ALLIANZ LIFE INSURANCE COMPANY OF NEW YORK
000 Xxxx 00xx Xxxxxx, 00xx Xxxxx
Xxx Xxxx, Xxx Xxxx 00000
This is a legal Contract between the Contract Owner (referred to in this
Contract as you and your) and Allianz Life Insurance Company of New York
(Allianz Life of NY) (herein referred to as we, us and our). We will make
Annuity Payments as set forth in this Contract beginning on the Income Date.
This Contract is issued in consideration of the attached application and payment
of the initial Purchase Payment.
READ YOUR CONTRACT CAREFULLY
RIGHT TO EXAMINE: This Contract may be returned within 10 days after you receive
it. It can be mailed or delivered to either us or the agent who sold it. Return
of this Contract by mail is effective on being postmarked, properly addressed
and postage prepaid. The returned Contract will be treated as if we had never
issued it. We will promptly refund an amount equal to the sum of (i) and (ii),
where (i) is the difference between the Purchase Payments and bonus amounts,
including any fees or other charges, and the amounts, if any, allocated to the
Variable Account, less any withdrawals, and (ii) the Contract Value, less any
bonus amounts credited.
This is a Variable Annuity Contract with Annuity Payments and Contract Values
increasing or decreasing depending on the experience of the Variable Account
which is set forth in the Contract Schedule. Annuity Payments and Contract
Values in the Variable Account are not guaranteed as to fixed dollar amounts.
Signed by the Company:
[Xxxxxxx X. Xxxxx] [Xxxxxxx Xxxxxxxx]
Xxxxxxx X. Xxxxx Xxxxxxx Xxxxxxxx
Senior Vice President, Secretary Chairman of the Board, CEO and President
and Chief Legal Officer
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE ANNUITY
NONPARTICIPATING
Annuity Payments will not decrease as long as the investment return of the
Variable Account assets equals or exceeds 6.4% (assuming a 4.5% Assumed
Investment Return) on an annual basis. Variable Account expenses consist of a
mortality and expense risk charge, a contract maintenance charge, and transfer
fees. These are shown on the Contract Schedule Page. The variable provisions can
be found on pages 7, 8 and 14 of this Contract.
TABLE OF CONTENTS
RIGHT TO EXAMINE...............................................................1
CONTRACT SCHEDULE............................................................i-v
DEFINITIONS....................................................................4
PURCHASE PAYMENTS..............................................................6
PURCHASE PAYMENTS.....................................................6
CHANGE IN PURCHASE PAYMENTS...........................................6
NO DEFAULT............................................................6
..........BONUS.................................................................6
ALLOCATION OF PURCHASE PAYMENTS AND BONUS AMOUNTS ....................6
VARIABLE ACCOUNT...............................................................7
THE VARIABLE ACCOUNT..................................................7
VALUATION OF ASSETS...................................................7
ACCUMULATION UNITS....................................................7
ACCUMULATION UNIT VALUE...............................................7
NET INVESTMENT FACTOR.................................................7
MORTALITY AND EXPENSE RISK CHARGE.....................................8
MORTALITY AND EXPENSE GUARANTEE.......................................8
CONTRACT VALUE.................................................................8
CONTRACT MAINTENANCE CHARGE....................................................8
TRANSFERS......................................................................8
WITHDRAWAL PROVISIONS.........................................................10
WITHDRAWALS..........................................................10
WITHDRAWAL CHARGE....................................................10
PROCEEDS PAYABLE ON DEATH.....................................................10
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PHASE................10
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE...................10
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PHASE..................10
DEATH OF CONTRACT OWNER DURING THE ANNUITY PHASE.....................11
DEATH OF ANNUITANT...................................................11
PAYMENT OF DEATH BENEFIT.............................................11
BENEFICIARY..........................................................12
CHANGE OF BENEFICIARY................................................12
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION..................................12
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS..............................13
CONTRACT OWNER........................................................13
JOINT OWNER...........................................................13
ANNUITANT.............................................................13
ASSIGNMENT OF A CONTRACT..............................................13
ANNUITY PROVISIONS............................................................13
GENERAL............................................................. 13
FIXED ANNUITY........................................................14
VARIABLE ANNUITY..............................................................14
INCOME DATE...................................................................14
SELECTION OF AN ANNUITY OPTION................................................15
DEFAULT ANNUITY OPTION........................................................15
ANNUITY OPTIONS...............................................................15
OPTION 1 - LIFE ANNUITY.............................................15
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15, OR 20
YEARS GUARANTEED....................................................15
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY..........................16
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTS OVER
5, 10, 15 OR 20 YEARS GUARANTEED....................................16
OPTION 5 - REFUND LIFE ANNUITY......................................16
GENERAL PROVISIONS............................................................16
THE CONTRACT.........................................................16
NON-PARTICIPATING IN SURPLUS.........................................16
MINIMUM VALUES......................................................16
INCONTESTABILITY.....................................................16
MISSTATEMENT OF AGE OR SEX...........................................17
CONTRACT SETTLEMENT..................................................17
REPORTS..............................................................17
EVIDENCE OF SURVIVAL.................................................17
PROTECTION OF PROCEEDS...............................................17
MODIFICATION OF CONTRACT.............................................17
TABLES.......................................................... 19-22
DEFINITIONS
ACCUMULATION PHASE: The period prior to the Income Date during which you can
make Purchase Payments.
ACCUMULATION UNIT: An accounting unit of measure used to calculate the Contract
Value prior to the Income Date.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax.
This amount is used to determine the death benefit during the Accumulation Phase
or the initial Annuity Payment.
AGE: Age last birthday unless otherwise specified.
ANNUITANT(S): The natural person(s) upon whose continuation of life any Annuity
Payment involving life contingencies depends. You may change the Annuitant(s) at
any time prior to the Income Date unless the Contract Owner is a non-individual.
On or after the Income Date, any reference to Annuitant shall also include any
Joint Annuitant.
ANNUITY OPTION: An arrangement under which Annuity Payments are made under this
Contract.
ANNUITY PAYMENTS: The series of payments made to you or any named payee after
the Income Date under the Annuity Option selected.
ANNUITY PHASE: The period of time beginning on the Income Date during which
Annuity Payments are made.
ANNUITY RESERVE: The assets which support the Annuity Option you have selected
during the Annuity Phase.
ANNUITY UNIT: An accounting unit of measure used to calculate Annuity Payments
beginning on the Income Date.
ASSUMED INVESTMENT RETURN ("AIR"): The investment return upon which the variable
Annuity Payments in the Contract are based.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Service Center.
BENEFICIARY: The person(s) or entity(ies) who will receive any death benefit
payable under this Contract.
COMPANY: Allianz Life Insurance Company of New York.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date of this Contract.
CONTRACT OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in this Contract. If Joint Owners are named, all references to Contract
Owner shall mean the Joint Owners.
CONTRACT VALUE: The dollar value as of any Valuation Date including any bonus
amounts, accumulated under this Contract.
