Exhibit 99.(4)(a)
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
Home Office: Dallas, Texas 75201
Administrative Office: 0000 Xxxxxxxxx Xxxxxx Xxxxx, Xxxxx 0000, Xxxxxxxxxx,
Xxxxxxxx 00000
Telephone: 0-000-000-0000
A Stock Company
Jefferson National Life Insurance Company ("the Company") agrees with the
Contract Owner to provide benefits to the Owner, subject to the provisions set
forth in this Contract and in consideration of the Purchase Payments received
from the Owner.
RIGHT OF RETURN: WITHIN 10 DAYS OF THE RECEIPT OF THIS CONTRACT BY THE OWNER, IT
MAY BE RETURNED BY DELIVERING OR MAILING IT TO THE COMPANY AT ITS ADMINISTRATIVE
OFFICE. WHEN THE CONTRACT IS RECEIVED BY THE COMPANY, IT WILL BE VOIDED AS IF IT
HAD NEVER BEEN IN FORCE. THE COMPANY WILL REFUND THE CONTRACT VALUE COMPUTED AT
THE END OF THE VALUATION PERIOD DURING WHICH THE CONTRACT IS RECEIVED BY THE
COMPANY AT ITS ADMINISTRATIVE OFFICE.
THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY
READ YOUR CONTRACT CAREFULLY
Signed for the Company at its Administrative Office in Louisville, Kentucky, on
the Contract date.
/s/ Xxxxx Xxxxxx Xxxxx Xxxxxxx
Secretary President
Xxxxx Xxxxxx Xxxxx Xxxxxxx
INDIVIDUAL AND VARIABLE
ANNUITY CONTRRACT
NON-PARTICIPATING
WITHDRAWAL VALUES AND DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE VALUES MAY INCREASE OR DECREASE
BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED IN THIS CONTRACT
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TABLE OF CONTENTS
CONTRACT SCHEDULE 4
DEFINITIONS 7
PURCHASE PAYMENTS PROVISIONS 8
PURCHASE PAYMENTS 8
PURCHASE PAYMENTS 8
SEPARATE ACCOUNT PROVISIONS 9
THE SEPARATE ACCOUNT 9
VARIABLE ACCOUNT 9
VALUATION OF ASSETS 9
ACCUMULATION UNITS 9
ACCUMULATION UNIT VALUE 9
MORTALITY AND EXPENSE RISK CHARGE 9
ADMINISTRATION CHARGE 9
DISTRIBUTION EXPENSE CHARGE 9
MVA ACCOUNT PROVISIONS 9
MVA ACCOUNT 9
INTEREST TO BE CREDITED 10
GUARANTEE PERIOD 10
MULTIPLE GUARANTEE PERIODS 10
CHANGE IN GUARANTEED PERIOD 10
MARKET VALUE ADJUSTMENT 10
MVA ACCOUNT VALUES 10
FIXED ACCOUNT PROVISIONS 11
FIXED ACCOUNT VALUES 11
INTEREST TO BE CREDITED 11
CONTRACT VALUE 11
CONTRACT MAINTENANCE CHARGE PROVISIONS 11
DEDUCTION FOR CONTRACT MAINTENANCE CHARGE 11
TRANSFERS 11
TRANSFER DURING THE ACCUMULATION PERIOD 11
TRANSFER DURING THE ANNUITY PERIOD 12
WITHDRAWAL PROVISIONS 12
WITHDRAWALS 12
CONTINGENT DEFERREFD SALES CHARGE 12
WITHDRAWAL CHARGE 12
PROCEEDS PAYABLE ON DEATH 12
DEATH OF OWNER 12
DURING THE ACCUMULATION PERIOD 12
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 12
DEATH BENEFIT OPPTIONS DURING THE ACCUMULATION PERIOD 13
DEATH DURING THE ANNUITY PERIOD 13
DEATH OF ANNUITANT 13
DURING THE ACCUMULATION PERIOD 13
DURING THE ANNUITY PERIOD 13
PAYMENT OF DEATH BENEFIT 13
BENEFICIARY 13
CHANGE OF BENEFICIARY 14
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISONS 14
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISONS 14
OWNER 14
JOINT OWNER 14
ANNUITANT 14
ASSIGNMENT OF A CONTRACT 14
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ANNUITY PROVISIONS 14
GENERAL 14
ANNUITY DATE 15
SELECTION OF AN ANNUITY OPTION 15
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 15
ANNUITY OPTIONS 15
OPTION 1. INCOME FOR SPECIFIED PERIOD 15
OPTION 2. LIFE INCOME 15
OPTION 3. INCOME OF SPECIFIED AMOUNT 15
OPTION 4. JOINT AND SURVIVOR INCOME 15
ANNUITY 15
FIXED ANNUITY 15
VARIABLE ANNUITY 15
ANNUITY UNIT 16
MORTALITY TABLES 16
GENERAL PROVISIONS 17
THE CONTRACT 17
MISSTATEMENT OF AGE 17
INCONTESTABILITY 17
MODIFICATION 17
NON-PARTICIPATING 17
EVIDENCE OF SURVIVAL 17
PROOF OF AGE 17
PROTECTION OF PROCEEDS 17
REPORTS 17
TAXES 17
REGULATORY REQUIREMENTS 17
ANNUITY OPTIONS TABLE 19
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CONTRACT SCHEDULE
OWNER: ((FIRSTNAM))((LASTNAME))
CONTRACT DATE: ((COVEFF))
JOINT OWNER NAME: ((JFIRSTNM))((JLASTNAM))
ANNUITANT: ((AFIRSTNM))((ALASTNAM))
ANNUITY DATE: ((COVEFF))
CONTRACT NUMBER: ((POLNUM))
PURCHASE PAYMENTS:
INITIAL PURCHASE PAYMENT: ((COVPRM))
MINIMINUM SUBSEQUENT PURCHASE $500 ($50 for IRAs & EFTs); or $200
PAYMENT: Monthly for non-qualified Contracts if
the automatic premium check option is
elected.
MAXIMUM TOTAL PURCHASE PAYMENTS: $5,000,000, without prior Company
approval
ALLOCATION GUIDELINES:
1. The Owner can select all investment options, including
Sub-Accounts of the Variable Account, the MVA Account and the
Fixed Account Options. However, Owners are limited to 15
Sub-Accounts at any one time.
2. If the Purchase Payments and forms required to issue a Contract
are in good order, the initial Purchase Payment will be credited
to the Contract within two (2) business days after receipt at the
Administrative Office. Additional Purchase Payments will be
credited to the contract as of the Valuation Period when they are
received.
3. Allocation percentages must be in whole numbers. Each allocation
must be at least 1%.
4. The minimum amount which must be allocated for any Guarantee
Period in the MVA Account is $2,000. The company reserves the
right to change this minimum in the future.
BENEFICIARY:
As designated by the Owner at the Contract Issue Date, unless subsequently
changed.
