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Exhibit 4(a)
[WESTERN-SOUTHERN LIFE LOGO]
Western-Southern Life Assurance Company
Agrees to provide the benefits and rights set out on this and the pages
that follow which are a part of the Contract. They are provided as consideration
for the application and purchase payment(s) for the Contract.
The Contract, the attached application, and any amendments, riders or
endorsements make up the entire Contract. The Contract does not take effect
until the Contract Date and until we have received the initial purchase payment.
TEN DAY FREE LOOK. Please examine the Contract. If you are not
satisfied, you may cancel the Contract by returning it to us at our Variable
Annuity Service Center listed on page 3 within 10 days after you receive it. We
will refund the Contract Value computed at the end of the Valuation Period
during which the Contract was received, plus any premium tax deducted from the
purchase payment, within 7 days of our receipt of the Contract.
/s/ XXXXX X. XXXXX /s/ XXXX X. XXXXXXX
Secretary President and
Chief Executive Officer
This Annuity Contract is a legal contract between the Contract Owner and the
Company.
READ YOUR CONTRACT CAREFULLY
All values provided by this Contract, when based on the investment
experience of the Variable Account, are variable and are not guaranteed as to
fixed dollar amount. These values may increase or decrease to reflect the
investment experience of the Variable Account.
Issued by a Stock Company
Home Office: 000 Xxxxxxxx, Xxxxxxxxxx, Xxxx 00000
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
Income Payable at Income Date
Death Benefit Prior to Income Date
Non-Participating
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CONTENTS
DATA PAGE..................................................... 3
DEFINITIONS................................................... 4
ACCUMULATION PROVISIONS....................................... 4
Purchase Payments........................................ 4
Allocation of Purchase Payments.......................... 5
Fixed Account............................................ 5
Fixed Account Value................................. 5
Interest Credited................................... 5
Variable Account......................................... 5
Variable Account Value.............................. 5
Sub-Account......................................... 5
Accumulation Units.................................. 6
Net Investment Factor............................... 6
Transfers................................................ 7
CONTRACT CHARGES AND
DEDUCTIONS.................................................... 7
Contract Maintenance Charge.............................. 7
Mortality and Expense Risk Charge........................ 8
Contract Administration Charge........................... 8
Premium Tax Deductions................................... 8
Surrender Charge......................................... 8
SURRENDER AND WITHDRAWAL
PROVISIONS.................................................... 8
General Surrender Provisions............................. 8
Partial Withdrawals...................................... 8
Surrender................................................ 9
Surrender Charge......................................... 9
Free Withdrawal Amount................................... 9
Systematic Withdrawal Plan............................... 9
Reduction of Surrender Charge............................ 9
Delay in Payment......................................... 10
OWNERSHIP PROVISIONS.......................................... 10
Contract Owner........................................... 10
Joint Owner.............................................. 10
Contingent Owner......................................... 10
Beneficiary.............................................. 10
Assignment............................................... 10
DEATH PROVISIONS.............................................. 11
Death of Owner........................................... 11
Death of Annuitant....................................... 11
Death Benefit............................................ 11
Required Distributions................................... 11
Priority of Beneficiaries................................ 12
PAYOUT PROVISIONS............................................. 12
Income Date.............................................. 12
Payout Plans............................................. 12
Additional Interest...................................... 14
Choosing a Payout Plan................................... 14
Minimum Installment...................................... 15
Due Date................................................. 15
GENERAL PROVISIONS............................................ 15
Reports.................................................. 15
Statements In Application................................ 15
Modification Of Contract................................. 15
Incontestability......................................... 15
Incorrect Age Or Sex..................................... 15
Place Of Payment......................................... 15
Submission Of Contract................................... 15
Creditors' Claims........................................ 16
Proof Of Facts........................................... 16
Non-participating........................................ 16
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DATA PAGE
Owner Region Number
Xxxxxxxxx Xxxxxxxxx's
Birthdate
Contract Number Contract Date
Initial Purchase Income Date
Payment
Western-Southern Life Assurance Company
Special Markets Service Center
P.O. Box 2850
Cincinnati, Ohio 45201-2850
ALLOCATION OF INITIAL PURCHASE PAYMENT (percentages must be in whole numbers not
less than 5% and must total 100%):
VARIABLE ACCOUNT SUB-ACCOUNTS: FIXED ACCOUNT: 50%
Emerging Growth Sub-Account
International Equity Sub-Account
Growth & Income Sub-Account
Balanced Sub-Account 30%
Income Opportunity Sub-Account
Bond Sub-Account
Standby Reserves Sub-Account 20%
FIXED ACCOUNT INITIAL INTEREST RATE: (Effective Annual Rate) through
The interest rate credited to subsequent purchase payments allocated to
the Fixed Account will be the current rate in effect on the date the payment is
received. It will be guaranteed for one year from the date of receipt of payment
and will never be less than 3%.