CONTRACT YEAR: Any period of twelve (12) months commencing with the Issue Date
and each Contract Anniversary thereafter.
GENERAL ACCOUNT: Our general investment account which contains all the assets of
the Company with the exception of the Variable Account and other segregated
asset accounts.
INCOME DATE: The date on which Annuity Payments are to begin.
INVESTMENT OPTION(S): Those investments available under the Contract. Current
Investment Options are shown on the Contract Schedule.
ISSUE DATE: The date shown on the Contract Schedule on which the first Contract
Year begins. Contract Anniversaries and Contract Years are measured from the
Issue Date.
JOINT OWNER: If there is more than one Contract Owner, each Contract Owner shall
be a Joint Owner of the Contract. There can only be 2 Joint Owners. Joint Owners
have equal ownership rights and must both authorize any exercising of those
ownership rights unless otherwise allowed by us.
NET ASSET VALUE: The value of a share of the underlying Investment Options, less
any investment management and portfolio administration fees and expenses, as of
the close of trading on a Valuation Date.
PREMIUM TAX: Any premium taxes owed to any governmental entity and assessed
against Purchase Payments, Contract Value, or Annuity Payments.
PURCHASE PAYMENT: A payment made toward this Contract.
SERVICE CENTER: The office indicated on the Contract Schedule of this Contract
to which notices, requests and Purchase Payments must be sent.
VALUATION DATE: The Variable Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period commencing at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account maintained by us in which a portion of our
assets has been allocated for this and certain other contracts. It has been
designated on the Contract Schedule.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: Purchase Payments are payable according to the frequency and
in the amount selected by you. The initial Purchase Payment is due on the Issue
Date. The minimum subsequent Purchase Payment and the maximum total Purchase
Payments allowed are shown on the Contract Schedule. Purchase Payments will not
be accepted after the oldest Contract Owner attains Age 81.
CHANGE IN PURCHASE PAYMENTS: You may elect to increase or decrease or to change
the frequency of Purchase Payments as set forth in the Contract Schedule.
NO DEFAULT: Unless a full withdrawal is made, this Contract remains in force and
will not be in default if no additional Purchase Payments are made.
BONUS: During the Accumulation Phase, a bonus will be credited with each
Purchase Payment made prior to the Contract Owner's attained Age 81. The bonus
will be credited on the date the Purchase Payment is allocated to the Contract.
After a withdrawal of Purchase Payments, a bonus is only applicable to
additional Purchase Payment amounts in excess of any previous Purchase Payments
withdrawn.
The bonus rate is specified in the Contract Schedule. The bonus will be credited
to the Contract under the following terms:
1. All bonus amounts and any gains and losses attributable to such amounts
shall be treated as earnings under the Contract.
2. All gains and losses attributable to bonus amounts and the bonus are part
of the Contract Value.
ALLOCATION OF PURCHASE PAYMENTS AND BONUS AMOUNTS: Purchase Payments and bonus
amounts are allocated to one or more of the Investment Options in accordance
with your selection. The allocation of the initial Purchase Payment and bonus
amount is made in accordance with your selection made at the Issue Date. Unless
you inform us otherwise, subsequent Purchase Payments and bonus amounts are
allocated in the same manner as the initial Purchase Payment. However, the
Company reserves the right to allocate the initial Purchase Payment and bonus
amounts to the Money Market Investment Option, until the expiration of the Right
to Examine period.
During the Right to Examine period, however, bonus amounts will not be included
in the refund amount. All gains and losses attributable to the bonus amounts
will be included in the refund amount.
All allocations of Purchase Payments are subject to the Allocation Guidelines
shown on the Contract Schedule. We guarantee that you will be allowed to select
at least ten Investment Options for allocation of Purchase Payments. This number
will not decrease after the Issue Date. You will be allowed to choose at least
this number of Investment Options from the Investment Options specified in the
Contract Schedule and in the application unless Investment Options are
eliminated or substituted.
VARIABLE ACCOUNT
THE VARIABLE ACCOUNT: The Variable Account is designated on the Contract
Schedule. It consists of assets we have set aside and have kept separate from
the rest of our assets and those of our other separate accounts. The assets of
the Variable Account, equal to reserves and other liabilities of your Contract
and those of other Contract Owners, will not be charged with liabilities arising
out of any other business we may conduct.
The Variable Account assets are divided into sub-accounts. Each sub-account
invests exclusively in one Investment Option. The Investment Options are shown
on the Contract Schedule. We may add additional Investment Options to those
shown. You may be permitted to transfer your Contract Value or allocate Purchase
Payments to the additional Investment Options.
Should the shares of any Investment Option become unavailable for investment by
the Variable Account, or our Board of Directors deems further investment in the
shares inappropriate, we may limit further purchase of such shares or substitute
shares of another Investment Option for shares already purchased. No such
limitations will be imposed or substitutions made unless prior approval is
obtained from the New York State Insurance Department.
VALUATION OF ASSETS: Assets of each Investment Option will be valued at their
Net Asset Value on each Valuation Date.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the sub-accounts of the Variable Account as a
result of Purchase Payments, withdrawals, transfers, or fees and charges. We
will determine the number of Accumulation Units of a sub-account purchased or
canceled. This will be done by dividing the amount allocated to (or the amount
withdrawn from) the sub-account by the dollar value of one Accumulation Unit of
the sub-account as of the end of the Valuation Period during which the
transaction is processed at the Service Center. Purchase Payments, withdrawals
and transfers or fees and charges from or to a sub-account will result in the
addition of or the cancellation of Accumulation Units in a sub-account.
ACCUMULATION UNIT VALUE: The Accumulation Unit value for each sub-account was
initially arbitrarily set. Subsequent Accumulation Unit values for each
sub-account are determined by multiplying the Accumulation Unit value for the
immediately preceding Valuation Period by the net investment factor for the
sub-account for the current period.
The Accumulation Unit value may increase or decrease from Valuation Period to
Valuation Period.
NET INVESTMENT FACTOR: The net investment factor for each sub-account is
determined by dividing A by B and multiplying by (1 - C) where:
A is the value per share of the sub-account at the end of the
current Valuation Period;
B is the value per share of the sub-account for the immediately
preceding Valuation Period.
C is (i) the Valuation Period equivalent of the mortality and
expense risk charge, which is shown on the Contract Schedule;
plus
(ii) a charge factor, if any, for any taxes or any tax reserve
we have established as a result of the operation or
maintenance of the sub-account.
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, we deduct a mortality
and expense risk charge from the Contract Value in the Variable Account which is
equal, on an annual basis, to the amount shown on the Contract Schedule. The
mortality and expense risk charge compensates the Company for assuming the
mortality and expense risks under this Contract.
MORTALITY AND EXPENSE GUARANTEE: We guarantee that the dollar amount of each
Annuity Payment after the first will not be affected by variations in mortality
or expense experience.
CONTRACT VALUE
The Contract Value in the Variable Account for any Valuation Period is equal to
the total dollar value accumulated under this Contract in all of the Investment
Options. The Contract Value in a sub-account of the Variable Account is
determined by multiplying the number of Accumulation Units by the Accumulation
Unit value. Purchase Payments, withdrawals and transfers from or to a
sub-account will result in the addition of or the cancellation of Accumulation
Units in a sub-account.
