READ YOUR CONTRACT CAREFULLY
Pacific Life & Annuity Company
000 Xxxxxxx Xxxxxx Xxxxx
Xxxxxxx Xxxxx, XX 00000
(000) 000-0000
000 Xxxxxxx Xxxxxx Xxxxx
Xxxxxxx Xxxxx, XX 00000
(000) 000-0000
READ YOUR CONTRACT CAREFULLY
This is a legal contract between you (the “Owner”) and Pacific Life & Annuity Company, a stock
company, (hereinafter referred to as “we”, “us”, “our” and the “Company”).
We agree to pay the benefits provided under this Contract, subject to its provisions.
We have issued this Contract in consideration of the application and payment of the Initial
Purchase Payment.
BENEFITS AND VALUES PROVIDED UNDER THIS CONTRACT MAY BE ON A VARIABLE BASIS. AMOUNTS DIRECTED INTO
ONE OR MORE OF THE VARIABLE INVESTMENT OPTIONS WILL REFLECT THE INVESTMENT EXPERIENCE OF THOSE
INVESTMENT OPTIONS. THESE AMOUNTS MAY INCREASE OR DECREASE, AND ARE NOT GUARANTEED AS TO A DOLLAR
AMOUNT. DETAILS OF THE VARIABLE PROVISIONS BEGIN ON PAGE 11.
THE AMOUNTS ALLOCATED TO A FIXED ACCOUNT OPTION EARN INTEREST NOT LESS THAN THE MINIMUM GUARANTEED
INTEREST RATE STATED IN THE CONTRACT SPECIFICATIONS. ADDITIONAL INTEREST MAY BE ADDED TO THE FIXED
ACCOUNT OPTION BASED ON AN EXTERNAL INDEX OR INDICES. THIS INTEREST IS NOT
GUARANTEED, AND WHILE THE FIXED ACCOUNT OPTION VALUE MAY BE AFFECTED BY AN EXTERNAL INDEX, THE
FIXED ACCOUNT OPTION DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK OR EQUITY INVESTMENTS. THE DETAILS
OF THE FIXED ACCOUNT OPTIONS BEGIN ON PAGE 10.
THERE IS A SALES CHARGE APPLICABLE TO YOUR CONTRACT. PLEASE REVIEW YOUR CONTRACT PAGES 3, 15 AND
16 CAREFULLY.
Right to Cancel — You may return this Contract within ten (10) days after you receive it. To do
so, mail it to us at our Service Center or to the agent who sold it to you. No withdrawal charge
will be imposed, and we will refund the Contract Value, including any fees or charges for premium
taxes and/or other taxes that were deducted from the Contract Value.
Signed for the Company at Newport Beach, California, to be effective as of the Contract Date.
PACIFIC LIFE & ANNUITY COMPANY
Chairman and Chief Executive Officer | Secretary |
The smallest gross annual rate of return needed for the dollar amount of the variable annuity
payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 3% and all
product fees and charges. The fees and charges would include the Mortality and Expense Risk charge
of 0.20% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would
need to be at least 3.45% (net of fund level expenses).
INDIVIDUAL LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT
Investment Experience Reflected in Benefits
Variable and Fixed Accumulation Before Annuity Date
Annuities Payable in Fixed Dollar Amounts
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating
Investment Experience Reflected in Benefits
Variable and Fixed Accumulation Before Annuity Date
Annuities Payable in Fixed Dollar Amounts
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating
10-2169
TABLE OF CONTENTS
PAGE | ||||
CONTRACT SPECIFICATIONS |
3 | |||
DEFINITION OF TERMS |
4 | |||
GENERAL PROVISIONS |
7 | |||
PURCHASE PAYMENTS |
||||
Initial Purchase Payment |
9 | |||
Additional Purchase Payments |
9 | |||
Purchase Payment Allocation |
9 | |||
Allocations During the Right to Cancel
Period |
9 | |||
Minimum Investment Option Value |
9 | |||
FIXED ACCOUNT OPTIONS |
||||
Fixed Account Options (FAOs) |
10 | |||
Minimum Allocation Amount |