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DEFINITIONS
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"The Company", "we", "our" and "us", is Western-Southern Life Assurance Company.
"Accumulation Unit" is an accounting unit of measure used to calculate the
Variable Account Value prior to the Income Date.
"Annuitant" is the natural person whose life is used to determine the duration
and amount of any annuity payments.
"Beneficiary" is the person, persons or entity to whom the death benefit will be
paid if the Annuitant dies before the Income Date.
"Contract Value" is the sum of the Variable Account Value and the Fixed Account
Value.
"Contract Year" is a year starting with the Contract Date indicated on page 3 or
with a Contract Anniversary. A "Contract Anniversary" is the same day and month
as the Contract Date in each subsequent year.
"Fixed Account" is an option under this Contract where purchase payments are
allocated to the general account of the Company at a guaranteed interest rate.
"Income Date" is the date annuity payments begin. The Income Date is shown on
page 3 and can be changed by written notice to us.
"Owner" is the person, persons or entity having all rights under this Contract
unless otherwise provided. If there are Joint Owners they own the Contract
equally with a right of survivorship. "Contingent Owner" is the person, persons
or entity who will own the Contract following the Owner's death (or the death of
both Joint Owners).
"Portfolio" is an investment portfolio of an open-end management investment
company registered under the Investment Company Act of 1940.
"Qualified Contracts" are Contracts purchased in connection with a plan that
qualifies for favorable tax treatment under Sections 401, 403(b) or 408 of the
Internal Revenue Code.
"Sub-Account" is a division of the Variable Account which invests in a
Portfolio. Purchase payments allocated to the Variable Account are further
allocated to one or more of these Sub-Accounts, as designated by the Owner.
"Surrender Value" is the Contract Value less any surrender charge and less the
Contract Maintenance Charge.
"Valuation Date" is each day on which valuation of the Variable Account
Sub-Accounts is required by applicable law, including every day that the New
York Stock Exchange is open.
"Valuation Period" is the period of time beginning at the close of a Valuation
Date and ending at the close of the next succeeding Valuation Date.
"Variable Account" is an option under this Contract where purchase payments are
allocated to a separate investment account of the Company.
"You" and "your" refer to the Owner or Owners if there are Joint Owners.
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ACCUMULATION PROVISIONS
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PURCHASE PAYMENTS
The initial purchase payment may not be less than $2,000. For Qualified
Contracts, the minimum initial purchase payment is $1,000. However,
monthly purchase payments of not less than $50 will be permitted if
payments are made under an automatic or scheduled installment plan. If
no purchase payments have been received for 2 full years, and both
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(a) the total purchase payments less any partial withdrawals, and (b)
the Contract Value, are less than $2,000, the Company will, after 14
days written notice to you, terminate this Contract and pay you the
Surrender Value.
Subsequent purchase payments must be at least $100 (at least $50 if
made under an automatic or scheduled installment plan), and may be made
at any time.
The total of all purchase payments under this Contract may not exceed
$500,000 without prior approval of the Company.
ALLOCATION OF PURCHASE PAYMENTS
You elect to have purchase payments allocated to the Fixed Account
and/or one or more Sub-Accounts of the Variable Account. Each
allocation must be in whole percentages of at least 5%. The sum of the
allocation percentages must equal 100%.
The allocation of the initial purchase payment is set forth on page 3.
Additional purchase payments will be allocated in the same manner as
your initial purchase payment unless changed by written request. All
purchase payments received after a change in allocation will be
invested in the same manner as your most recent allocation unless you
instruct otherwise in writing.
FIXED ACCOUNT
The Fixed Account is an option under this Contract where purchase
payments are allocated to the general account of the Company at a
guaranteed interest rate.
FIXED ACCOUNT VALUE
The Fixed Account Value is equal to:
o The sum of all purchase payments allocated to the Fixed Account;
plus
o Any Variable Account Value transferred to the Fixed Account; plus
o Interest credited to the Fixed Account; less
o Any amounts transferred from the Fixed Account to the Variable
Account; less
o Any amounts withdrawn for charges, deductions or surrenders.
INTEREST CREDITED
The Company will credit interest to each purchase payment allocated to
the Fixed Account at the interest rate in effect when such purchase
payment was received. That interest rate will be guaranteed for one
year from the date of receipt. At the end of that year and at the end
of each successive one year period, the Company will declare a new
interest rate applicable for that purchase payment which will be
guaranteed for the following year. The effective annual interest rate
will never be less than 3%.
The Company will credit interest on amounts transferred to the Fixed
Account from the Variable Account in the manner stated above as of the
date of transfer.
