Exhibit 1.(5)(a)
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LIBERTY LIFE ASSURANCE COMPANY OF BOSTON
A Member of the Liberty Mutual Group
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Home Office: 000 Xxxxxxxx Xxxxxx, X.X. Xxx 000, Xxxxxx, Xxxxxxxxxxxxx
00000-0000.
Service Center: 000 Xxxxxxx Xxx, Xxxxx, Xxx Xxxxxxxxx 00000-0000
READ THIS INSURANCE CONTRACT CAREFULLY
RIGHT TO RETURN
This is a legal contract between You and the Company. If You are not satisfied,
You may return it to Us or Your agent within 20 days of its receipt and any
payment will be refunded.
Liberty Life Assurance Company of Boston, a stock Company, will pay the benefits
provided in this contract, subject to its terms and conditions. The CONTRACT
GUIDE on the inside of the front cover shows where the major contract provisions
can be found.
We have issued this modified single payment variable life insurance contract in
consideration of Your application and the receipt of Your Initial Payment.
THE AMOUNT AND DURATION OF THE DEATH BENEFIT AND OTHER VALUES PROVIDED BY THIS
CONTRACT ARE BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, THE
FIXED ACCOUNT EARNINGS AND CONTRACT CHARGES. SEPARATE ACCOUNT VALUES ARE
VARIABLE AND MAY INCREASE OR DECREASE. THESE VALUES ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. THE DEATH BENEFIT IS DESCRIBED ON PAGE 3.
Signed for the Company.
/s/ Xxxxx X. Xxxxxx /s/ Xxxxxx X. Xxxxx
SECRETARY PRESIDENT
CONTRACT DESCRIPTION
This is a MODIFIED SINGLE PAYMENT VARIABLE LIFE INSURANCE CONTRACT.
The Death Benefit is payable if the Insured dies while this contract is in force
and before the Maturity Date.
A Maturity Benefit is payable if the Insured is living on the Maturity Date.
Death Benefit and Account Value may vary with investment and earnings experience
and contract charges.
This contract is not eligible for Dividends.
Page
CONTRACT ASSIGNMENT........................................................5
GUIDE CONTRACT CHARGES.................................................20
CONTRACT LOANS...................................................10
CONTRACT VALUES...................................................6
CONTRACT WITHDRAWAL..............................................11
DEATH BENEFIT.....................................................3
DEFINITIONS.......................................................2
GENERAL CONTRACT PROVISIONS.......................................5
GRACE PERIOD......................................................4
INCONTESTABILITY AND SUICIDE......................................6
MATURITY BENEFIT..................................................4
OWNER AND BENEFICIARY.............................................5
PAYMENT OF PROCEEDS..............................................15
PAYMENT OF PROCEEDS OPTIONS......................................15
REINSTATEMENT.....................................................4
SEPARATE ACCOUNT PROVISIONS.......................................9
PAYMENTS..........................................................4
TABLE OF GUARANTEED MONTHLY MAXIMUM
COST OF INSURANCE RATES.......................................18,19
TABLE OF WITHDRAWAL CHARGES......................................20
ANY ADDITIONAL AGREEMENTS, ENDORSEMENTS
AND A COPY OF THE APPLICATION APPEAR
AFTER PAGE.......................................................20
DEFINITIONS This is what We mean when We use the following words in Your
contract:
Accumulation Unit. An accounting unit of measurement which We use to
calculate the value of a sub-account.
Attained Age. The Insured's age on his or her last birthday.
Contract Date. The date when insurance coverage becomes effective.
Indebtedness. Any unpaid contract loan and unpaid loan interest.
Loan Account. An account established for amounts transferred from
the sub-accounts or the Fixed Account as security for outstanding
Indebtedness.
Monthly Date. The same day in each month as the Contract Date. The
day of the month on which the Monthly Deduction is taken from Your
Account Value.
Net Death Benefit. The Death Benefit, less any Indebtedness.
Proceeds. All or part of the amount payable under any provision of
this contract.
Written Request. A notice in writing, satisfactory to Us, placed on
file at Our Service Center.
Valuation Day. The day when a sub-account is valued. This occurs
every day We are open and the New York Stock Exchange is open for
trading.
Valuation Period. The time period between the close of business on
successive Valuation Days.
We, Our, Us, The Company. Liberty Life Assurance Company of Boston.
You, Your. The Owner of this contract, who may be someone other
than the Insured.
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DEATH THE BENEFIT
BENEFIT If the Insured dies while this contract is in force, We will pay a
Death Benefit to the Beneficiary. The Death Benefit will be the
greater of:
[bullet] the Initial Death Benefit shown on the Contract Information
page; or
[bullet] a percentage, shown below, of the Account Value.
The Initial Death Benefit is reduced proportionately for partial
withdrawals (see page 11). We will reduce the Death Benefit by any
Indebtedness. The Death Benefit will be determined on the date We
receive proof, satisfactory to Us, of the Insured's death. The
applicable percentage is based upon the Insured's Attained Age.
Attained Age Account Attained Age Account Attained Age Account Attained Age Account
Value % Value % Value % Value %
40 & less 250 51 178 62 126 73 109
41 243 52 171 63 124 74 107
42 236 53 164 64 122 75-90 105
43 229 54 157 65 120 91 104
44 222 55 150 66 119 92 103
45 215 56 146 67 118 93 102
46 209 57 142 68 117 94-99 101
47 203 58 138 69 116 100 100
48 197 59 134 70 115
49 191 60 130 71 113
50 185 61 128 72 111
GUARANTEED DEATH BENEFIT
The contract has a guaranteed Death Benefit equal to the Initial
Death Benefit. This guaranteed Death Benefit will be in effect until
the Maturity Date. The guaranteed Death Benefit is reduced
proportionately for partial withdrawals (see page 11). We will
reduce the guaranteed Death Benefit by any Indebtedness.
On any Monthly Date when the Surrender Value is not sufficient to
cover the Monthly Deduction and the contract has no Indebtedness, We
will waive that insufficiency and waive all future Monthly
Deductions until the Surrender Value is sufficient to cover the
Monthly Deductions.
If the contract has Indebtedness and the Surrender Value is not
sufficient to pay the Monthly Deduction or Loan Interest, the
contract will enter the Grace Period. To keep the contract in force,
an amount at least as large as (A) plus (B) plus (C) must be
remitted, where:
(A) is the amount by which the Monthly Deduction is insufficient;
(B) is the next three Monthly Deductions; and
(C) is the net loan interest for the next 3 months (net loan
interest is contract loan interest charged less interest
credited on the loan balance).
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This remittance will be considered a loan repayment, unless
otherwise specified in writing. If the amount necessary to keep the
contract in force exceeds the outstanding Indebtedness, only the
Indebtedness is due. Once the Indebtedness has been repaid, all
future Monthly Deductions will be waived until the Surrender Value
is sufficient to cover the Monthly Deductions.
