at least 5 years, but not more than 30
years.
OPTION 2
LIFE ANNUITY - We will make monthly payments while the Payee is alive.
OPTION 3
LIFE ANNUITY WITH INSTALMENTS GUARANTEED - We will make monthly payments for a
guaranteed period and thereafter while the Payee is alive. The guaranteed period
must be selected at the time the annuity option is chosen. The guaranteed
periods available are 5, 10, 15 and 20 years.
OPTION 4
JOINT AND SURVIVOR ANNUITY - We will pay the full monthly income while both
Payees are alive. Upon the death of either Xxxxx, we will continue to pay the
surviving Payee a percentage of the original monthly payment. The percentage
payable to the surviving Payee must be selected at the time the annuity option
is chosen. The percentages available are 50%, 66 2/3%, 75%, and 100%.
OTHER OPTIONS
We may make other annuity options available. Payments are also available on a
quarterly, semi-annual or annual basis.
FIXED ANNUITY - The Fixed Account Certificate Value plus the Accumulated
Guarantee Period Values adjusted for any applicable Market Value Adjustment, on
the first day preceding the date on which the first annuity payment is due, is
first reduced by any annuitization charge, charges for other benefits, records
maintenance charge, and premium taxes that apply. The value that remains will be
used to determine the fixed annuity monthly payment in accordance with the
annuity option selected.
VARIABLE ANNUITY - The Separate Account Certificate Value, at the end of the
Valuation Period preceding the Valuation Period that includes the date on which
the first annuity payment is due, is first reduced by any annuitization charge,
records maintenance charge, charges for other benefits, and premium taxes that
apply. The value that remains is used to determine the first monthly annuity
payment. The first monthly annuity payment is based on the guaranteed annuity
option shown in the Annuity Option Table. You may elect any option available.
The dollar amount of subsequent payments may increase or decrease depending on
the investment experience of each Subaccount. The number of Annuity Units per
payment will remain fixed for each Subaccount unless a transfer is made. If a
transfer is made, the number of Annuity Units per payment will change.
The number of Annuity Units for each Subaccount is calculated by dividing a. by
b. where:
a. is the amount of the monthly payment that can be attributed to that
Xxxxxxxxxx; and
b. is the Annuity Unit Value for that Subaccount at the end of the Valuation
Period. The Valuation Period includes the date on which the payment is
made.
Monthly annuity payments, after the first payment, are calculated by summing
up, for each Subaccount, the product of a. times b. where:
a. is the number of Annuity Units per payment in each Subaccount; and
b. is the Annuity Unit Value for that Subaccount at the end of the Valuation
Period. The Valuation Period includes the date on which the payment is
made.
After the first payment, we guarantee that the dollar amount of each annuity
payment will not be affected adversely by actual expenses or changes in
mortality experience from the expense and mortality assumptions on which we
based the first payment.
ANNUITY UNIT VALUE - The value of an Annuity Unit for each Subaccount at the
end of any subsequent Valuation Period is determined by multiplying the result
of a. times b. by c. where:
a. is the Annuity Unit Value for the immediately preceding Valuation Period;
and
b. is the net investment factor for the Valuation Period for which the Annuity
Unit Value is being calculated; and
c. is the interest factor of .99993235 per calendar day of such subsequent
Valuation Period to offset the effect of the assumed rate of 2.50% per year
used in the Annuity Option Table.
L-8165 Page 7
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L-8165 Page 8
The net investment factor for each Subaccount for any Valuation Period is
determined by dividing a. by b. where:
a. is the value of an Annuity Unit of the applicable Subaccount as of the end
of the current Valuation Period plus or minus the per share charge or credit
for taxes reserved; and
b. is the value of an Annuity Unit of the applicable Subaccount as of the end
of the immediately preceding Valuation Period, plus or minus the per share
charge or credit for taxes reserved.
