INDIVIDUAL FLEXIBLE PREMIUM
VARIABLE ANNUITY CONTRACT
HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
Hartford, Connecticut 06104-2999
(a stock life insurance company, herein called the Company)
We will pay the first of a series of Annuity payments to the Payee as of the
Annuity Commencement Date, if You, the Annuitant, or the Joint Annuitant, if
any, are living. The manner in which the dollar amount of annuity payments is
determined is described in this contract.
This contract is issued in consideration of the payment of the initial premium
payment.
This contract is subject to the laws of the jurisdiction where it is delivered.
The Contract Specifications on Page 3 and the conditions and provisions on this
and the following pages are part of the contract.
RIGHT TO EXAMINE CONTRACT
We want You to be satisfied with the contract You have purchased. We urge You to
closely examine its provisions. If for any reason You are not satisfied with
Your purchase, You may cancel the contract by returning the contract within ten
days after You receive it. A written request for cancellation must accompany the
contract. In such event, We will pay You an amount equal to the sum of the
Contract Value and any Premium Taxes as of the date of cancellation. You bear
only the investment risk during the period prior to Our receipt of request for
cancellation.
Signed for the Company
/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX
Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT
PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN.
NONPARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION
PROVISIONS, PAGES 6 AND 7.
[HARTFORD LOGO]
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TABLE OF CONTENTS
PAGE
Contract Specifications 3
Definition of Certain Terms 4
Premium Payments 6
Valuation Provisions 6
Transfer Between Sub-Accounts Provision 7
Contract Control Provisions 8
General Provisions 8
Surrenders 10
Death Benefits 11
Settlement Provisions 13
Annuity Tables 16
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CONTRACT SPECIFICATIONS
CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [ SEPTEMBER 8, 2002 ]
NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2032 ]
ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $10,000 ]
ANNUITANT SEX [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ]
CONTINGENT ANNUITANT [ XXXX XXXXX ]
DESIGNATED BENEFICIARY [ XXX XXXXX ]
CONTRACT OWNER [ XXXXX XXXXX ]
DESCRIPTION OF BENEFITS
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY
SEPARATE ACCOUNT TWO ]
ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE
CONTRACT ANNIVERSARY.
$30 IF THE CONTRACT VALUE IS LESS THAN $50,000
ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT
IS FULLY SURRENDERED.
MORTALITY AND EXPENSE RISK CHARGE: [1.60%] PER ANNUM OF THE DAILY CONTRACT VALUE.
ADMINISTRATION CHARGE: [0.25%] PER ANNUM OF THE DAILY CONTRACT VALUE.
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DEFINITION OF CERTAIN TERMS
ACCOUNT - Any of the Sub-Accounts.
ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of
a Sub-Account of this contract before annuity payments begin.
ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 000 Xxxxxxxxx Xx.,
Xxxxxxxx, XX. All correspondence concerning this contract should be sent to our
mailing address: Attn: Hartford Life Investment Product Services, P.O. Box 5085,
Hartford, CT 06102-5085.
ANNUAL MAINTENANCE FEE - An amount which, depending on the amount of the
Contract Value, may be deducted from the value of the contract on the Contract
Anniversary and upon full surrender of this contract. The Annual Maintenance Fee
is shown on Page 3.
ANNUITANT - The person on whose life this contract is issued. The Annuitant may
not be changed. Also, see Contingent Annuitant and Joint Annuitant.
ANNUITY CALCULATION DATE - The date on which the first annuity payment will be
calculated. It will be no more than five Valuation Days prior to the Annuity
Commencement Date.
ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin as
described under Settlement Provisions in this contract.
ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be
made. The frequencies available are monthly, quarterly, semi-annual, and annual.
ANNUITY UNIT - An accounting unit of measure used to calculate the value of
annuity payments under a variable annuity option.
ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return
("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily
factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when
the AIR is 6%, the daily factor is 0.999840.
ASSUMED INVESTMENT RETURN - The investment return upon which the variable
annuity payments in this contract will be based. The annual rates available are
3%, 5%, and 6%. You may select one of these rates prior to the Annuity
Commencement Date.
BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the
contract in case of the death of the Contract Owner or Annuitant, as applicable.
COMMUTED VALUE - The present value of the remaining guaranteed annuity payments.
CONTINGENT ANNUITANT - The person that You may designate who, upon the
Annuitant's death, prior to the Annuity Commencement Date, becomes the
Annuitant.
CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date.
CONTRACT ISSUE DATE - The date as of which the contract is established for You
by Us. The Contract Issue Date is shown on Page 3.
CONTRACT OWNER - The owner(s) or holder of the contract.
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DEFINITION OF CERTAIN TERMS (CONTINUED)
CONTRACT VALUE - The aggregate value of the Sub-Accounts on any Valuation Day.
CONTRACT YEAR - A period of 12 months commencing with the Contract Issue Date or
any other anniversary thereafter.
DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a
court of competent jurisdiction, or any other proof acceptable to Us.
FUNDS - The securities which underlie Your Sub-Accounts.
GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate
Account.
INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as
amended or any successor law.
INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any
successor agency.
JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose
continuation of life annuity payments may be made. The contract will have a
Joint Annuitant only if the annuity settlement option selected provides for a
survivor. The Joint Annuitant may not be changed.
PAYEE - The person, designated by You, to whom annuity payments will be made.
PREMIUM TAX - The amount of tax, if any, charged by a federal, state, or other
governmental entity on premium payments or Contract Values. On any contract
subject to a Premium Tax, We may deduct the tax at the time We pay the tax to
the applicable taxing authorities, at the time the contract is surrendered or on
the Annuity Commencement Date. If We deduct the tax after Your premium payments
have been applied to the Accounts, the tax will be deducted from the Accounts on
a pro-rata basis.
SEPARATE ACCOUNT - An account that We established to separate the assets funding
the variable benefits for this type of contracts from the other assets of the
Company. The assets in the Separate Account are not chargeable with liabilities
arising out of any other business We may conduct. The name of the Separate
Account is shown on Page 3.
SUB-ACCOUNT - The subdivisions of the Separate Account which are used to
allocate Your Contract Value among the corresponding Funds.
SURRENDER VALUE - The Contract Value prior to the Annuity Commencement Date,
less any applicable Premium Taxes, and/or Annual Maintenance Fee.
VALUATION DAY - Every day the New York Stock Exchange is open for trading. The
value of the Separate Account is determined at the close of the New York Stock
Exchange (generally 4:00 p.m. Eastern Time) on such days.
VALUATION PERIOD - The period of time between the close of business on
successive Valuation Days.
WE, US, OUR - The company referred to on the first page of this contract.
YOU, YOUR - The Contract Owner(s).
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PREMIUM PAYMENTS
PREMIUM PAYMENTS
Premium payments are payable at the Administrative Office of the Company.
Payments may be made by check or by any other method that We deem acceptable.
The initial premium payment is shown on Page 3. This is a flexible premium
annuity. We may accept additional payments. The additional payments must be at
least equal to the minimum subsequent premium payment shown on Page 3. Our
approval is required for any premium payment if the aggregate of all premium
payments received from You under all deferred variable annuity contracts issued
by Us or Our affiliates then equals or exceeds $1,000,000.
ALLOCATION OF PREMIUM PAYMENTS
Premium payments, minus any applicable Premium Tax We may deduct, will be
allocated to each Sub-Account according to Our minimum amount(s) then in effect.
Any subsequent premium payments will be allocated to Sub-Accounts in accordance
with the most recent premium allocation instructions that We received.
VALUATION PROVISIONS
NET PREMIUM PAYMENTS
The net premium payment is equal to the premium payment minus any applicable
Premium Taxes We may deduct, and is applied to purchase Accumulation Units with
respect to the Sub-Account(s) that You have selected.
The number of Accumulation Units credited to each Sub-Account is determined by
dividing the net premium payment allocated to a Sub-Account by the dollar value
of one Accumulation Unit for such Sub-Account. This is computed in compliance
with Securities and Exchange Commission regulations. The number of Accumulation
Units so determined will not be affected by any subsequent change in the value
of such Accumulation Units. The Accumulation Unit value in any Sub-Account may
increase or decrease from day to day as described below.
NET INVESTMENT FACTOR
The net investment factor for each of the Sub-Accounts is equal to:
a) the net asset value per share plus applicable distributions per share of the
corresponding Fund at the end of the Valuation Period; divided by
b) the net asset value per share of the corresponding Fund at the beginning of
the Valuation Period; multiplied by
c) the daily expense factor for mortality and expense risk charge, any
applicable administration charge shown on page 3, and the charge for elected
optional riders, if any, adjusted for the number of days in the Valuation
Period.
ACCUMULATION UNIT VALUE
The value of an Accumulation Unit for each Sub-Account of the Separate Account
will vary to reflect the investment experience of the applicable Funds. It will
be determined by multiplying:
(a) the value of the Accumulation Unit for that Sub-Account as of the preceding
Valuation Day by
(b) the net investment factor for that Sub-Account for the Valuation Day for
which the Accumulation Unit value is being calculated.
The value of the Sub-Account as of each Valuation Day is then determined by
multiplying:
(a) the number of Accumulation Units in that Sub-Account by
(b) the Accumulation Unit value as of that Valuation Day.
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VALUATION PROVISIONS (CONTINUED)
ANNUITY UNIT VALUE
The value of an Annuity Unit for each Sub-Account of the Separate Account will
vary to reflect the investment experience of the applicable Funds. It will be
determined by multiplying:
a) the value of the Annuity Unit for that Sub-Account as of the preceding
Valuation Day; by
b) the net investment factor for that Sub-Account for the Valuation Day for
which the Annuity Unit value is being calculated; and by
c) the Annuity Unit Factor.
ANNUAL MAINTENANCE FEE
During each year that this contract is in force prior to the Annuity
Commencement Date, the Annual Maintenance Fee, if applicable, will be deducted
on the Contract Anniversary and upon full surrender of the contract. The fee
will be charged against the Contract Value by reducing the number of
Accumulation Units from the Sub-Accounts held as of that date. The fee will be
charged on a pro-rate basis with respect to each active Sub-Account. The number
of Accumulation Units deducted from each Sub-Account is determined by dividing
the pro-rata portion of the Annual Maintenance Fee by the value of an
Accumulation Unit for the applicable Sub-Account.
TRANSFERS BETWEEN SUB-ACCOUNTS
TRANSFER BETWEEN ACCOUNTS
You may transfer Contract Values held in the Accounts into other Accounts before
and after Xxxxxxx Commencement Date. However, We may establish, from time to
time, restrictions, policies, and procedures relating to transfers between
Accounts, which We may modify or terminate at any time. We may, according to Our
then current policies and procedures, restrict or terminate Your transfer
privileges if We determine, in Our sole discretion, that You have engaged in a
pattern of transfers that is disadvantageous or potentially harmful to other
Contract Owners.
We may establish, from time to time, restrictions, policies, and procedures,
which We may modify or terminate at any time, relating to transfers between
Accounts that We determine are competing investment choices. We may, according
to Our then current policies and procedures, restrict or terminate Your ability
to transfer Contract Values between any Accounts that We determine are competing
investment choices. We may also establish time periods during which We may
restrict or terminate Your ability to transfer any Contract Values into an
Account if, during the time period We establish, Contract Values were
transferred out of a competing investment choice of such Account.
