XXXX XXXXXXX LIFE INSURANCE [XXXX XXXXXXX LOGO]
COMPANY OF NEW YORK
ANNUITY SERVICE OFFICE
HOME OFFICE [P.O. Box 55230
[000 Xxxxxx Xxxx Xxxxx, 0xx Xxxxx Xxxxxx, XX 00000-0000
Xxxxxxxx, XX 00000] 0-000-000-0000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
WE AGREE to pay the benefits of this Contract in accordance with its terms.
THIS CONTRACT is issued in consideration of the Payments.
TEN DAY RIGHT TO REVIEW
The Owner may cancel the Contract by returning it to our Annuity Service Office
or agent at any time within 10 days after receipt of the Contract. Within 7 days
of delivery of the Contract to us, we will pay to the Owner an amount equal to
the sum of (i) and (ii), where (i) is the difference between the payments made,
including any fees and deductions, and the amounts, if any, allocated to the
Separate Account under the Contract, (ii) is the Contract Value attributable to
the amounts, if any, allocated to the separate account under the Contract. The
Contract Value will be computed at the end of the Valuation Period during which
the Contract is delivered to us.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this 10 day period, we will return the greater of (i) Contract
Value computed at the end of the Valuation Period during which the Contract is
received by us or (ii) sum of all Payments.
The smallest annual rate of investment return which is required to be earned on
the assets of the separate account so that the dollar amount of variable annuity
payments will not decrease is 4.78%. Explicit annual charges against the assets
of the separate account are as follows:
Contract Asset Fee Charge: Not greater than 1.49%
SIGNED FOR THE COMPANY at its Home Office, Valhalla, New York,
on the Contract Date.
DETAILS OF VARIABLE ACCOUNT PROVISIONS ON PAGE 6.1
DETAILS OF FIXED ACCOUNT PROVISIONS ON PAGE 7.1
[/S/ XXXXX X. XXXXXXXXX] [XXXXXXX XXXXX]
President Secretary
Flexible Payment Deferred Combination Fixed* and Variable Annuity
Non-Participating
ANNUITY PAYMENTS, DEATH BENEFITS, SURRENDER VALUES, AND OTHER CONTRACT VALUES
PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE
ACCOUNT, ARE VARIABLE, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE
FLUCTUATIONS IN THE NET INVESTMENT FACTOR, AS APPLICABLE, AND ARE NOT GUARANTEED
AS TO FIXED DOLLAR AMOUNT, UNLESS OTHERWISE SPECIFIED.
*FIXED ACCOUNT(S) MAY NOT BE AVAILABLE AT THIS TIME. PLEASE REVIEW AVAILABLE
INVESTMENT OPTIONS PAGE FOR DETAILS.
INTRODUCTION
This is a flexible payment deferred combination fixed and variable annuity
contract. This Contract provides that prior to the Maturity Date, the Contract
Value will accumulate on either a fixed or variable basis or a combination of
both. After the Maturity Date, annuity payments may be either fixed or variable,
or a combination of fixed and variable.
The variable portion of the Contract will vary with the investment performance
of your Investment Account. The fixed portion of the Contract will accumulate
based on interest rates guaranteed by the Company for the period selected.
If you select annuity payments on a variable basis, the payment amount will vary
with the investment performance of the Variable Account.
You must allocate Payments among one or more Investment Options. The Investment
Options are identified on the Specifications Page.
TABLE OF CONTENTS PAGE
--------------------------------------------------------------------------------
SPECIFICATIONS PAGE S.1
PART 1 - DEFINITIONS 1.1
PART 2 - GENERAL PROVISIONS 2.1
PART 3 - OWNERSHIP 3.1
PART 4 - BENEFITS 4.1
PART 5 - PAYMENTS 5.1
PART 6 - VARIABLE ACCOUNT PROVISIONS 6.1
PART 7 - FIXED ACCOUNT PROVISIONS 7.1
PART 8 - ANNUITY PROVISIONS 8.1
PART 9 - TRANSFERS 9.1
PART 10 - WITHDRAWAL PROVISIONS 10.1
PART 11 - FEES AND DEDUCTIONS 11.1
PART 12 - LOAN PROVISIONS 12.1
PART 13 - PAYMENT OF CONTRACT BENEFITS 13.1
TABLE OF ANNUITY PAYMENT RATES T.1
SPECIFICATIONS PAGE
TYPE OF CONTRACT: [QUALIFIED] MATURITY DATE: [02/01/2052]
CONTRACT DATE: [02/01/2007] CONTRACT NUMBER: [000000005]
INITIAL PAYMENT: [$3,500.00] GOVERNING LAW: NY
OWNER: [XXXXXX XXXXX] OWNER'S AGE [45]
CO-OWNER [ ] CO-OWNER'S AGE [ ]
ANNUITANT: [COOKIE DOUGH] ANNUITANT'S AGE: [45]
CO-ANNUITANT: [ ] CO-ANNUITANT'S AGE [ ]
ANNUITY OPTION: [Life 10-Year Certain]
PLAN Venture Access
MINIMUM GUARANTEED INTEREST RATE [3.0%] per year
ON FIXED ACCOUNTS
ASSET FEES
CONTRACT ASSET FEE 1.49% years [1+]
[RIDER ASSET FEE(S)] [RIDER FEE PERCENTAGE]
[Enhanced Death Benefit Marketing Name] [0.20%]
TOTAL ASSET FEE PERCENTAGE [1.49%] years [1+]
(CONTRACT ASSET FEE PLUS RIDER FEE(S)):
ANNUAL FEE [$30.001]
(1) Prior to the Maturity Date, when the Annual Administration Fee is to
be assessed, if the sum of all your Investment Accounts exceeds $100,000,
the Annual Administration Fee will be waived.] [OTHER FEES]
[RIDER] [RIDER FEE PERCENTAGE]
MINIMUM DEATH BENEFIT The sum of all Payments made, less any amount deducted in connection with partial withdrawals. For
purposes of calculating the Minimum Death Benefit, the amount deducted in connection with partial
withdrawals will be equal to (i) times (ii), where (i) is equal to the Minimum Death Benefit prior
to the withdrawal, and (ii) is equal to the partial withdrawal amount divided by the Contract
Value prior to the partial withdrawal.
[S.1]
PAYMENT LIMITS The initial Payment is shown above. Additional
Payments may be made at any time. However, each
additional Payment must be at least $30. If a
Payment would cause the Contract Value to exceed
$1,000,000, or the Contract Value already exceeds
$1,000,000, no additional Payments will be
accepted without our prior approval.