CONACT MAINTENANCE CHARGE:
The Contract Maintenance Charge is $30 each Contract Year. The Company
reserves the right to change the Contract Maintenance Charge but it will
not exceed $60 per Contract Year. During the Accumulation Period, if the
Contract Value on the Contract Anniversary is at least $50,000, then no
Contract Maintenance Charge will be deducted. During the Accumulation
Period, a total withdrawal is made on other than on a Contract Anniversary
and the Contract Value for the Valuation Period during which the total
withdrawal is made is less than $50,000, the full Contract Maintenance
Charge will be deducted at the time of the total withdrawal. If at
annuitization, the Annuity Date is not the Contract Anniversary and the
Contract Value on the Annuity Date is less than $50,000, then the full
Contract Maintenance Charge will be deducted on the Annuity Date. During
the Annuity Period, no Contract Maintenance Charges will be deducted.
MORTALITY AND EXPENSE RISK CHARGE:
Equal, on an annual basis, to 1.25% of the average daily net asset value of
the Variable Account.
ADMINISTRATIVE CHARGE:
Equal, on an annual basis, to .15% of the average daily net asset value of
the Variable Account. The Company may increase this charge; however, the
maximum Administrative Charge will not exceed .25% of the average daily net
asset value of the Variable Account. In the event of an increase, the
Company will give Owners 90 days prior notice of the increase.
DISTRIBUTION EXPPENSE CHARGE:
NONE
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TRANSFERS:
NUMBER OF TRANSFERS PERMITTED: There are currently no limits on the number
of transfers that can be made during the Accumulation Period. Owners are
permitted two per contract Year during the Annuity Period.
TRANSFER FEE: The Company does not assess a Transfer Fee on one transfer in
a 30-day period during the Accumulation Period or the two transfers
permitted during the Annuity Period. You can transfer the Sub-Accounts at
the least every 30 days. If you transfer more often, you may be assessed a
$25 fee. The Company reserves the right to change the transfer fee. All
reallocations made on a given date count as one transfer. Transfers made at
the end of the Right to Examine Contract period by the Company and any
transfers made pursuant to a pre-approval Dollar Cost Averaging Program or
pursuant to a pre-approved Rebalancing Program will not be counted in
determining the application of the Transfer Fee.
MINIMUM AMOUNT TO BE TRANSFERRED: $500 (from any Sub-Account or any
Guarantee Period of the MVA Account), or the Owner's entire interest in the
Sub-Account or the Guarantee Period; if less. This requirement is waived if
the transfer is pursuant to a pre-approved Dollar Cost Averaging Program or
Rebalancing Program. Transfers from the Fixed Account are limited to 20% of
the Contract Value every six(6) months.
MINIMUM AMOUNT WHICH MUST REMAIN IN EACH ACCOUNT AFTER A TRANSFER: $500 per
Sub-Account or Guarantee Period in the MVA Account; or $0 if the entire
amount in any Sub-Account of the Variable Account, or Guarantee Period in
the MVA account is transferred.
MAXIMUM AMOUNT WHICH CAN BE TRANSFERRED FROM THE FIXED ACCOUNT TO THE
VARIABLE ACCOUNT: NONE
WITHDRAWALS:
CONTIGENT DEFFERRED SALES CHARGE: A Contingent Deferred Sales Charge is
assessed against each Purchase Payment withdrawn and will result in a
reduction un remaining Contract Value. The Purchase Payment is tracked from
its date of receipt and the charges are determined in accordance with the
following:
NUMBER OF YEARS FROM RECEIPT CONTINGENT DEFERRED
OF PURCHASE PAYMENT SALES CHARGE
------------------------------------------------------------------------
1st Year 7%
2nd Year 7%
3rd Year 6%
4th Year 5%
5th Year 4%
6th Year 3%
7th Year 2%
8th Year and Later 0%
Wavier of Contingent Deferred Sales Charge: In every Contract Year, an
amount equal to the greater of: (i) 10% of the Contract Value, on a
non-cumulative basis, (ii) the IRS minimum distribution requirement, if the
Contract was issued as an IRA, or (iii) the total premiums paid that have
been in the Contract more than seven complete years is available free of
Contingent Deferred Sales Charges.
WITHDRAWAL CHARGES: NONE
MINIMUM PARTIAL WITHDRAWAL: $500 from each Sub-Account of the Variable Account,
each Guarantee Period the MVA Account and the Fixed Account. This requirement is
waived if the partial withdrawal is pursuant to the Systematic Withdrawal
Program.
MINIMUM CONTRACT VALUE MUST REMAIN IN CONTRACT AFTER PARTIAL WITHDRAWAL: $ 500.
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN ANY SUB-ACCOUNT OF THE VARIABLE
ACCOUNT AFTER A PARTIAL WITHDRAWAL: $500.
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MAXIMUM AMOUNT WHICH CAN BE WITHDRAWN FROM THE FIXED AND MVA ACCOUNTS: There is
currently no limitation on the maximum amount which can be withdrawn from the
Fixed Account or MVA Account.
SEPARATE ACCOUNTS:
Variable Account:: Jefferson National Life Variable Annuity Account I
for the Variable Annuity portion of the Contract.
And
MVA Account: Jefferson National Life Market Value Adjustment
Account for the portion of the Contract that may be
subject to a Market Value Adjustment.
MVA ACCOUNT:
Minimum Guarantee Interest Rate: 3%
Current MVA Account Guaranteed Period Option and
Credited Interest Rates:
Years
Years
Years
MARKET VALUE ADJUSTMENT FACTOR:
THE MARKET VALUE ADJUSTMENT FACTOR IS EQUAL TO:
(1 + A)
------- (TO THE POWER OF N/365) - 1
(1 + B)
Where: A = the U.S. Treasury rate in effect at the beginning of the
Guarantee Period for the length of the guarantee period
selected.
B = the current U.S. Treasury rate as of the transaction date
plus .005. Treasury rate period is determined by N/365 rounded
to the next highest year.
N = the number of days remaining on the MVA Guarantee Period.
If the Treasury rate is not available for the period, the rate will be
arrived at by interpolation. If no Treasury Rates are available, an Index
will be selected by the Company and approved by the State Insurance
Commissioner.
MVA WAIVER: For withdrawals from MVA Account Guarantee Period Option, after
the first year in such Guarantee Period option, the Owner can make one
withdrawal each Contract Year of up to a total of 10% of each such
Guarantee Period option of the MVA without the Market Value Adjustment.
FIXED ACCOUNT:
Minimum Guarantee Interest Rate: 3 %
Current Interest Rate as of Issue Date:((IRATE1))
RIDERS:
IRA ENDORSEMENT
ADMINISTRATIVE OFFICE:
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
Administrative Office: 0000 Xxxxxxxxx Xxxxxx Xx., Xxxxx 0000
Xxxxxxxxxx, Xxxxxxxx 00000
Telephone: 0-000-000-0000
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DEFINITIONS
ACCOUNT(S): The Fixed Account, the MVA Account and the General Account and/or
one or more of the Sub-Accounts of the Variable Account.
ACCUMULATION PERIOD: The period prior to the Annuity Date during which Purchase
Payments may be made by an Owner.
ACCUMULATION UNIT: A unit of measure used to determine the value of an Owner's
interest in a Sub-Account of the Variable Account during the Accumulation
Period.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax, and
Contract Maintenance Charge plus the applicable Market Value Adjustment which
may be positive or negative. This amount is applied to the applicable Annuity
Tables to determine Annuity Payments.