INTEREST ON DEATH BENEFIT
We will pay interest on any Death Benefit payable in one sum. The
interest rate will never be less than 3 1/2% per year from the date
of death to the date of payment, or the rate required by applicable
state law, if greater.
MATURITY MATURITY BENEFIT
BENEFIT We will pay a Maturity Benefit to You if the Insured is living and
this contract is in force on the Maturity Date, which is the
contract anniversary on or following the Insured's 100th birthday.
The amount of the Maturity Benefit is equal to the Surrender Value.
PAYMENTS INITIAL PAYMENT
The Initial Payment is shown on the Contract Information page and is
payable on or before delivery of the contract. The payment is
payable at Our Service Center or to an authorized agent. A copy of
Your application, signed by Us or Our authorized agent, is Your
receipt for Your Initial Payment.
SUBSEQUENT PAYMENTS
We will accept additional payments if:
[bullet] the payment is required to keep the contract in force; or
[bullet] the payment is at least $1,000 and the payment will not
disqualify this contract as a life insurance contract under
the Internal Revenue Code as it now exists or may later be
amended.
If We accept an additional payment, evidence of insurability
satisfactory to Us will be required if an increase in the Death
Benefit occurs as a result of such payment.
PAYMENT ALLOCATION
The Initial Payment will be allocated to the Fixed Account on the
date We receive the payment.
The Account Value of the Fixed Account will then be allocated to the
sub-accounts, in whole percentages, according to the payment
allocation specified in the application. We may delay such
allocation until after the expiration of the Right to Return period
stated on the front page of Your contract.
GRACE PERIOD
If the contract has Indebtedness and the Surrender Value is
insufficient to pay the Monthly Deduction or Loan Interest, a Grace
Period of 61 days will be permitted for a payment sufficient to
continue the contract in force. We will send a notice to You at Your
last known address requesting the amount due. If the required amount
is not received within 61 days, the contract will terminate without
value. If the Insured dies during a Grace Period, the Death Benefit
will be reduced by any Monthly Deductions or Loan Interest due but
not paid.
REINSTATEMENT
This contract may be reinstated within five years of the end of the
Grace Period and prior to the Maturity Date if We receive:
[bullet] Your Written Request to reinstate the contract;
[bullet] evidence of insurability satisfactory to Us; and
[bullet] a payment equal to at least three Monthly Deductions
following the effective date of reinstatement.
If the Indebtedness is not repaid, such Indebtedness will also be
reinstated.
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LIFE LIFE INSURANCE QUALIFICATION
INSURANCE This contract is intended to qualify for treatment as a life
QUALI- insurance contract under the Internal Revenue Code as it now exists
FICATION or may later be amended. We reserve the right to amend this contract
to comply with future changes in the Code and its Regulations. Any
amendments will be made by an agreement approved by the proper
regulatory authorities. We will promptly provide You with a copy of
any amendment.
We reserve the right to refuse premium payments and to return those
premium payments, in whole or in part, if accepting them would
disqualify this contract from favorable tax treatment under the
Code. A premium payment will not be refused if the payment will
prevent the contract from terminating.
GENERAL YOUR CONTRACT
CONTRACT Your contract is issued in consideration of the application and the
PROVISIONS Initial Payment. All statements made in the application are
representations and not warranties. No statement made by or on
behalf of the Insured will be used by Us to contest this contract,
or defend a claim under it, unless it is in the application.
Any additional agreements are shown on the Contract Information
page. These agreements are attached to and made a part of this
contract. This contract and the application contain the entire
contract between You and Us.
WAIVER
Only an officer of the Company can waive or change any provision of
this contract, and only by means of a written instrument.
MISSTATEMENT OF AGE OR SEX
If the age or sex of the Insured has been misstated, any Proceeds
will be adjusted to that amount which the payments paid would have
purchased at the correct age and sex. Age refers to the Insured's
age last birthday on the Contract Date.
ASSIGNMENT
Your contract may be assigned. We will not be on notice of any
assignment until a duplicate of the original assignment is filed at
Our Service Center. We assume no responsibility for the validity or
effect of any assignment, and may rely solely on the assignee's
statement of interest.
CONTRACT ANNIVERSARY
Contract years and anniversaries will be computed from the Contract
Date.
OWNER AND OWNER
BENEFICIARY The Owner is as named in the application on the Contract Date, and
may be changed from time to time. Unless otherwise provided, the
ownership rights of an individual who dies before the Insured will
belong to the surviving joint owner, or if no joint owner, to the
executors or administrators of that individual's estate. The
ownership rights of a corporation, partnership or fiduciary will
belong to its successors or assigns.
During the Insured's lifetime, the rights and privileges stated in
this contract may be exercised only by the Owner.
BENEFICIARY
The Beneficiary is as named in the application on the Contract Date,
and may be changed from time to time. The interest of any
Beneficiary who dies before the Insured will terminate at the death
of that Beneficiary.
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If no Beneficiary designation is in effect at the Insured's death,
or if there is no designated Beneficiary then living, You will be
the Beneficiary. However, if the Insured was the Owner, the
executors or administrators of the Insured's estate will be the
Beneficiary.
CHANGE OF OWNERSHIP OR BENEFICIARY
You may change the Owner or any Beneficiary by Written Request
during the Insured's lifetime. The change will take effect as of the
date the request is signed after We acknowledge receipt in writing,
whether or not You or the Insured is living at the time of
acknowledgment. The change will be subject to any assignment, and to
any payment made or action taken by Us before acknowledgment.
INCONTEST- INCONTESTABILITY AFTER TWO YEARS
ABILITY AND In the absence of fraud, this contract will be incontestable after
SUICIDE it has been in force during the Insured's lifetime;
[bullet] with respect to the Initial Death Benefit, for two years
from the Contract Date; and
[bullet] with respect to each increase in the Initial Death Benefit,
for two years from the effective date of that increase.
SUICIDE WITHIN TWO YEARS
If the Insured dies by suicide within two years from the Contract
Date, while sane or insane, the amount payable under this contract
will be limited to the greater of the Account Value less
Indebtedness or the minimum value required by the state where this
contract was issued for delivery.
CONTRACT ACCOUNT VALUE
VALUES Your Account Value on the Contract Date is equal to the Initial
Payment less the Monthly Deduction for the first contract month.
On each Monthly Date, Your Account Value equals:
[bullet] the sum of the value of Your Accumulation Units in the
sub-accounts; plus
[bullet] Your Account Value in the Fixed Account; plus
[bullet] the value of Your Loan Account, if any; minus
[bullet] the Monthly Deduction.
On each Valuation Day, other than a Monthly Date, Your Account Value
equals:
[bullet] the sum of the value of Your Accumulation Units in the
sub-accounts; plus
[bullet] Your Account Value in the Fixed Account; plus
[bullet] the value of Your Loan Account, if any.
