Valley Forge Life Insurance Company
A Stock Company
Administrative Office: Home Office:
000 XXX Xxxxx 000 Xxxx Xx.
Xxxxxxxxx, Xxxxxxxxx 00000 Xxxxxxx, Xxxxxxxxxxxx 00000
We agree to pay the benefits described in this contract in accordance with its
provisions.
PLEASE READ THIS CONTRACT CAREFULLY. THIS IS A LEGAL CONTRACT BETWEEN YOU AND
VALLEY FORGE LIFE INSURANCE COMPANY.
NOTICE OF FREE LOOK PERIOD
If, for any reason, you are not satisfied with this contract, you may return it
to us for cancellation within 10 days of the day you receive it by delivering or
mailing it to us at our Administrative Office or to the agent from whom it was
purchased. This contract will be void as of the date we receive it and we will
promptly return the contract value.
Signed for the Company at its Executive Office, CNA Plaza, Chicago, Illinois
60685.
Chief Executive Officer Group Vice President
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Annuity payments and other values provided by this contract, when based on the
investment performance of the Variable Account, may increase or decrease daily
as a function of the investment performance of the subaccounts you select and
are not guaranteed as to dollar amount. No minimum contract value is guaranteed.
--------------------------------------------------------------------------------
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Non-Participating
CONTRACT DATA PAGE
OWNER: [XXXX XXX] AGE AT ISSUE: [35]
JOINT OWNER: [XXXX XXX] AGE AT ISSUE: [32]
ANNUITANT: [XXXX XXX] AGE AT ISSUE: [35]
CONTRACT NUMBER: [12345] CONTRACT DATE: [July 1, 2001]
PLAN TYPE: [Non-Qualified] ANNUITY DATE: [July 1, 2034]
ADMINISTRATIVE OFFICE: [Valley Forge Life Insurance Company, Attn:Variable Team
000 XXX Xxxxx, Xxxxxxxxx, XX 00000]
[0-000-000-0000]
PURCHASE PAYMENTS:
Initial Purchase Payment: [$15,000]
Minimum Subsequent Purchase Payment: [$1,000]
Maximum Total Purchase Payments: [$1,000,000 without approval]
BENEFICIARY:
[As designated by the owner on the contract date unless changed in
accordance with the contract provisions.]
CONTRACT MAINTENANCE CHARGE:
The contract maintenance charge is currently [$0.00] each contract year. We
reserve the right to change the contract maintenance charge and will provide
notice of the change. The maximum contract maintenance charge is $50.00 per
contract year. The contract maintenance charge will be deducted from the
contract value on each contract anniversary while this contract is in force. If
during the accumulation period, your contract value on a contract anniversary is
at least [$50,000] then no contract maintenance charge is deducted. If a total
withdrawal is made on other than a contract anniversary and your contract value
for the business day when the total withdrawal is made is less than [$50,000],
the full contract maintenance charge will be deducted at the time of total
withdrawal. The contract maintenance charge will be deducted from the
subaccounts and any fixed account selected in the same proportion that the
amount of contract value in each subaccount and/or any fixed account bears to
the total contract value. During the annuity period, the contract maintenance
charge will be collected pro rata from each annuity payment. If the owner is not
a natural person, we will look to the annuitant in determining the above.
PRODUCT EXPENSE CHARGE:
Equal on an annual basis to [.50%] of the average daily net asset value
of the Variable Account.
[TAX CHARGES:
We reserve the right to deduct from purchase payments or from the
Variable Account any federal, state or municipal taxes that may be
attributable to this contract.]
FIXED ACCOUNT OPTIONS:
[Fixed Account I:
---------------
Minimum Guaranteed Interest Rate: [3.00%]
Current Interest Rate as of Contract Date: [x%.] [The current
interest rates applies only to purchase payments allocated or
transferred to Fixed Account I during the calendar month in
which this contract is issued. This rate is guaranteed for one
contract year.]
INVESTMENT OPTIONS:
[Rydex Nova Fund]
[Federated Prime Money Fund II] [Rydex Ursa Fund]
[Federated High Income Bond Fund II] [Rydex OTC Fund]
[Federated Utility Fund II] [Rydex Arktos Fund]
[Rydex U.S. Government Bond Fund]
[Rydex Medius Fund]
[Fidelity VIP Equity-Income Portfolio] [Rydex Mekros Fund]
[Rydex Large-Cap Europe Fund]
[Xxxxx American MidCap Growth Portfolio] [Rydex Large-Cap Japan Fund]
[Xxxxx American Growth Portfolio] [Rydex Titan 500 Fund]
[Xxxxx American Leveraged AllCap Portfolio] [Rydex Tempest 500 Fund]
[Rydex Velocity 100 Fund]
[MFS Investors Trust Series] [Rydex Venture 100 Fund]
[MFS Total Return Series] [Rydex Banking Fund]
[Rydex Basic Materials Fund]
[Alliance Growth and Income Portfolio] [Rydex Biotechnology Fund]
[Rydex Consumer Products Fund]
[American Century VP Value Fund] [Rydex Electronics Fund]
[Rydex Energy Fund]
[Xxxxxxxxx Asset Strategy Fund] [Rydex Energy Services Fund]
[Xxxxxxxxx Developing Markets Securities Fund] [Rydex Financial Services Fund]
[Rydex Health Care Fund]
[Lazard Retirement Small Cap Portfolio] [Rydex Internet Fund]
[Rydex Leisure Fund]
[Xxxxxx Xxxxxxx Emerging Markets Equity [Rydex Precious Metals Fund]
[Rydex REIT Fund]
Portfolio] [Rydex Retailing Fund]
[Xxxxxx Xxxxxxx International Magnum Portfolio][Rydex Technology Fund]
[Rydex Telecommunications Fund]
[Janus Aspen Series Balanced Portfolio] [Rydex Transportation Fund]
[Janus Aspen Series Flexible Income Portfolio] [Rydex Utilities Fund]
[Rydex U.S. Government Money
Market Fund]
VARIABLE ACCOUNT: [Valley Forge Life Insurance Company Variable Annuity Separate
Account]
[ALLOCATION GUIDELINES:
1. Currently, you may select as many investment options as you wish. We
reserve the right to limit this in the future.