AGE: The age of any Owner or Annuitant on his/her last birthday. For Joint
Owners, all provisions which are based on age are based on the Age of the older
of the Joint Owners.
ADMINISTRATIVE OFFICE: The office address is indicated on the Contract Schedule
of this Contract to which notices, requests and Purchase Payments must be sent.
All sums payable to the Company under this Contract are payable at the
Administrative Office or an address designated by the Company in writing.
ANNUITANT: The natural person on whose life Annuity Payments are based. On or
after the Annuity Date, the annuitant shall also include any Joint Annuitant.
ANNUITY DATE: The date on which Annuity Payments begin. The Annuity Date is
shown on the Contract Schedule.
ANNUITY OPTIONS: Options available for Annuity Payments.
ANNUITY PAYMENTS: The series of payments made to the Owner or any named payee
after the Annuity Date under the Annuity Option selected.
ANNUITY PERIOD: The period of time beginning with the Annuity Date during which
Annuity Payments are made.
ANNUITY UNIT: An accounting unit of measure used to calculate the amount of
Annuity Payments.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Administrative Office.
BENEFICIARY: The person(s) or entity(ies) who will receive the death benefit
payable under this Contract.
COMPANY: Jefferson National Life Insurance Company.
CONTRACT ANNIVERSARY: An Anniversary of the Contract Issue Date.
CONTRACT ISSUE DATE: The later of the date on the cover of the Contract or the
date Purchase Payments are received. The Contract Issue Date is shown on the
Contract Schedule.
CONTRACT VALUE: The dollar value as of any Valuation Period of all amounts in
the Contract.
CONTRACT WITHDRAWAL VALUE: The Contract Value, less any applicable Premium Tax,
plus any Market Value Adjustment which may be positive or negative, less any
Contingent Deferred Sales Charge and less any applicable Contract Maintenance
Charge.
CONTRACT YEAR: The first Contract year is the annual period which begins on the
Contract Issue Date. Subsequent Contract years begin on each anniversary of the
Contract Issue Date.
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CREDITED INTEREST RATE: The interest rate credited to the Contract by the
Company for any given Guarantee Period in the MVA Account and the Fixed Account.
The Credited Interest Rates for the available Guarantee Periods for the MVA
Account and the Fixed Account are shown on the Contract Schedule.
ELIGIBLE FUND: An investment entity that is made available for this Contract.
FIXED ACCOUNT: An investment option within the General Account.
FIXED ANNUITY: A series of payments made during the Annuity Period which are
guaranteed as to dollar amount by the Company.
GENERAL ACCOUNT: The Company's general investment account which contains all the
assets of the Company except for the Variable Account and other segregated asset
accounts.
GUARANTEE PERIOD: The period for which the credited Interest Xxxx is credited in
the MVA Account. Each deposit or transfer to the MVA Account creates one or more
new Guarantee Period(s). The Guarantee periods selected by the Owner are shown
on the Contract Schedule.
MARKET VALUE ADJUSTMENT: An adjustment to the amount withdrawn or transferred
from an MVA Account prior to the end of the applicable Guarantee Period. The
adjustment reflects the change in the value of the funds withdrawn or
transferred due to the change in the interest rates since the beginning of the
Guarantee Period.
MVA ACCOUNT: A separate account which provides investment options where the
Company guarantees the rate of interest for a specified Guarantee Period and
where withdrawals or transfers may be subject to a Market Value Adjustment.
OWNER: The person(s) who owns the Contract.
PORTFOLIO: A segment of an Eligible Fund which constitutes a separate and
distinct class of shares.
PREMIUM TAX: Any premium taxes payable to any government entity and assessed
against Purchase Payments or Contract Value.
PURCHASE PAYMENT: A payment made by or for an Owner with respect to this
Contract. All payments must be made payable to the Company.
SUB-ACCOUNT: Variable Account assets are divided into Sub-Accounts. Assets of
each Sub-Account will be invested in shares of an Eligible Fund or a Portfolio
of an Eligible Fund.
VALUATION DATE: Each day on which the New York Stock Exchange ("NYSE") is open
for business.
VALUATION PERIOD: The period of time beginning at the close of business of the
NYSE on each Valuation Date and ending with the close of business for the next
succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account which provides investment options where the
benefits are variable and are not guaranteed as to dollar amount.
WRITTEN REQUEST: A request in writing, in a form satisfactory to the Company,
which is received by the Administrative Office.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS: The initial Purchase Payment for an Owner is due on the
Contract Issue Date. Subject to the maximum and minimum amounts shown on the
Contract Schedule, the owner may make subsequent Purchase Payments and may
increase or decrease or change the frequency of such payments. The Company
reserves the right to reject any application or Purchase Payment.
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ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to the Fixed
Account and/or to one or more of the MVA Account Guarantee Period options and/or
to one or more Sub-Accounts of the Variable Account in accordance with the
selections made by the Owner. The allocation of the initial Purchase Payment for
an Owner is made in accordance with the selection made by the Owner at the
Contact Issue Date. Unless otherwise changed by the Owner, subsequent Purchase
Payments are allocated to the same manner as the initial Purchase Payment.
Allocation of the Purchase Payments is subject to the Allocation Guidelines
shown on the Contract Schedule. The Company reserves the right to allocate
initial Purchase Payments to the Money Market Sub-Account (except for any
amounts allocated to the Fixed Account and/or MVA Account) until the expiration
of the Right to Examine period.
SEPARATE ACCOUNT PROVISIONS
THE SEPARATE ACCOUNTS: The Separate Account consist of assets set aside by the
Company, which are kept separate from that of the general assets and other
separate account assets of the Company.
VARIABLE ACOUNT: The assets of the Variable Account will not be charged with
liabilities arising out of any other business the Company may conduct.
The Variable Account assets are divided into Sub-Accounts. The assets of the
Sub-Accounts are allocated to the Eligible Fund(s) and the Portfolio(s), if any,
within an Eligible Fund become unavailable for investment by the Variable
Account, or the Company's Board of Directors deems further investment in these
shares inappropriate, the Company may limit future purchase of such shares or
substitute shares of Eligible Fund or Portfolio for shares already purchased
under a Contract.
VALUATION OF ASSETS: The assets of the Accounts are valued at their fair market
value in accordance with procedures of the Company.
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. The
Company will determine the number of Accumulation Units of a Sub-Account
purchased or cancelled. 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 the request of the transaction is received at the Administrative Office.
ACCUMIULATION UNIT VALUE: The Accumulation Unit Value of each Sub-Account is
arbitrarily set initially at $10. 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 Net Investment Factor for each Sub-Account is determined by dividing A by B
and subtracting C where:
A is (i) The net asst value per share of the Eligible Fund or Portfolio
of the Eligible Fund held by the Sub-Account at the end of the
current Valuation Period; plus
(ii) any dividend or capital gains per share declared on behalf of
such Eligible Fund or Portfolio that has an ex-divided date
within the current Valuation Period; plus
(iii) a charge factor, if any, for any taxes or any tax reserve
established by the Company as a result of the operation or
maintenance of the Sub-Account.
B is the net asset value per share of the Eligible Fund or Portfolio
held by the Sub-Account for the immediately preceding Valuation
Period.