TRANSFERS DURING THE ANNUITY PERIOD - During the annuity period, the Payee(s)
may: convert Fixed Annuity payments to Variable Annuity payments; convert
Variable Annuity payments to Fixed Annuity payments; or, have Variable Annuity
payments reflect the investment experience of other Subaccounts. A transfer
may be made subject to the following:
1. The Payee must send us a written notice in a form satisfactory to us;
2. One transfer is permitted each twelve month period from the Annuity Date. We
must receive notice of such transfer at least [thirty] days prior to the
effective date of the transfer;
3. A Payee may not have more than three Subaccounts after any transfer;
4. At least $1,000 of Annuity Unit Value or annuity reserve value must be
transferred from a Subaccount or from the Fixed Account; and
6. At least $1,000 of Annuity Unit Value or annuity reserve value must remain
in the account from which the transfer was made.
When a transfer is made between Subaccounts, the number of Annuity Units per
payment attributable to a Subaccount to which transfer is made is equal to a.
multiplied by b. divided by c., where:
a. is the number of Annuity Units per payment in the Subaccount from which
transfer is being made;
b. is the Annuity Unit Value for the Subaccount from which the transfer is
being made; and
c. is the Annuity Unit Value for the Subaccount to which transfer is being
made.
When a transfer is made from the Fixed Account to a Subaccount, the number of
Annuity Units per payment attributable to a Subaccount to which transfer is
made is equal to a. times b., where:
a. is the Fixed Account annuity value being transferred; and
b. is the Annuity Unit Value for the Subaccount to which transfer is being
made.
The Fixed Account annuity value equals the present value of the remaining Fixed
Annuity payments using the same interest and mortality basis used to calculate
the Fixed Annuity payments.
The amount of money allocated to the Fixed Account in case of a transfer from a
Subaccount equals the annuity reserve for the Payee's interest in such
Subaccount. The annuity reserve is the product of a. multiplied by b.
multiplied by c. where:
a. is the number of Annuity Units representing the
Payee's interest in such Subaccount per annuity payment;
b. is the Annuity Unit Value for such Subaccount; and
c. is the present value of $1.00 per payment period using the attained
age(s) of the Payee(s) and any remaining guaranteed payments that may be
due at the time of the transfer.
Money allocated to the Fixed Account upon such transfer will be applied under
the same annuity option as originally elected. Guaranteed period payments will
be adjusted to reflect the number of guaranteed payments already made. If all
guaranteed payments have already been made, no further payments will be
guaranteed.
All amounts and Annuity Unit Values are determined as of the end of the
Valuation Period preceding the effective date of the transfer.
We reserve the right at any time and without notice to any party to terminate,
suspend or modify these transfer privileges.
SUPPLEMENTARY AGREEMENT - A supplementary agreement will be issued to reflect
payments that will be made under a settlement option. If payment is made as a
death benefit distribution, the effective date will be the date of death.
Otherwise, the effective date will be the date chosen by the Owner.
DATE OF FIRST PAYMENT - Interest, under an option, will start to accrue on the
effective date of the supplementary agreement. If the normal effective date is
the 29th, 30th, or 31st of the month, the effective date will be the 28th day
of that month.
EVIDENCE OF AGE, SEX AND SURVIVAL - We may require satisfactory evidence of the
age, sex and the continued survival of any person on whose life the income is
based.
MISSTATEMENT OF AGE OR SEX - If the age or sex of the Payee has been misstated,
the amount payable under the contract will be such as the Purchase Payments
sent to us would have purchased at the correct age or sex. Interest not to
exceed 6% compounded each year will be charged to any overpayment or credited
to any underpayment against future payments we may make under the contract.
BASIS OF ANNUITY OPTIONS - The guaranteed monthly payments are based on an
interest rate of 2.50% per year and, where mortality is involved, the "1983
Table a" individual annuity mortality table developed by the Society of
Actuaries, projected using Projection Scale G. We may also make available
variable annuity payment options based on assumed investment rates other than
2.50%.
