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PREFERRED LIFE INSURANCE COMPANY OF NEW YORK
000 Xxxx 00xx Xxxxxx, 00xx Xxxxx
Xxx Xxxx, Xxx Xxxx 00000
This is a legal Contract between the Contract Owner (referred to in this
Contract as you and your) and Preferred Life Insurance Company of New York
(Preferred Life) (herein referred to as we, us and our). We will make Annuity
Payments and pay other benefits as set forth in each Certificate issued under
this Contract, subject to the provisions of this Contract.
This Contract is issued in, and is governed by, the laws of the state of New
York applicable to contracts delivered in such state.
READ YOUR CONTRACT CAREFULLY
RIGHT TO EXAMINE: Each Certificate Owner may cancel his or her Certificate by
returning it within 10 days after receipt. It can be mailed or delivered to
either us or the agent who sold it. Return of a Certificate by mail is effective
on being postmarked, properly addressed and postage prepaid. The returned
Certificate will be treated as if we had never issued it. We will promptly
refund the Certificate Value as of the date of surrender. This may be more or
less than the Purchase Payments. We have the right to allocate payments to the
Money Market Fund until the expiration of the Right to Examine period. If we so
allocate payments, we will refund the greater of the Purchase Payments, less any
surrenders, or the Certificate Value.
This is a Variable Annuity Contract with Annuity Payments and Certificate Values
increasing or decreasing depending on the experience of the Variable Account
which is set forth in the Contract Schedule.
Signed by the Company:
/s/XXXXXXX X. XXXXXXXXXXX /s/XXXXXX X. XXXXX
Secretary President
GROUP FLEXIBLE PAYMENT VARIABLE ANNUITY CONTRACT
NONPARTICIPATING
Annuity payments will not decrease as long as the investment return of the
variable account assets equals or exceeds 6.4% (assuming a 5% Assumed Investment
Return) on an annual basis. Variable Account expenses consist of a Mortality and
Expense Risk Charge, an Administrative Charge, a Distribution Expense Charge, a
Certificate Maintenance Charge, and Transfer Fees. These are shown on the
Certificate's Certificate Schedule Page. The variable provisions can be found on
pages 4, 5, 6, and 16 of this Contract.
TABLE OF CONTENTS
RIGHT TO EXAMINE..................................................................................................1
CONTRACT SCHEDULE.................................................................................................i
DEFINITIONS.......................................................................................................2
PURCHASE PAYMENTS.................................................................................................4
PURCHASE PAYMENTS........................................................................................4
CHANGE IN PURCHASE PAYMENTS..............................................................................4
NO DEFAULT...............................................................................................4
ALLOCATION OF PURCHASE PAYMENTS..........................................................................4
VARIABLE ACCOUNT..................................................................................................4
THE VARIABLE ACCOUNT.....................................................................................4
VALUATION OF ASSETS......................................................................................5
ACCUMULATION UNITS.......................................................................................5
ACCUMULATION UNIT VALUE..................................................................................5
NET INVESTMENT FACTOR....................................................................................5
MORTALITY AND EXPENSE RISK CHARGE........................................................................6
ADMINISTRATIVE CHARGE....................................................................................6
DISTRIBUTION EXPENSE CHARGE..............................................................................6
MORTALITY AND EXPENSE GUARANTEE..........................................................................6
CERTIFICATE VALUE.................................................................................................6
CERTIFICATE MAINTENANCE CHARGE....................................................................................6
TRANSFERS.........................................................................................................6
SURRENDER PROVISIONS..............................................................................................7
SURRENDERS...............................................................................................7
CONTINGENT DEFERRED SALES CHARGE.........................................................................8
PROCEEDS PAYABLE ON DEATH.........................................................................................8
DEATH OF CERTIFICATE OWNER DURING THE ACCUMULATION PERIOD................................................8
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD......................................................8
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD.....................................................8
DEATH OF CERTIFICATE OWNER DURING THE ANNUITY PERIOD.....................................................9
DEATH OF ANNUITANT.......................................................................................9
PAYMENT OF DEATH BENEFIT.................................................................................9
BENEFICIARY..............................................................................................9
CHANGE OF BENEFICIARY...................................................................................10
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION.....................................................................10
CERTIFICATE OWNER, ANNUITANT, ASSIGNMENT PROVISIONS..............................................................10
CERTIFICATE OWNER........................................................................................10
JOINT OWNER..............................................................................................10
ANNUITANT................................................................................................10
ASSIGNMENT OF A CERTIFICATE..............................................................................10
ANNUITY PROVISIONS...............................................................................................11
GENERAL.................................................................................................11
INCOME DATE.............................................................................................11
SELECTION OF AN ANNUITY OPTION..........................................................................11
ANNUITY OPTIONS.........................................................................................11
OPTION 1 - LIFE ANNUITY...........................................................................11
OPTION 2 - LIFE ANNUITY WITH 60, 120, 180, OR 240 MONTHLY ANNUITY PAYMENTS GUARANTEED.............11
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY........................................................11
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH 60, 120, 180, OR 240 MONTHLY ANNUITY PAYMENT
GUARANTEED..................................................................................... 12
OPTION 5 - REFUND LIFE ANNUITY....................................................................12
ANNUITY.................................................................................................12
FIXED ANNUITY...........................................................................................13
VARIABLE ANNUITY........................................................................................16
GENERAL PROVISIONS...............................................................................................19
THE CONTRACT............................................................................................19
NON-PARTICIPATING IN SURPLUS............................................................................19
INCONTESTABILITY........................................................................................19
MISSTATEMENT OF AGE OR SEX..............................................................................19
CERTIFICATE SETTLEMENT..................................................................................19
REPORTS.................................................................................................19
TAXES...................................................................................................19
EVIDENCE OF SURVIVAL....................................................................................19
PROTECTION OF PROCEEDS..................................................................................19
MODIFICATION OF CONTRACT OR CERTIFICATE.................................................................20
CONTRACT SCHEDULE
CONTRACT SCHEDULE
CONTRACT SCHEDULE
CONTRACT SCHEDULE
DEFINITIONS
ACCUMULATION UNIT: An accounting unit of measure used to calculate a
Certificate's Certificate Value prior to the Income Date.
ACCUMULATION PERIOD: The period prior to the Income Date during which a
Certificate Owner can make Purchase Payments.
ADJUSTED CERTIFICATE VALUE: A Certificate's Certificate Value less any
applicable Premium Tax. This amount is applied to the applicable Annuity Table
to determine the initial Annuity Payment.
AGE: Age last birthday unless otherwise specified.
ANNUITANT: The natural person upon whose continuation of life any Annuity
Payment involving life contingencies depends. A Certificate Owner may change the
Annuitant under a Certificate at any time prior to the Income Date unless the
Certificate Owner is a non-individual. On or after the Income Date, any
reference to Annuitant shall also include any Joint Annuitant.
ANNUITY OPTION: An arrangement under which Annuity Payments are made under a
Certificate.