C is the Valuation Period equivalent of the per monthly Mortality and
Expense Risk Charge, for the Administrative Charge and for the
Distribution Charge, if any, which are shown on the Contract
Schedule.
The Accumulation Unit Value may increase or decrease from Valuation Period to
Valuation Period.
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MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, the Company deducts a
Mortality and Expense Risk Charge from 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 mortality and expense
risks under the Contract.
ADMINISTRATIVE CHARGE: Each Valuation Period, the Company deducts an
Administrative Charge from the Variable Account which is equal, on an annual
basis, to the amount shown on the Contract Schedule. The Administration Charge
compensates the Company for the costs associated with the administration of this
Contract and the Variable Account.
DRIBUTION EXPENSE CHARGE: Each Valuation Period, the Company deducts a
Distribution Expense Charge from the Variable Account which is equal, on an
annual basis, to the amount shown on the Contract Schedule. The Distribution
Charge compensates the Company for the costs associated with the distribution of
the Contracts.
MVA ACCOUNT PROVISIONS
MVA ACOUNT: The assets of the MVA Account will not charge with liabilities
arising out of any other business the Company may conduct.
Purchase Payments may be allocated to one or more of the MVA Account Guarantee
Period options which are available at the time the Purchase Payment is made. The
initial MVA Account Guarantee Period options are shown on the Contract Schedule.
In addition, during the Accumulation Period, Contract Values can be transferred
from the Variable Account and/or the Fixed Account to one or more of the MVA
Account Guarantee Period options.
INTEREST TO BE CREDITED: The Credited Interest Rate for the Guarantee Period(s)
of the MVA Account is shown on the Contract Schedule. After the initial
Guarantee Period, the Credited Interest Rate for any subsequent Guarantee Period
of the MVA Account may change. All interest payable under this Contract is
compounded daily at the stated effective annual interest rate. In no event will
the Credited Interest Rate be less than the Minimum Guaranteed Interest Rate,
prior to the application of the Market Value Adjustment, specified on the
Contract Schedule.
GUARANTEE PERIOD: The Current MVA Account Guarantee Period is shown on the
Contract Schedule. During the thirty (30) days prior to the end of a current
Guarantee Period, the Owner may renew for the same or any other Guarantee Period
then available at the Credited Interest Rate or may elect to transfer all or a
portion of the amount to a Fixed Account option, if available, or the Variable
Account. Any transfer election during the thirty (30) days prior to the end of a
current Guarantee Period will be made as of the date the request is received by
the Company and will not be subject to any Market Value Adjustment.
If the Owner does not specify a Guarantee Period at the time of renewal, the
Company will select and transfer to the same Guarantee Period as has just
expired, as long as such Guarantee Period does not extend beyond the latest
Annuity Date that can be selected by an Owner. If such Guarantee Period does
extend beyond the latest Annuity Date, the Company will choose the one year
period. If there is no Guarantee for the same period available, the one year
period will be selected. If the one year period is no longer available, the next
longest available will be selected.
MULTIPLE GUARANTEE PERIODS: The Owner may elect one or more Guarantee Periods
subject to the Company's underwriting rules. Multiple Guarantee Periods are
treated separately for purposes of applying the Market Value Adjustment. The
Company reserves the right to credit different Credited Interest Rates to the
Contract Value attributable:
1. to different Guarantee Periods; and
2. to Guarantee Periods of the same duration with different Effective
Dates.
CHANGE IN GUARANTEE PERIOD: The Owner may, upon Written Request, change to any
Guarantee Period then being offered by the Company with respect to Contracts of
this type and class. The Market Value Adjustment will apply to a change made at
any time other than at the end of a Guarantee Period. The Market Value
Adjustment will not apply to a change made at the end of a Guarantee Period if
Written Request is received by the Company within thirty (30) days prior to the
end of the Guarantee period.
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MARKET VALUE ADJUSTMENT: Any amount withdrawn, transferred or annuitized prior
to the end of that Guarantee Period may be subject to a Market Value Adjustment.
The Market Value Adjustment will be calculated by multiplying the amount
withdrawn, transferred or annuitized by the formula shown on the Contract
Schedule.
There will be no Market Value Adjustment on withdrawals from the MVA Account in
the following situations:(1) death benefit paid under a Contract; (2) amounts
withdrawn to pay fees or charges; (3) amounts withdrawn or transferred from MVA
Account during the thirty (30) days prior to the end of the Guaranteed Period;
(4) an Owner annuitizes this Contract under an Annuity Option providing for at
least sixty (60) monthly Annuity Payments; and (5) any withdrawal subject to the
MVA Waiver shown on the Contract Schedule.
MVA ACCOUNT VALUES: The MVA Account portion of a Contract at any time is equal
to:
1. the Purchase Payments allocated to the MVA Account on behalf of an Owner;
plus
2. the Contract Value transferred to the MVA Account; plus
3. interest credited to the Contract Value in the MVA Account; less
4. any prior withdrawals of Contract Value in the MVA Account and any
Contingent Deferred Sales Charges; less
5. any Contract Value transferred from the MVA Account ; less
6. Contract Maintenance Charges or Transfer Fees deducted from the Contract
Value allocated to the MVA Account.
Any subsequent Purchase Payments and transfers to the MVA Account will be
allocated to a new Guarantee Period with a new Effective Date.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT VALUES: The Fixed Account portion of the Contact at any time is
equal to:
1. the Purchase Payments allocated to the Fixed Account on behalf of an Owner;
plus
2. the Contract Value transferred to the Fixed Account; plus
3. interest credited to the Contract Value in the Fixed Account; less
4. any prior withdrawals of Contract Value in the Fixed Account and any
Contingent Deferred Sales Charges; less
5. any Contract Value transferred from the Fixed Account; less
6. Contract Maintenance Charges or Transfer Fees deducted from the Contract
Values allocated to the Fixed Account.
INTEREST TO BE CREDITED: The Company guarantees that the interest to be credited
to the Fixed Account will not be less than the Minimum Guaranteed Interest Rate
shown on the Contract Schedule. The Company may credit additional interest at
its sole discretion for any Fixed Account Option. The Fixed Account Option and
the Initial Current Interest Rate are shown on the Contract Schedule.
CONTRACT VALUE
The Value for any Valuation Period is the sum of the Contract Value in each of
the Sub-Accounts of the Variable Account, the Contract Value in the MVA Account
and the Contract Value in the Fixed Account.
The Contract Value in a Sub-Account of the Variable Account is determined by
multiplying the number of Accumulation Units allocated to the Owner's Account
for the Sub-Account by the Accumulative Unit Value.
Withdrawals will result in the cancellation of Accumulation Units in a
Sub-Account or a reduction in the Contract Value in the Fixed Account, as
applicable.
CONTRACT MAINTENANCE CHARGE
DEDUCTION FOR CONTRACT MAINTENANCE CHARGE: During the Accumulation Period, on
each Contract Anniversary the Company will deduct a Contract Maintenance Charge
from the Contract Value by reducing the Contract Value in the Fixed Account
and/or the MVA Account and by canceling Accumulation Units from each applicable
Sub-Account to reimburse it for expenses relating to maintenance of the
Contract. The Contract
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Maintenance Charge will be deducted first from the Fixed Account and if there
are insufficient value in the Fixed Account, then the Contract Maintenance
Charge will be deducted from the MVA Account or the Sub-Account of the Variable
Account with the largest balance. The Contract Maintenance Charge is shown on
the Contract Schedule.