DISBURSEMENT UPON DEATH OF PAYEE: UNDER OPTIONS 1 or 3 - When the Payee dies,
if the beneficiary is a natural person, we will automatically continue any
unpaid installments for the remainder of the elected period under Option 1 or
Option 3 to the Beneficiary. If the Beneficiary is either an estate or trust,
we will pay a commuted value of the remaining payments. The commuted value
will be based upon a minimum interest rate of not less than 2.50%. The commuted
value of any variable instalments will be determined by applying the Annuity
Unit Value next determined following our receipt of due proof of death.
PROTECTION OF BENEFITS - Unless otherwise provided in the supplementary
agreement, the Payee may not commute, anticipate, assign, alienate or otherwise
hinder the receipt of any payment.
15
CREDITORS - The proceeds of the contract and any payment under an annuity
option will be exempt from the claim of creditors and from legal process to the
extent permitted by law.
L-8165 Page 9
16
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
OPTION ONE - FIXED INSTALLMENT ANNUITY
Number Number Number Number
of years Monthly of years Monthly of years Monthly of years Monthly
selected Payment selected Payment selected Payment selected Payment
--------------------------------------------------------------------------------
5 17.69 12 8.01 19 5.48 26 4.33
6 14.92 13 7.48 20 5.27 27 4.22
7 12.94 14 7.03 21 5.08 28 4.11
8 11.46 15 6.64 22 4.90 29 4.02
9 10.31 16 6.29 23 4.74 30 3.92
10 9.39 17 5.99 24 4.59
11 8.64 18 5.72 25 4.46
OPTION TWO AND THREE - LIFE ANNUITY WITH INSTALLMENTS GUARANTEED:
Age of MONTHLY PAYMENTS GUARANTEED Age of MONTHLY PAYMENTS GUARANTEED
Male Female
Payee NONE 60 120 180 240 Payee NONE 60 120 180 240
55 4.17 4.16 4.13 4.06 3.96 55 3.87 3.86 3.84 3.81 3.75
56 4.27 4.25 4.21 4.14 4.03 56 3.95 3.94 3.92 3.88 3.82
57 4.36 4.35 4.30 4.22 4.09 57 4.03 4.02 4.00 3.95 3.88
58 4.46 4.45 4.40 4.30 4.16 58 4.11 4.11 4.08 4.03 3.95
59 4.57 4.55 4.50 4.39 4.22 59 4.21 4.20 4.17 4.11 4.01
60 4.69 4.67 4.60 4.48 4.29 60 4.30 4.29 4.26 4.19 4.08
61 4.81 4.79 4.71 4.57 4.36 61 4.41 4.40 4.35 4.28 4.15
62 4.94 4.92 4.83 4.66 4.43 62 4.52 4.50 4.46 4.37 4.23
63 5.09 5.05 4.95 4.76 4.49 63 4.64 4.62 4.56 4.46 4.30
64 5.24 5.20 5.08 4.86 4.56 64 4.76 4.74 4.68 4.56 4.37
65 5.40 5.35 5.21 4.96 4.62 65 4.90 4.87 4.80 4.66 4.45
66 5.57 5.52 5.35 5.06 4.69 66 5.04 5.01 4.93 4.77 4.52
67 5.75 5.69 5.49 5.17 4.75 67 5.19 5.16 5.06 4.87 4.59
68 5.95 5.87 5.64 5.27 4.81 68 5.36 5.32 5.20 4.98 4.66
69 6.15 6.07 5.80 5.37 4.86 69 5.53 5.49 5.35 5.10 4.73
70 6.38 6.27 5.96 5.48 4.91 70 5.72 5.68 5.51 5.21 4.80
71 6.61 6.49 6.12 5.58 4.96 71 5.93 5.87 5.67 5.33 4.86
72 6.86 6.72 6.29 5.68 5.00 72 6.15 6.08 5.85 5.44 4.92
73 7.13 6.96 6.47 5.77 5.04 73 6.39 6.31 6.03 5.56 4.97
74 7.42 7.21 6.64 5.86 5.08 74 6.65 6.55 6.21 5.67 5.02
75 7.72 7.48 6.82 5.95 5.11 75 6.93 6.81 6.41 5.78 5.06
76 8.05 7.76 7.00 6.03 5.14 76 7.24 7.08 6.60 5.88 5.10
77 8.40 8.06 7.18 6.11 5.17 77 7.57 7.38 6.80 5.98 5.13