ANNUITY PAYMENTS: The series of payments under a Certificate made to a
Certificate Owner or any named payee after the Income Date under the Annuity
Option selected.
ANNUITY PERIOD: The period of time beginning on the Income Date during which
Annuity Payments are made.
ANNUITY RESERVE: The assets which support the Annuity Option which a Certificate
Owner has selected during the Annuity Period.
ANNUITY UNIT: An accounting unit of measure used to calculate Annuity Payments
after the Income Date.
ASSUMED INVESTMENT RETURN: The investment return upon which the Variable Annuity
Payments under a Certificate are based.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Valuemark Service Center.
BENEFICIARY: The person(s) or entity(ies) who will receive any death benefit
payable under a Certificate.
COMPANY: Preferred Life Insurance Company of New York.
CONTRACT: This Group Annuity Contract.
CERTIFICATE ANNIVERSARY: An anniversary of the Issue Date of a Certificate.
CERTIFICATE OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in a Certificate. If Joint Owners are named, all references to
Certificate Owner shall mean the Joint Owners.
CERTIFICATE SURRENDER VALUE: A Certificate's Certificate Value less any
applicable Premium Tax, less any Contingent Deferred Sales Charge and less any
applicable Certificate Maintenance Charge.
CERTIFICATE VALUE: The dollar value as of any Valuation Date of all amounts
accumulated under a Certificate.
CERTIFICATE YEAR: Any period of twelve (12) months commencing with the Issue
Date of a Certificate and each Certificate Anniversary thereafter.
ELIGIBLE INVESTMENT(S): Those investments available under a Certificate. Current
Eligible Investments are shown on the Contract Schedule and on each Certificate
Owner's Certificate Schedule.
FUND: A segment of an Eligible Investment which constitutes a separate and
distinct class of interests under an Eligible Investment.
GENERAL ACCOUNT: Our general investment account which contains all the assets of
the Company with the exception of the Variable Account and other segregated
asset accounts.
INCOME DATE: The date on which Annuity Payments are to begin under a
Certificate.
ISSUE DATE: The date shown on a Certificate Schedule on which the first
Certificate Year begins.
JOINT OWNER: If there is more than one Certificate Owner, each Certificate Owner
shall be a Joint Owner of the Certificate. There can only be two Joint Owners.
Joint Owners have equal ownership rights and must both authorize any exercising
of those ownership rights unless otherwise allowed by us.
PREMIUM TAX: Any premium taxes owed to any governmental entity and assessed
against Purchase Payments or a Certificate's Certificate Value.
PURCHASE PAYMENT: A payment made toward a Certificate.
SUB-ACCOUNT: Variable Account assets are divided into Sub-Accounts. Assets of
each Sub-Account will be invested in shares of an Eligible Investment or Fund.
In a Certificate, "Fund" may also refer to the Sub-Accounts from which the Fund
investment is made.
VALUATION DATE: The Variable Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period commencing at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
VALUEMARK SERVICE CENTER: The office indicated on the Certificate Schedule of a
Certificate to which notices, requests and Purchase Payments must be sent. All
sums payable to us under a Certificate are payable only at the Valuemark Service
Center.
VARIABLE ACCOUNT: A separate account maintained by us in which a portion of our
assets has been allocated for Certificates. It has been designated on the
Contract Schedule.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: Purchase Payments toward a Certificate are payable according
to the frequency and in the amount selected by the Certificate Owner. The
initial Purchase Payment is due on the Certificate's Issue Date. We reserve the
right to decline any Purchase Payment. The Minimum Subsequent Purchase Payment
and the Maximum Total Purchase Payments allowed are shown on the Certificate
Schedule.
CHANGE IN PURCHASE PAYMENTS: A Certificate Owner may elect to increase or
decrease or to change the frequency of Purchase Payments.
NO DEFAULT: Unless surrendered, a Certificate remains in force and will not be
in default if no additional Purchase Payments are made.
ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to one or more
of the Funds of the Variable Account in accordance with the Certificate Owner's
selection. The allocation of the initial Purchase Payment is made in accordance
with such Certificate Owner's selection made at the Issue Date. Unless the
Certificate Owner informs us otherwise, subsequent Purchase Payments are
allocated in the same manner as the initial Purchase Payment. However, the
Company has reserved the right to allocate the initial Purchase Payment to the
Money Market Fund until the expiration of the Right to Examine period. All
allocations of Purchase Payments are subject to the Allocation Guidelines shown
on the Certificate Schedule. We guarantee that a Certificate Owner will be
allowed to select at least five Funds for allocation of Purchase Payments.
VARIABLE ACCOUNT
THE VARIABLE ACCOUNT: The Variable Account is designated on the Certificate
Schedule. It consists of assets we have set aside and have kept separate from
the rest of our assets and those of our other separate accounts. The assets of
the Variable Account, equal to reserves and other liabilities of each
Certificate and those of other Certificate Owners, will not be charged with
liabilities arising out of any other business we may conduct.
The Variable Account assets are divided into Funds. The Funds which are
available under each Certificate are listed on the Certificate Schedule. The
assets of the Fund are allocated to the Eligible Investments (and/or the Funds,
if any, within an Eligible Investment) shown on the Certificate Schedule. We may
add additional Eligible Investments or Funds to those shown. A Certificate Owner
may be permitted to transfer his or her Certificate Value or allocate Purchase
Payments to the additional Fund(s). However, the right to make such transfers or
allocations will be limited by any terms and conditions we may impose.
Should the shares of any Eligible Investment(s), or any Fund(s) within an
Eligible Investment, become unavailable for investment by the Variable Account,
or our Board of Directors deems further investment in the shares inappropriate,
we may limit further purchase of such shares or substitute shares of another
Eligible Investment or Fund for shares already purchased.
VALUATION OF ASSETS: Assets of Eligible Investments within each Fund will be
valued at their net asset value on each Valuation Date.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Funds of the Variable Account as a result of
Purchase Payments, surrenders, transfers, or fees and charges. We will determine
the number of Accumulation Units of a Sub-Account purchased or canceled. This
will be done by dividing the amount allocated to (or the amount withdrawn from)
the Sub-Account by the dollar value of one Accumulation Unit of the Sub-Account
as of the end of the Valuation Period during which the transaction is processed
at the Valuemark Service Center.
ACCUMULATION UNIT VALUE: The Accumulation Unit Value for each Fund was
arbitrarily set initially. Subsequent Accumulation Unit Values for each Fund are
determined by multiplying the Accumulation Unit Value for the immediately
preceding Valuation Period by the Net Investment Factor for the Fund for the
current period.
The Accumulation Unit value may increase or decrease from Valuation Period to
Valuation Period.
NET INVESTMENT FACTOR: The Net Investment Factor for each Fund is determined by
dividing A by B and multiplying by (1 - C) where:
A is (i) the net asset value per share of the Eligible Investment or the
Fund of an Eligible Investment held by the Fund at the end of the
current Valuation Period; plus
(ii) any dividend or capital gains per share declared on behalf of
such Eligible Investment or Fund that has an ex-dividend date
within the current Valuation Period.