VARIABLE ACCOUNT
The Variable Account is an option under this Contract where purchase
payments are allocated to a separate investment account of the Company.
Assets of the Variable Account are the property of the Company and will
be used to provide values and benefits under this Contract and similar
contracts. The Variable Account may not be charged with liabilities
arising out of any other business the Company may conduct.
VARIABLE ACCOUNT VALUE
The Variable Account Value is equal to the current value of all
Accumulation Units in Sub-Accounts to which Contract Value is
allocated.
SUB-ACCOUNT
The Variable Account is divided into Sub-Accounts, each of which
invests in a Portfolio. Purchase payments are allocated to one or more
of these Sub-Accounts as designated by you.
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The Company may from time to time make additional Sub-Accounts
available. These Sub-Accounts will invest in investment portfolios that
the Company deems suitable for the Contracts. The Company also has the
right to eliminate Sub-Accounts from the Variable Account, to combine
two or more Sub-Accounts, or to substitute a new Portfolio or similar
investment option for the Portfolio in which a Sub-Account invests. A
substitution may become necessary if, in the Company's judgment, the
Portfolio or other investment option no longer suits the purposes of
the Contracts. This may happen due to unsatisfactory investment
performance, a change in laws or regulations, a change in a Portfolio's
investment objectives or restrictions, because the Portfolio is no
longer available for investments, or for some other reason. The Company
will obtain prior approval from the SEC to the extent required and any
other required approvals before making such a change or substitution.
ACCUMULATION UNITS
The Company will use amounts allocated or transferred to a Sub-Account
to buy Accumulation Units. The number of Accumulation Units is
determined by dividing the amount allocated or transferred to the
Sub-Account by the Accumulation Unit Value for the Sub-Account for the
Valuation Period during which the purchase payment was received or the
transfer was made.
The Accumulation Unit Value for each Sub-Account was arbitrarily set at
$10 when the first Portfolio interest was purchased by the Sub-Account.
The Accumulation Unit Value for any subsequent Valuation Period is
equal to:
o The Accumulation Unit Value for the Sub-Account for the immediately
preceding Valuation Period; multiplied by
o The Net Investment Factor for the Sub-Account for such subsequent
Valuation Period.
NET INVESTMENT FACTOR
The Net Investment Factor is an index applied to measure the investment
performance of a Sub-Account from one Valuation Period to the next. The
Net Investment Factor may be greater or less than one; therefore, the
Accumulation Unit Value may increase or decrease.
For all Sub-Accounts (except the Growth & Income Sub-Account and the
Bond Sub-Account), the Net Investment Factor for each Sub-Account for
any Valuation Period is determined by dividing (a) by (b) and
subtracting (c) from the result, where
(a) is:
(1) the net asset value per share of the corresponding Portfolio
at the end of the current Valuation Period, plus
(2) the per share amount of a dividend or capital gain
distribution made by the Portfolio on shares held in the
Sub-Account if the "ex-dividend" date occurs during the
current Valuation Period, plus or minus
(3) a per share charge or credit for any taxes reserved, which is
determined by the Company to have resulted from the investment
operations of the Sub-Account during the current Valuation
Period; and
(b) is:
(1) the net asset value per share of the corresponding Portfolio
at the end of the immediately preceding Valuation Period, plus
or minus
(2) a per share charge or credit for any taxes reserved for the
immediately preceding Valuation Period; and
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(c) is:
a factor representing the charges deducted from the
Sub-Account on a daily basis for the daily portion of the
annual Mortality and Expense Risk Charge (1.20%) and the
annual Contract Administration Charge (0.15%).
For the Growth & Income Sub-Account and the Bond Sub-Account, the Net
Investment Factor for any Valuation Period is equal to one plus the net
result of (a) divided by (b) where:
(a) is the accrued gain or loss in the corresponding Sub-Account
for the Valuation Period, including investment income, capital
gains and losses, adjusted by:
(1) a charge to the Sub-Account on a daily basis representing
the portion of the annual Mortality and Expense Risk
Charge (1.20%) and the annual Contract Administration
Charge (0.15%) that is allocable to the Sub-Account for
the Valuation Period, and
(2) a charge or credit to the Sub-Account for any tax charge
or tax credit determined by the Company to have resulted
from the investment operations of the Sub-Account during
the Valuation Period; and
(b) is the value of the Sub-Account as of the close of the
immediately preceding Valuation Period.