2. Currently, you may also select any available fixed account at the time the
purchase payment or transfer is made.
3. The initial purchase payment will be credited to your contract within two
(2) business days after receipt at our Administrative Office. Additional
purchase payments will be credited to your contract as of the business day
they are received.
4. Allocation percentages must be in whole numbers. Each allocation must be at
least [1%].]
TRANSFERS:
Number of Transfers Permitted:
During the Accumulation Period: [Subject to any transfer fees
and any minimum and maximum amounts that may be transferred,
currently there is no limitation on the number of transfers
that may be made between subaccounts. Currently, you may make
unlimited transfers to any fixed account option, subject to
any transfer fees and any required minimum or maximum amounts
that may be transferred. We reserve the right to limit the
number of transfers, but you will always be allowed at least
[12] transfers between subaccounts in a contract year during
the accumulation period.]
During the Annuity Period: [Currently, during a contract year
you may make [4] transfers between subaccounts, or, from one
or more subaccounts to the general account. The amounts
transferred are subject to any minimums and maximums we may
establish. You may not make a transfer from the general
account to the subaccounts.]
Number of Free Transfers: [Currently, you are allowed [24] free
transfers each contract year during the accumulation period and [4]
free transfers each contract year during the annuity period.]
Transfer Fee: [For each transfer in excess of the free transfers
permitted, the transfer fee is [$25]. Transfers made pursuant to a
prescheduled transfer will not be counted in determining the
application of the transfer fee.]
Minimum Amount to be Transferred: [The minimum amount which may be
transferred is [$500] or your entire interest in any subaccount or any
fixed account, if less. This requirement is waived if the transfer is
pursuant to a prescheduled transfer or applied to a specified annuity
option.]
Prescheduled Transfers: [You may elect the dollar cost averaging option or the
automatic transfer option. We reserve the right to limit the availability of any
subaccount or fixed account for a prescheduled transfer.]
WITHDRAWALS:
No withdrawal charge is assessed against each purchase payment
withdrawn.
Order of Withdrawals: The order of withdrawal is as follows:
--------------------
1. purchase payments on a first in, first out basis; and
2. contract value in excess of 1. above.
Minimum partial withdrawal amount: [[$500] Withdrawals made pursuant to
the systematic withdrawal option [or any minimum distribution option]
are not subject to this minimum.] [Withdrawals made pursuant to the
systematic withdrawal option must be at least [$100].]
[Minimum contract value which must remain in an account or subaccount after a
partial withdrawal: [[$1,000] in any subaccount or [$500] in any fixed account
Minimum contract value which must remain in the contract after a partial
withdrawal: [$15,000 for non-qualified contracts] [$2,000 for qualified
contracts]
ATTACHED RIDERS AND ENDORSEMENTS:
[Individual Retirement Annuity Endorsement]
[Tax Sheltered Annuity Endorsement]
[Pension/Profit Sharing Endorsement]
[Xxxx XXX Endorsement]
[Dollar Cost Averaging I]
[Systematic Withdrawal Rider]
[Automatic Transfer Rider]
TABLE OF CONTENTS
Contract Data Page.............................................................2
Definitions ...................................................................7
General Provisions ............................................................9
Ownership and Assignment ......................................................9
Beneficiary Provisions .......................................................10
Purchase Payments ............................................................10
Contract Value ...............................................................11
....Fixed Account ............................................................11
The Variable Account ................................................11
Transfers ....................................................................12
Withdrawals ..................................................................14
Payment of Benefits ..........................................................14
Death Benefit ................................................................15
Annuity Provisions and Payment Options .......................................16
Annuity Tables ...............................................................18
DEFINITIONS
Accumulation Period: The period prior to the annuity date during which you may
make purchase payments.
Accumulation Unit: A unit of measure used to calculate the contract value in a
subaccount.
Age: The age as of the nearest birthday.
Annuitant: The person or person(s) whose life (or lives) determines the annuity
payments under this contract.
Annuity Date: The date when annuity payments begin. This is shown on the
contract data page.
Annuity Payments: The periodic payment we make under an annuity payment option.
