A MISSOURI STOCK COMPANY . HOME OFFICE; JEFFERSON CITY, MISSOURI 65101
ADMINISTRATIVE OFFICE: 0000 XXXXXXXX XXXX X.X., XXXXX XXXXXX, XXXX 52499
0-000-000-0000
We, Providian Life and Health Insurance Company, have issued this Contract on
the life of the Annuitant in consideration of Our receipt of Your Initial
Purchase Payment.
This plan provides a monthly Annuity Payment for the life of the Annuitant.
Payments start on the Annuity Date.
Benefits under this Contract when based on the investment experience of a
separate account are variable and are not guaranteed as to amount.
FREE LOOK PERIOD - RIGHT TO CANCEL CONTRACT
If for any reason You are not satisfied with this Contract, You may return it to
Us within 10 days (20 days if this Contract is replacing a previously existing
life insurance or annuity contract) of the date You received it. You may return
it by delivering or mailing it to Our Administrative Office, 0000 Xxxxxxxx Xxxx
X.X., Xxxxx Xxxxxx, XX 00000, or to the agent from whom You purchased this
Contract. If returned, the Contract shall be void from the Contract Date. We
will return the Accumulated Value of Your Contract, as of the date We receive
it, plus any loads, fees, and/or Premium Taxes that may have been subtracted
from Your Purchase Payment(s).
This is a legal contract between You and Us. READ THE CONTRACT CAREFULLY.
Signed for the Company by its President and Secretary.
Xxxx Xxxxxxx, Xx. Xxxxx X. Xxxxxx
President Secretary
Flexible Premium Multi-Funded Variable Deferred Annuity Contract
The Details Of The Variable Provision Begin On Page 8
Nonparticipating
[THE GUARANTEED EQUITY FIXED ACCOUNT OPTION DOES NOT PROVIDE CASH SURRENDER
VALUES PRIOR TO THE END OF THE GUARANTEED PERIOD] (appears only in states where
Guaranteed Equity Option is allowed)
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TABLE OF CONTENTS
Index
Page No.
Right to Cancel Contract........................................................
Contract Schedule Page..........................................................
Definitions.....................................................................
The Separate Account............................................................
Accumulated Value
Exchanges
Dollar Cost Averaging......................................................
Asset Rebalancing..........................................................
Withdrawals
Partial or Full Withdrawals................................................
Systematic Withdrawal Option...............................................
Death Benefit...................................................................
Ownership, Assignment and Beneficiary...........................................
Death of Annuitant..............................................................
Death of Annuitant's Beneficiary................................................
Death of Owner..................................................................
General Provisions..............................................................
Annuity Payment Options.........................................................
Annuity Tables..................................................................
2
Contract Schedule Page
Please address all correspondence to the address listed below. Include the
Contract number on all correspondence in order to facilitate the processing of
the request.
Providian Life and Health Insurance Company
Administrative Office
0000 Xxxxxxxx Xxxx X.X.
Cedar Rapids, IA 52499
Contract Schedule:
Contract Owner: xxxxxxxxxxxxxxxx Contract Number: xxxxxxxxxxx
Joint Owner: yyyyyyyyyyyyyyyy Contract Date: yyyyyyyyyyy
Annuitant: zzzzzzzzzzzzzzzz Annuity Date: zzzzzzzzzzz
Annuitant's Beneficiary: @@@@@@@@@@@@@@@@ Initial Purchase Payment: @@@@@@@@@@@
Death Benefit: 6 Year Step-up
Each Subaccount of the Providian Life and Health Insurance Company Separate
Account V offered in this Contract invests in a corresponding Portfolio of the
Providian Life and Health Advisor's Edge Select Fund(s). These Portfolios are
listed below. The allocation of the Initial Purchase Payment that You chose is
also shown below.
Separate Account Allocations
Dreyfus Small Cap Value Portfolio % Enhanced Index managed by X.X. Xxxxxx %
Federated American Leaders Portfolio % Federated Utility Portfolio %
Federated Prime Money Portfolio % Federated High Income Bond Portfolio %
Federated Fund for U.S. Government % Montgomery Growth Portfolio %
Securities Portfolio
Xxxxxxxxxx Emerging Markets Portfolio % SteinRoe Special Venture Portfolio %
Strong International Stock Portfolio % Strong Xxxxxxx Value Portfolio %
Xxxxxx U.S. Small Cap Advisor Portfolio % Xxxxxx International Small Cap Portfolio %
Warburg Pincus International Equity Portfolio % Warburg Pincus Small Company Growth Portfolio %
T Xxxx Price International Stock Portfolio %
Fixed Account Allocations:
One-Year Guaranteed Rate Option
Multi-Year Guaranteed Rate Option
Guaranteed Equity Option
Dollar Cost Averaging Option
Contract Charges:
. Daily Administrative Charge corresponding to an annual charge of .15% of the
value of the Subaccounts.
. Daily Mortality and Expense Risk Charge corresponding to an annual charge of
1.35% of the value of the Subaccounts.
We have the right to charge a fee of $15 for each Exchange after the first 12
Exchanges made in any Contract Year. All Exchanges made simultaneously will be
treated as a single request.
3
Definitions
Whenever used in this Contract, the following shall mean:
Accumulated Value
The value of all amounts accumulated under the Contract prior to the Annuity
Date.
Adjusted Death Benefit
The Adjusted Death Benefit during the first six Contract Years will be equal to
the sum of all Net Purchase Payments made less any partial withdrawals. During
each subsequent six-year period beginning before age 81, the Adjusted Death
Benefit will be equal to the Death Benefit on the last day of the previous six-
year period, plus any Net Purchase Payments made, less any partial withdrawals
taken during the current six-year period. For any six-year period after the one
in which the Annuitant attains age 81, the Adjusted Death Benefit will be equal
to the Death Benefit on the last day of the six-year period before age 81
occurs, plus any Net Purchase Payments subsequently made, less any partial
withdrawals subsequently taken.
Administrative Charge
A daily charge to the Contract to cover issuance and maintenance costs expected
to be incurred over the life of the Contract.
Annuitant
The person or persons on whose life expectancy the duration of any Annuity
Payments under Payment Options 1, 2, 3, and 4 is determined and upon whose
death, benefits under the Contract are paid. See Primary Annuitant.
Annuitant's Beneficiary
The person to whom any benefits are due upon the Annuitant's death.
Annuity Date
The date on which Annuity Payments begin. The Annuity Date is always the first
day of the month.
Annuity Payment
One of a series of payments made under an Annuity Payment Option.
Annuity Payment Option
One of several ways in which the Accumulated Value of this Contract can be paid.
Under a Fixed Annuity Option, the dollar amount of each Annuity Payment does not
change over time. Under a Variable Annuity Option, the dollar amount of each
Annuity Payment will change over time, depending upon the investment experience
of the underlying Portfolio or Portfolios You choose.
Annuity Unit
Unit of measure used to calculate variable Annuity Payments.
Annuity Unit Value
The value calculated for each Annuity Unit.
Business Day
A day when the New York Stock Exchange is open for trading.
Contract Anniversary
Any anniversary of the Contract Date.
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Contract Date
The date of issue of this Contract as shown on the Contract Schedule Page.
Contract Year
A period of 12 months starting with the Contract Date or any Contract
Anniversary.
Death Benefit
The greater of the Adjusted Death Benefit or the Contract's Accumulated Value on
the date that We receive proof of the Annuitant's death.
Exchange
One Exchange will be deemed to occur with each voluntary transfer from any
Subaccount. All exchanges made simultaneously will be treated as a single
request.
Free Look Period
The period during which this Contract can be canceled.
Initial Purchase Payment
The first payment You make to purchase this Contract. The Initial Purchase
Payment must be at least $25,000 for Non-Qualified Contracts and $1,000 (or $50
if payments are to be made by monthly payroll deduction) for Qualified
Contracts. In no event, however, can the Initial Purchase Payment be greater
than $1,000,000 without Our consent. The Initial Purchase Payment less any
applicable Premium Tax, if any, will be credited to Your Accumulated Value
within two Business Days after We receive Your Initial Purchase Payment.
Mortality and Expense Risk Charge
An annual charge to the Contract as compensation to the Company for bearing
certain mortality and expense risks under the Contract. These risks include the
guarantees associated with the Death Benefit and any fixed annuity payments
made, and the first variable annuity payment.
Net Asset Value
The Net Asset Value of a fund share is the per-share value calculated by the
Fund. The Net Asset Value is computed by adding the value of the Subaccount's
investments, cash and other assets, subtracting its liabilities, and then
dividing by the number of shares outstanding. Net Assets Values of Fund shares
reflect investment advisory fees and other expenses incurred in managing a Fund.
Net Investment Factor
The Net Investment Factor used to calculate the value of an Accumulation Unit in
each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:
(a) is the result of:
(1) the net asset value of a Fund share held in that Subaccount determined
as of the end of the current Valuation Period; plus
(2) the per share amount of any dividend or capital gain distributions made
by the Fund for shares held in that Subaccount if the ex-dividend date
occurs during the Valuation Period; plus or minus
(3) a per share credit or charge for any taxes reserved for, which We
determine to have resulted from the investment operations of that
Subaccount.
(b) is the net asset value of a Fund share held in that Subaccount determined
as of the end of the immediately preceding Valuation Period.
(c) is a factor representing the Mortality and Expense Risk Charge and the
Administrative Charge.
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This factor is less than or equal to, on an annual basis, the percentage shown
on the Schedule Page of the daily net asset value of a Fund share held in that
Subaccount.
Net Purchase Payment
Any Purchase Payment less any applicable Premium Tax.
Nonnatural Owner
Any Owner that is not a living person or persons.
Non-Qualified Contract
Any Contract other than those described under the Qualified Contract definition
in this Definitions section.
Owner
The purchaser of this Contract, as shown in the Contract Schedule Page. Any
Joint Owner shares ownership in all respects with the Owner. The Owner has the
right to assign ownership to a person or party other than himself.
Owner's Designated Beneficiary
The person You designate to receive Your interest in this Contract if You die,
pursuant to Section 72(s) of the Internal Revenue Code of 1986, as amended,
unless You are also the Annuitant, in which case the Annuitant's Beneficiary is
entitled to the benefits due.
Payee
You, the Annuitant, the Owner's Designated Beneficiary, the Annuitant's
Beneficiary or any other person, estate, or legal entity to whom benefits are to
be paid.
Portfolio
A collection of various types of securities available for investment under this
Contract.
Premium Tax
A regulatory tax that may be assessed by Your state on the Purchase Payments You
make to this Contract or at the time Annuity Payments begin. The amount which We
must pay as Premium Tax will be deducted from each Purchase Payment or from Your
Accumulated Value at the time it is incurred by Us.
Primary Annuitant
First person named as the Annuitant on the Contract Schedule Page.
Proof of Death
A certified death certificate; a certified decree from a court of competent
jurisdiction as to the finding of death; a written statement by a medical doctor
who attended the deceased; or any other proof satisfactory to Us.
Purchase Payment
An amount You invest in this Contract. Purchase Payments after the Initial
Purchase Payment may be made at any time prior to the Annuity Date as long as
the Annuitant is living. Each Purchase Payment after the Initial Purchase
Payment must be at least $500 for Non-Qualified Contracts or $50 for Qualified
Contracts. The total of all Purchase Payments may not exceed $1,000,000 without
Our consent. Net Purchase Payments received prior to the close of the New York
Stock Exchange will be credited to Your Accumulated Value at the close of
business that same day. Net Purchase Payments received after the close of the
New York Stock Exchange will be credited the following Business Day.
Qualified Contract
An annuity contract as defined under certain sections of the Internal Revenue
Code, as amended (the "Code").
6
SEC
The Securities and Exchange Commission.
Separate Account
The Providian Life and Health Insurance Company Separate Account V. The Separate
Account consists of assets that are segregated by Us and invested in the Fund(s)
as shown on the Schedule Page. The investment performance of the Separate
Account is independent of the performance of the general assets of the Company.
Subaccount
That portion of the Separate Account which invests in shares of the Fund(s)'
Portfolios. Each Subaccount will invest only in a single Portfolio. The
investment performance of each Subaccount is linked directly to the investment
performance of the underlying Portfolio of the Fund(s).
Valuation Period
A period between two successive Business Days commencing at the close of
business on the first Business Day and ending at the close of business of the
following Business Day.
We, Us, Ours
"We" means Providian Life and Health Insurance Company. "Us", "Our" and "Ours"
also refer to Providian Life and Health Insurance Company.
Withdrawal
Any amount equal to or greater than $500 that the Owner may remove from the
Contract prior to the Annuity Date. Accumulated Value will be reduced by any
Withdrawal.
Written Request (or Written Notice)
Any notice, change or request in writing by You to Us. It is how You let Us know
any requests You have or changes You want to make to this Contract. Such
requests must be in a format and content acceptable to Us. A signature guarantee
may be required for Your protection.
You, Your, Yours
"You" refers to the purchaser ("Owner") of this Contract unless another Owner is
named by You, the purchaser. The term shall also include any person named as
Joint Owner. A Joint Owner shares ownership in all respects with the Owner. The
Owner has the right to assign ownership to a person or party other than himself.
"Your" and "Yours" also refer to the Owner and the Joint Owner.
7
The Separate Account
Nature of the Separate Account
The Separate Account was established under Missouri law and is registered with
the SEC under the Investment Company Act of 1940 as a Unit Investment Trust type
of investment company. We established the Separate Account to support variable
annuity contracts. We own the assets of the Separate Account and keep them
separate from the assets of Our general investment account.
We use the assets of the Separate Account to buy shares in the Fund(s). The
Separate Account has Subaccounts which are invested in corresponding specific
Portfolios of the Fund(s). Income and realized and unrealized gains and losses
from assets in each Subaccount are credited to, or charged against, the
Subaccount without regard to income, gains or losses in Our other investment
accounts.
We will determine the value of the assets in the Separate Account at the end of
each Business Day. In order to determine the value of an asset on a day that is
not a Business Day, We will use the value of that asset as of the end of the
next Business Day.
We will always keep assets in the Separate Account with a value at least equal
to the total investment amount under Contracts similar to this one. To the
extent those assets do not exceed this total, We use them to support only those
Contracts and do not use those assets to support any other business. We may use
any excess over this amount at Our discretion.