B is the net asset value per share of the Eligible Investment or Fund
held by the Fund for the immediately preceding Valuation Period.
C is (i) the Valuation Period equivalent of the daily Mortality and
Expense Risk Charge, for the Administrative Charge and for the
Distribution Expense Charge, if any, which are shown on the
Certificate Schedule; plus
(ii) a charge factor, if any, for any taxes or any tax reserve we have
established as a result of the operation or maintenance of the
Fund.
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, we deduct a Mortality
and Expense Risk Charge from the Variable Account which is equal, on an annual
basis, to the amount shown on a Certificate's Certificate Schedule. The
Mortality and Expense Risk Charge compensates us for assuming the mortality and
expense risks under a Certificate Owner's Certificate.
ADMINISTRATIVE CHARGE: Each Valuation Period, we deduct an Administrative Charge
from the Variable Account which is equal, on an annual basis, to the amount
shown on a Certificate's Certificate Schedule. The Administrative Charge
compensates us for the costs associated with the administration of a Certificate
Owner's Certificate and the Variable Account.
DISTRIBUTION EXPENSE CHARGE: Each Valuation Period, we deduct a Distribution
Expense Charge from the Separate Account which is equal, on an annual basis, to
the amount shown on a Certificate's Certificate Schedule. The Distribution
Expense Charge compensates us for costs associated with the distribution of
Certificates.
MORTALITY AND EXPENSE GUARANTEE: We guarantee that the dollar amount of each
annuity payment after the first will not be affected by variations in mortality
or expense experience.
CERTIFICATE VALUE
The Certificate Value for any Valuation Period is equal to the total dollar
value accumulated under a Certificate. The Certificate Value in a Fund of the
Variable Account is determined by multiplying the number of Accumulation Units
allocated to the Certificate Value for the Fund by the Accumulation Unit Value.
Purchase Payments, surrenders and transfers from or to a Fund will result in the
addition of or the cancellation of Accumulation Units in a Fund.
CERTIFICATE MAINTENANCE CHARGE
We deduct an annual Certificate Maintenance Charge shown on the Certificate
Schedule. During the Accumulation Period, this will be deducted from the
Certificate Value by canceling Accumulation Units to reimburse us for expenses
relating to maintenance of a Certificate. The number of Accumulation Units to be
canceled will be from each applicable Fund and is the ratio that the value of
each Fund bears to the total Certificate Value. During the Annuity Period, the
Certificate Maintenance Charge will be collected pro rata from each Annuity
Payment. However, the result will not be less than the Annuity Payment
guarantees defined in the Annuity Provisions section of the Certificate.
TRANSFERS
A Certificate Owner may transfer all or a part of his or her interest in a Fund
to another Fund. We reserve the right to charge for transfers if there are more
than the number of free transfers shown on the Certificate Schedule.
Pre-scheduled transfer programs may be available. All transfers are subject to
the following:
1. The deduction of any Transfer Fee that may be imposed as shown on the
Certificate Schedule. The Transfer Fee will be deducted from the Fund from
which the transfer is made. If the entire amount in the Fund is
transferred, then the Transfer Fee will be deducted from the amount
transferred. If there are multiple source Funds, it will be treated as a
single transfer. Any Transfer Fee will be deducted proportionally from the
source Funds if less than the entire amount in the Fund is transferred.
2. We reserve the right to limit transfers until the expiration of the Right
to Examine period.
3. The minimum amount which can be transferred is shown on the Certificate
Schedule.
4. No transfer will be effective within seven calendar days prior to the date
on which the first Annuity Payment is due.
5. Any transfer direction must clearly specify:
a. the amount which is to be transferred; and
b. the Funds which are to be affected.
6. After the Income Date, transfers may not be made from a fixed annuity
option to a variable annuity option.
7. After the Income Date, a Certificate Owner can make at least one transfer
from a variable annuity option to a fixed annuity option. The number of
Annuity Units canceled from the variable annuity option will be equal in
value to the amount of the Annuity Reserve transferred out of the Variable
Account. The amount transferred will purchase fixed annuity payments under
the Annuity Option in effect and based on the age and sex of the Annuitant
at the time of the transfer where allowed.
8. We reserve the right to establish policies that limit or discourage
excessive trading that may be disruptive to the Fund.
9. We reserve the right at any time and without prior notice to any party to
modify the transfer provisions described above. However, if we do modify
these provisions we guarantee that they will not be any more restrictive
than the above.
If a Certificate Owner elects to use this transfer privilege, we will not be
liable for transfers made in accordance with such Certificate Owner's
instructions. All amounts and Accumulation Units will be determined as of the
end of the Valuation Period during which the request for transfer is received at
the Valuemark Service Center.
SURRENDER PROVISIONS
SURRENDERS: During the Accumulation Period, a Certificate Owner may, upon
Authorized Request, make a total or partial surrender of the Certificate
Surrender Value. Surrenders will result in the cancellation of Accumulation
Units from each Fund in the ratio that the value of each Fund bears to the total
Certificate Value. A Certificate Owner must specify, by Authorized Request,
which Accumulation Units are to be canceled if other than the above mentioned
method of cancellation is desired.
The Company will pay the amount of any surrender from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
Each partial surrender must be for an amount which is not less than the amount
shown on the Certificate Schedule. The minimum Certificate Value which must
remain in a Certificate after a partial surrender is shown on the Certificate
Schedule.
CONTINGENT DEFERRED SALES CHARGE: Upon a surrender of Certificate Value, a
Contingent Deferred Sales Charge as set forth on the Certificate Schedule may be
assessed. Under certain circumstances, we allow surrenders without the
Contingent Deferred Sales Charge as set forth on the Certificate Schedule.
PROCEEDS PAYABLE ON DEATH
DEATH OF CERTIFICATE OWNER DURING THE ACCUMULATION PERIOD: Upon the death of a
Certificate Owner, or any Joint Owner, during the Accumulation Period, the death
benefit will be paid to the Beneficiary(ies) designated by the Certificate
Owner. Upon the death of a Joint Owner, the surviving Joint Owner, if any, will
be treated as the primary Beneficiary. Any other Beneficiary designation on
record at the time of death will be treated as a contingent Beneficiary.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: The death benefit will be
the Adjusted Certificate Value determined as of the end of the Valuation Period
during which the Company receives both due proof of death and an election for
the payment method.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: A Beneficiary may request
that the death benefit be paid under one of the Death Benefit Options below. In
addition, if the Beneficiary is the spouse of the Certificate Owner, he or she
may elect to continue the Certificate in his or her own name and exercise all
the Certificate Owner's rights under the Certificate. In this event, the
Certificate Value for the Valuation Period during which this election is
implemented will be adjusted to equal the death benefit.