CONTRACT MAINTENANCE CHARGE
We deduct an annual contract maintenance charge shown on the Contract Schedule.
Prior to the Income Date, this will be deducted from the Contract Value. The
number of Accumulation Units to be canceled from each applicable sub-account is
in the ratio that the value of each sub-account bears to the total Contract
Value. After the Income Date, the contract maintenance charge is deducted from
the Annuity Payments.
TRANSFERS
You may transfer all or a part of your interest in an Investment Option to
another Investment Option. We reserve the right to charge for transfers if there
are more than the number of free transfers shown on the Contract Schedule.
Pre-scheduled transfer programs may be available.
All transfers are subject to the following:
1. The deduction of any transfer fee that may be imposed as shown on the
Contract Schedule. The transfer fee will be deducted from the Investment
Option from which the transfer is made. If the entire amount in the
Investment Option is transferred, then the transfer fee will be deducted
from the amount transferred. If there are multiple source Investment
Options, it will be treated as a single transfer. Any transfer fee will be
deducted proportionally from the source Investment Options if less than the
entire amount in the Investment Option is transferred.
2. We reserve the right to limit transfers until the expiration of the Right
to Examine period.
3. During the Accumulation Phase, no transfer will be effective within seven
calendar days prior to the date on which the first Annuity Payment is due.
4. Any transfer direction must clearly specify:
a. the amount which is to be transferred; and
b. the Investment Options which are to be affected.
5. After the Income Date, during the Annuity Phase, transfers may not be
made from a fixed Annuity Option to a variable Annuity Option.
6. After the Income Date, during the Annuity Phase, you can make at least one
transfer from a variable Annuity Option to a fixed Annuity Option. The
number of Annuity Units canceled from the variable Annuity Option will be
equal in value to the amount of the Annuity Reserve transferred out of the
Variable Account. The Annuity Reserve transferred out of the Variable
Account is defined as the present value of the current variable payment
discounted with mortality at the Assumed Investment Return. The amount
transferred will purchase fixed Annuity Payments at current payout rates
under the Annuity Option in effect and based on the Age and sex of the
Annuitant, (where allowed), at the time of the transfer.
7. Restrictions may be applied in any manner reasonably designed to prevent
any use of the transfer right which we consider to be part of a market
timing program. A market timing program is one where transfers are made to
or from Investment Options in anticipation of expected future changes in
the performance of the Investment Options. Market timing may be
characterized by frequent or large trades or a grouping of trades for
multiple Contract Owners.
A modification could be applied to transfers to or from one or more of the
Investment Options, 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 a registered representative on
behalf of more than one Contract Owner; or
c. limiting the dollar amount that may be transferred between the
Investment Options by a Contract Owner at any one time.
If you elect to use this transfer privilege, we will not be liable for transfers
made in accordance with your instructions. All amounts and Accumulation Units
will be determined as of the end of the Valuation Period during which the
request for transfer is received at the Service Center.
WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Phase, you may, upon Authorized Request,
make a full or partial withdrawal of the Contract Value. Withdrawals will result
in the cancellation of Accumulation Units from each sub-account in the ratio
that the value of each sub-account bears to the total Contract Value. You must
specify, by Authorized Request, which Accumulation Units are to be canceled if
other than the above mentioned method of cancellation is desired.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
WITHDRAWAL CHARGE: Upon a full or partial withdrawal of this Contract, a
withdrawal charge as set forth on the Contract Schedule may be assessed. Under
certain circumstances, we allow withdrawals without the withdrawal charge, as
set forth in the Contract Schedule. The Company will not assess the withdrawal
charge on any payments paid out as Annuity Payments or as death benefits.
PROCEEDS PAYABLE ON DEATH
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PHASE: Upon the death of the
Contract Owner, or any Joint Owner, during the Accumulation Phase, the death
benefit will be paid to the Beneficiary(ies) designated by the Contract Owner.
Upon the death of a Joint Owner, the surviving Joint Owner, if any, will be
treated as the primary Beneficiary. Any other Beneficiary designation on record
at the time of death will be treated as a contingent Beneficiary. If the
Contract is owned by a non-individual, the death benefit will be paid upon the
death of an Annuitant.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE: The death benefit will be
the Adjusted Contract Value determined as of the end of the Valuation Period
during which the Company receives both due proof of death and an election for
the payment method.
Any part of the death benefit amount that had been invested in the Variable
Account remains in the Variable Account until distribution begins. From the time
the death benefit is determined until complete distribution is made, any amount
in the Variable Account will be subject to investment risk, which is borne by
the Beneficiary.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PHASE: If the Owner has not
previously designated a death benefit option, a Beneficiary must request that
the death benefit be paid under one of the death benefit options below.
If the Beneficiary is the spouse of the Contract Owner, he or she may elect to
continue the Contract in his or her own name and exercise all the Contract
Owner's rights under the Contract. In this event, the Contract Value for the
Valuation Period during which this election is implemented will be adjusted to
equal the death benefit.
Option A - lump sum payment of the death benefit. The contract
maintenance charge will not be deducted at the time of distribution,
if the distribution is due to death; or
Option B - the payment of the entire death benefit within 5 years of
the date of the death of the Contract Owner or any Joint Owner. The
full contract maintenance charge is assessed each Beneficiary on each
Contract Anniversary; or
Option C - payment of the death benefit under an Annuity Option over
the lifetime of the Beneficiary or over a period not extending beyond
the life expectancy of the Beneficiary with distribution beginning
within one year of the date of death of the Contract Owner or any
Joint Owner. The full contract maintenance charge is assessed to each
Beneficiary.
Any portion of the death benefit not applied under Option C within one year of
the date of the Contract Owner's death, must be distributed within five years of
the date of death.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the valid election, including any required
governmental forms, unless the Suspension or Deferral of Payments Provision is
in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period after the day on which such lump sum first became payable
to the Company.
DEATH OF CONTRACT OWNER DURING THE ANNUITY PHASE: If you, or any Joint Owner,
dies during the Annuity Phase, and you are not an Annuitant, any remaining
payments under the Annuity Option elected will continue at least as rapidly as
under the method of distribution in effect at such Contract Owner's death. Upon
your death during the Annuity Phase, the Beneficiary becomes the Contract Owner.
DEATH OF ANNUITANT: Upon the death of an Annuitant, (or death of both Joint
Annuitants), who is not the Contract Owner, during the Accumulation Phase, you
will become the Annuitant, unless you designate another Annuitant within 30 days
of the death of the Annuitant. If the Contract Owner is a non-individual, the
death of an Annuitant will be treated as the death of the Contract Owner and a
new Annuitant may not be designated.
Upon the death of the Annuitant during the Annuity Phase, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death and
payment election and any required governmental forms before any death benefit is
paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the
finding of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments. If there is a delay in the payment of death
benefits, we will pay interest on death benefits from date of death, in
accordance with New York Insurance Law Section 3214.