Annuity Payment Date: The date when we make annuity payments. This is the same
day of the month as the annuity date.
Annuity Period: The period starting on the annuity date during which annuity
payments are paid.
Annuity Unit: A unit of measure used to calculate variable annuity payments.
Annuity Value: The value of the contract available to be applied to an annuity
option.
Beneficiary: The person(s) who will receive the death benefit.
Business Day: Any day that the New York Stock Exchange is open for business.
Contract Anniversary: The same date each calendar year as the contract date.
Contract Date: The date on which the contract becomes effective as shown on the
contract data page.
Contract Value: The sum of the variable contract value and any fixed account.
Contract Year: A twelve-month period beginning on the contract date or contract
anniversary.
Fixed Account: A portion of the general account into which you may allocate
purchase payments or transfer contract value. It is equal to the sum of all
purchase payments allocated to any fixed account less withdrawals and charges.
At our discretion, we may from time to time declare an excess interest rate for
Fixed Account I. The excess interest rate will be guaranteed for one contract
year. A fixed account is available only during the accumulation period.
General Account: Our assets other than those allocated to any Variable Account
of the Company.
Investment Option: The investment choices within the Variable Account available
under the contract. Current investment options are shown on the contract data
page.
Owner: The person(s) or entity(ies) who is (are) entitled to exercise all
ownership rights and privileges provided in the contract. All references to
owner shall include any named joint owner. Any joint owner must be the spouse of
the other owner unless limited by state law.
Subaccount: A subdivision of the Variable Account which is invested in a
corresponding investment option.
Subaccount Value: The amount equal to that part of any purchase payment
allocated or transferred to the subaccount adjusted by interest income,
dividends, net capital gains or losses, realized or unrealized, and decreased by
withdrawals (including any applicable tax charges) and any amounts transferred
out of that subaccount.
The Company, We, Us, Our: Valley Forge Life Insurance Company
Variable Account: Valley Forge Life Insurance Company Variable Annuity Separate
Account
Variable Contract Value: The sum of all subaccount values.
Withdrawal Value: The contract value plus or minus any applicable interest
adjustment, less any applicable tax charges not previously deducted, less the
contract maintenance fee, if any.
Written Notice: A notice or request submitted in writing in a form satisfactory
to us that is signed by you and received at our Administrative Office.
You, Your: The owner
GENERAL PROVISIONS
Entire Contract: The contract is made up of this contract, any attached
endorsements or riders, and the attached application.
Incontestability: We will not contest the validity of this contract.
Misstatement of Age or Sex: If the age or sex of the owner or annuitant has been
misstated, we will adjust the benefits paid under this contract to reflect the
correct age and/or sex. Underpayments will be made up immediately, overpayments
will be deducted from future annuity payments until the total is repaid.
Periodic Reports: At least once each contract year we will furnish you with a
report showing the contract value and any other information as may be required
by law. Reports will be sent to your last known address.
Non Participating: This contract does not participate in the surplus or profits
of the Company.
Protection of Benefits: To the extent permitted by law, no benefits payable or
account values under this contract are subject to the claims of creditors. No
beneficiary may commute, encumber, alienate or assign any payments under this
contract.
Taxes: Any taxes paid to any governmental entity relating to this contract will
be deducted from the purchase payments or contract value when incurred. We will
determine when taxes have resulted from the investment experience of the
Variable Account, receipt by us of purchase payments or commencement of annuity
payments. We may pay taxes when due and deduct that amount from the contract
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 will deduct any withholding taxes
required by applicable law.
Proof of Age and Survival: We have the right to require proof of the owner or
annuitant's age prior to the annuity date. We also reserve the right to require
proof of the owner or annuitant's survival before any annuity payment date.
Modification: We may modify this contract in order to maintain compliance with
applicable state and federal law. This contract may be changed or altered only
by one of our officers. Any change or alteration must be in writing.
Currency: Any money we pay, or that is paid to us, must be in United States
currency.
OWNERSHIP AND ASSIGNMENT
Owner: You, as the owner, have all the interest and rights under this contract.
The owner is designated on the contract date unless changed.
You may change the owner at any time. A change of owner will automatically
revoke any prior designation of owner. A request for change must be made by
written notice. The change will be effective as of the date the written notice
is signed. A new designation of owner will not apply to any payment made or
action taken by us prior to the time the new designation was recorded. A change
in ownership is subject to the written consent of any irrevocable beneficiary.
Joint Owner: A contract may be owned by joint owners. Any joint owner must be
the spouse of the other owner, unless limited by state law. Any actions which
are to be performed by the owner, in the case of joint owners, require the
signature of both owners, unless otherwise allowed by us. Upon the death of
either owner, the surviving joint owner will be the primary beneficiary. Any
other beneficiary designation will be treated as a contingent beneficiary unless
otherwise indicated in a written notice.
Annuitant: The person on whose life annuity payments are based. You designate
the annuitant on the contract date, and you may change the annuitant prior to
the annuity date. The annuitant may not be changed in a contract which is owned
by a non-individual. Any change of annuitant is subject to our consent.
