EXHIBIT 4(a)
ML LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: [000 Xxxxxxxx, Xxx Xxxx, XX 00000]
SERVICE CENTER: [P. O. Box 44222]
[Jacksonville, Florida 32231-4222]
ML LIFE INSURANCE COMPANY OF NEW YORK (the "Company") will make annuity payments
as described in this Contract.
This is a legal Contract between the Contract Owner ("You") and the Company
("Us"). PLEASE READ THIS CONTRACT CAREFULLY.
ANNUITY PAYMENTS, DEATH BENEFITS, SURRENDER VALUES AND OTHER CONTRACT VALUES
PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE
SEPARATE ACCOUNT, ARE VARIABLE, MAY INCREASE OR DECREASE, AND ARE NOT GUARANTEED
AS TO DOLLAR AMOUNT.
RIGHT TO REVIEW CONTRACT: You may cancel this Contract within [ten (10)] days
after You receive it. Simply return or mail it to Us at Our Service Center or to
Your Financial Advisor. We will refund the greater of the Contract Value or all
of Your Premiums.
ML Life Insurance Company of New York is a stock life insurance company.
/s/ XXXXX X. XXXXXXXXX /s/ XXXX X. XXXXX
---------------------- -----------------
President Secretary
Individual Deferred Variable Annuity Contract
Flexible Premiums - Nonparticipating
TABLE OF CONTENTS
SECTION PAGE
Definitions ................................................................. 3
Contract Schedule............................................................ 5
1. General Provisions .................................................... 6
2. Premiums .............................................................. 9
3. The Separate Account .................................................. 9
4. Charges, Deductions and Credits ....................................... 11
5. Transfers ............................................................. 12
6. Withdrawals ........................................................... 13
7. Death Benefit Provisions .............................................. 14
8. Annuity Provisions .................................................... 15
9. Annuity Options ....................................................... 16
10. Annuity Option Tables.................................................. 17
-2-
DEFINITIONS
1. ACCOUNT VALUE: The sum of the values of Your interests in the subaccounts
of the Separate Account as of the end of a Valuation Period.
2. ACCUMULATION PERIOD: The period of time from the Contract Date to the
Annuity Date.
3. ACCUMULATION UNIT: A unit of measure used to determine the value of Your
interest in a subaccount during the Accumulation Period.
4. ACCUMULATION UNIT VALUE: The value of an Accumulation Unit during a
Valuation Period. Accumulation Unit Values are usually determined as of
the close of regular trading on each day the New York Stock Exchange is
open for business.
5. ANNUITANT: Any natural person(s) on whose life annuity payments are based.
During the Accumulation Period, all references to the Annuitant shall
include any Joint Annuitant.
6. ANNUITY DATE: The date on which You choose to begin receiving annuity
payments.
7. ANNUITY OPTIONS: Options under whose terms annuity payments will be made
during the Annuity Period.
8. ANNUITY PERIOD: The period beginning on the Annuity Date during which
annuity payments are made under an Annuity Option.
9. ANNUITY VALUE: The amount which will be applied to an Annuity Option on
the Annuity Date. It is the Contract Value on the Annuity Date reduced by
any charges for premium taxes and any other charges deducted on the
Annuity Date.
10. BENEFICIARY: The person(s) or entity(ies) designated by You to receive
payment of the Death Benefit provided under this Contract.
11. COMPANY: ML Life Insurance Company of New York. Also referred to as "We",
"Us" or "Our".
12. CONTRACT ANNIVERSARY: An anniversary of the Contract Date.
13. CONTRACT DATE: The effective date of this Contract as shown on the
Contract Schedule. This is usually the business day We receive Your
Initial Premium at Our Service Center.
14. CONTRACT VALUE: The total value of Your interest in this Contract as of
the end of a Valuation Period. It is equal to the Account Value plus the
value of Your interest in any other accounts that may be included by Rider
or by Endorsement.
15. CONTRACT YEAR: A one year period starting on the Contract Date and on each
Contract Anniversary thereafter.
16. DEATH BENEFIT: During the Accumulation Period, the amount payable upon the
death of the Owner (the first Owner to die if this Contract has
Co-Owners), or, if the Owner is a non-natural person, upon the death of
the Annuitant (the first Annuitant to die if this Contract has Joint
Annuitants). During the Annuity Period, the amount payable upon the death
of the Annuitant, or the last surviving Joint Annuitant.
17. DUE PROOF OF DEATH: A certified death certificate or other legal proof of
death acceptable to Us, a completed beneficiary claim form, and any
additional paperwork necessary to process a death claim.
18. ELIGIBLE SPOUSAL BENEFICIARY: A Beneficiary who is the spouse of a
deceased Owner and who satisfies the requirements described on the
Contract Schedule.
-3-
DEFINITIONS (CONTINUED)
19. FUND: An investment portfolio of an open-end management investment company
or unit investment trust in which a subaccount may invest.
20. INVESTMENT CATEGORY: A classification of subaccounts as determined by Us.
The Investment Categories as of the Contract Date are shown on the
Contract Schedule.
21. MATURITY AGE: The age of the Annuitant used in the determination of the
Maturity Date. The Maturity Age is shown on the Contract Schedule.
22. MATURITY DATE: The latest possible Annuity Date as shown on the Contract
Schedule.
23. MONTHAVERSARY: The Contract Date and the same calendar day of each
successive month during the Accumulation Period.
24. NET ASSET VALUE: The value of one share of a Fund at the end of a
Valuation Period.
25. NET INVESTMENT FACTOR: An index used to measure the investment performance
of a subaccount from one Valuation Period to the next Valuation Period.
26. NET PREMIUM(S): The Premium(s) You pay into this Contract less any Premium
Load. The Premium Load, if any, and the Initial Net Premium are shown on
the Contract Schedule.
27. OWNER: The person(s) or entity(ies) entitled to exercise all ownership
rights under this Contract. The Owner is deemed a non-natural person if
this Contract is owned by a Corporation, a Trust, or similar situations
where the Owner is not a person(s). All references to the Owner shall
include any Co-Owner. Unless otherwise specified, age refers to the oldest
Co-Owner's age. In this Contract, "You" and "Your" refer to the Owner.
28. PREMIUMS: The money You pay into this Contract as consideration for the
benefits it provides.
29. QUARTERVERSARY: The same calendar day of each successive three month
period during the Accumulation Period, beginning with the Contract Date.
30. SEPARATE ACCOUNT: This Contract is funded by a Separate Account of the
Company, which is a segregated asset account and is not a part of Our
general account. The Separate Account has multiple subaccounts, each of
which invests in shares or units of a Fund.
31. SPOUSAL CONTINUATION DATE: The date that an Eligible Spousal Beneficiary
provides all of the information necessary to continue the Contract in his
or her own name or the date the Spousal Beneficiary Continuation Option is
automatically applied.
32. SURRENDER VALUE: The amount available upon full withdrawal. It is equal to
the Contract Value reduced by any charges, including any Surrender Charge,
and increased by any credits which apply upon full withdrawal.
33. VALUATION PERIOD: The interval from one determination of the Accumulation
Unit Value for a subaccount to the next such determination.
-4-
1. GENERAL PROVISIONS
1.1 OWNER: Unless another Owner is named by the purchaser of this Contract,
the purchaser is the Owner. Upon written request You may designate a new
Owner, subject to Our requirements and limitations in effect on the date
the request is signed. A change in Owner terminates all prior Beneficiary
designations, except that any irrevocable Beneficiary must consent to such
change of beneficiary. If the Owner is changed, the age of the new Owner
as of the Contract Date must not have been greater than the Maximum Owner
Age shown on the Contract Schedule. We will not be responsible for the tax
consequences of any change of Owner.
A Contract may be owned by Co-Owners, limited to two natural persons.
Ownership rights must be exercised jointly by Co-Owners unless otherwise
allowed by us. Upon the death of either Co-Owner, the surviving Co-Owner
will be deemed to be the Primary Beneficiary unless You specify otherwise.
Any other Beneficiary designation will be treated as a Contingent
Beneficiary unless otherwise indicated on the Contract Schedule or in a
notice to Us.
1.2 BENEFICIARY: The Beneficiary is shown on the Contract Schedule. You may
change the Beneficiary while You or the surviving Co-Owner are alive.
You may name the Beneficiary irrevocably. If You do so, You can later
change the Beneficiary only with the Beneficiary's written consent.
Unless You have provided otherwise, the Death Benefit will be paid to, or
in equal shares to:
(a) the Primary Beneficiary who survives You (or who survives the
Annuitant if the Owner is a non-natural person); or, if no Primary
Beneficiary survives You,
(b) the Contingent Beneficiary who survives You (or who survives the
Annuitant if the Owner is a non-natural person); or, if no
Contingent Beneficiary survives You,
(c) Your estate.
If a Beneficiary survives You but dies before the Death Benefit is paid,
the estate of such Beneficiary is entitled to the Death Benefit that would
otherwise have been paid to such Beneficiary.
1.3 ANNUITANT: The Annuitant is shown on the Contract Schedule. Prior to the
Annuity Date, except when the Owner is a non-natural person, the Owner may
make a written request to change the Annuitant, subject to Our
requirements and limitations in effect on the date the request is signed.
If the Annuitant is changed, the age of the new Annuitant as of the
Contract Date must not have been greater than the Maximum Annuitant Age
shown on the Contract Schedule.
1.4 NOTICES, CHOICES AND REQUESTS: To be effective, all notices, choices and
requests You make under this Contract must be in writing and signed, and
be received at Our Service Center, unless We have authorized You to use
another method. Such communication must be provided by You or Your
representative, if authorized by You in writing. If acceptable to Us,
notices, choices and requests relating to Beneficiaries, Owners,
Annuitants, and the Annuity Date will take effect as of the date signed,
unless We have already acted in reliance on the prior status. We are not
responsible for their validity.
-6-
1. GENERAL PROVISIONS (CONTINUED)
1.5 EVIDENCE OF SURVIVAL: We may require proof that any person on whose
continued life any payments under this Contract are based is alive. We
reserve the right to withhold or discontinue payments until We receive
proof, in a form satisfactory to Us, that such person is living.
1.6 MISSTATEMENT OF AGE OR SEX: We may require proof at any time, in a form
satisfactory to Us, of the age or sex of any Annuitant, Owner or
Beneficiary if any payments and benefits under this Contract are based on
such person's age and sex. If the age or sex of any such person has been
misstated, any payments and benefits will be adjusted based on the correct
age and sex of such person.
Once annuity payments have begun, any amount We have overpaid as a result
of such misstatement will be deducted from the next payment(s) made by Us
under this Contract. Any amount We have underpaid will be paid in full
with the next payment made by Us. We will pay interest on the
underpayment. The rate of interest will not be less than 3% per year.
1.7 THE CONTRACT: This Contract, any application and any Endorsements or
Riders are the entire Contract. It is issued in consideration of the
payment of the Initial Premium shown on the Contract Schedule.
Only Our President, a Vice President, Secretary, or Assistant Secretary
may change this Contract. Any change must be in writing. No one else has
authority to modify or waive any provision of this Contract.
At any time, We may make such changes to this Contract, without Your
consent, as required to conform it with any law, regulation, or ruling
issued by a governmental agency. We will notify You of such changes, and,
when required, will obtain approval from the appropriate regulatory
authority and You.
1.8 NONPARTICIPATING: This Contract is nonparticipating. It does not share in
Our surplus. No dividends are payable on this Contract.
1.9 INCONTESTABILITY: We will not contest this Contract.
1.10 CONTRACT PAYMENTS: All sums payable to or by Us are payable at Our Service
Center. We may require return of this Contract prior to making payment.
Payment generally will be made within seven (7) days of Our receipt of a
request acceptable to Us at Our Service Center. Our payment obligations
are subject to all payments made and actions taken by Us prior to Our
receipt of a payment request.
1.11 REGULATORY REQUIREMENTS: Paid-up annuity benefits, Contract withdrawal
benefits, and death benefits available under this Contract will not be
less than the minimum required by the laws of the state in which this
Contract is delivered.
-7-
1. GENERAL PROVISIONS (CONTINUED)
1.12 ASSIGNMENT: You may assign Your rights under this Contract unless
restricted by applicable law. Assignments will be subject to any payments
made and any actions taken by Us before a signed copy of the assignment is
received at Our Service Center. We will not be responsible for determining
whether an assignment is valid or for the tax consequences of any
assignment.
1.13 PROTECTION OF PROCEEDS: To the extent permitted by law, all payments under
this Contract shall be free from legal process or the claim of any
creditor. No payment and no amount under this Contract can be taken or
assigned in advance of its payment date unless We receive the Owner's
written consent.
1.14 TAX QUALIFICATION: This Contract is intended to qualify as an annuity
contract for federal income tax purposes. To that end, the provisions of
this Contract are to be interpreted to ensure or maintain such tax
qualification, notwithstanding any other provision to the contrary.
Distributions under this Contract shall be made in a time and manner
necessary to maintain such qualification under the applicable provisions
of the Internal Revenue Code. Both We and You agree to amend this Contract
to reflect any clarifications that may be needed or are appropriate to
maintain such qualification or to conform this Contract to any applicable
changes in the tax qualification requirements.
1.15 SUSPENSION OR DEFERRAL OF PAYMENTS OR TRANSFERS: We may suspend or
postpone payments of any amount due under this Contract where permitted
under applicable federal or state laws, rules or regulations.
We may suspend or defer payments or transfers from the Separate Account
under this Contract in the event that:
(a) the New York Stock Exchange is closed for business, other than
normal weekend and holiday closings;
(b) trading on the New York Stock Exchange is restricted;
(c) an emergency exists such that it is not reasonably practical to
dispose of securities in the Separate Account or to determine the
value of its assets;
(d) the Securities and Exchange Commission by order so permits for Your
protection;
(e) the payment is derived from a check used to pay a Premium which has
not cleared through the banking system; or
(f) the transfer is subject to limitations as described in Section 5.2.
Conditions (b), (c) and (d) will be decided by or in accordance with rules
of the Securities and Exchange Commission. We reserve the right, at our
option, to defer any payments in accordance with the deferment provisions
of the Investment Company Act of 1940, as amended. We will add interest
from the date of our receipt of a completed request to the date of payment
if such payment is not made within 10 days following receipt of the
completed request. The rate of interest will not be less than 3% per year.
-8-
1. GENERAL PROVISIONS (CONTINUED)
1.16 CONTRACT TERMINATION: This Contract will terminate upon the occurrence of
any of the events listed under Contract Termination on the Contract
Schedule.
1.17 INACTIVE CONTRACT: If, at any time prior to the Annuity Date, all of the
conditions listed under Inactive Contract on the Contract Schedule are
met, We will terminate this Contract. If the Contract is terminated under
this provision, We will pay You the Surrender Value in a lump sum.
1.18 PERIODIC REPORTS: At least once a year during the Accumulation Period We
will furnish You with a report for Your Contract. It will show the current
number of Accumulation Units, the Accumulation Unit Values, the Account
Value, the Contract Value and any other information as may be required.
2. PREMIUMS
2.1 PREMIUMS: This Contract is issued in consideration of Your payment of the
Initial Premium. Additional Premiums may be paid during the Accumulation
Period, subject to the Premium Requirements and Limitations described on
the Contract Schedule.
You may choose to have additional premiums paid systematically from Your
Xxxxxxx Xxxxx brokerage account. You may change the frequency of payment,
the premium amount, the premium allocation, or may cancel this feature
upon written notice to Us.
2.2 PREMIUM LOAD: A Premium Load may be deducted from the Initial Premium and
any additional Premiums. The amount of this charge, how it is determined,
and when and how it is collected are described on the Contract Schedule.
2.3 PREMIUM ALLOCATION: Your Initial Net Premium and any additional Net
Premiums will be allocated to the subaccounts You select, as described on
the Contract Schedule.
3. THE SEPARATE ACCOUNT
3.1 THE SEPARATE ACCOUNT: The Separate Account is identified on the Contract
Schedule. It is a separate investment account of ML Life Insurance Company
of New York. With respect to the Separate Account, income, gains, and
losses, whether or not realized, from assets allocated to the Separate
Account are credited to or charged against the Separate Account without
regard to Our other income, gains, or losses. Assets allocated to the
Separate Account remain Our property but are separate from Our general
account and any other separate accounts We may have. Separate Account
assets, to the extent equal to the Separate Account's reserves and other
liabilities, may not be charged with liabilities from any other business
We conduct. We reserve the right to transfer any amount in excess of the
Separate Account's reserves and liabilities to our general account.
-9-
3. THE SEPARATE ACCOUNT (CONTINUED)
3.2 SUBACCOUNTS: The Separate Account is divided into subaccounts. The
subaccounts available on the Contract Date are shown on the Contract
Schedule. The allocation of Your Initial Net Premium and any additional
Net Premiums to the subaccounts is subject to the Allocation Guidelines
and Restrictions described on the Contract Schedule.