The right to make transfers between sub-Accounts is subject to modification if
We determine, in Our opinion, that exercising that right by one or more Contract
Owners is, or would be, to the disadvantage of other Contract Owners. Any
modification could be applied to transfers to or from some or all of the
Sub-Accounts and could include, but not be limited to:
a) the requirement of a minimum time period between each transfer;
b) not accepting transfer requests of an agent acting under a power of attorney
or on behalf of more than one Contract Owner, or
c) limiting the dollar amount that may be transferred between the Sub-Accounts
by a Contract Owner at any one time.
Such restrictions may be applied in any manner reasonably designed to prevent
any use of the transfer right which is considered by Us to be to the
disadvantage of other Contract Owners.
No transfers may be made between Sub-Accounts and the General Account after
Xxxxxxx Commencement Date.
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CONTRACT CONTROL PROVISIONS
ANNUITANT, CONTINGENT ANNUITANT, CONTRACT OWNER
The Annuitant may not be changed.
The designations of Contract Owner and Contingent Annuitant will remain in
effect until You change them. The designation of the Contract Owner may be
changed during the lifetime of the Annuitant by written notice to Us. The
designation of the Contingent Annuitant may be changed at any time during the
lifetime of the Annuitant and prior to the Annuity Commencement Date by written
notice to Us. If no Contingent Annuitant has been named and the Contract
Owner/Xxxxxxxxx's spouse is a Beneficiary, the Contract Owner/Xxxxxxxxx's spouse
will be presumed to be the Contingent Annuitant. In any other situation, if no
Contingent Annuitant has been named, the Contract Owner (or in the case of joint
Contract Owners, the younger Contract Owner) will be presumed to be the
Contingent Annuitant provided that the Contract Owner is not the Annuitant. The
Contract Owner may waive this presumption.
OWNERSHIP
You have the sole power to exercise all the rights, options, and privileges
granted by this contract or permitted by us and to agree with Us to any change
in or amendment to the contract. Your rights will be subject to the rights of
any assignee of record with Us and of any irrevocably designated Beneficiary. In
the case of joint Contract Owners, each Contract Owner alone may exercise all
rights, options, and privileges, except with respect to the surrender, partial
surrender, selection of an annuity option, and change of ownership.
BENEFICIARY
The designated Beneficiary will remain in effect until You change it. The
designated Beneficiary may be changed during the lifetime of the Annuitant by
written notice to Us at the Administrative Office of the Company. If the
designated Beneficiary has been designated irrevocably, the designation cannot
be changed or revoked without such Beneficiary's written consent. Upon receipt
of written notice and consent, if required by Us, the new designation will take
effect as of the date the notice is signed, whether or not the Annuitant or
Contract Owner is alive at the time of receipt. Any payments made or other
action taken by Us before the receipt of the notice will not be subject to the
requested change.
Subject to any tax qualification requirements under the Internal Revenue Code,
Our then policies and procedures, and subject to the paragraph entitled
"Distribution Requirements" of this contract, a Beneficiary may designate
another individual or entity to receive, upon the death of the Beneficiary, any
remaining interest of the Beneficiary in the contract.
GENERAL PROVISIONS
THE CONTRACT
This contract and the endorsements or riders, if any, constitute the entire
contract
FUND MODIFICATION
We reserve the right, subject to any applicable law, to make certain changes,
including the right to add, eliminate, or substitute any investment options
offered under the contract.
CONTRACT MODIFICATION
No modification of this contract shall be made without the signature of Our
President, a Senior Vice President, Executive Vice President, or Assistant Vice
President. No modification will affect the amount or term of any annuity begun
prior to the modification unless it is required to conform the contract to any
federal or state statute. No modification will affect the method by which the
Contract Value will be determined.
MINIMUM VALUE STATEMENT
Any Surrender Values, Death Benefits, or settlement provisions available under
this contract equal or exceed those required by the state in which the contract
is delivered.
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GENERAL PROVISIONS (CONTINUED)
NON-PARTICIPATION
This contract does not share in Our surplus earnings. That portion of the assets
of the Separate Account equal to the reserves and other contract liabilities of
the Separate Account shall not be chargeable with liabilities arising out of any
other business We may conduct.
MISSTATEMENT OF AGE AND GENDER
If the age or gender of the Annuitant has been misstated, the amount of the
annuity payable by Us will be adjusted based on the correct information without
changing the date of the first payment. Any underpayments by Us will be made up
immediately and any overpayments will be charged against future amounts becoming
payable.
If the age of the Annuitant or Contract Owner has been misstated, the amount of
any Death Benefit payable will be determined based upon the correct age of the
Annuitant or Contract Owner.
INCONTESTABILITY
We cannot contest this Contract.
REPORTS TO THE CONTRACT OWNER
You will be sent copies of any shareholder reports of the Funds and of any other
notices, reports or documents required by law to be delivered to You. At least
annually, a statement of the Contract will be sent to You.
VOTING RIGHTS
We will notify You of any Fund shareholder's meetings at which the shares held
for Your account may be voted. We will send proxy materials and instructions for
You to vote the shares held for Your account. We will arrange for the handling
and tallying of proxies received from Contract Owners. We will vote the Fund
shares held by Us in accordance with the instructions received from Contract
Owners. You may attend any meeting, where shares held for Your benefit, will be
voted.
In the event that You give no instructions or leave the manner of voting
discretionary, We will vote such shares of the appropriate Fund in the same
proportion as shares of that Fund for which instructions have been received.
Also, We will vote the Fund shares in this proportionate manner which are held
by Us for Our own account. After annuity payments begin, the number of votes
will decrease.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At Our election and subject to any necessary vote by persons having the right to
give instructions with respect to the voting of the Fund shares held by the
Sub-Accounts, the Separate Account may be operated as a management company under
the Investment Company Act of 1940 or any other form permitted by law, may be
deregistered under the Investment Company Act of 1940 in the event registration
is no longer required, or may be combined with one or more Separate Accounts.
PROOF OF SURVIVAL
The payment of any Annuity benefit will be subject to evidence that the
Annuitant is alive on the date such payment is otherwise due.
TAX QUALIFICATION
This contract is intended to qualify as an annuity contract for federal income
tax purposes. To that end, the provisions of this contract are to be interpreted
to ensure and maintain such tax qualification, notwithstanding any other
provisions to the contrary. We reserve the right to amend this contract to
conform to any changes in the tax qualification requirements under the
applicable provisions of the Internal Revenue Code.
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SURRENDERS
FULL SURRENDER PRIOR TO THE ANNUITY COMMENCEMENT DATE
At any time prior to the Annuity Commencement Date, You have the right to
terminate the contract by submitting a written request to Us at the
Administrative Office of the Company. In such event, the Surrender Value of the
contract may be taken in the form of a cash settlement.
The Surrender Value of the contract is equal to the Contract Value less:
(a) any applicable Premium Taxes not previously deducted; and
(b) the Annual Maintenance Fee as specified on Page 3.
PARTIAL SURRENDERS PRIOR TO THE ANNUITY COMMENCEMENT DATE
You may request, in writing, or other means acceptable to Us, a partial
surrender of Contract Values at any time prior to the Annuity Commencement Date
provided the Contract Value remaining after the surrender is at least equal to
Our minimum amount rules then in effect. If the remaining Contract Value
following such surrender is less than Our minimum amount rules, We will
terminate the contract and pay the Surrender Value.
SURRENDERS AFTER THE ANNUITY COMMENCEMENT DATE
You may surrender all or portions of Your contract attributable to Period
Certain payments if You selected an annuity under Option 3 (Life Annuity with
Payments for a Period Certain), Option 5 (Joint Life Annuity with Payments for a
Period Certain), or Option 6 (Payments for a Period Certain).
We pay You the Commuted Value of the amounts surrendered that We would have paid
during the Period Certain. Your surrender must occur during the Period Certain.
For Options 5 and 6, on the date the Period Certain would have expired had it
not been surrendered and if the Annuitant is living, annuity payments will
resume ceasing with the last payment due prior to the death of the Annuitant.
To calculate the Commuted Value for variable annuity payments, We will use the
AIR elected by You and the Annuity Unit Value(s) on the date We receive a fully
completed request for surrender. To calculate the Commuted Value for fixed
dollar payments, We will use an interest rate We determine at Our discretion.
PAYMENT ON SURRENDER - DEFERRAL OF PAYMENT
Payment on any request for surrender will be made as soon as possible and with
respect to Contract Values in the Sub-Accounts, within seven days after the
written request is received by Us in good order. However, such payment may be
subject to postponement:
(a) for any period during which the New York Stock Exchange is closed or during
which trading on the New York Stock Exchange is restricted;
(b) for any period during which an emergency exists as a result of which (i)
disposal of the securities held in the Sub-Accounts is not reasonably
practicable, or (ii) it is not reasonably practicable for the value of the
net assets of the Separate Account to be fairly determined; and
(c) for such other periods as the Securities and Exchange Commission may, by
order, permit for the protection of the Contract Owners. The conditions
under which trading shall be deemed to be restricted or any emergency shall
be deemed to exist shall be determined by rules and regulations of the
Securities and Exchange Commission.
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DEATH BENEFITS
DEATH BEFORE THE ANNUITY COMMENCEMENT DATE
We pay a Death Benefit before the Annuity Commencement Date if one of the
following conditions is met: If the Contract Owner dies, and:
a) the joint Contract Owner is living, the joint Contract owner will become the
Beneficiary. In this case, the rights of the designated Beneficiary are
voided.
b) there is no surviving joint Contract Owner, the designated Beneficiary will
be the Beneficiary.
c) no Beneficiary designation is in effect or the designated Beneficiary has
predeceased the Contract Owner, the Contract Owner's estate shall be the
Beneficiary.
If the Annuitant dies, and:
a) is also the sole Contract Owner, the designated beneficiary will be the
Beneficiary.
b) both the Contract Owner and the Contingent Annuitant are living, the
Contingent Annuitant will become the Annuitant. The contract will continue.
c) the Contract Owner is living, and there is no Contingent Annuitant or the
Contingent Annuitant is not living, the Contract Owner will be the
Beneficiary. In this case, the rights of the designated Beneficiary are
voided.
d) the contract is owned by a corporation or other entity, the Contract Owner
will be the Beneficiary. In this case, the rights of the designated
Beneficiary are voided.
DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
If provided under the annuity option You select, We pay a Death Benefit after
the Annuity Commencement Date to the Beneficiary.
If the Annuitant dies, the Contract Owner will be the Beneficiary, and the
rights of the designated Beneficiary are voided. If the Annuitant who is also
the Contract Owner dies, the designated Beneficiary will be the Beneficiary.
If the Contract Owner dies, and the Annuitant is living, the designated
Beneficiary will become the Contract Owner.
CALCULATION OF THE DEATH BENEFIT
If a Death Benefit is payable before the Annuity Commencement Date, the Death
Benefit payable will be calculated as of the date We receive written
notification of Due Proof of Death at the Administrative Office of the Company.
If a Death Benefit is payable after the Annuity Commencement Date, the Death
Benefit will be calculated as of the date We receive both written notification
of Due Proof of Death and settlement instructions as in the manner described in
the settlement option then in effect.