Subaccounts
The Separate Account has several Subaccounts. Each Subaccount invests in a
corresponding Portfolio of the Fund(s). The Portfolios available on the Contract
Date are listed on the Contract Schedule Page.
Allocations to the Subaccounts
You determine, using whole percentages, what portion of the Net Purchase
Payment(s) will be allocated among the Subaccounts. The Contract Schedule Page
will show Your initial allocation percentages. You may choose to allocate
nothing to a particular Subaccount. The minimum balance for each Subaccount
prior to the Annuity Date must be at least $250.
You may change the allocation percentages for additional Purchase Payments at
any time. The change will take effect on the date We receive notice as required
by Us.
Accumulated Value
On the Contract Date, the Accumulated Value is equal to Your Initial Purchase
Payment less any applicable Premium Tax. On any Business day after the Contract
Date, the Accumulated Value is equal to the Accumulated Value from the previous
Business Day, PLUS:
1. Any Additional Net Purchase Payments received; and
2. Any increase in the value of the Subaccount(s), due to investment results,
to which the Accumulated Value is allocated;
LESS:
1. Any decrease in the value of the Subaccount(s), due to investment results,
to which the Accumulated Value is allocated;
2. The Mortality and Expense Risk Charge, as shown on the Contract Schedule
Page;
3. The daily Administrative Charge, as shown on the Contract Schedule Page;
4. Any applicable fees for exchanges as shown on the Contract Schedule Page;
and
5. Any withdrawals.
8
Exchanges
Exchanging Units
You may make as many Exchanges among Subaccounts during a Contract Year as You
wish, provided You maintain a minimum balance of $250 in any Subaccount to which
You have allocated Net Purchase Payments. We have the right to charge a fee of
$15 for each Exchange after the first 12 Exchanges made in any Contract Year.
Exchanges may be made by notifying Us in writing. All Exchanges made
simultaneously will be treated as a single request.
If You make an Exchange from one Subaccount to any of the other Subaccounts at
any time prior to the Annuity Date, We will reduce the value of that Subaccount
by the amount exchanged.
Dollar Cost Averaging
If You have at least $5,000 of Accumulated Value in the money market portfolio,
or Dollar Cost Averaging Fixed Account (if shown on the Contract Schedule Page),
You may elect to have a specified dollar amount transferred from that Subaccount
to other Subaccounts on a monthly basis.
The minimum amount You may exchange each month is $250 for each Subaccount. The
maximum amount You may transfer is equal to the value of the money market
portfolio (or Dollar Cost Averaging Fixed Account) when You made Your election,
divided by 12. You may change the amount to be exchanged once each Contract Year
provided We receive Written Notice at least seven days prior to the next
exchange date.
We will make this Exchange each month on the same date as the Contract Date. The
dollar amount will be allocated to the Subaccounts in the proportions You
specified in Your notice. If, on any Exchange date, the value in the money
market portfolio (or Dollar Cost Averaging Fixed Account) is equal to or less
than the amount You elected to have exchanged, We will exchange the entire
amount and Dollar Cost Averaging will cease.
You may cancel this option at any time provided We receive Written Notice at
least seven days prior to the next exchange date.
Asset Rebalancing
Prior to the Annuity Date, You may instruct Us to automatically exchange amounts
among the Subaccounts of the Separate Account to maintain a desired allocation
of the Accumulated Value among those Subaccounts. Rebalancing will occur
monthly, quarterly, semi-annually, or annually, beginning on the date You
select. You must select the percentage of the Separate Account Accumulated Value
You desire in each of the various Subaccounts offered (totaling 100%).
Rebalancing can be started, stopped or changed at any time, except that
rebalancing will not be available when Dollar Cost Averaging is in effect or
when any other Exchange is requested.
Withdrawals
Partial or Full Withdrawals
You may make a partial or full withdrawal of Your Accumulated Value at any time
before the Annuity Date. The minimum partial withdrawal is $500. On the Annuity
Date, You may elect to have the full withdrawal amount paid in a lump sum, or
You may elect to have it all paid out under an Annuity Payment Option. See
Payment Option section for more information.
On the date We receive Your Written Request for a partial withdrawal, the
Accumulated Value will be reduced by an amount equal to the withdrawal amount,
subject to the following:
9
1. Partial withdrawals will be deducted as directed by You in Your Written
Request for a partial withdrawal. In the absence of specific direction from You,
We will make deductions from the Subaccounts to which You have allocated Net
Purchase Payments on a pro rata basis.
2. If a partial withdrawal or exchange would reduce the value in a Subaccount
to less than $250, the remaining balance in that Subaccount will be exchanged to
the other Subaccounts in which the Contract's Accumulated Value is then
allocated on a pro rata basis. If the Accumulated Value under this Contract is
less than $1,000, We reserve the right to terminate the Contract and pay You the
Accumulated Value. You will be notified if Your Accumulated Value is below the
minimum, and will be given 60 days in which to make an additional Purchase
Payment.
On the date We receive Your Written Request for full withdrawal, the amount
payable is the Accumulated Value.
Systematic Withdrawal Option
You may elect to have a specified dollar amount withdrawn from that portion of
Your Contract's Accumulated Value which is allocated to the Subaccounts, on a
monthly, quarterly, semiannual or annual basis. The minimum amount for each
withdrawal is $100.
You may elect this option by completing a Systematic Withdrawal Request Form. We
must receive it at least 30 days prior to the date You want systematic
withdrawals to begin. We will process each systematic withdrawal on the date and
at the frequency specified by You in Your Systematic Withdrawal Request Form. We
will forward the withdrawal amount to You within 10 Business Days of the process
date.
You may change the amount to be withdrawn, or elect to cancel the systematic
withdrawals at any time provided We receive Written Notice at least 30 days
prior to the next systematic withdrawal date.
We reserve the right to discontinue offering this systematic withdrawal option.
We will notify You in writing 30 days prior to discontinuing this option.
Death Benefit
Death Benefit Prior to the Annuity Date
We will pay the Death Benefit to the Annuitant's Beneficiary when we receive
proof that the Annuitant died prior to the Annuity Date. The Death Benefit may
be paid as a lump sum cash benefit or an annuity payment benefit. If You and the
Annuitant are the same person and the Annuitant's Beneficiary is your surviving
spouse, then the Annuitant's Beneficiary may elect to be treated as the Owner's
Designated Beneficiary pursuant to the "Owner's Death Before Entire Interest is
Distributed" provision.
Ownership, Assignment and Beneficiary
Ownership of the Contract
You may, while the Annuitant is living:
1. Assign this Contract.
2. Surrender the Contract to Us.
3. Amend or modify the Contract with Our consent.
4. Receive Annuity Payments or name a Payee to receive the payments.
5. Exercise, receive and enjoy every other right and benefit contained in the
Contract.
The Annuitant is the Owner unless You have designated another person as Owner.
During the Annuitant's lifetime, all rights and privileges under this Contract
may be exercised solely by the Owner. The use of these rights may be
10
subject to the consent of any assignee or irrevocable beneficiary, and of the
spouse in a community or marital property state. Unless We have been notified of
a community or marital property interest in this contract, We will rely on Our
good faith belief that no such interest exists and will assume no responsibility
for inquiry. From time to time, We may require proof that the Annuitant is still
living.
Change of Ownership
In the case of a Non-Qualified Annuity, You can change the Owner of this
Contract, from Yourself to a new Owner, in a Written Request that You sign that
gives Us the facts that We need. When this change takes effect, all rights of
ownership in this Contract will pass to the new Owner.
A change of Owner will not be effective until it is recorded by Us. After it has
been so recorded, the change will take effect as of the date You signed the
Written Request. However, if the Annuitant dies before the notice has been so
recorded, it will not be effective as to those proceeds We have paid before the
change was recorded by Us. We may require that the change be endorsed in the
Contract. Changing the Owner or naming a new Successor Owner cancels any prior
choice of Successor Owner, but does not change the Beneficiary or the Annuitant.
A change in ownership may result in adverse tax consequences.
Assignment of the Contract
We are not responsible for the validity or effect of any assignment. No
assignment will be recognized until We receive Written Notice. The interest of
any Annuitant's Beneficiary which the assignor has the right to change shall be
subordinate to the interest of an assignee. Any amount paid to the assignee
shall be paid in one sum, notwithstanding any settlement agreement in effect at
the time the assignment was executed. We shall not be liable as to any payment
or other settlement made by Us before We received the Written Notice.
Annuitant's Beneficiary
You may name an Annuitant's Beneficiary in writing. You may make this
designation irrevocable by a Written Notice filed and approved by Us. An
irrevocable Annuitant's Beneficiary may be changed only with his or her own
written consent. (If an irrevocable Beneficiary dies, You may designate a new
Beneficiary.) Changes in Annuitant's Beneficiary must be made by Written Notice
to Us. The notice must have been postmarked (or show other evidence of delivery
that is acceptable to Us) on or before the date of death. The change will take
effect on the date the notice is signed, whether or not You are living when We
receive it. We will acknowledge in writing receipt of this notice. The change
will not affect any payment made or other action taken before the Written Notice
was received.
You may direct that the Annuitant's Beneficiary shall not have the right to
withdraw, assign or commute any sum payable under an option. In the absence of
such election or direction, the Annuitant's Beneficiary may change the manner of
payment or make an election of any option.
Death of Annuitant
Xxxxxxxxx's Death Prior to Annuity Date
If the Owner and the Annuitant are different and if the Annuitant dies prior to
the Annuity Date, the following will apply unless You have made other
provisions:
1. If there is more than one Annuitant's Beneficiary, each will share equally.
2. If one of two or more Annuitant's Beneficiaries has already died, that share
of the Death Benefit will be paid equally to the surviving Annuitant's
Beneficiaries.
3. If no Annuitant's Beneficiary is living, the Death Benefit will be paid to
You, your legal representatives or assigns.
4. If an Annuitant's Beneficiary dies at the same time as the Annuitant, the
Death Benefit will be paid as though the Annuitant's Beneficiary had died
first.
5. If an Annuitant's Beneficiary dies within 15 days after the Annuitant's
death and before we receive due proof
11
of the Annuitant's death, the Death Benefit will be paid as though the
Annuitant's Beneficiary had died first.
6. If any Annuitant's Beneficiary is alive at the time the Death Benefits
become payable, but dies before receiving their payment, their share will be
paid to their estate.
The Annuitant's Beneficiary may choose to receive a lump sum payment or to
receive a series of payments under one of the Annuity Payment Options available
under the Contract. However, any election to receive an Annuity Payment Option
must be made within 60 days of the date on which the Death Benefit becomes
payable. These Annuity Payments must begin within one year of the date the Death
Benefit became payable.
Xxxxxxxxx's Death After Annuity Date
If the Annuitant dies on or after the Annuity Date, any unpaid payments certain
will be paid to the Annuitant's Beneficiary.
Death of Xxxxxxxxx's Beneficiary
Death of Xxxxxxxxx's Beneficiary
If an Annuitant's Beneficiary who is currently receiving Annuity Payments dies,
any remaining Payments Certain will be paid to that Annuitant's Beneficiary's
named beneficiary as they come due.
Death of Owner
Owner's Death Before Entire Interest is Distributed:
If any Owner dies before the entire interest in the Contract is distributed:
1. The following applies:
(a) If You die on or after the Annuity Date, the remaining portion of
such interest will be distributed at least as rapidly as under the
method of distribution being used as of the date of death; and
(b) If You die before the Annuity Date, the entire interest in this
Contract will be distributed as follows:
1) within five years after the date of the Owner's death;
2) over the lifetime of the Owner's Designated Beneficiary of this
Contract; or
3) over a period that does not exceed the life expectancy, as
defined by Internal Revenue Code regulations, of the Owner's
Designated Beneficiary of this Contract.
Subparagraphs 2) and 3) apply only to individuals, and such payments
must start within one year of the date of such Owner's death.
The preceding paragraph (b) does not apply in the case of a Qualified
Contract. Any after death distributions from a Qualified Contract must
comply with the specific Internal Revenue Code requirements applicable to
such Qualified Contract.
2. Special rule where surviving spouse is entitled to Death Benefit: If any
Owner dies before the Annuity Date and the individual entitled to the Death
Benefit is your surviving spouse, he or she may elect to become the Owner
under the Contract and to treat the Contract as his or her own. If no such
election is made, payments will be made to your spouse in accordance with
paragraph (b).
Special rules for Nonnatural Owners
If a Nonnatural person is named as Owner of this Contract, then the death of the
Primary Annuitant shall be treated as the death of the Owner and the entire
interest in this Contract must be distributed within five years of (1) the
Primary Annuitant's death prior to the Annuity Date, or (2) a change in the
Primary Annuitant.
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General Provisions
Entire Contract
The entire contract consists of this Contract, including any riders or
endorsements. Changes to this Contract are not valid unless We make them in
writing. They must be signed by one of Our Executive Officers. No agent has the
authority to change this Contract or to waive any of its provisions.
Incontestability
This Contract is incontestable from the Contract Date.
Nonparticipating
This Contract is nonparticipating. This means We do not pay dividends on it. The
Contract will not share in Our profits or surplus.
Protection of Proceeds and Payments
To the extent permitted by law, neither the proceeds nor any payments under this
Contract shall be subject to the claims of creditors or legal process.
Annual Statement
You will receive an annual statement at least once each Contract Year. It will
show such things as the beginning and ending account values, as well as any
additional Purchase Payments, withdrawals, exchanges, or charges that apply to
this Contract for the year. The statement may contain other information
required by law or regulation.
Misstatement of Age or Sex
If the Annuitant's age or sex is misstated, payments will be adjusted to the
amount which would have been provided for at the correct age or sex. If
payments have already commenced and the misstatement has caused an underpayment,
the full amount due will be paid with the next scheduled payment. If the
misstatement has caused an overpayment, the amount due will be deducted from one
or more future payments.
Deferment of Payment
If a lump sum or cash withdrawal is to be paid from the Separate Account,
payment will be made within seven calendar days from the date the election
becomes effective.
We may defer payment in cases where the New York Stock Exchange is closed or
trading has been restricted by the SEC, or when the SEC allows Us to defer
payments in order to protect Our Contract Owners.