Assignment: You may, at any time during your lifetime, assign your rights under
this contract. We will not be bound by any assignments until we record written
notice of the assignment. We are not responsible for the validity or sufficiency
of any assignments. We will not be liable as to any payment or other settlement
we make before we record the assignment.
BENEFICIARY PROVISIONS
Beneficiary: The beneficiary designation in effect on the contract date will
remain in effect unless changed. Unless you provide otherwise, the death benefit
will be paid in equal shares or all to the survivor as follows:
1. to the primary beneficiaries who survive you, and/or the annuitant(s), as
applicable; or if there are none,
2. to the contingent beneficiaries who survive you, and/or the annuitant(s),
as applicable; or if there are none,
3. to your estate.
Changing the Beneficiary: Subject to the rights of any irrevocable beneficiary,
you may change the primary or contingent beneficiary. A change may be made by
filing written notice. The change will take effect as of the date the written
notice is signed. We will not be liable for any payment made or action taken
before we record the change.
PURCHASE PAYMENTS
Purchase Payments: The initial purchase payment is due on the contract date. The
minimum subsequent purchase payments and maximum total purchase payments are
shown on the contract data page. Subject to the minimum and maximum payments
shown on the contract data page, you may increase or decrease or change the
frequency of subsequent purchase payments. We reserve the right to reject any
purchase payment.
Allocation of Purchase Payments: The allocation of purchase payments is made in
accordance with your selection made at the contract date. We reserve the right
to allocate initial purchase payments to the money market or similar subaccount
during the free look period. Unless you elect otherwise, subsequent purchase
payments will be allocated in accordance with your initial selection.
You may change the allocation of purchase payments by written notice. Any
additional purchase payments will be allocated in accordance with the allocation
schedule in effect unless accompanied by written notice requesting a different
allocation. Only whole percentages may be applied. The minimum percentage that
may be allocated is shown on the contract data page. Purchase payments may be
allocated net of any government imposed tax charges.
CONTRACT VALUE
FIXED ACCOUNT
Fixed Account I Value: The value of Fixed Account I at any time is equal to:
1. the purchase payments allocated to Fixed Account I; plus
2. amounts transferred to Fixed Account I; plus
3. any interest credited to Fixed Account I; less
4. any prior withdrawals deducted from Fixed Account I; less
5. any amounts transferred from Fixed Account I; less
6. any applicable taxes or charges deducted from Fixed Account I.
Interest To Be Credited: We guarantee that the interest to be credited to any
fixed account will not be less than the minimum guaranteed interest rate shown
on the contract data page or any supplemental data page. We may credit
additional interest at our sole discretion to Fixed Account I. Declared interest
will be guaranteed for one contract year.
THE VARIABLE ACCOUNT
Variable Account: The Variable Account consists of assets set aside by us, which
are kept separate from our general assets and all of our other Variable Account
assets. The assets of the Variable Account, equal to reserves and other
liabilities of your contract and those of other owners, will not be charged with
liabilities arising out of any other business we may do.
The Variable Account assets are divided into subaccounts. The assets of the
subaccounts are allocated to the investment options shown on the contract data
page.
Investments of the Variable Account: Purchase payments applied to the Variable
Account are allocated to subaccounts. We may, from time to time, add additional
investment options to those options shown on the contract data page. You may be
permitted to transfer contract values to the additional investment option(s).
However, the right to make any transfer will be limited by any terms and
conditions in effect at the time of transfer.
If the shares of any of the investment options become unavailable for investment
by the Variable Account, or if we deem further investment in these shares
inappropriate, we may limit further purchase of such shares or substitute shares
of another investment option for shares already purchased under this contract.
Valuation of Assets: Assets of the Variable Account are valued each business day
at their fair market value in accordance with our procedures.
Change in Operation of the Variable Account: We reserve the right to modify the
structure or operation of the Variable Account. If we do so, we guarantee that
such modification will not affect the value of your contract.
Accumulation Units: Accumulation units shall be used to account for all amounts
allocated to or withdrawn from a subaccount as a result of purchase payments,
transfers, withdrawals, or fees and charges. We will determine the number of
accumulation units of a subaccount purchased or canceled. This is done by
dividing the amount allocated to (or the amount withdrawn from) the subaccount,
by the dollar value of one accumulation unit of the subaccount as of the end of
the business day during which the request for transfer is received at our
Administrative Office.
Accumulation Unit Value: The Accumulation Unit Value for each subaccount was set
at $10 when the subaccount became part of the Variable Account. Subsequent
accumulation unit values for each subaccount are determined by multiplying the
accumulation unit value for the immediate preceding business day by the net
investment factor of the subaccount for the current business day. The
accumulation unit value may increase or decrease from business day to business
day.
Net Investment Factor: The net investment factor for each subaccount is
determined by dividing (1) by (2) and subtracting (3) from the result, where:
1. is the result of:
a. the net asset value per share of the investment option held in the
subaccount, determined at the end of the business day; plus
b. the per share amount of any dividend or capital gain distributions made by
the investment option held in the subaccount, if the "ex-dividend" date
occurs as of the current business day; plus or minus
c. a per share charge or credit for any taxes reserved for, which we determine
to have resulted from the operations of the subaccount.
2. is the net asset value per share of the investment option held in the
subaccount, determined at the end of the prior business day.