BENEFICIARY: The Beneficiary designation in effect on the Issue Date will remain
in effect until changed. The Beneficiary is entitled to receive the benefits to
be paid at your death.
Unless you provide otherwise, the death benefit will be paid in equal shares to
the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive your death and/or the
Annuitant's death, as applicable; or if there are none,
2. to the contingent Beneficiary(ies) who survive your death and/or
the Annuitant's death, as applicable; or if there are none,
3. to your estate.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), you may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Authorized Request. The change will
take effect as of the date the Authorized Request is signed. If the Authorized
Request reaches our Service Center after the Contract Owner dies, but before any
payment is made, the change will be valid. Such changes will be effective on the
date the Authorized Request is signed subject to any actions taken by the
insurer prior to receipt of the Authorized Request.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange is closed (other than customary
weekend and holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities
held in the Variable Account is not reasonably practicable or it
is not reasonably practicable to determine the value of the
Variable Account's net assets; or
4. during any other period when the Securities and Exchange
Commission, by order, so permits for the protection of Contract
Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS
CONTRACT OWNER: As the Contract Owner you have all the interests and rights
under this Contract. The Contract Owner is the person designated as such on the
Issue Date, unless changed.
You may change Owners of the Contract at any time by Authorized Request subject
to our approval. A change of Contract Owner will automatically revoke any prior
designation of Contract Owner. Upon our approval, the change will become
effective on the date the Authorized Request is signed subject to any actions
taken by the insurer prior to receipt of the Authorized Request. We will not be
responsible for any tax consequences of any such change.
JOINT OWNER: A Contract may be owned by Joint Owners (maximum of two). Upon the
death of either Joint Owner, the surviving Joint Owner, if any, will be the
primary Beneficiary. Any other Beneficiary designation will be treated as a
contingent Beneficiary unless otherwise indicated in an Authorized Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by you subject to our underwriting rules
then in effect. The Annuitant may not be changed in a Contract which is owned by
a non-individual.
ASSIGNMENT OF A CONTRACT: An Authorized Request specifying the terms of an
assignment of a Contract must be provided to the Service Center. We will not be
liable for any payment made or action taken before we record the assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent.
If the Contract is assigned, your rights may only be exercised with the consent
of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Income Date, the Adjusted Contract Value will be applied to the
current purchase rates under the Annuity Option you have selected to provide you
with Annuity Payments.
You may elect to have the Adjusted Contract Value applied to provide a fixed
annuity, a variable annuity or a combination fixed and variable annuity.
If a combination is elected, you must specify what part of the Adjusted Contract
Value is to be applied to the fixed and variable Annuity Options. If you select
a fixed annuity, the Adjusted Contract Value is allocated to the General Account
and the annuity is paid as a fixed annuity. If you select a variable annuity,
the Adjusted Contract Value will be allocated to the Investment Options of the
Variable Account in accordance with your selection, and the annuity will be paid
as a variable annuity.
Unless you designate another payee, you will be the payee of the Annuity
Payments. The Adjusted Contract Value will be applied to the applicable annuity
rate based upon the Annuity Option you have selected. The Annuity Payments will
be at least as favorable as those that would be provided by the application of
the Adjusted Contract Value to purchase any single premium immediate annuity
contract offered by us at the time for the same class of Annuitants.
We may offer more favorable rates than those guaranteed here at the time your
first Annuity Payment is calculated. Annuity Payments will depend on the Age
and, where permitted, sex of the Annuitant.
If Annuity Payments amount to less than $20, we may change the frequency of the
payments. We will not allow amounts less than $2,000 to be applied under any
Annuity Payment Option. If the Adjusted Contract Value is less than $2,000, we
will pay that amount to you.
FIXED ANNUITY: You may elect to have the Adjusted Contract Value applied to
provide a fixed annuity. The dollar amount of each fixed Annuity Payment is
guaranteed to be at least an amount equal to the Adjusted Contract Value,
divided first by $1000 and then multiplied by the appropriate Annuity Payment
amount for each $1000 of value for the Annuity Option selected. The guaranteed
rates, as set forth in the tables at the end of the Contract, are based on an
interest rate of 2 1/2% per year and the 1983(a) Individual Annuity Mortality
Table with mortality improvement projected 30 years using Mortality Projection
Scale G.
VARIABLE ANNUITY: You may elect to have the Adjusted Contract Value applied to
provide a variable annuity. Variable Annuity Payments reflect the investment
performance of the Variable Account in accordance with the allocation of the
Adjusted Contract Value to the sub-accounts during the Annuity Phase. Variable
Annuity Payments are not guaranteed as to dollar amount.
On the Income Date, Annuity Units will be purchased as follows:
The first Annuity Payment is equal to the Adjusted Contract Value, divided first
by $1000 and then multiplied by the appropriate Annuity Payment amount for each
$1000 of value for the Annuity Option selected as set forth in the table at the
end of the Contract. These rates are based on the specified Assumed Investment
Return and the 1983(a) Individual Annuity Mortality Table with mortality
improvement projected 30 years using Mortality Projection Scale G. In each
sub-account, the number of Annuity Units is determined by dividing the amount of
the initial Annuity Payment determined for each sub-account by the Annuity Unit
value on the Income Date. Thereafter, the number of Annuity Units in each
sub-account remains unchanged unless you elect to transfer between sub-accounts.
All calculations will appropriately reflect the Annuity Payment frequency
selected.
On each subsequent Annuity Payment date, the total Annuity Payment is the sum of
the Annuity Payments for each sub-account. The Annuity Payment in each
sub-account is determined by multiplying the number of Annuity Units then
allocated to such sub-account by the Annuity Unit value for that sub-account.
On each subsequent Valuation Date, the value of an Annuity Unit is determined in
the following way:
First: The net investment factor is determined as described under "Variable
Account - net investment factor" above.
Second: The value of an Annuity Unit for a Valuation Period is equal to:
a. the value of the Annuity Unit for the immediately preceding
Valuation Period;
b. multiplied by the net investment factor for the current Valuation
Period;
c. divided by the assumed net investment factor (see below) for the
Valuation Period.
The assumed net investment factor is equal to one plus the Assumed Investment
Return which is used in determining the basis for the purchase of an Annuity,
adjusted to reflect the particular Valuation Period. The Assumed Investment
Return that you can select is either 3% or 4.5%.
INCOME DATE: Your Income Date is shown in the Contract Schedule. It is the date
the Annuity Payments are to begin. You select an Income Date at the time of
issue. The Income Date must always be the first day of a calendar month. The
earliest Income Date you can select is a date that is thirteen months after the
Issue Date. The latest Income Date you can select is the first day of the first
calendar month following the Annuitant's 90th birthday. You may, at any time
prior to the Income Date, change the Income Date by Authorized Request 30 days
in advance.
SELECTION OF AN ANNUITY OPTION: You can select an Annuity Option by Authorized
Request. You may, at any time prior to 30 days in advance of the Income Date, by
Authorized Request, select and/or change the Annuity Option.