CASH VALUE
A Withdrawal Charge will be subtracted from the Account Value to
determine the Cash Value. The Withdrawal Charges are shown on the
Contract Charges page.
SURRENDER VALUE
Your Surrender Value is equal to Your Cash Value, minus the Contract
Fee, and minus any Indebtedness.
ACCOUNT VALUE IN FIXED ACCOUNT
The Account Value in the Fixed Account on the Contract Date is equal
to the Initial Payment less the Monthly Deduction for the first
contract month.
On each Monthly Date, the Account Value in the Fixed Account is
equal to:
[bullet] the Account Value in the Fixed Account on the preceding
Monthly Date with one month's interest; plus
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[bullet] the Account Values transferred to the Fixed Account since
the preceding Monthly Date and interest from the date the
Account Value is transferred to the Monthly Date; minus
[bullet] the Account Values transferred from the Fixed Account since
the preceding Monthly Date and interest from the date the
Account Value is transferred to the Monthly Date; minus
[bullet] all withdrawals from the Fixed Account since the preceding
Monthly Date plus interest from the date of the withdrawal
to the Monthly Date; minus
[bullet] the portion of the Monthly Deduction allocated to the
Account Value in the Fixed Account, to cover the contract
month following the Monthly Date.
On any date other than a Monthly Date, the Account Value will be
calculated on a consistent basis.
SUB-ACCOUNT VALUES
Amounts allocated to sub-accounts are applied to provide
Accumulation Units in each sub- account. An Accumulation Unit is
used to calculate the value of a sub-account. The number of
Accumulation Units credited to each sub-account is determined by
dividing the amount allocated to a sub-account by the dollar value
of one Accumulation Unit for such sub-account. The number of Your
Accumulation Units is not affected by any subsequent change in the
value of the units. The Accumulation Unit values in each sub-account
may increase or decrease daily.
SUB-ACCOUNT ACCUMULATION UNIT VALUE
The Accumulation Unit value for each sub-account will vary to
reflect the investment experience of the applicable sub-account and
will be determined on each Valuation Day by multiplying the
Accumulation Unit value of the particular sub-account on the
preceding Valuation Day by a net investment factor for that
sub-account for the Valuation Period then ended. The net investment
factor for each sub-account is equal to the net asset value per
share of the corresponding investment at the end of the Valuation
Period (plus the per share amount of any dividend or capital gain
distributions paid by that investment in the Valuation Period then
ended) divided by the net asset value per share of the corresponding
investment at the beginning of the Valuation Period, less the
Separate Account Expense Charge.
While We are not currently making a provision for current taxes, any
new taxes or increase in taxes attributable to the operations of the
Separate Account, We reserve the right to deduct such a charge from
the Accumulation Unit value.
SUB-ACCOUNT ACCUMULATION VALUE
Your accumulation value in any sub-account equals:
[bullet] the number of Your Accumulation Units in that sub-account
on the Valuation Day;
[bullet] multiplied by that sub-account's Accumulation Unit value on
the Valuation Day.
EMERGENCY PROCEDURE
With the exception of weekends or holidays, if a national stock
exchange is closed, or trading is restricted due to an existing
emergency as defined by the Securities and Exchange Commission (SEC)
so that We cannot value the sub-accounts, or as otherwise ordered by
the SEC, We may postpone all procedures which require valuation of
the sub-accounts until valuation is possible. Any provision of this
contract which specifies a Valuation Day will be superseded by the
emergency procedure.
COST OF INSURANCE
The Cost of Insurance is determined on the Monthly Date and is
computed as follows:
[bullet] Divide the Death Benefit on the first day of the contract
month by 1 plus the Guaranteed Monthly Equivalent Interest
Rate shown on the Contract Charges page;
[bullet] Reduce the result by the Account Value on that day before
computing the Monthly Deduction for the Cost of Insurance;
and
[bullet] Multiply the difference by the Cost of Insurance Rate for
that month divided by 1000.
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COST OF INSURANCE RATE
The Cost of Insurance Rate is the rate applied to the insurance
under this contract to determine the Cost of Insurance. It is based
on the Attained Age, sex and rating classification of the Insured.
The Cost of Insurance Rate will not be greater than the guaranteed
rates shown in the Table of Guaranteed Monthly Maximum Cost of
Insurance Rates (see pages 18 and 19).
MONTHLY DEDUCTION
A Monthly Deduction is made for the Cost of Insurance, Contract Fee,
the Expense Charge on the Fixed Account and the cost of any
Additional Benefit Agreements. The Monthly Deduction for a contract
month will be calculated by adding:
[bullet] the Contract Fee, if due;
[bullet] the Expense Charge on the Fixed Account;
[bullet] the Cost of Insurance for the contract month; and
[bullet] the cost for the contract month of any Additional Benefit
Agreements.
The Expense Charge on the Fixed Account will be deducted from Your
Fixed Account balance. The remainder of the Monthly Deduction for a
contract month will be allocated among the Fixed Account and the
sub-accounts of the Separate Account in proportion to the Account
Value in each account. When determining these proportions, the
Account Values are used net of any Indebtedness at the beginning of
the month. The Monthly Deduction for each date that falls on a
contract anniversary also includes the Contract Fee.
CONTRACT FEE
On each contract anniversary, the Contract Fee shown on the Contract
Charges page will be deducted from the Fixed Account and the
sub-accounts in proportion to the Account Value in each account. The
Contract Fee is also deducted upon full surrender of the contract.
FIXED ACCOUNT EXPENSE CHARGE
On each Monthly Date, an expense charge equal to the monthly
equivalent of the annual rate as shown on the Contract Charges page
is deducted from the Fixed Account.
INTEREST RATES
The Guaranteed Interest Rate for the Fixed Account is shown on the
Contract Charges page. Interest rates are expressed as effective
annual rates. The rate is compounded daily and is used to calculate
Account Values of the Fixed Account. We may credit interest in
excess of the Guaranteed Interest Rate. Such excess interest will be
at Our sole discretion.
The Account Value allocated to the Fixed Account will be guaranteed
and the rate of interest will be guaranteed for at least the balance
of the contract year. We determine interest rates in accordance with
market conditions and other factors. We may change the rate
guaranteed on new allocations at any time. This may cause the
guaranteed interest rate on Account Values at the beginning of a
contract year to differ from the guaranteed rate on values
transferred in at a later date. Once We guarantee an interest rate
for an amount in the Fixed Account, We will not change it until the
end of the current guarantee period.
Interest on Indebtedness will be credited on each contract
anniversary at the Guaranteed Interest Rate for the Fixed Account,
as shown on the Contract Charges page.
BASIS OF VALUES
The method used in computing Account Values and reserves in the
Separate Account is in accordance with actuarial procedures that
recognize the variable nature of the Separate Account. A detailed
statement of the method of computing values has been filed with the
Insurance Department of the state in which this contract was issued
for delivery. All contract values are equal to or in excess of the
minimum values required and all comply with the laws of that state.