78 8.77 8.37 7.35 6.18 5.19 78 7.92 7.69 7.01 6.07 5.16
79 9.18 8.69 7.53 6.25 5.20 79 8.31 8.02 7.21 6.15 5.18
80 9.60 9.03 7.70 6.31 5.22 80 8.72 8.37 7.41 6.23 5.20
81 10.06 9.38 7.86 6.36 5.23 81 9.17 8.74 7.61 6.30 5.22
82 10.55 9.74 8.02 6.41 5.24 82 9.66 9.13 7.80 6.35 5.23
83 11.07 10.12 8.17 6.45 5.25 83 10.20 9.54 7.98 6.41 5.24
84 11.63 10.50 8.32 6.49 5.26 84 10.77 9.96 8.15 6.45 5.25
85 12.22 10.89 8.45 6.52 5.26 85 11.39 10.40 8.31 6.49 5.26
OPTION FOUR - JOINT AND 100% SURVIVOR ANNUITY
Age of Age of Female Payee
Male
Payee 55 60 65 70 75 80 85
55 3.49 3.66 3.81 3.93 4.02 4.08 4.12
60 3.61 3.83 4.05 4.24 4.40 4.52 4.59
65 3.69 3.97 4.28 4.57 4.84 5.05 5.20
70 3.76 4.09 4.47 4.89 5.31 5.67 5.95
75 3.80 4.17 4.63 5.16 5.75 6.34 6.83
80 3.83 4.23 4.73 5.37 6.14 6.99 7.80
85 3.84 4.26 4.80 5.51 6.44 7.55 8.75
L-1551
17
GROUP FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
READ YOUR CONTRACT CAREFULLY
XXXXXX INVESTORS LIFE INSURANCE COMPANY
A Stock Life Insurance Company
0 Xxxxxx Xxxxx, Xxxx Xxxxx, Xxxxxxxx 00000-0000
Policy Form No. L-8165
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ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
OPTION ONE - FIXED INSTALLMENT ANNUITY
Number Number Number Number
of years Monthly of years Monthly of years Monthly of years Monthly
selected Payment selected Payment selected Payment selected Payment
5 17.69 12 8.01 19 5.48 26 4.33
6 14.92 13 7.48 20 5.27 27 4.22
7 12.94 14 7.03 21 5.08 28 4.11
8 11.46 15 6.64 22 4.90 29 4.02
9 10.31 16 6.29 23 4.74 30 3.92
10 9.39 17 5.99 24 4.59
11 8.64 18 5.72 25 4.46
OPTIONS TWO AND THREE - LIFE ANNUITY WITH INSTALLMENTS GUARANTEED
MONTHLY PAYMENTS GUARANTEED
AGE NONE 60 120 180 240
55 4.02 4.01 3.99 3.94 3.86
56 4.11 4.10 4.07 4.01 3.92
57 4.20 4.19 4.15 4.09 3.99
58 4.29 4.28 4.24 4.17 4.05
59 4.39 4.38 4.33 4.25 4.12
60 4.50 4.48 4.43 4.34 4.19
61 4.61 4.59 4.53 4.43 4.26
62 4.73 4.71 4.64 4.52 4.33
63 4.86 4.84 4.76 4.61 4.40
64 5.00 4.97 4.88 4.71 4.47
65 5.15 5.11 5.01 4.81 4.54
66 5.30 5.26 5.14 4.92 4.61
67 5.47 5.43 5.28 5.02 4.68
68 5.65 5.60 5.43 5.13 4.74
69 5.84 5.78 5.58 5.24 4.80
70 6.05 5.97 5.74 5.35 4.86
71 6.27 6.18 5.90 5.46 4.91
72 6.50 6.40 6.07 5.56 4.96
73 6.76 6.63 6.25 5.67 5.01
74 7.03 6.88 6.43 5.77 5.05
75 7.32 7.14 6.62 5.87 5.09
76 7.64 7.42 6.80 5.96 5.12
77 7.98 7.72 6.99 6.05 5.15
78 8.34 8.03 7.18 6.13 5.17
79 8.73 8.36 7.37 6.20 5.19
80 9.16 8.70 7.56 6.27 5.21
81 9.61 9.06 7.74 6.33 5.23
82 10.10 9.44 7.91 6.38 5.24
83 10.63 9.83 8.08 6.43 5.25
84 11.19 10.23 8.24 6.47 5.25
85 11.80 10.64 8.38 6.50 5.26
OPTION FOUR - JOINT AND 100% SURVIVOR ANNUITY
Age of Age of Secondary Payee
Primary
Payee 55 60 65 70 75 80 85
55 3.51 3.64 3.76 3.85 3.92 3.96 3.99
60 3.64 3.84 4.02 4.18 4.29 4.38 4.43
65 3.76 4.02 4.29 4.54 4.75 4.90 5.00
70 3.85 4.18 4.54 4.91 5.25 5.53 5.74
75 3.92 4.29 4.75 5.25 5.77 6.26 6.64
80 3.96 4.38 4.90 5.53 6.26 7.00 7.69
85 3.99 4.43 5.00 5.74 6.64 7.69 8.76
L-1552
19
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
ENDORSEMENT