DEFAULT ANNUITY OPTION: If no Annuity Option is selected, Option 2, which is a
life annuity with period certain, 60 Monthly Payments Guaranteed, will be
automatically applied.
ANNUITY OPTIONS: This Contract provides for Annuity Payments under one of the
Annuity Options described below. Any other Annuity Payment plan that is
acceptable to us may be selected.
OPTION 1 - LIFE ANNUITY. We will make monthly Annuity Payments during the life
of the Annuitant and ceasing with the last Annuity Payment due prior to the
Annuitant's death.
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15, OR 20 YEARS
GUARANTEED. We will make monthly Annuity Payments during the life of the
Annuitant with a guarantee that if at the Annuitant's death there have been
fewer than 60, 120, 180, or 240 monthly Annuity Payments made as selected,
monthly Annuity Payments will continue for the remainder of the guaranteed
period. Alternatively, the Contract Owner may elect to receive a lump-sum
payment equal to the present value of the guaranteed monthly Annuity Payments
remaining, as of the date proof of the Annuitant's death is received at the
Service Center, commuted at an appropriate rate as defined below. Proof of the
Annuitant's death and return of the Contract are required prior to the payment
of any commuted values. For a fixed Annuity Option, the lump-sum payment
alternative is not available. For a variable Annuity Option, the commutation
rate will be the Assumed Investment Return.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. We will make monthly Annuity
Payments during the joint lifetime of the Annuitant and the Joint Annuitant.
Upon the death of one Annuitant, Annuity Payments will continue to be paid
during the remaining lifetime of the surviving Joint Annuitant at a level of
100%, 75% or 50% of the previous level, as selected. Monthly Annuity Payments
cease with the final Annuity Payment due prior to the last survivor's death.
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15,
0R 20 YEARS GUARANTEED. We will make monthly Annuity Payments during the joint
lifetime of the Annuitant and the Joint Annuitant. Monthly Annuity Payments will
continue to be paid during the remaining lifetime of the Joint Annuitant at 100%
of the previous level. The Company guarantees that if at the last death of the
Annuitant and the Joint Annuitant, there have been fewer than 60, 120, 180, or
240 monthly Annuity Payments made as selected, monthly Annuity Payments will
continue to be made for the remainder of the guaranteed period. Alternatively,
the Contract Owner may elect to receive a lump-sum payment equal to the present
value of the guaranteed monthly Annuity Payments remaining, as of the date proof
of the Annuitant's and Joint Annuitant's death is received at the Service
Center, commuted at an appropriate rate as defined below. Proof of death of the
Annuitant and Joint Annuitant and return of the Contract are required prior to
the payment of any commuted values. For a fixed Annuity Option, the lump-sum
payment alternative is not available. For a variable Annuity Option, the
commutation rate will be the Assumed Investment Return.
OPTION 5 - REFUND LIFE ANNUITY. We will make monthly Annuity Payments during the
lifetime of the Annuitant ceasing with the last Annuity Payment due prior to the
Annuitant's death with a guarantee that after the Annuitant's death, you may
receive a refund. For a fixed Annuity Option, the amount of the refund will be
any excess of the Adjusted Contract Value applied under this Option over the sum
of all Annuity Payments made under this Option. For a variable Annuity Option,
the amount of the refund will depend on the current Investment Option allocation
and will be the sum of refund amounts attributable to each Investment Option.
The refund amount for a given Investment Option is calculated using the
following formula:
(1) x {[(2) x (3) x (4)/(5)] - [(4) x (6)]}
where:
--------------------------------------------------------------------------------
(1) = Annuity Unit value of the given sub-account when due proof of the
Annuitant's death is received at the Service Center.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
(2) = The amount available for Annuity Payments on the Income Date.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
(3) = Allocation percentage in the given sub-account (in decimal form) when
claim proofs are received.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
(4) = Current number of Annuity Units used in determining each Annuity
Payment attributable to the given sub-account.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
(5) = Dollar value of first Annuity Payment.
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
(6) = Number of Annuity Payments made since the Income Date.
--------------------------------------------------------------------------------
This calculation will be based upon the allocation of Annuity Units actually
in-force at the time claim proofs are received at the Service Center. There will
be no refund paid if the total refund determined using the above calculations is
less than or equal to zero.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, and any attached
application endorsements or riders. This Contract may be changed or altered only
by our President or Secretary. Any change, modification or waiver must be made
in writing.
NON-PARTICIPATING IN SURPLUS: This Contract does not share in any distribution
of our profits or surplus.
MINIMUM VALUES: The minimum values for any paid-up annuity, withdrawal value or
death benefit available under the Contract are not less than those required by
the state where the Contract is delivered.
INCONTESTABILITY: We will not contest this Contract from its Issue Date.
MISSTATEMENT OF AGE OR SEX: We may require proof of Age of the Annuitant before
making any life contingent Annuity Payment provided for by this Contract. If the
Age or sex of the Annuitant has been misstated, the amount payable will be the
Adjusted Contract Value that would have been provided at the true Age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment, and overpayments will be deducted from the future
Annuity Payments until the total is repaid. There is no interest rate used in
the calculation of the adjustments for underpayments and overpayments.
CONTRACT SETTLEMENT: This Contract must be returned to us upon any settlement.
Prior to any settlement as a death claim, due proof of death must be submitted
to us. Any paid-up annuity, cash withdrawal or death benefit that may be
available is not less than the minimum benefit required by any statute of the
state in which the contract is delivered.
REPORTS: We will furnish you with a report showing the number of Accumulation
Units credited to the Contract, the dollar value of each Accumulation Unit, the
Contract Value, the Adjusted Contract Value, the death benefit, the available
cash withdrawal and any applicable withdrawal charges, transfer fees, and the
contract maintenance charge.
The report will be sent to you at least once each calendar year. This report
will be sent to your last known address.
EVIDENCE OF SURVIVAL: Where any benefits under this Contract are contingent upon
the recipient being alive on a given date, we may require proof satisfactory to
us that the condition has been met.
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under this Contract before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
MODIFICATION OF CONTRACT: This Contract may not be modified by us without your
consent except as may be required by applicable law.