If the calculated Death Benefit exceeds the Contract Value, the difference will
be allocated to the Sub-Accounts(s) in accordance with the last Sub-Account
allocation instructions received from the Contact Owner. During the time period
between Our receipt of written notification of Due Proof of Death and Our
receipt of complete settlement instructions from each Beneficiary, the
calculated Death Benefit amount will be subject to market fluctuations.
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit payable is equal to the greater of:
a) Surrender Value, or
b) the greatest Death Benefit payable under any rider or endorsement made part
of this contract.
LIMITATIONS ON THE DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit before the Annuity Commencement Date under this contract and
any riders or endorsements is limited if the death of one person results in
death benefits payable under one or more deferred variable annuity contracts
that are issued by Us or Our affiliates, have aggregate premium payments of
$5,000,000 or more, and have a provision that limits the amount of payable death
benefits.
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DEATH BENEFITS (CONTINUED)
If You purchase one or more contracts with an initial premium payment of
$5,000,000 or more, the aggregate death benefits cannot exceed:
a) the aggregate premium payments, modified by adjustments for partial
surrenders under all applicable contracts and associated riders; or
b) the aggregate Contract Value plus $1 million.
If You purchase one or more contracts with an initial premium payment of less
than $5,000,000, but You add premium payments or purchase additional contracts
such that premium payments under the contracts aggregate to $5,000,000 or more,
the aggregate death benefits cannot exceed:
c) the aggregate premium payments, modified by adjustments for partial
surrenders under all applicable contracts and associated riders; or
d) the aggregate Contract Value plus $1 million; or
e) the aggregate Contract Value plus the sum of the death benefits in excess of
the aggregate Contract Value payable at the time aggregate premium payments
first exceeded $5,000,000.
These limitations are applied to multiple contracts in proportion to the death
benefit payable on each contract. Any death benefits limited under Section (e)
above are applied to multiple contracts so that the death benefit under each
contract does not exceed the death benefit otherwise payable without any
limitation under this provision.
For the purposes of this provision, contracts purchased on the same day are
considered one contract.
SETTLEMENT OF THE DEATH BENEFIT
The Death Benefit may be taken in one sum or under any of the settlement options
then being offered by Us subject, however, to the Distribution Requirements
below. The Beneficiary may elect any available settlement option unless the
Contract Owner has designated the settlement option for that Beneficiary. The
available settlement options include any of the annuity options under this
contract or any other options then being offered by Us. If payment is taken in
one sum, an interest-bearing draft account ("Safe Haven Account") will be
offered and maintained until the entire balance is withdrawn. The Safe Haven
Account is part of the General Account. The minimum draft writing amount and
remaining balance must be at least equal to the minimum amounts according to Our
rules then in effect. If the remaining balance falls below Our minimum amount
rules, the Safe Haven Account will terminate and We will pay the remaining
balance in one sum.
As of the date of receipt of complete disbursement instructions from the
Beneficiary, the amount to be paid or applied to a selected settlement option
will be computed. When there is more than one Beneficiary, the amount will be
calculated for each Beneficiary's share of the proceeds and paid or applied to a
selected settlement option according to and upon each Beneficiary's
instructions. If the date of receipt of complete instructions falls on a
non-valuation Day, the amount will be computed on the next Valuation Day.
When payment is taken in one sum, payment will be made within 7 days of Our
receipt of complete instructions, except when we pare permitted to defer such
payment under the Investment Company Act of 1940.
DISTRIBUTION REQUIREMENTS
Subject to the Alternative Election or Spouse Beneficiary provisions below,
a) if any Contract Owner dies before the Annuity Commencement Date, the entire
interest in the Contract will be distributed within five years after such
death; and
b) if any Contract Owner dies on or after the Annuity Commencement Date, and
before the entire interest in the contract has been distributed, the
remaining portion of such interest will be distributed at least as rapidly
as under the method of distribution being used as of the date of such death.
If the Contract Owner is not an individual, then for purposes of the preceding
paragraph a or b, the primary Annuitant will be treated as the Contract Owner.
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DEATH BENEFITS (CONTINUED)
ALTERNATIVE ELECTION TO SATISFY DISTRIBUTION REQUIREMENTS
If any portion of the interest of a Contract Owner described above is payable to
or for the benefit of a designated Beneficiary, and the Beneficiary elects after
the Contract Owner's death to have the benefit distributed over a period that:
a) does not extend beyond such Beneficiary's life (or life expectancy); and
b) does commence within one year of the Contract Owner's date of death, then for
purposes of satisfying the Distribution Requirements above, the benefit will
be treated as distributed entirely on the date such periodic distributions
begin.
SPOUSE BENEFICIARY
If the Contract Owner's spouse becomes a Beneficiary by reason of the Contract
Owner's death and the Annuitant (or Contingent Annuitant, if applicable) is
alive, that portion of the contract for which the spouse is the Beneficiary will
continue with the spouse as the Contract Owner, unless the spouse elects to be
paid a Death Benefit option. This provision will apply only once with respect to
this contract.
If the contract continues with the spouse as the Contract Owner, the death
benefit will be calculated on receipt of Due Proof of Death. If the Contract
Value is less than the calculated death benefit amount, the Contract Value will
be increased appropriately.
SETTLEMENT PROVISIONS
ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is shown on Page 3. You may change the date by
notifying Us within 30 days prior to the Annuity Commencement Date. This date
will not be deferred beyond the Valuation Date immediately following the later
of:
a) the Annuitant's 90th birthday; or
b) the end of the tenth Contract Year unless the Contract Owner elects a later
Annuity Commencement Date subject to laws and regulations then in effect and
Company approval.
If this contract is issued to the trustee of a charitable remainder trust, the
Annuity Commencement Date may be deferred to the Annuitant's 100th birthday.
ELECTION OF ANNUITY OPTION
You may elect, in writing, any one of the annuity options described below
(except the seventh option - Annuity Proceeds Settlement Option) or any annuity
option then being offered by Us. The annuity option may not be changed on or
after the Annuity Commencement Date.
In the absence of an election by You, the Contract Value will be used to
calculate an annuity under the Third Option (Life Annuity with 10 Years Period
Certain). Annuity payments will be variable depending on the allocation of Your
Accounts at the time annuity payments begin. Variable dollar annuity payments
will be based on an assumed investment return according to state law.
Some of the options may not be available if this contract is issued to qualify
under Section 401, 403, or 408 of the Internal Revenue Code. The third, fifth
and sixth options (Life Annuity with Payments for a Period Certain, Joint and
Last Survivor Life Annuity with Payments for a Period Certain, and Payment for a
Period Certain) will be available only if the guaranteed payment period is not
greater than the life expectancy of the Annuitant at the time the option becomes
effective. Such life expectancy will be computed under applicable Internal
Revenue Service tables.
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SETTLEMENT PROVISIONS (CONTINUED)
ELECTION OF ANNUITY PAYMENT FREQUENCY
You may elect the Annuity Payment Frequency. Available Annuity Payment
Frequencies include: monthly, quarterly, semi-annual, and annual. In the event
that You do not elect a payment frequency, annuity payments will be made
monthly. Annuity payments will be made according to the Annuity Payment
Frequency selected.
ANNUITY CALCULATION DATE
The Annuity Calculation Date will be no more than five Valuation Days prior to
the Annuity Commencement Date. You may elect a variable annuity, a fixed dollar
annuity or a combination fixed dollar and variable annuity. You cannot change
this election on or after the Annuity Commencement Date.
If You elect a variable annuity, the Contract Value (less applicable Premium
Taxes) is applied pro-rata to Your selected Sub-Account(s). If You elect a fixed
dollar annuity, Contract Values will be applied to the General Account.
VARIABLE ANNUITY PAYMENTS - The contract contains tables indicating the minimum
dollar amount of the first monthly payment under the optional forms of annuity
for each $1,000 of value of a Sub-Account under the contract. The first monthly
payment varies according to the variable annuity payment option selected.
The first annuity payment is computed using the value of the Annuity Units as of
the Annuity Calculation Date.
If You elect variable annuity payments, Your election must specify the Assumed
Investment Return upon which Your payments are to be based. The available rates
are 3%, 5%, and 6%.
The first annuity payment is payable on the Annuity Commencement Date. The
remaining annuity payments are computed and payable as of the same day of the
month as the Annuity Commencement Date based on the elected Annuity Payment
Frequency.
The amount of the first variable annuity payment is divided by the Annuity Unit
value for Your selected Sub-Account(s) as of the Annuity Commencement Date. This
number of Annuity Units remains constant for the selected Sub-Account during the
annuity payment period. For each subsequent payment the dollar amount of the
Variable Annuity payment is determined by multiplying the specified number of
Annuity Units by the Annuity Unit value.
If subsequent payment dates fall on a non-Valuation Day (weekend or holiday),
the payment will be computed and payable as of the prior Valuation Day. If the
day of the month elected does not occur in a given month (29th, 30th, or 31st),
the payments will be computed and payable as of the last Valuation Day of the
month.
Variable annuity payments under the Sixth Option with periods of 10 years or
greater are available at any time and periods of 5 to 10 years are available on
or after the second Contract Anniversary.
FIXED DOLLAR ANNUITY PAYMENTS - A fixed dollar annuity is an annuity with
payments that remain level as to dollar amount throughout the payment period. A
fixed dollar annuity is available on or after the second Contract Anniversary.
If You elect a fixed dollar annuity payment, the payment will be based on
current rates.
COMBINATION FIXED DOLLAR AND VARIABLE ANNUITY PAYMENTS - A combination fixed
dollar and variable annuity payments is available on or after the second
Contract Anniversary.
MINIMUM PAYMENT
The first payment must be at least equal to the minimum payment amount according
to Our rules then in effect. If at any time, payments become less than the
minimum payment amount, We have the right to change the payment frequency to
meet the minimum payment requirements. If any payment amount is less than the
minimum annual payment amount, We may make an alternative arrangement with You.
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SETTLEMENT PROVISIONS (CONTINUED)
ANNUITY OPTIONS
FIRST OPTION - Life Annuity - An annuity payable during the lifetime of the
Annuitant, ceasing with the last payment due prior to the death of the
Annuitant. There is no Death Benefit payable to the Beneficiary under this
Option.
SECOND OPTION - Life Annuity With a Cash Refund - An annuity payable during the
lifetime of the Annuitant. At the death of the Annuitant, any remaining value
will be paid to the Beneficiary. The remaining value equals the Contract Value,
less Premium Tax, minus the sum of all annuity payments made. This option is
only available for fixed dollar annuity payments.
THIRD OPTION - Life Annuity with Payments for a Period Certain - An annuity
payable for a specified number of years and for as long as the Annuitant is
living. If at the death of the Annuitant, payments have been made for less than
the period selected, the remaining payments will be made to the Beneficiary. The
Beneficiary may elect to receive the present value of the remaining payments in
one sum. To calculate the present value for fixed dollar annuity payments We
will use an interest rate We determine at Our discretion. To calculate the
present value of variable annuity payments, We will use the AIR elected by the
Contract Owner when this annuity option was selected and the Annuity Unit value
on the date of receipt of Due Proof of Death.