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SEPARATE SEPARATE ACCOUNT
ACCOUNT The assets of the Separate Account will be used to provide values
PROVISIONS and benefits under this contract and any similar policies. The
assets of the Separate Account are owned by Us and cannot be charged
with liabilities which may arise from any other business the Company
may conduct. The assets of the Separate Account are not part of Our
general account. We may transfer to Our general account any assets
of the Separate Account which exceed the reserves and other contract
liabilities of the account. Unless otherwise permitted by law, the
investment policy of the Separate Account will not be changed
without the express or deemed approval of the state where this
contract was issued for delivery.
INVESTMENT ALLOCATIONS
The Separate Account is divided into several sub-accounts. We use
amounts allocated to a sub- account to buy shares or units of the
investment option shown in the prospectus for that sub-account. The
Initial Payment initially is allocated to the Fixed Account.
Subsequently, the payment will be allocated as You requested in the
application. We may delay such allocation until after the expiration
of the Right to Return period stated on the front page of your
Contract.
SUBSTITUTION
We may substitute another underlying investment without Your
consent. Substitution would occur if We determine that the use of
such underlying investment is no longer possible or if We determine
it is no longer appropriate for the purposes of the contract. No
substitution will be made without notice to You and without the
prior approval of the SEC and the state where this contract was
issued for delivery, if required. Should a substitution, addition or
deletion occur, You will be allowed to select from the then current
sub-accounts and substitution may be made with respect to both
existing payments and the investment of future payments.
TRANSFERS
You may transfer Account Values among the sub-accounts or from the
sub-accounts into the Fixed Account, upon request. The value
transferred from any sub-account must be at least $250 or the entire
balance, if less. The Account Value remaining in a sub-account after
any transfer must be at least $500. If the balance remaining in a
sub-account as a result of a transfer is less than $500, we may
require You to transfer the entire balance.
Transfers may be subject to a transfer charge. This charge will not
exceed $25.
Transfers from the Fixed Account to the sub-accounts must occur
within 60 days after each contract anniversary. The largest amount
that may be transferred out in each contract year is the greater of
the amount transferred in the prior contract year or 20% of the
balance in the Fixed Account. A transfer of all of the Account Value
from the Separate Account to the Fixed Account will not be subject
to a transfer charge.
We may modify or terminate the transfer privilege at any time.
SEPARATE ACCOUNT EXPENSE CHARGE
On each Valuation Day, an expense charge equal to the daily
equivalent of the annual rate as shown on the Contract Charges page
is deducted proportionately from the sub-accounts.
REPORTS ANNUAL REPORT
At least once each year, We will send You a report which shows:
[bullet] the current Death Benefit;
[bullet] the current Account Value;
[bullet] the current Cash Value;
[bullet] the Payments paid;
[bullet] investment gain/loss;
[bullet] any Indebtedness;
[bullet] the Cost of Insurance;
[bullet] the Expense Charge;
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[bullet] the current Surrender Value; and
[bullet] any other information required by the state in which this
contract was issued for delivery.
ILLUSTRATION OF BENEFITS
During any contract year, We will provide You with one illustration
of hypothetical future Account Values and Death Benefits at any time
upon Written Request. We may charge a reasonable fee for any
subsequent illustrations during the same contract year. However, the
fee will not be greater than $25.
CONTRACT LOANS
LOANS Your contract has a Loan Value which is equal to 90% of the Cash
Value (see page 6) as of the date of the loan. Loans must be at
least $250. You may borrow the Loan Value by assigning this contract
to Us as security for the loan. The assignment form must be
satisfactory to Us. Loans may be made at any time while this
contract is in force. We may defer the granting of a loan for up to
6 months.
You may decide the proportions in which to allocate the contract
loan among the sub-accounts of the Separate Account. If You do not
specify the allocation, then the contract loan will be allocated
among the sub-accounts of the Separate Account and the Fixed Account
in proportion to the Account Value in each account. The Account
Value equal to the portion of the contract loan allocated to a
sub-account and the Fixed Account will be transferred from that
sub-account and the Fixed Account to the Loan Account and the
Account Value in that sub-account and the Fixed Account will be
reduced by the amount transferred. If loan interest is not paid when
due, an amount of Account Value equal to the loan interest will also
be transferred.
If on any contract anniversary, the contract's Indebtedness exceeds
the Account Value in the Loan Account, We will transfer Account
Value equal to the excess Indebtedness from the Fixed Account and
the sub-accounts of the Separate Account to the Loan Account as
security for the excess debt in the same manner as the original
loan.
PREFERRED LOAN
The amount available for a Preferred Loan is the earnings of the
contract since its inception.
Earnings equals (A) minus (B) minus (C) minus (D) plus (E); where
(A) is the Account Value;
(B) is total payments made;
(C) is the preferred loan balance;
(D) is accrued loan interest; and
(E) is all prior partial withdrawals in excess of earnings.
LOAN INTEREST
Interest on contract loans equals the Guaranteed Interest Rate For
the Fixed Account, as shown on the Contract Charges page, plus 2%.
Interest on Preferred Loans equals the Guaranteed Interest Rate For
the Fixed Account, as shown on the Contract Charges page. Interest
will accrue daily from the date of the loan, and is due on each
contract anniversary. Unpaid interest will be added to existing
Indebtedness, and will accrue interest at the same rate.
REPAYMENT
While this contract is in force during the Insured's lifetime, any
loan may be repaid in whole or in part. When a loan repayment is
made, the Account Value in the Loan Account will be reduced by the
loan repayment, and this amount will be allocated proportionately
among the Fixed Account and sub-accounts of the Separate Account.
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CONTRACT CONTRACT WITHDRAWAL
WITHDRAWAL You may withdraw from this contract its full Surrender Value upon
Written Request at any time during the lifetime of the Insured. Upon
withdrawal of the full Surrender Value, this contract will
terminate.
You may also make a partial withdrawal under this contract. Partial
withdrawals must be at least $250. For any partial withdrawal after
the first in any contract year, We may charge a transaction fee of
the lesser of $25 or 2% of the amount of the partial withdrawal. You
may select the sub- accounts from which to deduct the amount of the
partial withdrawal. If You do not indicate where the funds will be
deducted from, the amount of the partial withdrawal will be deducted
on a pro rata basis from the sub-accounts and the Fixed Account. The
Initial Death Benefit is reduced on the date of the partial
withdrawal in the same proportion that the Account Value was
reduced. If a partial withdrawal less any applicable Withdrawal
Charge, as described below, reduces the Account Value to below Our
current minimum, then the withdrawal request will be treated as a
request to withdraw the full Surrender Value.
We may defer the payment of Your withdrawal from the Fixed Account
for up to 6 months.