TRANSFERS
You may transfer all or a portion of the Contract Value among the
Sub-Accounts and the Fixed Account. A transfer request must be in
writing unless telephone transfer authorization has been received and
approved by the Company. Transfers must be in amounts not less than
$250 and may be made:
o among Sub-Accounts once every thirty days;
o from one or more Sub-Accounts to the Fixed Account once per
Contract Year; and
o from the Fixed Account to one or more Sub-Accounts once per
Contract Year, restricted to a maximum of 25% of the Fixed Account
Value.
When transferring Contract Value to more than one Sub-Account, not less
than 5% of the total amount being transferred can be directed to each
such Sub-Account.
We may at any time revoke or modify the transfer provisions. Any change
will be confirmed in writing to you.
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CONTRACT CHARGES AND DEDUCTIONS
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The following contract charges may be imposed and are designed to
reimburse the Company for expenses incurred that relate to the
Contract. The Company guarantees that these charges will not increase,
with the exception of the premium tax deduction.
CONTRACT MAINTENANCE CHARGE
On each Contract Anniversary prior to the Income Date we will deduct a
Contract Maintenance Charge. The charge will also be deducted on any
date that is not a Contract Anniversary on which you fully surrender
the Contract or on the Income Date. The Contract Maintenance Charge for
the first 10 Contract Years is $35. After the 10th Contract
Anniversary, the Contract Maintenance Charge is the lesser of (a) $35,
and (b) .17% of the Contract Value.
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MORTALITY AND EXPENSE RISK CHARGE
On each Valuation Date we will deduct from the Accumulation Unit Value
a Mortality and Expense Risk Charge equal to a percentage of such value
that is the daily equivalent of an effective annual rate of 1.20%. The
Company assumes a "mortality risk" from our promise to pay a death
benefit prior to the Income Date and from our obligation to make
annuity payments to each annuitant regardless of how long he or she
lives. For assuming this risk, we deduct a charge equal to an annual
rate of .80% of the assets in the Sub-Account. The Company assumes an
"expense risk" from the possibility that amounts deducted for
administrative expenses may be insufficient to cover the actual costs.
For assuming this risk, we deduct a charge at an annual rate of .40% of
the assets in the Sub-Account.
CONTRACT ADMINISTRATION CHARGE
On each Valuation Date we will deduct from the Accumulation Unit Value
a Contract Administration Charge equal to a percentage of such value
that is the daily equivalent of an effective annual rate of .15%.
PREMIUM TAX DEDUCTIONS
The Company will deduct the amount of any premium taxes levied by a
state or any other governmental entity. The Company currently deducts
the applicable amount of premium taxes from the Contract Value on the
Income Date except in those states which require such taxes to be paid
when purchase payments are made. In those states, the Company deducts
the applicable amount of premium taxes upon receipt of a purchase
payment.
SURRENDER CHARGE
At the time of a surrender or withdrawal from the Contract Value and on
the Income Date the Company may deduct a percentage of the amount
surrendered or withdrawn as a surrender charge. See Surrender and
Withdrawal Provisions below.
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SURRENDER AND WITHDRAWAL PROVISIONS
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GENERAL SURRENDER PROVISIONS
The Owner may withdraw part or surrender all of the Contract Value at
any time this Contract is in force and prior to the earlier of the
Income Date and the Annuitant's death, subject to the conditions set
forth below. The withdrawal or surrender will be effective on the
Valuation Date on or next following the date we receive your request at
our Variable Annuity Service Center. The Company is not responsible for
the tax consequences of any withdrawals or surrender.
PARTIAL WITHDRAWALS
You may request in writing to withdraw part of the Contract Value in
amounts not less than $250. Your request must be received before the
Income Date. If the Contract Value is reduced to below $2,000 by a
partial withdrawal, the Company reserves the right to pay the total
Surrender Value to you in a lump sum. Such payment will terminate this
Contract and all obligations under this Contract. The amount withdrawn
from the Contract Value will include any applicable surrender charge.
The Company will process the withdrawals, unless instructed otherwise,
by liquidating, on a prorata basis, Accumulation Units from all
Sub-Accounts in which Contract Value is allocated and value from the
Fixed Account.
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SURRENDER
The Surrender Value is the amount that will be paid if the full
Contract Value is surrendered. When written request for surrender and
the Contract are received, the Company will pay:
o the Contract Value on the date the surrender is effective; less
o any surrender charge which applies; less
o any Contract Maintenance Charge which applies.
SURRENDER CHARGE
If part or all of the Contract Value is withdrawn or surrendered or if
annuity payments begin within the first seven Contract Years, a
surrender charge will be deducted except as described below. The
surrender charge is assessed on each purchase payment and is based upon
the number of years since the purchase payment was received. For the
purpose of calculating any surrender charge, purchase payments will be
deemed to be withdrawn first and in the order they were received before
any amounts in excess of purchase payments are withdrawn from the
Contract Value. (Note - for tax purposes, withdrawals may be treated
differently.)