TRANSFER CHARGES AND We reserve the right to impose, upon notice, a
LIMITATIONS - BEFORE transaction charge for transfers. In the event a
MATURITY DATE charge is imposed, it will not exceed the
lesser of $25.00 or 2% of the amount of each
transfer.
We reserve the right to limit, upon notice, the
amount of the transfer and the maximum number of
transfers that can be made.
You must transfer at least $300 or, if less, the
entire amount in the Investment Account each time
you make a transfer. If, after the transfer, the
amount remaining in the Investment Account from
which the transfer is made is less than $100, then
we will transfer the entire amount instead of the
requested amount.
Should we limit the maximum number of transfers
that can be made per Contract Year, that limit
will be no less than one per month or six at any
time within a Contract Year
TRANSFER CHARGES AND We reserve the right to limit, upon notice, the
LIMITATIONS - ON OR AFTER maximum number of transfers you may make per
MATURITY DATE Contract Year after variable annuity payments
have begun.
If we limit the maximum number of transfers that
can be made after variable annuity payments have
begun, the maximum number of transfers you may
make per Contract Year shall be no less than 4.
LIMITATIONS ON AMOUNT OF Any withdrawal from an Investment Account must be
PARTIAL WITHDRAWALS at least $300 or the entire balance of the
Investment Account, if less. If after the
withdrawal, the amount remaining in that
Investment Account is less than $100, then we will
consider the withdrawal request to be a request
for withdrawal of the entire amount held in the
Investment Account. If a partial withdrawal would
reduce the Contract Value to less than $300, or if
the amount requested is greater than or equal to
the amount available as a total withdrawal, then
we will treat the partial withdrawal request as a
total withdrawal of the Contract Value.
TABLE OF WITHDRAWAL None
CHARGES
FREE WITHDRAWAL AMOUNT None
[S.2]
SPECIFICATIONS PAGE (CONTINUED)
[ENHANCED DEATH BENEFIT RIDER MARKETING NAME]
[RIDER DATE:] [02/01/2007]
[RIDER FEE PERCENTAGE:] [0.20%]
OWNER: [XXXXXX XXXXX] OWNER'S AGE [45]
CO-OWNER [ ] CO-OWNER'S AGE [ ]
ANNUITANT: [COOKIE DOUGH] ANNUITANT'S AGE: [45]
CO-ANNUITANT: [ ] CO-ANNUITANT'S AGE [ ]
BENEFICIAIRY SEE ATTACHED LIST
[S.3]
INITIAL ALLOCATION OF NET PAYMENT: (SEE REVERSE FOR ALL AVAILABLE OPTIONS)
INITIAL INITIAL GUARANTEE
FIXED INVESTMENT OPTIONS: INTEREST RATE PERIOD EXPIRES
[6 MONTH DCA] [25.00%] [3.00%] [08/01/2007]
[12 MONTH DCA] [00.00%] [3.00%] [02/01/2008]
THE INTEREST RATE FOR THE 6 [OR 12] MONTH DCA FIXED ACCOUNT OPTION MAY CONTAIN AN ENHANCEMENT THAT MAY NOT BE PROVIDED IN SUBSEQUENT
GUARANTEE PERIODS [OR IN THE ONE YEAR FIXED ACCOUNT]
VARIABLE INVESTMENT OPTIONS:
[AMERICAN ASSET ALLOCATION] [75.00%]
TOTAL 100.00%
[THIS PLAN IS INTENDED TO QUALIFY UNDER THE INTERNAL REVENUE CODE FOR
TAX-FAVORED STATUS. LANGUAGE CONTAINED IN THIS CONTRACT REFERRING TO FEDERAL TAX
STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. PLEASE SEEK THE ADVICE OF
YOUR OWN TAX ADVISOR REGARDING YOUR INDIVIDUAL TAX TREATMENT.]
[S.4]
AVAILABLE INVESTMENT OPTIONS
[FIXED INVESTMENT OPTIONS]
One Year [1 YEAR FIXED NOT CURRENTLY AVAILABLE]
6 Month DCA [6 MONTH DCA NOT CURRENTLY AVAILABLE]
12 Month DCA [12 MONTH DCA NOT CURRENTLY AVAILABLE]1
[VARIABLE INVESTMENT OPTIONS]
[American Asset Allocation]
[Xxxxxxxx Xxxxxxxxx Founding Allocation]
[Money Market] LIFESTYLE PORTFOLIOS:
[Value & Restructuring] [Aggressive]
[American Growth] [Growth]
[International Opportunties] [Balanced]
[International Value] [Moderate]
[Strategic Bond] [Conservative]
[Global Bond]
[S.5]
BENEFICIARY INFORMATION
[Play Dough]
[S.6]
PART 1 DEFINITIONS
------------------------------------------- ----------------------------------------------------------------------------------------
WE AND YOU "We", "us" and "our" means Xxxx Xxxxxxx Life Insurance Company of New York. "You" or
"your" means the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the value of the variable portion of this
Contract before the Maturity Date.
ANNUITANT Any individual person or persons whose life is used to determine the duration of annuity
payments involving life contingencies. The Annuitant is as designated on the
Specifications Page, unless changed.
ANNUITY OPTION The method selected by you for annuity payments made by us.
ANNUITY SERVICE OFFICE Any office designated by us for the receipt of Payments and processing of Owner
requests.
ANNUITY UNIT A unit of measure that is used after the Maturity Date to calculate Variable Annuity
payments.
BENEFICIARY The person, persons or entity to whom certain benefits are payable following the death
of an Owner, or in certain circumstances, an Annuitant.
CONTRACT ANNIVERSARY The anniversary of the Contract Date.
CONTRACT DATE The date of issue of this Contract as designated on the Specifications Page.
CONTRACT VALUE The total of your Investment Account Values and, if applicable, any amount in the Loan
Account attributable to your Contract.
CONTRACT YEAR The period of twelve consecutive months beginning on the Contract Date or any
anniversary thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled to receive the Contract proceeds if
all Beneficiaries die before the annuitant dies.
DEBT Any amounts in the Loan Account attributable to your Contract plus any accrued loan
interest on that amount. The loan provision is only available to certain Qualified
Contracts.
DESIGNATED BENEFICIARY For purposes of section 72(s) if the Internal Revenue Code, the "designated beneficiary"
under the contract shall be the individual who is entitled to receive the amounts
payable on death of an Owner, or if any Owner is not an individual, on any change in, or
death of, an Annuitant.