3. is a daily factor representing the product expense charge deducted from the
subaccount.
TRANSFERS
A transfer is subject to the following:
1. The maximum number of transfers without a transfer processing fee is shown
on the contract data page;
2. We reserve the right to assess a transfer processing fee if the number of
transfers exceeds the maximum number of free transfers. We will notify you
of the assessment of any transfer processing fee. Any transfer processing
fee we may assess is deducted from the amount which is transferred;
3. You may not make a transfer until after the end of the free look period;
4. The minimum amount which may be transferred is shown on the contract data
page;
5. A transfer will be effected as of the end of the business day when we
receive an acceptable transfer request;
6. We are not liable for a transfer made in accordance with your instructions;
7. We reserve the right to restrict transfers between subaccounts to a maximum
of twelve (12) per contract year and to restrict transfers from being made
on consecutive business days. We also reserve the right to restrict
transfers into and out of any fixed account;
8. Your right to make transfers is subject to modification if we determine, in
our sole opinion, that the exercise of the right by one or more owners is,
or would be, to the disadvantage of other owners. Restrictions may be
applied in any manner reasonably designed to prevent any use of the
transfer right which we considered to be to the disadvantage of other
owners. A modification could be applied to transfers to or from, one or
more of the subaccounts and could include, but is not limited to:
a. the requirement of a minimum time period between each transfer;
b. not accepting a transfer request from an agent acting under a power of
attorney on behalf of more than one owner; or
c. limiting the dollar amount that may be transferred between the subaccounts
by an owner at any one time;
9. During times of severe economic or market conditions, we may suspend the
transfer privilege temporarily without notice and treat transfer requests
based on their separate components (a redemption order with a simultaneous
request for purchase of another subaccount). In such a case, the redemption
order would be processed at the source subaccount's next determined
accumulation unit value. However, the purchase into the new subaccount
would be effective at the next determined accumulation unit value for the
new subaccount only after we receive proceeds from the source subaccount,
or we otherwise receive cash on behalf of the source subaccount;
10. Transfers do not change the allocation instructions for future purchase
payments;
11. You may elect to make transfers by telephone or other communication medium.
To elect this option you must first make a written request. If there are
joint owners, unless we are instructed to the contrary, instructions by
telephone or other communication medium will be accepted from either one of
the joint owners. We will use reasonable procedures to confirm that
instructions communicated are genuine;
12. Transfers made during the annuity period are also subject to the following:
a. The number of transfers is limited to the number of transfers set forth on
the contract data page;
b. You may not make a transfer from the general account to a subaccount;
c. The amount transferred to the general account from a subaccount will be
based on current company practice for such requests at the time of the
transfer; and
d. You may not make a transfer within three (3) business days of an annuity
payment date.
WITHDRAWALS
Withdrawals During the Accumulation Period: You may withdraw all or part of the
contract value subject to the following:
1. The minimum partial withdrawal amount is shown on the contract data page.
2. The maximum partial withdrawal is the amount that would leave a minimum
contract value of the amount shown on the contract data page.
This contract ends when we pay the withdrawal value. The withdrawal value will
be determined as of the date we receive your written notice and this contract.
We will withdraw the amount you request from the contract value as of the day
that we receive your written notice. We will deduct any applicable contract
maintenance and/or other charges.
If your written notice does not specify the amount to be withdrawn from each
subaccount or any fixed account, we will make the withdrawal based on the
proportion that each subaccount and each fixed account bears to the contract
value as of the date of the withdrawal.
Termination: We may terminate this contract and pay you the withdrawal value, if
before the annuity date your withdrawal will result in your contract value
falling below the minimum stated on the contract data page.
We will mail you a notice of our intent to terminate this contract. This
contract will automatically terminate unless we receive additional purchase
payments in excess of the minimum amount specified on the contract data page
within thirty (30) days.
Minimum Benefit: The value of this contract is at least equal to the minimum
under any nonforfeiture law where this contract has been issued.
PAYMENT OF BENEFITS
Payment of Benefits from Subaccounts: We will make any transfer and will pay the
proceeds of any withdrawal, death benefit or annuity payment within seven
business days after receipt of all written notices and/or due proofs of death.
This payment or transfer may be postponed if:
1. The New York Stock Exchange is closed, other than customary weekend or
holiday closing, or trading on the exchange is restricted as determined by
the Securities and Exchange Commission ("SEC"); or
2. The SEC permits, by an order, the postponement for your protection; or
3. The SEC determines that an emergency exists that would make the disposal of
securities held in the Variable Account or determination of their value not
reasonably practicable.
Right to Defer Payments or Transfers from any Fixed Account: We have the right
to defer payment of any withdrawal or transfer from any fixed account for up to
six (6) months from the date we receive your written notice, unless the law in
your state provides otherwise.
DEATH BENEFIT
Death Benefit During the Accumulation Period Prior to the Owner's Age 85: The
death benefit during the accumulation period prior to the owner attaining age 85
is equal to the greater of:
1. the contract value determined as of the end of the business day during
which we receive both due proof of death and an election for the payment
method; or
2. the guaranteed minimum death benefit, which is total purchase payments less
any adjusted withdrawals.