FOURTH OPTION - Joint and Last Survivor Life Annuity - An annuity payable during
the lifetimes of the Annuitant and the Joint Annuitant and thereafter during the
remaining lifetime of the survivor. At the time of electing this annuity option,
the Contract Owner may elect reduced payments over the remaining lifetime of the
survivor. Payments will cease with the last payment prior to the death of the
survivor.
FIFTH OPTION - Joint and Last Survivor Life Annuity with Payments for a Period
Certain - An annuity payable for a specified number of years and during the
lifetimes of the Annuitant and the Joint Annuitant and thereafter during the
remaining lifetime of the survivor. At the time of electing this annuity option,
the Contract Owner may elect reduced payments over the remaining lifetime of the
survivor. If at the death of the survivor, payments have been made for less than
the period selected, the remaining payments will be made to the Beneficiary. The
Beneficiary may elect to receive the present value of the remaining payments in
one sum. To calculate the present value for fixed dollar annuity payments We
will use an interest rate We determine at Our discretion. To calculate the
present value of variable annuity payments, We will use the AIR elected by the
Contract Owner when this annuity option was selected and the Annuity Unit value
on the date of receipt of Due Proof of Death.
SIXTH OPTION - Payment for a Period Certain - An annuity payable for a specified
number of years. If at the death of the Annuitant, payments have been made for
less than the period selected, the remaining payments will be made to the
Beneficiary. The Beneficiary may elect to receive the present value of the
remaining payments in one sum. To calculate the present value for fixed dollar
annuity payments We will use an interest rate We determine at Our discretion. To
calculate the present value of variable annuity payments, we will use the AIR
elected by the Contract Owner when this annuity option was selected and the
Annuity Unit value on the date of receipt of Due Proof of Death.
SEVENTH OPTION - Annuity Proceeds Settlement Option - Proceeds from the Death
Benefit can be left with Us for a period not to exceed five years from the date
of the Contract Owner's or the Annuitant's death prior to the Annuity
Commencement Date. The proceeds will remain in the Sub-Account(s) to which they
were allocated at the time of death unless the Beneficiary elects to reallocate
them. Full or partial withdrawals may be made at any time. In the event of
withdrawals, the remaining value will equal the Contract Value of the proceeds
left with Us, minus any withdrawals.
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ANNUITY TABLES
DESCRIPTION OF TABLES
The attached tables show the actual first monthly payment for each $1,000
applied to variable annuity payments. Under the First, Second and Third Options,
the amount of each payment will depend upon the age and gender of the Annuitant
at the time the first payment is due. Under the Fourth and Fifth Options, the
amount of the first payment will depend upon the gender of both Annuitants and
their ages at the time the first payment is due.
Gender will not be used to determine the amount of the annuity payable if this
contract is issued to qualify under certain sections of the Internal Revenue
Code. If gender is used to determine the amount of annuity payable, the annuity
tables at the end of this contract will provide rates of payment for male
Annuitants and female Annuitants.
The variable payment annuity tables for the First through Fifth Options are
based on the [1983a Individual Annuity Mortality Table projected to the year
2000 using Projection Scale G and the Assumed Investment Return]. The table for
the Sixth Option is based on an Assumed Investment Return.
The annuity tables for the First through Fifth variable annuity Options are age
dependent. For annuity payments beginning after 2000, the amount of the first
payment will be based on an age a specified number of years younger than the
annuitant's then-attained age. The age setback is as follows:
DATE OF FIRST PAYMENT AGE SETBACK
[Prior to 2005 2 years
2005 - 2014 3 years
2015 - 2019 4 years
2020 - 2029 5 years
2030 - 2039 6 years
2040 or later 7 years]
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ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [3%] ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
The second and subsequent annuity payments under a variable annuity are based on
the investment experience of a Separate Account and are not guaranteed as to
fixed dollar amount. Payments for any available Annuity Payment Frequency,
Period Certain, age, or combination of ages not shown will be quoted upon
request.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
-------- --------------- --------------- -------------- ---------------- --------------- -------------- --------------- ----------
[35 $3.35 $3.35 $3.34 $3.33 $3.18 $3.18 $3.18 $3.17
40 3.54 3.53 3.52 3.50 3.33 3.33 3.32 3.31
45 3.78 3.76 3.74 3.71 3.52 3.51 3.50 3.49
50 4.08 4.05 4.01 3.95 3.76 3.75 3.73 3.70
51 4.15 4.12 4.07 4.01 3.81 3.80 3.78 3.75
52 4.23 4.19 4.14 4.06 3.87 3.86 3.84 3.80
53 4.30 4.26 4.20 4.12 3.93 3.92 3.89 3.85
54 4.38 4.34 4.27 4.18 4.00 3.98 3.95 3.91
55 4.47 4.42 4.35 4.24 4.07 4.04 4.01 3.96
56 4.56 4.50 4.42 4.30 4.14 4.11 4.08 4.02
57 4.66 4.59 4.50 4.37 4.22 4.19 4.15 4.08
58 4.76 4.68 4.58 4.43 4.30 4.26 4.22 4.15
59 4.87 4.78 4.67 4.50 4.38 4.35 4.29 4.21
60 4.98 4.89 4.76 4.56 4.47 4.43 4.37 4.28
61 5.11 5.00 4.85 4.63 4.57 4.52 4.45 4.35
62 5.24 5.11 4.94 4.69 4.67 4.62 4.54 4.42
63 5.38 5.23 5.04 4.76 4.78 4.72 4.63 4.49
64 5.54 5.36 5.13 4.83 4.90 4.83 4.72 4.56
65 5.70 5.50 5.23 4.89 5.03 4.94 4.82 4.63
66 5.87 5.63 5.34 4.95 5.16 5.06 4.92 4.70
67 6.06 5.78 5.44 5.01 5.30 5.19 5.02 4.78
68 6.25 5.93 5.54 5.07 5.45 5.32 5.13 4.85
69 6.46 6.08 5.64 5.12 5.62 5.46 5.24 4.92
70 6.69 6.24 5.74 5.17 5.80 5.61 5.35 4.98
75 8.05 7.10 6.21 5.36 6.92 6.46 5.91 5.26
80 9.97 7.97 6.56 5.47 8.57 7.45 6.39 5.42]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $3.04 $3.11 $3.16 $3.21 $3.25 $3.28 $3.30 $3.32 $3.33 $3.34 $3.34 $3.35
40 3.08 3.16 3.24 3.31 3.37 3.42 3.46 3.49 3.51 3.52 3.53 3.53
45 3.11 3.21 3.31 3.41 3.50 3.58 3.64 3.69 3.72 3.74 3.76 3.77
50 3.13 3.25 3.37 3.50 3.62 3.74 3.84 3.92 3.98 4.02 4.05 4.06
55 3.15 3.27 3.41 3.57 3.74 3.90 4.06 4.19 4.29 4.36 4.41 4.43
60 3.16 3.29 3.45 3.63 3.84 4.06 4.28 4.48 4.65 4.78 4.87 4.92
65 3.17 3.31 3.47 3.67 3.91 4.19 4.48 4.78 5.06 5.29 5.46 5.56
70 3.17 3.32 3.49 3.71 3.97 4.29 4.66 5.07 5.49 5.88 6.18 6.39
75 3.18 3.32 3.50 3.73 4.01 4.36 4.79 5.31 5.90 6.49 7.02 7.42
80 3.18 3.33 3.51 3.74 4.03 4.40 4.88 5.49 6.24 7.08 7.92 8.63
85 3.18 3.33 3.51 3.75 4.05 4.43 4.94 5.62 6.50 7.58 8.78 9.92
90 3.18 3.33 3.52 3.75 4.05 4.45 4.98 5.70 6.68 7.96 9.52 11.18]
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ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [3%] ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $3.04 $3.11 $3.16 $3.21 $3.25 $3.28 $3.30 $3.32 $3.33 $3.34 $3.34 $3.34
40 3.08 3.16 3.24 3.31 3.37 3.42 3.46 3.49 3.51 3.52 3.53 3.53
45 3.11 3.21 3.31 3.41 3.50 3.58 3.64 3.69 3.72 3.74 3.75 3.76
50 3.13 3.25 3.37 3.50 3.62 3.74 3.84 3.92 3.97 4.01 4.03 4.05
55 3.15 3.27 3.41 3.57 3.74 3.90 4.05 4.18 4.28 4.35 4.39 4.40
60 3.16 3.29 3.45 3.63 3.83 4.05 4.27 4.47 4.64 4.76 4.83 4.86
65 3.17 3.31 3.47 3.67 3.91 4.18 4.48 4.77 5.04 5.24 5.38 5.45
70 3.17 3.31 3.49 3.70 3.97 4.28 4.65 5.05 5.45 5.79 6.02 6.16
75 3.18 3.32 3.50 3.72 4.00 4.35 4.77 5.27 5.82 6.32 6.71 6.94
80 3.18 3.32 3.51 3.73 4.02 4.39 4.86 5.43 6.10 6.79 7.35 7.70
85 3.18 3.33 3.51 3.74 4.04 4.41 4.90 5.53 6.30 7.12 7.85 8.33
90 3.18 3.33 3.51 3.74 4.04 4.42 4.93 5.58 6.40 7.32 8.16 8.74]
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
[5 $17.91 10 $9.61 15 $6.87 20 $5.51 25 $4.71 30 $4.18]
6 15.14 11 8.86 16 6.53 21 5.32 26 4.59
7 13.16 12 8.24 17 6.23 22 5.15 27 4.47
8 11.68 13 7.71 18 5.96 23 4.99 28 4.37
9 10.53 14 7.26 19 5.73 24 4.84 29 4.27
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ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [5%] ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Second and subsequent Annuity payments under a variable annuity are based on the
investment experience of a Separate Account and are not guaranteed as to fixed
dollar amount. Payments for any available Annuity Payment Frequency, Period
Certain, age, or combination of ages not shown will be quoted upon request.