3.3 CHANGES TO THE SEPARATE ACCOUNT: We may add subaccounts. We reserve the
right, subject to obtaining any necessary regulatory approvals, to close
or eliminate subaccounts; to substitute shares of a new portfolio for
shares of the portfolio in which a subaccount invests; to deregister the
Separate Account under the Investment Company Act of 1940 (the "1940
Act"); to make any changes required by the 1940 Act; to operate the
Separate Account as a unit investment trust or a management investment
company under the 1940 Act, or any other form permitted by law; to
transfer all or a portion of the assets of a subaccount or Separate
Account to another subaccount or Separate Account pursuant to a
combination or otherwise; and to create new Separate Accounts. We may add,
close, or substitute subaccounts with respect to existing Account Value or
future Premiums, or both, for some or all classes of Contracts, at any
time, in Our sole discretion.
3.4 NUMBER OF ACCUMULATION UNITS: During the Accumulation Period, Accumulation
Units are added to, or subtracted from each subaccount, as a result of
Premium payments, transfers, withdrawals, charges and credits (except for
charges and credits used in determining the Net Investment Factor) during
a Valuation Period. The number of Accumulation Units is determined by
dividing the amount added to, or the amount subtracted from, the
subaccount, by the Accumulation Unit Value for that subaccount for that
Valuation Period.
3.5 ACCUMULATION UNIT VALUE: For each subaccount, the Accumulation Unit Value
was set by Us when the subaccount was established. The value may increase
or decrease from one Valuation Period to the next. For any Valuation
Period the Accumulation Unit Value is determined by multiplying A by B
where:
A is the Accumulation Unit Value for the prior Valuation Period;
and
B is the Net Investment Factor for that subaccount for the current
Valuation Period.
To the extent permitted by law, We may change when the Accumulation Unit
Value is calculated by giving You 30 days prior notice; or We may defer
calculation of the Accumulation Unit Value, if an emergency exists making
valuation of assets in the subaccount not reasonably practical, or if the
Securities and Exchange Commission permits such deferral.
3.6 NET INVESTMENT FACTOR: The Net Investment Factor for each subaccount is
determined by dividing A by B and then subtracting C where:
A is (i) the Net Asset Value per share (or for a unit investment
trust, the Net Asset Value per unit of the trust) of the Fund in
which the subaccount invests at the end of the current Valuation
Period; plus
(ii) any dividend or capital gain per share or unit declared on
behalf of the Fund in which the subaccount invests that has an
ex-dividend date during the current Valuation Period; minus
-10-
3. THE SEPARATE ACCOUNT (CONTINUED)
(iii) the cumulative charge or credit for any taxes or tax
reserve We have established as a result of the operation or
maintenance of the subaccount;
B is the Net Asset Value per share or unit of the Fund in which the
subaccount invests for the preceding Valuation Period; and
C is (i) the Valuation Period equivalent of the current annual
Asset-Based Insurance Charge shown on the Contract Schedule;
plus
(ii) a charge factor, if any, We have established as a result
of the operation or maintenance of the subaccount.
4. CHARGES, DEDUCTIONS AND CREDITS
4.1 ASSET-BASED INSURANCE CHARGE: The Asset-Based Insurance Charge compensates
Us for Our expenses in the establishment and administration of the
Separate Account, for issue and administration of this Contract, and for
the risks We assume in providing the benefits under this Contract. The
current and maximum Asset-Based Insurance Charge, how the charge is
determined, and when and how it is collected are described on the Contract
Schedule. The current Asset-Based Insurance Charge may be changed, but it
will never exceed the maximum charge shown on the Contract Schedule.
4.2 CONTRACT FEE: A Contract Fee may be deducted from the Contract Value to
compensate Us for expenses related to the maintenance of this Contract.
The current and maximum Contract Fee, how the fee is determined, and when
and how it is collected are described on the Contract Schedule. The
current Contract Fee may be changed, but it will never exceed the maximum
fee shown on the Contract Schedule.
4.3 OTHER CONTRACT CHARGES: Other charges may be deducted from Your Contract
Value. The purpose of each such charge, the current and maximum amount of
the charge, how it is determined, and when and how it is collected are
described on the Contract Schedule. The current amount of a charge may be
changed, but it will never exceed the maximum charge shown on the Contract
Schedule.
4.4 CONTRACT CREDITS: Credits may be added to Your Contract Value. The purpose
of each such credit, the amount of the credit, how the credit is
determined, and when and how it is paid are described on the Contract
Schedule.
4.5 CHANGES IN CONTRACT CHARGES: Changes to any Contract charge will be
applied by Contract class, and will be based upon changes in applicable
experience factors such as investment income and returns, mortality,
persistency, expenses and taxes. Any change will be determined in
accordance with procedures and standards on file, if required, with the
insurance supervisory official of the jurisdiction in which this Contract
is delivered.
-11-
4. CHARGES, DEDUCTIONS AND CREDITS (CONTINUED)
4.6 PREMIUM TAXES: Any charges made by Us attributable to premium taxes
imposed by a state or other governmental authority will be deducted in a
manner determined solely by Us, in compliance with applicable state law.
We currently deduct such charges as described on the Contract Schedule.
4.7 OTHER TAXES AND ASSESSMENTS: We reserve the right to deduct a charge for
assessments or federal, state, or local excise, profits, or income taxes.
We also reserve the right to deduct from the Separate Account any taxes
imposed on the Separate Account.
5. TRANSFERS
5.1 TRANSFERS AMONG SUBACCOUNTS: You may transfer all or part of Your Account
Value among the subaccounts, subject to the Requirements and Limitations
described on the Contract Schedule, and subject to Section 5.2 below. A
transfer will be processed as of the end of the Valuation Period during
which We receive all the information necessary to process the transfer at
Our Service Center.
A Transfer Fee may apply to certain transfers. The current and maximum
Transfer Fee, how the fee is determined, and when and how it is collected
are described on the Contract Schedule. The current Transfer Fee may be
changed, but it will never exceed the maximum fee shown on the Contract
Schedule.
There are no transfer charges related to the allocation of the initial
premium payment under the Contract, or the allocation of any subsequent
premium, nor to any of the automatic transfers related to the Dollar Cost
Averaging, Asset Allocation, or Rebalancing programs described below in
this section. In addition, none of the transfers referenced in the
previous sentence count toward the number of transfers permitted without
charge each contract year.
We reserve the right not to process a transfer request when the sale or
purchase of shares or units is not reasonably practical due to actions
taken or limitations imposed by Us or by a Fund. We also reserve the right
to deduct any Redemption Fee related to short term, frequent or disruptive
trading, as determined by any Fund, or under any regulatory requirements.
5.2 DISRUPTIVE TRANSFERS: If, in Our sole opinion, We determine that there has
been a pattern of disruptive transfers including short term "market
timing" transfers for a Contract, We reserve the right to impose
limitations on the processing of transfer requests with respect to such
Contract. Such limitations could be applied to transfers to, or from, one
or more of the subaccounts and could include, but are not limited to:
(a) the requirement of a minimum time period between each transfer;
(b) not accepting a transfer request from a third party acting under
authorization on behalf of more than one Owner;
(c) limiting the dollar amount that may be transferred between the
subaccounts at any one time; and
(d) requiring that a written transfer request be provided to Us signed
by the Owner.
-12-
5. TRANSFERS (CONTINUED)
5.3 DOLLAR COST AVERAGING PROGRAM: You may transfer all or part of your
Contract Value in a designated subaccount to one or more other subaccounts
pursuant to the Dollar Cost Averaging Program (DCA Program). We will
transfer a specified amount at the frequency You select from the
subaccount that You designate (the "source subaccount") and allocate it in
accordance with Your instructions to the subaccount(s) that You select. To
elect the DCA Program You need to have a minimum amount in the source
subaccount equal to the amount to be transferred each period multiplied by
the number of periodic transfers.
5.4 ASSET ALLOCATION PROGRAM: You may choose to have Your premiums and
Contract Value allocated among the subaccounts in accordance with an Asset
Allocation Model You select based on Your investment goals and risk
tolerance. Each model identifies specific subaccounts and the percentage
of premium or Contract Value which should be allocated to each of these
subaccounts. At the end of each calendar quarter, unless You instruct Us
otherwise, We will automatically reallocate your Contract Value to
maintain the subaccounts and percentages then in effect for Your selected
model.
5.5 REBALANCING PROGRAM: You may choose the Rebalancing Program where You
select the percentage of Premium and Contract Value to be allocated to
subaccounts You select based on Your investment goals and risk tolerance.
We will allocate Your Premiums or Contract Value to these subaccounts in
accordance with the percentages You select. At the end of each selected
period, We will automatically reallocate your Contract Value to maintain
the particular percentage allocation among the subaccounts You have
selected.
6. WITHDRAWALS
6.1 WITHDRAWALS: During the Accumulation Period, You may request partial
withdrawals or a full withdrawal of the Surrender Value, subject to the
Requirements and Limitations described on the Contract Schedule. A
withdrawal will be processed as of the end of the Valuation Period during
which We receive all the information necessary to process the withdrawal
at Our Service Center.
Partial withdrawals will be deducted from the subaccounts as described on
the Contract Schedule. For a full withdrawal, upon receipt of this
Contract and all other information necessary to process the withdrawal at
Our Service Center, We will determine and pay You the Surrender Value in a
lump sum or apply it under an Annuity Option described in Section 9.
6.2 SURRENDER CHARGE: A Surrender Charge may be deducted in connection with
partial or full withdrawals of the Surrender Value. The amount of the
Surrender Charge, how the charge is determined, and when and how it is
collected are described on the Contract Schedule.
6.3 FREE WITHDRAWAL AMOUNT: The Free Withdrawal Amount is an amount that can
be withdrawn from the Contract without the deduction of a Surrender
Charge. The Free Withdrawal Amount available under this Contract, if any,
and how such amount is determined, are described on the Contract Schedule.
-13-
6. WITHDRAWALS (CONTINUED)
6.4 SYSTEMATIC WITHDRAWAL PROGRAM: You may set up automatic withdrawals of a
specified dollar amount to be made periodically. We will make these
withdrawals from the subaccounts in the same proportion as the value of
each subaccount bears to the Contract Value. The minimum amount of each
withdrawal and the remaining Contract Value after each withdrawal is shown
in the Contract Schedule. The Systematic Withdrawal Program cannot extend
beyond the Annuity Date.
7. DEATH BENEFIT PROVISIONS
7.1 DEATH DURING THE ACCUMULATION PERIOD
7.1.1 DEATH OF OWNER: If the Owner dies (the first Owner to die if this Contract
has Co-Owners) during the Accumulation Period, upon receipt of Due Proof
of Death of such Owner, We will pay the Death Benefit to the Beneficiary
as provided in Section 7.1.3. An Eligible Spousal Beneficiary may continue
this Contract as provided in Section 7.1.4. If the Contract is owned by a
non-natural person, the Death Benefit will be paid to the Beneficiary upon
receipt of Due Proof of Death of the Annuitant (the first Annuitant to die
if this Contract has Joint Annuitants).
7.1.2
DEATH BENEFIT AMOUNT: The Death Benefit during the Accumulation Period is
equal to the Contract Value as of the date We receive Due Proof of Death
of the Owner at Our Service Center.
7.1.3 DEATH BENEFIT PAYMENT OPTIONS: Except as provided in Section 7.1.4, if an
Owner dies during the Accumulation Period, the Beneficiary must receive
his/her respective Death Benefit under one of the following payment
options:
OPTION 1 - payment of the Death Benefit in a lump sum within five years of
the date of such Owner's death; or
OPTION 2 - payment of the entire Death Benefit within five years of the
date of such Owner's death; or
OPTION 3 - payment of the Death Benefit under an Annuity Option over the
lifetime of such Beneficiary, or over a period that does not exceed the
life expectancy, as defined by Internal Revenue Service regulations, of
such Beneficiary, with payments starting within one year of the date of
death of such Owner. This option is not available if the Beneficiary is a
non-natural person.
If We do not receive Due Proof of Death by the end of the Death Benefit
Payment Election Period shown on the Contract Schedule, We will
automatically apply the Default Death Benefit Payment Option shown on the
Contract Schedule.
-14-
7.1 DEATH DURING THE ACCUMULATION PERIOD (CONTINUED)
7.1.4 SPOUSAL BENEFICIARY CONTINUATION OPTION: If an Owner dies during the
Accumulation Period and the Beneficiary is an Eligible Spousal
Beneficiary, such Beneficiary may choose to continue this Contract in his
or her own name and exercise all the rights of the Owner under this
Contract.
7.1.5 DEATH OF ANNUITANT: If an Owner of this Contract is a non-natural person,
the death of an Annuitant during the Accumulation Period will be treated
as the death of an Owner.
If an Owner is a natural person, and if an Annuitant who is not an Owner
dies during the Accumulation Period, the Owner may name a new Annuitant
subject to Our requirements and limitations in effect on the date the
request is signed. If no Annuitant is living on the Annuity Date, the
Owner (or the oldest Co-Owner) will become the Annuitant.
7.2 DEATH DURING THE ANNUITY PERIOD
7.2.1 DEATH OF OWNER: If an Owner who is not an Annuitant dies during the
Annuity Period, any remaining payments under the Annuity Option in effect
will continue to be made at least as rapidly as under the distribution
method in effect as of such Owner's death. Upon such death, if there is no
surviving Co-Owner, the Beneficiary will become the Owner.
7.2.2 DEATH OF ANNUITANT: If the Annuitant under a Life Annuity Option, or the
last surviving Joint Annuitant under a Joint and Survivor Life Annuity
Option, dies while any guaranteed amounts remain unpaid, the Owner, or the
Beneficiary if there is no surviving Owner, may choose either:
(a) to receive payments for the remainder of the period
guaranteed; or
(b) to receive the present value of the remaining guaranteed
payments in a lump sum.
The interest rate used to calculate any present value is described on the
Contract Schedule.
8. ANNUITY PROVISIONS
8.1 ANNUITY DATE: If You selected an Annuity Date at the time of application
for this Contract, it is shown on the Contract Schedule. Otherwise, the
Annuity Date shown on the Contract Schedule is the Maturity Date. Prior to
the Maturity Date, You may change the Annuity Date subject to Our
requirements and limitations described on the Contract Schedule.
8.2 ANNUITY OPTION: If You do not select an Annuity Option, annuity payments
will be made under the Default Annuity Option described on the Contract
Schedule. You may change the Annuity Option at any time prior to the
Annuity Date. An option not described in Section 9 in this Contract may be
chosen if acceptable to Us.
-15-
8. ANNUITY PROVISIONS (CONTINUED)
8.3 AMOUNT OF ANNUITY PAYMENTS: The annuity payment amount is based on the age
(and sex, where permissible) of the Annuitant(s), the Annuity Option and
payment frequency selected, the Annuity Value, and the payout rates, as of
the Annuity Date.
The Annuity Value will be transferred to Our general account and applied
to the Annuity Option, at the then current payout rates, which will be
furnished on request. The payout rates will not be less than the
Guaranteed Payout Rates based on the Annuitant's Adjusted Age, the
Guaranteed Mortality Table, if applicable, and the Guaranteed Interest
Rate as described on the Contract Schedule. The Guaranteed Payout Rates
per $1000 of Annuity Value applied will be within the range of the rates
shown in the Annuity Option Tables in Section 10.
The amount of Your annuity payments will not be less than those that would
be provided by application of the Annuity Value to purchase any single
premium immediate annuity contract then offered by Us to the same class of
annuitants.
8.4 ANNUITY PAYMENTS: You may choose to receive payments at any payment
interval which We make available, but not less frequently than once per
year. If the amount of any annuity payment would be less than the Minimum
Annuity Payment shown on the Contract Schedule, We will change the
frequency so payments are at least equal to such amount. If the Annuity
Value on the Annuity Date is less than the Minimum Annuity Value shown on
the Contract Schedule, or if after the change in frequency the annuity
payment is less than the Minimum Annuity Payment, We will pay the Annuity
Value in a lump sum.
9. ANNUITY OPTIONS
9.1 OPTION 1 - LIFE ANNUITY: Payments will be made for the life of the
Annuitant. Payments will cease with the last payment due prior to the
Annuitant's death.
9.2 OPTION 2 - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 YEARS: Payments
will be made for a 10 year guaranteed period and as long thereafter as the
Annuitant is alive.
9.3 OPTION 3 - JOINT AND SURVIVOR LIFE ANNUITY: Payments will be made while
either of the Joint Annuitants is alive. The amount of such payments will
not change by reason of the death of the first of the Joint Annuitants to
die.
9.4 OPTION 4 - JOINT AND SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10
YEARS: Payments will be made for a 10 year guaranteed period and as long
thereafter as either Joint Annuitant is alive. The amount of such payments
will not change by reason of the death of the first of the Joint
Annuitants to die.