Contract Amendment
We will amend this Contract from time to time in cases where We are acting to
comply with the United States Internal Revenue Code and/or regulations of the
United States Treasury Department, or are acting to maintain the tax-deferred
status of this Contract, pursuant to these provisions or regulations. You have
the right to refuse such amendment. Such refusal may result in adverse tax
consequences.
Rights Reserved by the Company
Subject to any required approval by the SEC, the Missouri Department of
Insurance, and any other regulatory authority, We reserve the right, when
permitted by law, to:
a) deregister the Separate Account under the Investment Company Act of 1940;
b) manage the Separate Account under the direction of a committee at any time;
c) restrict or eliminate any voting rights of policyowners or other persons who
have voting rights as to the Separate Account; and
d) combine the Separate Account with one or more other separate accounts;
e) create new Separate Accounts;
13
f) add new Subaccounts to or remove existing Subaccounts from the Separate
Account, or combine Subaccounts;
g) add new underlying mutual funds, remove existing funds, or substitute a new
fund for an existing fund.
We also reserve the right to exchange assets of the Separate Account, which We
determine to be associated with the class of policies to which this contract
belongs, to another separate account. If this type of exchange is made, the term
"Separate Account", as used in this contract, shall then mean the separate
account to which the assets were exchanged.
Annuity Payment Options
You may elect that Annuity Payments be received on a fixed basis, a variable
basis, or some combination of both.
Proceeds
The normal Annuity Date is the first day of the month following the Annuitant's
85th birthday. However, You may choose to advance or defer the Annuity Date,
provided that notice of each change is received by Us at least thirty (30) days
prior to the then current Annuity Date. Except as otherwise permitted by Us, a
new Annuity Date must be a date which is: (1) at least thirty (30) days after
the date notice of the change is received by Us and (2) not later than the last
day of the Policy month starting after the Annuitant's 85th birthday. In no
event will an Annuity Date be permitted to be later than the last day of the
Policy month following month of the Annuitant's 95th birthday. The Annuity Date
may also be changed by the Beneficiary's election of the Annuity Option after
the Annuitant's death. On the Annuity Date the proceeds to be applied under a
Payment Option will be equal to the Contract's Accumulated Value 10 Business
Days prior to the Annuity Date less any applicable Premium Tax. Any Accumulated
Values attributable to Fixed Account Allocations, if any, as listed on the
Contract Schedule Page, will become a portion of the proceeds to be applied
under a Payment Option. No Market Value Adjustment or Interest Penalty will
apply on the Annuity Date.
Annuity Payments
The Annuitant at the Annuity Date may be either the Contract Owner or the
individual named as the Primary Annuitant as shown on the Contract Schedule
Page. Annuity Payments are made monthly, quarterly, semi-annually, or annually
starting on the Annuity Date. We may require all monthly and quarterly payments
to be made by Electronic Funds Transfer. The Annuity Payments are guaranteed to
be no less than the amount provided by the Annuity Tables. The minimum payment
is $100. The number of payments made in a year may be adjusted to maintain this
minimum. If the Accumulated Value is less than $2,000, We have the right to pay
that amount in a lump sum. We may require proof of the Annuitant's age before
making payments. From time to time, We may require proof that the Annuitant is
living.
Supplementary Contract
Once proceeds become payable and a payment option has been selected, this
contract will terminate and we will issue a supplementary contract to reflect
the terms of the selected option. The supplementary contract will name the
payees and will describe the payment schedule.
Payment Options
1. Life Annuity - We will make Annuity Payments for the lifetime of the
Annuitant, ceasing with the last payment due prior to the Annuitant's death.
2. Life Annuity with 120, 180 or 240 Monthly Payments Certain - We will make
Annuity Payments for the lifetime of the Annuitant, or if the Annuitant dies
prior to the end of the certain period elected, payments will continue for
the remainder of the 120, 180 or 240 months.
14
3. Joint and Last Survivor Annuity - We will make Annuity Payments as long as
the Annuitant or Joint Annuitant is living. Payments to be made following
the death of one of the Annuitants may be the same amount or may be reduced
to a percentage of the original Annuity Payment. Such percentage must be
chosen at the time You selected a Payment Option.
4. Installment (Fixed Annuity Payment Option) or Unit Refund (Variable Annuity
Payment Option) Life Annuity - We will make Annuity Payments for the
lifetime of the Annuitant, with a Period Certain which is determined by
dividing the Accumulated Value at the Annuity Date by the first Annuity
Payment.
5. Designated Period Annuity - We will make Annuity payments for a Period
Certain which may be from 10 to 30 years, as elected. This option is only
available on a Fixed Payment basis.
Additional Options
Other options may be arranged by agreement with Us.
--------------------------------------------------------------------------------
Annuity Tables
The annuity tables show the guaranteed minimum amount of monthly Annuity Payment
for each $1,000 of proceeds to be applied to each Fixed Annuity option. We may,
at the time of election of a Fixed Annuity Payment Option, offer more favorable
rates in lieu of the guaranteed rates shown in the annuity tables. The amount of
each Annuity Payment will depend on the Annuitant's sex and adjusted age on the
birthday nearest to the date the first Annuity Payment is due (unless a
Designated Period Annuity is chosen). The adjusted age is the Annuitant's actual
age on the Annuitant's nearest birthday, at the annuity commencement date,
adjusted as follows:
Annuity Commencement Date Adjusted Age
Before Year 2001 Actual Age
2001 - 2010 Actual Age minus 1
2011 - 2020 Actual Age minus 2
2021 - 2027 Actual Age minus 3
2028 - 2035 Actual Age minus 4
After 2035 to be determined.
We base the tables for the first four options on the 1983 Table "A" Mortality
Table projected for mortality improvement using Projection Scale G and an
interest rate of 3% a year for Fixed Payment Options and 4% a year for Variable
Payment Options. The table for Option 5 is based on an interest rate of 3% a
year for Fixed Payment Options. On request We will furnish the amount of monthly
Annuity Payment per $1,000 applied for any ages not shown.
Fixed Payment Amounts
With respect to a Fixed Payment option, the amounts shown on the tables
represent the guaranteed minimum for each Annuity Payment. If a Fixed Payment
Option is selected and the first Annuity Payment has been received, the Annuity
Payment election can not be revoked.
Variable Payment Amounts
With respect to a Variable Payment option, the amounts shown on the tables
represent the first Annuity Payment, based on the assumed interest rate of 4%.
The amount of each Annuity Payment after the first is determined by means of
Annuity Units.
You may exchange all or a part of the value of Variable Annuity Units to Fixed
Annuity Payments.
If You exchange Variable Annuity Payments to Fixed Annuity Payments, the Fixed
Annuity Payments will be a
15
continuation of the Payment Option under which Your Variable Annuity Payments
were being made. For example, if You were receiving payments under a Variable
Life with 10 Year Certain for 2 years and elect to exchange to a Fixed Annuity
Payment, Your Payment Option would be a Fixed Life and 8 Year Certain Option.
You should consult a competent tax adviser regarding the tax implications of
exchanging from a Variable to a Fixed Payment Option after the Annuity Date.
You may exchange between Subaccounts while receiving Variable Payments. We
reserve the right to limit Exchanges to no more than 12 in any one Contract
Year. Any Exchanges in excess of 12 per Contract Year may be charged a $15 fee
per Exchange. (All Exchanges made simultaneously will be treated as a single
request.)
The number of Annuity Units is determined by dividing the first Annuity Payment
by the Selected Subaccount's Annuity Unit value as of 10 Business Days prior to
the Annuity Date. The number of Annuity Units for the Subaccount then remains
fixed, unless an exchange of Annuity Units is made. After the first Annuity
Payment, the dollar amount of each subsequent Annuity Payment is equal to the
number of the Selected Subaccounts' annuity units multiplied by the respective
Annuity Unit Values as of 10 Business Days before the due date of the Annuity
Payment.
The Annuity Unit Value for each Subaccount was established at $10. The Annuity
Unit Value for any subsequent Business Day is equal to (a) times (b) times (c),
where:
(a) is the Annuity Unit Value on the immediately preceding Business Day;
(b) is the Net Investment Factor for the day;
(c) is the Investment Result Adjustment Factor (.99989255 per day), which
recognized an assumed interest rate of 4% per year used in determine the
Annuity Payment Amounts.
The Net Investment Factor is a factor applied to a Subaccount that reflects
daily changes in the value of the Subaccount due to:
(a) Any increase or decrease in the value of the Subaccount due to investment
results.
(b) Daily Mortality and Expense Risk Charge corresponding to an annual charge
as shown on the Contract Schedule Page.
(c) Daily Administrative Charge corresponding to an annual charge as shown on
the Contract Schedule Page.
(d) A charge or credit for any taxes reserved for, which We determine to have
resulted from the investment operations of the Subaccount.
When annuity payments begin, neither expenses actually incurred other than taxes
on the investment return, nor mortality actually experienced, shall adversely
affect the dollar amount of variable annuity payments.
Alternate Annuity
We may, at the time of election of an Annuity Payment Option, offer more
favorable rates in lieu of the guaranteed rates shown in the Annuity Tables for
Fixed Payment amounts.
16
Annuity Tables
Guaranteed Minimum
Fixed Amount of Monthly Payment
For Each $1,000 Applied
Male, Single Life Annuities, Payment Options One, Two and Four (fixed basis)
--------------------------------------------------------------------------------------------------------------