ENDORSEMENT An Endorsement modifies the contract to which it is attached. Endorsements must be
signed by an officer of the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are predetermined and guaranteed as to dollar
amount.
GENERAL ACCOUNT All the assets of Xxxx Xxxxxxx Life Insurance Company of New York other than assets in
separate accounts.
INTERNAL REVENUE CODE The Internal Revenue Code of 1986, as amended from time to time, and any successor
(IRC) statute of similar purposes.
INVESTMENT ACCOUNT An account established by us which represents your interest in an Investment Option
prior to the Maturity Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment Account.
1.1
INVESTMENT OPTIONS The Investment Options can be either fixed or variable. The Investment Options available
under this Contract are shown on the Specifications Page.
LOAN ACCOUNT The portion of the General Account that is used for collateral when a loan is taken.
MATURITY DATE The date on which annuity benefits commence. It is the date specified on the
Specifications Page, unless changed.
NET PAYMENT The Payment less the amount of premium tax, if any, deducted from the Payment.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified Plans.
OWNER The person, persons or entity entitled to the ownership rights under this Contract. The
Owner is as designated on the Specifications Page, unless changed.
PORTFOLIO OR TRUST A separate portfolio of Xxxx Xxxxxxx Investment Trust, a mutual fund in which the
PORTFOLIO Variable Account invests, or a portfolio of any other mutual fund in which the Variable
Account invests.
PAYMENT An amount paid to us by you as consideration for the benefits provided by this Contract.
RIDER A rider provides an optional benefit, which may result in an additional charge to the
Contract. A rider supplements the contract to which it is attached. Riders must be
signed by an officer of the Company in order to be effective.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax treatment under sections 401, 403, 408 or
457, of the Internal Revenue Code of 1986, as amended.
SEPARATE ACCOUNT A segregated account of Xxxx Xxxxxxx Life Insurance Company of New York that is not
commingled with our general assets and obligations.
SUB-ACCOUNT(S) One or more of the Sub-Accounts of the Variable Account. Each Sub-Account is invested in
shares of a different Trust Portfolio.
VALUATION DATE Any date on which the New York Stock Exchange is open for business and the net asset
value of a Trust Portfolio is determined.
VALUATION PERIOD Any period from one Valuation Date to the next, measured from the time on each such date
that the net asset value of each Portfolio is determined.
VARIABLE ACCOUNT Xxxx Xxxxxxx Life Insurance Company of New York Separate Account A.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not predetermined or guaranteed as to
dollar amount; and (2) vary in relation to the investment experience of one or more
specified variable Sub-Accounts.
1.2
PART 2 GENERAL PROVISIONS
------------------------------------------- ----------------------------------------------------------------------------------------
ENTIRE CONTRACT The entire Contract consists of this Contract, Endorsements and Riders, if any, and the
application, if one is attached to this Contract. Only the President, a Vice President,
or the Secretary of the Company has authority to agree on our behalf to any alteration
of the Contract or to any waiver of our rights or requirements. The change or waiver
must be in writing.
The benefits and values available under this Contract are not less than the minimum
required by any statute of the state in which this Contract is delivered. We have filed
a detailed statement of the method used to calculate the benefits and values with the
Department of Insurance in the state in which this Contract is delivered, if required by
law.
MODIFICATION We will not change or modify this Contract without your consent except as may be
required to make it conform to any applicable law or regulation or any ruling issued by
a government agency.
BENEFICIARY The Beneficiary is as designated on the Specifications Page, unless changed. However, if
there is a surviving Owner, that person will be treated as the Beneficiary. If no such
Beneficiary is living, the Beneficiary is the "Contingent Beneficiary". If no
Beneficiary or Contingent Beneficiary is living, the Beneficiary is the estate of the
deceased Owner.
CHANGE IN MATURITY DATE Prior to the Maturity Date, you may change the Maturity Date by written request at least
one month before both the previously specified Maturity Date and the new Maturity Date.
Once elected, the new Maturity Date will become the Maturity Date. The maximum Maturity
Date will be the later of age 90 or the end of the 10th Contract Year. Any extension of
the Maturity Date will be subject to the laws and regulations then in effect and our
prior approval.
ASSIGNMENT You may assign this Contract at any time prior to the Maturity Date. No assignment will
be binding on us unless it is written in a form acceptable to us and received at our
Annuity Service Office. We will not be liable for any payments made or actions we take
before the assignment is accepted by us. An absolute assignment will revoke the interest
of any revocable Beneficiary. We will not be responsible for the validity of any
assignment.
CLAIMS OF CREDITORS To the extent permitted by law, no benefits payable under this Contract will be subject
to the claims of your, the Beneficiary's, or the Annuitant's creditors.
MISSTATEMENT AND PROOF OF We may require proof of age, sex or survival of any person upon whose age, sex or
AGE, SEX OR SURVIVAL survival any payments depend. If the age or sex of the Annuitant has been misstated,
the benefits will be those which the Payments would have provided for the correct age
and sex. If we have made incorrect annuity payments, the amount of any underpayment,
adjusted with interest at 3% per annum, will be paid immediately. The amount of any
overpayment will be deducted from future annuity payments without adjustment for
interest.
2.1
ADDITION, DELETION OR We reserve the right, subject to prior approval of the New York Superintendent of
SUBSTITUTION OF INVESTMENT Insurance and in compliance with applicable law, to make additions to, deletions from,
OPTIONS or substitutions for the Portfolio shares that are held by the Variable Account or that
the Variable Account may purchase. We reserve the right to eliminate the shares of any
of the eligible Portfolios and to substitute shares of another Portfolio of the Trust,
or of another open-end registered investment company, if the shares of any eligible
Portfolio are no longer available for investment, or if in our judgment further
investment in any eligible Portfolio should become inappropriate in view of the purposes
of the Variable Account. We will not substitute any shares attributable to your interest
in a Sub-Account without notice to you and prior approval of the Securities and Exchange
Commission to the extent required by the Investment Company Act of 1940. Nothing
contained herein shall prevent the Variable Account from purchasing other securities for
other series or classes of contracts, or from effecting a conversion between shares of
another open-end investment company.