[ ]CheckBox1
-16-
10. ANNUITY OPTION TABLES
GUARANTEED MORTALITY TABLE: Annuity 2000 Mortality Table (M/F) projected to year
2025 under Scale G
GUARANTEED INTEREST RATE: Minimum 1.0 % - Maximum 3.0 %
RANGE OF MINIMUM GUARANTEED MONTHLY ANNUITY
PAYMENTS FOR EACH $1,000 APPLIED UNDER OPTION
OPTION 1 (LIFE ANNUITY) OPTION 2 (LIFE ANNUITY WITH 10 YEARS GUARANTEED)
ADJUSTED ADJUSTED
AGE MALE FEMALE AGE MALE FEMALE
--- ---- ------ --- ---- ------
56 3.24 - 4.38 2.96 - 4.08 56 3.15 - 4.22 2.89 - 3.96
57 3.32 - 4.46 3.03 - 4.15 57 3.23 - 4.30 2.96 - 4.02
58 3.41 - 4.56 3.11 - 4.23 58 3.31 - 4.38 3.03 - 4.09
59 3.51 - 4.65 3.19 - 4.31 59 3.40 - 4.46 3.11 - 4.16
60 3.61 - 4.75 3.28 - 4.39 60 3.49 - 4.55 3.19 - 4.24
61 3.72 - 4.86 3.37 - 4.48 61 3.59 - 4.65 3.27 - 4.32
62 3.83 - 4.98 3.46 - 4.58 62 3.69 - 4.75 3.36 - 4.41
63 3.95 - 5.11 3.56 - 4.68 63 3.79 - 4.85 3.45 - 4.50
64 4.08 - 5.24 3.67 - 4.79 64 3.90 - 4.96 3.55 - 4.60
65 4.22 - 5.38 3.79 - 4.91 65 4.02 - 5.08 3.65 - 4.70
66 4.37 - 5.53 3.91 - 5.03 66 4.15 - 5.20 3.76 - 4.80
67 4.53 - 5.70 4.04 - 5.16 67 4.27 - 5.33 3.88 - 4.92
68 4.69 - 5.87 4.18 - 5.31 68 4.41 - 5.46 4.00 - 5.04
69 4.87 - 6.05 4.33 - 5.46 69 4.55 - 5.60 4.13 - 5.17
70 5.06 - 6.25 4.49 - 5.63 70 4.70 - 5.74 4.27 - 5.30
71 5.26 - 6.46 4.66 - 5.81 71 4.85 - 5.89 4.41 - 5.44
72 5.48 - 6.68 4.85 - 6.00 72 5.00 - 6.04 4.57 - 5.59
73 5.71 - 6.92 5.06 - 6.21 73 5.17 - 6.19 4.73 - 5.75
74 5.95 - 7.17 5.27 - 6.43 74 5.33 - 6.36 4.90 - 5.91
75 6.21 - 7.44 5.51 - 6.68 75 5.50 - 6.52 5.07 - 6.09
76 6.50 - 7.74 5.76 - 6.94 76 5.68 - 6.69 5.25 - 6.27
77 6.80 - 8.05 6.04 - 7.22 77 5.86 - 6.87 5.44 - 6.45
78 7.12 - 8.38 6.33 - 7.53 78 6.05 - 7.04 5.64 - 6.64
79 7.47 - 8.74 6.66 - 7.86 79 6.23 - 7.22 5.84 - 6.84
80 7.85 - 9.13 7.01 - 8.23 80 6.42 - 7.40 6.05 - 7.04
81 8.25 - 9.55 7.39 - 8.62 81 6.61 - 7.58 6.26 - 7.24
82 8.69 - 10.00 7.80 - 9.05 82 6.80 - 7.76 6.47 - 7.44
83 9.16 - 10.49 8.25 - 9.51 83 6.98 - 7.93 6.68 - 7.64
84 9.67 - 11.01 8.74 - 10.02 84 7.16 - 8.10 6.89 - 7.84
85 10.22 - 11.58 9.28 - 10.58 85 7.34 - 8.27 7.09 - 8.03
OPTION 3 (JOINT AND SURVIVOR LIFE ANNUITY)
ADJUSTED ADJUSTED MALE AGE
FEMALE ------------------------------------------------------------------------------------------------------
AGE 50 55 60 65 70 75 80 85
--- -- -- -- -- -- -- -- --
50 2.32 - 3.39 2.40 - 3.46 2.45 - 3.52 2.49 - 3.56 2.52 - 3.59 2.53 - 3.61 2.54 - 3.62 2.55 - 3.63
55 2.44 - 3.50 2.55 - 3.60 2.65 - 3.69 2.72 - 3.76 2.77 - 3.82 2.80 - 3.85 2.82 - 3.88 2.83 - 3.89
60 2.54 - 3.59 2.70 - 3.74 2.85 - 3.88 2.97 - 4.00 3.06 - 4.09 3.12 - 4.16 3.16 - 4.20 3.18 - 4.23
65 2.61 - 3.67 2.82 - 3.86 3.03 - 4.06 3.23 - 4.24 3.39 - 4.41 3.51 - 4.53 3.59 - 4.62 3.64 - 4.68
70 2.67 - 3.73 2.92 - 3.96 3.19 - 4.22 3.47 - 4.49 3.74 - 4.75 3.96 - 4.97 4.12 - 5.14 4.23 - 5.26
75 2.71 - 3.78 2.99 - 4.04 3.32 - 4.36 3.69 - 4.71 4.08 - 5.09 4.44 - 5.44 4.75 - 5.76 4.98 - 6.00
80 2.73 - 3.81 3.04 - 4.10 3.41 - 4.46 3.85 - 4.89 4.37 - 5.39 4.91 - 5.92 5.43 - 6.43 5.88 - 6.89
85 2.75 - 3.83 3.06 - 4.13 3.46 - 4.52 3.97 - 5.02 4.59 - 5.63 5.30 - 6.33 6.08 - 7.10 6.86 - 7.87
OPTION 4 (JOINT AND SURVIVOR LIFE ANNUITY WITH 10 YEARS GUARANTEED)
ADJUSTED ADJUSTED MALE AGE
FEMALE ------------------------------------------------------------------------------------------------------
AGE 50 55 60 65 70 75 80 85
--- -- -- -- -- -- -- -- --
50 2.32 - 3.39 2.40 - 3.46 2.45 - 3.52 2.49 - 3.56 2.52 - 3.59 2.53 - 3.60 2.54 - 3.62 2.55 - 3.62
55 2.44 - 3.50 2.55 - 3.60 2.65 - 3.69 2.72 - 3.76 2.77 - 3.82 2.80 - 3.85 2.81 - 3.87 2.82 - 3.88
60 2.54 - 3.59 2.70 - 3.74 2.84 - 3.88 2.97 - 4.00 3.06 - 4.09 3.12 - 4.15 3.15 - 4.20 3.17 - 4.22
65 2.61 - 3.67 2.82 - 3.86 3.03 - 4.06 3.22 - 4.24 3.38 - 4.40 3.50 - 4.52 3.58 - 4.60 3.62 - 4.65
70 2.67 - 3.73 2.92 - 3.96 3.19 - 4.22 3.47 - 4.48 3.73 - 4.73 3.94 - 4.95 4.09 - 5.11 4.19 - 5.21
75 2.71 - 3.77 2.99 - 4.04 3.31 - 4.35 3.68 - 4.70 4.06 - 5.06 4.41 - 5.40 4.69 - 5.69 4.89 - 5.89
80 2.73 - 3.80 3.03 - 4.09 3.40 - 4.44 3.84 - 4.87 4.33 - 5.34 4.84 - 5.83 5.30 - 6.28 5.67 - 6.64
85 2.74 - 3.82 3.06 - 4.12 3.45 - 4.50 3.94 - 4.98 4.52 - 5.54 5.17 - 6.17 5.83 - 6.80 6.40 - 7.35
-7-
ML LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: [000 Xxxxxxxx, Xxx Xxxx, XX 00000]
SERVICE CENTER: [P. O. Box 44222]
[Jacksonville, Florida 32231-4222]
ML LIFE INSURANCE COMPANY OF NEW YORK (the "Company") will make annuity payments
as described in this Contract.
This is a legal Contract between the Contract Owner ("You") and the Company
("Us"). PLEASE READ THIS CONTRACT CAREFULLY.
ANNUITY PAYMENTS, DEATH BENEFITS, SURRENDER VALUES AND OTHER CONTRACT VALUES
PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE
SEPARATE ACCOUNT, ARE VARIABLE, MAY INCREASE OR DECREASE, AND ARE NOT GUARANTEED
AS TO DOLLAR AMOUNT.
RIGHT TO REVIEW CONTRACT: You may cancel this Contract within [ten (10)] days
after You receive it. Simply return or mail it to Us at Our Service Center or to
Your Financial Advisor. We will refund the greater of the Contract Value or all
of Your Premiums.
ML Life Insurance Company of New York is a stock life insurance company.
/s/ XXXXX X. XXXXXXXXX /s/ XXXX X. XXXXX
---------------------- ---------------------
President Secretary
THIS CONTRACT INCLUDES A BONUS FEATURE. A BONUS AMOUNT WILL BE ADDED TO YOUR
CONTRACT VALUE AT THE TIME OF EACH PREMIUM PAYMENT. ANY BONUS AMOUNT PAID WITHIN
6 MONTHS OF THE DATE OF DEATH OF THE OWNER WILL BE RECAPTURED. SEE THE ATTACHED
PREMIUM-BASED BONUS ENDORSEMENT, FORM MLNY101, AND BONUS ENDORSEMENT SCHEDULE,
FORM MLNY101-5, FOR A COMPLETE DESCRIPTION OF THE BONUS AMOUNT AND THE RECAPTURE
PROVISIONS.
Individual Deferred Variable Annuity Contract
Flexible Premiums - Nonparticipating
TABLE OF CONTENTS
SECTION PAGE
Definitions .................................................................... 3
Contract Schedule............................................................... 5
1. General Provisions ........................................................ 6
2. Premiums .................................................................. 9
3. The Separate Account ...................................................... 9
4. Charges, Deductions and Credits ........................................... 11
5. Transfers ................................................................. 12
6. Withdrawals ............................................................... 13
7. Death Benefit Provisions .................................................. 14
8. Annuity Provisions ........................................................ 15
9. Annuity Options ........................................................... 16
10. Annuity Option Tables...................................................... 17
-2-
DEFINITIONS
1. ACCOUNT VALUE: The sum of the values of Your interests in the subaccounts
of the Separate Account as of the end of a Valuation Period.
2. ACCUMULATION PERIOD: The period of time from the Contract Date to the
Annuity Date.
3. ACCUMULATION UNIT: A unit of measure used to determine the value of Your
interest in a subaccount during the Accumulation Period.
4. ACCUMULATION UNIT VALUE: The value of an Accumulation Unit during a
Valuation Period. Accumulation Unit Values are usually determined as of
the close of regular trading on each day the New York Stock Exchange is
open for business.
5. ANNUITANT: Any natural person(s) on whose life annuity payments are based.
During the Accumulation Period, all references to the Annuitant shall
include any Joint Annuitant.
6. ANNUITY DATE: The date on which You choose to begin receiving annuity
payments.
7. ANNUITY OPTIONS: Options under whose terms annuity payments will be made
during the Annuity Period.
8. ANNUITY PERIOD: The period beginning on the Annuity Date during which
annuity payments are made under an Annuity Option.
9. ANNUITY VALUE: The amount which will be applied to an Annuity Option on
the Annuity Date. It is the Contract Value on the Annuity Date reduced by
any charges for premium taxes and any other charges deducted on the
Annuity Date.
10. BENEFICIARY: The person(s) or entity(ies) designated by You to receive
payment of the Death Benefit provided under this Contract.
11. COMPANY: ML Life Insurance Company of New York. Also referred to as "We",
"Us" or "Our".
12. CONTRACT ANNIVERSARY: An anniversary of the Contract Date.
13. CONTRACT DATE: The effective date of this Contract as shown on the
Contract Schedule. This is usually the business day We receive Your
Initial Premium at Our Service Center.
14. CONTRACT VALUE: The total value of Your interest in this Contract as of
the end of a Valuation Period. It is equal to the Account Value plus the
value of Your interest in any other accounts that may be included by Rider
or by Endorsement.
15. CONTRACT YEAR: A one year period starting on the Contract Date and on each
Contract Anniversary thereafter.
16. DEATH BENEFIT: During the Accumulation Period, the amount payable upon the
death of the Owner (the first Owner to die if this Contract has
Co-Owners), or, if the Owner is a non-natural person, upon the death of
the Annuitant (the first Annuitant to die if this Contract has Joint
Annuitants). During the Annuity Period, the amount payable upon the death
of the Annuitant, or the last surviving Joint Annuitant.
17. DUE PROOF OF DEATH: A certified death certificate or other legal proof of
death acceptable to Us, a completed beneficiary claim form, and any
additional paperwork necessary to process a death claim.
18. ELIGIBLE SPOUSAL BENEFICIARY: A Beneficiary who is the spouse of a
deceased Owner and who satisfies the requirements described on the
Contract Schedule.
-3-
DEFINITIONS (CONTINUED)
19. FUND: An investment portfolio of an open-end management investment company
or unit investment trust in which a subaccount may invest.
20. INVESTMENT CATEGORY: A classification of subaccounts as determined by Us.
The Investment Categories as of the Contract Date are shown on the
Contract Schedule.
21. MATURITY AGE: The age of the Annuitant used in the determination of the
Maturity Date. The Maturity Age is shown on the Contract Schedule.
22. MATURITY DATE: The latest possible Annuity Date as shown on the Contract
Schedule.
23. MONTHAVERSARY: The Contract Date and the same calendar day of each
successive month during the Accumulation Period.
24. NET ASSET VALUE: The value of one share of a Fund at the end of a
Valuation Period.
25. NET INVESTMENT FACTOR: An index used to measure the investment performance
of a subaccount from one Valuation Period to the next Valuation Period.
26. NET PREMIUM(S): The Premium(s) You pay into this Contract less any Premium
Load. The Premium Load, if any, and the Initial Net Premium are shown on
the Contract Schedule.
27. OWNER: The person(s) or entity(ies) entitled to exercise all ownership
rights under this Contract. The Owner is deemed a non-natural person if
this Contract is owned by a Corporation, a Trust, or similar situations
where the Owner is not a person(s). All references to the Owner shall
include any Co-Owner. Unless otherwise specified, age refers to the oldest
Co-Owner's age. In this Contract, "You" and "Your" refer to the Owner.
28. PREMIUMS: The money You pay into this Contract as consideration for the
benefits it provides.
29. QUARTERVERSARY: The same calendar day of each successive three month
period during the Accumulation Period, beginning with the Contract Date.
30. SEPARATE ACCOUNT: This Contract is funded by a Separate Account of the
Company, which is a segregated asset account and is not a part of Our
general account. The Separate Account has multiple subaccounts, each of
which invests in shares or units of a Fund.
31. SPOUSAL CONTINUATION DATE: The date that an Eligible Spousal Beneficiary
provides all of the information necessary to continue the Contract in his
or her own name or the date the Spousal Beneficiary Continuation Option is
automatically applied.
32. SURRENDER VALUE: The amount available upon full withdrawal. It is equal to
the Contract Value reduced by any charges, including any Surrender Charge,
and increased by any credits which apply upon full withdrawal.
33. VALUATION PERIOD: The interval from one determination of the Accumulation
Unit Value for a subaccount to the next such determination.
-4-
1. GENERAL PROVISIONS
1.1 OWNER: Unless another Owner is named by the purchaser of this Contract,
the purchaser is the Owner. Upon written request You may designate a new
Owner, subject to Our requirements and limitations in effect on the date
the request is signed. A change in Owner terminates all prior Beneficiary
designations, except that any irrevocable Beneficiary must consent to such
change of beneficiary. If the Owner is changed, the age of the new Owner
as of the Contract Date must not have been greater than the Maximum Owner
Age shown on the Contract Schedule. We will not be responsible for the tax
consequences of any change of Owner.
A Contract may be owned by Co-Owners, limited to two natural persons.
Ownership rights must be exercised jointly by Co-Owners unless otherwise
allowed by us. Upon the death of either Co-Owner, the surviving Co-Owner
will be deemed to be the Primary Beneficiary unless You specify otherwise.
Any other Beneficiary designation will be treated as a Contingent
Beneficiary unless otherwise indicated on the Contract Schedule or in a
notice to Us.
1.2 BENEFICIARY: The Beneficiary is shown on the Contract Schedule. You may
change the Beneficiary while You or the surviving Co-Owner are alive.
You may name the Beneficiary irrevocably. If You do so, You can later
change the Beneficiary only with the Beneficiary's written consent.
Unless You have provided otherwise, the Death Benefit will be paid to, or
in equal shares to:
(a) the Primary Beneficiary who survives You (or who survives the
Annuitant if the Owner is a non-natural person); or, if no Primary
Beneficiary survives You,
(b) the Contingent Beneficiary who survives You (or who survives the
Annuitant if the Owner is a non-natural person); or, if no
Contingent Beneficiary survives You,
(c) Your estate.