This Endorsement forms a part of the attached contract. The effective date of
this Endorsement is the effective date of this contract.
All references throughout this contract to the sex of a person used in the
calculation of benefits are deleted from this contract.
Except as modified herein, all terms and conditions of the contract remain
unchanged.
IN WITNESS WHEREOF, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
/S/ [SIGNATURE] /S/ [SIGNATURE]
---------------------- ------------------------
Secretary President
Form L-9006 (9/88)
20
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
ENDORSEMENT
This Endorsement forms a part of the Certificate to which it is attached. The
effective date of this Endorsement is the Contract Date stated in the
Certificate Schedule.
Withdrawal charges will not be assessed when a total or partial withdrawal is
requested in a form satisfactory to us if the Owner or Annuitant is disabled.
Disability must begin after the effective date of this Endorsement and prior to
age 65.
Withdrawal charges will not be waived when disability is due to substance
abuse, mental or personality disorders without a demonstrable organic disease.
A degenerative brain disease such as Alzheimer's Disease is considered an
organic disease.
For purposes of this provision:
"Disability" is defined as the inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment
which can be expected to result in death, or which has lasted, or can be
expected to last, for a continuous period of not less than 12 months.
"Disabled" is defined as having the conditions of the disability definition.
Except as modified herein, all terms and conditions of this Certificate remain
unchanged.
In witness whereof, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
/s/ [SIGNATURE] /s/ [SIGNATURE]
----------------------- -----------------------
Secretary President
L-8168
21
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
ENDORSEMENT
This Endorsement forms a part of the Contract to which it is attached. The
effective date of this Endorsement is the Contract Date stated in the Contract
Schedule.
Withdrawal charges will not be assessed when a total or partial withdrawal is
requested in a form satisfactory to us if the Owner or Annuitant is disabled.
Disability must begin after the effective date of this Endorsement and prior to
age 65.
Withdrawal charges will not be waived when disability is due to substance
abuse, mental or personality disorders without a demonstrable organic disease.
A degenerative brain disease such as Alzheimer's Disease is considered an
organic disease.
For purposes of this provision:
"Disability" is defined as the inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment
which can be expected to result in death, or which has lasted, or can be
expected to last, for a continuous period of not less than 12 months.
"Disabled" is defined as having the conditions of the disability definition.
Except as modified herein, all terms and conditions of this Contract remain
unchanged.