Adjusted Monthly Payments Certain Adjusted Monthly Payments Certain
Age of ------------------------ Install- Age of ------------------------ Install-
Payee ment Payee ment
None 120 180 240 Refund None 120 180 240 Refund
--------------------------------------------------------------------------------------------------------------
45 3.68 3.66 3.64 3.61 3.59 66 5.63 5.42 5.16 4.84 5.08
46 3.73 3.71 3.69 3.66 3.63 67 5.80 5.56 5.27 4.90 5.20
47 3.78 3.76 3.74 3.70 3.67 68 5.99 5.70 5.37 4.96 5.32
48 3.84 3.81 3.79 3.75 3.72 69 6.19 5.86 5.47 5.02 5.45
49 3.90 3.87 3.84 3.80 3.77 70 6.41 6.01 5.58 5.08 5.59
50 3.96 3.93 3.89 3.85 3.83 71 6.63 6.17 5.68 5.13 5.73
51 4.02 3.99 3.95 3.90 3.88 72 6.88 6.34 5.78 5.18 5.88
52 4.09 4.05 4.01 3.95 3.93 73 7.14 6.51 5.88 5.23 6.04
53 4.16 4.12 4.08 4.01 3.99 74 7.41 6.68 5.98 5.27 6.21
54 4.24 4.19 4.14 4.06 4.05 75 7.71 6.86 6.07 5.31 6.40
55 4.32 4.27 4.21 4.12 4.11 76 8.03 7.04 6.16 5.34 6.59
56 4.40 4.35 4.28 4.18 4.18 77 8.38 7.22 6.25 5.38 6.79
57 4.49 4.43 4.36 4.24 4.25 78 8.75 7.41 6.33 5.40 7.01
58 4.59 4.52 4.43 4.31 4.33 79 9.15 7.59 6.41 5.43 7.23
59 4.69 4.61 4.51 4.37 4.41 80 9.58 7.77 6.48 5.45 7.47
60 4.80 4.71 4.60 4.44 4.49 81 10.03 7.95 6.54 5.46 7.72
61 4.91 4.81 4.69 4.50 4.58 82 10.52 8.12 6.60 5.48 7.98
62 5.04 4.92 4.78 4.57 4.67 83 11.05 8.28 6.65 5.49 8.27
63 5.17 5.04 4.87 4.64 4.76 84 11.61 8.44 6.69 5.50 8.57
64 5.31 5.16 4.97 4.70 4.86 85 12.21 8.59 6.73 5.50 8.88
65 5.47 5.29 5.06 4.77 4.97
--------------------------------------------------------------------------------------------------------------
Female, Single Life Annuities, Payment Options One, Two and Four (fixed basis)
--------------------------------------------------------------------------------------------------------------
Adjusted Monthly Payments Certain Adjusted Monthly Payments Certain
Age of ------------------------ Install- Age of ------------------------ Install-
Payee ment Payee ment
None 120 180 240 Refund None 120 180 240 Refund
--------------------------------------------------------------------------------------------------------------
45 3.43 3.43 3.42 3.41 3.39 66 4.95 4.86 4.75 4.57 4.65
46 3.47 3.47 3.46 3.44 3.43 67 5.08 4.98 4.84 4.64 4.75
47 3.51 3.51 3.50 3.48 3.47 68 5.23 5.11 4.95 4.72 4.86
48 3.56 3.55 3.54 3.52 3.51 69 5.38 5.24 5.05 4.79 4.97
49 3.60 3.59 3.58 3.56 3.55 70 5.55 5.38 5.16 4.86 5.09
50 3.65 3.64 3.63 3.61 3.59 71 5.73 5.53 5.28 4.93 5.22
51 3.70 3.69 3.68 3.65 3.63 72 5.92 5.69 5.39 5.00 5.36
52 3.76 3.74 3.73 3.70 3.68 73 6.13 5.86 5.51 5.07 5.50
53 3.81 3.80 3.78 3.75 3.73 74 6.36 6.03 5.63 5.13 5.66
54 3.87 3.86 3.83 3.80 3.78 75 6.61 6.21 5.74 5.18 5.82
55 3.94 3.92 3.89 3.85 3.83 76 6.88 6.40 5.86 5.23 5.99
56 4.00 3.98 3.95 3.91 3.89 77 7.17 6.60 5.97 5.28 6.18
57 4.07 4.05 4.02 3.97 3.95 78 7.49 6.80 6.07 5.32 6.38
58 4.15 4.12 4.08 4.02 4.01 79 7.83 7.00 6.18 5.36 6.59
59 4.23 4.20 4.15 4.09 4.08 80 8.20 7.21 6.27 5.40 6.80
60 4.31 4.28 4.23 4.15 4.15 81 8.61 7.42 6.36 5.42 7.04
61 4.40 4.36 4.30 4.22 4.22 82 9.05 7.63 6.44 5.45 7.30
62 4.50 4.45 4.38 4.28 4.30 83 9.53 7.83 6.52 5.47 7.56
63 4.60 4.54 4.47 4.35 4.38 84 10.05 8.03 6.59 5.48 7.85
64 4.71 4.64 4.56 4.43 4.47 85 10.62 8.22 6.65 5.49 8.15
65 4.83 4.75 4.65 4.50 4.56
--------------------------------------------------------------------------------------------------------------
17
Annuity Tables
Guaranteed Minimum
Fixed Amount of Monthly Payment
For Each $1,000 Applied
Payment Option Three (fixed basis) Joint and Last Survivor Annuity
------------------------------------------------------------------------------------------------------------------------------------
Adjusted Age of Female Payee
Adjusted
Age of
Male 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
Payee
50 3.52 3.55 3.57 3.59 3.61 3.63 3.65 3.67 3.69 3.71 3.72 3.74 3.75 3.77 3.78 3.80 3.81 3.82 3.83 3.84 3.85
51 3.55 3.57 3.59 3.62 3.64 3.66 3.68 3.70 3.72 3.74 3.76 3.78 3.80 3.81 3.83 3.84 3.86 3.87 3.88 3.89 3.91
52 3.57 3.59 3.62 3.64 3.67 3.69 3.71 3.74 3.76 3.78 3.80 3.82 3.84 3.86 3.87 3.89 3.91 3.92 3.93 3.95 3.96
53 3.59 3.61 3.64 3.67 3.69 3.72 3.74 3.77 3.79 3.82 3.84 3.86 3.88 3.90 3.92 3.94 3.96 3.97 3.99 4.00 4.02
54 3.61 3.64 3.66 3.69 3.72 3.75 3.78 3.80 3.83 3.85 3.88 3.90 3.92 3.95 3.97 3.99 4.01 4.03 4.04 4.06 4.07
55 3.63 3.66 3.69 3.72 3.75 3.78 3.81 3.84 3.86 3.89 3.92 3.94 3.97 3.99 4.02 4.04 4.06 4.08 4.10 4.12 4.13
56 3.65 3.68 3.71 3.74 3.77 3.81 3.84 3.87 3.90 3.93 3.96 3.99 4.01 4.04 4.06 4.09 4.11 4.14 4.16 4.18 4.20
57 3.66 3.70 3.73 3.77 3.80 3.83 3.87 3.90 3.93 3.97 4.00 4.03 4.06 4.09 4.11 4.14 4.17 4.19 4.22 4.24 4.26
58 3.68 3.72 3.75 3.79 3.82 3.86 3.90 3.93 3.97 4.00 4.04 4.07 4.10 4.13 4.17 4.19 4.22 4.25 4.28 4.30 4.33
59 3.70 3.74 3.77 3.81 3.85 3.89 3.93 3.96 4.00 4.04 4.08 4.11 4.15 4.18 4.22 4.25 4.28 4.31 4.34 4.37 4.40
60 3.71 3.75 3.79 3.83 3.87 3.91 3.95 3.99 4.03 4.07 4.11 4.15 4.19 4.23 4.27 4.30 4.34 4.37 4.40 4.44 4.47
61 3.73 3.77 3.81 3.85 3.90 3.94 3.98 4.02 4.07 4.11 4.15 4.20 4.24 4.28 4.32 4.36 4.40 4.43 4.47 4.50 4.54
62 3.74 3.79 3.83 3.87 3.92 3.96 4.01 4.05 4.10 4.15 4.19 4.24 4.28 4.33 4.37 4.41 4.46 4.50 4.54 4.57 4.61
63 3.76 3.80 3.85 3.89 3.94 3.99 4.03 4.08 4.13 4.18 4.23 4.28 4.33 4.37 4.42 4.47 4.51 4.56 4.60 4.65 4.69
64 3.77 3.82 3.86 3.91 3.96 4.01 4.06 4.11 4.16 4.21 4.27 4.32 4.37 4.42 4.47 4.52 4.57 4.62 4.67 4.72 4.76
65 3.78 3.83 3.88 3.93 3.98 4.03 4.08 4.14 4.19 4.25 4.30 4.36 4.41 4.47 4.52 4.58 4.63 4.69 4.74 4.79 4.84
66 3.79 3.84 3.89 3.94 4.00 4.05 4.11 4.16 4.22 4.28 4.34 4.39 4.45 4.51 4.57 4.63 4.69 4.75 4.81 4.86 4.92
67 3.81 3.86 3.91 3.96 4.01 4.07 4.13 4.19 4.25 4.31 4.37 4.43 4.49 4.56 4.62 4.68 4.75 4.81 4.87 4.94 5.00
68 3.82 3.87 3.92 3.97 4.03 4.09 4.15 4.21 4.27 4.34 4.40 4.47 4.53 4.60 4.67 4.74 4.81 4.87 4.94 5.01 5.08
69 3.82 3.88 3.93 3.99 4.05 4.11 4.17 4.23 4.30 4.36 4.43 4.50 4.57 4.64 4.71 4.79 4.86 4.94 5.01 5.08 5.15
70 3.83 3.89 3.94 4.00 4.06 4.12 4.19 4.25 4.32 4.39 4.46 4.53 4.61 4.68 4.76 4.84 4.92 5.00 5.07 5.15 5.23
71 3.84 3.90 3.95 4.01 4.07 4.14 4.20 4.27 4.34 4.41 4.49 4.56 4.64 4.72 4.80 4.89 4.97 5.05 5.14 5.22 5.31
72 3.85 3.90 3.96 4.02 4.09 4.15 4.22 4.29 4.36 4.44 4.51 4.59 4.67 4.76 4.84 4.93 5.02 5.11 5.20 5.29 5.39
73 3.86 3.91 3.97 4.03 4.10 4.16 4.23 4.31 4.38 4.46 4.54 4.62 4.71 4.79 4.88 4.98 5.07 5.17 5.26 5.36 5.46
74 3.86 3.92 3.98 4.04 4.11 4.18 4.25 4.32 4.40 4.48 4.56 4.65 4.74 4.83 4.92 5.02 5.12 5.22 5.32 5.43 5.53
75 3.87 3.93 3.99 4.05 4.12 4.19 4.26 4.34 4.41 4.50 4.58 4.67 4.76 4.86 4.96 5.06 5.16 5.27 5.38 5.49 5.60
76 3.87 3.93 3.99 4.06 4.13 4.20 4.27 4.35 4.43 4.51 4.60 4.69 4.79 4.89 4.99 5.10 5.21 5.32 5.43 5.55 5.67
77 3.88 3.94 4.00 4.07 4.13 4.21 4.28 4.36 4.44 4.53 4.62 4.72 4.81 4.92 5.02 5.13 5.25 5.37 5.49 5.61 5.74
78 3.88 3.94 4.01 4.07 4.14 4.22 4.29 4.37 4.46 4.55 4.64 4.74 4.84 4.94 5.05 5.17 5.29 5.41 5.54 5.67 5.80
79 3.89 3.95 4.01 4.08 4.15 4.22 4.30 4.38 4.47 4.56 4.65 4.75 4.86 4.97 5.08 5.20 5.32 5.45 5.58 5.72 5.86
80 3.89 3.95 4.02 4.08 4.16 4.23 4.31 4.39 4.48 4.57 4.67 4.77 4.88 4.99 5.10 5.23 5.36 5.49 5.63 5.77 5.92
Monthly payment for ages not shown will be furnished by the Company on request.
------------------------------------------------------------------------------------------------------------------------------------
Payment Option Five (fixed basis) Payment for a Designated Period
-------------------------------------------------------------------------------------------------------------------------------
Amount of Monthly Amount of Monthly Amount of Monthly
Years of Payments Payment Years of Payments Payment Years of Payment Payment
-------------------------------------------------------------------------------------------------------------------------------
10 9.61 17 6.23 24 4.84
11 8.86 18 5.96 25 4.71
12 8.24 19 5.73 26 4.59
13 7.71 20 5.51 27 4.47
14 7.26 21 5.32 28 4.37
15 6.87 22 5.15 29 4.27
16 6.53 23 4.99 30 4.18
-------------------------------------------------------------------------------------------------------------------------------
18
Annuity Tables
Payment Options Applied on a Variable Basis
Amount of First Monthly Payment
For Each $1,000 Applied
Male, Single Life Annuities, Payment Options One, Two and Four (variable basis)
Monthly Payments Certain Monthly Payments Certain
------------------------ ------------------------
Adjusted Adjusted
Age of Unit Age of Unit
Payee None 120 180 240 Refund Payee None 120 180 240 Refund
---------------------------------------------------------------------------------------------------------------------------------
45 4.28 4.27 4.24 4.21 4.21 66 6.22 5.98 5.70 5.36 5.73
46 4.33 4.31 4.29 4.25 4.25 67 6.39 6.11 5.80 5.42 5.85
47 4.39 4.36 4.33 4.29 4.29 68 6.58 6.26 5.90 5.48 5.98
48 4.44 4.41 4.38 4.34 4.34 69 6.78 6.40 6.00 5.54 6.12
49 4.50 4.47 4.43 4.38 4.39 70 7.00 6.56 6.10 5.59 6.26
50 4.56 4.52 4.48 4.43 4.44 71 7.23 6.71 6.20 5.64 6.41
51 4.62 4.58 4.54 4.48 4.49 72 7.47 6.88 6.29 5.69 6.58
52 4.69 4.64 4.59 4.53 4.55 73 7.73 7.04 6.39 5.73 6.75
53 4.76 4.71 4.65 4.58 4.61 74 8.01 7.21 6.48 5.77 6.93
54 4.83 4.78 4.72 4.63 4.67 75 8.31 7.39 6.57 5.81 7.12
55 4.91 4.85 4.78 4.69 4.74 76 8.64 7.56 6.66 5.84 7.32
56 4.99 4.93 4.85 4.74 4.81 77 8.98 7.74 6.74 5.87 7.53
57 5.08 5.01 4.92 4.80 4.88 78 9.36 7.92 6.82 5.90 7.75
58 5.17 5.09 5.00 4.86 4.95 79 9.76 8.09 6.89 5.92 7.99
59 5.28 5.19 5.08 4.92 5.03 80 10.19 8.27 6.96 5.94 8.24
60 5.38 5.28 5.16 4.99 5.12 81 10.65 8.44 7.02 5.96 8.52
61 5.50 5.38 5.24 5.05 5.21 82 11.14 8.60 7.07 5.97 8.80
62 5.62 5.49 5.33 5.11 5.30 83 11.67 8.76 7.12 5.98 9.11
63 5.76 5.60 5.42 5.17 5.40 84 12.24 8.91 7.17 5.99 9.42
64 5.90 5.72 5.51 5.24 5.50 85 12.84 9.06 7.20 5.99 9.75
65 6.05 5.85 5.60 5.30 5.61
--------------------------------------------------------------------------------------------------------------------------------
Female, Single Life Annuities, Payment Options One,
Two and Four (variable basis)
Monthly Payments Certain Monthly Payments Certain
------------------------ ------------------------
Adjusted Adjusted
Age of Unit Age of Unit
Payee None 120 180 240 Refund Payee None 120 180 240 Refund
--------------------------------------------------------------------------------------------------------------------------------
45 4.05 4.04 4.03 4.01 4.01 66 5.52 5.42 5.29 5.11 5.27
46 4.08 4.07 4.06 4.05 4.04 67 5.65 5.54 5.39 5.18 5.37
47 4.12 4.11 4.10 4.08 4.08 68 5.80 5.66 5.49 5.25 5.48
48 4.16 4.15 4.14 4.12 4.12 69 5.95 5.79 5.59 5.32 5.60
49 4.21 4.20 4.18 4.16 4.16 70 6.12 5.93 5.70 5.39 5.72
50 4.25 4.24 4.22 4.20 4.20 71 6.30 6.08 5.81 5.45 5.86