If a Beneficiary survives You but dies before the Death Benefit is paid,
the estate of such Beneficiary is entitled to the Death Benefit that would
otherwise have been paid to such Beneficiary.
1.3 ANNUITANT: The Annuitant is shown on the Contract Schedule. Prior to the
Annuity Date, except when the Owner is a non-natural person, the Owner may
make a written request to change the Annuitant, subject to Our
requirements and limitations in effect on the date the request is signed.
If the Annuitant is changed, the age of the new Annuitant as of the
Contract Date must not have been greater than the Maximum Annuitant Age
shown on the Contract Schedule.
1.4 NOTICES, CHOICES AND REQUESTS: To be effective, all notices, choices and
requests You make under this Contract must be in writing and signed, and
be received at Our Service Center, unless We have authorized You to use
another method. Such communication must be provided by You or Your
representative, if authorized by You in writing. If acceptable to Us,
notices, choices and requests relating to Beneficiaries, Owners,
Annuitants, and the Annuity Date will take effect as of the date signed,
unless We have already acted in reliance on the prior status. We are not
responsible for their validity.
-6-
1. GENERAL PROVISIONS (CONTINUED)
1.5 EVIDENCE OF SURVIVAL: We may require proof that any person on whose
continued life any payments under this Contract are based is alive. We
reserve the right to withhold or discontinue payments until We receive
proof, in a form satisfactory to Us, that such person is living.
1.6 MISSTATEMENT OF AGE OR SEX: We may require proof at any time, in a form
satisfactory to Us, of the age or sex of any Annuitant, Owner or
Beneficiary if any payments and benefits under this Contract are based on
such person's age and sex. If the age or sex of any such person has been
misstated, any payments and benefits will be adjusted based on the correct
age and sex of such person.
Once annuity payments have begun, any amount We have overpaid as a result
of such misstatement will be deducted from the next payment(s) made by Us
under this Contract. Any amount We have underpaid will be paid in full
with the next payment made by Us. We will pay interest on the
underpayment. The rate of interest will not be less than 3% per year.
1.7 THE CONTRACT: This Contract, any application and any Endorsements or
Riders are the entire Contract. It is issued in consideration of the
payment of the Initial Premium shown on the Contract Schedule.
Only Our President, a Vice President, Secretary, or Assistant Secretary
may change this Contract. Any change must be in writing. No one else has
authority to modify or waive any provision of this Contract.
At any time, We may make such changes to this Contract, without Your
consent, as required to conform it with any law, regulation, or ruling
issued by a governmental agency. We will notify You of such changes, and,
when required, will obtain approval from the appropriate regulatory
authority and You.
1.8 NONPARTICIPATING: This Contract is nonparticipating. It does not share in
Our surplus. No dividends are payable on this Contract.
1.9 INCONTESTABILITY: We will not contest this Contract.
1.10 CONTRACT PAYMENTS: All sums payable to or by Us are payable at Our Service
Center. We may require return of this Contract prior to making payment.
Payment generally will be made within seven (7) days of Our receipt of a
request acceptable to Us at Our Service Center. Our payment obligations
are subject to all payments made and actions taken by Us prior to Our
receipt of a payment request.
1.11 REGULATORY REQUIREMENTS: Paid-up annuity benefits, Contract withdrawal
benefits, and death benefits available under this Contract will not be
less than the minimum required by the laws of the state in which this
Contract is delivered.
-7-
1. GENERAL PROVISIONS (CONTINUED)
1.12 ASSIGNMENT: You may assign Your rights under this Contract unless
restricted by applicable law. Assignments will be subject to any payments
made and any actions taken by Us before a signed copy of the assignment is
received at Our Service Center. We will not be responsible for determining
whether an assignment is valid or for the tax consequences of any
assignment.
1.13 PROTECTION OF PROCEEDS: To the extent permitted by law, all payments under
this Contract shall be free from legal process or the claim of any
creditor. No payment and no amount under this Contract can be taken or
assigned in advance of its payment date unless We receive the Owner's
written consent.
1.14 TAX QUALIFICATION: This Contract is intended to qualify as an annuity
contract for federal income tax purposes. To that end, the provisions of
this Contract are to be interpreted to ensure or maintain such tax
qualification, notwithstanding any other provision to the contrary.
Distributions under this Contract shall be made in a time and manner
necessary to maintain such qualification under the applicable provisions
of the Internal Revenue Code. Both We and You agree to amend this Contract
to reflect any clarifications that may be needed or are appropriate to
maintain such qualification or to conform this Contract to any applicable
changes in the tax qualification requirements.
1.15 SUSPENSION OR DEFERRAL OF PAYMENTS OR TRANSFERS: We may suspend or
postpone payments of any amount due under this Contract where permitted
under applicable federal or state laws, rules or regulations.
We may suspend or defer payments or transfers from the Separate Account
under this Contract in the event that:
(a) the New York Stock Exchange is closed for business, other than
normal weekend and holiday closings;
(b) trading on the New York Stock Exchange is restricted;
(c) an emergency exists such that it is not reasonably practical to
dispose of securities in the Separate Account or to determine the
value of its assets;
(d) the Securities and Exchange Commission by order so permits for Your
protection;
(e) the payment is derived from a check used to pay a Premium which has
not cleared through the banking system; or
(f) the transfer is subject to limitations as described in Section 5.2.
Conditions (b), (c) and (d) will be decided by or in accordance with rules
of the Securities and Exchange Commission. We reserve the right, at our
option, to defer any payments in accordance with the deferment provisions
of the Investment Company Act of 1940, as amended. We will add interest
from the date of our receipt of a completed request to the date of payment
if such payment is not made within 10 days following receipt of the
completed request. The rate of interest will not be less than 3% per year.
-8-
1. GENERAL PROVISIONS (CONTINUED)
1.16 CONTRACT TERMINATION: This Contract will terminate upon the occurrence of
any of the events listed under Contract Termination on the Contract
Schedule.
1.17 INACTIVE CONTRACT: If, at any time prior to the Annuity Date, all of the
conditions listed under Inactive Contract on the Contract Schedule are
met, We will terminate this Contract. If the Contract is terminated under
this provision, We will pay You the Surrender Value in a lump sum.
1.18 PERIODIC REPORTS: At least once a year during the Accumulation Period We
will furnish You with a report for Your Contract. It will show the current
number of Accumulation Units, the Accumulation Unit Values, the Account
Value, the Contract Value and any other information as may be required.
2. PREMIUMS
2.1 PREMIUMS: This Contract is issued in consideration of Your payment of the
Initial Premium. Additional Premiums may be paid during the Accumulation
Period, subject to the Premium Requirements and Limitations described on
the Contract Schedule.
You may choose to have additional premiums paid systematically from Your
Xxxxxxx Xxxxx brokerage account. You may change the frequency of payment,
the premium amount, the premium allocation, or may cancel this feature
upon written notice to Us.
2.2 PREMIUM LOAD: A Premium Load may be deducted from the Initial Premium and
any additional Premiums. The amount of this charge, how it is determined,
and when and how it is collected are described on the Contract Schedule.
2.3 PREMIUM ALLOCATION: Your Initial Net Premium and any additional Net
Premiums will be allocated to the subaccounts You select, as described on
the Contract Schedule.
3. THE SEPARATE ACCOUNT
3.1 THE SEPARATE ACCOUNT: The Separate Account is identified on the Contract
Schedule. It is a separate investment account of ML Life Insurance Company
of New York. With respect to the Separate Account, income, gains, and
losses, whether or not realized, from assets allocated to the Separate
Account are credited to or charged against the Separate Account without
regard to Our other income, gains, or losses. Assets allocated to the
Separate Account remain Our property but are separate from Our general
account and any other separate accounts We may have. Separate Account
assets, to the extent equal to the Separate Account's reserves and other
liabilities, may not be charged with liabilities from any other business
We conduct. We reserve the right to transfer any amount in excess of the
Separate Account's reserves and liabilities to our general account.
-9-
3. THE SEPARATE ACCOUNT (CONTINUED)
3.2 SUBACCOUNTS: The Separate Account is divided into subaccounts. The
subaccounts available on the Contract Date are shown on the Contract
Schedule. The allocation of Your Initial Net Premium and any additional
Net Premiums to the subaccounts is subject to the Allocation Guidelines
and Restrictions described on the Contract Schedule.
3.3 CHANGES TO THE SEPARATE ACCOUNT: We may add subaccounts. We reserve the
right, subject to obtaining any necessary regulatory approvals, to close
or eliminate subaccounts; to substitute shares of a new portfolio for
shares of the portfolio in which a subaccount invests; to deregister the
Separate Account under the Investment Company Act of 1940 (the "1940
Act"); to make any changes required by the 1940 Act; to operate the
Separate Account as a unit investment trust or a management investment
company under the 1940 Act, or any other form permitted by law; to
transfer all or a portion of the assets of a subaccount or Separate
Account to another subaccount or Separate Account pursuant to a
combination or otherwise; and to create new Separate Accounts. We may add,
close, or substitute subaccounts with respect to existing Account Value or
future Premiums, or both, for some or all classes of Contracts, at any
time, in Our sole discretion.
3.4 NUMBER OF ACCUMULATION UNITS: During the Accumulation Period, Accumulation
Units are added to, or subtracted from each subaccount, as a result of
Premium payments, transfers, withdrawals, charges and credits (except for
charges and credits used in determining the Net Investment Factor) during
a Valuation Period. The number of Accumulation Units is determined by
dividing the amount added to, or the amount subtracted from, the
subaccount, by the Accumulation Unit Value for that subaccount for that
Valuation Period.
3.5 ACCUMULATION UNIT VALUE: For each subaccount, the Accumulation Unit Value
was set by Us when the subaccount was established. The value may increase
or decrease from one Valuation Period to the next. For any Valuation
Period the Accumulation Unit Value is determined by multiplying A by B
where:
A is the Accumulation Unit Value for the prior Valuation Period;
and
B is the Net Investment Factor for that subaccount for the current
Valuation Period.
To the extent permitted by law, We may change when the Accumulation Unit
Value is calculated by giving You 30 days prior notice; or We may defer
calculation of the Accumulation Unit Value, if an emergency exists making
valuation of assets in the subaccount not reasonably practical, or if the
Securities and Exchange Commission permits such deferral.
3.6 NET INVESTMENT FACTOR: The Net Investment Factor for each subaccount is
determined by dividing A by B and then subtracting C where:
A is (i) the Net Asset Value per share (or for a unit investment
trust, the Net Asset Value per unit of the trust) of the Fund in
which the subaccount invests at the end of the current Valuation
Period; plus
(ii) any dividend or capital gain per share or unit declared on
behalf of the Fund in which the subaccount invests that has an
ex-dividend date during the current Valuation Period; minus
-10-
3. THE SEPARATE ACCOUNT (CONTINUED)
(iii) the cumulative charge or credit for any taxes or tax
reserve We have established as a result of the operation or
maintenance of the subaccount;
B is the Net Asset Value per share or unit of the Fund in which the
subaccount invests for the preceding Valuation Period; and
C is (i) the Valuation Period equivalent of the current annual
Asset-Based Insurance Charge shown on the Contract Schedule;
plus
(ii) a charge factor, if any, We have established as a result
of the operation or maintenance of the subaccount.
4. CHARGES, DEDUCTIONS AND CREDITS
4.1 ASSET-BASED INSURANCE CHARGE: The Asset-Based Insurance Charge compensates
Us for Our expenses in the establishment and administration of the
Separate Account, for issue and administration of this Contract, and for
the risks We assume in providing the benefits under this Contract. The
current and maximum Asset-Based Insurance Charge, how the charge is
determined, and when and how it is collected are described on the Contract
Schedule. The current Asset-Based Insurance Charge may be changed, but it
will never exceed the maximum charge shown on the Contract Schedule.
4.2 CONTRACT FEE: A Contract Fee may be deducted from the Contract Value to
compensate Us for expenses related to the maintenance of this Contract.
The current and maximum Contract Fee, how the fee is determined, and when
and how it is collected are described on the Contract Schedule. The
current Contract Fee may be changed, but it will never exceed the maximum
fee shown on the Contract Schedule.
4.3 OTHER CONTRACT CHARGES: Other charges may be deducted from Your Contract
Value. The purpose of each such charge, the current and maximum amount of
the charge, how it is determined, and when and how it is collected are
described on the Contract Schedule. The current amount of a charge may be
changed, but it will never exceed the maximum charge shown on the Contract
Schedule.
4.4 CONTRACT CREDITS: Credits may be added to Your Contract Value. The purpose
of each such credit, the amount of the credit, how the credit is
determined, and when and how it is paid are described on the Contract
Schedule.
4.5 CHANGES IN CONTRACT CHARGES: Changes to any Contract charge will be
applied by Contract class, and will be based upon changes in applicable
experience factors such as investment income and returns, mortality,
persistency, expenses and taxes. Any change will be determined in
accordance with procedures and standards on file, if required, with the
insurance supervisory official of the jurisdiction in which this Contract
is delivered.
-11-
4. CHARGES, DEDUCTIONS AND CREDITS (CONTINUED)
4.6 PREMIUM TAXES: Any charges made by Us attributable to premium taxes
imposed by a state or other governmental authority will be deducted in a
manner determined solely by Us, in compliance with applicable state law.
We currently deduct such charges as described on the Contract Schedule.
4.7 OTHER TAXES AND ASSESSMENTS: We reserve the right to deduct a charge for
assessments or federal, state, or local excise, profits, or income taxes.
We also reserve the right to deduct from the Separate Account any taxes
imposed on the Separate Account.
5. TRANSFERS
5.1 TRANSFERS AMONG SUBACCOUNTS: You may transfer all or part of Your Account
Value among the subaccounts, subject to the Requirements and Limitations
described on the Contract Schedule, and subject to Section 5.2 below. A
transfer will be processed as of the end of the Valuation Period during
which We receive all the information necessary to process the transfer at
Our Service Center.
A Transfer Fee may apply to certain transfers. The current and maximum
Transfer Fee, how the fee is determined, and when and how it is collected
are described on the Contract Schedule. The current Transfer Fee may be
changed, but it will never exceed the maximum fee shown on the Contract
Schedule.
There are no transfer charges related to the allocation of the initial
premium payment under the Contract, or the allocation of any subsequent
premium, nor to any of the automatic transfers related to the Dollar Cost
Averaging, Asset Allocation, or Rebalancing programs described below in
this section. In addition, none of the transfers referenced in the
previous sentence count toward the number of transfers permitted without
charge each contract year.
We reserve the right not to process a transfer request when the sale or
purchase of shares or units is not reasonably practical due to actions
taken or limitations imposed by Us or by a Fund. We also reserve the right
to deduct any Redemption Fee related to short term, frequent or disruptive
trading, as determined by any Fund, or under any regulatory requirements.
5.2 DISRUPTIVE TRANSFERS: If, in Our sole opinion, We determine that there has
been a pattern of disruptive transfers including short term "market
timing" transfers for a Contract, We reserve the right to impose
limitations on the processing of transfer requests with respect to such
Contract. Such limitations could be applied to transfers to, or from, one
or more of the subaccounts and could include, but are not limited to:
(a) the requirement of a minimum time period between each transfer;
(b) not accepting a transfer request from a third party acting under
authorization on behalf of more than one Owner;
(c) limiting the dollar amount that may be transferred between the
subaccounts at any one time; and
(d) requiring that a written transfer request be provided to Us signed
by the Owner.
-12-
5. TRANSFERS (CONTINUED)
5.3 DOLLAR COST AVERAGING PROGRAM: You may transfer all or part of your
Contract Value in a designated subaccount to one or more other subaccounts
pursuant to the Dollar Cost Averaging Program (DCA Program). We will
transfer a specified amount at the frequency You select from the
subaccount that You designate (the "source subaccount") and allocate it in
accordance with Your instructions to the subaccount(s) that You select. To
elect the DCA Program You need to have a minimum amount in the source
subaccount equal to the amount to be transferred each period multiplied by
the number of periodic transfers.
5.4 ASSET ALLOCATION PROGRAM: You may choose to have Your premiums and
Contract Value allocated among the subaccounts in accordance with an Asset
Allocation Model You select based on Your investment goals and risk
tolerance. Each model identifies specific subaccounts and the percentage
of premium or Contract Value which should be allocated to each of these
subaccounts. At the end of each calendar quarter, unless You instruct Us
otherwise, We will automatically reallocate your Contract Value to
maintain the subaccounts and percentages then in effect for Your selected
model.
5.5 REBALANCING PROGRAM: You may choose the Rebalancing Program where You
select the percentage of Premium and Contract Value to be allocated to
subaccounts You select based on Your investment goals and risk tolerance.
We will allocate Your Premiums or Contract Value to these subaccounts in
accordance with the percentages You select. At the end of each selected
period, We will automatically reallocate your Contract Value to maintain
the particular percentage allocation among the subaccounts You have
selected.