The adjusted withdrawal amount is dependent upon the relationship between the
contract value and the guaranteed minimum death benefit.
If the contract value equals or exceeds the guaranteed minimum death benefit at
the time of withdrawal, the adjusted withdrawal will equal 100% of the actual
withdrawal amount.
If the contract value is less than the guaranteed minimum death benefit at the
time of withdrawal, the adjusted withdrawal will equal the actual withdrawal
times the ratio of the guaranteed minimum death benefit to the contract value.
In the case of joint owners, the oldest joint owner's age will be used to
determine the death benefit amount.
Death Benefit During the Accumulation Period On Or After the Owner's Age 85: The
death benefit during the accumulation period on or after the owner attains age
85, is equal to the contract value determined as of the end of the business day
during which we receive both due proof of death and an election for
the payment method.
In the case of joint owners, the oldest joint owner's age will be used to
determine the death benefit amount.
Death of Owner During the Accumulation Period: Upon your death or the death of
any joint owner during the accumulation period, the death benefit will be paid
to the beneficiary(ies) you designated who will be treated as a new owner. Upon
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 Options During the Accumulation Period: Unless already selected by
the owner, a beneficiary must elect the death benefit to be paid under one (1)
of the options below in the event of the death of an owner during the
accumulation period. Furthermore, if the beneficiary is the spouse of the owner,
he or she may elect to continue this contract in his or her own name at the
current contract value and exercise all the owner's rights under the contract.
In this event, the contract value will be adjusted to equal the death benefit.
Option 1 - lump sum payment of the death benefit;
Option 2 - payment of the entire death benefit within five (5) years of the date
of the death of the owner or any joint owner; or
Option 3 - 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 (1)
year of the date of death of the owner or any joint owner.
Any portion of the death benefit not applied to option 3 within one (1) year of
the date of death of the owner or joint owner must be distributed within five
(5) 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 election, unless payment is postponed as
described above.
Payment to the beneficiary, other than in a single sum, may be elected only
during the 60-day period beginning with the date we receive due proof of death.
Contract value is computed as of the date we receive due proof of death of the
owner. From the time the death benefit is determined until complete distribution
is made, any amount in any subaccount will be subject to investment risk which
is borne by the beneficiary.
Death Benefits on or After the Annuity Date: If the owner or joint owner, who is
not the annuitant, dies after the annuity date, any remaining payments under the
annuity option elected will continue at least as rapidly as under the method of
distribution in effect on the date of the owner's death. Upon the death of the
owner during the annuity period, the beneficiary becomes the new owner.
Death of the Annuitant: Upon the death of an annuitant, who is not the owner,
during the accumulation period, the owner automatically becomes the annuitant.
The owner may designate a new annuitant, subject to the Company's underwriting
rules then in effect. If the owner is a non-natural person, the death of the
primary annuitant will be treated as death of the 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.
ANNUITY PROVISIONS AND PAYMENT OPTIONS
The Annuity Date: The annuity date may not be sooner than the first day of the
second contract year nor may it be later than the 99th birthday of the
annuitant, or earlier if required by law. Upon your request to annuitize, we
will issue a supplemental contract. If you do not elect an annuity option,
Option 4 with 10 year period certain is the default.
Annuity Payments: Annuity payments start at least 30 days after the annuity
date, provided the annuitant is alive. All annuity payments are made to you,
unless you elect otherwise.
Minimum Annuity Benefit: The minimum annuity benefit will be greater than or
equal to that mandated by law in the state of issue.
Fixed Annuity Payments: Fixed annuity payments are periodic payments that depend
only on the form and duration of the annuity payment option selected, the
annuity value applied to purchase the annuity payments and the age and sex of
the annuitant.
Variable Annuity Payments: The value of a variable annuity payment is based on
the annuity units on the annuity date. The number of annuity units attributable
to each subaccount under a contract remains fixed unless there is an exchange of
annuity units.
Annuity Unit: An annuity unit is the unit of measure used to calculate variable
annuity payments. An annuity unit is calculated by dividing the dollar amount of
the first variable annuity payment attributable to that subaccount by the
annuity unit value of that subaccount.
Annuity Unit Value: The annuity unit value of each subaccount for any business
day is equal to (1) multiplied by (2) divided by (3) where:
1. is the net investment factor for the business day for which the annuity
unit value is being calculated;
2. is the annuity unit value for the preceding valuation period;
3. is the Annual Investment Factor adjusted for the number of days in the
valuation period. The Annual Investment Factor is equal to one plus 3% or
1.03. The annual factor can be translated into a daily factor of
1.00008098.
Payment Option Rate Tables: The amount of monthly payments per $1,000 applied is
shown for a fixed annuity in these tables. For a variable annuity, the tables
show the amount of the first variable annuity payment only. Subsequent variable
annuity payments will change with changes in annuity unit value.
Option 1 - Payment Certain: We pay the annuity value in equal payments as you
specify. The total of all payments made in each year must be at least 5% of the
annuity value applied under this option. The amount of each fixed annuity
payment and the first variable annuity payment for each $1,000 of annuity value
applied is shown in Table 1. The owner has the right of commutation at the
interest rate used for determination of payments less any applicable.