The applicable surrender charge percentages are: 7% in the first year
following receipt of each purchase payment, 7% in year 2, 6% in year 3,
5% in year 4, 4% in year 5, 2% in year 6, 1% in year 7 and 0%
thereafter. The surrender charge will be waived upon the death of the
Annuitant or, if at least two years after the Contract Date, payments
begin under one of the plans allowed in the Payout Provisions. Such a
plan must have payments which will be made for at least five years.
In any event, the surrender charge will be no more than 7% of the
lesser of: (1) the total of all purchase payments made within 84 months
prior to the date of request for surrender or withdrawal; or (2) the
amount surrendered or withdrawn.
FREE WITHDRAWAL AMOUNT
You may withdraw, without a surrender charge, an amount equal to 10% of
all purchase payments not already withdrawn which were made more than
one year and less than seven years prior to the date of surrender or
withdrawal. This free withdrawal privilege is non-cumulative and
available each Contract Year for eligible purchase payments not already
withdrawn. Free withdrawal amounts are deemed to be withdrawn on a
first-in, first-out basis.
SYSTEMATIC WITHDRAWAL PLAN
You may elect in writing on a form provided by the Company to take
systematic withdrawals by withdrawing a specified dollar amount of at
least $100 on a monthly, quarterly, semi-annual, or annual basis. The
Company will process the withdrawals by liquidating, on a pro rata
basis, Accumulation Units from all Sub-Accounts in which Contract Value
is allocated and value from the Fixed Account. A surrender charge may
apply to systematic withdrawals. However, for the purpose of
calculating any such surrender charge, purchase payments will be deemed
to be withdrawn last and after any amounts in excess of purchase
payments are withdrawn from the Contract Value. You may discontinue
systematic withdrawals at any time by notifying the Company in writing.
The Company reserves the right to discontinue offering systematic
withdrawals upon 30 days' written notice to you; however, any such
discontinuation would not affect a systematic withdrawal plan already
commenced. The Company also reserves the right to assess a processing
fee for this plan.
REDUCTION OF SURRENDER CHARGE
The surrender charge may be reduced or eliminated for annuity contracts
sold to a trustee, employer or similar entity pursuant to a retirement
plan or otherwise when contracts are
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sold to a group of individuals such that the Company saves sales
expenses. The decision to reduce or eliminate the surrender charge will
be made exclusively by the Company.
DELAY IN PAYMENT
Payment of a surrender or withdrawal from the Variable Account will be
made within seven days. The Company has the right to suspend or delay
calculation or payment of any surrender or withdrawal from the Variable
Account for any of the following reasons:
1. The New York Stock Exchange is closed other than for customary
weekend and holiday closings; or
2. Trading on the New York Stock Exchange is restricted; or
3. An emergency exists as a result of which disposal of the securities
is not reasonably practicable or it is not reasonably practicable
to fairly determine the value of the net assets of the Variable
Account; or
4. The Securities and Exchange Commission, by order, permits
postponement of payments for the protection of security holders; or
5. The request for surrender or withdrawal is not made in writing.
Rules and regulations of the Securities and Exchange Commission will
govern as to whether the conditions set forth in numbers 2 and 3 above
exist.
The Company further reserves the right to delay withdrawal of the Fixed
Account Value for up to six months in those states where applicable law
requires the Company to reserve such right.
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OWNERSHIP PROVISIONS
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CONTRACT OWNER
The Annuitant is the Owner of the Contract unless some other person(s)
is(are) named as Owner on page 3. The Owner has all rights under the
Contract unless otherwise provided.
JOINT OWNER
The Contract may be owned by two persons as Joint Owners. In this case,
both Joint Owners must consent to any withdrawals, surrenders or
changes to the Contract or beneficiary.
CONTINGENT OWNER
If you are the Owner but are not the Annuitant, you may name a
Contingent Owner to take over as Owner upon your death. The naming of a
Contingent Owner will not take effect until we record it at the Home
Office. We are not responsible for the tax consequences resulting from
the change of the Owner.
BENEFICIARY
You may designate a beneficiary and change any designated beneficiary
any time during the lifetime of the Annuitant by written notice
satisfactory to us. The change will take effect on the date the notice
is signed. A change will not apply to any payment we make or any other
action we take before the notice is received and recorded by us at our
Home Office.
ASSIGNMENT
You may assign the Contract in writing. The assignment will not bind us
until our Home Office records show that we have received a copy. Your
rights and those of any beneficiary or Contingent Owner will be subject
to the assignment. We are not responsible for the validity or tax
consequences of the assignment.