We reserve the right, subject to prior approval of the New York Superintendent of
Insurance and in compliance with applicable law, to establish additional Sub-Accounts
which would invest in shares of a new Portfolio of the Trust or in shares of another
open-end investment company. We also reserve the right to eliminate existing
Sub-Accounts, to combine Sub-Accounts or to transfer assets in a Sub-Account to another
Separate Account established by us or an affiliated company. In the event of any such
substitution or change, we may, by appropriate endorsement, make such changes in this
and other Contracts as may be necessary or appropriate to reflect such substitutions or
change. If deemed by us to be in the best interests of persons having voting rights
under the Contracts, the Variable Account may be operated as a management company under
the Investment Company Act of 1940 or it may be de-registered under such Act in the
event such registration is no longer required.
NON-PARTICIPATING Your Contract is non-participating and will not share in our profits or surplus
earnings. We will pay no dividends on your Contract.
REPORTS We will send you reports containing information required by the Investment Company Act
of 1940 and applicable state law in the time periods required by such laws.
INSULATION The portion of the assets of the Variable Account equal to the reserves and other
contract liabilities with respect to such account are not chargeable with liabilities
arising out of any other business we may conduct. Moreover, the income, gains and
losses, realized or unrealized, from assets allocated to the Variable Account shall be
credited to or charged against such account without regard to our other income, gains or
losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets with a value at least equal to the
amounts accumulated in accordance with the terms of the applicable agreements with
respect to the Separate Account, and the reserves for annuities, in the course of
payment that vary with the investment experience of the Separate Account.
CURRENCY AND PLACE OF All payments made to or by us shall be made in the lawful currency of the United States
PAYMENTS of America at the Annuity Service Office or elsewhere if we consent.
NOTICES AND ELECTIONS To be effective, all notices and elections you make under this Contract must be in
writing, signed by you and received by us at the Annuity Service Office. Unless
otherwise provided in this Contract, all notices, requests and elections will be
effective when received by us at our Annuity Service Office, complete with all necessary
information and your signature.
GOVERNING LAW This Contract will be governed by the laws of the jurisdiction indicated on the
Specifications Page.
2.3
SECTION 72(s) The provisions of this Contract shall be interpreted so as to comply with the
requirements of Section 72(s) of the Internal Revenue Code.
2.3
PART 3 OWNERSHIP
GENERAL Before the Maturity Date, the Owner of this
Contract shall be the person, persons or
entity designated on the Specifications Page
or the latest change filed with us. On the
Maturity Date the Annuitant becomes the
Owner of this Contract. If amounts become
payable to the Beneficiary under this
Contract, the Beneficiary becomes the Owner
of this Contract.
CHANGE OF OWNER, Subject to the rights of an irrevocable
ANNUITANT, BENEFICIARY Beneficiary, you may change the Owner,
Annuitant, or Beneficiary by written request
in a form acceptable to us and which is
received at our Annuity Service Office. The
Annuitant may not be changed after the
Maturity Date. You need not send us the
Contract unless we request it. Any change
must be approved by us. If approved, any
change of Owner, Annuitant, or Beneficiary
will take effect on the date the request is
signed. We will not be liable for any
payments or actions we take before the
change is approved.
The substitution or addition of any Owner
may result in the resetting of the Death
Benefit to an amount equal to the Contract
Value as of the date of such change. For
purposes of subsequent calculations of the
Death Benefit, described in Part 4,
Benefits, Death Benefit Before Maturity
Date, the Contract Value on the date of the
change will be treated as a Payment made on
that date. In addition, all anniversary
values, all Payments made and all amounts
deducted in connection with partial
withdrawals prior to the date of the change
of Owner will not be considered in the
determination of the Death Benefit. This
paragraph will not apply if (a) the
individual whose death will cause the Death
Benefit to be paid is the same after the
change of Owner, or (b) if Ownership is
transferred to the Owner's spouse.
If any Annuitant is changed and any Owner is
not an individual, the entire interest in
the Contract must be distributed to the
Owner within five years of the change.
3.1
PART 4 BENEFITS
ANNUITY BENEFITS We will pay a monthly income to the
Annuitant, if living, on the Maturity Date.
Payments can be fixed or variable, or a
combination of fixed and variable. Annuity
benefits will commence on the Maturity Date
and continue for the period of time provided
for under the Annuity Option indicated on
the Specifications Page. On or before to the
Maturity Date, you may change the Annuity
Option.
You may select a Fixed or Variable Annuity.
Unless you indicate otherwise, we will
provide either variable or fixed, or a
combination variable and fixed annuity
payments in proportion to the Investment
Account Value of each Investment Option at
the Maturity Date. Once annuity payments
commence, the Annuity Option may not be
changed.
The method used to calculate the amount of
the initial and subsequent payments is
described under the Part 8, Annuity
Provisions, of this Contract.
We may pay the Contract Value, less Debt, on
the Maturity Date in one lump sum if the
monthly income is less than $20.
DEATH BENEFIT BEFORE A Death Benefit will be determined as of the
MATURITY DATE date on which written notice and proof of
death and all required claim forms are
received at the Company's Annuity Service
Office as follows:
The Death Benefit will be determined as the
greater of the Contract Value or the Minimum
Death Benefit described on the
Specifications Page.
If there is any Debt, the Death Benefit
equals the amount described above less the
Debt under the Contract.
We will permit the Owner to limit the Death
Benefit option(s) to be offered any named
Beneficiary, if the Owner provides written
notice to the Company prior to death and the
desired option(s) is one provided for in
this Contract.
DEATH OF ANNUITANT: On the death of the last
surviving Annuitant, the Owner becomes the
new Annuitant, if the Owner is an
individual. If any Owner is not an
individual the death of any Annuitant is
treated as the death of an Owner and the
Death Benefit will be determined by
substituting the Annuitant for the Owner as
described below.
DEATH OF OWNER: We will pay the Death
Benefit to the Beneficiary if any Owner dies
prior to the Maturity Date. The Death
Benefit may be taken in one sum immediately,
in which case the Contract will terminate.
If the Death Benefit is not taken in one sum
immediately, the Contract will continue
subject to the following provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death
Benefit over the Contract Value
will be allocated to and among the
Investment Accounts in proportion
to their values as of the date on
which the Death Benefit is
determined.
(c) No additional Payments may be
applied to the Contract.
(d) If the Beneficiary is not the
deceased Owner's spouse, the entire
interest in the Contract must be
distributed under one of the
following options:
4.1
(i) The entire interest in the
Contract must be
distributed over the life
of the Beneficiary, or
over a period not
extending beyond the life
expectancy of the
Beneficiary, with
distributions beginning
within one year of the
Owner's death; or
(ii) the entire interest in the
Contract must be
distributed within 5 years
of the Owner's Death.