51 4.30 4.29 4.27 4.24 4.24 72 6.49 6.23 5.92 5.52 6.00
52 4.35 4.34 4.31 4.28 4.29 73 6.71 6.40 6.03 5.58 6.15
53 4.41 4.39 4.36 4.33 4.34 74 6.94 6.57 6.14 5.64 6.31
54 4.47 4.44 4.42 4.38 4.39 75 7.19 6.74 6.25 5.69 6.48
55 4.53 4.50 4.47 4.43 4.44 76 7.46 6.93 6.36 5.74 6.66
56 4.59 4.56 4.53 4.48 4.50 77 7.75 7.12 6.47 5.78 6.86
57 4.66 4.63 4.59 4.53 4.56 78 8.07 7.32 6.57 5.82 7.07
58 4.73 4.70 4.65 4.59 4.62 79 8.41 7.52 6.67 5.86 7.30
59 4.81 4.77 4.72 4.65 4.68 80 8.79 7.72 6.76 5.89 7.53
60 4.89 4.85 4.79 4.71 4.75 81 9.20 7.92 6.85 5.92 7.78
61 4.98 4.93 4.87 4.77 4.83 82 9.64 8.12 6.93 5.94 8.04
62 5.08 5.02 4.94 4.84 4.91 83 10.13 8.32 7.00 5.96 8.33
63 5.18 5.11 5.02 4.90 4.99 84 10.65 8.51 7.06 5.97 8.62
64 5.28 5.21 5.11 4.97 5.07 85 11.22 8.70 7.12 5.98 8.97
65 5.40 5.31 5.20 5.04 5.17
--------------------------------------------------------------------------------------------------------------------------------
19
Annuity Tables
Payment Options applied on a Variable Basis
Amount of First Monthly Payment
For Each $1,000 Applied
Payment Option Three (variable basis) Joint and Last Survivor Annuity
------------------------------------------------------------------------------------------------------------------------------------
Adjusted Age of Female Payee
Adjusted
Age of
Male
Payee 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
50 4.11 4.13 4.15 4.17 4.19 4.21 4.23 4.25 4.27 4.29 4.30 4.32 4.34 4.35 4.37 4.38 4.39 4.41 4.42 4.43 4.44
51 4.13 4.16 4.18 4.20 4.22 4.24 4.26 4.28 4.30 4.32 4.34 4.36 4.38 4.39 4.41 4.42 4.44 4.45 4.46 4.48 4.49
52 4.15 4.18 4.20 4.22 4.25 4.27 4.29 4.31 4.34 4.36 4.38 4.40 4.41 4.43 4.45 4.47 4.48 4.50 4.51 4.53 4.54
53 4.17 4.20 4.22 4.25 4.27 4.30 4.32 4.35 4.37 4.39 4.41 4.43 4.46 4.48 4.49 4.51 4.53 4.55 4.56 4.58 4.59
54 4.19 4.22 4.24 4.27 4.30 4.32 4.35 4.38 4.40 4.43 4.45 4.47 4.50 4.52 4.54 4.56 4.58 4.60 4.62 4.63 4.65
55 4.21 4.24 4.27 4.30 4.32 4.35 4.38 4.41 4.43 4.46 4.49 4.51 4.54 4.56 4.59 4.61 4.63 4.65 4.67 4.69 4.71
56 4.23 4.26 4.29 4.32 4.35 4.38 4.41 4.44 4.47 4.50 4.52 4.55 4.58 4.61 4.63 4.66 4.68 4.70 4.73 4.75 4.77
57 4.24 4.28 4.31 4.34 4.37 4.41 4.44 4.47 4.50 4.53 4.56 4.59 4.62 4.65 4.68 4.71 4.73 4.76 4.78 4.81 4.83
58 4.26 4.29 4.33 4.36 4.40 4.43 4.47 4.50 4.53 4.57 4.60 4.63 4.67 4.70 4.73 4.76 4.79 4.81 4.84 4.87 4.89
59 4.28 4.31 4.35 4.38 4.42 4.46 4.49 4.53 4.57 4.60 4.64 4.67 4.71 4.74 4.78 4.81 4.84 4.87 4.90 4.93 4.96
60 4.29 4.33 4.37 4.40 4.44 4.48 4.52 4.56 4.60 4.64 4.68 4.71 4.75 4.79 4.82 4.86 4.90 4.93 4.96 4.99 5.02
61 4.31 4.35 4.39 4.43 4.47 4.51 4.55 4.59 4.63 4.67 4.71 4.75 4.79 4.83 4.87 4.91 4.95 4.99 5.03 5.06 5.09
62 4.32 4.36 4.40 4.44 4.49 4.53 4.57 4.62 4.66 4.71 4.75 4.79 4.84 4.88 4.92 4.97 5.01 5.05 5.09 5.13 5.17
63 4.34 4.38 4.42 4.46 4.51 4.55 4.60 4.64 4.69 4.74 4.79 4.83 4.88 4.93 4.97 5.02 5.07 5.11 5.15 5.20 5.24
64 4.35 4.39 4.44 4.48 4.53 4.57 4.62 4.67 4.72 4.77 4.82 4.87 4.92 4.97 5.02 5.07 5.12 5.17 5.22 5.27 5.31
65 4.36 4.41 4.45 4.50 4.55 4.60 4.65 4.70 4.75 4.80 4.86 4.91 4.96 5.02 5.07 5.13 5.18 5.23 5.29 5.34 5.39
66 4.37 4.42 4.47 4.52 4.57 4.62 4.67 4.72 4.78 4.83 4.89 4.95 5.00 5.06 5.12 5.18 5.24 5.30 5.35 5.41 5.46
67 4.38 4.43 4.48 4.53 4.58 4.64 4.69 4.75 4.80 4.86 4.92 4.98 5.04 5.11 5.17 5.23 5.29 5.36 5.42 5.48 5.54
68 4.39 4.44 4.49 4.55 4.60 4.65 4.71 4.77 4.83 4.89 4.95 5.02 5.08 5.15 5.22 5.28 5.35 5.42 5.49 5.55 5.62
69 4.40 4.45 4.51 4.56 4.61 4.67 4.73 4.79 4.85 4.92 4.98 5.05 5.12 5.19 5.26 5.33 5.41 5.48 5.55 5.62 5.70
70 4.41 4.46 4.52 4.57 4.63 4.69 4.75 4.81 4.88 4.94 5.01 5.08 5.16 5.23 5.31 5.38 5.46 5.54 5.62 5.69 5.77
71 4.42 4.47 4.53 4.58 4.64 4.70 4.77 4.83 4.90 4.97 5.04 5.12 5.19 5.27 5.35 5.43 5.51 5.60 5.68 5.76 5.85
72 4.43 4.48 4.54 4.60 4.66 4.72 4.78 4.85 4.92 4.99 5.07 5.15 5.22 5.31 5.39 5.48 5.56 5.65 5.74 5.83 5.92
73 4.44 4.49 4.55 4.61 4.67 4.73 4.80 4.87 4.94 5.02 5.09 5.17 5.26 5.34 5.43 5.52 5.61 5.71 5.80 5.90 6.00
74 4.44 4.50 4.56 4.62 4.68 4.74 4.81 4.88 4.96 5.04 5.12 5.20 5.29 5.38 5.47 5.56 5.66 5.76 5.86 5.97 6.07
75 4.45 4.51 4.56 4.63 4.69 4.76 4.83 4.90 4.98 5.06 5.14 5.22 5.31 5.41 5.50 5.60 5.71 5.81 5.92 6.03 6.14
76 4.46 4.51 4.57 4.63 4.70 4.77 4.84 4.91 4.99 5.07 5.16 5.25 5.34 5.44 5.54 5.64 5.75 5.86 5.98 6.09 6.21
77 4.46 4.52 4.58 4.64 4.71 4.78 4.85 4.93 5.01 5.09 5.18 5.27 5.37 5.47 5.57 5.68 5.79 5.91 6.03 6.15 6.28
78 4.47 4.52 4.59 4.65 4.72 4.79 4.86 4.94 5.02 5.11 5.20 5.29 5.39 5.49 5.60 5.71 5.83 5.95 6.08 6.21 6.34
79 4.47 4.53 4.59 4.66 4.72 4.80 4.87 4.95 5.03 5.12 5.21 5.31 5.41 5.52 5.63 5.75 5.87 6.00 6.13 6.26 6.40
80 4.48 4.53 4.60 4.66 4.73 4.80 4.88 4.96 5.05 5.14 5.23 5.33 5.43 5.54 5.66 5.78 5.90 6.04 6.17 6.32 6.46
Monthly payment for ages not shown will be furnished by the Company on request.
------------------------------------------------------------------------------------------------------------------------------------
20
Annuity Tables
Guaranteed Minimum
Fixed Amount of Monthly Payment
For Each $1,000 Applied
Unisex, Single Life Annuities, Payment Options One, Two and Four (fixed basis)
------------------------------------------------------------------------------------------------------------------------------
Monthly Payments Certain Monthly Payments Certain
------------------------ ------------------------
Adjusted Install- Adjusted Install-
Age of ment Age of ment
Payee None 120 180 240 Refund Payee None 120 180 240 Refund
------------------------------------------------------------------------------------------------------------------------------
45 3.53 3.52 3.51 3.49 3.47 66 5.22 5.09 4.92 4.69 4.82
46 3.58 3.57 3.55 3.53 3.51 67 5.37 5.22 5.02 4.76 4.93
47 3.62 3.61 3.60 3.57 3.55 68 5.53 5.35 5.13 4.82 5.04
48 3.67 3.66 3.64 3.62 3.60 69 5.70 5.49 5.23 4.89 5.16
49 3.72 3.71 3.69 3.66 3.64 70 5.89 5.64 5.34 4.96 5.29
50 3.78 3.76 3.74 3.71 3.69 71 6.09 5.80 5.45 5.02 5.42
51 3.83 3.81 3.79 3.75 3.73 72 6.30 5.96 5.56 5.08 5.57
52 3.89 3.87 3.84 3.80 3.78 73 6.53 6.13 5.67 5.14 5.72
53 3.96 3.93 3.90 3.86 3.84 74 6.78 6.30 5.78 5.19 5.87
54 4.02 4.00 3.96 3.91 3.89 75 7.05 6.48 5.89 5.24 6.05
55 4.09 4.06 4.02 3.97 3.95 76 7.34 6.67 5.99 5.28 6.23
56 4.17 4.13 4.09 4.02 4.01 77 7.65 6.86 6.09 5.32 6.42
57 4.24 4.21 4.16 4.08 4.08 78 7.99 7.05 6.19 5.36 6.62
58 4.33 4.28 4.23 4.14 4.14 79 8.35 7.25 6.28 5.39 6.84
59 4.42 4.37 4.30 4.21 4.21 80 8.74 7.45 6.36 5.42 7.07
60 4.51 4.45 4.38 4.27 4.29 81 9.17 7.64 6.44 5.44 7.32
61 4.61 4.55 4.46 4.34 4.37 82 9.63 7.84 6.51 5.46 7.57
62 4.72 4.64 4.55 4.41 4.45 83 10.13 8.02 6.58 5.48 7.84
63 4.83 4.75 4.64 4.48 4.53 84 10.67 8.20 6.63 5.49 8.13
64 4.95 4.86 4.73 4.55 4.63 85 11.25 8.38 6.69 5.50 8.44
65 5.08 4.97 4.82 4.62 4.72
------------------------------------------------------------------------------------------------------------------------------
21
Annuity Tables
Guaranteed Minimum
Fixed Amount of Monthly Payment
For Each $1,000 Applied
Payment Option Three (fixed basis)
Unisex Joint and Last Survivor Annuity
Adjusted Age of Joint Payee
Adjusted
Age of
First
Payee
55 56 57 58 59 60 61 62 63 64 65
50 3.50 3.51 3.53 3.55 3.56 3.58 3.59 3.60 3.61 3.63 3.64
51 3.52 3.54 3.56 3.58 3.59 3.61 3.62 3.64 3.65 3.67 3.68
52 3.55 3.57 3.59 3.61 3.62 3.64 3.66 3.67 3.69 3.70 3.72
53 3.57 3.60 3.62 3.64 3.66 3.68 3.69 3.71 3.73 3.74 3.76
54 3.60 3.62 3.64 3.67 3.69 3.71 3.73 3.75 3.77 3.78 3.80
55 3.62 3.65 3.67 3.70 3.72 3.74 3.76 3.79 3.81 3.83 3.85
56 3.65 3.68 3.70 3.73 3.75 3.78 3.80 3.82 3.85 3.87 3.89
57 3.67 3.70 3.73 3.76 3.78 3.81 3.84 3.86 3.89 3.91 3.93
58 3.70 3.73 3.76 3.79 3.82 3.84 3.87 3.90 3.93 3.95 3.98
59 3.72 3.75 3.78 3.81 3.85 3.88 3.91 3.94 3.97 4.00 4.02
60 3.74 3.78 3.81 3.84 3.88 3.91 3.94 3.98 4.01 4.04 4.07
61 3.76 3.80 3.83 3.87 3.91 3.94 3.98 4.01 4.05 4.08 4.11
62 3.78 3.82 3.86 3.90 3.94 3.97 4.01 4.05 4.09 4.12 4.16
63 3.80 3.84 3.88 3.92 3.96 4.01 4.05 4.09 4.13 4.17 4.21
64 3.82 3.86 3.91 3.95 3.99 4.04 4.08 4.12 4.17 4.21 4.25
65 3.84 3.88 3.93 3.97 4.02 4.07 4.11 4.16 4.20 4.25 4.30
66 3.86 3.90 3.95 4.00 4.05 4.09 4.14 4.19 4.24 4.29 4.34
67 3.87 3.92 3.97 4.02 4.07 4.12 4.17 4.23 4.28 4.33 4.38
68 3.89 3.94 3.99 4.04 4.10 4.15 4.20 4.26 4.31 4.37 4.43
69 3.91 3.96 4.01 4.06 4.12 4.17 4.23 4.29 4.35 4.41 4.47
70 3.92 3.97 4.03 4.08 4.14 4.20 4.26 4.32 4.38 4.44 4.51
71 3.93 3.99 4.04 4.10 4.16 4.22 4.28 4.35 4.41 4.48 4.55
72 3.95 4.00 4.06 4.12 4.18 4.24 4.31 4.38 4.44 4.51 4.59
73 3.96 4.01 4.07 4.14 4.20 4.26 4.33 4.40 4.47 4.55 4.62
74 3.97 4.03 4.09 4.15 4.22 4.28 4.35 4.43 4.50 4.58 4.66
75 3.98 4.04 4.10 4.17 4.23 4.30 4.38 4.45 4.53 4.61 4.69
76 3.99 4.05 4.11 4.18 4.25 4.32 4.39 4.47 4.55 4.64 4.72
77 4.00 4.06 4.12 4.19 4.26 4.34 4.41 4.49 4.58 4.66 4.75
78 4.00 4.07 4.13 4.20 4.27 4.35 4.43 4.51 4.60 4.69 4.78
79 4.01 4.08 4.14 4.21 4.29 4.36 4.44 4.53 4.62 4.71 4.80
80 4.02 4.08 4.15 4.22 4.30 4.38 4.46 4.55 4.64 4.73 4.83
66 67 68 69 70 71 72 73 74 75
50 3.65 3.66 3.67 3.68 3.68 3.69 3.70 3.71 3.71 3.72
51 3.69 3.70 3.71 3.72 3.73 3.74 3.75 3.75 3.76 3.77
52 3.73 3.74 3.76 3.77 3.78 3.79 3.80 3.80 3.81 3.82
53 3.77 3.79 3.80 3.81 3.83 3.84 3.85 3.86 3.86 3.87
54 3.82 3.83 3.85 3.86 3.87 3.89 3.90 3.91 3.92 3.93
55 3.86 3.88 3.90 3.91 3.93 3.94 3.95 3.96 3.98 3.99
56 3.91 3.93 3.95 3.96 3.98 3.99 4.01 4.02 4.03 4.05
57 3.95 3.98 4.00 4.02 4.03 4.05 4.07 4.08 4.10 4.11
58 4.00 4.03 4.05 4.07 4.09 4.11 4.13 4.14 4.16 4.17
59 4.05 4.08 4.10 4.12 4.15 4.17 4.19 4.21 4.22 4.24
60 4.10 4.13 4.15 4.18 4.20 4.23 4.25 4.27 4.29 4.31
61 4.15 4.18 4.21 4.24 4.26 4.29 4.32 4.34 4.36 4.38
62 4.20 4.23 4.26 4.29 4.33 4.35 4.38 4.41 4.44 4.46
63 4.24 4.28 4.32 4.35 4.39 4.42 4.45 4.48 4.51 4.54
64 4.29 4.33 4.37 4.41 4.45 4.49 4.52 4.55 4.59 4.62
65 4.34 4.39 4.43 4.47 4.51 4.55 4.59 4.63 4.66 4.70
66 4.39 4.44 4.48 4.53 4.58 4.62 4.66 4.70 4.74 4.78
67 4.44 4.49 4.54 4.59 4.64 4.69 4.74 4.78 4.83 4.87
68 4.48 4.54 4.59 4.65 4.70 4.76 4.81 4.86 4.91 4.96
69 4.53 4.59 4.65 4.71 4.77 4.82 4.88 4.94 4.99 5.04
70 4.57 4.64 4.70 4.77 4.83 4.89 4.96 5.02 5.08 5.13
71 4.62 4.68 4.75 4.82 4.89 4.96 5.03 5.10 5.16 5.23
72 4.66 4.73 4.80 4.88 4.95 5.03 5.10 5.17 5.25 5.32
73 4.70 4.78 4.85 4.93 5.01 5.09 5.17 5.25 5.33 5.41
74 4.74 4.82 4.90 4.99 5.07 5.16 5.24 5.33 5.41 5.50
75 4.77 4.86 4.95 5.04 5.13 5.22 5.31 5.41 5.50 5.59
76 4.81 4.90 4.99 5.09 5.18 5.28 5.38 5.48 5.58 5.68
77 4.84 4.94 5.03 5.13 5.24 5.34 5.45 5.55 5.66 5.77
78 4.87 4.97 5.07 5.18 5.29 5.40 5.51 5.62 5.74 5.85
79 4.90 5.01 5.11 5.22 5.33 5.45 5.57 5.69 5.81 5.94
80 4.93 5.04 5.15 5.26 5.38 5.50 5.63 5.75 5.88 6.02
Monthly payment for ages not shown will be furnished by the Company on request.