6. WITHDRAWALS
6.1 WITHDRAWALS: During the Accumulation Period, You may request partial
withdrawals or a full withdrawal of the Surrender Value, subject to the
Requirements and Limitations described on the Contract Schedule. A
withdrawal will be processed as of the end of the Valuation Period during
which We receive all the information necessary to process the withdrawal
at Our Service Center.
Partial withdrawals will be deducted from the subaccounts as described on
the Contract Schedule. For a full withdrawal, upon receipt of this
Contract and all other information necessary to process the withdrawal at
Our Service Center, We will determine and pay You the Surrender Value in a
lump sum or apply it under an Annuity Option described in Section 9.
6.2 SURRENDER CHARGE: A Surrender Charge may be deducted in connection with
partial or full withdrawals of the Surrender Value. The amount of the
Surrender Charge, how the charge is determined, and when and how it is
collected are described on the Contract Schedule.
6.3 FREE WITHDRAWAL AMOUNT: The Free Withdrawal Amount is an amount that can
be withdrawn from the Contract without the deduction of a Surrender
Charge. The Free Withdrawal Amount available under this Contract, if any,
and how such amount is determined, are described on the Contract Schedule.
-13-
6. WITHDRAWALS (CONTINUED)
6.4 SYSTEMATIC WITHDRAWAL PROGRAM: You may set up automatic withdrawals of a
specified dollar amount to be made periodically. We will make these
withdrawals from the subaccounts in the same proportion as the value of
each subaccount bears to the Contract Value. The minimum amount of each
withdrawal and the remaining Contract Value after each withdrawal is shown
in the Contract Schedule. The Systematic Withdrawal Program cannot extend
beyond the Annuity Date.
7. DEATH BENEFIT PROVISIONS
7.1 DEATH DURING THE ACCUMULATION PERIOD
7.1.1 DEATH OF OWNER: If the Owner dies (the first Owner to die if this Contract
has Co-Owners) during the Accumulation Period, upon receipt of Due Proof
of Death of such Owner, We will pay the Death Benefit to the Beneficiary
as provided in Section 7.1.3. An Eligible Spousal Beneficiary may continue
this Contract as provided in Section 7.1.4. If the Contract is owned by a
non-natural person, the Death Benefit will be paid to the Beneficiary upon
receipt of Due Proof of Death of the Annuitant (the first Annuitant to die
if this Contract has Joint Annuitants).
7.1.2 DEATH BENEFIT AMOUNT: The Death Benefit during the Accumulation Period is
equal to the Contract Value as of the date We receive Due Proof of Death
of the Owner at Our Service Center.
7.1.3 DEATH BENEFIT PAYMENT OPTIONS: Except as provided in Section 7.1.4, if an
Owner dies during the Accumulation Period, the Beneficiary must receive
his/her respective Death Benefit under one of the following payment
options:
OPTION 1 - payment of the Death Benefit in a lump sum within five years of
the date of such Owner's death; or
OPTION 2 - payment of the entire Death Benefit within five years of the
date of such Owner's death; or
OPTION 3 - payment of the Death Benefit under an Annuity Option over the
lifetime of such Beneficiary, or over a period that does not exceed the
life expectancy, as defined by Internal Revenue Service regulations, of
such Beneficiary, with payments starting within one year of the date of
death of such Owner. This option is not available if the Beneficiary is a
non-natural person.
If We do not receive Due Proof of Death by the end of the Death Benefit
Payment Election Period shown on the Contract Schedule, We will
automatically apply the Default Death Benefit Payment Option shown on the
Contract Schedule.
-14-
7.1 DEATH DURING THE ACCUMULATION PERIOD (CONTINUED)
7.1.4 SPOUSAL BENEFICIARY CONTINUATION OPTION: If an Owner dies during the
Accumulation Period and the Beneficiary is an Eligible Spousal
Beneficiary, such Beneficiary may choose to continue this Contract in his
or her own name and exercise all the rights of the Owner under this
Contract.
7.1.5 DEATH OF ANNUITANT: If an Owner of this Contract is a non-natural person,
the death of an Annuitant during the Accumulation Period will be treated
as the death of an Owner.
If an Owner is a natural person, and if an Annuitant who is not an Owner
dies during the Accumulation Period, the Owner may name a new Annuitant
subject to Our requirements and limitations in effect on the date the
request is signed. If no Annuitant is living on the Annuity Date, the
Owner (or the oldest Co-Owner) will become the Annuitant.
7.2 DEATH DURING THE ANNUITY PERIOD
7.2.1 DEATH OF OWNER: If an Owner who is not an Annuitant dies during the
Annuity Period, any remaining payments under the Annuity Option in effect
will continue to be made at least as rapidly as under the distribution
method in effect as of such Owner's death. Upon such death, if there is no
surviving Co-Owner, the Beneficiary will become the Owner.
7.2.2 DEATH OF ANNUITANT: If the Annuitant under a Life Annuity Option, or the
last surviving Joint Annuitant under a Joint and Survivor Life Annuity
Option, dies while any guaranteed amounts remain unpaid, the Owner, or the
Beneficiary if there is no surviving Owner, may choose either:
(a) to receive payments for the remainder of the period
guaranteed; or
(b) to receive the present value of the remaining guaranteed
payments in a lump sum.
The interest rate used to calculate any present value is described on the
Contract Schedule.
8. ANNUITY PROVISIONS
8.1 ANNUITY DATE: If You selected an Annuity Date at the time of application
for this Contract, it is shown on the Contract Schedule. Otherwise, the
Annuity Date shown on the Contract Schedule is the Maturity Date. Prior to
the Maturity Date, You may change the Annuity Date subject to Our
requirements and limitations described on the Contract Schedule.
8.2 ANNUITY OPTION: If You do not select an Annuity Option, annuity payments
will be made under the Default Annuity Option described on the Contract
Schedule. You may change the Annuity Option at any time prior to the
Annuity Date. An option not described in Section 9 in this Contract may be
chosen if acceptable to Us.
-15-
8. ANNUITY PROVISIONS (CONTINUED)
8.3 AMOUNT OF ANNUITY PAYMENTS: The annuity payment amount is based on the age
(and sex, where permissible) of the Annuitant(s), the Annuity Option and
payment frequency selected, the Annuity Value, and the payout rates, as of
the Annuity Date.
The Annuity Value will be transferred to Our general account and applied
to the Annuity Option, at the then current payout rates, which will be
furnished on request. The payout rates will not be less than the
Guaranteed Payout Rates based on the Annuitant's Adjusted Age, the
Guaranteed Mortality Table, if applicable, and the Guaranteed Interest
Rate as described on the Contract Schedule. The Guaranteed Payout Rates
per $1000 of Annuity Value applied will be within the range of the rates
shown in the Annuity Option Tables in Section 10.
The amount of Your annuity payments will not be less than those that would
be provided by application of the Annuity Value to purchase any single
premium immediate annuity contract then offered by Us to the same class of
annuitants.
8.4 ANNUITY PAYMENTS: You may choose to receive payments at any payment
interval which We make available, but not less frequently than once per
year. If the amount of any annuity payment would be less than the Minimum
Annuity Payment shown on the Contract Schedule, We will change the
frequency so payments are at least equal to such amount. If the Annuity
Value on the Annuity Date is less than the Minimum Annuity Value shown on
the Contract Schedule, or if after the change in frequency the annuity
payment is less than the Minimum Annuity Payment, We will pay the Annuity
Value in a lump sum.
9. ANNUITY OPTIONS
9.1 OPTION 1 - LIFE ANNUITY: Payments will be made for the life of the
Annuitant. Payments will cease with the last payment due prior to the
Annuitant's death.
9.2 OPTION 2 - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 YEARS: Payments
will be made for a 10 year guaranteed period and as long thereafter as the
Annuitant is alive.
9.3 OPTION 3 - JOINT AND SURVIVOR LIFE ANNUITY: Payments will be made while
either of the Joint Annuitants is alive. The amount of such payments will
not change by reason of the death of the first of the Joint Annuitants to
die.
9.4 OPTION 4 - JOINT AND SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10
YEARS: Payments will be made for a 10 year guaranteed period and as long
thereafter as either Joint Annuitant is alive. The amount of such payments
will not change by reason of the death of the first of the Joint
Annuitants to die.
-16-
10. ANNUITY OPTION TABLES
GUARANTEED MORTALITY TABLE: Annuity 2000 Mortality Table (M/F) projected to year
2025 under Scale G
GUARANTEED INTEREST RATE: Minimum 1.0 % - Maximum 3.0 %
RANGE OF MINIMUM GUARANTEED MONTHLY ANNUITY
PAYMENTS FOR EACH $1,000 APPLIED UNDER OPTION
OPTION 1 (LIFE ANNUITY) OPTION 2 (LIFE ANNUITY WITH 10 YEARS GUARANTEED)
----------------------- ------------------------------------------------
ADJUSTED ADJUSTED
AGE MALE FEMALE AGE MALE FEMALE
--- ---- ------ --- ---- ------
56 3.24 - 4.38 2.96 - 4.08 56 3.15 - 4.22 2.89 - 3.96
57 3.32 - 4.46 3.03 - 4.15 57 3.23 - 4.30 2.96 - 4.02
58 3.41 - 4.56 3.11 - 4.23 58 3.31 - 4.38 3.03 - 4.09
59 3.51 - 4.65 3.19 - 4.31 59 3.40 - 4.46 3.11 - 4.16
60 3.61 - 4.75 3.28 - 4.39 60 3.49 - 4.55 3.19 - 4.24
61 3.72 - 4.86 3.37 - 4.48 61 3.59 - 4.65 3.27 - 4.32
62 3.83 - 4.98 3.46 - 4.58 62 3.69 - 4.75 3.36 - 4.41
63 3.95 - 5.11 3.56 - 4.68 63 3.79 - 4.85 3.45 - 4.50
64 4.08 - 5.24 3.67 - 4.79 64 3.90 - 4.96 3.55 - 4.60
65 4.22 - 5.38 3.79 - 4.91 65 4.02 - 5.08 3.65 - 4.70
66 4.37 - 5.53 3.91 - 5.03 66 4.15 - 5.20 3.76 - 4.80
67 4.53 - 5.70 4.04 - 5.16 67 4.27 - 5.33 3.88 - 4.92
68 4.69 - 5.87 4.18 - 5.31 68 4.41 - 5.46 4.00 - 5.04
69 4.87 - 6.05 4.33 - 5.46 69 4.55 - 5.60 4.13 - 5.17
70 5.06 - 6.25 4.49 - 5.63 70 4.70 - 5.74 4.27 - 5.30
71 5.26 - 6.46 4.66 - 5.81 71 4.85 - 5.89 4.41 - 5.44
72 5.48 - 6.68 4.85 - 6.00 72 5.00 - 6.04 4.57 - 5.59
73 5.71 - 6.92 5.06 - 6.21 73 5.17 - 6.19 4.73 - 5.75
74 5.95 - 7.17 5.27 - 6.43 74 5.33 - 6.36 4.90 - 5.91
75 6.21 - 7.44 5.51 - 6.68 75 5.50 - 6.52 5.07 - 6.09
76 6.50 - 7.74 5.76 - 6.94 76 5.68 - 6.69 5.25 - 6.27
77 6.80 - 8.05 6.04 - 7.22 77 5.86 - 6.87 5.44 - 6.45
78 7.12 - 8.38 6.33 - 7.53 78 6.05 - 7.04 5.64 - 6.64
79 7.47 - 8.74 6.66 - 7.86 79 6.23 - 7.22 5.84 - 6.84
80 7.85 - 9.13 7.01 - 8.23 80 6.42 - 7.40 6.05 - 7.04
81 8.25 - 9.55 7.39 - 8.62 81 6.61 - 7.58 6.26 - 7.24
82 8.69 - 10.00 7.80 - 9.05 82 6.80 - 7.76 6.47 - 7.44
83 9.16 - 10.49 8.25 - 9.51 83 6.98 - 7.93 6.68 - 7.64
84 9.67 - 11.01 8.74 - 10.02 84 7.16 - 8.10 6.89 - 7.84
85 10.22 - 11.58 9.28 - 10.58 85 7.34 - 8.27 7.09 - 8.03
OPTION 3 (JOINT AND SURVIVOR LIFE ANNUITY)
ADJUSTED ADJUSTED MALE AGE
-----------------------------------------------------------------------------------------------------
FEMALE
AGE 50 55 60 65 70 75 80 85
--- -- -- -- -- -- -- -- --
50 2.32 - 3.39 2.40 - 3.46 2.45 - 3.52 2.49 - 3.56 2.52 - 3.59 2.53 - 3.61 2.54 - 3.62 2.55 - 3.63
55 2.44 - 3.50 2.55 - 3.60 2.65 - 3.69 2.72 - 3.76 2.77 - 3.82 2.80 - 3.85 2.82 - 3.88 2.83 - 3.89
60 2.54 - 3.59 2.70 - 3.74 2.85 - 3.88 2.97 - 4.00 3.06 - 4.09 3.12 - 4.16 3.16 - 4.20 3.18 - 4.23
65 2.61 - 3.67 2.82 - 3.86 3.03 - 4.06 3.23 - 4.24 3.39 - 4.41 3.51 - 4.53 3.59 - 4.62 3.64 - 4.68
70 2.67 - 3.73 2.92 - 3.96 3.19 - 4.22 3.47 - 4.49 3.74 - 4.75 3.96 - 4.97 4.12 - 5.14 4.23 - 5.26
75 2.71 - 3.78 2.99 - 4.04 3.32 - 4.36 3.69 - 4.71 4.08 - 5.09 4.44 - 5.44 4.75 - 5.76 4.98 - 6.00
80 2.73 - 3.81 3.04 - 4.10 3.41 - 4.46 3.85 - 4.89 4.37 - 5.39 4.91 - 5.92 5.43 - 6.43 5.88 - 6.89
85 2.75 - 3.83 3.06 - 4.13 3.46 - 4.52 3.97 - 5.02 4.59 - 5.63 5.30 - 6.33 6.08 - 7.10 6.86 - 7.87
OPTION 4 (JOINT AND SURVIVOR LIFE ANNUITY WITH 10 YEARS GUARANTEED)
ADJUSTED ADJUSTED MALE AGE
FEMALE ------------------------------------------------------------------------------------------------------
AGE 50 55 60 65 70 75 80 85
--- -- -- -- -- -- -- -- --
50 2.32 - 3.39 2.40 - 3.46 2.45 - 3.52 2.49 - 3.56 2.52 - 3.59 2.53 - 3.60 2.54 - 3.62 2.55 - 3.62
55 2.44 - 3.50 2.55 - 3.60 2.65 - 3.69 2.72 - 3.76 2.77 - 3.82 2.80 - 3.85 2.81 - 3.87 2.82 - 3.88
60 2.54 - 3.59 2.70 - 3.74 2.84 - 3.88 2.97 - 4.00 3.06 - 4.09 3.12 - 4.15 3.15 - 4.20 3.17 - 4.22
65 2.61 - 3.67 2.82 - 3.86 3.03 - 4.06 3.22 - 4.24 3.38 - 4.40 3.50 - 4.52 3.58 - 4.60 3.62 - 4.65
70 2.67 - 3.73 2.92 - 3.96 3.19 - 4.22 3.47 - 4.48 3.73 - 4.73 3.94 - 4.95 4.09 - 5.11 4.19 - 5.21
75 2.71 - 3.77 2.99 - 4.04 3.31 - 4.35 3.68 - 4.70 4.06 - 5.06 4.41 - 5.40 4.69 - 5.69 4.89 - 5.89
80 2.73 - 3.80 3.03 - 4.09 3.40 - 4.44 3.84 - 4.87 4.33 - 5.34 4.84 - 5.83 5.30 - 6.28 5.67 - 6.64
85 2.74 - 3.82 3.06 - 4.12 3.45 - 4.50 3.94 - 4.98 4.52 - 5.54 5.17 - 6.17 5.83 - 6.80 6.40 - 7.35
-7-
CONTRACT SCHEDULE
ML LIFE INSURANCE COMPANY OF NEW YORK Contract Number: [%999999999]
Service Center: Contract Date: [January 3, 2005]
[P.O. Box 44222]
[Jacksonville, FL 32231-4222] Financial Advisor:
[0-000-000-0000] [XXX XXXXXX]
CONTRACT INFORMATION
Contract Form: MLNY-VA-010 - Flexible Premium Deferred
Variable Annuity
Surrender Charge Period: 1 Year
Type of Contract: [Non-Qualified]
Owner(s) Information:
Name(s) Sex Age
[Xxxx Xxx] [M] [65]
Maximum Owner Age: 80
Annuitant(s) Information:
Name(s) Sex Age
[Xxx Xxxxx] [M] [55]
Maximum Annuitant Age: 80
Beneficiary(s) Information:
Primary Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Spouse] [100]%
Contingent Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [ Daughter] [100]%
CONTRACT TERMINATION
This Contract will terminate upon the occurrence of any of the following events:
a. the date the Contract is returned under the RIGHT TO REVIEW CONTRACT
provision;
b. the date of payment of the entire Surrender Value;
c. the date of the last Death Benefit payment to the last Beneficiary;
or
d. the date of the final annuity payment.