---------------------------------------------------------------------------------------------------------------------------------
Guaranteed Monthly Payments Per $1,000 of Proceeds
---------------------------------------------------------------------------------------------------------------------------------
Fixed Payouts
---------------------------------------------------------------------------------------------------------------------------------
Age of Annuitant Option 2
---------------------------------------------------------------------------------------------
Nearest Birthday Option 1 5 Years 10 Years 15 Years 20 Years Option 5
When First Payment Minimum Minimum Minimum Minimum
---------------------------------------------------------------------------------------------
Is Made M F M F M F M F M F M F
---------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
30 2.85 2.72 2.85 2.72 2.84 2.72 2.84 2.71 2.84 2.71 2.81 2.70
31 2.87 2.74 2.87 2.74 2.87 2.74 2.87 2.74 2.86 2.73 2.84 2.72
32 2.90 2.76 2.90 2.76 2.90 2.76 2.89 2.76 2.89 2.75 2.86 2.74
33 2.93 2.78 2.93 2.78 2.92 2.78 2.92 2.78 2.91 2.78 2.89 2.76
34 2.96 2.81 2.96 2.81 2.95 2.81 2.95 2.80 2.94 2.80 2.91 2.79
35 2.99 2.83 2.99 2.83 2.98 2.83 2.98 2.83 2.97 2.82 2.94 2.81
36 3.02 2.86 3.02 2.86 3.02 2.86 3.01 2.85 3.00 2.85 2.97 2.83
37 3.05 2.88 3.05 2.88 3.05 2.88 3.04 2.88 3.03 2.88 3.00 2.86
38 3.09 2.91 3.09 2.91 3.09 2.91 3.08 2.91 3.07 2.90 3.03 2.89
39 3.13 2.94 3.13 2.94 3.12 2.94 3.11 2.94 3.10 2.93 3.06 2.91
40 3.17 2.97 3.16 2.97 3.16 2.97 3.15 2.97 3.14 2.96 3.10 2.94
41 3.21 3.01 3.21 3.01 3.20 3.00 3.19 3.00 3.17 2.99 3.13 2.97
42 3.25 3.04 3.25 3.04 3.24 3.04 3.23 3.03 3.21 3.03 3.17 3.00
43 3.29 3.08 3.29 3.08 3.29 3.07 3.27 3.07 3.25 3.06 3.20 3.03
44 3.34 3.11 3.34 3.11 3.33 3.11 3.32 3.10 3.29 3.09 3.24 3.07
45 3.39 3.15 3.39 3.15 3.38 3.15 3.36 3.14 3.34 3.13 3.28 3.10
46 3.44 3.19 3.44 3.19 3.43 3.19 3.41 3.18 3.38 3.17 3.32 3.14
47 3.49 3.23 3.49 3.23 3.48 3.23 3.46 3.22 3.43 3.21 3.37 3.17
48 3.55 3.28 3.55 3.28 3.53 3.27 3.51 3.26 3.48 3.25 3.41 3.21
49 3.61 3.33 3.60 3.32 3.59 3.32 3.57 3.31 3.53 3.29 3.46 3.25
50 3.67 3.38 3.67 3.37 3.65 3.37 3.62 3.36 3.58 3.34 3.51 3.29
51 3.73 3.43 3.73 3.43 3.71 3.42 3.68 3.41 3.63 3.38 3.56 3.34
52 3.80 3.48 3.80 3.48 3.78 3.47 3.74 3.46 3.69 3.43 3.61 3.39
53 3.87 3.54 3.87 3.54 3.84 3.53 3.80 3.51 3.74 3.48 3.67 3.43
54 3.95 3.60 3.94 3.60 3.92 3.59 3.87 3.57 3.80 3.54 3.73 3.48
55 4.03 3.66 4.02 3.66 3.99 3.65 3.94 3.63 3.86 3.59 3.79 3.54
56 4.11 3.73 4.10 3.72 4.07 3.71 4.01 3.69 3.92 3.65 3.85 3.59
57 4.20 3.80 4.19 3.79 4.15 3.78 4.09 3.75 3.99 3.71 3.92 3.65
58 4.29 3.87 4.28 3.87 4.24 3.85 4.17 3.82 4.05 3.77 3.99 3.71
59 4.39 3.95 4.38 3.95 4.33 3.93 4.25 3.89 4.12 3.83 4.06 3.77
60 4.50 4.03 4.48 4.03 4.43 4.01 4.33 3.96 4.18 3.90 4.13 3.84
61 4.61 4.12 4.59 4.12 4.53 4.09 4.42 4.04 4.25 3.96 4.21 3.91
62 4.73 4.22 4.71 4.21 4.64 4.18 4.51 4.12 4.32 4.03 4.29 3.98
63 4.86 4.32 4.83 4.31 4.75 4.27 4.60 4.21 4.39 4.10 4.38 4.06
64 4.99 4.42 4.97 4.41 4.87 4.37 4.70 4.30 4.45 4.18 4.47 4.14
65 5.14 4.54 5.11 4.52 5.00 4.48 4.80 4.39 4.52 4.25 4.56 4.22
66 5.30 4.66 5.26 4.64 5.13 4.59 4.90 4.49 4.59 4.32 4.66 4.31
67 5.46 4.78 5.42 4.77 5.26 4.71 5.00 4.59 4.65 4.40 4.76 4.40
68 5.64 4.92 5.58 4.90 5.40 4.83 5.11 4.69 4.72 4.47 4.87 4.50
69 5.83 5.07 5.76 5.05 5.55 4.96 5.21 4.80 4.78 4.55 4.99 4.60
70 6.03 5.23 5.95 5.20 5.70 5.10 5.31 4.91 4.83 4.62 5.11 4.72
71 6.24 5.40 6.15 5.37 5.86 5.25 5.42 5.02 4.89 4.69 5.23 4.83
72 6.47 5.58 6.36 5.54 6.02 5.40 5.52 5.14 4.94 4.76 5.36 4.95
73 6.71 5.78 6.58 5.73 6.19 5.56 5.62 5.25 4.99 4.83 5.49 5.08
74 6.96 6.00 6.81 5.94 6.36 5.73 5.72 5.37 5.03 4.89 5.64 5.21
75 7.23 6.23 7.05 6.16 6.53 5.91 5.81 5.49 5.07 4.95 5.79 5.35
76 7.53 6.48 7.31 6.39 6.71 6.09 5.91 5.60 5.11 5.00 5.94 5.50
77 7.84 6.75 7.59 6.64 6.89 6.28 5.99 5.71 5.14 5.05 6.11 5.66
78 8.18 7.04 7.87 6.90 7.07 6.48 6.08 5.82 5.17 5.09 6.28 5.83
79 8.54 7.35 8.18 7.18 7.25 6.68 6.16 5.93 5.19 5.13 6.47 6.00
80 8.92 7.68 8.49 7.48 7.43 6.88 6.23 6.02 5.21 5.16 6.66 6.18
81 9.34 8.05 8.83 7.80 7.61 7.09 6.29 6.11 5.23 5.19 6.86 6.37
82 9.78 8.45 9.17 8.14 7.78 7.29 6.35 6.20 5.24 5.22 7.07 6.59
83 10.25 8.88 9.53 8.50 7.95 7.49 6.41 6.28 5.25 5.23 7.30 6.80
84 10.76 9.34 9.91 8.88 8.12 7.69 6.46 6.35 5.26 5.25 7.54 7.04
85 11.30 9.85 10.29 9.29 8.27 7.89 6.50 6.41 5.27 5.26 7.79 7.28
86 11.89 10.40 10.70 9.71 8.42 8.08 6.54 6.47 5.27 5.26 8.07 7.54