In witness whereof, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
/s/ [SIGNATURE] /s/ [SIGNATURE]
--------------------- ---------------------
Secretary President
L-8182
22
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
ENDORSEMENT
This endorsement forms a part of the Certificate to which it is attached.
DEFINITIONS
GUARANTEED RETIREMENT INCOME BENEFIT BASE - An amount which is applied to the
guaranteed annuity factors to produce the Guaranteed Retirement Income Benefit.
It is equal to the greater of:
(1) the total amount of Purchase Payments less withdrawals,
(2) the Certificate Value,
(3) the total amount of Purchase Payments less withdrawals accumulated at 5.00%
per annum to the earlier of age 80 or date of determination, or
(4) the greatest Anniversary Value immediately preceding the earlier of age 81
or date of determination increased by Purchase Payments made since the
date of the greatest Anniversary Value, and decreased by any withdrawals
since that date.
EXERCISE PERIODS - The Guaranteed Retirement Income Benefit may only be
exercised within 30 days of the seventh or later Certificate Anniversary. In
addition, the Annuitant must be at least age 60 but no older than age 90.
However, if the Annuitant's age is 44 or less on the Issue Date, the Guaranteed
Retirement Income Benefit may be exercised within 30 days of the 15th or later
Certificate Anniversary, but no later than Annuitant's age 90.
CERTAIN PERIOD - The certain period for the Guaranteed Retirement Income
Benefit is based on the Annuitant's age at the time the benefit is exercised and
qualification status, as follows:
Xxxxxxxxx's Certain Period Years
Age at Election Qualified Nonqualified
75 or less 10 10
76 9 10
77 8 10
78 7 10
79 7 10
80 7 10
81 7 9
82 7 8
83 7 7
84 6 6
85 to 90 5 5
GUARANTEED RETIREMENT INCOME BENEFIT PROVISIONS
If the Owner has selected the Guaranteed Retirement Income Benefit option, it
will be indicated on the Certificate Schedule. A separate charge will be made
for this benefit, also shown on the Certificate Schedule.
The Owner may elect to discontinue the Guaranteed Retirement Income Benefit
option any time on or after the seventh Certificate Anniversary, prior to
exercise of the benefit. We must receive a written election to discontinue this
benefit. The benefit will be discontinued effective as of the date the written
election is received by us. Once the benefit has been discontinued, it may not
be elected again.
During the Exercise Period, the Owner may apply the Guaranteed Retirement
Income Benefit Base to purchase a fixed annuity income for the Annuitant's
lifetime. Payments will be determined under Annuity Option 3 under the
Certificate based on the Certain Period defined above. The payout factors will
be those shown in the Certificate for amounts being annuitized, except that if
the Guaranteed Retirement Income Benefit is exercised on the 10th year or later,
the interest rate assumption will be 3.50%.
CONTINGENT ANNUITANT - If a Contingent Annuitant is in effect due to the death
of the original Annuitant, the Exercise Periods will be based on the issue age
of the original Annuitant and the Contingent Annuitant's age at election. The
Certain Period will be based on the Contingent Annuitant's age at election.
Except as modified herein, all terms and conditions of this Certificate remain
unchanged.
In witness whereof, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
/s/ [SIGNATURE] /s/ [SIGNATURE]
------------------------- -------------------------
Secretary President
L-8198
23
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
ENDORSEMENT
This endorsement forms a part of the Contract to which it is attached.
DEFINITIONS
GUARANTEED RETIREMENT INCOME BENEFIT BASE - An amount which is applied to the
guaranteed annuity factors to produce the Guaranteed Retirement Income Benefit.
It is equal to the greater of:
(1) the total amount of Purchase Payments less withdrawals,
(2) the Contract Value,
(3) the total amount of Purchase Payments less withdrawals accumulated at 5.00%
per annum to the earlier of age 80 or date of determination, or
(4) the greatest Anniversary Value immediately preceding the earlier of age 81
or date of determination increased by Purchase Payments made since the date
of the greatest Anniversary Value, and decreased by any withdrawal since
that date.