TRANSFERS
TRANSFERS DURING THE ACCUMULATION PERIOD: Subject to any limitation imposed by
the Company on the number of transfers during the Accumulation Period shown on
the Contract Schedule, an Owner may transfer all or part of this Contract Value
in the Fixed Account, the MVA Account or a Sub-Account by Authorized Request
without the imposition of any Transfer Fee if there have been no more than the
number of free transfers shown on the Contract Schedule for the Contract Year.
All transfers are subject to the following:
1. If more than the number of free transfers, shown on the Contract
Schedule, have been made in a Contract Year, the company will deduct a
Transfer Fee, shown on the Contract Schedule, for each subsequent
transfer permitted. The Transfer Fee is deducted from the Account
which is the source of the transfer. However, if the Owner's entire
interest in an Account is being transferred, the Transfer Fee will be
deducted from the amount whish is transferred. If there are multiple
source Accounts, the transfer will be allocated first to the Fixed
Account and then to the Sub-Account or the MVA Account with the
largest balance involved in a transfer transaction.
2. The minimum amount which can be transferred from a Sub-Account is
shown on the Contract Schedule. The minimum amount which must remain
in a Sub-Account, the Fixed and MVA-Account is shown on the Contract
Schedule, The maximum amounts which can be transferred from the Fixed
Account or the MVA Account to the Variable Account are shown on the
Contract Schedule.
3. The Company reserves the right, at any time and without prior notice
to any party, to terminate, suspend or modify the transfer privilege
described above
If an Owner elects to use the transfer privilege, the Company will not be liable
for transfers made in accordance with the instructions received from the Owner
or other authorizing. All amounts and Accumulations Units will be determined as
of the end of the Valuation Period during the request for transfer is received
at the Administrative office.
TRANSFERS DURING THE ANNUITY PERIOD: Subject to any limitations imposed by the
Company on the number of transfers during the Annuity Period shown on the
Contract Schedule, the Owner may transfer Annuity Units in accordance with the
following:
1. Transfers may be made upon written notice to the Company at least
thirty (30) days before the due date of the first Annuity Payment for
which the change will apply. Transfers will be made by converting the
number of Annuity Units being transferred to the number of Annuity
Units of the Sub-Account to which the transfer is made, so that the
next Annuity Payment. If it were made would be the same amount that it
would have been without the transfer. Thereafter, Annuity Payments
will reflect changes inn the value of the new Annuity Units.
2. If more than the number of free transfers, shown on the Contract
Schedule, have been made in a Contract Year, the Company will deduct a
Transfer Fee, shown on the Contract Schedule, for each subsequent
transfer. The Transfer Fee is deducted from the Account which is the
source of the transfer. However, if the Owner's entire interest in an
Account is being transferred, the Transfer Fee will be deducted from
the amount which is transferred. If there are multiple source
Accounts, the Transfer Fee will be allocated first to the Fixed
Account and then the Sub-Account or the MVA Account with the largest
balance involved in a transfer transaction.
3. The minimum amount which can be transferred from a Sub-Account is
shown on the Contract Schedule. The minimum amount which must remain
inn a Sub-Account after transfer is shown on the Contract Schedule,
4. No transfers can be made between the General Account and the Variable
Account.
5. The Company reserves the right, at any time and without notice, to
terminate suspend of modify the transfer privilege described above.
If an Owner elects to use the transfer privilege, the Company will not be liable
for transfers made in accordance with the instructions received from the Owner
or other authorizing. All amounts and Accumulations Units will be determined as
of the end of the Valuation Period during which the request for transfer is
received at the Administrative office.
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WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Period, the Owner may, upon written
Request, make a total or partial withdrawal of the Contract Withdrawal Value.
The Owner must specify by Written Request which Sub-Account or Guarantee Period
of the MVA Account or Fixed Account, as applicable, is the source of the partial
withdrawal.
A withdrawal from the MVA Account may be subject to a Market Value Adjustment.
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 of Deferral of Payments Provision is in effect.
Each partial withdrawal must be for an amount is not less than the minimum
amount shown on the Contract Schedule. The minimum Contract Value which must
remain in a Sub-Account after a partial withdrawal is shown on the Contract
Schedule. The maximum amounts which can be withdrawn from the Fixed Account is
shown on the Contract Schedule.
CONTINGENT DEFERRED SALES CHARGE: Upon a withdrawal of Contract Value, a
Contingent Deferred Sales Charge as set forth on the Contract Schedule, may be
assessed.
WITHDRAWAL CHARGE: Upon a withdrawal of Contract Value, a Withdrawal Charge, as
set forth on the Contract Schedule, may be assessed.
PROCEEDS PAYABLE ON DEATH
DEATH OF OWNER:
DURING THE ACCUMULATION PERIOD: Upon the death of the Owner, or any Joint
Owner, during the Accumulation Period, the death benefit will be paid to
the Beneficiary(ies) designated by the Owner. Upon the death of any Joint
Owner, the surviving Joint Owner, if any will be treated as the Primary
Beneficiary. Any other Beneficiary designated on record at the time of
death will be treated as a contingent Beneficiary.
A Beneficiary may request that the death benefit be paid under one of the
Death Benefit Options below. If the Beneficiary is the spouse of the Owner,
he or she may elect to continue the Contract at the then current Contract
Value in his or her own name and exercise all the owner's rights under the
Contract.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: If death occurs prior
to age 90, the death benefit will be the greater of:
1. the total Purchase Payments, less any prior Adjusted Partial
Withdrawals accumulated at 5% per year up to the date of death.
Adjusted Partial Withdrawals are equal to; the Partial Withdrawal
multiplied by the Death Benefit just before the Partial
Withdrawal, divided by the Contract Value just before Partial
Withdrawal; or
2. the Contract Value determined as of the end of the Valuation
Period during which the Company receives both due proof of death
and election for the payment method
If death occurs at age 90 or later, the death benefit will be the Contract
Value determined as of the end of the Valuation Period during which the
Company received both due proof of death and an election for the payment
method.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: A non-spousal
Beneficiary must elect the death benefit to be paid under one of the
following options in the event of the death of the Owner or any Joint Owner
during the Accumulation Period.
Option 1 - lump sum payment of the death benefit; or
Option 2 - the payment of the entire death benefit within 5 years of
the date of the death of the Owner or any Joint Owner; or
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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 year of the death of the Owner or any
Joint Owner.
Any portion of the death benefit not applied under Option 3 within one year of
the date of the Owner's death, must be distributed within five years of the date
of the death.
A spousal Beneficiary may elect to continue the Contract in his or her own
name at the then current Contract Value, elect a lump sum payment of the
death benefit or apply the death benefit to an Annuity Option.
If a lump sum payment is requested, the amount will be paid within seven
(7) days of receipt of proof of death and the election, unless the
Suspension or Deferral of Payments Provision, as set forth on page 15 of
this Contract, is in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected
during the sixty-day period beginning with the date of receipt of proof of
death.