Option A - lump sum payment of the death benefit; or
Option B - the payment of the entire death benefit within 5 years of the
date of the death of the Certificate Owner or any Joint Owner; or
Option C - payment of the death benefit under an Annuity Option over the
lifetime of the Beneficiary or over a period not extending beyond the life
expectancy of the Beneficiary with distribution beginning within one year
of the date of death of the Certificate Owner or any Joint Owner.
Any portion of the death benefit not applied under Option C within one year of
the date of the Certificate Owners' death, must be distributed within five years
of the date of death.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the election, unless the Suspension or
Deferral of Payments Provision is in effect. Payment to the Beneficiary, other
than in a lump sum, may only be elected during the sixty-day period beginning
with the date of receipt of proof of death.
DEATH OF CERTIFICATE OWNER DURING THE ANNUITY PERIOD: If a Certificate Owner, or
any Joint Owner, dies during the Annuity Period, and such Certificate Owner is
not an Annuitant, any remaining payments under the Annuity Option elected will
continue at least as rapidly as under the method of distribution in effect at
such Certificate Owner's death. Upon a Certificate Owner's death during the
Annuity Period, the Beneficiary becomes the Certificate Owner.
DEATH OF ANNUITANT: Upon the death of an Annuitant who is not the Certificate
Owner, during the Accumulation Period, the Certificate Owner may designate a new
Annuitant, subject to our underwriting rules then in effect. If no designation
is made within 30 days of the death of the Annuitant, the Certificate Owner will
become the Annuitant. If the Certificate Owner is a non-individual, the death of
the Annuitant will be treated as the death of the Certificate Owner and a new
Annuitant may not be designated.
Upon the death of the Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death before any
death benefit is paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the
finding of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.
BENEFICIARY: The Beneficiary designation in effect on a Certificate's Issue Date
will remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the Certificate Owner's death.
Unless the Certificate Owner provides otherwise, the death benefit will be paid
in equal shares to the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive the Certificate Owner
and/or the Annuitant's death, as applicable; or if there are none
2. to the contingent Beneficiary(ies) who survive the Certificate Owner
and/or the Annuitant's death, as applicable; or if there are none
3. to the Certificate Owner's estate.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), the Certificate Owner may change the primary Beneficiary(ies)
or contingent Beneficiary(ies). A change may be made by Authorized Request. The
change will take effect as of the date the Authorized Request is signed. The
Company will not be liable for any payment made or action taken before it
records the change.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a surrender or transfer 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. during any other period when the Securities and Exchange Commission,
by order, so permits for the protection of Contract Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
CERTIFICATE OWNER, ANNUITANT, ASSIGNMENT PROVISIONS
CERTIFICATE OWNER: A Certificate Owner has all the interest and rights under his
or her Certificate. The Certificate Owner is the person designated as such on
the Certificate's Issue Date, unless changed.
A Certificate Owner may change Owners of the Certificate at any time by
Authorized Request. A change of Certificate Owner will automatically revoke any
prior designation of Certificate Owner. The change will become effective as of
the date the Authorized Request is signed. We will not be liable for any payment
made or action taken before the change is recorded.
JOINT OWNER: A Certificate may be owned by Joint Owners. Upon the death of
either Joint Owner, the surviving Joint Owner, if any, will be the primary
Beneficiary. Any other Beneficiary designation will be treated as a contingent
Beneficiary unless otherwise indicated in an Authorized Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by the Certificate Owner subject to our
underwriting rules then in effect. The Annuitant may not be changed in a
Certificate which is owned by a non-individual.
ASSIGNMENT OF A CERTIFICATE: An Authorized Request specifying the terms of an
assignment of a Certificate must be provided to the Valuemark Service Center. We
will not be liable for any payment made or action taken before we record the
assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent.
If a Certificate is assigned, the Certificate Owner's rights may only be
exercised with the consent of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Income Date, the Adjusted Certificate Value will be applied
under the Annuity Option selected by the Certificate Owner. The Certificate
Owner may elect to have the Adjusted Certificate Value applied to provide a
Fixed Annuity, a Variable Annuity or a combination Fixed and Variable Annuity.
If a combination is elected, the Certificate Owner must specify what part of the
Adjusted Certificate Value is to be applied to the Fixed and Variable Annuity
Options.
INCOME DATE: A Certificate Owner selects an Income Date at the time of issue.
The Income Date must always be the first day of a calendar month. The earliest
Income Date a Certificate Owner can select is two years after the Issue Date.
The latest Income Date a Certificate Owner can select is the later of the first
day of the first calendar month following the Annuitant's 90th birthday. A
Certificate Owner may, at any time prior to the Income Date, change the Income
Date by Authorized Request 30 days in advance.
SELECTION OF AN ANNUITY OPTION: A Certificate Owner can select an Annuity Option
by Authorized Request. If no Annuity Option is selected, Option 2, with 60
Monthly Payments Guaranteed, will automatically be applied. A Certificate Owner
may, at any time prior to the Income Date, by Authorized Request 30 days in
advance, select and/or change the Annuity Option.
ANNUITY OPTIONS: Each Certificate provides for Annuity Payments under one of the
Annuity Options described below. Any other Annuity Option acceptable to us may
be selected.
OPTION 1 - LIFE ANNUITY. We will make monthly Annuity Payments during the life
of the Annuitant and ceasing with the last Annuity Payment due prior to the
Annuitant's death.
OPTION 2 - LIFE ANNUITY WITH 60, 120, 180, OR 240 MONTHLY ANNUITY PAYMENTS
GUARANTEED. We will make monthly Annuity Payments during the life of the
Annuitant with a guarantee that if at the Annuitant's death there have been less
than 60, 120, 180, or 240 monthly Annuity Payments made as selected, monthly
Annuity Payments will continue for the remainder of the guaranteed period. A
Certificate Owner may elect to have the present value of the guaranteed monthly
Annuity Payments remaining, as of the date notice of the Annuitant's death is
received at the Valuemark Service Center, commuted at the Assumed Investment
Return selected for a Variable Annuity or for a Fixed Annuity the Statutory
Calendar Year Interest Rate based on the New York's Standard Valuation Law for
Single Premium Immediate Annuities corresponding to the Income Date. We will
require the return of the Certificate and proof of death prior to the payment of
any commuted values.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. We will make monthly Annuity
Payments during the joint lifetime of the Annuitant and the Joint Annuitant.
Upon the death of the Annuitant, if the Joint Annuitant is then living, Annuity
Payments will continue to be paid during the remaining lifetime of the Joint
Annuitant at a level of 100%, 75% or 50% of the previous level, as selected.
Monthly Annuity Payments cease with the final Annuity Payment due prior to the
last survivor's death.