-5A -
CONTRACT SCHEDULE (CONTINUED)
Contact Number: [%000000000]
INACTIVE CONTRACT
[This Contract will be terminated by Us if, at the end of any Valuation Period:
1. no Premium payments have been received during the prior 36 months;
and
2. the total of all Premium payments made, less any partial
withdrawals, is less than $5,000; and
3. the Contract Value is less than $5,000.
PREMIUMS
Initial Premium: $[ ]
Initial Net Premium: $[ ]
Allocation of Initial Net Premium:
On the Contract Date, the Initial Net Premium will be allocated as shown
in the Investment Options section of this Contract Schedule.
Allocation of Additional Net Premiums:
Additional Net Premiums will be allocated at the end of the Valuation
Period during which the Additional Premium payment is received and
accepted at Our Service Center. Additional Net Premiums will be allocated
according to any instructions the Owner provides at the time of such
Premium payment, or, if none are received, according to the allocation
instructions We have on file, subject to any allocation requirements
imposed by Us.
Premium Load - See the Fees and Charges section of this Contract Schedule.
PREMIUM REQUIREMENTS AND LIMITATIONS
Minimum Additional Premiums: $[ 50]
Maximum Total Premium Limit:
This limit applies to each Owner based on that Owner's age on the date of
each Premium payment (the Annuitant's age if the Owner is a non-natural
person). If an Owner is under age 70: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by an
affiliated insurance company, to that Owner is limited to $ 1,000,000
without Our prior approval.
If an Owner is age 70 or over: The total of all Premiums paid under this
Contract and any other annuity contract(s) issued by Us, or by an
affiliated insurance company, to that Owner is limited to $ 500,000
without Our prior approval.
No additional Premiums can be paid on or after the Owner's (or older Co-Owner's)
age 85, or, if the Owner is a non-natural person, the Annuitant's (or older
Joint Annuitant's) age 85.
We reserve the right to refuse to accept any Premium payment.
-5B-
CONTRACT SCHEDULE (CONTINUED)
Contact Number: [%000000000]
INVESTMENT OPTIONS
Separate Account: ML of New York Variable Annuity Separate Account [A]
Allocation Guidelines and Restrictions:
1. At any one time, Net Premiums and Account Value may be allocated
among up to [20] of the available subaccounts.
2. All allocations must be in whole percentages.
3. The minimum amount which may be allocated to any subaccount is
[$1,000].
4. We reserve the right to impose restrictions on allocations to
certain subaccounts.
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ----------- ----------
[Large Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Mid Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Small Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
-5C-
CONTRACT SCHEDULE (CONTINUED)
Contact Number: [%000000000]
INVESTMENT OPTIONS (CONTINUED)
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ----------- ----------
[Large Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Blanced] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Moneny MARKET] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Fixed Income] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Other] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
Total 100%
-5D-
CONTRACT SCHEDULE(Continued)
Contract Number: [%999999999]
FEES AND CHARGES
Asset-Based Insurance Charge:
Current Annual see Table of Investment Options
Maximum Annual 2.00 %
The daily Asset-Based Insurance Charge is 1/365th of the annual charge.
The Asset-Based Insurance Charge will be deducted daily in the
determination of the Net Investment Factor for each subaccount.
We reserve the right to apply different current Asset-Based Insurance
Charges to designated subaccounts. The current Asset-Based Insurance
Charge that applies to each subaccount on the Contract Date is shown in
the Table of Investment Options above.
Contract Fee:
Current $ [50] Maximum $ 75
If, on a Contract Anniversary on or prior to the Annuity Date, or on the
date of a full withdrawal, or on the Annuity Date, both the Contract Value
and Premiums less withdrawals, are less than $50,000, We will deduct a
Contract Fee.
The fee will be deducted from each subaccount in the ratio of your
interest in each subaccount to your Account Value.
We reserve the right not to deduct a Contract Fee from designated
subaccounts which may be made available in the future.
Premium Tax Charge:
Any charges made by Us attributable to premium taxes imposed by a state or
other governmental unit will be deducted at the Annuity Date. In those
jurisdictions that do not allow Us to reduce our current taxable premium
income by the amount of any withdrawal or death benefit, We will also
deduct a charge for those taxes on any withdrawal or death benefit paid
under this Contract.
Premium Load:
None
Transfer Fee:
Current $ [25] Maximum $ 30
A Transfer Fee will be collected for each transfer in a Contract Year in
excess of the number of transfers allowed without a fee as shown in the
Transfers section of this Contract Schedule.
The Transfer Fee will be deducted from each transfer in the ratio of the
amount transferred from each subaccount to the total amount transferred
prior to the deduction of the Transfer Fee.
-5E-
CONTRACT SCHEDULE(Continued)
Contract Number: [%999999999]
FEES AND CHARGES (Continued)
Redemption Fee:
We reserve the right to collect any Redemption Fee imposed by any Fund, or
as required by any regulatory authority.
Surrender Charge:
A Surrender Charge may apply upon a partial or full withdrawal of the
Surrender Value.
The Surrender Charge is a percentage of the amount of each Premium
withdrawn in excess of the Free Withdrawal Amount described in this
Contract Schedule. The applicable Surrender Charge for each Premium is
determined as follows:
Number of Complete Surrender
Years Since the Charge
Premium Payment Percentage
------------------- ----------
less than 1 2%
1+ 0%
For a full withdrawal, the Surrender Charge will be deducted from the Contract
Value prior to payment of the Surrender Value. For partial withdrawals, unless
you specify otherwise, the Surrender Charge will be deducted from the requested
withdrawal amount prior to payment.
For the purpose of determining the Surrender Charge, partial and full
withdrawals in a Contract Year assume Gain is withdrawn first, followed by
Premiums on a First-In, First-Out (FIFO) basis.
Gainis the excess, if any, of (i) over (ii) where:
(i) is the Contract Value just prior to the withdrawal; and
(ii) is the sum of all Premiums paid less any prior withdrawal of those
Premiums.
We reserve the right not to deduct the Surrender Charge from designated
subaccounts which may be made available in the future.
-5F-
CONTRACT SCHEDULE(Continued)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Free Withdrawal Amount:
Each Contract Year, You may withdraw a portion of Your Contract Value
without deduction of a Surrender Charge. This amount is known as the Free
Withdrawal Amount. The Free Withdrawal Amount available each Contract Year
is the greater of (i) or (ii) where:
(i) is (a) less (b), where:
(a) is the sum of: 10% of each Premium subject to a
Surrender Charge, but not greater than the Remaining
Premium as of the beginning of the Contract Year; and
(b) is any prior withdrawals during the Contract Year; and
(ii) is Gain in the Contract, plus Remaining Premiums no longer
subject to a Surrender Charge.
Remaining Premium is the Premium less prior withdrawals of that Premium.
Gain is defined in the Surrender Charge section of this Contract Schedule.
Other Contract Charges:
None
Optional Rider Charges:
If You have elected any optional Rider, the charges for such Rider are
described on the Contract Schedule page applicable to that Rider.
CONTRACT CREDITS
None
-5G-
CONTRACT SCHEDULE(Continued)
Contract Number: [%999999999]
TRANSFERS
Requirements and Limitations:
Number of transfers allowed each Contract Year before the Transfer Fee applies: [12]
Minimum Transfer Amount:
The minimum amount of a transfer, from one or multiple subaccounts, is
$[1,000] or the remaining Account Value in a subaccount, if less than
$[1,000].
Minimum Value in a subaccount after a transfer: $ [1,000]
We reserve the right to impose additional limitations on Your ability to
make transfers to or from designated subaccounts which may be made
available in the future.
Transfer Fee - See the Fees and Charges section of this Contract Schedule.
Redemption Fee - See the Fees and Charges section of this Contract Schedule.
WITHDRAWALS
Requirements and Limitations:
Minimum Withdrawal Amount: $ [100]
Minimum Surrender Value after a partial withdrawal: $ [5,000]
We reserve the right to impose additional limitations on Your ability to take withdrawals
from designated subaccounts which may be made available in the future.
Deduction of Partial Withdrawals:
Unless you specify otherwise or unless restrictions apply, partial withdrawals will be
deducted from each subaccount in the ratio of your interest in each subaccount to your
Account Value.
Surrender Charge - See the Fees and Charges section of this Contract Schedule.
Free Withdrawal Amount - See the Fees and Charges section of this Contract
Schedule.
-5H-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
DEATH BENEFIT INFORMATION
Eligible Spousal Beneficiary: A spousal Beneficiary whose age as of
the Contract Date was not greater
than the Maximum Owner Age shown on
this Contract Schedule
Death Benefit Payment Election Period: [60] days from our receipt of a
certified death certificate or other
legal proof of death acceptable to Us
Default Death Benefit Payment Option:
For an Eligible Spousal Beneficiary Spousal Beneficiary Continuation Option
For any other Beneficiary Death Benefit Payment Option 1- Lump Sum
Payment
ANNUITY PERIOD INFORMATION
Requirements and Limitations:
The Annuity Date may not be later than the Maturity Date.
The Annuity Date may not be earlier than the first Contract Anniversary.
A change of Annuitant may not cause the Maturity Date to be later than the
Maturity Date established on the Contract Date.
Annuity Date: [ Jan 1, 2045 ]
Maturity Age: 90
Maturity Date: [ Jan 1, 2045 ]
The Maturity Date is the birthday on which the oldest Annuitant reaches
the Maturity Age.
Guaranteed Payout Rates:
The guaranteed payout rates will be based on the Annuitant's Adjusted Age,
the Guaranteed Mortality Table, if applicable, and the Guaranteed Interest
Rate.
Adjusted Age: For Annuity Dates from January 1, 2025 through December 31,
2034, the Annuitant's Adjusted Age will be his/her actual age reduced by
one year. For each subsequent 10 year period, the Adjusted Age for the
prior 10 year period will be reduced by an additional year.
For example:
ANNUITY DATE ADJUSTED AGE
------------ ------------
before Dec. 31, 2024 actual age
Jan. 1, 2025 through Dec. 31, 2034 subtract 1 year from actual age
Jan. 1, 2035 through Dec. 31, 2044 subtract 2 years from actual age
Jan. 1, 2045 through Dec. 31, 2054 subtract 3 years from actual age
Jan. 1, 2055 through Dec. 31, 2064 subtract 4 years from actual age
-5I-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
ANNUITY PERIOD INFORMATION (CONTINUED)
Guaranteed Mortality Table: Annuity 2000 Mortality Table [(M/F)] projected
to year 2025 under Scale G.
Guaranteed Interest Rate: Lesser of (a) and (b) where:
(a) is 3.00%; and
(b) is the interest rate calculated under the Redetermination
Provision as of the Annuity Date, but not less than 1.00%.
Redetermination Provision: For each calendar quarter, the Guaranteed
Interest Rate is equal to the average of the monthly 5-Year Constant
Maturity Treasury Rates reported by the Federal Reserve over a consecutive
12 month period ending with the second month of the previous calendar
quarter, rounded to the nearest one-twentieth of 1 percent, less 1.25%.
Minimum Annuity Payment: $ 20
Minimum Annuity Value: $ 2,000
Default Annuity Option:
For a single Annuitant - Annuity Option 2 - Life Annuity with Payments
Guaranteed 10 Years
For Joint Annuitants - Annuity Option 4 - Joint and Survivor Life
Annuity with Payments Guaranteed 10 Years
Present Value Interest Rate: The interest rate We use on the Annuity Date
to compute the amount of the annuity payments
ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT
[None]
[MLNY101 Premium-Based Bonus Endorsement]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Return of Premium]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Maximum Anniversary Value]
[MLNY105 Guaranteed Minimum Income Benefit Rider]
[MLNY107 Spousal Beneficiary Continuation Option Endorsement]
[MLNY108 Tax Sheltered Annuity Endorsement]
[MLNY109 Individual Retirement Annuity Endorsement]
[MLNY109B Individual Retirement Annuity Endorsement]
[MLNY110 Xxxx Individual Retirement Annuity Endorsement]
[MLNY110B Xxxx Individual Retirement Annuity Endorsement]
-5J-
THIS PAGE INTENTIONALLY LEFT BLANK.
CONTRACT SCHEDULE
ML LIFE INSURANCE COMPANY OF NEW YORK Contract Number: [%999999999]
Service Center: Contract Date: [January 3, 2005]
[P.O. Box 44222]
[Jacksonville, FL 32231-4222] Financial Advisor:
[0-000-000-0000] [XXX XXXXXX]
CONTRACT INFORMATION
--------------------
Contract Form: MLNY-VA-010 - Flexible Premium Deferred Variable Annuity
Surrender Charge Period: 4 Years
Type of Contract: [Non-Qualified]
Owner(s) Information:
Name(s) Sex Age
[Xxxx Xxx] [M] [65]
Maximum Owner Age: 80
Annuitant(s) Information:
Name(s) Sex Age
[Xxx Xxxxx] [M] [55]
Maximum Annuitant Age: 80
Beneficiary(s) Information:
Primary Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Spouse] [100]%
Contingent Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Daughter] [100]%
CONTRACT TERMINATION
This Contract will terminate upon the occurrence of any of the following events:
a. the date the Contract is returned under the RIGHT TO REVIEW CONTRACT
provision;
b. the date of payment of the entire Surrender Value;
c. the date of the last Death Benefit payment to the last Beneficiary;
or
d. the date of the final annuity payment.
-5A-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INACTIVE CONTRACT
[This Contract will be terminated by Us if, at the end of any Valuation Period:
1. no Premium payments have been received during the prior 36 months;
and
2. the total of all Premium payments made, less any partial
withdrawals, is less than $5,000; and 3. the Contract Value is less
than $5,000.
PREMIUMS
Initial Premium: $[ ]
Initial Net Premium: $[ ]
Allocation of Initial Net Premium:
On the Contract Date, the Initial Net Premium will be allocated as shown
in the Investment Options section of this Contract Schedule.
Allocation of Additional Net Premiums:
Additional Net Premiums will be allocated at the end of the Valuation
Period during which the Additional Premium payment is received and
accepted at Our Service Center. Additional Net Premiums will be allocated
according to any instructions the Owner provides at the time of such
Premium payment, or, if none are received, according to the allocation
instructions We have on file, subject to any allocation requirements
imposed by Us.
Premium Load - See the Fees and Charges section of this Contract Schedule.
PREMIUM REQUIREMENTS AND LIMITATIONS
Minimum Additional Premiums: $[ 50]
Maximum Total Premium Limit:
This limit applies to each Owner based on that Owner's age on the date of
each Premium payment (the Annuitant's age if the Owner is a non-natural
person).
If an Owner is under age 70: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by
an affiliated insurance company, to that Owner is limited to $
1,000,000 without Our prior approval.
If an Owner is age 70 or over: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by
an affiliated insurance company, to that Owner is limited to $
500,000 without Our prior approval.
No additional Premiums can be paid on or after the Owner's (or older Co-Owner's)
age 85, or, if the Owner is a non-natural person, the Annuitant's (or older
Joint Annuitant's) age 85.
We reserve the right to refuse to accept any Premium payment.
-5B-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INVESTMENT OPTIONS
Separate Account: ML of New York Variable Annuity Separate Account [A]
Allocation Guidelines and Restrictions:
1. At any one time, Net Premiums and Account Value may be allocated
among up to [20] of the available subaccounts.
2. All allocations must be in whole percentages.
3. The minimum amount which may be allocated to any subaccount is
[$1,000].
4. We reserve the right to impose restrictions on allocations to
certain subaccounts.
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ------ ----------
[Large Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Mid Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Small Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
-5C-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INVESTMENT OPTIONS (CONTINUED)
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ------ ----------
[International] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Balanced] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Money Market] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Fixed Income] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Other] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
Total 100%
-5D-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
FEES AND CHARGES
Asset-Based Insurance Charge:
Current Annual see Table of Investment Options
Maximum Annual 2.00 %
The daily Asset-Based Insurance Charge is 1/365th of the annual charge.
The Asset-Based Insurance Charge will be deducted daily in the
determination of the Net Investment Factor for each subaccount.
We reserve the right to apply different current Asset-Based Insurance
Charges to designated subaccounts. The current Asset-Based Insurance
Charge that applies to each subaccount on the Contract Date is shown in
the Table of Investment Options above.
Contract Fee:
Current $ [50] Maximum $ 75
If, on a Contract Anniversary on or prior to the Annuity Date, or on the
date of a full withdrawal, or on the Annuity Date, both the Contract Value
and Premiums less withdrawals, are less than $50,000, We will deduct a
Contract Fee.
The fee will be deducted from each subaccount in the ratio of your
interest in each subaccount to your Account Value.
We reserve the right not to deduct a Contract Fee from designated
subaccounts which may be made available in the future.
Premium Tax Charge:
Any charges made by Us attributable to premium taxes imposed by a state or
other governmental unit will be deducted at the Annuity Date. In those
jurisdictions that do not allow Us to reduce our current taxable premium
income by the amount of any withdrawal or death benefit, We will also
deduct a charge for those taxes on any withdrawal or death benefit paid
under this Contract.