DURING THE ANNUITY PERIOD: If the Owner, or Joint Owner, who is not the
Annuitant, dies during the Annuity Period, any remaining payments under the
Annuity Option elected will continue at least as rapidly as under the
method of distribution in effect at such Owner's or Joint Owner's death.
Upon the death of any Owner during the Annuity Period, the Beneficiary
becomes the Owner. Upon the death of any Joint Owner during the Annuity
Period, 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 OF ANNUITANT:
DURING THE ACCUMULATION PERIOD: Upon the death of an Annuitant, who is not
the Owner, during the Accumulation Period, the Owner may designate a new
Annuitant, subject to the Company's underwriting rules then in effect. If
no designation is made within thirty (30) days of the death of the
Annuitant, the Owner will become the Annuitant effective as of the death of
the Annuitant. If the Owner is a non-natural person, the death of the
Annuitant will be treated as the death of the Owner and a new Annuitant may
not be designated.
DURING THE ANNUITY PERIOD: Upon the death of the Annuitant during the
Annuity Period, the death benefit, if any, will be as specified in the
Annuity Option elected. Death benefits will be paid at least as rapidly as
under the method of distribution in effect at the Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death
before any death benefit is paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent justification as to
the finding of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or
regulations governing death benefit payments.
BENEFICIARY: The Beneficiary designation in effect on the Contract Issue Date
will remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the death of the Owner.
Unless the Owner provides otherwise, the death will be paid in equal shares to
the survivor(s) as follows:
1. to the Primary Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable: or if there are none
2. to the Contingent Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable: or if there are none
3. to the estate of the Owner.
CHANGE OF THE BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), the Owner may change the Primary Beneficiary(ies) or
Contingent Beneficiary(ies). A CHANGE MAY BE MADE BY Written Request. The change
will take effect as of the date the Written Request is signed. The Company will
not be liable for any payment made or action taken before it records the change.
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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); or
2. trading on the New York Stock Exchange is restricted; or
3. an emergency exits 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 Owners;
provided that applicable rules and regulations of the Security and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
The Company further reserves the right to postpone payments from the Fixed
Account and the MVA Account for a period of up to six (6) months.
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
OWNER: The Owner has all interest and right to amounts held in this Contract.
The Owner is the person designated as such on the Contract Issue Date, unless
changed.
The Owner may change owners of the Contract at any time by Written Request. A
change of Owner will automatically revoke any prior designation of Owner. The
change will become effective as of the date the Written Request is signed. The
Company will not be liable for any payment made or action taken before it
records the change.
JOINT OWNER: A Contract may be owned by Joint Owners. If Joint Owners are named,
any Joint Owner must be the spouse of the Owner. Upon the death of either Joint
Owner, The surviving spouse will be the Primary Beneficiary. Any other
Beneficiary designation will be treated as a Contingent Beneficiary unless
otherwise indicated in a Written Request.
ANNUITANT: The Annuitant is the person whose Life Annuity Payments are based.
The Annuitant is the person designated by the Owner at the Contract Issue Date,
unless changed prior to the Annuity Date. In the event that the Annuitant dies
prior to the Annuity Date, the Owner must designate a new Annuitant. If no
Annuitant is designated by the Owner within 30 days of the death of the
Annuitant, effective as of the death of the Annuitant, the Owner becomes the
Annuitant. The Annuitant may not be changed in a Contract which is owned by a
non-natural person. Any change of Annuitant is subject to the Company's
underwriting rules in effect at the time the request is recorded by the Company.
ASSIGNMENT OF A CONTRACT: A Written Request specifying the terms of an
assignment of a Contract must be provided to the Administrative Office. The
Company will not be liable for any payment made or action taken before it
records the assignment. The Company 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 Company consent. If the Contract is
assigned, the Owner's right may only be exercised with the consent of the
assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Annuity Date, the Contract Withdrawals Value will be applied
under the Annuity Option selected by the Owner. The Owner may elect to have the
Contract Withdrawal Value applied to provide a Fixed Annuity, a Variable Annuity
or a combined Fixed and Variable Annuity. The Contract Value may be applied
under the Annuity Option selected if the annuitization is after the 4th policy
year and the option is life contingent or for a minimum of 5 years. If a
combination is elected, the Owner must specify what part of the Contract
Withdrawal Value is to be applied to the Fixed and Variable Options.
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ANNUITY DATE: The Annuity Date is selected by the Owner at the Contract Issue
Date. The Annuity Date must be the first day of a calendar month and must be at
least ninety (90) days after the Contract Issue Date. The Annuity Date may not
be later than the earlier of when the ANNUITANT reached attained age 90 or the
maximum date permitted under the law of the state in which the Contract is
delivered.
Prior to the Annuity Date, the Owner, subject to the above, may change the
Annuity Date by Written Request. Any change must be requested at least thirty
(30) days prior to the new Annuity Date.
SELECTION OF AN ANNUITY OPTION: An Annuity Option may be selected by Written
Request of the Owner. If no Annuity Option is selected, Option 2 with 120
monthly payments guaranteed will automatically be applied. Unless specified
otherwise, that portion of the Contract Withdrawal Value allocated to the
Variable Account shall be used to provide a Variable Annuity and that portion of
the Contract Withdrawal Value allocated to the Fixed Account and the MVA Account
will be used to provide a Fixed Annuity. Prior to the Annuity Date, the Owner
can change the Annuity Option selected by Written Request. Any change must be
requested at least thirty (30) days prior to the Annuity Date.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS: Annuity Payments are paid in monthly
installments. The Contract Withdrawal Value is applied to the Annuity Table for
the Annuity Option selected. If the Contract Withdrawal Value to applied under
an Annuity Option is less than $5,000, the Company reserves the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment would be or
become less than $50, the Company reserves the right to reduce the frequency of
payments to an interval which results in each payment being at least $50.
ANNUITY OPTION: The following Annuity Options or any annuity option acceptable
to the Company may be selected:
OPTION 1. INCOME FOR SPECIFIED PERIOD: We will pay an income for a specific
number of years in equal installments. We guarantee these payments to be
least those shown in Table 1.
OPTION 2. LIFE INCOME: We will pay equal monthly payments for a specified
period certain and then for life. We guarantee these payments to be at
least those shown in Table 2.
OPTION 3. INCOME OF SPECIFIED AMOUONT: We will pay income of the specified
amount until the principal and interest are exhausted.
OPTION 4. JOINT AND SURVIVOR INCOME: We will pay equal monthly payments
during the joint lifetime of the Annuitant and the named Beneficiary/Payee.
We will determine the payment by the Age of each person from Table 4. The
Annuitant must be at least 50 years old, and the Beneficiary/Payee must be
at least 45 years old, at the time of the first monthly payment.
ANNUITY: If the Owner selects a Fixed Annuity, the Contract Withdrawal Value is
allocated to the General Account and the Annuity is paid as Xxxxx Xxxxxxx. If
the Owner selects a Variable Annuity, the Contract Withdrawal Value will be
allocated to the Sub-Accounts of the Variable Account in accordance with the
selection made by the Owner, and the Annuity will be paid as a Variable Annuity.