WITHDRAWAL CHARGE
Unless waived by Us, a Withdrawal Charge will be deducted from the
Account Value in the event of a withdrawal.
For a full withdrawal, the Withdrawal Charge is calculated by
multiplying (B) by (C) and subtracting the product from (A), where:
(A) is the Initial Payment multiplied by the applicable percentage
rate from the Table of Withdrawal Charges;
(B) is each previous withdrawal charge collected; and
(C) is the Withdrawal Charge percentage in effect at the time of a
full withdrawal divided by the Withdrawal Charge percentage at
the time each withdrawal was made.
For a partial withdrawal, the Withdrawal Charge is calculated by
multiplying the applicable percentage rate from the Table of
Withdrawal Charges by the amount of the partial withdrawal. The
total of the Withdrawal Charges in a contract year may not be
greater than the applicable percentage rate from the Table of
Withdrawal Charges multiplied by the portion of the Initial Payment
not previously withdrawn as of the beginning of the Contract Year.
WAIVER OF WITHDRAWAL CHARGE
We will waive the Withdrawal Charge on that portion of a withdrawal
not exceeding the greater of:
[bullet] 10% of the Account Value less any prior partial withdrawals
and Preferred Loans taken during the contract year; or
[bullet] the earnings of the contract since its inception (see
page 10).
We will also waive the Withdrawal Charge in the event of a
Qualifying Medical Stay. To qualify for this waiver:
[bullet] the Insured must have a Qualifying Medical Stay which
begins after the first contract year and lasts at least 45
days during any continuous 60 day period; or
[bullet] the Insured's spouse must have a Qualifying Medical Stay
which begins after the first contract year and lasts at
least 45 days during any continuous 60 day period; and
[bullet] You must mail your Written Request for this waiver,
together with proof, satisfactory to Us, of the stay,
within 180 days of initial eligibility.
If the Insured's spouse had a Qualifying Medical Stay within 45 days
prior to the Contract Date, a waiver of the Withdrawal Charge will
not be considered for the Insured's spouse, until the later of:
11
[bullet] 6 months from the date of the last Qualifying Medical Stay;
or
[bullet] the first contract anniversary.
Qualifying Medical Stay means: 1) confinement in a Qualifying
Institution; and 2) treatment by a Qualifying Medical Professional.
Qualifying Institution means a licensed hospital or licensed skilled
or intermediate care nursing facility at which: 1) medical treatment
is available on a daily basis; and 2) daily medical records are kept
on each patient. It does not include: 1) a facility whose purpose is
to provide accommodations, board or personal care services to
individuals who do not need medical or nursing care; or 2) a place
mainly for rest.
A Qualifying Medical Professional is a legally qualified
practitioner of the healing arts who is: 1) acting within the scope
of his or her license; 2) not a resident of Your household; and 3)
not a member of Your immediate family (children, grandchildren,
parents, grandparents, siblings and their spouses).
Treatment means the rendering of medical care or advice related to a
specific medical condition. Treatment includes diagnosis and
subsequent care. It does not include routine monitoring unless
medically necessary.
ACCELERATED THE RECEIPT OF AN ACCELERATED DEATH BENEFIT MAY BE TAXABLE.
DEATH YOU SHOULD CONSULT YOUR PERSONAL TAX OR LEGAL ADVISOR BEFORE
BENEFIT APPLYING FOR THIS BENEFIT.
PROVISIONS
THE DEATH BENEFIT, ACCOUNT VALUE AND LOAN VALUE WILL BE REDUCED IF
AN ACCELERATED DEATH BENEFIT IS PAID.
ACCELERATED DEATH BENEFIT
If, while this contract is in force, We receive proof, satisfactory
to Us, that the Insured either:
(1) has a Terminal Condition; or
(2) is Chronically Ill;
We will pay a portion of the contract's Death Benefit to you as an
Accelerated Death Benefit.
The balance of the Death Benefit is payable upon the Insured's
Death. Only one Accelerated Death Benefit payment is payable under
this contract.
DEFINITION OF TERMINAL CONDITION
Terminal Condition means a medical condition which is expected to
result in the Insured's death within 24 months from the date of the
medical certification submitted to Us in connection with the
application for the Accelerated Death Benefit and from which there
is no reasonable prospect of recovery. Such Terminal Condition must
be certified by a physician who meets the definition of a physician
under Section 101(g) of the Internal Revenue Code.
DEFINITION OF CHRONICALLY ILL
Chronically ill means any Insured who has been certified by a
licensed health care practitioner within the last 12 months as:
(1) being unable to perform, without substantial assistance from
another individual, at least two activities of daily living for
a period of at least 90 days due to a loss of functional
capacity; or
(2) requiring substantial supervision to protect such individual
from threats to health and safety due to severe cognitive
impairment.
Such licensed health care practitioner must meet the definition of a
licensed health care practitioner under Section 7702B(c) of the
Internal Revenue Code.
12
ACTIVITIES OF DAILY LIVING
The activities of daily living prescribed in item (1) above are:
[bullet] eating
[bullet] toileting
[bullet] transferring
[bullet] bathing
[bullet] dressing
[bullet] continence
AMOUNT OF ACCELERATED DEATH BENEFIT
We first calculate the Benefit Base, which equals the Death Benefit
as defined in the DEATH BENEFIT section of the contract (before
subtracting any Indebtedness).
We then calculate the Maximum Available Accelerated Death Benefit by
multiplying the Benefit Base by 90%.
You may elect all or a portion of this Maximum Available Accelerated
Death Benefit. However, the amount elected may not be less than
$10,000, nor greater than $250,000. Additionally, the Initial Death
Benefit for the contract remaining in force must be no less than
$10,000.
You will receive less than the amount you elect because We:
(1) discount the amount you receive because it is an early payment;
(2) deduct a processing fee not to exceed $100; and
(3) repay and reduce any Indebtedness by the percentage of Death
Benefit accelerated.
In discounting the amount you elect, We will assume that the Death
Benefit would have been paid 24 months after the date the
Accelerated Death Benefit is paid. The discount rate will equal the
greater of:
(1) the current yield on 90 day treasury bills; or
(2) the current maximum statutory adjustable contract loan interest
rate based on the greater of:
(a) Xxxxx'x Corporate Bond Yield Averages-Monthly Average
Corporates-published by Xxxxx'x Investors Services, Inc., or
any successor thereto for the calendar month ending two months
before the date of application for an accelerated payment; and
(b) the contract's Guaranteed Annual Interest Rate for the
Fixed Account rate plus 1%.
No Withdrawal Charge will apply when you receive an Accelerated
Death Benefit.
TERMINAL CONDITION OPTION
This option provides that the Accelerated Death Benefit will be paid
to you in equal monthly installments for 12 months. For each $1,000
of Accelerated Death Benefit, each payment will be at least $84.65.