Payment Option Five (fixed basis) Payment for a Designated Period
Amount of Amount of Amount of
Years of Monthly Years of Monthly Years of Monthly
Payments Payment Payments Payment Payments Payment
--------------------------------------------------------------------------------
10 9.61 17 6.23 24 4.84
11 8.86 18 5.96 25 4.71
12 8.24 19 5.73 26 4.59
13 7.71 20 5.51 27 4.47
14 7.26 21 5.32 28 4.37
15 6.87 22 5.15 29 4.27
16 6.53 23 4.99 30 4.18
----------------------------------------------------------------------------------
22
Annuity Tables
Payment Options Applied on a Variable Basis
Amount of First Monthly Payment
For Each $1,000 Applied
Unisex, Single Life Annuities,
Payment Options One, Two and Four (variable basis)
Monthly Payments Certain Monthly Payments Certain
------------------------ ------------------------
Adjusted Adjusted
Age of Unit Age of Unit
Payee None 120 180 240 Refund Payee None 120 180 240 Refund
------------------------------------------------------------------------------------------------------------------
45 4.14 4.13 4.12 4.10 4.09 66 5.80 5.65 5.46 5.22 5.45
46 4.19 4.17 4.16 4.13 4.13 67 5.95 5.77 5.56 5.28 5.57
47 4.23 4.22 4.20 4.17 4.17 68 6.11 5.91 5.66 5.35 5.69
48 4.28 4.26 4.24 4.21 4.21 69 6.28 6.04 5.76 5.41 5.81
49 4.33 4.31 4.28 4.25 4.25 70 6.47 6.19 5.87 5.48 5.94
50 4.38 4.36 4.33 4.29 4.30 71 6.67 6.34 5.97 5.54 6.08
51 4.43 4.41 4.38 4.34 4.35 72 6.88 6.50 6.08 5.59 6.23
52 4.49 4.46 4.43 4.39 4.40 73 7.11 6.66 6.18 5.65 6.39
53 4.55 4.52 4.48 4.43 4.45 74 7.36 6.84 6.29 5.70 6.56
54 4.61 4.58 4.54 4.49 4.50 75 7.63 7.01 6.39 5.74 6.74
55 4.68 4.65 4.60 4.54 4.56 76 7.92 7.19 6.49 5.79 6.92
56 4.75 4.71 4.66 4.59 4.62 77 8.24 7.38 6.59 5.82 7.13
57 4.83 4.79 4.73 4.65 4.69 78 8.58 7.57 6.68 5.86 7.34
58 4.91 4.86 4.80 4.71 4.76 79 8.94 7.76 6.77 5.89 7.57
59 5.00 4.94 4.87 4.77 4.83 80 9.34 7.95 6.85 5.91 7.81
60 5.09 5.03 4.94 4.83 4.90 81 9.77 8.14 6.92 5.94 8.07
61 5.19 5.12 5.02 4.89 4.98 82 10.23 8.33 6.99 5.96 8.34
62 5.30 5.21 5.10 4.95 5.07 83 10.73 8.51 7.05 5.97 8.63
63 5.41 5.31 5.19 5.02 5.16 84 11.28 8.69 7.11 5.98 8.95
64 5.53 5.42 5.28 5.09 5.25 85 11.86 8.85 7.16 5.99 9.27
65 5.66 5.53 5.37 5.15 5.35
------------------------------------------------------------------------------------------------------------------
23
Annuity Tables
Payment Options applied on a Variable Basis
Amount of First Monthly Payment
For Each $1,000 Applied
Payment Option Three (variable basis) Unisex Joint and Last Survivor Annuity
-------------------------------------------------------------------------------------------------------------------------------
Adjusted Adjusted Age of Joint Payee
Age of
First
Payee 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69
50 4.09 4.10 4.12 4.14 4.15 4.16 4.18 4.19 4.20 4.21 4.23 4.24 4.25 4.26 4.27
51 4.11 4.13 4.15 4.16 4.18 4.19 4.21 4.22 4.24 4.25 4.26 4.27 4.29 4.30 4.31
52 4.14 4.16 4.17 4.19 4.21 4.23 4.24 4.26 4.27 4.29 4.30 4.31 4.33 4.34 4.35
53 4.16 4.18 4.20 4.22 4.24 4.26 4.27 4.29 4.31 4.32 4.34 4.35 4.37 4.38 4.39
54 4.18 4.21 4.23 4.25 4.27 4.29 4.31 4.33 4.34 4.36 4.38 4.40 4.41 4.43 4.44
55 4.21 4.23 4.25 4.28 4.30 4.32 4.34 4.36 4.38 4.40 4.42 4.44 4.45 4.47 4.49
56 4.23 4.26 4.28 4.30 4.33 4.35 4.37 4.40 4.42 4.44 4.46 4.48 4.50 4.52 4.53
57 4.25 4.28 4.31 4.33 4.36 4.38 4.41 4.43 4.46 4.48 4.50 4.52 4.55 4.57 4.58
58 4.28 4.30 4.33 4.36 4.39 4.42 4.44 4.47 4.50 4.52 4.55 4.57 4.59 4.61 4.64
59 4.30 4.33 4.36 4.39 4.42 4.45 4.48 4.51 4.53 4.56 4.59 4.61 4.64 4.66 4.69
60 4.32 4.35 4.38 4.41 4.45 4.48 4.51 4.54 4.57 4.60 4.63 4.66 4.69 4.72 4.74
61 4.34 4.37 4.41 4.44 4.48 4.51 4.54 4.58 4.61 4.64 4.68 4.71 4.74 4.77 4.80
62 4.36 4.40 4.43 4.47 4.50 4.54 4.58 4.61 4.65 4.68 4.72 4.75 4.79 4.82 4.85
63 4.38 4.42 4.45 4.49 4.53 4.57 4.61 4.65 4.69 4.73 4.76 4.80 4.84 4.87 4.91
64 4.40 4.44 4.48 4.52 4.56 4.60 4.64 4.68 4.73 4.77 4.81 4.85 4.89 4.93 4.97
65 4.42 4.46 4.50 4.54 4.59 4.63 4.67 4.72 4.76 4.81 4.85 4.89 4.94 4.98 5.02
66 4.43 4.48 4.52 4.57 4.61 4.66 4.70 4.75 4.80 4.85 4.89 4.94 4.99 5.03 5.08
67 4.45 4.50 4.54 4.59 4.64 4.69 4.73 4.78 4.84 4.89 4.94 4.99 5.04 5.09 5.14
68 4.47 4.51 4.56 4.61 4.66 4.71 4.76 4.82 4.87 4.92 4.98 5.03 5.09 5.14 5.20
69 4.48 4.53 4.58 4.63 4.68 4.74 4.79 4.85 4.90 4.96 5.02 5.08 5.14 5.20 5.25
70 4.50 4.55 4.60 4.65 4.71 4.76 4.82 4.88 4.94 5.00 5.06 5.12 5.19 5.25 5.31
71 4.51 4.56 4.61 4.67 4.73 4.79 4.85 4.91 4.97 5.03 5.10 5.17 5.23 5.30 5.37
72 4.52 4.58 4.63 4.69 4.75 4.81 4.87 4.93 5.00 5.07 5.14 5.21 5.28 5.35 5.42
73 4.53 4.59 4.65 4.70 4.77 4.83 4.89 4.96 5.03 5.10 5.17 5.25 5.32 5.40 5.48
74 4.55 4.60 4.66 4.72 4.78 4.85 4.92 4.99 5.06 5.13 5.21 5.29 5.37 5.45 5.53
75 4.56 4.61 4.67 4.74 4.80 4.87 4.94 5.01 5.09 5.16 5.24 5.32 5.41 5.49 5.58
76 4.57 4.63 4.69 4.75 4.82 4.89 4.96 5.03 5.11 5.19 5.28 5.36 5.45 5.54 5.63
77 4.58 4.64 4.70 4.76 4.83 4.90 4.98 5.05 5.14 5.22 5.31 5.40 5.49 5.58 5.68
78 4.58 4.65 4.71 4.78 4.85 4.92 5.00 5.07 5.16 5.24 5.33 5.43 5.52 5.62 5.73
79 4.59 4.65 4.72 4.79 4.86 4.93 5.01 5.09 5.18 5.27 5.36 5.46 5.56 5.66 5.77
80 4.60 4.66 4.73 4.80 4.87 4.95 5.03 5.11 5.20 5.29 5.39 5.49 5.59 5.70 5.81
Adjusted Adjusted Age of Joint Payee
Age of
First
Payee 70 71 72 73 74 75
50 4.27 4.28 4.29 4.30 4.30 4.31
51 4.32 4.33 4.33 4.34 4.35 4.36
52 4.36 4.37 4.38 4.39 4.40 4.41
53 4.41 4.42 4.43 4.44 4.45 4.46
54 4.45 4.47 4.48 4.49 4.50 4.51
55 4.50 4.52 4.53 4.54 4.55 4.56
56 4.55 4.57 4.58 4.60 4.61 4.62
57 4.60 4.62 4.64 4.65 4.67 4.68
58 4.66 4.68 4.69 4.71 4.73 4.74
59 4.71 4.73 4.75 4.77 4.79 4.81
60 4.77 4.79 4.81 4.84 4.86 4.88
61 4.82 4.85 4.88 4.90 4.92 4.95
62 4.88 4.91 4.94 4.97 4.99 5.02
63 4.94 4.97 5.01 5.04 5.07 5.09
64 5.00 5.04 5.07 5.11 5.14 5.17
65 5.06 5.10 5.14 5.18 5.22 5.25
66 5.13 5.17 5.21 5.25 5.29 5.33
67 5.19 5.24 5.28 5.33 5.37 5.42
68 5.25 5.30 5.35 5.40 5.45 5.50
69 5.31 5.37 5.43 5.48 5.54 5.59
70 5.37 5.44 5.50 5.56 5.62 5.68
71 5.44 5.50 5.57 5.64 5.70 5.77
72 5.50 5.57 5.64 5.71 5.79 5.86
73 5.56 5.63 5.71 5.79 5.87 5.95
74 5.61 5.70 5.78 5.87 5.95 6.04
75 5.67 5.76 5.85 5.94 6.04 6.13
76 5.73 5.82 5.92 6.02 6.12 6.22
77 5.78 5.88 5.99 6.09 6.20 6.30
78 5.83 5.94 6.05 6.16 6.27 6.39
79 5.88 5.99 6.11 6.23 6.35 6.47
80 5.93 6.05 6.17 6.30 6.42 6.56
Monthly payment for ages not shown will be furnished by the Company on request.
-------------------------------------------------------------------------------------------------------------------------------
24
One-Year Guaranteed Rate Fixed Account Option Rider
This rider has been attached to and made a permanent part of your Contract as of
the original Contract Date. Subject to the provisions of this rider and of your
Contract, we will provide the benefits described below should you choose to
allocate a portion of your Net Purchase Payment(s) to this Fixed Account Option.
Definitions
"Exchange" - One Exchange will be deemed to occur with each voluntary transfer
from any Subaccount or any Fixed Account Option available under your Contract.
"Fixed Account" - The Fixed Account, which is part of our General Account,
consists of Accumulated Values that are allocated to it from contracts similar
to this one. We will credit these values with interest as specified in the One-
Year Guaranteed Rate Option provision, until the Annuity Date.
"General Account" - The account that contains all of our assets other than those
held in our separate accounts.
Allocations to the Fixed Account
You determine, using whole percentages, what portion of your initial Net
Purchase Payment will be allocated to this Option shown on the Schedule Page.
You may choose to allocate nothing to this Fixed Account Option. Any allocations
you do make must be at least $1,000 for Non-qualified or Qualified Contracts.
The minimum balance for this Option must be at least $1,000.
You may change the allocation for additional Net Purchase Payments at any time
by providing notice to us in writing or by phone. The change will take effect on
the date we receive notice from you.
One-Year Guaranteed Rate Option
On the date that you make an allocation to this option, we will declare an
interest rate effective for a one-year guarantee period. Each allocation will
have its own interest rate and one-year guarantee period. In no event will any
interest rate set for this option be less than 3%.
Unless you have previously given us notice directing us to do otherwise, at the
end of an allocation's one-year guarantee period, we will automatically renew
the value of that allocation for another one-year guarantee period in this
option at the rate we declare at the time of the renewal. You will have a ten-
day period, starting on the first day of the automatic renewal, during which you
may, without penalty, elect to transfer all or part of the value of that
allocation to: any of the Subaccounts then available; or any Fixed Account
Option then available. You must provide notice of your election to us by phone
or in writing within 10 days after the first day of each allocation's automatic
renewal to another one-year guarantee period.