87 12.52 11.00 11.11 10.14 8.56 8.26 6.57 6.51 5.27 5.27 8.36 7.83
88 13.21 11.66 11.53 10.60 8.70 8.43 6.59 6.55 5.27 5.27 8.68 8.13
89 13.95 12.36 11.97 11.06 8.83 8.59 6.61 6.58 5.27 5.27 9.02 8.45
90 14.75 13.12 12.41 11.52 8.94 8.74 6.62 6.60 5.27 5.27 9.39 8.81
---------------------------------------------------------------------------------------------------------------------------------
Guaranteed Monthly Payments per $1,000 of Proceeds
Fixed Payout
Option 3
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.97 3.07 3.12 3.15 3.16
50 2.69 2.90 3.14 3.37 3.53 3.62 3.65
60 2.71 2.94 3.27 3.67 4.05 4.32 4.45
70 2.71 2.96 3.33 3.87 4.59 5.32 5.78
80 2.71 2.97 3.36 3.98 4.97 6.40 7.81
90 2.72 2.97 3.37 4.02 5.15 7.19 10.23
-------------------------------------------------------------------
Option 4
5 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.97 3.07 3.12 3.15 3.16
50 2.69 2.90 3.14 3.37 3.53 3.62 3.65
60 2.71 2.94 3.27 3.67 4.05 4.31 4.44
70 2.71 2.96 3.33 3.87 4.59 5.31 5.77
80 2.71 2.97 3.36 3.98 4.97 6.38 7.72
90 2.72 2.97 3.37 4.02 5.14 7.13 9.90
-------------------------------------------------------------------
Option 4
10 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.96 3.07 3.12 3.15 3.16
50 2.69 2.90 3.14 3.37 3.53 3.61 3.64
60 2.70 2.94 3.27 3.67 4.05 4.16 4.41
70 2.71 2.96 3.33 3.87 4.58 5.26 5.63
80 2.71 2.97 3.36 3.97 4.93 6.21 7.18
90 2.72 2.97 3.37 4.00 5.08 6.77 8.42
-------------------------------------------------------------------
Option 4
15 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.96 3.07 3.12 3.15 3.15
50 2.69 2.90 3.14 3.37 3.53 3.60 3.62
60 2.70 2.94 3.27 3.66 4.04 4.26 4.33
70 2.71 2.96 3.33 3.86 4.53 5.10 5.30
80 2.71 2.97 3.35 3.94 4.82 5.77 6.20
90 2.71 2.97 3.36 3.96 4.91 6.01 6.58
-------------------------------------------------------------------
Option 4
20 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-------------------------------------------------------------------
30 2.61 2.71 2.77 2.81 2.83 2.84 2.84
40 2.66 2.82 2.96 3.06 3.12 3.14 3.14
50 2.69 2.90 3.14 3.37 3.51 3.57 3.58
60 2.70 2.94 3.26 3.65 3.99 4.13 4.18
70 2.71 2.96 3.32 3.83 4.41 4.77 4.83
80 2.71 2.96 3.34 3.89 4.60 5.11 5.21
90 2.71 2.96 3.34 3.90 4.62 5.16 5.27
-------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
Guaranteed Initial Monthly Payment Per $1,000 of Proceeds
--------------------------------------------------------------------------------------------------------------------------------
Variable Payouts Based on 4.50% AIR
--------------------------------------------------------------------------------------------------------------------------------
Age of Option
Annuitant 2
--------------------------------------------------------------------------
Nearest Option 1 5 Years 10 Years 15 Years 20 Option 5
Birthday years
When First Minimum Minimum Minimum Minimum
Payment
Is Made M F M F M F M F M F M F
--------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------
30 4.12 4.01 4.12 4.01 4.12 4.01 4.11 4.01 4.11 4.00 4.10 4.00
31 4.14 4.03 4.14 4.03 4.14 4.03 4.13 4.02 4.13 4.02 4.12 4.02
32 4.17 4.04 4.16 4.04 4.16 4.04 4.16 4.04 4.15 4.04 4.14 4.03
33 4.19 4.06 4.19 4.06 4.18 4.06 4.18 4.06 4.17 4.05 4.16 4.05
34 4.21 4.08 4.21 4.08 4.21 4.08 4.20 4.08 4.19 4.07 4.19 4.07
35 4.24 4.10 4.24 4.10 4.24 4.10 4.23 4.10 4.22 4.09 4.21 4.09
36 4.27 4.12 4.27 4.12 4.26 4.12 4.25 4.12 4.24 4.11 4.24 4.11
37 4.30 4.14 4.30 4.14 4.29 4.14 4.28 4.14 4.27 4.13 4.26 4.13
38 4.33 4.17 4.33 4.17 4.32 4.16 4.31 4.16 4.30 4.15 4.29 4.15
39 4.36 4.19 4.36 4.19 4.35 4.19 4.34 4.18 4.33 4.18 4.32 4.17
40 4.40 4.22 4.40 4.22 4.39 4.21 4.38 4.21 4.36 4.20 4.35 4.20
41 4.43 4.25 4.43 4.24 4.42 4.24 4.41 4.24 4.39 4.23 4.38 4.22
42 4.47 4.27 4.47 4.27 4.46 4.27 4.44 4.26 4.42 4.25 4.41 4.25
43 4.51 4.30 4.51 4.30 4.50 4.30 4.48 4.29 4.45 4.28 4.45 4.28
44 4.56 4.34 4.55 4.34 4.54 4.33 4.52 4.32 4.49 4.31 4.48 4.30
45 4.60 4.37 4.60 4.37 4.58 4.36 4.56 4.35 4.53 4.34 4.52 4.34
46 4.65 4.41 4.64 4.40 4.63 4.40 4.60 4.39 4.57 4.37 4.56 4.37
47 4.70 4.44 4.69 4.44 4.68 4.44 4.65 4.42 4.61 4.41 4.60 4.40
48 4.75 4.48 4.74 4.48 4.72 4.47 4.69 4.46 4.65 4.44 4.65 4.44
49 4.81 4.53 4.80 4.52 4.78 4.52 4.74 4.50 4.69 4.48 4.69 4.47
50 4.86 4.57 4.86 4.57 4.83 4.56 4.79 4.54 4.74 4.52 4.74 4.51
51 4.92 4.62 4.91 4.61 4.89 4.60 4.84 4.59 4.78 4.56 4.79 4.56
52 4.99 4.67 4.98 4.66 4.95 4.65 4.90 4.63 4.83 4.60 4.85 4.60
53 5.06 4.72 5.04 4.72 5.01 4.70 4.96 4.68 4.88 4.64 4.90 4.64
54 5.13 4.78 5.12 4.77 5.08 4.76 5.02 4.73 4.94 4.69 4.96 4.69