FIRST, SECOND, AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
---------------------------------------------------------------------------------------------------------------------------
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 CASH REFUND NONE 120 180 240 CASH REFUND
-----------------------------------------------------------------------------------------------------------------------------------
[35 $4.63 $4.62 $4.61 $4.60 $4.60 $4.48 $4.48 $4.47 $4.47 $4.46
40 4.80 4.78 4.77 4.74 4.74 4.60 4.60 4.59 4.58 4.58
45 5.02 4.99 4.96 4.91 4.92 4.77 4.75 4.74 4.72 4.72
50 5.30 5.25 5.20 5.13 5.16 4.98 4.96 4.94 4.90 4.91
51 5.36 5.31 5.26 5.18 5.21 5.03 5.01 4.98 4.94 4.95
52 5.43 5.38 5.31 5.23 5.27 5.08 5.06 5.03 4.99 5.00
53 5.51 5.45 5.37 5.28 5.33 5.14 5.11 5.08 5.03 5.05
54 5.58 5.52 5.44 5.33 5.39 5.20 5.17 5.13 5.08 5.10
55 5.67 5.59 5.50 5.38 5.46 5.26 5.23 5.19 5.13 5.16
56 5.75 5.67 5.57 5.44 5.53 5.33 5.29 5.25 5.18 5.21
57 5.85 5.75 5.64 5.49 5.60 5.40 5.36 5.31 5.24 5.27
58 5.95 5.84 5.72 5.55 5.68 5.48 5.43 5.37 5.29 5.34
59 6.05 5.94 5.80 5.61 5.76 5.56 5.51 5.44 5.35 5.41
60 6.17 6.04 5.88 5.67 5.85 5.65 5.59 5.51 5.41 5.48
61 6.29 6.14 5.96 5.73 5.94 5.74 5.67 5.59 5.47 5.55
62 6.42 6.25 6.05 5.78 6.04 5.84 5.76 5.67 5.53 5.63
63 6.56 6.37 6.14 5.84 6.14 5.95 5.86 5.75 5.59 5.72
64 6.71 6.49 6.23 5.90 6.24 6.06 5.96 5.84 5.66 5.81
65 6.87 6.62 6.32 5.96 6.36 6.18 6.07 5.93 5.72 5.91
66 7.05 6.75 6.41 6.01 6.47 6.31 6.18 6.02 5.79 6.01
67 7.23 6.89 6.51 6.06 6.60 6.46 6.30 6.11 5.85 6.12
68 7.43 7.03 6.60 6.11 6.73 6.61 6.43 6.21 5.92 6.23
69 7.65 7.18 6.69 6.16 6.87 6.77 6.57 6.31 5.98 6.35
70 7.87 7.33 6.79 6.21 7.01 6.95 6.71 6.42 6.04 6.48
75 9.25 8.14 7.21 6.38 7.85 8.08 7.53 6.94 6.29 7.25
80 11.20 8.97 7.53 6.47 8.92 9.75 8.47 7.37 6.43 8.27]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $4.35 $4.40 $4.44 $4.48 $4.52 $4.55 $4.57 $4.59 $4.60 $4.61 $4.62 $4.63
40 4.38 4.44 4.50 4.56 4.61 4.66 4.70 4.73 4.75 4.77 4.78 4.79
45 4.41 4.48 4.56 4.64 4.72 4.79 4.85 4.90 4.94 4.97 4.99 5.00
50 4.42 4.51 4.61 4.71 4.82 4.93 5.02 5.10 5.17 5.21 5.25 5.27
55 4.44 4.54 4.65 4.78 4.92 5.07 5.21 5.34 5.45 5.53 5.58 5.62
60 4.45 4.55 4.68 4.83 5.01 5.21 5.41 5.61 5.78 5.92 6.02 6.08
65 4.46 4.57 4.71 4.88 5.09 5.33 5.60 5.89 6.17 6.40 6.58 6.70
70 4.47 4.58 4.73 4.91 5.14 5.43 5.78 6.17 6.58 6.97 7.29 7.52
75 4.47 4.59 4.74 4.94 5.19 5.51 5.91 6.41 6.98 7.57 8.11 8.53
80 4.48 4.59 4.75 4.95 5.21 5.56 6.01 6.60 7.33 8.16 9.00 9.72
85 4.48 4.60 4.76 4.96 5.23 5.60 6.08 6.73 7.60 8.66 9.86 11.01
90 4.48 4.60 4.76 4.97 5.25 5.62 6.12 6.82 7.79 9.05 10.61 12.27]
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ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [5%] ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $4.35 $4.40 $4.44 $4.48 $4.52 $4.55 $4.57 $4.59 $4.60 $4.61 $4.62 $4.62
40 4.38 4.44 4.50 4.56 4.61 4.66 4.70 4.73 4.75 4.77 4.78 4.78
45 4.41 4.48 4.56 4.64 4.72 4.79 4.85 4.90 4.93 4.96 4.98 4.99
50 4.42 4.51 4.61 4.71 4.82 4.93 5.02 5.10 5.16 5.20 5.23 5.24
55 4.44 4.53 4.65 4.78 4.92 5.07 5.21 5.33 5.44 5.51 5.55 5.58
60 4.45 4.55 4.68 4.83 5.01 5.20 5.41 5.60 5.76 5.89 5.97 6.01
65 4.46 4.57 4.71 4.88 5.08 5.33 5.60 5.88 6.14 6.35 6.49 6.57
70 4.47 4.58 4.73 4.91 5.14 5.42 5.76 6.14 6.52 6.86 7.10 7.24
75 4.47 4.59 4.74 4.93 5.18 5.49 5.89 6.36 6.88 7.37 7.75 7.98
80 4.47 4.59 4.75 4.95 5.20 5.54 5.97 6.52 7.16 7.82 8.36 8.70
85 4.48 4.60 4.75 4.95 5.22 5.57 6.03 6.62 7.35 8.14 8.83 9.29
90 4.48 4.60 4.75 4.96 5.23 5.58 6.05 6.68 7.46 8.34 9.13 9.68]
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
[5 $18.74 10 $10.51 15 $7.82 20 $6.51 25 $5.76 30 $5.28]
6 15.99 11 9.77 16 7.49 21 6.33 26 5.65
7 14.02 12 9.16 17 7.20 22 6.17 27 5.54
8 12.56 13 8.64 18 6.94 23 6.02 28 5.45
9 11.42 14 8.20 19 6.71 24 5.88 29 5.36
NCDSC03SXD5 Page 21 PRINTED IN U.S.A.
B698R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [6%] ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Second and subsequent Annuity payments under a variable annuity are based on the
investment experience of a Separate Account and are not guaranteed as to fixed
dollar amount. Payments for any available Annuity Payment Frequency, Period
Certain, age, or combination of ages not shown will be quoted upon request.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MALE PAYEE FEMALE PAYEE
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
-------- --------------- --------------- -------------- ---------------- --------------- -------------- --------------- ----------
[35 $5.31 $5.30 $5.29 $5.27 $5.17 $5.17 $5.16 $5.15
40 5.46 5.45 5.43 5.40 5.28 5.27 5.26 5.25
45 5.67 5.64 5.60 5.56 5.43 5.42 5.40 5.38
50 5.94 5.89 5.83 5.75 5.63 5.60 5.58 5.54
51 6.00 5.94 5.88 5.80 5.67 5.65 5.62 5.58
52 6.07 6.00 5.93 5.84 5.72 5.70 5.66 5.62
53 6.14 6.07 5.99 5.89 5.78 5.75 5.71 5.66
54 6.22 6.14 6.05 5.94 5.84 5.80 5.76 5.70
55 6.30 6.21 6.11 5.99 5.90 5.86 5.81 5.75
56 6.38 6.28 6.18 6.04 5.96 5.92 5.87 5.80
57 6.47 6.36 6.24 6.09 6.03 5.98 5.92 5.85
58 6.57 6.45 6.32 6.14 6.10 6.05 5.98 5.90
59 6.67 6.54 6.39 6.19 6.18 6.12 6.05 5.95
60 6.78 6.64 6.47 6.25 6.27 6.20 6.12 6.01
61 6.90 6.74 6.55 6.30 6.36 6.28 6.19 6.06
62 7.03 6.84 6.63 6.36 6.46 6.37 6.26 6.12
63 7.17 6.96 6.71 6.41 6.56 6.46 6.34 6.18
64 7.32 7.07 6.80 6.47 6.67 6.56 6.42 6.24
65 7.48 7.20 6.88 6.52 6.79 6.66 6.51 6.30
66 7.66 7.33 6.97 6.57 6.92 6.77 6.59 6.36
67 7.84 7.46 7.06 6.62 7.06 6.89 6.69 6.42
68 8.04 7.60 7.15 6.67 7.21 7.01 6.78 6.48
69 8.25 7.74 7.24 6.71 7.37 7.14 6.88 6.54
70 8.48 7.89 7.33 6.75 7.54 7.28 6.97 6.59
75 9.86 8.68 7.73 6.91 8.67 8.08 7.47 6.83
80 11.81 9.47 8.04 7.00 10.35 8.99 7.89 6.96]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $5.05 $5.09 $5.13 $5.16 $5.19 $5.22 $5.25 $5.27 $5.28 $5.29 $5.30 $5.30
40 5.08 5.13 5.18 5.23 5.28 5.32 5.36 5.39 5.41 5.43 5.45 5.45
45 5.10 5.16 5.23 5.30 5.37 5.43 5.49 5.54 5.58 5.61 5.64 5.65
50 5.11 5.19 5.27 5.36 5.46 5.56 5.65 5.73 5.80 5.85 5.88 5.91
55 5.13 5.21 5.31 5.42 5.55 5.69 5.82 5.95 6.06 6.14 6.20 6.24
60 5.14 5.23 5.34 5.48 5.64 5.82 6.01 6.20 6.37 6.52 6.62 6.69
65 5.15 5.24 5.36 5.52 5.71 5.94 6.20 6.47 6.75 6.99 7.17 7.30
70 5.16 5.26 5.38 5.55 5.77 6.04 6.36 6.74 7.15 7.54 7.86 8.10
75 5.16 5.26 5.40 5.58 5.81 6.11 6.50 6.98 7.54 8.13 8.67 9.10
80 5.17 5.27 5.41 5.60 5.84 6.17 6.60 7.17 7.89 8.71 9.55 10.28
85 5.17 5.27 5.42 5.61 5.86 6.21 6.68 7.31 8.16 9.22 10.41 11.56
90 5.17 5.28 5.42 5.61 5.88 6.23 6.72 7.40 8.36 9.62 11.16 12.81]
NCDSC03SXD6 Page 22 PRINTED IN U.S.A.
B699R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [6%] ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $5.05 $5.09 $5.13 $5.16 $5.19 $5.22 $5.25 $5.26 $5.28 $5.29 $5.30 $5.30
40 5.08 5.13 5.18 5.23 5.28 5.32 5.36 5.39 5.41 5.43 5.44 5.44
45 5.10 5.16 5.23 5.30 5.37 5.43 5.49 5.54 5.58 5.61 5.62 5.63
50 5.11 5.19 5.27 5.36 5.46 5.56 5.65 5.72 5.79 5.83 5.86 5.88
55 5.13 5.21 5.31 5.42 5.55 5.69 5.82 5.94 6.04 6.12 6.17 6.19
60 5.14 5.23 5.34 5.47 5.63 5.82 6.01 6.19 6.36 6.48 6.56 6.61
65 5.15 5.24 5.36 5.52 5.71 5.93 6.19 6.46 6.71 6.92 7.07 7.14
70 5.16 5.25 5.38 5.55 5.76 6.03 6.35 6.71 7.08 7.42 7.66 7.79
75 5.16 5.26 5.40 5.57 5.80 6.10 6.47 6.93 7.43 7.91 8.29 8.51
80 5.17 5.27 5.41 5.59 5.83 6.15 6.56 7.09 7.71 8.35 8.88 9.21
85 5.17 5.27 5.41 5.60 5.84 6.17 6.62 7.19 7.90 8.67 9.34 9.78
90 5.17 5.27 5.41 5.60 5.85 6.19 6.64 7.25 8.01 8.86 9.63 10.16]
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
[5 $19.17 10 $10.97 15 $8.31 20 $7.04 25 $6.32 30 $5.87]
6 16.42 11 10.24 16 7.99 21 6.86 26 6.21
7 14.46 12 9.63 17 7.71 22 6.70 27 6.11
8 13.00 13 9.12 18 7.46 23 6.56 28 6.02
9 11.87 14 8.69 19 7.24 24 6.43 29 5.94
NCDSC03SXD6 Page 23 PRINTED IN U.S.A.