Exchanges
You may make as many exchanges from the One-Year Guaranteed Rate Option to any
of the Subaccounts or any Fixed Account Options available under your Contract
during a Contract Year as you wish, subject to the terms and conditions set
forth for exchanges in the "Exchanging Units" section of your Contract.
However, if you make an exchange from this option at any time prior to the end
of a one-year guarantee period, we will reduce the amount exchanged by an amount
equal to the previous 90 days of interest on the amount of that exchange. The
value of this option will then be reduced by the exchange amount requested.
We guarantee that any loss of previous interest described above applicable to an
allocation will never be greater than the amount of interest credited to that
allocation in excess of 3%.
25
Exchanges will be taken from your allocations to this option in the order
specified in your notice to us. If you do not specify which allocations to take
exchanges from, we will first take the exchange from the allocation with the
shortest time remaining until the end of its guarantee period, and then from the
allocation with the next shortest time remaining, and so on until the exchange
amount requested is reached.
Partial or Full Withdrawals
If you make a partial or full withdrawal from this option at any time prior to
the end of a one-year guarantee period, we will reduce the amount you withdraw
by an amount equal to the previous 90 days of interest on the amount of the
withdrawal.
As a result, you will receive an amount equal to: (a) the amount withdrawn from
this option; less (b) the applicable charges described above. The value of this
option will then be reduced by the amount withdrawn from this option.
We guarantee that any loss of previous interest described above applicable to an
allocation will never be greater than the amount of interest credited to that
allocation in excess of 3%.
Withdrawals will be taken from your allocations to this option in the order
specified in your Written Notice. If you do not specify which allocations to
take withdrawals from, we will first take the withdrawal from the allocation
with the shortest time remaining until the end of its guarantee period, and then
from the allocation with the next shortest time remaining, and so on until the
withdrawal amount requested is reached.
Deferment of Payment
We may defer payment of a partial or full withdrawal from this Fixed Account
Option for up to six months from receipt of Written Notice.
Dollar Cost Averaging
Subject to the same terms and conditions as set forth in the "Dollar Cost
Averaging" provision of your Contract and in this rider, you may elect to have a
specified dollar amount transferred from the money market portfolio to this
Fixed Account Option on a monthly basis.
Accumulated Value
On any Business Day after the Contract Date, the Accumulated Value is equal to:
(a) the Accumulated Value as defined in the Accumulated Value section of your
Contract; plus (b) any interest credited to this Fixed Account Option and any
other Fixed Account Option available under your Contract to which you have
allocated Net Purchase Payments.
This rider is subject to all the exclusions, definitions and provisions of the
Contract that are not inconsistent herewith. It will terminate when your
Contract terminates.
Providian Life and Health Insurance Company
/s/ Xxxxx X. Xxxxxx
Xxxxx X. Xxxxxx
Secretary
26
Multi-Year Guaranteed Rate Fixed Account Option Rider
This rider has been attached to and made a permanent part of your Contract as of
the original Contract Date. Subject to the provisions of this rider and of your
Contract, we will provide the benefits described below should you choose to
allocate a portion of your Net Purchase Payment(s) to this Fixed Account Option.
Definitions
"Exchange" - One Exchange will be deemed to occur with each voluntary transfer
from any Subaccount or any Fixed Account Option available under your Contract.
"Fixed Account" - The Fixed Account, which is part of our General Account,
consists of Accumulated Values that are allocated to it from contracts similar
to this one. We will credit these values with interest as specified in the
Multi-year Guaranteed Rate Option provision, until the Annuity Date.
"General Account" - The account that contains all of our assets other than those
held in our separate accounts.
Allocations to the Fixed Account
You determine, using whole percentages, what portion of your initial Net
Purchase Payment will be allocated to this Option as shown on the Schedule Page.
You may choose to allocate nothing to this Fixed Account Option. Any allocations
you do make must be at least $1,000 for Non-qualified or Qualified Contracts.
The minimum balance for this Option must be at least $1,000.
You may change the allocation for additional Net Purchase Payments at any time
by providing notice to us in writing or by phone. The change will take effect on
the date we receive notice from you.
Multi-year Guaranteed Rate Option
On the date that you make an allocation to this option, we will declare an
interest rate effective for the duration of the guarantee period you select.
Each allocation will have its own interest rate and guarantee period. In no
event will any interest rate set for this option be less than 3%.
Unless you have previously given us notice directing us to do otherwise, at the
end of an allocation's guarantee period, we will automatically renew the value
of that allocation for another guarantee period of the same duration as the one
just ended at the rate we declare at the time of the renewal unless such an
automatic renewal would result in a guarantee period that has an ending date
later than the Annuity Date. In this case, we will transfer the value of that
allocation to the money market portfolio.
For each allocation that is automatically renewed for another guarantee period
of the same duration, you will have a ten-day period, starting on the first day
of the automatic renewal, during which you may, without a market value
adjustment, elect to transfer all or part of the value of that allocation to:
any of the Subaccounts then available; any Fixed Account Option then available;
or to renew the value of that allocation for any guarantee period then available
under this option whose ending date is not later than the Annuity Date at the
rate we declare at the time of your renewal. You must provide notice of your
election to us by phone or in writing within 10 days after the first day of each
allocation's automatic renewal.
Exchanges
You may make as many exchanges from the Multi-year Guaranteed Rate Option to any
of the Subaccounts or any Fixed Account Options available under your Contract
during a Contract Year as you wish, subject to the terms and conditions set
forth for exchanges in the "Exchanging Units" section of your Contract.
If you have more than one allocation in the Multi-year Guaranteed Rate Option,
you may choose which allocation or allocations the exchange is to be made from.
If you do not specify which allocation or
27
allocations to take the exchange from, we will first take the exchange amount
requested from the allocation with the shortest time remaining until the end of
its guarantee period and then from the allocation with the next shortest time
remaining until the end of its guarantee period until the amount of the exchange
requested is reached.
However, if you make an exchange from this option at any time prior to the end
of a guarantee period, we will increase or decrease the amount exchanged by a
market value adjustment equal to: (a) the exchange amount requested; multiplied
by (b) the Market Value Adjustment Factor described below.
We guarantee that any negative market value adjustment applicable to an
allocation will never be greater than the amount of interest credited to that
allocation in excess of 3%.
The Market Value Adjustment Factor is equal to: (N/12) x (B-E)
where:
"N" is the number of months remaining in the applicable guarantee period,
including any part of a month;
"B" is the interest rate in effect for the applicable guarantee period, which
was declared on the date of the applicable allocation to this option; and
"E" is the constant maturity Treasury rate for the duration equal to that of the
applicable guarantee period. If a constant maturity Treasury rate is not
published for that duration, we will use the published constant maturity
Treasury rate of the next longest maturity. For example, if the duration of the
guarantee period is nine years, we will use the 10-year constant maturity
Treasury rate. A constant maturity Treasury rate is the weekly average yield of
United States Treasury Securities adjusted to a constant maturity of a specified
number of years. Constant maturity Treasury rates are published in the Federal
Reserve Board Statistical Release H.15(519). Should constant maturity Treasury
rates ever change in frequency or be withdrawn from publication, we will replace
them with a comparable nationally published index.
The value of this option will be reduced by an amount equal to the exchange
amount requested.
Partial or Full Withdrawals
If you make a partial or full withdrawal from this option at any time prior to
the end of a guarantee period, the amount you withdraw will be increased or
decreased by an amount equal to: (a) the amount withdrawn; multiplied by (b) the
Market Value Adjustment Factor.
As a result, you will receive an amount equal to: (a) the amount withdrawn from
this option; adjusted by (b) a positive or negative Market Value Adjustment
Factor. The value of this option will be reduced by the amount withdrawn from
this option.
If you have more than one allocation in the Multi-year Guaranteed Rate Option,
you may choose which allocation or allocations the withdrawal is to be made
from. If you do not specify which allocation or allocations to take the
withdrawal from, we will first take the withdrawal from the allocation with the
shortest time remaining until the end of its guarantee period and then from the
allocation with the next shortest time remaining until the withdrawal amount
requested is reached.
Deferment of Payment
We may defer payment of a partial or full withdrawal from this Fixed Account
Option for up to six months from receipt of Written Notice.
Dollar Cost Averaging
Subject to the same terms and conditions as set forth in the "Dollar Cost
Averaging" provision of your Contract and this rider, you may elect to have a
specified dollar amount transferred from the money market portfolio to this
Fixed Account Option on a monthly basis.
28
Accumulated Value
On any Business Day after the Contract Date, the Accumulated Value is equal to:
(a) the Accumulated Value as defined in the Accumulated Value section of your
Contract; plus (b) any interest credited to this Fixed Account Option and any
other Fixed Account Option available under your Contract to which you have
allocated Net Purchase Payments.
Death Benefit
If any portion of the Death Benefit described in your Contract is derived from
the Multi-year Guaranteed Rate Option, that portion of the Accumulated Value
will be adjusted by a positive Market Value Adjustment Factor, if applicable, as
defined above.
Annuity Payment Option Proceeds
If, on the Annuity Date, a portion of the Accumulated Value of your Contract is
allocated to this option, the proceeds to be applied under a Payment Option will
be equal to the Contract's Accumulated Value 10 Business Days prior to the
Annuity Date, less any applicable Premium Tax, adjusted by applying any positive
Market Value Adjustment Factor to that portion of the Accumulated Value that is
allocated to this option.
This rider is subject to all the exclusions, definitions and provisions of the
Contract that are not inconsistent herewith. It will terminate when your
Contract terminates.
Providian Life and Health Insurance Company
/s/ Xxxxx X. Xxxxxx
Xxxxx X. Xxxxxx
Secretary
29
Guaranteed Equity Fixed Account Option Rider
This rider has been attached to and made a permanent part of your Contract as of
the original Contract Date. Subject to the provisions of this rider and of your
Contract, we will provide the benefits described below should you choose to
allocate a portion of your Net Purchase Payment(s) to this Fixed Account Option.
Definitions
"Averaging Period" - The Averaging Period is the number of months prior to the
end of an allocation's guarantee period that we will use to determine the ending
value (the "Ending Value") of the S&P 500 Index at the end of that allocation's
guarantee period. In no event will the number of months comprising the Averaging
Period be less than one.
"Exchange" - One Exchange will be deemed to occur with each voluntary transfer
from any Subaccount or any Fixed Account Option available under your Contract.
"Fixed Account" - The Fixed Account, which is part of our General Account,
consists of Accumulated Values that are allocated to it from contracts similar
to this one. We will credit these values with interest as specified below, until
the Annuity Date.
"General Account" - The account that contains all of our assets other than those
held in our separate accounts.
"Index Affected Value" - At the end of an allocation's guarantee period, the
Index Affected Value is equal to (1) plus (2) where: (1) is that allocation; and
(2) is the Participation Rate for that allocation, multiplied by the percentage
change of the S&P 500 Index for that allocation (determined as described below),
multiplied by that allocation.
We calculate the percentage change of the S&P 500 Index for an allocation in the
following manner. First, the Ending Value of the S&P 500 Index is calculated for
the Averaging Period specified for that allocation. If the Averaging Period is
one month, then the closing value of the S&P 500 Index on the last business day
of the last month during the guarantee period is the Ending Value. If the
Averaging Period is greater than one month, then the average of the closing
value of the S&P 500 Index on the last business day of each month during the
Averaging Period is the Ending Value. Second, the Ending Value is divided by the
Beginning Value, which is the value of the S&P 500 Index on the date you made
that allocation. Third, one is subtracted from the value resulting from this
division.
"Participation Rate" - The Participation Rate is the rate at which you
participate in the percentage change of the S&P 500 Index for an allocation. In
no event will the Participation Rate be less than 0%.
"S&P 500 Index" - The S&P 500 Index is the Standard and Poor's Composite Stock
Price Index, as compiled and calculated by the Standard and Poor's Corporation.
Should the S&P 500 Index ever change in frequency or be withdrawn from
publication, we will replace it with a nationally published index. "S&P 500/R/"
is a trademark of The XxXxxx-Xxxx Companies, Inc. and has been licensed for use
by Providian Corporation.
The Guaranteed Equity Option is not sponsored by, endorsed, sold or promoted by
Standard & Poor's Corporation ("S&P"). S&P makes no representation or warranty,
express or implied, to investors in this Fixed Account Option or any member of
the public regarding the advisability of investing in securities generally or in
this Fixed Account Option particularly or the ability of the S&P 500 Index to
track general stock market performance. S&P's only relationship to Providian
Life and Health Insurance Company is the licensing of certain trademarks and
trade names of S&P and of the S&P 500 Index that is determined, composed and
calculated by S&P without regard to Providian Life and Health Insurance Company
or the
30
Guaranteed Equity Option. S&P has no obligation to take the needs of Providian
Life and Health Insurance Company or the investors in this Fixed Account Option
into consideration in determining, composing or calculating the S&P 500 Index.
S&P is not responsible for and has not participated in the determination of the
timing of, prices at, or quantities of this Fixed Account Option to be issued or
in the determination or calculation of the equation by which this Fixed Account
Option is to be converted into cash. S&P has no obligation or liability in
connection with the administration, marketing or trading of the Guaranteed
Equity Option.
S&P does not guarantee the accuracy and/or the completeness of the S&P 500 Index
or any data included therein. S&P makes no warranty, express or implied, as to
the results to be obtained by Providian Life and Health Insurance Company,
investors in the Guaranteed Equity Option, or any other person or entity from
the use of the S&P 500 Index or any data included therein in connection with the
rights licensed by Providian Life and Health Insurance Company or fro any other
use. S&P makes no express or implied warranties, and hereby expressly disclaims
all warranties of merchantability or fitness for a particular purpose or use
with respect to the S&P 500 Index or any data included therein. Without limiting
any of the foregoing, in no event shall S&P have any liability for any special,
punitive, indirect, or such consequential damages (including lost profits), even
if notified of the possibility of such damages.
Allocations to the Fixed Account Option
You determine, using whole percentages, what portion of your initial Net
Purchase Payment will be allocated to this Option as shown on the Schedule Page.
You may choose to allocate nothing to this Fixed Account Option. Any allocations
you do make must be at least $1,000 for Non-qualified or Qualified Contracts.
You may change the allocation for additional Net Purchase Payments at any time
by providing notice to us in writing or by phone. The change will take effect on
the date we receive notice from you.