If the Beneficiary dies before the
distributions required by (i) or
(ii) are complete, the entire
remaining Contract Value must be
distributed in a lump sum
immediately.
e) If the Beneficiary is the deceased
Owner's spouse, the Contract will
continue with the surviving spouse
as the new Owner. The surviving
spouse may name a new Beneficiary
(and, if no Beneficiary is so
named, the surviving spouse's
estate will be the Beneficiary).
(f) Withdrawal Charges will be waived
on any withdrawals.
If there is more than one Beneficiary, the
foregoing provisions will independently
apply to each Beneficiary, to the extent of
that Beneficiary's share.
DEATH BENEFIT ON OR AFTER If annuity payments have been selected based
MATURITY DATE on an Annuity Option providing for payments
for a guaranteed period, and the Annuitant
dies on or after the Maturity Date, we will
make the remaining guaranteed payments to
the Beneficiary. Any remaining payments will
be made as rapidly as under the method of
distribution being used as of the date of
the Annuitant's death. If no Beneficiary is
living, we will commute any unpaid
guaranteed payments to a single sum (on the
basis of the interest rate used in
determining the payments) and pay that
single sum to the estate of the last to die
of the Annuitant and the Beneficiary.
PROOF OF DEATH Proof of death is required upon the death of
the Annuitant or the Owner. Proof of death
is one of the following received at the
Annuity Service Office:
(a) A certified copy of a death
certificate.
(b) A certified copy of a decree of a
court of competent jurisdiction as
to the finding of death.
(c) Any other proof satisfactory to us.
4.2
PART 5 PAYMENTS
GENERAL All Payments under this Contract are payable
at our Annuity Service Office or such other
place as we may designate. Payment Limits
are identified on the Specifications Page.
NONPAYMENT OF PAYMENTS If, prior to the Maturity Date, no Payments
FOR THREE YEARS have been made for three consecutive
Contract Years, and if both:
(a) the total Payments made, less any
partial withdrawals, are less then
$2,000; and
(b) the Contract Value at the end of
such three year period is less than
$2,000;
We may cancel this Contract and pay you the
Contract Value (measured as of the Valuation
Period during which the cancellation
occurs), less the Debt and Annual
Administration Fee. We will provide you with
31 days prior written notice before
canceling the Contract.
ALLOCATION OF NET When we receive Payments, the Net Payments
PAYMENTS will be allocated among Investment Options
in accordance with the allocation
percentages shown on the Specifications
Page. You may change the allocation of
subsequent Net Payments at any time, without
charge, by giving us written notice in a
form acceptable to us.
5.1
PART 6 VARIABLE ACCOUNT PROVISIONS
INVESTMENT ACCOUNT We will establish a separate Investment
Account for you for each variable Investment
Option to which you allocate amounts. The
Investment Account represents the number of
your Accumulation Units in an Investment
Option.
INVESTMENT ACCOUNT VALUE The Investment Account Value of an
Investment Account is determined by (a)
times (b) where:
(a) equals the number of Accumulation
Units credited to the Investment
Account; and,
(b) equals the value of the appropriate
Accumulation Unit.
ACCUMULATION UNITS We will credit Net Payments to your
Investment Accounts in the form of
Accumulation Units. The number of
Accumulation Units to be credited to each
Investment Account of the Contract will be
determined by dividing the Net Payment
allocated to that Investment Account by the
Accumulation Unit value for that Investment
Account.
Accumulation Units will be adjusted for any
transfers and will be canceled on payment of
a death benefit, withdrawal, maturity or
assessment of certain charges based on their
value for the Valuation Period in which such
transaction occurs.
VALUE OF ACCUMULATION UNIT The Accumulation Unit value for a particular
Investment Account for any Valuation Period
is determined by multiplying the
Accumulation Unit value for the immediately
preceding Valuation Period by the "net
investment factor" for the Valuation Period
for which the value is being determined. The
value of an Accumulation Unit may increase,
decrease or remain the same from one
Valuation Period to the next.
NET INVESTMENT FACTOR The net investment factor is an index that
measures the investment performance of a
Sub-Account from one Valuation Period to the
next. The net investment factor for any
Valuation Period is determined by dividing
(a) by (b) and subtracting (c) from the
result where:
(a) is the net result of:
1) the net asset value per
share of a Portfolio share
held in the Sub-Account
determined as of the end
of the current Valuation
Period, plus:
2) the per share amount of
any dividend or capital
gain distributions made by
the Portfolio on shares
held in the Sub-Account if
the "ex-dividend" date
occurs during the current
Valuation Period, and
(b) is the net asset value per share of
a Portfolio share held in the
Sub-Account determined as of the
end of the immediately preceding
Valuation Period, and
(c) is the Asset Fee shown on the
Specifications Page.
The net investment factor may be greater or
less than, or equal to, one.
6.1
PART 7 FIXED ACCOUNT PROVISIONS
INVESTMENT ACCOUNT We will establish a separate Investment
Account for you each time you allocate
amounts to a fixed Investment Option.
Amounts invested in these Investment
Accounts will earn interest at the
guaranteed rate in effect on the date the
amounts are allocated for the duration of
the guarantee period.
We will determine the guaranteed rates from
time to time for Net Payments, renewal
amounts and amounts transferred to a fixed
Investment Option. In no event will the rate
be less than the Minimum Guaranteed Interest
Rate on Fixed Accounts as specified in the
Specifications Page.
We reserve the right to prohibit or restrict
Payments and transfers to the fixed
Investment Option(s) if the effective annual
rate of interest that would apply to the
Payment or transfer is equal to the Minimum
Guaranteed Interest Rate on Fixed Accounts,
as specified on the Specifications Page.
If such restrictions on Payments or
Transfers are not in effect on the Contract
Date, we will provide at least 30 days prior
written notice of any restrictions on
Payments and transfers after the Contract
Date. Prior written notice will specify the
fixed Investment Option(s) that are affected
by such restriction.
Any such restriction on Payments or
Transfers to the fixed Investment Option(s)
will not apply to automatic renewals of
amounts already allocated to a fixed
Investment Option(s). Renewal amount(s) are
otherwise subject to the terms and
conditions described in the Renewal
provisions of the Contract.
We will provide notice in writing within 30
days of when restrictions on Payments or
transfers to fixed Investment Option(s) are
removed.
GUARANTEE PERIODS For any amounts allocated to the fixed
Investment Options, you have the choice of
the guarantee periods available as shown on
the Specifications Page. The amount can be
allocated into any combination of the fixed
Investment Options offered under this
Contract.