This assumes an annual interest rate of 3.5%.
If the Insured dies before all the payments have been made, We will
pay the Beneficiary in one sum. The one sum payment will be the
present value of the payments that remain. We will compute the value
based on the interest rate We used to determine those payments.
If you do not want monthly payments, We will pay you the Accelerated
Death Benefit in one sum if you ask Us to, using the process
described in the Amount of Accelerated Death Benefit provision.
CHRONICALLY ILL PAYMENT OPTION
This option provides level monthly payments for the number of years
shown in the table that follows. For each $1,000 of Accelerated
Death Benefit, each payment will be at least the minimum amount
shown in the table. The table uses an annual interest rate of 3.5%;
We may use a higher rate.
13
ATTAINED PAYMENT MINIMUM MONTHLY
AGE OF PERIOD IN PAYMENT FOR EACH
INSURED YEARS $1,000 OF DISCOUNTED BENEFIT
64 and under 10 $9.83
65-67 8 $11.90
68-70 7 $13.38
71-73 6 $15.35
74-77 5 $18.12
78-81 4 $22.27
82-86 3 $29.19
87 and over 2 $43.05
If the Insured dies before all the payments have been made, We will
pay the beneficiary in one sum. The one sum We pay will be the
present value of the payments that remain. We will compute the value
based on the interest rate We used to determine those payments.
If We agree, you may choose a longer payment period than that shown
in the table; if you do, monthly payments will be reduced so that
the present value of the payments is the same. We will use an
interest rate of at least 3.5%.
We reserve the right to set a maximum monthly benefit that We will
pay under this option. If We do so, it will be at least $5,000.
If you do not want monthly payments, We will pay you the Accelerated
Death Benefit in one sum if you ask Us to. Such payment will be
calculated as described in the Amount of Accelerated Death Benefit
provision with the exception of the period over which the payment
will be discounted. The lump sum payment will be discounted over a
period not less than the Payment Period in Years section of this
provision. If the Insured dies before the end of the discount
period, we will recalculate the Accelerated Benefit based upon the
number of years between the end of the discount period and the date
of death. The Beneficiary will be paid the difference between this
recalculated amount and the amount that was received, minus the
processing fee.
EFFECT ON THIS CONTRACT
When We pay the Accelerated Death Benefit, We will calculate a
percentage which equals:
(1) the amount you elect to receive (before any reductions); divided
by
(2) the Benefit Base.
We will reduce by that percentage:
(1) the Initial Death Benefit;
(2) the Account Value; and
(3) any Indebtedness.
Any future Monthly Deductions, Cost of Insurance charges, or
Withdrawal Charges will be based on the reduced amount of insurance.
Once We approve your claim, We will send you new Contract
Information page with these changes. The subsequent payment of a
Death Benefit or Maturity Benefit of this contract will constitute
full settlement of the obligations of this contract.
CONDITIONS
Your right to receive the Accelerated Death Benefit is subject to
the following conditions:
(1) We must receive evidence, satisfactory to Us, of the Insured's
eligibility for this Benefit. Evidence satisfactory to Us, may
include, but is not limited to:
[bullet] the records of the Insured's attending physician, including
a prognosis of the Insured;
[bullet] all pertinent facts concerning the Insured's health; and
[bullet] a medical examination of the Insured conducted by a
physician chosen by Us and at Our expense. If there is a
difference of opinion as to the prognosis of the Insured,
the opinion of a licensed physician, acceptable to both Us
and the Insured, will control.
(2) You must choose the option in writing in a form that meets Our
needs.
14
(3) If you have assigned all or a portion of this contract, you must
also give Us a signed consent form from the assignee.
(4) All beneficiaries must consent in writing to the payment of the
Accelerated Death Benefit on the date the Benefit is requested.
(5) You must send Us the contract.
EXCEPTIONS
This Benefit will not be paid if:
(1) the Insured is required by a governmental agency to claim this
Benefit in order to apply for, receive, or continue a government
benefit or entitlement;
(2) the Insured is required by law to use this Benefit to meet the
claims of creditors, whether in bankruptcy or otherwise;
(3) all or part of the contract's Death Benefit must be paid to the
Insured's children or spouse or former spouse as part of a
divorce decree, separate maintenance or property settlement
contract; or
(4) the Insured is married and lives in a community property state,
unless the Insured's spouse has given Us signed written consent.
PAYMENT OF PAYMENT
PROCEEDS The Proceeds of this contract will be subject first to the interest
of an assignee, to whom payment will be made in one sum. We will pay
any remaining Proceeds to You before the Insured's death, and to the
Beneficiary after the Insured's death.
Payment to the Beneficiary will be made only if We receive proof,
satisfactory to Us, of the Insured's death. Unless otherwise
provided, payment will be made in equal shares to those
Beneficiaries entitled to receive the Proceeds.
DELAY OF PAYMENT
We will pay Surrender Values, withdrawals and contract loans
allocated to the Separate Account within seven days after We receive
Your Written Request. We will pay death Proceeds allocated to the
Separate Account within seven days, only after We receive Your
Written Request and receive proof, satisfactory to Us, of the
Insured's death. Payment may be delayed if:
[bullet] the New York Stock Exchange is closed on other than
customary weekend and holiday closings or trading on the
New York Stock Exchange is restricted as determined by the
SEC; or
[bullet] an emergency exists, as determined by the SEC, as a result
of which disposal of securities is not reasonably
practicable to determine the value of the sub-accounts; or
[bullet] the SEC, by order, permits postponement for the protection
of contract owners.
PAYMENT OF PAYMENT OF PROCEEDS OPTIONS
PROCEEDS The Proceeds may be applied under one of the following Options. An
OPTIONS Option must be selected by Written Request. You may select an Option
during the Insured's lifetime. If You have not selected an Option
before the Insured's death, the Beneficiary may choose one. We will
not permit surrenders or partial withdrawals after payments under a
proceeds option involving life contingencies commence.
THE OPTIONS
1. Interest. We will pay interest monthly on Proceeds left on
deposit with Us. We will declare the interest rate each year. It
will never be less than 3 1/2% a year.
2. Fixed Amount. We will pay equal monthly installments, first
payment immediately, until the Proceeds and the interest have been
exhausted. Interest will be credited on unpaid balances at the rate
which We will declare each year. It will never be less than 3 1/2%,
compounded annually.
3. Fixed Period. We will pay equal monthly installments, first
payment immediately, for not more than 25 years. The minimum amount
of each installment may be determined from the
15
OPTION 3 TABLE on page 17. This Table is based on a guaranteed
interest rate of 3 1/2%, compounded annually.
4. Life Income. We will pay equal monthly installments, first
payment immediately, for the lifetime of the payee with or without a
guaranteed period. The minimum amount of each installment may be
determined from the OPTION 4 TABLE on page 17. This Table is based
on a guaranteed interest rate of 3 1/2%, compounded annually. The
guaranteed period selected may be: (1) 10 years; (2) 15 years; or
(3) 20 years.