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DEATH PROVISIONS
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DEATH OF OWNER
If the Contract is owned by Joint Owners and one of them dies, the
surviving Owner will become the sole Owner. If the Contract is owned by
one person and a Contingent Owner has been named, the Contingent Owner
will become the Owner if the sole Owner dies. If there is no Joint
Owner or Contingent Owner at the time of the Owner's death, the estate
of the Owner becomes Owner.
If an Owner who is not also the Annuitant dies before the Annuitant and
before the Income Date, the Surrender Value must be paid to the new
Owner (or surviving Joint Owner) within 5 years of the deceased Owner's
death. Alternatively, the new Owner (or surviving Joint Owner) may
elect to receive periodic payments to begin within one year of the
deceased Owner's death in the form of a life annuity or an annuity for
a period certain not exceeding the new Owner's (or surviving Joint
Owner's) life expectancy. (If the Annuitant dies prior to payment of
the Surrender Value or commencement of periodic payments, no death
benefit shall be payable.) In addition, if the new Owner (or surviving
Joint Owner) is the surviving spouse of the deceased Owner, then the
Contract may continue in the name of the surviving spouse who may
exercise all rights of ownership under the Contract.
If an Owner or Joint Owner who is the Annuitant dies before the Income
Date, the Death of Annuitant provision shall apply.
If an Owner dies on or after the Income Date, any payments that remain
to be made must be made at least as rapidly as under the payout plan in
effect on the date of the Owner's death.
DEATH OF ANNUITANT
If the Annuitant dies before the Income Date, the beneficiary will be
paid a death benefit. The death benefit will be paid to the beneficiary
either in one sum or in the form of an annuity if the beneficiary
should so elect within 60 days of the Annuitant's death. However, if
the Annuitant is the Owner and the surviving spouse is the sole
beneficiary, then the spouse may elect to continue the Contract and
become the new Owner and Annuitant.
DEATH BENEFIT
If the Annuitant dies during the first seven Contract Years and prior
to the first day of the calendar month after his or her 80th birthday,
the death benefit will equal the greater of (1) the Contract Value on
the date both due proof of death and death benefit payout instructions
are received by the Company; and (2) the sum of all purchase payments
less any amounts previously withdrawn. If the Annuitant dies on or
after the seventh Contract Anniversary and prior to the first day of
the calendar month after his or her 80th birthday, the death benefit
will equal the greatest of (1) the Contract Value on the date both due
proof of death and death benefit payout instructions are received by
the Company; (2) the sum of all purchase payments less any amounts
previously withdrawn; and (3) the Contract Value on the most recent
septennial Contract Anniversary plus any purchase payments made since
that Contract Anniversary and less any amounts withdrawn since that
Contract Anniversary. If the Annuitant dies on or after the first day
of the calendar month after his or her 80th birthday, the death benefit
will equal the Contract Value on the date both due proof of death and
death benefit payout instructions are received by the Company.
REQUIRED DISTRIBUTIONS
An Owner or beneficiary who is required to surrender this Contract
within a specified time or begin to receive payments in the form of a
life annuity or annuity for a period certain
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not exceeding the recipient's life expectancy may choose a Payout Plan
in the Payout Provisions of the Contract that meets those requirements.
PRIORITY OF BENEFICIARIES
You may designate the beneficiaries as primary or contingent to
indicate the order in which they will receive any death benefit
payable. If you name two or more beneficiaries of the same class, they
will share equally unless you state how they are to share. If you
identify a beneficiary as a relative, we will interpret that to mean a
relative of the Annuitant unless you state that the relationship is to
another person.
Any death benefit will be paid to the primary beneficiaries who are
living when payment is due. If there are no living primary
beneficiaries, payment will be made to the contingent beneficiaries who
are living when payment is due. If all beneficiaries have predeceased
the Annuitant, the death benefit will be paid to the Owner if different
than the Annuitant and, if not, to the Annuitant's estate.
Any beneficiary who dies within 10 days after the Annuitant's death
will not be entitled to any benefits payable on such a death unless
that beneficiary is living when we receive due proof of the Annuitant's
death.
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PAYOUT PROVISIONS
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INCOME DATE
We will start annuity payments on the Income Date shown on page 3
unless you request a change in the Income Date. The Income Date is the
Contract Anniversary on or following the Annuitant's 80th birthday or
the 10th Contract Anniversary, if later, unless otherwise indicated on
page 3. The Income Date can be changed by written notice to us. Your
written request must be received by us at least 31 days prior to the
existing Income Date. Upon receipt of your request, the Income Date
will be the date you select.
Annuity payments will be paid to the Annuitant unless you designate
another payee. You may change the payee at any time by written notice
to us. Such notice must be received at our Home Office at least 31 days
prior to a payment due date for the change to be effective on such
date. An executor, administrator, trustee, corporation, partnership or
association other than the Owner may not be a payee without our
approval. A payee designation is automatically revoked by the death of
the designated payee.