Separate Investment Accounts will be
established for each guarantee period. The
guarantee period will be the duration of the
fixed Investment Option selected measured
from the date the amount is allocated to the
Investment Account. Amounts cannot be
allocated to a fixed Investment Option that
would extend the guarantee period beyond the
Maturity Date.
RENEWALS The renewal amount is the Investment Account
Value at the end of the particular guarantee
period. The renewal amount will be
automatically renewed in the same Investment
Option at the end of the guarantee period,
unless you specify otherwise. If renewal in
a particular Investment Option would result
in the guarantee period for that Investment
Account extending beyond the Maturity Date,
the renewal amount may not be renewed in
that Investment Option. The renewal amount
will be applied to the longest guarantee
period of a fixed Investment Option such
that the guarantee period does not extend
beyond the Maturity Date.
DOLLAR COST AVERAGING The DCA Investment Option may be elected by
(DCA) the Owner to make automatic monthly
transfers from a fixed Investment Account to
one or more variable Investment Options.
Only initial and subsequent Net Payments may
be allocated to the DCA Investment Option.
Amounts may not be transferred from other
Investment Options to the DCA Investment
Option.
7.1
INVESTMENT ACCOUNT VALUE The amount in the fixed Investment Accounts
will accumulate at a rate of interest
determined by us and in effect on the date
the amount is allocated to the Investment
Account. The Investment Account Value is the
accumulated value of the amount invested in
the Investment Account reduced by any
withdrawals, loans, transfers or charges
taken from the Investment Account. In no
event will the sum of the Investment Account
Values for all fixed Investment Options be
less than the Minimum Investment Account
Value.
MINIMUM INVESTMENT The Minimum Investment Account Value is the
ACCOUNT VALUE sum of the amounts allocated to all fixed
Investment Accounts reduced by any
withdrawals, loans, transfers or charges
taken from all fixed Investment Accounts,
accumulated at the Minimum Guaranteed
Interest Rate on Fixed Accounts, as
specified on the Specifications Page.
7.2
PART 8 ANNUITY PROVISIONS
VARIABLE ANNUITY PAYMENTS The amount of the first Variable Annuity
payment is determined by applying the
portion of the Contract Value used to effect
a Variable Annuity (minus any applicable
premium taxes) to the appropriate table(s)
contained in this Contract. If the table in
use by us on the Maturity Date is more
favorable to you, we will use that table.
The portion of the Contract Value used to
effect a Variable Annuity will be measured
as of a date not more than 10 business days
prior to the Maturity Date.
Subsequent payments will be based on the
investment performance of one or more
Sub-Accounts as you select. The amount of
such payments is determined by the number of
Annuity Units credited for each Sub-Account.
Such number is determined by dividing the
portion of the first payment allocated to
that Sub-Account by the Annuity Unit value
for that Sub-Account determined as of the
same date that the Contract Value used to
effect annuity payments was determined. This
number of Annuity Units for each Sub-Account
is then multiplied by the appropriate
Annuity Unit value for each subsequent
determination date, which is a uniformly
applied date not more than 10 business days
before the payment is due.
Variable Annuity payments, at the time of
their commencement, will not be less than
those that would be provided by the
application of an amount to purchase any
single consideration immediate
annuity
contract, offered at the time, to the same
class of annuitants. Since no such
annuity
contract currently exists, a comparable
contract in an affiliated company will be
used. Such an amount would be equal to the
greater of:
(a) the Contract Value less applicable
Withdrawal Charges; or
(b) 95% of the Contract Value.
MORTALITY AND EXPENSE We guarantee that the dollar amount of each
GUARANTEE variable annuity payment will not be
affected by changes in mortality and expense
experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each
Sub-Account for any Valuation Period is
determined as follows:
(a) The net investment factor for the
Sub-Account for the Valuation
Period for which the Annuity Unit
value is being calculated is
multiplied by the value of the
Annuity Unit for the preceding
Valuation Period; and
(b) The result is adjusted to
compensate for the interest rate
assumed in the tables used to
determine the first Variable
Annuity payment.
The dollar value of Annuity Units may
increase, decrease or remain the same from
one Valuation Period to the next.
8.1
FIXED ANNUITY PAYMENTS The amount of each Fixed Annuity payment is
determined by applying the portion of the
Contract Value used to effect a Fixed
Annuity measured as of a date not more than
10 business days prior to the Maturity Date
(minus any applicable premium taxes) to the
appropriate table(s) contained in the
Contract. If the table in use by us on the
Maturity Date is more favorable to the
Owner, we will use that table.
Fixed Annuity payments, at the time of their
commencement, will not be less than those
that would be provided by the application of
an amount to purchase any single
consideration immediate
annuity contract,
offered at the time, to the same class of
annuitants. Since no such
annuity contract
currently exists, a comparable contract in
an affiliated company will be used. Such an
amount would be equal to the greater of:
(a) the Contract Value less applicable
Withdrawal Charges; or
(b) 95% of the Contract Value.
We guarantee the dollar amount of Fixed
Annuity payments.
8.2
PART 9 TRANSFERS
TRANSFERS BEFORE MATURITY DATE Before the Maturity Date, you may transfer
amounts among Investment Accounts of the
Contract. Amounts will be canceled from the
Investment Accounts from which amounts are
transferred and credited to the Investment
Account to which amounts are transferred. We
will effect such transfers so that the
Contract Value on the date of transfer will
not be affected by the transfer.
We reserve the right to defer, modify or
terminate the transfer privilege at any
time. Other transfer charges and limitations
are identified on the Specifications Page.
Amounts may not be transferred from a fixed
Investment Account unless those amounts have
been in the fixed Investment Account for at
least one year.
We reserve the right to prohibit or restrict
Payments and transfers to the fixed
Investment Option(s) if the effective annual
rate of interest that would apply to the
Payment or transfer is equal to the Minimum
Guaranteed Interest Rate on Fixed Accounts,
as specified on the Specifications Page.
If such restrictions on Payments or
Transfers are not in effect on the Contract
Date, we will provide at least 30 days prior
written notice of any restrictions on
Payments and transfers after the Contract
Date. Prior written notice will specify the
fixed Investment Option(s) that are affected
by such restriction.
Any such restriction on Payments or
Transfers to the fixed Investment Option(s)
will not apply to automatic renewals of
amounts already allocated to a fixed
Investment Option(s). Renewal amount(s) are
otherwise subject to the terms and
conditions described in the Renewal
provisions of the Contract.
We will provide notice in writing within 30
days of when restrictions on Payments or
transfers to fixed Investment Option(s) are
removed.