Premium Load:
None
Transfer Fee:
Current $ [25] Maximum $ 30
A Transfer Fee will be collected for each transfer in a Contract Year in
excess of the number of transfers allowed without a fee as shown in the
Transfers section of this Contract Schedule.
The Transfer Fee will be deducted from each transfer in the ratio of the
amount transferred from each subaccount to the total amount transferred
prior to the deduction of the Transfer Fee.
-5E-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Redemption Fee:
We reserve the right to collect any Redemption Fee imposed by any Fund, or
as required by any regulatory authority.
Surrender Charge:
A Surrender Charge may apply upon a partial or full withdrawal of the
Surrender Value.
The Surrender Charge is a percentage of the amount of each Premium
withdrawn in excess of the Free Withdrawal Amount described in this
Contract Schedule. The applicable Surrender Charge for each Premium is
determined as follows:
Number of Complete Surrender
Years Since the Charge
Premium Payment Percentage
--------------- ----------
less than 1 6%
1 5%
2 4%
3 3%
4+ 0%
For a full withdrawal, the Surrender Charge will be deducted from the
Contract Value prior to payment of the Surrender Value. For partial
withdrawals, unless you specify otherwise, the Surrender Charge will be
deducted from the requested withdrawal amount prior to payment.
For the purpose of determining the Surrender Charge, partial and full
withdrawals in a Contract Year assume Gain is withdrawn first, followed by
Premiums on a First-In, First-Out (FIFO) basis.
Gainis the excess, if any, of (i) over (ii) where:
(i) is the Contract Value just prior to the withdrawal; and
(ii) is the sum of all Premiums paid less any prior withdrawal of those
Premiums.
We reserve the right not to deduct the Surrender Charge from designated
subaccounts which may be made available in the future.
-5F-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Free Withdrawal Amount:
Each Contract Year, You may withdraw a portion of Your Contract Value
without deduction of a Surrender Charge. This amount is known as the Free
Withdrawal Amount. The Free Withdrawal Amount available each Contract Year
is the greater of (i) or (ii) where:
(i) is (a) less (b), where:
(a) is the sum of: 10% of each Premium subject to a
Surrender Charge, but not greater than the Remaining
Premium as of the beginning of the Contract Year; and
(b) is any prior withdrawals during the Contract Year; and
(ii) is Gain in the Contract, plus Remaining Premiums no longer
subject to a Surrender Charge.
Remaining Premium is the Premium less prior withdrawals of that Premium.
Gain is defined in the Surrender Charge section of this Contract Schedule.
Other Contract Charges:
None
Optional Rider Charges:
If You have elected any optional Rider, the charges for such Rider are
described on the Contract Schedule page applicable to that Rider.
CONTRACT CREDITS
None
-5G-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
TRANSFERS
Requirements and Limitations:
Number of transfers allowed each Contract Year before the Transfer Fee applies: [12]
Minimum Transfer Amount:
The minimum amount of a transfer, from one or multiple subaccounts, is $[1,000]
or the remaining Account Value in a subaccount, if less than $[1,000].
Minimum Value in a subaccount after a transfer: $ [1,000]
We reserve the right to impose additional limitations on Your ability to make
transfers to or from designated subaccounts which may be made available in the
future.
Transfer Fee - See the Fees and Charges section of this Contract Schedule.
Redemption Fee - See the Fees and Charges section of this Contract Schedule.
WITHDRAWALS
Requirements and Limitations:
Minimum Withdrawal Amount: $ [100]
Minimum Surrender Value after a partial withdrawal: $ [5,000]
We reserve the right to impose additional limitations on Your ability to take
withdrawals from designated subaccounts which may be made available in the future.
Deduction of Partial Withdrawals:
Unless you specify otherwise or unless restrictions apply, partial withdrawals will
be deducted from each subaccount in the ratio of your interest in each subaccount to
your Account Value.
Surrender Charge - See the Fees and Charges section of this Contract Schedule.
Free Withdrawal Amount - See the Fees and Charges section of this Contract Schedule.
-5H-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
DEATH BENEFIT INFORMATION
Eligible Spousal Beneficiary: A spousal Beneficiary whose age as of
the Contract Date was not greater than
the Maximum Owner Age shown on this
Contract Schedule
Death Benefit Payment Election Period: [60] days from our receipt of a
certified death certificate or other
legal proof of death acceptable to Us
Default Death Benefit Payment Option:
For an Eligible Spousal Beneficiary Spousal Beneficiary Continuation Option
For any other Beneficiary Death Benefit Payment Option 1- Lump Sum
Payment
ANNUITY PERIOD INFORMATION
Requirements and Limitations:
The Annuity Date may not be later than the Maturity Date.
The Annuity Date may not be earlier than the first Contract Anniversary.
A change of Annuitant may not cause the Maturity Date to be later than the
Maturity Date established on the Contract Date.
Annuity Date: [Jan 1, 2045]
Maturity Age: 90
Maturity Date: [Jan 1, 2045]
The Maturity Date is the birthday on which the oldest Annuitant reaches
the Maturity Age.
Guaranteed Payout Rates:
The guaranteed payout rates will be based on the Annuitant's Adjusted Age,
the Guaranteed Mortality Table, if applicable, and the Guaranteed Interest
Rate.
Adjusted Age: For Annuity Dates from January 1, 2025 through December 31,
2034, the Annuitant's Adjusted Age will be his/her actual age reduced by
one year. For each subsequent 10 year period, the Adjusted Age for the
prior 10 year period will be reduced by an additional year.
For example:
ANNUITY DATE ADJUSTED AGE
------------ ------------
before Dec. 31, 2024 actual age
Jan. 1, 2025 through Dec. 31, 2034 subtract 1 year from actual age
Jan. 1, 2035 through Dec. 31, 2044 subtract 2 years from actual age
Jan. 1, 2045 through Dec. 31, 2054 subtract 3 years from actual age
Jan. 1, 2055 through Dec. 31, 2064 subtract 4 years from actual age
-5I-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
ANNUITY PERIOD INFORMATION (CONTINUED)
Guaranteed Mortality Table: Annuity 2000 Mortality Table [(M/F)] projected
to year 2025 under Scale G.
Guaranteed Interest Rate: Lesser of (a) and (b) where:
(a) is 3.00%; and
(b) is the interest rate calculated under the Redetermination
Provision as of the Annuity Date, but not less than 1.00%.
Redetermination Provision: For each calendar quarter, the Guaranteed
Interest Rate is equal to the average of the monthly 5-Year Constant
Maturity Treasury Rates reported by the Federal Reserve over a consecutive
12 month period ending with the second month of the previous calendar
quarter, rounded to the nearest one-twentieth of 1 percent, less 1.25%.
Minimum Annuity Payment: $ 20
Minimum Annuity Value: $ 2,000
Default Annuity Option:
For a single Annuitant - Annuity Option 2 - Life Annuity with Payments
Guaranteed 10 Years
For Joint Annuitants - Annuity Option 4 - Joint and Survivor Life
Annuity with Payments Guaranteed 10 Years
Present Value Interest Rate: The interest rate We use on the Annuity Date to
compute the amount of the annuity payments
ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT
[None]
[MLNY101 Premium-Based Bonus Endorsement]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Return of Premium]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Maximum Anniversary Value]
[MLNY105 Guaranteed Minimum Income Benefit Rider]
[MLNY107 Spousal Beneficiary Continuation Option Endorsement]
[MLNY108 Tax Sheltered Annuity Endorsement ]
[MLNY109 Individual Retirement Annuity Endorsement]
[MLNY109B Individual Retirement Annuity Endorsement]
[MLNY110 Xxxx Individual Retirement Annuity Endorsement]
[MLNY110B Xxxx Individual Retirement Annuity Endorsement]
-5J-
THIS PAGE INTENTIONALLY LEFT BLANK.
CONTRACT SCHEDULE
ML LIFE INSURANCE COMPANY OF NEW YORK Contract Number: [%999999999]
Service Center: Contract Date: [January 3, 2005]
[P.O. Box 44222]
[Jacksonville, FL 32231-4222] Financial Advisor:
[0-000-000-0000] [XXX XXXXXX]
CONTRACT INFORMATION
-------- -----------
Contract Form: MLNY-VA-010 - Flexible Premium Deferred Variable Annuity
Surrender Charge Period: 7 Years
Type of Contract: [Non-Qualified]
Owner(s) Information:
Name(s) Sex Age
[Xxxx Xxx] [M] [65]
Maximum Owner Age: 80
Annuitant(s) Information:
Name(s) Sex Age
[Xxx Xxxxx] [M] [55]
Maximum Annuitant Age: 80
Beneficiary(s) Information:
Primary Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Spouse] [100]%
Contingent Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Daughter] [100]%
CONTRACT TERMINATION
This Contract will terminate upon the occurrence of any of the following events:
a. the date the Contract is returned under the RIGHT TO REVIEW CONTRACT
provision;
b. the date of payment of the entire Surrender Value;
c. the date of the last Death Benefit payment to the last Beneficiary;
or
d. the date of the final annuity payment.
-5A-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INACTIVE CONTRACT
[This Contract will be terminated by Us if, at the end of any Valuation Period:
1. no Premium payments have been received during the prior 36 months;
and
2. the total of all Premium payments made, less any partial
withdrawals, is less than $5,000; and
3. the Contract Value is less than $5,000.
PREMIUMS
Initial Premium: $[ ]
Initial Net Premium: $[ ]
Allocation of Initial Net Premium:
On the Contract Date, the Initial Net Premium will be allocated as shown
in the Investment Options section of this Contract Schedule.
Allocation of Additional Net Premiums:
Additional Net Premiums will be allocated at the end of the Valuation
Period during which the Additional Premium payment is received and
accepted at Our Service Center. Additional Net Premiums will be allocated
according to any instructions the Owner provides at the time of such
Premium payment, or, if none are received, according to the allocation
instructions We have on file, subject to any allocation requirements
imposed by Us.
Premium Load - See the Fees and Charges section of this Contract Schedule.
PREMIUM REQUIREMENTS AND LIMITATIONS
Minimum Additional Premiums: $[ 50]
Maximum Total Premium Limit:
This limit applies to each Owner based on that Owner's age on the date of
each Premium payment (the Annuitant's age if the Owner is a non-natural
person).
If an Owner is under age 70: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by
an affiliated insurance company, to that Owner is limited to $
1,000,000 without Our prior approval.
If an Owner is age 70 or over: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by
an affiliated insurance company, to that Owner is limited to $
500,000 without Our prior approval.
No additional Premiums can be paid on or after the Owner's (or older Co-Owner's)
age 83, or, if the Owner is a non-natural person, the Annuitant's (or older
Joint Annuitant's) age 83.
We reserve the right to refuse to accept any Premium payment.
-5B-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INVESTMENT OPTIONS
Separate Account: ML of New York Variable Annuity Separate Account [A]
Allocation Guidelines and Restrictions:
1. At any one time, Net Premiums and Account Value may be allocated
among up to [20] of the available subaccounts.
2. All allocations must be in whole percentages.
3. The minimum amount which may be allocated to any subaccount is
[$1,000].
4. We reserve the right to impose restrictions on allocations to
certain subaccounts.
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ------ ----------
[Large Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Mid Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Small Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
-5C-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INVESTMENT OPTIONS (CONTINUED)
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ------ ----------
[International] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Balanced] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Money Market] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Fixed Income] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Other] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
Total 100%
-5D-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
FEES AND CHARGES
Asset-Based Insurance Charge:
Current Annual see Table of Investment Options
Maximum Annual 2.00 %
The daily Asset-Based Insurance Charge is 1/365th of the annual charge.
The Asset-Based Insurance Charge will be deducted daily in the
determination of the Net Investment Factor for each subaccount.
We reserve the right to apply different current Asset-Based Insurance
Charges to designated subaccounts. The current Asset-Based Insurance
Charge that applies to each subaccount on the Contract Date is shown in
the Table of Investment Options above.
Contract Fee:
Current $ [50] Maximum $ 75
If, on a Contract Anniversary on or prior to the Annuity Date, or on the
date of a full withdrawal, or on the Annuity Date, both the Contract Value
and Premiums less withdrawals, are less than $50,000, We will deduct a
Contract Fee.
The fee will be deducted from each subaccount in the ratio of your
interest in each subaccount to your Account Value.
We reserve the right not to deduct a Contract Fee from designated
subaccounts which may be made available in the future.
Premium Tax Charge:
Any charges made by Us attributable to premium taxes imposed by a state or
other governmental unit will be deducted at the Annuity Date. In those
jurisdictions that do not allow Us to reduce our current taxable premium
income by the amount of any withdrawal or death benefit, We will also
deduct a charge for those taxes on any withdrawal or death benefit paid
under this Contract.
Premium Load:
None
Transfer Fee:
Current $ [25] Maximum $ 30
A Transfer Fee will be collected for each transfer in a Contract Year in
excess of the number of transfers allowed without a fee as shown in the
Transfers section of this Contract Schedule.
The Transfer Fee will be deducted from each transfer in the ratio of the
amount transferred from each subaccount to the total amount transferred
prior to the deduction of the Transfer Fee.
-5E-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Redemption Fee:
We reserve the right to collect any Redemption Fee imposed by any Fund, or
as required by any regulatory authority.
Surrender Charge:
A Surrender Charge may apply upon a partial or full withdrawal of the
Surrender Value.
The Surrender Charge is a percentage of the amount of each Premium
withdrawn in excess of the Free Withdrawal Amount described in this
Contract Schedule. The applicable Surrender Charge for each Premium is
determined as follows:
Number of Complete Surrender
Years Since the Charge
Premium Payment Percentage
--------------- ----------
less than 1 7%
1 6%
2 5%
3 4%
4 3%
5 2%
6 1%
7+ 0%
For a full withdrawal, the Surrender Charge will be deducted from the
Contract Value prior to payment of the Surrender Value. For partial
withdrawals, unless you specify otherwise, the Surrender Charge will be
deducted from the requested withdrawal amount prior to payment.
For the purpose of determining the Surrender Charge, partial and full
withdrawals in a Contract Year assume Gain is withdrawn first, followed by
Premiums on a First-In, First-Out (FIFO) basis.
Gain is the excess, if any, of (i) over (ii) where:
(i) is the Contract Value just prior to the withdrawal; and
(ii) is the sum of all Premiums paid less any prior withdrawal of
those Premiums.
We reserve the right not to deduct the Surrender Charge from designated
subaccounts which may be made available in the future.
-5F-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Free Withdrawal Amount:
Each Contract Year, You may withdraw a portion of Your Contract Value
without deduction of a Surrender Charge. This amount is known as the Free
Withdrawal Amount. The Free Withdrawal Amount available each Contract Year
is the greater of (i) or (ii) where:
(i) is (a) less (b), where:
(a) is the sum of: 10% of each Premium subject to a
Surrender Charge, but not greater than the Remaining
Premium as of the beginning of the Contract Year; and
(b) is any prior withdrawals during the Contract Year; and
(ii) is Gain in the Contract, plus Remaining Premiums no longer
subject to a Surrender Charge.
Remaining Premium is the Premium less prior withdrawals of that Premium.
Gain is defined in the Surrender Charge section of this Contract Schedule.
Other Contract Charges:
None
Optional Rider Charges:
If You have elected any optional Rider, the charges for such Rider are
described on the Contract Schedule page applicable to that Rider.
CONTRACT CREDITS
None
-5G-
CONTRACT SCHEDULE (Continued)
Contract Number: [%99999999]
TRANSFERS
Requirements and Limitations:
Number of transfers allowed each Contract Year before the Transfer Fee applies: [ 12 ]
Minimum Transfer Amount:
The minimum amount of a transfer, from one or multiple subaccounts, is $[1,000]
or the remaining Account Value in a subaccount, if less than $[1,000].
Minimum Value in a subaccount after a transfer: $ [ 1,000]
We reserve the right to impose additional limitations on Your ability to
make transfers to or from designated subaccounts which may be made
available in the future.
Transfer Fee - See the Fees and Charges section of this Contract Schedule.
Redemption Fee - See the Fees and Charges section of this Contract Schedule.
WITHDRAWALS
Requirements and Limitations:
Minimum Withdrawal Amount: $ [100]
Minimum Surrender Value after a partial withdrawal: $ [5,000]
We reserve the right to impose additional limitations on Your ability to
take withdrawals from designated subaccounts which may be made available
in the future.
Deduction of Partial Withdrawals:
Unless you specify otherwise or unless restrictions apply, partial
withdrawals will be deducted from each subaccount in the ratio of your
interest in each subaccount to your Account Value.
Surrender Charge - See the Fees and Charges section of this Contract Schedule.
Free Withdrawal Amount - See the Fees and Charges section of this Contract
Schedule.