5. Other Payment. We will pay the Proceeds in any other manner that
may be mutually agreed upon.
AVAILABILITY
No Option may be selected unless the amount to be applied is more
than $2,000 and will provide an installment payment of at least $20.
Unless We consent, these Options will not be available if the payee
is an assignee, administrator, executor, trustee, association,
partnership or corporation.
ADDITIONAL INTEREST
At our discretion, additional interest may be declared annually on
all Payment Options. This interest will lengthen the period under
Option 2, and increase the installment amounts under Options 3 and
4.
OPTION 3 TABLE
MINIMUM MONTHLY INSTALLMENT PAYMENT PER $1,000 APPLIED
-----------------------------------------------------------------------------------------------------------------
Number Monthly Number Monthly Number Monthly Number Monthly Number Monthly
of Years Payment of Years Payment of Years Payment of Years Payment of Years Payment
-----------------------------------------------------------------------------------------------------------------
1 $84.65 6 $15.35 11 $9.09 16 $6.76 21 $5.56
-----------------------------------------------------------------------------------------------------------------
2 43.05 7 13.38 12 8.46 17 6.47 22 5.39
-----------------------------------------------------------------------------------------------------------------
3 29.19 8 11.90 13 7.94 18 6.20 23 5.24
-----------------------------------------------------------------------------------------------------------------
4 22.27 9 10.75 14 7.49 19 5.97 24 5.09
-----------------------------------------------------------------------------------------------------------------
5 18.12 10 9.83 15 7.10 20 5.75 25 4.96
-----------------------------------------------------------------------------------------------------------------
16
OPTION 4 TABLE
MINIMUM MONTHLY INSTALLMENT PAYMENT PER $1,000 APPLIED
------------------------------------------------------------------------------------------------------------------
MALE FEMALE
------------------------------------------------------------------------------------------------------------------
No Guaranteed Guaranteed Guaranteed No Guaranteed Guaranteed Guaranteed
Guaranteed Period Period Period Guaranteed Period Period Period
Age Period 10 Years 15 Years 20 Years Age Period 10 Years 15 Years 20 Years
50 $4.45 $4.41 $4.36 $4.29 50 $4.11 $4.09 $4.07 $4.04
51 4.52 4.47 4.42 4.34 51 4.16 4.15 4.12 4.09
52 4.59 4.55 4.48 4.40 52 4.22 4.20 4.18 4.14
53 4.67 4.62 4.55 4.45 53 4.29 4.27 4.24 4.19
54 4.76 4.70 4.62 4.51 54 4.36 4.33 4.30 4.24
55 4.85 4.78 4.70 4.57 55 4.43 4.40 4.36 4.30
56 4.94 4.87 4.77 4.63 56 4.50 4.47 4.42 4.36
57 5.04 4.96 4.85 4.70 57 4.58 4.54 4.49 4.42
58 5.15 5.06 4.93 4.76 58 4.67 4.62 4.57 4.48
59 5.26 5.16 5.02 5.82 59 4.76 4.71 4.64 4.55
60 5.39 5.26 5.11 4.89 60 4.85 4.80 4.72 4.61
61 5.52 5.38 5.20 4.95 61 4.95 4.89 4.81 4.68
62 5.66 5.50 5.29 5.01 62 5.06 4.99 4.89 4.75
63 5.80 5.62 5.39 5.08 63 5.18 5.10 4.98 4.82
64 5.96 5.75 5.49 5.14 64 5.30 5.21 5.08 4.89
65 6.14 5.89 5.58 5.20 65 5.43 5.32 5.18 4.96
66 6.32 6.03 5.68 5.26 66 5.57 5.45 5.28 5.03
67 6.51 6.18 5.78 5.31 67 5.72 5.58 5.38 5.10
68 6.72 6.33 5.88 5.37 68 5.89 5.72 5.49 5.17
69 6.94 6.49 5.98 5.42 69 6.06 5.86 5.60 5.23
70 7.18 6.65 6.08 5.46 70 6.25 6.01 5.71 5.30
71 7.44 6.82 6.18 5.50 71 6.45 6.18 5.82 5.36
72 7.71 6.99 6.27 5.54 72 6.67 6.34 5.93 5.41
73 7.99 7.16 6.36 5.58 73 6.91 6.52 6.04 5.46
74 8.30 7.33 6.44 5.61 74 7.17 6.70 6.15 5.51
75 8.63 7.51 6.52 5.63 75 7.45 6.89 6.26 5.55
76 8.99 7.68 6.60 5.66 76 7.75 7.08 6.36 5.59
77 9.37 7.86 6.67 5.68 77 8.08 7.28 6.45 5.62
78 9.77 8.03 6.73 5.69 78 8.43 7.48 6.54 5.65
79 10.21 8.19 6.79 5.71 79 8.81 7.68 6.62 5.67
80 10.67 8.36 6.84 5.72 80 9.22 7.88 6.70 5.69
------------------------------------------------------------------------------------------------------------------
17
TABLE OF GUARANTEED MONTHLY MAXIMUM COST OF INSURANCE RATES
PER $1,000 OF INSURANCE NET AMOUNT AT RISK
NON-TOBACCO
Attained Monthly Cost of Attained Monthly Cost of Attained Monthly Cost of
Age Insurance Rate Age Insurance Rate Age Insurance Rate
Male Female Male Female Male Female
0 0.2193 0.1567 35 0.1442 0.1259 70 3.0703 1.8585
1 0.0859 0.0701 36 0.1517 0.1342 71 3.4033 2.0584
2 0.0826 0.0667 37 0.1617 0.1442 72 3.7600 2.3037
3 0.0809 0.0651 38 0.1726 0.1551 73 4.1934 2.5976
4 0.0776 0.0642 39 0.1843 0.1667 74 4.6701 2.9361
5 0.0734 0.6254 40 0.1984 0.1809 75 5.1801 3.3143
6 0.0692 0.0609 41 0.2134 0.1959 76 5.7192 3.7239
7 0.0651 0.0592 42 0.2293 0.2109 77 6.2835 4.1631
8 0.0626 0.0584 43 0.2468 0.2259 78 6.8762 4.6390
9 0.0617 0.0576 44 0.2660 0.2409 79 7.5161 5.1666
10 0.0626 0.0567 45 0.2876 0.2576 80 8.2238 5.7673
11 0.0676 0.0584 46 0.3110 0.2751 81 9.0181 6.4590
12 0.0767 0.0609 47 0.3360 0.2943 82 9.9157 7.2573
13 0.0892 0.0642 48 0.3635 0.3143 83 10.9129 8.1594
14 0.1034 0.0684 49 0.3935 0.3368 84 11.9904 9.1556
15 0.1134 0.0717 50 0.4277 0.3618 85 13.1242 10.2354
16 0.1234 0.0751 51 0.4669 0.3894 86 14.3000 11.3917
17 0.1309 0.0776 52 0.5120 0.4211 87 15.5000 12.6232
18 0.1359 0.0801 53 0.5637 0.4561 88 16.7191 13.9315
19 0.1392 0.0826 54 0.6213 0.4920 89 17.9749 15.3273
20 0.1401 0.0842 55 0.6855 0.5303 90 19.2858 16.8225
21 0.1384 0.0859 56 0.7556 0.5687 91 20.6825 18.4527
22 0.1359 0.0867 57 0.8299 0.6063 92 22.2180 20.2807
23 0.1326 0.0884 58 0.9125 0.6438 93 24.0437 22.4383
24 0.1292 0.0901 59 1.0052 0.6864 94 26.5035 25.2231
25 0.1251 0.0917 60 1.1088 0.7364 95 30.2074 29.2496
26 0.1226 0.0942 61 1.2240 0.7982 96 36.3581 35.7221
27 0.1209 0.0959 62 1.3569 0.8750 97 47.2118 46.8683
28 0.1201 0.0984 63 1.5073 0.9693 98 66.2071 66.0943
29 0.1201 0.1017 64 1.6745 1.0754 99 82.5000 81.6667
30 0.1209 0.1042 65 1.8577 1.1898
31 0.1234 0.1076 66 2.0559 1.3084
32 0.1267 0.1109 67 2.2685 1.4296
33 0.1317 0.1151 68 2.4996 1.5550
34 0.1376 0.1201 69 2.7560 1.6946
Class A Guaranteed Monthly Maximum Insurance Rates are equal to 250% of the
Guaranteed Maximum Insurance Rates for the Standard Class.