If no selection is made, the Contract Withdrawal Value will be applied in the
same proportions to the same Sub-Accounts as the allocations are at the time of
election. Unless the Owner specifies otherwise, the payee of the Annuity
Payments shall bee the Owner. The Contract Withdrawal Value will be applied to
the applicable Annuity Table contained in the Contract based upon the Annuity
Option selected by the Owner. The amount of the first payment for each $1,000 of
Contract Withdrawal Value is shown in the Annuity Tables.
FIXED ANNUITY: The Owner may elect to have the Contract Withdrawal Value applied
to provide a Fixed Annuity.
The dollar amount of each Fixed Annuity Payment shall be determined in
accordance with the Annuity Tables contained in this Contract which are based on
the minimum guaranteed interest rate of 3% per year.
VARIABLE ANNUITY: The Owner may elect to have the Contract Withdrawal 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 Contract Withdrawal Value to the Sub-Account during the Annuity Period.
Variable Annuity Payments are not guaranteed as to the dollar amount.
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The dollar amount of the first Variable Annuity Payment is determined in
accordance with the description above. The dollar amount of the Variable Annuity
Payment for each applicable Sub-Account after the first Variable Annuity Payment
is determined as follows:
1. The dollar amount of the first Variable Annuity Payment is divided by
the value of an Annuity Unit for each applicable Sub-Account as of the
Annuity Date. This sets the number of Annuity Units for each monthly
payment for the applicable Sub-Accounts.
2. The fixed number of Annuity Units per payment in each Sub-Account is
multiplied by the Annuity Unit Value for that Sub-Account for the last
Valuation Period of the month proceeding the month for which the
payment is due. This result is the dollar amount of the payment for
each applicable Sub-Account.
The total dollar amount of each Variable Annuity Payment is the sum of all
Sub-Account Variable Annuity Payments reduced by the applicable portion of the
Contract Maintenance Charge.
ANNUITY UNIT: The Value of any Annuity Unit for each Sub-Account of the Variable
Account was set initially at $10.
The Sub-Account Annuity Value at the end of any subsequent Valuation Period is
determined as follows:
1. The Net Investment Factor for the current Valuation Period is
multiplied by the value of the Annuity Unit for the Sub-Account for
the immediately preceding Valuation Period.
2. The result in (1) is then divided by the Assured Investment Rate
Factor which equals 1.00 plus the Assured Investment Rate for the
number of days since the preceding Valuation Date. The Owner can
choose either a 5% or a 3% Assumed Investment Rate.
MORTALITY TABLES: The mortality table used in establishing the Annuity Table is
the Annuity 2000 Mortality Table.
The dollar amount of an Annuity Payment for any Age or combination of Ages not
shown in the Tables or for any other form of Annuity Option agreed to by the
Company will be provided by the Company upon Request.
GENERAL PROVISIONS
THE CONTRACT: The Contract consists of this Contract, the Application and any
riders or endorsements attached to this Contract. This Contract may be changed
or altered only by the President or Senior Vice President and the Secretary of
the Company. A change or alteration must be made in writing.
MISSTATEMENT OF AGE: If the Age of any Annuitant has been misstated, any Annuity
benefits payable will be the Annuity benefits provided by the correct Age. After
Annuity Payments have begun, any underpayment will be made up in one sum with
the next Annuity Payment. Any overpayment will be deducted from future Annuity
Payments until the total is repaid.
INCONTESTABILITY: This Contract will not be contestable from the date of issue.
MODIFICATION: This Contract may be modified in order to maintain compliance with
applicable state and/or federal law.
NON-PARTICIPATING: This Contract will not share in any distribution of
dividends, profits or income of the Company.
EVIDENCE OF SURVIVAL: The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments are based.
PROOF OF AGE: The Company may require evidence of Age of any Annuitant and any
Owner.
PROTECTION OF PROCEEDS: To the extent permitted by law, death benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
other than the person entitled to them under any Contract. No Payment and no
amount under this Contract can be taken or assigned in advance of its payment
date unless the Company receives the Owner's written consent.
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REPORTS: At least once each calendar year, the Company will furnish each Owner
with a report showing the Contract Value and other information as may be
required by law. The Company will also furnish an annual report of the Variable
Account.
PREMIUM TAXES: Any taxes paid to any government entity relating to the Contract
will be deducted from the Purchase Payment or Contract Value. The Company may,
in its sole discretion, 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 the Company my have to deduct amounts at a later date.
OTHER TAXES: The Company reserves the right to establish a provision for federal
income taxes if it determines, in its sole discretion, that it will incur a tax
as a result of the operation of the Separate Account. The Company will deduct
for any income taxes incurred by it as a result of the operation of the Separate
Account whether or not there was a provision for taxes and whether or not it was
sufficient. The Company will deduct any withholding taxes required by applicable
law.
REGULATORY REQUIREMENTS: All values payable under any Contract will not be less
than the minimum benefits required by the law and regulations of the states in
which the Contract is delivered.
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TABLE 1
Income for Specified period factors
Installments shown are for each $1,000 of net proceeds applied. Interest is 3%
and is subject to change as described in the Interest On Settlement Options
Section.
ANNUAL SEMI
YEARS ANNUAL ANNUAL QUARTERLY MONTHLY
-----------------------------------------------------
1 N/A N/A N/A N/A
2 N/A N/A N/A N/A
3 N/A N/A N/A N/A
4 N/A N/A N/A N/A
5 $ 211.99 $ 106.78 $ 53.59 $ 17.91
6 179.22 90.27 45.30 15.14
7 155.83 78.49 39.39 13.16
8 138.31 69.66 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 24.65 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 73.24 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
*Equal monthly payment for the number of years elected, not to exceed 25 years.
Payments will begin on the option date.
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TABLE 2
MONTHLY INCOME FOR LIFE WITH GUARANTEED PERIOD OF:
Equal monthly payments for a guaranteed period of 10, 15, or 20 years, as
elected, and for life thereafter as shown in the table below. Amount of each
monthly installment per $1,000 net proceeds. Amounts based on Annuity 2000
Mortality Tables and 3% interest.
MALE
AGE OF
PAYEE 10 YEARS 15 YEARS 20 YEARS
--------------------------------------------
25 $ 3.08 $ 3.08 $ 3.07
26 3.10 3.10 3.09
27 3.12 3.12 3.11
28 3.15 3.14 3.14
29 3.17 3.17 3.16
30 3.20 3.19 3.19
31 3.22 3.22 3.21
32 3.25 3.25 3.24
33 3.28 3.28 3.27
34 3.31 3.31 3.30
35 3.34 3.34 3.33
36 3.38 3.37 3.36
37 3.41 3.40 3.39
38 3.45 3.44 3.42
39 3.49 3.48 3.46
40 3.53 3.52 3.50
41 3.57 3.56 5.53
42 3.62 3.60 3.57
43 3.66 3.64 3.62
44 3.71 3.69 3.66
45 3.76 3.74 3.70
46 3.81 3.79 3.75
47 3.87 3.84 3.80
48 3.92 3.89 3.85
49 3.98 3.95 3.90
50 4.05 4.01 3.95
51 4.11 4.07 4.00
52 4.18 4.13 4.06
53 $ 4.25 $ 4.20 $ 4.12
54 4.33 4.27 4.18
55 4.41 4.34 4.24
56 4.49 4.42 4.30
57 4.58 4.49 4.36
58 4.68 4.58 4.43
59 4.78 4.66 4.49
60 4.88 4.75 4.56
61 4.99 4.84 4.62
62 5.10 4.93 4.69
63 5.23 5.03 4.75
64 5.35 5.13 4.82
65 5.48 5.22 4.88
66 5.62 5.33 4.94
67 5.77 5.43 5.00
68 5.92 5.53 5.06
69 6.07 5.63 5.11
70 6.23 5.73 5.16
71 6.39 5.83 5.21
72 6.56 5.93 5.25
73 6.73 6.02 5.29
74 6.90 6.11 5.33
75 7.08 6.20 5.36
76 7.25 6.28 5.39
77 7.43 6.35 5.41
78 7.61 6.42 5.43
79 7.78 6.49 5.45
80 7.95 6.55 5.46
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Equal monthly payments for a guaranteed period of 10, 15, or 20 years, as
elected, and for life thereafter as shown in the table below. Amount of each
monthly installment per $1,000 net proceeds. Amounts based on Annuity 2000
Mortality Tables and 3% interest.