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH 60, 120, 180, OR 240 MONTHLY
ANNUITY PAYMENTS GUARANTEED. We will make monthly Annuity Payments during the
joint lifetime of the Annuitant and the Joint Annuitant. Monthly Annuity
Payments will continue to be paid during the remaining lifetime of the Joint
Annuitant at 100% of the previous level, as selected. If at the last death of
the Annuitant and the Joint Annuitant, there have been less than 60, 120, 180,
or 240 monthly Annuity Payments made as selected, monthly Annuity Payments will
continue to be made for the remainder of the guaranteed period. The Certificate
Owner or the Certificate Owner's designated payee may elect to have the present
value of the guaranteed monthly Annuity Payments remaining, as of the date
notice of the Annuitant's death is received by us, commuted at the Assumed
Investment Return selected for a Variable Annuity or for a Fixed Annuity the
Statutory Calendar Year Interest Rate based on the New York's Standard Valuation
Law for Single Premium Immediate Annuities corresponding to the Income Date. We
will require the return of the Certificate and proof of death prior to the
payment of any commuted values.
OPTION 5 - REFUND LIFE ANNUITY. We will make monthly Annuity Payments during the
lifetime of the Annuitant ceasing with the last Annuity Payment due prior to the
Annuitant's death with a guarantee that after the Annuitant's death, the
Certificate Owner will receive a refund. For a Fixed Annuity the amount of the
refund will be any excess of the amount of the Adjusted Certificate Value
applied under this Option over the total of all Annuity Payments made under this
Option. For a Variable Annuity the amount of the refund will depend on the
current fund allocation and will be the sum of Refund Amounts attributable to
each fund. The Refund Amount for a given Fund is calculated using the following
formula:
(1) x {[(2) x (3) x (4)/(5)] - [(4) x (6)]}
where:
(1) = Annuity Unit value of that given Fund when claim proofs are
received.
(2) = Total Adjusted Certificate Value at the time of annuitization.
(3) = Allocation percentage in that given Fund (in decimal form) when
claim proofs are received.
(4) = Current number of Annuity Units used in determining each Annuity
Payment attributable to that given Fund.
(5) = Dollar value of first Annuity Payment.
(6) = Number of Annuity Payments made since annuitization.
This calculation will be based upon the allocation of Annuity Units actually
in-force at the time claim proofs are received at the Valuemark Service Center.
There will be no refund paid if the total refund determined using the above
calculations is less than or equal to zero.
ANNUITY: If a Certificate Owner selects a Fixed Annuity, the Adjusted
Certificate Value is allocated to the General Account and the Annuity is paid as
a Fixed Annuity. If a Certificate Owner selects a Variable Annuity, the Adjusted
Certificate Value will be allocated to the Funds of the Variable Account in
accordance with the Certificate Owner's selection, and the Annuity will be paid
as a Variable Annuity. Unless the Certificate Owner designates another payee,
the Certificate Owner will be the payee of the Annuity Payments. The Adjusted
Certificate Value will be applied to the applicable Annuity Table contained in
the Certificate based upon the Annuity Option the Certificate Owner has
selected. We may offer more favorable rates than those guaranteed here at the
time the first annuity payment is calculated. Where permitted, Annuity Payments
will depend on the Age and sex of the Annuitant. The Annuity Payments will be at
least as favorable as those that would be provided by the application of an
amount to purchase any single premium immediate annuity contract offered by us
at the time for the same class of Annuitants.
FIXED ANNUITY: The Certificate Owner may elect to have the Adjusted Certificate
Value applied to provide a Fixed Annuity. The dollar amount of each Fixed
Annuity Payment is guaranteed to be at least an amount equal to the Adjusted
Certificate Value, divided first by $1000 and then multiplied by the appropriate
Annuity Payment amount for each $1000 of value for the Annuity Option selected.
The guaranteed rates contained in the Annuity Tables in the Certificate are
based on an interest rate of 2 1/2% per year and the 1983(a) Individual Annuity
Mortality Table with mortality improvement projected 30 years using Mortality
Projection Scale G.
Guaranteed Monthly Payment Per $1,000 of Proceeds
Fixed Payouts
Opt 2 Opt 2 Opt 2 Opt 2 Opt 2 Opt 2 Opt 2 Opt 2
5 Yr 5 Yr 10 Yr 10 Yr 15 Yr 15 Yr 20 Yr 20 Yr
Opt 1 Opt 1 Minim Minim Minim Minim Minim Minim Minim Minim Opt 5 Opt 5
Age* M F M F M F M F M F M F
______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
30 2.84 2.71 2.84 2.71 2.84 2.71 2.84 2.71 2.83 2.71 2.82 2.71
31 2.87 2.74 2.87 2.73 2.87 2.73 2.84 2.73 2.86 2.73 2.84 2.73
32 2.90 2.76 2.90 2.76 2.89 2.76 2.86 2.75 2.88 2.75 2.87 2.75
33 2.92 2.78 2.92 2.78 2.92 2.78 2.89 2.78 2.91 2.77 2.89 2.77
34 2.95 2.80 2.95 2.80 2.95 2.80 2.92 2.80 2.94 2.80 2.92 2.79
35 2.98 2.83 2.98 2.83 2.98 2.83 2.95 2.82 2.97 2.82 2.95 2.81
36 3.02 2.85 3.02 2.85 3.01 2.85 2.98 2.85 3.00 2.85 2.98 2.84