B700R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [3%] ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed Dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. The second and subsequent annuity payments under a variable
annuity are based on the investment experience of a Separate Account and are not
guaranteed as to fixed dollar amount. Payments for any available Annuity Payment
Frequency, Period Certain, age, or combination of ages not shown will be quoted
upon request.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
----------------- ---------------------------------------------------------------
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240
----------------- --------------- --------------- --------------- ---------------
[35 $3.27 $3.26 $3.26 $3.25
40 3.44 3.43 3.42 3.41
45 3.65 3.64 3.62 3.60
50 3.92 3.90 3.87 3.83
51 3.98 3.96 3.93 3.88
52 4.05 4.02 3.99 3.93
53 4.12 4.09 4.05 3.99
54 4.19 4.16 4.11 4.05
55 4.27 4.23 4.18 4.11
56 4.35 4.31 4.25 4.17
57 4.44 4.39 4.33 4.23
58 4.53 4.47 4.40 4.29
59 4.62 4.56 4.48 4.36
60 4.73 4.66 4.57 4.43
61 4.84 4.76 4.65 4.49
62 4.95 4.87 4.74 4.56
63 5.08 4.98 4.84 4.63
64 5.21 5.09 4.93 4.70
65 5.36 5.22 5.03 4.77
66 5.51 5.35 5.13 4.83
67 5.67 5.48 5.24 4.90
68 5.85 5.63 5.34 4.96
69 6.03 5.77 5.45 5.03
70 6.23 5.93 5.55 5.08
75 7.47 6.79 6.07 5.32
80 9.25 7.72 6.48 5.45]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF SECOND PAYEE
FIRST
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $3.05 $3.10 $3.14 $3.18 $3.21 $3.22 $3.24 $3.25 $3.26 $3.26 $3.26 $3.27
40 3.10 3.17 3.23 3.29 3.33 3.36 3.39 3.41 3.42 3.43 3.43 3.43
45 3.14 3.23 3.32 3.40 3.47 3.52 3.56 3.59 3.62 3.63 3.64 3.64
50 3.18 3.29 3.40 3.51 3.61 3.70 3.77 3.82 3.86 3.88 3.90 3.91
55 3.21 3.33 3.47 3.61 3.76 3.89 4.00 4.09 4.16 4.20 4.23 4.25
60 3.22 3.36 3.52 3.70 3.89 4.08 4.25 4.40 4.52 4.60 4.65 4.69
65 3.24 3.39 3.56 3.77 4.00 4.25 4.51 4.75 4.95 5.10 5.21 5.27
70 3.25 3.41 3.59 3.82 4.09 4.40 4.75 5.11 5.44 5.71 5.92 6.05
75 3.26 3.42 3.62 3.86 4.16 4.52 4.95 5.44 5.94 6.41 6.79 7.06
80 3.26 3.43 3.63 3.88 4.20 4.60 5.10 5.71 6.41 7.13 7.79 8.32
85 3.26 3.43 3.64 3.90 4.23 4.65 5.21 5.92 6.79 7.79 8.83 9.76
90 3.2 7 3.43 3.64 3.91 4.25 4.69 5.27 6.05 7.06 8.32 9.76 11.22]
NCDSC03UST3 Page 18 PRINTED IN U.S.A.
B701R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [3%] ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE OF AGE OF SECOND PAYEE
FIRST
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $3.05 $3.10 $3.14 $3.18 $3.21 $3.22 $3.24 $3.25 $3.26 $3.26 $3.26 $3.26
40 3.10 3.17 3.23 3.29 3.33 3.36 3.39 3.40 3.42 3.42 3.43 3.43
45 3.14 3.23 3.32 3.40 3.47 3.52 3.56 3.59 3.61 3.63 3.63 3.64
50 3.18 3.29 3.40 3.51 3.61 3.70 3.77 3.82 3.85 3.88 3.89 3.90
55 3.21 3.33 3.47 3.61 3.76 3.89 4.00 4.09 4.15 4.19 4.21 4.22
60 3.22 3.36 3.52 3.70 3.89 4.08 4.25 4.40 4.51 4.58 4.62 4.65
65 3.24 3.39 3.56 3.77 4.00 4.25 4.50 4.74 4.93 5.06 5.15 5.19
70 3.25 3.40 3.59 3.82 4.09 4.40 4.74 5.08 5.39 5.63 5.79 5.88
75 3.26 3.42 3.61 3.85 4.15 4.51 4.93 5.39 5.85 6.25 6.52 6.68
80 3.26 3.42 3.63 3.88 4.19 4.58 5.06 5.63 6.25 6.82 7.26 7.53
85 3.26 3.43 3.63 3.89 4.21 4.62 5.15 5.79 6.52 7.26 7.87 8.26
90 3.26 3.43 3.64 3.90 4.22 4.65 5.19 5.88 6.68 7.53 8.26 8.76]
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
[5 $17.91 10 $9.61 15 $6.87 20 $5.51 25 $4.71 30 $4.18]
6 15.14 11 8.86 16 6.53 21 5.32 26 4.59
7 13.16 12 8.24 17 6.23 22 5.15 27 4.47
8 11.68 13 7.71 18 5.96 23 4.99 28 4.37
9 10.53 14 7.26 19 5.73 24 4.84 29 4.27
NCDSC03UST3 Page 19 PRINTED IN U.S.A.
B702R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [5%] ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Second and subsequent Annuity payments under a variable annuity are based on the
investment experience of a Separate Account and are not guaranteed as to fixed
dollar amount. Payments for any available Annuity Payment Frequency, Period
Certain, age, or combination of ages not shown will be quoted upon request.
FIRST, SECOND, AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
----------------------------------------------------------------------
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 CASH REFUND
----------------------------------------------------------------------
[35 $4.56 $4.55 $4.54 $4.53 $4.53
40 4.70 4.69 4.68 4.66 4.66
45 4.89 4.87 4.85 4.82 4.82
50 5.14 5.11 5.07 5.02 5.03
51 5.20 5.16 5.12 5.06 5.08
52 5.26 5.22 5.17 5.11 5.13
53 5.32 5.28 5.23 5.16 5.19
54 5.39 5.34 5.29 5.21 5.25
55 5.46 5.41 5.35 5.26 5.31
56 5.54 5.48 5.41 5.31 5.37
57 5.62 5.56 5.48 5.37 5.44
58 5.71 5.64 5.55 5.43 5.51
59 5.81 5.72 5.62 5.48 5.58
60 5.91 5.81 5.70 5.54 5.66
61 6.01 5.91 5.78 5.60 5.75
62 6.13 6.01 5.86 5.66 5.83
63 6.25 6.11 5.95 5.72 5.93
64 6.38 6.23 6.04 5.79 6.03
65 6.52 6.34 6.13 5.85 6.13
66 6.68 6.47 6.22 5.91 6.24
67 6.84 6.60 6.32 5.97 6.35
68 7.01 6.73 6.41 6.02 6.48
69 7.20 6.88 6.51 6.08 6.61
70 7.40 7.02 6.61 6.13 6.74
75 8.65 7.84 7.08 6.34 7.54
80 10.45 8.73 7.46 6.45 8.59]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF SECOND PAYEE
FIRST
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $4.36 $4.40 $4.43 $4.46 $4.48 $4.50 $4.52 $4.53 $4.54 $4.55 $4.55 $4.55
40 4.40 4.45 4.50 4.54 4.58 4.61 4.64 4.66 4.67 4.68 4.69 4.70
45 4.43 4.50 4.57 4.63 4.69 4.74 4.79 4.82 4.84 4.86 4.87 4.88
50 4.46 4.54 4.63 4.73 4.81 4.89 4.96 5.02 5.06 5.09 5.11 5.12
55 4.48 4.58 4.69 4.81 4.94 5.06 5.17 5.26 5.33 5.38 5.41 5.43
60 4.50 4.61 4.74 4.89 5.06 5.23 5.39 5.54 5.66 5.75 5.81 5.85
65 4.52 4.64 4.79 4.96 5.17 5.39 5.63 5.86 6.07 6.23 6.34 6.42
70 4.53 4.66 4.82 5.02 5.26 5.54 5.86 6.20 6.53 6.81 7.03 7.18
75 4.54 4.67 4.84 5.06 5.33 5.66 6.07 6.53 7.02 7.49 7.88 8.17
80 4.55 4.68 4.86 5.09 5.38 5.75 6.23 6.81 7.49 8.20 8.87 9.41
85 4.55 4.69 4.87 5.11 5.41 5.81 6.34 7.03 7.88 8.87 9.90 10.85
90 4.55 4.70 4.88 5.12 5.43 5.85 6.42 7.18 8.17 9.41 10.85 12.30]
NCDSC03UST5 Page 20 PRINTED IN U.S.A.
B703R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [5%] ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE OF AGE OF SECOND PAYEE
FIRST
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $4.36 $4.40 $4.43 $4.46 $4.48 $4.50 $4.52 $4.53 $4.54 $4.55 $4.55 $4.55
40 4.40 4.45 4.50 4.54 4.58 4.61 4.64 4.66 4.67 4.68 4.69 4.69
45 4.43 4.50 4.57 4.63 4.69 4.74 4.78 4.82 4.84 4.86 4.87 4.87
50 4.46 4.54 4.63 4.73 4.81 4.89 4.96 5.01 5.05 5.08 5.09 5.10
55 4.48 4.58 4.69 4.81 4.94 5.06 5.16 5.25 5.32 5.36 5.39 5.40
60 4.50 4.61 4.74 4.89 5.06 5.22 5.39 5.53 5.64 5.72 5.77 5.80
65 4.52 4.64 4.78 4.96 5.16 5.39 5.62 5.85 6.04 6.18 6.27 6.31
70 4.53 4.66 4.82 5.01 5.25 5.53 5.85 6.17 6.47 6.71 6.88 6.97
75 4.54 4.67 4.84 5.05 5.32 5.64 6.04 6.47 6.91 7.30 7.57 7.74
80 4.55 4.68 4.86 5.08 5.36 5.72 6.18 6.71 7.30 7.85 8.27 8.54]
85 4.55 4.69 4.87 5.09 5.39 5.77 6.27 6.88 7.57 8.27 8.85 9.23
90 4.55 4.69 4.87 5.10 5.40 5.80 6.31 6.97 7.74 8.54 9.23 9.70
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
[5 $18.74 10 $10.51 15 $7.82 20 $6.51 25 $5.76 30 $5.28]
6 15.99 11 9.77 16 7.49 21 6.33 26 5.65
7 14.02 12 9.16 17 7.20 22 6.17 27 5.54
8 12.56 13 8.64 18 6.94 23 6.02 28 5.45
9 11.42 14 8.20 19 6.71 24 5.88 29 5.36
NCDSC03UST5 Page 21 PRINTED IN U.S.A.