18
TABLE OF GUARANTEED MONTHLY MAXIMUM COST OF INSURANCE RATES
PER $1,000 OF INSURANCE NET AMOUNT AT RISK
TOBACCO
Attained Monthly Cost of Attained Monthly Cost of Attained Monthly Cost of
Age Insurance Rate Age Insurance Rate Age Insurance Rate
Male Female Male Female Male Female
0 0.2193 0.1567 35 0.2268 0.1676 70 4.7492 2.4376
1 0.0859 0.0701 36 0.2434 0.1817 71 5.1624 2.6722
2 0.0826 0.0667 37 0.2643 0.1984 72 5.6299 2.9596
3 0.0809 0.0651 38 0.2876 0.2176 73 6.1485 3.3017
4 0.0776 0.0642 39 0.3143 0.2384 74 6.7174 3.6920
5 0.0734 0.0626 40 0.3452 0.2635 75 7.3258 4.1186
6 0.0692 0.0609 41 0.3785 0.2901 76 7.9486 4.5725
7 0.0651 0.0592 42 0.4152 0.3168 77 8.5746 5.0471
8 0.0626 0.0584 43 0.4553 0.3435 78 9.2082 5.5490
9 0.0617 0.0576 44 0.4995 0.3702 79 9.8715 6.0962
10 0.0626 0.0567 45 0.5462 0.3985 80 10.5868 6.7098
11 0.0676 0.0584 46 0.5946 0.4277 81 11.3746 7.4070
12 0.0767 0.0609 47 0.6471 0.4578 82 12.2491 8.2009
13 0.0892 0.0642 48 0.7039 0.4903 83 13.1961 9.1191
14 0.1034 0.0684 49 0.7656 0.5262 84 14.1843 10.1164
15 0.1467 0.0801 50 0.8341 0.5645 85 15.1804 11.1778
16 0.1634 0.0842 51 0.9117 0.6054 86 16.1604 12.2952
17 0.1751 0.0884 52 0.9994 0.6521 87 17.1682 13.4579
18 0.1843 0.0926 53 1.0988 0.7039 88 18.2203 14.6722
19 0.1901 0.0951 54 1.2073 0.7565 89 19.2685 15.9376
20 0.1934 0.0976 55 1.3235 0.8107 90 20.3284 17.3441
21 0.1934 0.0992 56 1.4463 0.8641 91 21.4331 18.8626
22 0.1901 0.1017 57 1.5759 0.9142 92 22.7172 20.5523
23 0.1868 0.1042 58 1.7121 0.9635 93 24.3689 22.5437
24 0.1817 0.1067 59 1.8585 1.0161 94 26.6300 25.2231
25 0.1759 0.1092 60 2.0216 1.0787 95 30.2074 29.2496
26 0.1726 0.1134 61 2.2057 1.1572 96 36.3581 35.7221
27 0.1709 0.1167 62 2.4134 1.2583 97 47.2118 46.8683
28 0.1709 0.1209 63 2.6454 1.3811 98 66.2071 66.0943
29 0.1734 0.1259 64 2.8993 1.5182 99 82.5000 81.6667
30 0.1776 0.1317 65 3.1684 1.6628
31 0.1834 0.1367 66 3.4502 1.8100
32 0.1909 0.1426 67 3.7423 1.9522
33 0.2009 0.1501 68 4.0489 2.0961
34 0.2126 0.1584 69 4.3817 2.2526
Class A Guaranteed Monthly Maximum Insurance Rates are equal to 250% of the
Guaranteed Maximum Insurance Rates for the Standard Class.
19
CONTRACT CHARGES
Interest Rates
Guaranteed Annual Interest Rate For the Fixed Account [3.50%]
Guaranteed Monthly Equivalent Interest Rate [0.28709%]
Contract Charges
Contract Fee [$30.00] per year
Cost of Insurance as defined on page 7.
Fixed Account Expense Charge [0.48%] per year
Separate Account Expense Charge [1.65%] per year
Withdrawal Charge on Withdrawal as defined on page 11.
Table of Withdrawal Charges
This table applies to the Initial Payment in the event of a
Withdrawal in the first [7] contract years.
Contract Percentage Contract Percentage
Year Year
[1 9.75% 5 7.25%
2 9.50% 6 5.00%
3 9.25% 7 4.75%
4 7.50% 8 and thereafter 0.00%]
Mortality Table
1980 Commissioners Standard Ordinary Age Last Birthday Smoker or Non-smoker
The contract may end before the Maturity Date if the payments are not sufficient
to continue the contract to that date. If current values change, this will also
affect the benefits.
20
--------------------------------------------------------------------------------
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON
A Member of the Liberty Mutual Group
--------------------------------------------------------------------------------
CONTRACT DESCRIPTION
This is a MODIFIED SINGLE PAYMENT VARIABLE LIFE INSURANCE CONTRACT.
The Death Benefit is payable if the Insured dies while this contract is in force
and before the Maturity Date.
A Maturity Benefit is payable if the Insured is living on the Maturity Date.
Death Benefit and Account Value may vary with investment and earnings experience
and contract charges.
This contract is not eligible for dividends.