37 3.05 2.88 3.05 2.88 3.05 2.88 3.01 2.88 3.03 2.87 3.01 2.86
38 3.09 2.91 3.09 2.91 3.08 2.91 3.04 2.91 3.06 2.90 3.04 2.89
39 3.12 2.94 3.12 2.94 3.12 2.94 3.08 2.93 3.10 2.93 3.07 2.92
40 3.16 2.97 3.16 2.97 3.16 2.97 3.11 2.96 3.13 2.96 3.10 2.95
41 3.20 3.00 3.20 3.00 3.20 3.00 3.15 3.00 3.17 2.99 3.14 2.97
42 3.25 3.04 3.24 3.04 3.24 3.03 3.19 3.03 3.21 3.02 3.17 3.01
43 3.29 3.07 3.29 3.07 3.28 3.07 3.23 3.06 3.25 3.06 3.21 3.04
44 3.34 3.11 3.33 3.11 3.33 3.10 3.27 3.10 3.29 3.09 3.25 3.07
45 3.39 3.15 3.38 3.15 3.37 3.14 3.31 3.14 3.33 3.13 3.29 3.10
46 3.44 3.19 3.43 3.19 3.42 3.18 3.36 3.18 3.38 3.16 3.33 3.14
47 3.49 3.23 3.49 3.23 3.48 3.22 3.41 3.22 3.42 3.20 3.38 3.18
48 3.55 3.27 3.54 3.27 3.53 3.27 3.45 3.26 3.47 3.24 3.42 3.22
49 3.60 3.32 3.60 3.32 3.58 3.31 3.51 3.30 3.52 3.29 3.47 3.26
50 3.66 3.37 3.66 3.37 3.64 3.36 3.56 3.35 3.57 3.33 3.52 3.30
51 3.73 3.42 3.72 3.42 3.71 3.41 3.62 3.40 3.62 3.38 3.57 3.34
52 3.80 3.47 3.79 3.47 3.77 3.46 3.67 3.45 3.68 3.42 3.62 3.39
53 3.87 3.53 3.86 3.53 3.84 3.52 3.73 3.50 3.74 3.48 3.68 3.44
54 3.94 3.59 3.93 3.59 3.91 3.58 3.80 3.56 3.79 3.53 3.74 3.49
55 4.02 3.65 4.01 3.65 3.98 3.64 3.86 3.62 3.85 3.58 3.80 3.54
56 4.10 3.72 4.09 3.71 4.06 3.70 3.93 3.68 3.91 3.64 3.86 3.60
57 4.19 3.79 4.18 3.78 4.14 3.77 4.00 3.74 3.98 3.70 3.93 3.65
58 4.28 3.86 4.27 3.86 4.23 3.84 4.16 3.81 4.04 3.76 4.00 3.71
59 4.38 3.94 4.37 3.93 4.32 3.91 4.24 3.88 4.11 3.82 4.07 3.78
60 4.49 4.02 4.47 4.02 4.42 3.99 4.32 3.95 4.17 3.88 4.14 3.84
61 4.60 4.11 4.58 4.10 4.52 4.08 4.41 4.03 4.24 3.95 4.23 3.91
62 4.72 4.20 4.69 4.19 4.63 4.16 4.50 4.11 4.31 4.02 4.31 3.99
63 4.84 4.30 4.82 4.29 4.74 4.26 4.59 4.19 4.38 4.09 4.39 4.06
64 4.98 4.41 4.95 4.39 4.86 4.36 4.69 4.28 4.44 4.16 4.49 4.14
65 5.12 4.52 5.09 4.50 4.98 4.46 4.79 4.37 4.51 4.23 4.58 4.23
66 5.28 4.64 5.24 4.62 5.11 4.57 4.89 4.47 4.58 4.31 4.68 4.31
67 5.44 4.76 5.39 4.75 5.24 4.69 4.99 4.57 4.64 4.38 4.78 4.41
68 5.61 4.90 5.56 4.88 5.38 4.81 5.09 4.67 4.70 4.45 4.89 4.50
69 5.80 5.04 5.73 5.02 5.53 4.94 5.19 4.78 4.76 4.53 5.01 4.60
70 6.00 5.20 5.92 5.17 5.68 5.07 5.30 4.88 4.82 4.60 5.13 4.72
71 6.21 5.37 6.12 5.34 5.84 5.22 5.40 4.99 4.88 4.67 5.25 4.83
72 6.43 5.55 6.32 5.51 6.00 5.37 5.50 5.11 4.93 4.74 5.38 4.95
73 6.66 5.75 6.54 5.70 6.16 5.53 5.60 5.22 4.97 4.80 5.51 5.07
74 6.91 5.96 6.77 5.90 6.33 5.69 5.70 5.34 5.02 4.86 5.66 5.20
75 7.18 6.18 7.01 6.11 6.50 5.87 5.79 5.45 5.06 4.92 5.82 5.35
76 7.49 6.43 7.28 6.34 6.69 6.05 5.89 5.56 5.09 4.97 5.97 5.49
77 7.80 6.69 7.55 6.58 6.86 6.23 5.97 5.67 5.12 5.01 6.14 5.65
78 8.13 6.97 7.83 6.84 7.04 6.42 6.05 5.78 5.15 5.06 6.31 5.81
79 8.49 7.27 8.13 7.11 7.22 6.61 6.13 5.88 5.17 5.09 6.50 5.97
80 8.87 7.60 8.44 7.40 7.39 6.81 6.20 5.97 5.20 5.13 6.69 6.15
81 9.27 7.95 8.77 7.71 7.57 7.01 6.26 6.06 5.21 5.15 6.89 6.34
82 9.70 8.33 9.10 8.03 7.73 7.21 6.32 6.14 5.23 5.18 7.10 6.53
83 10.16 8.74 9.45 8.38 7.90 7.40 6.37 6.21 5.24 5.20 7.32 6.74
84 10.65 9.18 9.81 8.74 8.05 7.59 6.42 6.28 5.25 5.22 7.55 6.95
85 11.18 9.66 10.19 9.12 8.20 7.77 6.46 6.34 5.26 5.23 7.80 7.17
*Age equals age of annuitant nearest birthday when first payment is made
Guaranteed Monthly Payment per $1,000 of Proceeds
Fixed Payout
Option 3
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 2.61 2.70 2.77 2.81 2.83 2.84
40 2.66 2.82 2.96 3.06 3.12 3.15
50 2.69 2.89 3.14 3.36 3.52 3.61
60 2.70 2.94 3.26 3.65 4.03 4.30
70 2.71 2.96 3.32 3.86 4.56 5.27
80 2.71 2.97 3.35 3.96 4.94 6.32
Option 4
5 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 2.61 2.70 2.77 2.81 2.83 2.84
40 2.66 2.82 2.96 3.06 3.12 3.15
50 2.69 2.89 3.14 3.36 3.52 3.61
60 2.70 2.94 3.26 3.65 4.03 4.30
70 2.71 2.96 3.32 3.86 4.56 5.26
80 2.71 2.97 3.35 3.96 4.93 6.30
Option 4
10 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 2.61 2.70 2.77 2.81 2.83 2.84
40 2.66 2.82 2.96 3.06 3.12 3.14
50 2.69 2.89 3.14 3.36 3.52 3.60
60 2.70 2.94 3.26 3.65 4.03 4.29
70 2.71 2.96 3.32 3.86 4.55 5.22
80 2.71 2.96 3.35 3.95 4.90 6.13
Option 4
15 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 2.61 2.70 2.77 2.81 2.83 2.84
40 2.66 2.82 2.96 3.06 3.12 3.14
50 2.69 2.89 3.13 3.36 3.52 3.59
60 2.70 2.94 3.26 3.65 4.01 4.24
70 2.71 2.96 3.32 3.84 4.50 5.05
80 2.71 2.96 3.34 3.93 4.79 5.70
Option 4
20 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 2.61 2.70 2.77 2.81 2.83 2.83
40 2.66 2.82 2.96 3.06 3.11 3.13
50 2.69 2.89 3.13 3.35 3.50 3.56
60 2.70 2.94 3.25 3.63 3.97 4.14
70 2.71 2.95 3.31 3.81 4.38 4.74
80 2.71 2.96 3.33 3.87 4.57 5.06
VARIABLE ANNUITY: A Certificate Owner may elect to have the Adjusted Certificate
Value applied to provide a Variable Annuity. Variable Annuity Payments reflect
the investment performance of the Variable Account in accordance with the
allocation of the Adjusted Certificate Value to the Funds during the Annuity
Period. The initial Variable Annuity Payment is guaranteed to be at least the
amount determined in accordance with the Annuity Tables contained in the
Certificate which are based on the 1983(a) Individual Mortality Table with
mortality improvement projected 30 years using Mortality Projection Scale G.
Variable Annuity Payments are not guaranteed as to dollar amount.