Option 2 - Period Certain: We pay the annuity value in equal installments over a
designated period of time you choose of not less than six (6) nor more than
thirty (30) years. The amount of each fixed annuity payment and the first
variable annuity payment for each $1,000 of annuity value applied is shown in
Table 2. The owner has the right of commutation at the interest rate used for
determination of payments.
Option 3 - Life Annuity: We apply the annuity value to make monthly payments
while the annuitant lives.
Option 4 - Life Annuity with Period Certain: We apply the annuity value to make
monthly payments until the later of the death of the annuitant or the period
certain. The period certain is not to be less than six (6) years nor more than
thirty (30) years. The amount of each fixed annuity payment and the first
variable annuity payment is shown in Table 2. If the annuitant dies during the
period certain payout, the owner has the right of commutation at the interest
rate used for determination of payments.
Option 5 - Joint Life and Survivor Annuity: We apply the annuity value to make
monthly payments while both annuitants are living. After the death of either
annuitant, payments continue as long as the other annuitant still lives. The
amount of each fixed annuity payment and the first variable annuity payment is
shown in Table 3.
Additional Options: We may make other income options available.
Table 1 - Payment Certain (per $1,000 of annuity value applied)
-------------------------------- -------------------------------------------------------------------------------------
Number of Years Specified Amount of Installments
-------------------------------- -------------------------------------------------------------------------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
Annual Semi-Annual Quarterly Monthly
------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
6 179.22 90.27 45.30 15.14
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
7 155.83 78.49 39.39 13.16
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
8 138.31 69.67 34.96 11.68
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
9 124.69 62.81 31.52 10.53
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
10 113.82 57.33 28.77 9.61
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
11 104.93 52.85 26.52 8.86
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
12 97.54 49.13 24.66 8.24
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
13 91.29 45.98 23.08 7.71
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
14 85.95 43.29 21.73 7.26
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
15 81.33 40.96 20.56 6.87
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
16 77.29 38.93 19.54 6.53
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
17 73.74 37.14 18.64 6.23
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
18 70.59 35.56 17.84 5.96
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
19 67.78 34.14 17.13 5.73
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
20 65.26 32.87 16.50 5.51
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
25 55.76 28.08 14.09 4.71
-------------------------------- ------------------------- --------------------- ------------------ ------------------
-------------------------------- ------------------------- --------------------- ------------------ ------------------
30 49.53 24.95 12.52 4.18
-------------------------------- ------------------------- --------------------- ------------------ ------------------
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Table 2 - Period Certain and Life (per $1,000 of annuity value applied)
-------------------------- ------------------ --------------------- ------------------ ----------------------- ------------------
Age of Annuitant* Number of Years Age of Annuitant* Number of Years Age of Annuitant* Number of Years
Specified Specified Specified
-------------------------- ------------------ --------------------- ------------------ ----------------------- ------------------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
Male Female 15 20 Male Female 15 20 Male Female 15 20
-------- --------- --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
16 and 21 and under 2.96 2.96 39 44 3.59 3.56 63 68 5.26 4.91
under
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
40 45 3.63 3.60 64 69 5.37 4.97
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
17 22 2.98 2.97 41 46 3.67 3.64 65 70 5.47 5.03
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
18 23 2.99 2.99 42 47 3.72 3.68 66 71 5.57 5.09
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
19 24 3.01 3.01 43 48 3.77 3.73 67 72 5.67 5.14
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
20 25 3.03 3.03 44 49 3.82 3.78 68 73 5.77 5.19
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
21 26 3.05 3.05 45 50 3.87 3.82 69 74 5.87 5.23
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
22 27 3.07 3.07 46 51 3.93 3.87 70 75 5.97 5.27
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- --------- --------
23 28 3.09 3.09 47 52 3.98 3.92 71 76 6.06 5.31
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
24 29 3.11 3.11 48 53 4.04 3.98 72 77 6.15 5.35
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
25 30 3.14 3.13 49 54 4.10 4.03 73 78 6.24 5.37
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
26 31 3.16 3.16 50 55 4.17 4.09 74 79 6.32 5.40
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
27 32 3.19 3.18 51 56 4.24 4.15 75 80 6.39 5.42
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
28 33 3.21 3.20 52 57 4.31 4.20 76 81 6.46 5.44
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
29 34 3.24 3.23 53 58 4.38 4.26 77 82 6.52 5.46
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
30 35 3.27 3.26 54 59 4.45 4.33 78 83 6.58 5.47
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
31 36 3.30 3.29 55 60 4.53 4.39 79 84 6.63 5.48
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
32 37 3.33 3.32 56 61 4.61 4.45 80 85+ 6.67 5.49
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
33 38 3.36 3.35 57 62 4.70 4.52 81 6.71
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
34 39 3.39 3.38 58 63 4.79 4.58 82 6.74
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
35 40 3.43 3.41 59 64 4.88 4.65 83 6.77
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
36 41 3.47 3.45 60 65 4.97 4.72 84 6.79
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
37 42 3.50 3.48 61 66 5.07 4.78 85+ 6.81
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
38 43 3.54 3.52 62 67 5.16 4.85
------------ ------------- -------- --------- -------- ------------ --------- -------- ---------- ------------ --------- --------
*Use the Payee's age nearest the Date of Settlement.