FEMALE
AGE OF
PAYEE 10 YEARS 15 YEARS 20 YEARS
----------------------------------------------
25 $ 2.99 $ 2.99 $ 2.99
26 3.01 3.01 3.00
27 3.03 3.03 3.02
28 3.05 3.05 3.04
29 3.07 3.07 3.06
30 3.09 3.09 3.09
31 3.11 3.11 3.11
32 3.14 3.14 3.13
33 3.16 3.16 3.15
34 3.19 3.19 3.18
35 3.22 3.21 3.21
36 3.24 3.24 3.23
37 3.27 3.27 3.26
38 3.30 3.30 3.29
39 3.34 3.33 3.32
40 3.37 3.36 3.35
41 3.41 3.40 3.39
42 3.44 3.44 3.42
43 3.48 3.47 3.46
44 3.52 3.51 3.50
45 3.57 3.55 3.54
46 3.61 3.60 3.58
47 3.66 3.64 3.62
48 3.71 3.69 3.66
49 3.76 3.74 3.71
50 3.81 3.79 3.76
51 3.87 3.85 3.81
52 3.93 3.90 3.86
53 $ 3.99 $ 3.96 $ 3.92
54 4.06 4.02 3.97
55 4.13 4.09 4.03
56 4.20 4.16 4.09
57 4.28 4.23 4.15
58 4.36 4.30 4.22
59 4.45 4.38 4.28
60 4.54 4.46 4.35
61 4.63 4.55 4.42
62 4.73 4.64 4.49
63 4.84 4.73 4.57
64 4.95 4.83 4.64
65 5.07 4.93 4.71
66 5.20 5.03 4.78
67 5.33 5.14 4.85
68 5.47 5.25 4.92
69 5.62 5.36 4.99
70 5.78 5.47 5.05
71 5.94 5.58 5.11
72 6.11 5.70 5.17
73 6.29 5.81 5.22
74 6.48 5.92 5.27
75 6.67 6.03 5.31
76 6.86 6.13 5.35
77 7.06 6.22 5.38
78 7.26 6.31 5.40
79 7.46 6.39 5.43
80 7.66 6.47 5.45
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TABLE 3
EQUAL PAYMENTS OF A SPECIFIED AMOUNT
Equal monthly payments of at least $4.71 per month for each $1,000 of proceeds.
Payments will begin on the option date and will continue until the proceeds and
interest, at a rate of 3% compounded annually, are exhausted.
TABLE 4
JOINT SURVIVOR INCOME FACTORS
We will furnish values for Age combinations not shown in the table upon request
MALE AGE
----------------------------------------------------------------------
FEMALE AGE 45 50 55 60 65 70
45 $ 3.34 $ 3.41 $ 3.46 $ 3.50 $ 3.54 $ 3.58
50 3.44 3.54 3.62 3.69 3.74 3.79
55 3.53 3.66 3.79 3.90 3.99 4.06
60 3.60 3.78 3.95 4.12 4.27 4.38
65 3.66 3.87 4.10 4.34 4.57 4.77
70 3.71 3.95 4.22 4.54 4.87 5.19
Installments shown are monthly and are for each $1,000 of net proceeds applied.
Based on Annuity 2000 Tables and 3% interest: Amounts are subject to change as
described in the Interest On Settlement Option Section.
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JEFFERSON NATIONAL LIFE INSURANCE COMPANY
FIXED ACCOUNT
ACCUMULATION TABLE FOR FLEXIBLE PREMIUM DEFERRED ANNUITY
$1,000 Annual Premium
Guaranteed Values*
END OF CONTRACT
POLICY CONTRACT VALUE WITHDRAWAL
YEAR INCREASE CONTRACT VALUE VALUE
--------------------------------------------------------------------
1 1,030.00 1,030.00 967.21
2 1,060.90 2,090.90 1,965.54
3 1,092.73 3,183.63 3,002.73
4 1,125.51 4,309.14 4,080.68
5 1,159.27 5,468.41 5,200.28
6 1,194.05 6,662.46 6,362.45
7 1,229.87 7,892.34 7,568.12
8 1,266.77 9,159.11 8,819.11
9 1,304.77 10,463.88 10,123.88
10 1,343.92 11,807.80 11,467.80
11 1,384.23 13,192.03 12,852.03
12 1,425.76 14,617.79 14,277.79
13 1,468.53 16,086.32 15,746.32
14 1,512.59 17,598.91 17,258.91
15 1,557.97 19,156.88 18,816.88
16 1,604.71 20,761.59 20,421.59
17 1,652.85 22,414.44 22,074.44
18 1,702.43 24,116.87 23,776.87
19 1,753.51 25,870.37 25,530.37
20 1,806.11 27,676.49 27,336.49
21 1,860.29 29,536.78 29,196.78
22 1,916.10 31,452.88 31,112.88
23 1,973.59 33,426.47 33,086.47
24 2,032.79 35,459.26 35,119.26
25 2,093.78 37,553.04 37,213.04
26 2,156.59 39,709.63 39,369.63
27 2,221.29 41,930.92 41,590.92
28 2,287.93 44,218.85 43,878.85
29 2,356.57 46,575.42 46,235.42
30 2,427.26 49,002.68 48,662.68
31 2,500.08 51,502.76 51,162.76
32 2,575.08 54,077.84 53,737.84
33 2,652.34 56,730.18 56,390.18
34 2,731.91 59,462.08 59,122.08
35 2,813.86 62,275.94 61,935.94
36 2,898.28 65,174.22 64,834.22
37 2,985.23 68,159.45 67,819.45
38 3,074.78 71,234.23 70,894.23
39 3,167.03 74,401.26 74,061.26
40 3,262.04 77,663.30 77,323.30
*Values shown are based on an interest rate of 3% for all years.
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JEFFERSON NATIONAL LIFE INSURANCE COMPANY
ADMINISTRATIVE OFFICE: 0000 XXXXXXXXX XXXXXX XX., XXXXX 0000
XXXXXXXXXX, XXXXXXXX 00000
TELEPHONE: 0-000-000-0000
A STOCK COMPANY
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
NON-PARTICIPATING
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