On the Income Date a fixed number of Annuity Units will be purchased as follows:
The first Annuity Payment is equal to the Adjusted Certificate Value, divided
first by $1000 and then multiplied by the appropriate Annuity Payment amount for
each $1000 of value for the Annuity Option selected, less any Certificate
Maintenance Charge due. In each Fund the fixed number of Annuity Units is
determined by dividing the amount of the initial Annuity Payment determined for
each Fund by the Annuity Unit value on the Income Date. Thereafter, the number
of Annuity Units in each Fund remains unchanged unless the Certificate Owner
elects to transfer between Funds. All calculations will appropriately reflect
the Annuity Payment frequency selected.
On each subsequent Annuity Payment date, the total Annuity Payment is the sum of
the Annuity Payments for each Fund less any Certificate Maintenance Charge due.
The Annuity Payment in each Fund is determined by multiplying the number of
Annuity Units then allocated to such Fund by the Annuity Unit value for that
Fund.
On each subsequent Valuation Date, the value of an Annuity Unit is determined in
the following way:
First: The Net Investment Factor is determined as described under "Variable
Account - Net Investment Factor" above.
Second: The value of an Annuity Unit for a Valuation Period is equal to:
a. the value of the Annuity Unit for the immediately preceding Valuation
Period;
b. multiplied by the Net Investment Factor for the current Valuation
Period;
c. divided by the Assumed Net Investment Factor (see below) for the
Valuation Period.
The Assumed Net Investment Factor is equal to one plus the Assumed Investment
Return which is used in determining the basis for the purchase of an Annuity,
adjusted to reflect the particular Valuation Period. The Assumed Investment
Return that we will use is 5%. However, we may agree with the Certificate Owner
to use a different value.
Guaranteed Initial Monthly Payment Per $1,000 of Proceeds
Variable Payouts Based on 5% AIR
Opt 2 Opt 2 Opt 2 Opt 2 Opt 2 Opt 2 Opt 2 Opt 2
5 Yr 5 Yr 10 Yr 10 Yr 15 Yr 15 Yr 20 Yr 20 Yr
Opt 1 Opt 1 Minim Minim Minim Minim Minim Minim Minim Minim Opt 5 Opt 5
Age* M F M F M F M F M F M F
______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
30 4.46 4.36 4.46 4.36 4.46 4.35 4.45 4.35 4.44 4.35 4.46 4.36
31 4.48 4.37 4.48 4.37 4.48 4.37 4.47 4.37 4.46 4.36 4.48 4.38
32 4.50 4.39 4.50 4.39 4.50 4.38 4.49 4.38 4.48 4.38 4.50 4.39
33 4.52 4.40 4.52 4.40 4.52 4.40 4.51 4.40 4.50 4.39 4.52 4.41
34 4.55 4.42 4.55 4.42 4.54 4.42 4.53 4.41 4.52 4.41 4.54 4.43
35 4.57 4.44 4.57 4.44 4.57 4.44 4.56 4.43 4.55 4.43 4.57 4.44
36 4.60 4.46 4.60 4.46 4.59 4.45 4.58 4.45 4.57 4.45 4.59 4.46
37 4.63 4.48 4.63 4.48 4.62 4.48 4.61 4.47 4.60 4.46 4.62 4.48
38 4.66 4.50 4.66 4.50 4.65 4.50 4.64 4.49 4.62 4.49 4.64 4.50
39 4.69 4.52 4.69 4.52 4.68 4.52 4.67 4.51 4.65 4.51 4.67 4.52
40 4.72 4.55 4.72 4.55 4.71 4.54 4.70 4.54 4.68 4.53 4.70 4.55
41 4.76 4.57 4.75 4.57 4.75 4.57 4.73 4.56 4.71 4.55 4.73 4.57
42 4.79 4.60 4.79 4.60 4.78 4.60 4.76 4.59 4.74 4.58 4.76 4.60
43 4.83 4.63 4.83 4.63 4.82 4.62 4.80 4.62 4.77 4.60 4.80 4.62
44 4.88 4.66 4.87 4.66 4.86 4.65 4.84 4.64 4.80 4.63 4.83 4.65
45 4.92 4.69 4.91 4.69 4.90 4.69 4.87 4.68 4.84 4.66 4.87 4.68
46 4.97 4.73 4.96 4.73 4.94 4.72 4.91 4.71 4.88 4.69 4.91 4.71
47 5.01 4.76 5.01 4.76 4.99 4.75 4.96 4.74 4.92 4.72 4.95 4.75
48 5.06 4.80 5.06 4.80 5.04 4.79 5.00 4.78 4.96 4.76 4.99 4.78
49 5.12 4.84 5.11 4.84 5.09 4.83 5.05 4.81 5.00 4.79 5.04 4.82
50 5.17 4.88 5.16 4.88 5.14 4.87 5.10 4.85 5.04 4.83 5.08 4.85
51 5.23 4.93 5.22 4.93 5.19 4.91 5.15 4.89 5.09 4.87 5.13 4.89
52 5.30 4.98 5.28 4.97 5.25 4.96 5.20 4.94 5.13 4.91 5.19 4.94
53 5.36 5.03 5.35 5.02 5.31 5.01 5.26 4.98 5.18 4.95 5.24 4.98
54 5.43 5.08 5.42 5.08 5.38 5.06 5.32 5.03 5.23 4.99 5.30 5.03
55 5.51 5.14 5.49 5.13 5.45 5.11 5.38 5.08 5.28 5.04 5.37 5.08
56 5.58 5.20 5.57 5.19 5.52 5.17 5.44 5.14 5.33 5.09 5.43 5.13
57 5.67 5.26 5.65 5.26 5.60 5.23 5.51 5.19 5.39 5.14 5.50 5.19
58 5.76 5.33 5.74 5.32 5.68 5.30 5.58 5.25 5.44 5.19 5.57 5.25
59 5.85 5.41 5.83 5.40 5.76 5.37 5.65 5.32 5.50 5.24 5.65 5.31
60 5.95 5.48 5.93 5.47 5.85 5.44 5.73 5.38 5.56 5.30 5.73 5.38
61 6.06 5.57 6.03 5.55 5.95 5.52 5.81 5.45 5.62 5.36 5.81 5.45
62 6.18 5.65 6.15 5.64 6.05 5.60 5.89 5.52 5.67 5.42 5.90 5.52
63 6.30 5.75 6.27 5.73 6.16 5.68 5.97 5.60 5.73 5.48 6.00 5.60
64 6.44 5.85 6.40 5.83 6.27 5.78 6.06 5.68 5.79 5.54 6.10 5.69
65 6.58 5.96 6.53 5.94 6.38 5.87 6.15 5.76 5.85 5.60 6.20 5.77
66 6.74 6.07 6.68 6.05 6.51 5.98 6.24 5.85 5.91 5.67 6.31 5.87
67 6.90 6.20 6.83 6.17 6.63 6.09 6.33 5.94 5.96 5.73 6.43 5.97
68 7.08 6.33 7.00 6.30 6.77 6.20 6.42 6.03 6.02 5.80 6.55 6.07
69 7.27 6.47 7.17 6.44 6.91 6.32 6.52 6.13 6.07 5.86 6.67 6.18
70 7.46 6.63 7.35 6.59 7.05 6.45 6.61 6.23 6.12 5.92 6.81 6.30
71 7.68 6.80 7.55 6.75 7.20 6.59 6.70 6.33 6.17 5.98 6.95 6.43
72 7.90 6.98 7.75 6.92 7.35 6.74 6.79 6.43 6.21 6.04 7.10 6.56
73 8.14 7.18 7.97 7.11 7.50 6.89 6.88 6.54 6.25 6.10 7.26 6.70
74 8.39 7.39 8.19 7.30 7.66 7.05 6.97 6.64 6.29 6.15 7.42 6.85
75 8.66 7.62 8.43 7.52 7.82 7.21 7.06 6.74 6.32 6.20 7.60 7.01
76 8.99 7.87 8.70 7.74 8.00 7.38 7.14 6.85 6.35 6.24 7.78 7.18
77 9.30 8.13 8.97 7.98 8.16 7.56 7.22 6.94 6.38 6.28 7.97 7.35