55 5.20 4.83 5.19 4.83 5.15 4.81 5.08 4.78 4.99 4.74 5.02 4.74
56 5.28 4.90 5.27 4.89 5.22 4.87 5.15 4.84 5.04 4.79 5.09 4.80
57 5.37 4.96 5.35 4.96 5.30 4.93 5.22 4.90 5.10 4.84 5.16 4.85
58 5.46 5.03 5.44 5.03 5.39 5.00 5.29 4.96 5.16 4.90 5.23 4.91
59 5.56 5.11 5.54 5.10 5.47 5.07 5.37 5.02 5.22 4.95 5.31 4.98
60 5.66 5.19 5.64 5.18 5.57 5.15 5.45 5.09 5.28 5.01 5.38 5.05
61 5.77 5.27 5.74 5.26 5.66 5.23 5.53 5.16 5.34 5.07 5.47 5.11
62 5.89 5.36 5.86 5.35 5.77 5.31 5.61 5.24 5.40 5.13 5.56 5.19
63 6.02 5.46 5.98 5.44 5.88 5.40 5.70 5.32 5.46 5.20 5.65 5.27
64 6.15 5.56 6.11 5.55 5.99 5.49 5.79 5.40 5.52 5.26 5.75 5.35
65 6.30 5.67 6.25 5.65 6.11 5.59 5.88 5.49 5.58 5.33 5.85 5.44
66 6.45 5.79 6.40 5.77 6.23 5.70 5.97 5.58 5.64 5.40 5.96 5.53
67 6.62 5.92 6.56 5.89 6.37 5.81 6.07 5.67 5.70 5.46 6.07 5.63
68 6.80 6.05 6.72 6.02 6.50 5.93 6.16 5.77 5.75 5.53 6.19 5.74
69 6.99 6.20 6.90 6.16 6.64 6.06 6.26 5.87 5.81 5.60 6.31 5.85
70 7.19 6.36 7.09 6.32 6.79 6.19 6.35 5.97 5.86 5.66 6.44 5.96
71 7.41 6.53 7.28 6.48 6.94 6.33 6.45 6.07 5.91 5.73 6.58 6.09
72 7.63 6.71 7.49 6.66 7.09 6.48 6.54 6.18 5.95 5.79 6.73 6.22
73 7.88 6.91 7.71 6.85 7.25 6.63 6.64 6.29 6.00 5.85 6.87 6.36
74 8.14 7.13 7.94 7.05 7.42 6.80 6.73 6.40 6.03 5.91 7.04 6.51
75 8.41 7.36 8.18 7.26 7.58 6.97 6.81 6.51 6.07 5.96 7.20 6.67
76 8.71 7.61 8.44 7.50 7.75 7.14 6.90 6.61 6.10 6.00 7.38 6.83
77 9.03 7.88 8.71 7.74 7.92 7.33 6.98 6.72 6.13 6.05 7.56 7.00
78 9.37 8.17 8.99 8.00 8.09 7.51 7.05 6.82 6.16 6.09 7.76 7.19
79 9.73 8.49 9.29 8.28 8.26 7.70 7.13 6.91 6.18 6.12 7.97 7.39
80 10.12 8.83 9.60 8.58 8.43 7.90 7.19 7.00 6.20 6.15 8.18 7.59
81 10.54 9.20 9.93 8.90 8.60 8.09 7.25 7.09 6.21 6.18 8.41 7.82
82 10.98 9.60 10.27 9.23 8.76 8.29 7.31 7.16 6.23 6.20 8.66 8.05
83 11.46 10.04 10.62 9.59 8.92 8.48 7.36 7.24 6.24 6.22 8.91 8.29
84 11.97 10.51 10.99 9.97 9.07 8.67 7.41 7.30 6.24 6.23 9.18 8.56
85 12.52 11.02 11.37 10.36 9.22 8.85 7.45 7.36 6.25 6.24 9.47 8.84
86 13.11 11.58 11.76 10.78 9.36 9.03 7.48 7.41 6.25 6.24 9.77 9.13
87 13.75 12.19 12.16 11.21 9.49 9.20 7.51 7.46 6.25 6.25 10.09 9.44
88 14.45 12.86 12.57 11.65 9.62 9.36 7.53 7.49 6.25 6.25 10.43 9.78
89 15.19 13.57 12.99 12.10 9.74 9.52 7.54 7.52 6.25 6.25 10.81 10.13
90 15.99 14.33 13.41 12.55 9.85 9.66 7.56 7.54 6.25 6.25 11.22 10.52
--------------------------------------------------------------------------------------------------------------------------------
Guaranteed Initial Monthly Payments per $1,000 of Proceeds
Variable Payout Based on 4.50% AIR
Option 3
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.12
40 3.96 4.07 4.19 4.28 4.34 4.37 4.39
50 3.98 4.14 4.33 4.54 4.69 4.79 4.84
60 4.00 4.18 4.45 4.80 5.16 5.44 5.59
70 4.00 4.20 4.51 5.00 5.67 6.39 6.90
80 4.01 4.21 4.55 5.11 6.06 7.45 8.88
90 4.01 4.22 4.56 5.16 6.26 8.27 11.28
-----------------------------------------------------------------
Option 4
5 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.12
40 3.96 4.07 4.19 4.28 4.34 4.37 4.39
50 4.14 4.33 4.54 4.69 4.79 4.84 3.98
60 4.00 4.18 4.45 4.80 5.16 5.44 5.58
70 4.00 4.20 4.51 5.00 5.67 6.39 6.87
80 4.01 4.21 4.55 5.11 6.05 7.43 8.78
90 4.01 4.22 4.56 5.16 6.24 8.20 10.90
-----------------------------------------------------------------
Option 4
10 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.12
40 3.96 4.07 4.19 4.28 4.34 4.37 4.39
50 3.98 4.14 4.33 4.53 4.69 4.79 4.82
60 4.00 4.18 4.45 4.80 5.16 5.43 5.54
70 4.00 4.20 4.51 5.00 5.66 6.32 6.71
80 4.01 4.21 4.54 5.10 6.01 7.23 8.18
90 4.01 4.21 4.56 5.14 6.16 7.78 9.35
-----------------------------------------------------------------
Option 4
15 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.11
40 3.96 4.07 4.19 4.28 4.34 4.37 4.37
50 3.98 4.14 4.33 4.53 4.69 4.77 4.79
60 4.00 4.18 4.44 4.79 5.14 5.37 5.44
70 4.00 4.20 4.51 4.98 5.60 6.14 6.34
80 4.01 4.21 4.53 5.07 5.88 6.76 7.17
90 4.01 4.21 4.54 5.09 5.97 6.99 7.52
-----------------------------------------------------------------
Option 4
20 Years Minimum
Female Age 30 40 50 60 70 80 90
Male Age
-----------------------------------------------------------------
30 3.92 3.99 4.04 4.08 4.10 4.11 4.11
40 3.96 4.07 4.19 4.28 4.33 4.35 4.36
50 3.98 4.14 4.33 4.53 4.67 4.73 4.74
60 3.99 4.17 4.44 4.77 5.09 5.25 5.28
70 4.00 4.19 4.50 4.94 5.46 5.86 5.80
80 4.00 4.20 4.52 5.00 5.64 6.37 6.20
90 4.00 4.20 4.52 5.01 5.66 6.15 6.25
-----------------------------------------------------------------
INDIVIDUAL FLEXIBLE PAYMENT VARIABLE ANNUITY
NON-PARTICIPATING