-5H-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
DEATH BENEFIT INFORMATION
Eligible Spousal Beneficiary: A spousal Beneficiary whose age as of the ContractDate
was not greater than the Maximum Owner Age shown on
this Contract Schedule
Death Benefit Payment Election Period: [60] days from our receipt of a certified death
certificate or other legal proof of death acceptable to Us
Default Death Benefit Payment Option:
For an Eligible Spousal Beneficiary Spousal Beneficiary Continuation Option
For any other Beneficiary Death Benefit Payment Option 1- Lump Sum Payment
ANNUITY PERIOD INFORMATION
Requirements and Limitations:
The Annuity Date may not be later than the Maturity Date.
The Annuity Date may not be earlier than the first Contract Anniversary.
A change of Annuitant may not cause the Maturity Date to be later than the
Maturity Date established on the Contract Date.
Annuity Date: [ Jan 1, 2045 ]
Maturity Age: 90
Maturity Date: [ Jan 1, 2045 ]
The Maturity Date is the birthday on which the oldest Annuitant reaches
the Maturity Age.
Guaranteed Payout Rates:
The guaranteed payout rates will be based on the Annuitant's Adjusted Age,
the Guaranteed Mortality Table, if applicable, and the Guaranteed Interest
Rate.
Adjusted Age: For Annuity Dates from January 1, 2025 through December 31,
2034, the Annuitant's Adjusted Age will be his/her actual age reduced by
one year. For each subsequent 10 year period, the Adjusted Age for the
prior 10 year period will be reduced by an additional year.
For example:
ANNUITY DATE ADJUSTED AGE
------------------------------------ --------------------------------
before Dec. 31, 2024 actual age
Jan. 1, 2025 through Dec. 31, 2034 subtract 1 year from actual age
Jan. 1, 2035 through Dec. 31, 2044 subtract 2 years from actual age
Jan. 1, 2045 through Dec. 31, 2054 subtract 3 years from actual age
Jan. 1, 2055 through Dec. 31, 2064 subtract 4 years from actual age
-5I-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
ANNUITY PERIOD INFORMATION (CONTINUED)
Guaranteed Mortality Table: Annuity 2000 Mortality Table [(M/F)] projected
to year 2025 under Scale G.
Guaranteed Interest Rate: Lesser of (a) and (b) where:
(a) is 3.00%; and
(b) is the interest rate calculated under the Redetermination
Provision as of the Annuity Date, but not less than 1.00%.
Redetermination Provision: For each calendar quarter, the Guaranteed
Interest Rate is equal to the average of the monthly 5-Year Constant
Maturity Treasury Rates reported by the Federal Reserve over a consecutive
12 month period ending with the second month of the previous calendar
quarter, rounded to the nearest one-twentieth of 1 percent, less 1.25%.
Minimum Annuity Payment: $ 20
Minimum Annuity Value: $ 2,000
Default Annuity Option:
For a single Annuitant - Annuity Option 2 - Life Annuity with Payments
Guaranteed 10 Years
For Joint Annuitants - Annuity Option 4 - Joint and Survivor Life
Annuity with Payments Guaranteed 10 Years
Present Value Interest Rate: The interest rate We use on the Annuity Date to
compute the amount of the annuity payments
ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT
[None]
[MLNY101 Premium-Based Bonus Endorsement]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Return of Premium]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Maximum Anniversary Value]
[MLNY105 Guaranteed Minimum Income Benefit Rider]
[MLNY107 Spousal Beneficiary Continuation Option Endorsement]
[MLNY108 Tax Sheltered Annuity Endorsement ]
[MLNY109 Individual Retirement Annuity Endorsement]
[MLNY109B Individual Retirement Annuity Endorsement]
[MLNY110 Xxxx Individual Retirement Annuity Endorsement]
[MLNY110B Xxxx Individual Retirement Annuity Endorsement]
-5J-
THIS PAGE INTENTIONALLY LEFT BLANK.
CONTRACT SCHEDULE
ML LIFE INSURANCE COMPANY OF NEW YORK Contract Number: [%999999999]
Service Center: Contract Date: [January 3, 2005]
[P.O. Box 44222]
[Jacksonville, FL 32231-4222] Financial Advisor:
[0-000-000-0000] [XXX XXXXXX]
CONTRACT INFORMATION
Contract Form: MLNY-VA-010 - Flexible Premium Deferred Variable
Annuity
Surrender Charge Period: 9 Years
Type of Contract: [Non-Qualified]
Owner(s) Information:
Name(s) Sex Age
[Xxxx Xxx] [M] [65]
Maximum Owner Age: 80
Annuitant(s) Information:
Name(s) Sex Age
[Xxx Xxxxx] [M] [55]
Maximum Annuitant Age: 80
Beneficiary(s) Information:
Primary Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Spouse] [100]%
Contingent Beneficiary
Name(s) Relationship Percentage
[Xxxx Xxx] [Daughter] [100]%
CONTRACT TERMINATION
This Contract will terminate upon the occurrence of any of the following events:
a. the date the Contract is returned under the RIGHT TO REVIEW CONTRACT
provision;
b. the date of payment of the entire Surrender Value;
c. the date of the last Death Benefit payment to the last Beneficiary;
or
d. the date of the final annuity payment.
-5A-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
INACTIVE CONTRACT
[This Contract will be terminated by Us if, at the end of any Valuation Period:
1. no Premium payments have been received during the prior 36 months; and
2. the total of all Premium payments made, less any partial withdrawals,
is less than $5,000; and
3. the Contract Value is less than $5,000.
PREMIUMS
Initial Premium: $[ ]
Initial Net Premium: $[ ]
Allocation of Initial Net Premium:
On the Contract Date, the Initial Net Premium will be allocated as shown
in the Investment Options section of this Contract Schedule.
Allocation of Additional Net Premiums:
Additional Net Premiums will be allocated at the end of the Valuation
Period during which the Additional Premium payment is received and
accepted at Our Service Center. Additional Net Premiums will be allocated
according to any instructions the Owner provides at the time of such
Premium payment, or, if none are received, according to the allocation
instructions We have on file, subject to any allocation requirements
imposed by Us.
Premium Load - See the Fees and Charges section of this Contract Schedule.
PREMIUM REQUIREMENTS AND LIMITATIONS
Minimum Additional Premiums: $[ 50]
Maximum Total Premium Limit:
This limit applies to each Owner based on that Owner's age on the date of
each Premium payment (the Annuitant's age if the Owner is a non-natural
person).
If an Owner is under age 70: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by
an affiliated insurance company, to that Owner is limited to $
1,000,000 without Our prior approval.
If an Owner is age 70 or over: The total of all Premiums paid under
this Contract and any other annuity contract(s) issued by Us, or by
an affiliated insurance company, to that Owner is limited to $
500,000 without Our prior approval.
No additional Premiums can be paid on or after the Owner's (or older Co-Owner's)
age 81, or, if the Owner is a non-natural person, the Annuitant's (or older
Joint Annuitant's) age 81.
We reserve the right to refuse to accept any Premium payment.
-5B-
CONTRACT SCHEDULE (Continued)
Contract Number: [%999999999]
INVESTMENT OPTIONS
Separate Account: ML of New York Variable Annuity Separate Account [A]
Allocation Guidelines and Restrictions:
1. At any one time, Net Premiums and Account Value may be allocated
among up to [20] of the available subaccounts.
2. All allocations must be in whole percentages.
3. The minimum amount which may be allocated to any subaccount is
[$1,000].
4. We reserve the right to impose restrictions on allocations to
certain subaccounts.
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ------ ----------
[Large Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Mid Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Small Cap] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
-5C-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
INVESTMENT OPTIONS (CONTINUED)
Current
Asset-Based
Insurance Allocation
Investment Category Subaccount Charge Percentage
------------------- ---------- ----------- ----------
[International] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Balanced] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Money Market] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Fixed Income] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[Other] [ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
[ X ] [xxx]% [xxx]%
-5D-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
FEES AND CHARGES
Asset-Based Insurance Charge:
Current Annual see Table of Investment Options
Maximum Annual 2.00 %
The daily Asset-Based Insurance Charge is 1/365th of the annual charge.
The Asset-Based Insurance Charge will be deducted daily in the
determination of the Net Investment Factor for each subaccount.
We reserve the right to apply different current Asset-Based Insurance
Charges to designated subaccounts. The current Asset-Based Insurance
Charge that applies to each subaccount on the Contract Date is shown in
the Table of Investment Options above.
Contract Fee:
Current $ [50] Maximum $ 75
If, on a Contract Anniversary on or prior to the Annuity Date, or on the
date of a full withdrawal, or on the Annuity Date, both the Contract Value
and Premiums less withdrawals, are less than $50,000, We will deduct a
Contract Fee.
The fee will be deducted from each subaccount in the ratio of your
interest in each subaccount to your Account Value.
We reserve the right not to deduct a Contract Fee from designated
subaccounts which may be made available in the future.
Premium Tax Charge:
Any charges made by Us attributable to premium taxes imposed by a state or
other governmental unit will be deducted at the Annuity Date. In those
jurisdictions that do not allow Us to reduce our current taxable premium
income by the amount of any withdrawal or death benefit, We will also
deduct a charge for those taxes on any withdrawal or death benefit paid
under this Contract.
Premium Load:
None
Transfer Fee:
Current $ [25] Maximum $ 30
A Transfer Fee will be collected for each transfer in a Contract Year in
excess of the number of transfers allowed without a fee as shown in the
Transfers section of this Contract Schedule.
The Transfer Fee will be deducted from each transfer in the ratio of the
amount transferred from each subaccount to the total amount transferred
prior to the deduction of the Transfer Fee.
-5E-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Redemption Fee:
We reserve the right to collect any Redemption Fee imposed by any Fund, or
as required by any regulatory authority.
Surrender Charge:
A Surrender Charge may apply upon a partial or full withdrawal of the
Surrender Value.
The Surrender Charge is a percentage of the amount of each Premium
withdrawn in excess of the Free Withdrawal Amount described in this
Contract Schedule. The applicable Surrender Charge for each Premium is
determined as follows:
Number of Complete Surrender
Years Since the Charge
Premium Payment Percentage
--------------- ----------
less than 1 8%
1 8%
2 7%
3 7%
4 6%
5 6%
6 5%
7 4%
8 3%
9+ 0%
For a full withdrawal, the Surrender Charge will be deducted from the
Contract Value prior to payment of the Surrender Value. For partial
withdrawals, unless you specify otherwise, the Surrender Charge will be
deducted from the requested withdrawal amount prior to payment.
For the purpose of determining the Surrender Charge, partial and full
withdrawals in a Contract Year assume Gain is withdrawn first, followed by
Premiums on a First-In, First-Out (FIFO) basis.
Gainis the excess, if any, of (i) over (ii) where:
(i) is the Contract Value just prior to the withdrawal; and
(ii) is the sum of all Premiums paid less any prior withdrawal of
those Premiums.
We reserve the right not to deduct the Surrender Charge from designated
subaccounts which may be made available in the future.
-5F-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
FEES AND CHARGES (CONTINUED)
Free Withdrawal Amount:
Each Contract Year, You may withdraw a portion of Your Contract Value
without deduction of a Surrender Charge. This amount is known as the Free
Withdrawal Amount. The Free Withdrawal Amount available each Contract Year
is the greater of (i) or (ii) where:
(i) is (a) less (b), where:
(a) is the sum of: 10% of each Premium subject to a
Surrender Charge, but not greater than the Remaining
Premium as of the beginning of the Contract Year; and
(b) is any prior withdrawals during the Contract Year; and
(ii) is Gain in the Contract, plus Remaining Premiums no longer
subject to a Surrender Charge.
Remaining Premium is the Premium less prior withdrawals of that Premium.
Gain is defined in the Surrender Charge section of this Contract Schedule.
Other Contract Charges:
None
Optional Rider Charges:
If You have elected any optional Rider, the charges for such Rider are
described on the Contract Schedule page applicable to that Rider.
CONTRACT CREDITS
None
-5G-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
TRANSFERS
Requirements and Limitations:
Number of transfers allowed each Contract Year before the Transfer Fee applies: [12]
Minimum Transfer Amount:
The minimum amount of a transfer, from one or multiple subaccounts, is $[1,000]
or the remaining Account Value in a subaccount, if less than $[1,000].
Minimum Value in a subaccount after a transfer: $ [ 1,000]
We reserve the right to impose additional limitations on Your ability to
make transfers to or from designated subaccounts which may be made
available in the future.
Transfer Fee - See the Fees and Charges section of this Contract Schedule.
Redemption Fee - See the Fees and Charges section of this Contract Schedule.
WITHDRAWALS
Requirements and Limitations:
Minimum Withdrawal Amount: $ [100]
Minimum Surrender Value after a partial withdrawal: $ [5,000]
We reserve the right to impose additional limitations on Your ability to
take withdrawals from designated subaccounts which may be made available
in the future.
Deduction of Partial Withdrawals:
Unless you specify otherwise or unless restrictions apply, partial
withdrawals will be deducted from each subaccount in the ratio of your
interest in each subaccount to your Account Value.
Surrender Charge - See the Fees and Charges section of this Contract Schedule.
Free Withdrawal Amount - See the Fees and Charges section of this Contract
Schedule.
-5H-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
DEATH BENEFIT INFORMATION
Eligible Spousal Beneficiary: A spousal Beneficiary whose age as of
the Contract Date was not greater than
the Maximum Owner Age shown on this
Contract Schedule
Death Benefit Payment Election Period: [60] days from our receipt of a
certified death certificate or other
legal proof of death acceptable to Us
Default Death Benefit Payment Option:
For an Eligible Spousal Beneficiary Spousal Beneficiary Continuation Option
For any other Beneficiary Death Benefit Payment Option 1- Lump Sum
Payment
ANNUITY PERIOD INFORMATION
Requirements and Limitations:
The Annuity Date may not be later than the Maturity Date. The Annuity Date
may not be earlier than the first Contract Anniversary. A change of
Annuitant may not cause the Maturity Date to be later than the Maturity
Date established on the Contract Date.
Annuity Date: [Jan 1, 2045]
Maturity Age: 90
Maturity Date: [Jan 1, 2045]
The Maturity Date is the birthday on which the oldest Annuitant reaches
the Maturity Age.
Guaranteed Payout Rates:
The guaranteed payout rates will be based on the Annuitant's Adjusted Age,
the Guaranteed Mortality Table, if applicable, and the Guaranteed Interest
Rate.
Adjusted Age: For Annuity Dates from January 1, 2025 through December 31,
2034, the Annuitant's Adjusted Age will be his/her actual age reduced by
one year. For each subsequent 10 year period, the Adjusted Age for the
prior 10 year period will be reduced by an additional year.
For example:
ANNUITY DATE ADJUSTED AGE
------------ ------------
before Dec. 31, 2024 actual age
Jan. 1, 2025 through Dec. 31, 2034 subtract 1 year from actual age
Jan. 1, 2035 through Dec. 31, 2044 subtract 2 years from actual age
Jan. 1, 2045 through Dec. 31, 2054 subtract 3 years from actual age
Jan. 1, 2055 through Dec. 31, 2064 subtract 4 years from actual age
-5I-
CONTRACT SCHEDULE (CONTINUED)
Contract Number: [%999999999]
ANNUITY PERIOD INFORMATION (CONTINUED)
Guaranteed Mortality Table: Annuity 2000 Mortality Table [(M/F)] projected
to year 2025 under Scale G.
Guaranteed Interest Rate: Lesser of (a) and (b) where:
(a) is 3.00%; and
(b) is the interest rate calculated under the Redetermination
Provision as of the Annuity Date, but not less than 1.00%.
Redetermination Provision: For each calendar quarter, the Guaranteed
Interest Rate is equal to the average of the monthly 5-Year Constant
Maturity Treasury Rates reported by the Federal Reserve over a consecutive
12 month period ending with the second month of the previous calendar
quarter, rounded to the nearest one-twentieth of 1 percent, less 1.25%.
Minimum Annuity Payment: $ 20
Minimum Annuity Value: $ 2,000
Default Annuity Option:
For a single Annuitant - Annuity Option 2 - Life Annuity with
Payments Guaranteed 10 Years
For Joint Annuitants - Annuity Option 4 - Joint and Survivor
Life Annuity with Payments Guaranteed 10
Years
Present Value Interest Rate: The interest rate We use on the Annuity
Date to compute the amount of the
annuity payments
ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT
[None]
[MLNY101 Premium-Based Bonus Endorsement]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Return of Premium]
[MLNY103 Guaranteed Minimum Death Benefit Rider - Maximum Anniversary Value]
[MLNY105 Guaranteed Minimum Income Benefit Rider]
[MLNY107 Spousal Beneficiary Continuation Option Endorsement]
[MLNY108 Tax Sheltered Annuity Endorsement ]
[MLNY109 Individual Retirement Annuity Endorsement]
[MLNY109B Individual Retirement Annuity Endorsement]
[MLNY110 Xxxx Individual Retirement Annuity Endorsement]
[MLNY110B Xxxx Individual Retirement Annuity Endorsement]
-5J-
THIS PAGE INTENTIONALLY LEFT BLANK.