78 9.64 8.42 9.25 8.24 8.33 7.74 7.29 7.04 6.40 6.32 8.18 7.54
79 9.99 8.72 9.54 8.51 8.49 7.92 7.36 7.13 6.42 6.35 8.39 7.74
80 10.38 9.06 9.84 8.80 8.65 8.11 7.42 7.21 6.44 6.38 8.61 7.95
81 10.79 9.41 10.16 9.10 8.82 8.29 7.48 7.29 6.46 6.41 8.85 8.17
82 11.23 9.80 10.49 9.43 8.97 8.48 7.53 7.36 6.47 6.43 9.09 8.40
83 11.69 10.22 10.83 9.77 9.12 8.66 7.58 7.43 6.48 6.45 9.36 8.65
84 12.19 10.68 11.19 10.13 9.27 8.83 7.62 7.49 6.49 6.46 9.63 8.91
85 12.73 11.17 11.55 10.50 9.41 9.00 7.66 7.54 6.50 6.47 9.92 9.17
*Age equals age of annuitant nearest birthday when first payment is made
Guaranteed Initial Monthly Payment per $1,000 of Proceeds
Variable Payout Based on 5% AIR
Option 3
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 4.26 4.33 4.38 4.41 4.44 4.45
40 4.30 4.40 4.51 4.60 4.66 4.70
50 4.32 4.47 4.65 4.84 4.99 5.09
60 4.34 4.51 4.76 5.09 5.44 5.72
70 4.35 4.53 4.82 5.29 5.93 6.63
80 4.35 4.54 4.86 5.40 6.31 7.65
Option 4
5 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 4.26 4.33 4.38 4.41 4.44 4.45
40 4.30 4.40 4.51 4.60 4.66 4.70
50 4.32 4.47 4.65 4.84 4.99 5.09
60 4.34 4.51 4.76 5.09 5.44 5.72
70 4.35 4.53 4.82 5.29 5.93 6.62
80 4.35 4.54 4.86 5.40 6.31 7.63
Option 4
10 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 4.26 4.33 4.38 4.41 4.44 4.45
40 4.30 4.40 4.51 4.60 4.66 4.69
50 4.32 4.47 4.65 4.84 4.99 5.09
60 4.34 4.50 4.76 5.09 5.43 5.70
70 4.35 4.53 4.82 5.28 5.91 6.56
80 4.35 4.54 4.86 5.39 6.26 7.43
Option 4
15 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 4.26 4.33 4.38 4.41 4.44 4.45
40 4.30 4.40 4.51 4.60 4.66 4.69
50 4.32 4.47 4.65 4.83 4.98 5.07
60 4.34 4.50 4.75 5.08 5.42 5.64
70 4.35 4.53 4.82 5.27 5.86 6.37
80 4.35 4.54 4.84 5.36 6.13 6.96
Option 4
20 Years Minimum
Female Age 30 40 50 60 70 80
Male Age ________ ________ ________ ________ ________ ________
30 4.26 4.33 4.38 4.41 4.43 4.44
40 4.30 4.40 4.51 4.60 4.65 4.67
50 4.32 4.46 4.64 4.83 4.97 5.03
60 4.34 4.50 4.75 5.06 5.36 5.52
70 4.34 4.52 4.80 5.23 5.72 6.04
80 4.35 4.53 4.82 5.29 5.89 6.32
GENERAL PROVISIONS
THE CONTRACT: The entire contract consists of this Group Annuity Contract, the
Certificates issued under such Contract, and any attached applications,
endorsements or riders. This Group Annuity Contract may be changed or altered
only by our President or Secretary. Any change, modification or waiver must be
made in writing.
NON-PARTICIPATING IN SURPLUS: Neither this Contract or any Certificate share in
any distribution of our profits or surplus.
INCONTESTABILITY: We will not contest any Certificate from its Certificate Date.
MISSTATEMENT OF AGE OR SEX: We may require proof of Age of the Annuitant before
making any life contingent Annuity Payment provided for by a Certificate. If the
Age or sex of the Annuitant has been misstated the amount payable will be the
amount that the Certificate Value would have provided at the true Age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment, and overpayments will be deducted from the future
Annuity Payments until the total is repaid. The annual interest rate to be used
in the calculation of the adjustments for underpayments and overpayments is 5%.
CERTIFICATE SETTLEMENT: The Certificate must be returned to us upon any
settlement. Prior to any settlement as a death claim, due proof of death must be
submitted to us. Any paid-up annuity, cash surrender or death benefits that may
be available are not less than the minimum benefits required by any statute of
the state in which the Certificate is delivered.
REPORTS: We will furnish the Certificate Owner with a report showing the
Certificate Value at least once each calendar year. This report will be sent to
the Certificate Owner's last known address.
TAXES: Any taxes paid to any governmental entity will be charged against a
Certificate's Certificate Value. We will, in our sole discretion, determine when
taxes have resulted from: the investment experience of the Variable Account;
receipt by us of the Purchase Payment(s); or commencement of Annuity Payments.
We may, at our discretion, pay taxes when due and deduct that amount from the
Certificate Value at a later date. Payment at an earlier date does not waive any
right we may have to deduct amounts at a later date. We reserve the right to
establish a provision for federal income taxes if we determine, in our sole
discretion, that we will incur a tax as a result of the operation of the
Variable Account. We will deduct for any income taxes incurred by it as a result
of the operation of the Variable Account whether or not there was a provision
for taxes and whether or not it was sufficient. The Company will deduct any
withholding taxes required by applicable law.
EVIDENCE OF SURVIVAL: Where any benefits under a Certificate are contingent upon
the recipient being alive on a given date, we may require proof satisfactory to
us that the condition has been met.
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under a Certificate before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
MODIFICATION OF CONTRACT OR CERTIFICATE: This Contract may not be modified by us
without your consent except as may be required by applicable law. No Certificate
will be modified by us without such Certificate Owner's consent except as may be
required by applicable law.