TRANSFERS ON OR AFTER Once variable annuity payments have begun,
MATURITY DATE you may transfer all or part of the
investment upon which your variable annuity
payments are based from one Sub-Account to
another. To do this, we will convert the
number of variable Annuity Units you hold in
the Sub-Account from which you are
transferring to a number of variable Annuity
Units of the Sub-Account to which you are
transferring so that the next annuity
payment, if it were made at that time, would
be the same amount that it would have been
without the transfer. After the transfer,
the variable annuity payments will reflect
changes in the values of your new variable
Annuity Units. You must give us notice at
least 30 days before the due date of the
first variable annuity payment to which the
transfer will apply.
We reserve the right to defer, modify or
terminate the transfer privilege at any
time. Other transfer charges and limitations
are identified on the Specifications Page.
After the Maturity Date, transfers will not
be allowed from a fixed to a variable
Annuity Option, or from a variable to a
fixed Annuity Option.
9.1
PART 10 WITHDRAWAL PROVISIONS
CONTRACT VALUE Your Contract Value is equal to the total of
your Investment Account Values and, if
applicable, any amount in the Loan Account
attributable to the Contract.
PAYMENTS OF WITHDRAWALS You may withdraw part or all of the Contract
Value, less any Debt, at any time before the
earlier of the death of an Owner or the
Maturity Date, by sending us a written
request. We will pay all withdrawals within
seven days of receipt at the Annuity Service
Office subject to postponement in certain
circumstances, as specified below.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from,
or postpone the date of payments from, the
variable Investment Accounts for any period
when: (1) the New York Stock Exchange is
closed (other than customary weekend and
holiday closings); (2) trading on the New
York Stock Exchange is restricted; (3) an
emergency exists as a result of which
disposal of securities held in the Variable
Account is not reasonably practicable or it
is not reasonably practicable to determine
the value of the Variable Account's net
assets; or (4) the Securities and Exchange
Commission, by order, so permits for the
protection of security holders; provided
that applicable rules and regulations of the
Securities and Exchange Commission shall
govern as to whether the conditions
described in (2) and (3) exist.
We may defer the right of withdrawal from
the fixed Investment Accounts for not more
than six months from the day we receive
written request and the Contract, if
required. If such payments are deferred 10
days or more, the amount deferred will earn
interest at a rate not less than 3% per
year.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the
entire Contract Value, we will terminate the
Contract and pay you the Contract Value,
less any applicable Debt, Withdrawal Charges
and the Annual Fee.
PARTIAL WITHDRAWAL If you are withdrawing part of the Contract
Value, you should specify the amount that
should be withdrawn from each Investment
Option of the Contract. If there are
multiple Investment Accounts under a fixed
Investment Option, the requested amount from
that Investment Option must be withdrawn
from those Investment Accounts on
first-in-first-out basis. If you do not
specify, the requested amount will be
withdrawn in the following order:
a) Variable Investment Accounts, on a
pro rata basis,
b) Fixed Investment Options beginning
with the shortest guarantee period
first and the longest guarantee
period last.
We will deduct the Withdrawal Charge, if
applicable, from the Contract Value
remaining after payment of the requested
amount.
Partial withdrawals will reduce the Minimum
Death Benefit, as described on the
Specifications Page.
10.1
WITHDRAWAL CHARGE If a withdrawal is made from the Contract
before the Maturity Date, a Withdrawal
Charge (contingent deferred sales charge)
may be assessed against Payments. The amount
of the Withdrawal Charge and when it is
assessed is discussed below:
1. The Free Withdrawal Amount is
defined on the Specifications Page.
The Free Withdrawal Amount may be
withdrawn free of a Withdrawal
Charge.
The Free Withdrawal Amount will be
applied to your requested
withdrawal in the following order:
(a) withdrawals from the
variable Investment
Accounts,
(b) withdrawals from the fixed
Investment Options
beginning with the
shortest guarantee period
first and the longest
guarantee period last.
2. If a withdrawal is made for an
amount greater than the Free
Withdrawal Amount, Payments will be
liquidated on a first-in-first-out
basis. We will liquidate Payments
in the order such Payments were
made: the oldest unliquidated
Payment first, the next Payment
second, etc. until all Payments
have been liquidated.
3. Any Payments liquidated may be
subject to a Withdrawal Charge
based on the length of time the
Payment has been in the Contract.
The Withdrawal Charge is determined
by multiplying the amount of the
Payment being liquidated by the
applicable Withdrawal Charge
Percentage obtained from the table
shown on the Specifications Page.
The total Withdrawal Charge will be
the sum of the Withdrawal Charges
for the Payments being liquidated.
4. The Withdrawal Charge is deducted
from the Contract Value remaining
after you are paid the amount
requested, except in the case of a
complete withdrawal when it is
deducted from the amount otherwise
payable. In the case of a partial
withdrawal, the amount requested
from an Investment Account may not
exceed the value of that Investment
Account less any applicable
Withdrawal Charge.
FREQUENCY AND AMOUNT OF You may make as many partial withdrawals as
PARTIAL WITHDRAWALS you wish. Limitations on the amount of
partial withdrawals are set forth on the
Specifications Page.
10.2
PART 11 FEES AND DEDUCTIONS
ASSET FEE To compensate us for assuming mortality and
expense risks, and certain administration
expenses, we deduct from each variable
Investment Option a fee each Valuation
Period at an annual rate set forth on the
Specifications Page. A portion of this Asset
Fee may also be used to reimburse us for
distribution expenses. This fee is reflected
in the Net Investment Factor used to
determine the value of Accumulation Units
and Annuity Units of the Contract.
ANNUAL FEE To compensate us for assuming certain
administrative expenses, we may charge an
Annual Fee if specified on the
Specifications Page. The Annual Fee deducted
from the Fixed Investment Accounts will not
exceed $30. Prior to the Maturity Date, the
Annual Fee is deducted on each Contract
Anniversary. It is withdrawn from each
Investment Option in the same proportion
that the value of the Investment Accounts of
each Investment Option bears to the Contract
Value. If the Contract Value is totally
withdrawn on any date other than the
Contract Anniversary, we will deduct the
total amount of the Annual Fee from the
amount paid. After the Maturity Date, the
Annual Fee is deducted on a pro rata basis
from each annuity payment. However, the
Annual Fee will not reduce the annuity
payments below the amount that would result
from the application of the annuity payment
rates stated in Part 13, Payment of Contract
Benefits.