Guaranteed Equity Option
You may allocate Net Purchase Payments or exchanges to this option only on the
first Business Day of each month. We reserve the right to allow the allocation
of Net Purchase Payments or exchanges more frequently than the first Business
Day of each month at our sole discretion.
On the date you make an allocation to this option, we will declare: (a) the
duration of the guarantee period applicable to the allocation; (b) the duration
of the Averaging Period; and (c) the Participation Rate. Each allocation will
have its own guarantee period, Averaging Period, and Participation Rate.
During each allocation's guarantee period, we will establish a guaranteed fund
(the "Guaranteed Fund") applicable to that allocation and will credit interest
to that Guaranteed Fund at a guaranteed annual effective rate of 3% compounded
annually on 100% of that allocation. At the end of an allocation's guarantee
period, the value of that allocation will be equal to the greater of (a) the
Guaranteed Fund or, (b) the Index Affected Value.
At the end of an allocation's guarantee period you may, without penalty, elect
to exchange all or part of the value of that allocation to: any of the
Subaccounts then available; any Fixed Account Option then available; or to
reallocate the value of that allocation to this option at the guarantee period,
Averaging Period, and Participation Rate declared by us at the time of your
reallocation.
You must provide notice of your election to us within 30 days before the end of
each allocation's guarantee period. If we do not receive your Written Notice
within an allocation's 30-day period, we will automatically transfer the value
of that allocation to this option to the Money Market Portfolio at the end of
that allocation's guarantee period.
31
Exchanges and Full and Partial Withdrawals
You may not make an exchange or a full or partial withdrawal from an allocation
to this option before the end of that allocation's guarantee period.
Dollar Cost Averaging
Subject to the terms and conditions set forth in the "Dollar Cost Averaging"
provision of your Contract and this rider, you may elect to have a specified
dollar amount transferred from the money market portfolio to the Guaranteed
Equity Option on a monthly basis.
Accumulated Value
On any Business Day after the Contract Date, the Accumulated Value is equal to:
(a) the Accumulated Value as defined in the Accumulated Value Section of your
Contract; plus (b) any interest credited to this Fixed Account Option; plus (c)
any interest credited to any other Fixed Account Options available under your
Contract to which you have allocated Net Purchase Payments.
Death Benefit
If any portion of the Death Benefit described in your Contract is derived from
the Guaranteed Equity Option, then that portion of the Death Benefit shall equal
the sum of the values of all current Guaranteed Funds.
This rider is subject to all the exclusions, definitions and provisions of the
Contract that are not inconsistent herewith. It will terminate when your
Contract terminates.
Providian Life and Health Insurance Company
/s/ Xxxxx X. Xxxxxx
Xxxxx X. Xxxxxx
Secretary
32
Dollar Cost Averaging Fixed Account Option Rider
This rider has been attached to and made a permanent part of your Contract as of
the original Contract Date. Subject to the provisions of this rider and of your
Contract, we will provide the benefits described below should you choose to
allocate a portion of your Net Purchase Payment(s) to this Dollar Cost Averaging
(DCA) Fixed Account.
Definitions
"Exchange" - One Exchange will be deemed to occur with each voluntary transfer
from any Subaccount or any Fixed Account Option available under your Contract.
No administrative fee will be charged for Exchanges from the DCA Fixed Account.
"Fixed Account" - The Fixed Account, which is part of our General Account,
consists of Accumulated Values that are allocated to it from contracts similar
to this one. We will credit these values with interest as specified in the DCA
Fixed Account Option provision, until the Annuity Date.
"General Account" - The account that contains all of our assets other than those
held in our separate accounts.
Allocations to the Dollar Cost Averaging Fixed Account
You may determine, using whole percentages, what portion of your initial Net
Purchase Payment, if any, will be allocated to this Option shown on the Schedule
Page. You may allocate all or any portion of subsequent Purchase Payments to the
DCA Fixed Account Option.
You may change the allocation for additional Net Purchase Payments at any time
by providing notice to us in writing or by phone. The change will take effect on
the date we receive notice from you.
Dollar Cost Averaging Fixed Account Option
We may offer a DCA Fixed Account Option. This option will have a one year
interest rate guarantee. The current interest rate we credit may vary on
different portions of the DCA Fixed Account. The credited interest rate will
never be less than the minimum effective annual interest rate of 3%.
Prior to the Annuity Date, if you have at least $5,000 in the DCA Fixed Account,
you may instruct us to automatically Exchange a specified amount from the DCA
Fixed Account to any Subaccount(s) of the Separate Account. The automatic
Exchange will occur monthly on a "first-in-first-out" basis. If the DCA request
is received prior to the 28th day of any month, the first Exchange will occur on
the 28th day of that month. If the DCA request is received on or after the 28th
day of any month, the first Exchange will occur on the 28th day of the following
month.
Prior to the Annuity Commencement Date, no Exchanges (except through automatic
Dollar Cost Averaging Exchanges) will be allowed from the DCA Fixed Account. On
the Annuity Date, any funds remaining in the DCA Fixed Account will be applied
to the Annuity Payment Option selected.
Exchanges will continue until the DCA Fixed Account value is depleted. The
amount transferred each time must be at least $250. All Exchanges from the DCA
Fixed Account will be the same amount as the initial Exchange. You may change
the amount Exchanged once per Contract Year. Changes can also be made, at any
time, to the choice of Subaccounts to which these Exchanges are allocated. We
must receive notice of any change, by phone or in writing, at least 7 days prior
to the next Exchange date. Exchanges must be scheduled for at least 6, but not
more than 24 months each time the DCA program is started or restarted following
termination of the program for any reason. If on any Exchange date, the value in
the DCA Fixed Account is equal to or less than the amount elected to have
transferred, we will transfer the entire amount and this program will no longer
be in effect.
33
You may discontinue automatic Dollar Cost Averaging Exchanges after satisfying
the minimum number of required Exchanges by phone or by sending written notice
to us at least 7 days prior to the next Exchange date. If the DCA program is
terminated by you for any reason, any remaining value attributable to the DCA
Fixed Account will remain in the DCA Fixed Account and will continue to earn
interest until such time as you either restart the program or make a full
withdrawal of the funds. If you wish to restart the program but have less than
$5,000 in the DCA Fixed Account, an exception will be made and Exchanges will
continue until the value in the DCA Fixed Account is depleted. You will not be
able to discontinue the automatic Exchanges until the value in the DCA Fixed
Account is depleted.
Partial or Full Withdrawals
For partial or full withdrawals, as described in the Contract to which this
Rider is attached, made during the first six Contract Years, we will reduce the
amount withdrawn by an additional amount equal to: (a) the applicable Withdrawal
Factor shown on the Contract Schedule Page; multiplied by (b) the amount of the
withdrawal which exceeds the Penalty Free Amount.
As a result, you will receive a withdrawal amount equal to: (a) the amount
withdrawn from this option; less (b) the applicable charges described above.
The value of this option will then be reduced by the amount withdrawn. Partial
withdrawals are made on a first in first out basis.
Deferment of Payment
We may defer payment of a partial or full withdrawal from this DCA Cost
Averaging Fixed Account Option for up to six months from receipt of Written
Notice.
Accumulated Value
On any Business Day after the Contract Date, the Accumulated Value under the
Contract is equal to: (a) the Accumulated Value as defined in the Accumulated
Value section of your Contract; plus (b) any interest credited to the DCA Fixed
Account Option.
This rider is subject to all the exclusions, definitions and provisions of the
Contract that are not inconsistent herewith. It will terminate when your
Contract terminates.
Providian Life and Health Insurance Company
/s/ Xxxxx X. Xxxxxx
Xxxxx X. Xxxxxx
Secretary
34
Qualified Annuity Plan Amendment To Qualify the Contract as an Individual
Retirement Annuity (IRA)
This Amendment is part of the Contract to which it is attached
The Contract is amended as specified below to qualify as an Individual
Retirement Annuity under Section 408(b) of the Internal Revenue Code of 1986, as
amended from time to time ("the Code").
Notwithstanding any provisions in the Contract to the contrary:
A. The Annuitant will at all times be the Owner. The Annuitant's rights under
the contract shall be nonforfeitable and for the exclusive benefit of the
Annuitant and his or her beneficiary. Any provision of the Contract which
would allow joint ownership or which would allow more than one person to
share Annuity Payments is deleted.
B. The Contract may not be transferred, sold, assigned, alienated, or pledged as
collateral for a loan or as security for the performance of an obligation, or
for any other purpose, to any person; except that the Contract may be
transferred to a former spouse of the Annuitant' under a divorce decree or
written instrument incident to such divorce. In the event of such transfer,
the transferee shall for all purposes be treated as the Owner and Annuitant
under this Contract.
C. Except in the case of a "rollover contribution" as described in Section
402(a)(5), 402 (a)(6)(F), 402(a)(7), 403(a)(4), 403(b)(8), or 408(d)(3) of
the Code or a contribution made in accordance with the terms of a Simplified
Employee Pension ("SEP") as described in Section 408(k) of the code, the
premium paid (or "Purchase Payment" made, if the contract is a variable
annuity) under this contract shall not exceed $2,000 in cash, or such other
maximum as the Code may allow. The Annuitant shall have the sole
responsibility for determining whether any Premium Payment (Purchase Payment)
qualifies as a rollover contribution for income tax purposes.
D. Any refund of premiums, other than refunds attributable to excess
contributions, will be applied before the close of the calendar year
following the year of the refund toward the payment of additional premiums or
the purchase of additional benefits.
E. The Annuity Date is the date on which the entire Contract value will be
distributed or commence to be distributed. The Annuity Date shall not be
later than April 1 of the calendar year following the year in which the
Annuitant attains age 70-1/2.
The annual distribution required to be made on the Annuity Date will be for
the calendar year in which the Annuitant attains age 70-1/2. Annual Payments
for subsequent years including the year in which the Annuity Date occurs,
must be made by December 31 of that year. The amount distributed for each
year shall equal or exceed the Contract value as of the close of business on
December 31 of the preceding year, divided by the applicable life expectancy
or joint life expectancy.
F. If the Annuitant should receive a distribution from the Plan before age
59-1/2, additional Federal Income Tax will be incurred unless the early
payment is due to disability or death or distribution in the form of an
annuity payable over the life expectancy of the Annuitant and his designated
beneficiary. "Disability" means a medically determinable disability of such
nature that the Annuitant is unable to engage in any substantial gainful
activity and that it can be expected to result in death or to be of long,
continued and indefinite duration.
G. Benefit Payments may be made only (1) in one lump sum, or (2) in equal or
substantially equal amounts over (a) the Annuitant's life, or over the lives
of the Annuitant and his or her designated beneficiary, or (b) over a
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period certain that does not exceed the Xxxxxxxxx's life expectancy, or the
joint life expectancy of the Annuitant and his or her beneficiary.
If the Annuitant's entire interest is to be distributed in other than lump
sum, then the minimum amount to be distributed each year, commencing with the
calendar year following the year in which the Annuitant attains age 70-1/2
and each year thereafter, shall be determined in accordance with Code Section
408(b)(3) and the regulations thereunder.
X. Xx the Annuitant dies after distribution of his or her interest has begun,
the remaining interest will continue to be distributed at least as rapidly as
under the method of distribution being used prior to the Annuitant's death.
If the Annuitant dies before his or her entire interest in this Contract has
been distributed, no additional premium payments (Purchase Payments) will be
accepted under this Contract after the Annuitant's death unless the
beneficiary is the Annuitant's surviving spouse.
If the Annuitant dies before any of his or her interest in the Contract has
been paid, the entire interest will be distributed no later than December 31
of the calendar year in which the fifth anniversary of the Annuitant's death
occurs unless (1) the interest is paid in substantially equal payments over a
period certain not to exceed the lifetime, or life expectancy, of a
designated beneficiary, and (2) payments begin not later than December 31 of
the calendar year following the year in which the Annuitant's death occurs.
If the designated beneficiary is the surviving spouse, the beneficiary may
elect no later than December 31 of the calendar year in which the fifth
anniversary of the Annuitant's death occurs, to receive equal or
substantially equal payments over the life or life expectancy of the
surviving spouse commencing no later than the date the Annuitant would have
attained age 70-1/2. Minimum payments will be calculated in accordance with
Code Section 408(b)(3) and the regulations thereunder. If the surviving
spouse dies before payments begin, subsequent distributions shall be made as
if the surviving spouse had been the Annuitant.
If the surviving spouse is not the beneficiary, the method of distribution
selected will assure that at least 50% of the present value of the amount
available for distribution is paid within the Annuitant's life expectancy and
that such method of distribution complies with the requirements of Code
Section 408(b)(3) and the regulations thereunder.
For purposes of this requirements, any amount paid to a child of the
Annuitant shall be treated as if it had been paid to the surviving spouse if
the remainder of the interest becomes payable to the surviving spouse when
the child reaches the age of majority.
I. For purposes of the foregoing provisions life expectancy of the Annuitant and
the joint life expectancy of the Annuitant and his or her beneficiary, shall
be computed by use of the expected return multiplies in Tables V and IV of
Sections 1.72-9 of the Income Tax Regulations, in accordance with Code
Section 408 (b)(3) and the regulations thereunder. In the case of
distributions under paragraph G above, the Annuitant's life expectancy or, if
applicable, the joint life expectancy of the Annuitant and his or her
beneficiary, will be initially determined on the basis of attained ages in
the year the Annuitant reaches age 70-1/2. In the case of a distribution
under paragraph H above, life expectancy shall be initially determined on the
basis of the computation of the Annuitant's life expectancy and the life
expectancy of his or her spouse shall be recalculated annually based on
attained ages in the year for which the required distribution is being
determined. The life expectancy of a nonspouse beneficiary shall not be
recalculated.
J. Death Benefits are subject to Federal Estate Tax.
K. We reserve the right to amend or modify the Contract or Amendment to the
extent necessary to qualify as an individual retirement annuity for federal
income tax purposes.
L. This Amendment is effective as of the Contract Date.
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This Amendment is subject to all exclusions, definitions, and provisions of the
Contract which are not inconsistent herewith.
In Witness Whereof, We have caused this Amendment to be signed by Our Secretary.
Providian Life and Health Insurance Company.
Xxxxx X. Xxxxxx
Secretary
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