EXERCISE PERIODS - The Guaranteed Retirement Income Benefit may only be
exercised within 30 days of the seventh or later Contract Anniversary. In
addition, the Annuitant must be at least age 60 but no older than age 90.
However, if the Annuitant's age is 44 or less on the Issue Date, the Guaranteed
Retirement Income Benefit may be exercised within 30 days of the 15th or later
Contract Anniversary, but no later than Annuitant's age 90.
CERTAIN PERIOD - The certain period for the Guaranteed Retirement Income
Benefit is based on the Annuitant's age at the time the benRefit is exercised
and qualification status, as follows:
Xxxxxxxxx's Certain Period Years
Age at Election Qualified Nonqualified
75 or less 10 10
76 9 10
77 8 10
78 7 10
79 7 10
80 7 10
81 7 9
82 7 8
83 7 7
84 6 6
85 to 90 5 5
GUARANTEED RETIREMENT INCOME BENEFIT PROVISIONS
If the Owner has selected the Guaranteed Retirement Income Benefit option, it
will be indicated on the Contract Schedule. A separate charge will be made for
this benefit, also shown on the Contract Schedule.
The Owner may elect to discontinue the Guaranteed Retirement Income Benefit
option any time on or after the seventh Contract Anniversary, prior to exercise
of the benefit. We must receive a written election to discontinue this benefit.
The benefit will be discontinued effective as of the date the written election
is received by us. Once the benefit has been discontinued, it may not be
elected again.
During the Exercise Period, the Owner may apply the Guaranteed Retirement Income
Benefit Base to purchase a fixed annuity income for the Annuitant's
lifetime. Payments will be determined under Annuity Option 3 under the Contract
based on the Certain Period defined above. The payout factors will be those
shown in the Contract for amounts being annuitized, except that if the
Guaranteed Retirement Income Benefit is exercised on the 10th year or later, the
interest rate assumption will be 3.50%.
CONTINGENT ANNUITANT - If a Contingent Annuitant is in effect due to the death
of the original Annuitant, the Exercise Periods will be based on the issue age
of the original annuitant and the Contingent Annuitant's age at election. The
Certain Period will be based on the Contingent Annuitant's age at election.
Except as modified herein, all terms and conditions of this Contract remain
unchanged.
In witness whereof, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
/S/ [SIGNATURE] /S/ [SIGNATURE]
---------------------- ---------------------
Secretary President
L-8199
24
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company ZURICH
0 Xxxxxx Xxxxx XXXXXX
Xxxx Xxxxx, Xxxxxxxx 00000-0000
ENDORSEMENT
This Endorsement forms a part of the contract to which it is attached. The
effective date of this Endorsement is the Contract Date stated in the Schedule.
Withdrawal charges will not be assessed when a total or partial withdrawal is
requested in a form satisfactory to the Company:
(1) after an Owner has been confined in a Hospital or Skilled Health Care
Facility for at least thirty consecutive days and the Owner remains confined in
the Hospital or Skilled Health Care Facility when the request is made; or
(2) within thirty days following an Owner's discharge from a Hospital or Skilled
Health Care Facility after a confinement of at least thirty days.
Confinement must begin after the effective date of this Endorsement.
Withdrawal charges will not be waived when confinement is due to substance
abuse, mental or personality disorders without a demonstrable organic disease.
A degenerative brain disease such as Alzheimer's Disease is considered an
organic disease.
For purposes of this provision:
"Hospital" means a place which is licensed by the State as a Hospital and is
operating within the scope of its license.
"Skilled Health Care Facility" means a place which:
(a) is licensed by the state;
(b) provides skilled nursing care under the supervision of a physician;
(c) has twenty-four hour a day nursing services by or under the supervision of
a registered nurse (RN); and
(d) keeps a daily medical record of each patient.
Except as modified herein, all terms and conditions of this Contract remain
unchanged.
IN WITNESS WHEREOF, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
/S/ [SIGNATURE] /S/ [SIGNATURE]
----------------------- -----------------------
Secretary President
Form L-7042 (5/91)