PAYOUT PLANS
You may apply the Surrender Value, less any applicable premium tax,
under any of the following payout plans. You may also request
quarterly, semiannual, or annual payments in place of monthly payments,
or, with our approval, choose another plan that is not listed below.
1) Installment Income Plans
A) Fixed Period - Paid in equal monthly payments for the
number of years you select (1-30). The payments for each
$1,000 applied will not be less than those shown in the Fixed
Period Table.
B) Fixed Amount - Paid in equal monthly payments of $5 or more
for each $1,000 applied until the full amount with compound
interest at not less than 3% a year is used up.
2) Life Income Plans
A) One Life - Paid in equal monthly payments during the lifetime
of a designated person. We will guarantee payments for either
10 years or 20 years and for as long as that person lives.
Payments for each $1,000 applied will not be less than those
shown in the One Life Table. The amount paid is based on the
person's sex and age on the date of the first payment.
Payments may not be commuted.
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B) Joint and Survivor - Paid in equal monthly payments during the
lifetimes of two designated persons. Payments will continue as
long as either person is living. The amount of each payment is
based on both persons' sex and age on the date of the first
payment. If either one dies before the due date of the first
payment, we will make payments during the survivor's lifetime
under Life Income Plan A with payments guaranteed for 10
years. Payments may not be commuted.
If you do not elect a payout plan by the Income Date, we will apply the
Surrender Value, less any applicable premium tax, on the Income Date
under Life Income Plan A with monthly payments guaranteed for 10 years.
When a payee dies, any remaining payments will be paid to the Owner
unless the Owner names another payee.
FIXED PERIOD MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
--------------------------------------------------------------------------------
Number Monthly Number Monthly Number Monthly
of Install- of Install- of Install-
Years ments Years ments Years ments
--------------------------------------------------------------------------------
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
*Values are based on compound interest at 3% a year.
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ONE LIFE MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
======================================================================================
Age of Life Life Age of Life Life
Payee 10 Years 20 years Payee 10 Years 20 Years
Last Certain Certain Last Certain Certain
Birth- --------------------------------- Birth- -----------------------------------
day Male Female Male Female day Male Female Male Female
--------------------------------------------------------------------------------------
15 and
under $2.84 $2.77 $2.84 $2.76 50 $4.04 $3.71 $3.92 $3.66
16 2.86 2.78 2.85 2.78 51 4.11 3.77 3.98 3.71
17 2.87 2.79 2.87 2.79 52 4.18 3.83 4.04 3.76
18 2.89 2.80 2.88 2.80 53 4.26 3.89 4.10 3.82
19 2.90 2.82 2.90 2.81 54 4.35 3.96 4.16 3.87
20 2.92 2.83 2.91 2.83 55 4.43 4.03 4.23 3.93
21 2.94 2.84 2.93 2.84 56 4.53 4.10 4.29 4.00
22 2.96 2.86 2.95 2.85 57 4.62 4.18 4.36 4.06
23 2.97 2.87 2.97 2.87 58 4.73 4.27 4.43 4.13
24 2.99 2.89 2.99 2.88 59 4.83 4.36 4.50 4.20
25 3.02 2.90 3.01 2.90 60 4.95 4.45 4.57 4.27
26 3.04 2.92 3.03 2.92 61 5.07 4.55 4.64 4.34
27 3.06 2.94 3.05 2.94 62 5.20 4.66 4.71 4.42
28 3.08 2.96 3.07 2.95 63 5.33 4.77 4.78 4.49
29 3.11 2.98 3.10 2.97 64 5.47 4.89 4.84 4.57
30 3.14 3.00 3.12 2.99 65 5.62 5.01 4.91 4.64
31 3.16 3.02 3.15 3.01 66 5.77 5.15 4.97 4.72
32 3.19 3.04 3.18 3.04 67 5.93 5.29 5.04 4.80
33 3.22 3.07 3.21 3.06 68 6.09 5.44 5.09 4.87
34 3.26 3.09 3.24 3.08 69 6.26 5.59 5.15 4.94
35 3.29 3.12 3.27 3.11 70 6.43 5.76 5.20 5.01
36 3.32 3.15 3.30 3.13 71 6.61 5.93 5.24 5.08
37 3.36 3.17 3.33 3.16 72 6.79 6.11 5.29 5.14
38 3.40 3.20 3.37 3.19 73 6.97 6.30 5.32 5.20
39 3.44 3.24 3.41 3.22 74 7.16 6.50 5.36 5.25
40 3.48 3.27 3.45 3.25 75 7.34 6.70 5.39 5.30
41 3.53 3.30 3.49 3.29 76 7.53 6.91 5.41 5.34
42 3.58 3.34 3.53 3.32 77 7.71 7.12 5.43 5.37
43 3.63 3.38 3.57 3.36 78 7.89 7.33 5.45 5.40
44 3.68 3.42 3.62 3.39 79 8.06 7.54 5.47 5.43
45 3.73 3.46 3.66 3.43 80 8.23 7.75 5.48 5.45
46 3.79 3.51 3.71 3.47 81 8.39 7.95 5.49 5.47
47 3.85 3.55 3.76 3.52 82 8.53 8.15 5.50 5.48
48 3.91 3.60 3.81 3.56 83 8.67 8.33 5.50 5.49
49 3.97 3.65 3.87 3.61 84 8.80 8.50 5.51 5.50
85 and 8.92 8.66 5.51 5.50
over
======================================================================================
*Values are based on the "1983 Table a" adjusted for age
last birthday, with compound interest at 3% a year.