TAXES We reserve the right to charge certain taxes
against your Payments (either at the time of
payment or liquidation), Contract Value,
payment of Death Benefit, or annuity
payments, as appropriate. Such taxes may
include premium taxes or other taxes levied
by any government entity which we, in our
sole discretion, determine have resulted
from the establishment or maintenance of the
Variable Account, or from the receipt by us
of Payments, or from the issuance of this
Contract, or from the commencement or
continuance of annuity payments under this
Contract.
11.1
PART 12 LOAN PROVISIONS (CERTAIN QUALIFIED CONTRACTS
ONLY)
GENERAL This loan provision applies only to certain
Qualified Contracts. All provisions and
terms of a loan are included in the
Qualified Plan Endorsement, if attached.
12.1
PART 13 PAYMENT OF CONTRACT BENEFITS
GENERAL Benefits payable under this Contract may be
applied in accordance with one or more of
the Annuity Options described below, subject
to any restrictions of Internal Revenue Code
section 72(s). Once annuity payments
commence, the Annuity Option may not be
changed. The "Life 10-year certain" Annuity
Option described under part b) of Options 1
and 2 below will be the default Annuity
Option, unless you request another, any time
on or before the Maturity Date.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the
Annuity Options described below, you may
choose an alternate form of settlement
acceptable to us. Once annuity payments
commence, the form of settlement may not be
changed.
DESCRIPTION OF ANNUITY Option 1: Life Annuity
OPTIONS
a) Life Non-Refund. We will make
payments during the lifetime of the
Annuitant. No payments are due
after the death of the Annuitant.
b) Life 10-Year Certain. We will make
payments for 10 years and after
that during the lifetime of the
Annuitant. No payments are due
after the death of the Annuitant
or, if later, the end of the
10-year period.
Option 2: Joint and Survivor Life Annuity
The second Annuitant named shall be referred
to as the Co-Annuitant.
a) Joint and Survivor Non-Refund. We
will make payments during the joint
lifetime of the Annuitant and
Co-Annuitant. Payments will then
continue during the remaining
lifetime of the survivor. No
payments are due after the death of
the last survivor of the Annuitant
and Co-Annuitant.
b) Joint and Survivor with 10-Year
Certain. We will make payments for
10 years and after that during the
joint lifetime of the Annuitant and
Co-Annuitant. Payments will then
continue during the remaining
lifetime of the survivor. No
payments are due after the death of
the survivor of the Annuitant and
Co-Annuitant or, if later, the end
of the 10-year period.
13.1
TABLE OF ANNUITY PAYMENT RATES
ANNUITY PAYMENT RATES The annuity payment rates on the attached
tables show, for each $1,000 applied, the
dollar amount of both: (a) the first monthly
variable annuity payment based on the
assumed interest rate of 3% per year; and
(b) the monthly fixed annuity payment, when
this payment is based on the minimum
guaranteed interest rate of 3% per year. The
annuity payment rates for payments made on a
less frequent basis (quarterly, semiannual
or annual) will be quoted by us upon
request.
The annuity payment rates are based on the
1983 Table A projected at Scale G with
interest at the rate of 3% per year, and
assume births in the year 1942. The amount
of each annuity payment will depend upon the
sex and adjusted age of the Annuitant, the
Co-Annuitant, if any, or other payee. The
actual age is determined based on the actual
age nearest birthday at the time the first
monthly annuity payment is due. The adjusted
age is determined by adjusting the actual
age in accordance with the following table:
Calendar Year of Birth Adjustment to Actual Age
---------------------- ------------------------
1899 - 1905 +6
1906 - 1911 +5
1912 - 1918 +4
1919 - 1925 +3
1926 - 1932 +2
1933 - 1938 +1
1939 - 1945 0
1946 - 1951 -1
1952 - 1958 -2
1959 - 1965 -3
1966 - 1972 -4
1973 - 1979 -5
1980 - 1986 -6
1987 - 1993 -7
1994 + -8
The dollar amount of annuity payment for any
age or combination of ages not shown
following or for any other form of Annuity
Option agreed to by us will be quoted on
request.
T.1
AMOUNT OF FIRST MONTHLY PAYMENT
PER $1000 OF CONTRACT VALUE
OPTION 1: LIFE ANNUITY
Option 1(A): Non-Refund Option 1(B): 10-Year Certain
------------------------------------------------------- ------------------------------------------------------
Adjusted Age of Adjusted Age of
Annuitant Male Female Annuitant Male Female
------------------------------------------------------- ------------------------------------------------------
55 4.27 3.86 55 4.22 3.84
60 4.69 4.19 60 4.61 4.15
65 5.25 4.61 65 5.10 4.55
70 6.02 5.19 70 5.71 5.07
75 7.01 5.99 75 6.42 5.73
80 8.34 7.10 80 7.20 6.52
85 10.13 8.64 85 7.97 7.37
OPTION 2: JOINT AND SURVIVOR LIFE ANNUITY
Option 2(A): Non-Refund
Age of Co-Annuitant
----------------------------------------------------------------------------------------------------------------
Adjusted Age of 10 Years 5 Years Same 5 Years 10 Years
Male Annuitant Younger Younger Age Older Older
----------------------------------------------------------------------------------------------------------------
55 3.25 3.39 3.55 3.72 3.87
60 3.41 3.60 3.81 4.02 4.21
65 3.62 3.87 4.14 4.41 4.67
70 3.89 4.21 4.57 4.95 5.29
75 4.24 4.67 5.17 5.67 6.11
80 4.71 5.30 5.97 6.63 7.19
85 5.35 6.15 7.05 7.92 8.60
Option 2(B): 10 Year Certain
Age of Co-Annuitant
----------------------------------------------------------------------------------------------------------------
Adjusted Age of 10 Years 5 Years Same 5 Years 10 Years
Male Annuitant Younger Younger Age Older Older
----------------------------------------------------------------------------------------------------------------
55 3.25 3.39 3.55 3.72 3.87
60 3.41 3.60 3.80 4.01 4.21
65 3.62 3.86 4.13 4.41 4.66
70 3.89 4.21 4.56 4.92 5.24
75 4.24 4.66 5.13 5.58 5.95
80 4.69 5.25 5.85 6.39 6.78
85 5.28 6.00 6.71 7.27 7.67
----------------------------------------------------------------------------------------------------------------
Monthly installments for ages not shown will be furnished on request.
T.2
XXXX XXXXXXX LIFE INSURANCE
COMPANY OF NEW YORK (XXXX XXXXXXX LOGO)