B704R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [6%] ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Second and subsequent Annuity payments under a variable annuity are based on the
investment experience of a Separate Account and are not guaranteed as to fixed
dollar amount. Payments for any available Annuity Payment Frequency, Period
Certain, age, or combination of ages not shown will be quoted upon request.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
----------------- ---------------------------------------------------------------
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240
----------------- --------------- --------------- --------------- ---------------
[35 $5.24 $5.23 $5.23 $5.21
40 5.37 5.36 5.35 5.33
45 5.55 5.53 5.50 5.47
50 5.78 5.75 5.70 5.65
51 5.84 5.80 5.75 5.69
52 5.90 5.85 5.80 5.73
53 5.96 5.91 5.85 5.78
54 6.03 5.97 5.91 5.82
55 6.10 6.03 5.96 5.87
56 6.17 6.10 6.02 5.92
57 6.25 6.17 6.09 5.97
58 6.33 6.25 6.15 6.02
59 6.43 6.33 6.22 6.08
60 6.52 6.42 6.30 6.13
61 6.63 6.51 6.37 6.19
62 6.74 6.61 6.45 6.25
63 6.86 6.71 6.53 6.30
64 6.99 6.82 6.61 6.36
65 7.13 6.93 6.70 6.42
66 7.28 7.05 6.79 6.47
67 7.44 7.18 6.88 6.53
68 7.62 7.31 6.97 6.58
69 7.80 7.45 7.07 6.63
70 8.00 7.59 7.16 6.68
75 9.25 8.39 7.61 6.88
80 11.06 9.24 7.97 6.98]
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE OF AGE OF SECOND PAYEE
FIRST
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
[35 $5.06 $5.09 $5.12 $5.14 $5.17 $5.19 $5.20 $5.21 $5.22 $5.23 $5.23 $5.24
40 5.09 5.13 5.17 5.21 5.25 5.28 5.31 5.33 5.34 5.35 5.36 5.37
45 5.12 5.17 5.23 5.29 5.35 5.40 5.44 5.47 5.50 5.52 5.53 5.54
50 5.14 5.21 5.29 5.37 5.45 5.53 5.60 5.65 5.69 5.72 5.75 5.76
55 5.17 5.25 5.35 5.45 5.57 5.68 5.78 5.87 5.94 6.00 6.04 6.06
60 5.19 5.28 5.40 5.53 5.68 5.84 6.00 6.14 6.26 6.35 6.42 6.46
65 5.20 5.31 5.44 5.60 5.78 6.00 6.22 6.45 6.65 6.81 6.93 7.01
70 5.21 5.33 5.47 5.65 5.87 6.14 6.45 6.78 7.10 7.38 7.60 7.76
75 5.22 5.34 5.50 5.69 5.94 6.26 6.65 7.10 7.58 8.05 8.44 8.74
80 5.23 5.35 5.52 5.72 6.00 6.35 6.81 7.38 8.05 8.75 9.42 9.97
85 5.23 5.36 5.53 5.75 6.04 6.42 6.93 7.60 8.44 9.42 10.45 11.40
90 5.24 5.37 5.54 5.76 6.06 6.46 7.01 7.76 8.74 9.97 11.40 12.85]
NCDSC03UST6 Page 22 PRINTED IN U.S.A.
B705R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A [6%] ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE OF AGE OF SECOND PAYEE
FIRST
PAYEE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
35 $5.06 $5.09 $5.12 $5.14 $5.17 $5.18 $5.20 $5.21 $5.22 $5.23 $5.23 $5.23
[40 5.09 5.13 5.17 5.21 5.25 5.28 5.30 5.32 5.34 5.35 5.36 5.36
45 5.12 5.17 5.23 5.29 5.35 5.39 5.43 5.47 5.49 5.51 5.52 5.52
50 5.14 5.21 5.29 5.37 5.45 5.53 5.59 5.65 5.69 5.71 5.73 5.74
55 5.17 5.25 5.35 5.45 5.57 5.68 5.78 5.87 5.93 5.98 6.01 6.02
60 5.18 5.28 5.39 5.53 5.68 5.83 5.99 6.13 6.24 6.32 6.37 6.40
65 5.20 5.30 5.43 5.59 5.78 5.99 6.21 6.43 6.62 6.76 6.85 6.90
70 5.21 5.32 5.47 5.65 5.87 6.13 6.43 6.74 7.04 7.28 7.44 7.53
75 5.22 5.34 5.49 5.69 5.93 6.24 6.62 7.04 7.46 7.84 8.12 8.28
80 5.23 5.35 5.51 5.71 5.98 6.32 6.76 7.28 7.84 8.38 8.80 9.06]
85 5.23 5.36 5.52 5.73 6.01 6.37 6.85 7.44 8.12 8.80 9.36 9.72
90 5.23 5.36 5.52 5.74 6.02 6.40 6.90 7.53 8.28 9.06 9.72 10.18
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- ----------- -------- -----------
[]5 $19.17 10 $10.97 15 $8.31 20 $7.04 25 $6.32 30 $5.87]
6 16.42 11 10.24 16 7.99 21 6.86 26 6.21
7 14.46 12 9.63 17 7.71 22 6.70 27 6.11
8 13.00 13 9.12 18 7.46 23 6.56 28 6.02
9 11.87 14 8.69 19 7.24 24 6.43 29 5.94
NCDSC03UST6 Page 23 PRINTED IN U.S.A.
B706R0.FRM
INDIVIDUAL FLEXIBLE PREMIUM
VARIABLE ANNUITY CONTRACT
HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
P.O. Box 2999
Hartford,
Connecticut 06104-2999
ADMINISTRATIVE OFFICE:
Attn: Investment Product Services
P.O. Box 5085
Hartford, CT 06102-5085
[HARTFORD LOGO]
LA-NCDSC03 PRINTED IN U.S.A.
B709R0.FRM
[HARTFORD LOGO]
[RETURN OF CONTRACT VALUE DEATH BENEFIT RIDER]
This rider is issued as part of the contract to which it is attached. The
effective date of this rider is the same as the Contract Issue Date. This rider
cannot be terminated either by the Contract Owner or the Company prior to the
Annuity Commencement Date. Except where this rider provides otherwise, it is
subject to all of the conditions and limitations of the contract.
In Your contract, the paragraph entitled "Death Benefit Before Annuity
Commencement Date", the following is added:
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit payable before the Annuity Commencement Date is equal to the
Contract Value.
If a spouse continues the contract under the "Spouse Beneficiary" provision of
the contract, then the "date of receipt of Due Proof of Death" as used in this
rider means the date of receipt of Due Proof of Death of the decedent that dies
after the death.
RIDER CHARGE
The charge for this rider is included in the net investment factor as an
optional rider charge. It is an annual charge of 0.00% that is deducted daily
from the value of the Sub-Accounts until the Annuity Commencement Date, however,
the Company reserves the right to assess a charge of up to [0.50%] for newly
issued riders.
Signed for HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX
Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT
LA-VA03CVR Page 1 of 1 PRINTED IN U.S.A.
B810R0.FRM
[HARTFORD LOGO]
[EARNINGS PROTECTION BENEFIT RIDER]
This rider is issued as part of the Contract to which it is attached. The
effective date of this rider is the date this rider is issued. This rider cannot
be terminated either by the Contract Owner or the Company. Except where this
rider provides otherwise, it is subject to all of the terms and conditions of
the Contract.
In Your contract, the paragraph entitled "Death Benefit Before the Annuity
Commencement Date", the following is added:
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
If both the Contract Owner(s) and Annuitant are age [80] or younger on the
effective date of this rider, the value of the Earnings Protection Benefit is
determined as follows:
The Contract Value as of the date of receipt of Due Proof of Death plus [40%] of
the lesser of 1. or 2. below if both the Contract Owner(s) and Annuitant are age
[69] or younger on the effective date of this rider, or [25%] of the lesser of
1. or 2. below if either the Contract Owner(s) or Annuitant is age [70] or older
on the effective date of this rider.
1. The greater of zero or the following amount:
A. the Contract Value as of the date of receipt of Due Proof of Death; less
B. the Contract Value on the effective date of this rider plus premium
payments received after the effective date of this rider; plus
C. the sum of Adjustments for all partial surrenders which occur after the
effective date of this rider.
2. [200%] of A. less B. below as follows:
A. the Contract Value on the effective date of this rider, plus premium
payments received after the effective date of this rider excluding
payments received within 12 months of the date of death, less
B. the sum of Adjustments for all partial surrenders which occur after the
effective date of this rider.
The adjustment for each partial surrender which occurs after the effective date
of this rider is equal to the greater of zero or the following amount:
1. the gross amount of the partial surrender; plus
2. the Contract Value on the effective date of this rider plus premium payments
received after the effective date of this rider and prior to the partial
surrender, less
3. the Contract Value on the Valuation Day immediately preceding the date of
partial surrender; less
4. the sum of Adjustments for all prior partial surrenders which have occurred
after the effective date of this rider.
LA-VA03EPB Page 1 of 2 PRINTED IN U.S.A.
B789R0.FRM
OWNERSHIP CHANGE - Upon a change in Contract Owner, where the new Owner is
ineligible for this rider, the Death Benefit under this rider becomes null and
void.
RIDER CHARGE
The charge for this rider is included in the net investment factor as an
optional rider charge. It is an annual charge of [0.30%] that is deducted from
the value of the Sub-Accounts until the Annuity Commencement Date.
Signed for HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX
Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT
LA-VA03EPB Page 2 of 2 PRINTED IN U.S.A.
B790R0.FRM
[HARTFORD LOGO]
[RETURN OF PREMIUM DEATH BENEFIT RIDER]
This rider is issued as part of the contract to which it is attached. The
effective date of this rider is the same as the Contract Issue Date. This rider
cannot be terminated either by the Contract Owner or the Company. Except where
this rider provides otherwise, it is subject to all of the terms and conditions
of the contract.
In Your contract, the paragraph entitled "Death Benefit Before the Annuity
Commencement Date", the following is added:
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit payable before the Annuity Commencement Date is equal to the
greater of the amounts determined in (A) or (B) below:
A. return of Premium Payments (defined below); or
B. the Contract Value at the date of receipt of Due Proof of Death.
PREMIUM PAYMENTS - All premium payments paid under the contract modified by
Adjustments for Partial Surrenders and less any premium payments received within
12 months of the date of death.
ADJUSTMENTS FOR PARTIAL SURRENDERS are calculated as follows:
For cumulative partial surrenders during each Contract Year that are equal to or
less than 10% of premium payments, the adjustment is the dollar amount of the
partial surrender.
For any partial surrender that causes cumulative partial surrenders during the
Contract Year to exceed 10% of premium payments, the adjustment is the dollar
amount of the partial surrender that does not exceed 10% of premiums, and the
adjustment for the remaining portion of the partial surrender is a factor
applied to the portion of premium payments that exceed 10% of premium payments
as follows:
1 - (A/(B-C )) where
A = partial surrenders during the Contract Year in excess of 10% of premium
payments;
B = Contract Value immediately prior to the partial surrender; and
C = 10% of premium payments less any partial surrenders during the Contract
Year. If C results in a negative number, C becomes zero.
For partial surrenders during each Contract Year that are entirely in excess of
10% of premium payments, the adjustment is a factor applied to adjusted premium
payments immediately before the surrender as follows:
1 - (A/B) where
A = partial surrenders during the Contract Year in excess of 10% of premium
payments;
B = Contract Value immediately prior to the partial surrender.
No Death Benefit is payable under this rider if the contract is surrendered and
the Contract Value is equal to zero.
LA-VAROP03 Page 1 of 2 PRINTED IN U.S.A.