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Table 3 - Joint and Survivor (per $1,000 of annuity value applied)
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
Age of Annuitants Male 55 56 57 58 59 60 61
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
Male Female 60 61 62 63 64 65 66
------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
51 56 3.89 3.92 3.94 3.97 3.99 4.01 4.04
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
52 57 3.93 3.96 3.98 4.01 4.04 4.06 4.08
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
53 58 3.96 3.99 4.02 4.05 4.08 4.11 4.13
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
54 59 4.00 4.03 4.06 4.09 4.12 4.15 4.18
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
55 60 4.03 4.07 4.10 4.14 4.17 4.20 4.23
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
56 61 4.07 4.11 4.14 4.18 4.21 4.25 4.28
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
57 62 4.10 4.14 4.18 4.22 4.26 4.30 4.33
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
58 63 4.14 4.18 4.22 4.26 4.30 4.34 4.38
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
59 64 4.17 4.21 4.26 4.30 4.35 4.39 4.44
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
60 65 4.20 4.25 4.30 4.34 4.39 4.44 4.49
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
61 66 4.23 4.28 4.33 4.38 4.44 4.49 4.54
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
62 67 4.26 4.32 4.37 4.42 4.48 4.53 4.59
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
63 68 4.29 4.35 4.41 4.46 4.52 4.58 4.63
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
64 69 4.32 4.38 4.44 4.50 4.56 4.62 4.68
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
65 70 4.35 4.41 4.47 4.54 4.60 4.66 4.73
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
66 71 4.37 4.44 4.50 4.57 4.64 4.71 4.78
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
67 72 4.40 4.47 4.53 4.60 4.67 4.75 4.82
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
68 73 4.42 4.49 4.56 4.64 4.71 4.79 4.86
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
69 74 4.45 4.52 4.59 4.67 4.74 4.82 4.90
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
70 75 4.47 4.54 4.62 4.70 4.78 4.86 4.94
------------------- ----------------- ------------ ------------ ----------- ------------ ----------- ------------ ------------
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Table 3 - Joint and Survivor (Continued)
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
Age of Annuitants Male 62 63 64 65 66 67 68 69 70
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
Male Female 67 68 69 70 71 72 73 74 75
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
51 56 4.06 4.08 4.10 4.12 4.13 4.15 4.17 4.18 4.19
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
52 57 4.11 4.13 4.15 4.17 4.19 4.21 4.23 4.24 4.26
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
53 58 4.16 4.18 4.21 4.23 4.25 4.27 4.29 4.31 4.33
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
54 59 4.21 4.24 4.26 4.29 4.31 4.33 4.36 4.38 4.40
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
55 60 4.26 4.29 4.32 4.35 4.37 4.40 4.42 4.45 4.47
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
56 61 4.32 4.35 4.38 4.41 4.44 4.47 4.49 4.52 4.54
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
57 62 4.37 4.41 4.44 4.47 4.50 4.53 4.56 4.59 4.62
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
58 63 4.42 4.46 4.50 4.54 4.57 4.60 4.64 4.67 4.70
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
59 64 4.48 4.52 4.56 4.60 4.64 4.67 4.71 4.74 4.78
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
60 65 4.53 4.58 4.62 4.66 4.71 4.75 4.79 4.82 4.86
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
61 66 4.59 4.63 4.68 4.73 4.78 4.82 4.86 4.90 4.94
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
62 67 4.64 4.69 4.74 4.80 4.85 4.89 4.94 4.99 5.03
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
63 68 4.69 4.75 4.81 4.86 4.92 4.97 5.02 5.07 5.12
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
64 69 4.74 4.81 4.87 4.93 4.99 5.05 5.10 5.16 5.21
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
65 70 4.80 4.86 4.93 4.99 5.06 5.12 5.18 5.24 5.30
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
66 71 4.85 4.92 4.99 5.06 5.13 5.19 5.26 5.33 5.39
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
67 72 4.89 4.97 5.05 5.12 5.19 5.27 5.34 5.41 5.48
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
68 73 4.94 5.02 5.10 5.18 5.26 5.34 5.42 5.50 5.58
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
69 74 4.99 5.07 5.16 5.24 5.33 5.41 5.50 5.58 5.67
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
70 75 5.03 5.12 5.21 5.30 5.39 5.48 5.58 5.67 5.76
------------------- ------------- -------- ---------- ---------- --------- ---------- --------- ---------- ---------- ---------
1983(a) mortality tables at 3% interest with a five (5) year setback for females
Valley Forge Life Insurance Company
A Stock Company
Administrative Office:..............................................Home Office:
100 CNA Drive.................................................000 Xxxx Xx.
Xxxxxxxxx, Xxxxxxxxx 00000...........................Reading, Pennsylvania 19601
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Annuity payments and other values provided by this contract, when based on the
investment performance of the Variable Account, may increase or decrease daily
as a function of the investment performance of the subaccounts you select and
are not guaranteed as to dollar amount. No minimum contract value is guaranteed.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Non-Participating