ADDITIONAL INTEREST
We guarantee interest under all Installment Income and Life Income
Plans at a minimum rate of 3% per year. We may increase the interest
rate above the minimum on these plans. Monthly payments under these
plans will be based on the interest rate in effect on the due date of
the first payment.
CHOOSING A PAYOUT PLAN
You may choose or change a payout plan any time before the Income Date.
The choice or later change of a payout plan must be in writing and in
satisfactory form to us. If you make the request, it must be received
before the Income Date. The minimum amount which may be applied under a
payout plan is $1,000. Any choice involving more than one payout plan
must have our approval.
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MINIMUM INSTALLMENT
Each payment must be at least $50. We may change the number of payments
we make in a year so that each payment is at least $50. If the amount
to be applied is less than $1,000 or an annual payment would be less
than $50, the payout plan will not take effect or will terminate.
DUE DATE
The first payment under a payout plan chosen by the beneficiary will be
due on the date the plan is selected. The first payment under a payout
plan chosen by you for the beneficiary will be due on the date of the
Annuitant's death. The first payment under a payout plan chosen by you
upon withdrawal of the Surrender Value will be due when the request to
withdraw is received.
================================================================================
GENERAL PROVISIONS
================================================================================
REPORTS
At least once each Contract Year prior to the Income Date, we will mail
a report to you at your last address known to us. This report shall
include a statement of the Fixed Account Value and the Variable Account
Value. The information in this report shall be as of the date not more
than 4 months prior to the date the report is mailed. We will also send
you confirmations of transactions under the Contract, such as purchase
payments, transfers and withdrawals and, at least semi-annually, a
report of the investments held in the Sub-Accounts and any other
information required by applicable law or regulation.
STATEMENTS IN APPLICATION
All statements made in the application are considered to be
representations and not warranties. No statement will be used in
defense of a claim unless it is in the application.
MODIFICATION OF CONTRACT
Any change in the Contract or waiver of its provisions must be in
writing and signed by our Chairman, President or Secretary. No other
person can change or waive any of its provisions.
INCONTESTABILITY
The Contract will be incontestable after it has been in force during
the Annuitant's lifetime for two years from the Contract Date.
INCORRECT AGE OR SEX
If the age or sex of the Annuitant has been misstated, we will adjust
all benefits to those that the purchase payment(s) for the Contract
would have purchased for the correct age and sex. Any overpayments we
make will be charged with compound interest against subsequent
payments. Any amounts we owe as a result of underpayments will be paid
with compound interest upon receipt of notice of the underpayment. The
rate will be the rate we used to determine the number or amount of the
payments.
PLACE OF PAYMENT
We will make all payments due under the contract at our Home Office.
SUBMISSION OF CONTRACT
We may ask you to relinquish the Contract or send it to us for
endorsement before we make any payment. Failure to have you relinguish
the Contract or to note payment on it does not indicate that we have
not made payment.
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CREDITORS' CLAIMS
All payments under the Contract will be exempt from the claims of
creditors and legal process to the extent permitted by law. No payment
will be transferred, assigned or withdrawn before it becomes payable
unless we agree.
PROOF OF FACTS
We may ask any person claiming the right to payments for proof
satisfactory to us of such person's right to payment. Any payment we
make relying on that proof discharges us from any obligation to make
that payment to another person. We will require proof of date of birth
of the person(s) on whose life (or lives) payments are based.
NON-PARTICIPATING
This contract does not participate in surplus earnings of the Company.
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Western-Southern Life Assurance Company
Cincinnati, Ohio
Issued by a Stock Company
Home Office: 000 Xxxxxxxx, Xxxxxxxxxx, Xxxx 00000
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
Income Payable at Income Date
Death Benefit Prior to Income Date
Non-Participating