B812R0.FRM
If a spouse continues the contract under the "Spouse Beneficiary" provision of
the contract, then the "date of receipt of Due Proof of Death" as used in this
rider means the date of receipt of Due Proof of Death of the decedent that dies
after the death
OWNERSHIP CHANGE - Upon a change in Contract Owner, where the new Owner is
ineligible for this rider, the Death Benefit set forth under this rider becomes
null and void.
RIDER CHARGE
The charge for this rider is included in the net investment factor as an
optional rider charge. it is an annual charge of 0.00% that is deducted daily
from the value of the Sub-Accounts until the Annuity Commencement Date, however,
the Company reserves the right to assess a charge of up to [0.50%] for newly
issued riders.
Signed for HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX
Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT
LA-VAROP03 Page 2 of 2 PRINTED IN U.S.A.
B830R0.FRM
[HARTFORD LOGO]
[EARNINGS PROTECTION BENEFIT / MAXIMUM ANNIVERSARY VALUE DEATH BENEFIT RIDER]
This rider is issued as part of the contract to which it is attached. The
effective date of this rider is the date this rider is issued. This rider cannot
be terminated either by the Contract Owner or the Company. Except where this
rider provides otherwise, it is subject to all of the terms and conditions of
the contract.
In Your contract, the paragraph entitled "Death Benefit Before the Annuity
Commencement Date", the following is added:
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit payable before the Annuity Commencement Date is equal to the
greatest of the amounts determined in (A), (B) or (C) below:
A. the EARNINGS PROTECTION BENEFIT value (defined below) at the date of
receipt of Due Proof of Death;
B. the MAXIMUM ANNIVERSARY VALUE (defined below); or
C. PREMIUM PAYMENTS (defined below).
EARNINGS PROTECTION BENEFIT - if both the Contract Owner(s) and Annuitant are
age [80] or younger on the effective date of this rider, the value of the
Earnings Protection Benefit is determined as follows:
The Contract Value as of the date of receipt of Due Proof of Death plus [40%] of
the lesser of 1. or 2. below if both the Contract Owner(s) and Annuitant are age
[69] or younger on the effective date of this rider, or [25%] of the lesser of
1. or 2. below if either the Contract Owner(s) or Annuitant is age [70] or older
on the effective date of this rider.
1. The greater of zero or the following amount:
C. the Contract Value as of the date of receipt of Due Proof of Death; less
D. the Contract Value on the effective date of this rider plus premium
payments received after the effective date of this rider; plus
E. the sum of adjustments for all partial surrenders which occur after the
effective date of this rider.
2. [200%] of F. less G. below as follows:
F. the Contract Value on the effective date of this rider, plus premium
payments received after the effective date of this rider excluding
payments received within 12 months of the date of death, less
G. the sum of adjustments for all partial surrenders which occur after the
effective date of this rider.
For the Earnings Protection Benefit, the adjustment for each partial surrender
which occurs after the effective date of this rider is equal to the greater of
zero or the following amount:
1. the gross amount of the partial surrender; plus
2. the Contract Value on the effective date of this rider plus premium payments
received after the effective date of this rider and prior to the partial
surrender, less
3. the Contract Value on the Valuation Day immediately preceding the date of
partial surrender; less
4. the sum of adjustments for all prior partial surrenders which have occurred
after the effective date of this rider.
MAXIMUM ANNIVERSARY VALUE - The highest attained Anniversary Value (defined
below) prior to the earlier of the date of death or the decedent's 81st
birthday.
ANNIVERSARY VALUE - We calculate an Anniversary Value for every Contract
Anniversary. At the time of each Contract Anniversary, the Anniversary Value is
equal to the Contract Value. Any time after each such Contract Anniversary, the
Anniversary Value is restated to be equal to the Contract Value at the time of
the Contract Anniversary, increased by the dollar amount of any premium payments
received, and modified by Adjustments for Partial Surrenders since such Contract
Anniversary.
LA-VAEPBMAV03 Page 1 of 2 PRINTED IN U.S.A.
B785R0.FRM
PREMIUM PAYMENTS - All premium payments received under the contract modified by
Adjustments for Partial Surrenders and less any premium payments received within
12 months of the date of death.
ADJUSTMENTS FOR PARTIAL SURRENDERS FOR MAXIMUM ANNIVERSARY VALUES AND PREMIUM
PAYMENTS are calculated as follows: For cumulative partial surrenders during
each Contract Year that are equal to or less than 10% of premium payments, the
adjustment is the dollar amount of the partial surrender.
For any partial surrender that causes cumulative partial surrenders during the
Contract Year to exceed 10% of premium payments, the adjustment is the dollar
amount of the partial surrender that does not exceed 10% of premiums, and the
adjustment for the remaining portion of the partial surrender is a factor. The
factor for Adjustments for Partial Surrenders for the Maximum Anniversary Value
is applied to the portion of Anniversary Values that exceed 10% of premium
payments. The factor for Adjustments for Partial Surrenders for premium payments
is applied to the portion of premium payments that exceed 10% of premium
payments. The factor is as follows:
1 - (A/(B-C)) where
A = partial surrenders during the Contract Year in excess of 10% of premium
payments;
B = Contract Value immediately prior to the partial surrender; and
C = 10% of premium payments less any partial surrenders during the Contract
Year. If C results in a negative number, C becomes zero.
For partial surrenders during each Contract Year that are entirely in excess of
10% of premium payments, the adjustment is a factor. The factor for Adjustments
for Partial Surrenders for the Maximum Anniversary Value is applied to the
adjusted Anniversary Value immediately before the surrender. The factor for
Adjustments for Partial Surrenders for premium payments is applied to the
adjusted premium payments immediately before the surrender. The factor is as
follows:
1 - (A/B) where
A = partial surrenders during the Contract Year in excess of 10% of premium
payments;
B = Contract Value immediately prior to the partial surrender.
No Death Benefit is payable under this rider if the contract is surrendered and
the Contract Value is equal to zero.
If a spouse continues the contract under the "Spouse Beneficiary" provision of
the contract, then the term "date of receipt of Due Proof of Death" as used in
this rider means the date of receipt of Due Proof of Death of the decedent that
dies after the death of the first spouse, and the Maximum Anniversary Value is
the highest attained Anniversary Value after the date of death of the first
spouse, and before the next decedent's date of death or 81st birthday, if
earlier.
OWNERSHIP CHANGE - Upon a change in Contract Owner, where the new Owner is
ineligible for this rider, the Death Benefit set forth under this rider becomes
null and void.
RIDER CHARGE
The charge for this rider is included in the net investment factor as an
optional rider charge. It is an annual charge of [0.50%] that is deducted daily
from the value of the Sub-Accounts until the Annuity Commencement Date.
Signed for HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX
Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT
LA-VAEPBMAV03 Page 2 of 2 PRINTED IN U.S.A.
B786R0.FRM
[HARTFORD LOGO]
[LOSS PROTECTION BENEFIT RIDER]
This rider is issued as part of the contract to which it is attached. The
effective date of this rider is the same as the Contract Issue Date. This rider
cannot be terminated either by the Contract Owner or the Company. Except where
this rider provides otherwise, it is subject to all of the terms and conditions
of the contract.
In Your contract, the paragraph entitled "Death Benefit Before the Annuity
Commencement Date", the following is added:
DEATH BENEFIT BEFORE THE ANNUITY COMMENCEMENT DATE
The Death Benefit payable before the Annuity Commencement Date is equal to the
greater of the amounts determined in (A) or (B) below:
A. the Contract Value at the date of receipt of Due Proof of Death; or
B. the lesser of (1) or (2) below:
1. the Contract Value at the date of receipt of Due Proof of Death plus the
Loss Protection Benefit (defined below); or
2. the greater of Maximum Anniversary Value (defined below) or Premium
Payments (defined below).
The LOSS PROTECTION BENEFIT (LPB) is equal to 25% of the greater of Maximum
Anniversary Value (defined below) or Premiums Payments (defined below).
MAXIMUM ANNIVERSARY VALUE - The highest attained Anniversary Value (defined
below) prior to the earlier of the date of death or the decedent's 81st
birthday.
ANNIVERSARY VALUE - We calculate an Anniversary Value for every Contract
Anniversary. At the time of each Contract Anniversary, the Anniversary Value is
equal to the Contract Value. Any time after each such Contract Anniversary, the
Anniversary Value is restated to be equal to the Contract Value at the time of
the Contract Anniversary, increased by the dollar amount of any premium payments
received, and modified by Adjustments for Partial Surrenders since such Contract
Anniversary.
PREMIUM PAYMENTS - All premium payments received under the contract modified by
Adjustments for Partial Surrenders and less any premium payments received within
12 months of the date of death.
ADJUSTMENTS FOR PARTIAL SURRENDERS ARE CALCULATED AS FOLLOWS:
For cumulative partial surrenders during each Contract Year that are equal to or
less than 10% of premium payments, the adjustment is the dollar amount of the
partial surrender.
For any partial surrender that causes cumulative partial surrenders during the
Contract Year to exceed 10% of premium payments, the adjustment is the dollar
amount of the partial surrender that does not exceed 10% of premiums, and the
adjustment for the remaining portion of the partial surrender is a factor. The
factor for Adjustments for Partial Surrenders for the Maximum Anniversary Value
is applied to the portion of Anniversary Values that exceed 10% of premium
payments. The factor for Adjustments for Partial Surrenders for premium payments
is applied to the portion of premium payments that exceed 10% of premium
payments.
LA-VALPB03 Page 1 of 2 PRINTED IN U.S.A.
B801R0.FRM
The factor is as follows:
1 - (A/(B-C)) where
A = partial surrenders during the Contract Year in excess of 10% of premium
payments;
B = Contract Value immediately prior to the partial surrender; and
C = 10% of premium payments less any partial surrenders during the Contract
Year. If C results in a negative number, C becomes zero.
For partial surrenders during each Contract Year that are entirely in excess of
10% of premium payments, the adjustment is a factor. The factor for Adjustments
for Partial Surrenders for the Maximum Anniversary Value is applied to the
adjusted Anniversary Value immediately before the surrender. The factor for
Adjustments for Partial Surrenders for premium payments is applied to the
adjusted premium payments immediately before the surrender.
The factor is as follows:
1 - (A/B) where
A = partial surrenders during the Contract Year in excess of 10% of premium
payments;
B = Contract Value immediately prior to the partial surrender.
No Death Benefit is payable under this rider if the contract is surrendered and
the Contract Value is equal to zero.
If a spouse continues the contract under the "Spouse Beneficiary" provision of
the contract, then:
1. The term "date of receipt of Due Proof of Death" as used in this rider
means the date of receipt of Due Proof of Death of the decedent that dies
after the death of the first spouse.
2. The Maximum Anniversary Value is the highest attained Anniversary Value
after the date of death of the first spouse, and before the next
decedent's date of death or 81st birthday, if earlier.
RIDER CHARGE
The charge for this rider is included in the net investment factor as an
optional rider charge. It is an annual charge of 0.00% that is deducted daily
from the value of the Sub-Accounts until the Annuity Commencement Date, however,
the Company reserves the right to assess a charge of up to [0.50%] for newly
issued riders.
Signed for HARTFORD LIFE AND ANNUITY INSURANCE COMPANY
/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX
Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT
LA-VALPB03 Page 2 of 2 PRINTED IN U.S.A.
B802R0.FRM