10 | |||
Crediting Interest |
10 | |||
VARIABLE INVESTMENT OPTIONS |
||||
Variable Investment Options |
12 | |||
Separate Account |
12 | |||
CONTRACT VALUES |
||||
Contract Value |
13 | |||
FAO Value |
13 | |||
Variable Account Value |
13 | |||
Subaccount Value |
13 | |||
Subaccount Unit Value |
14 | |||
Net Investment Factor |
14 | |||
CHARGES, FEES AND DEDUCTIONS |
||||
Administrative Fee |
15 | |||
Mortality and Expense Risk Charge
(“Risk Charge”) |
15 | |||
Premium Taxes |
15 | |||
Other Taxes |
15 | |||
Contingent Deferred Sales Charge
(‘Withdrawal Charge”) |
15 | |||
Amount of Withdrawal Charge |
16 | |||
Free Withdrawals |
16 | |||
TRANSFER PROVISIONS |
||||
Transfers |
17 | |||
Transfers between a Variable Investment
Option and a Fixed Account Option |
17 | |||
Transfers Among the Variable Investment
Options |
17 | |||
Transfer Limitations and Restrictions |
17 | |||
WITHDRAWAL PROVISIONS |
||||
Withdrawals |
19 | |||
Minimum Withdrawal Amount |
19 | |||
Amount Available for Withdrawal |
19 | |||
Termination of Contract |
19 | |||
DEATH BENEFIT PROVISIONS |
||||
Death Benefit |
20 | |||
Death Benefit Amount |
20 | |||
Death of Annuitant |
20 | |||
Death of Owner |
21 | |||
Death of Owner Distribution Rules |
21 | |||
BENEFICIARY PROVISIONS |
||||
Designation of Beneficiary |
23 | |||
Adding or Changing Your Beneficiary |
23 | |||
ANNUITY PROVISIONS |
||||
Date Annuity Payments Begin |
24 | |||
Default Annuity Date and Annuity Option |
24 | |||
Change of Annuity Date and Annuity Option. |
24 | |||
Application of Contract Value |
24 | |||
Minimum Amount |
24 | |||
Conversion to Current Rates |
24 | |||
ANNUITY OPTIONS |
||||
Option 1 — Life Only |
25 | |||
Option 2 — Life with Period Certain |
25 | |||
Option 3 — Joint and Survivor Life |
25 | |||
Option 4 — Period Certain Only |
25 | |||
ANNUITY OPTION TABLES |
||||
Applicability of Rates |
26 | |||
Basis of Computations |
26 | |||
Rates Not Shown |
26 |
10-2169
2
CONTRACT SPECIFICATIONS
CONTRACT DATA
Contract Number:
|
[VA999999] | |
Contract Type:
|
[Non-Qualified] | |
Minimum Purchase
Payment Amount:
|
[$25,000] | |
Minimum Allocation
Amount:
|
[$1,000] | |
Maximum Issue Age:
|
[Age 85] |
Owner(s):
|
[Xxxx Xxx] | |
[Xxxx Xxx] | ||
Annuitant(s):
|
[Xxxx Xxx] | |
[Xxxx Xxx] | ||
Annuity Date:
|
[01-01-2027] |
Fees & Charges
M&E Risk Charge: |
0.20% | |
Administrative Fee: |
0.25% |
Contract Date:
|
[01-01-2009] | |
Initial Purchase Payment:
|
[$500,000] | |
Maximum Purchase Payment
Amount Without Home Office
Approval:
|
[$1,000,000] | |
Maximum Additional
Purchase Payments:
|
[$100,000 aggregate amount] | |
Annuitant’s
[35] |
Annuitant’s [Male] | |
Age:
[35]
|
Sex [Female] | |
Withdrawal Charges
Year of Withdrawal | % of Gross Withdrawal | ||||
1 |
8 | % | |||
2 |
8 | % | |||
3 |
7 | % | |||
4 |
6 | % | |||
5 |
5 | % | |||
6 |
4 | % | |||
7 and Later |
0 | % |
FOR A COMPLETE DESCRIPTION OF THE CHARGES, FEES AND DEDUCTIONS SHOWN ABOVE AND OTHER APPLICABLE
FEES AND CHARGES, REFER TO THE CHARGES, FEES AND DEDUCTIONS SECTION OF THE CONTRACT OR THE ANNUAL
CHARGE PROVISION OF THE OPTIONAL RIDER(S) SHOWN ABOVE, IF ANY.
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3
INVESTMENT OPTIONS
Variable Investment Options:
[Equity Index]
[Money Market]
[Money Market]
Fixed Account Options:
[Index-Linked Interest*]
Fixed
Account Interest Rates:
Minimum Guaranteed Interest Rate: [1.00%-3.00%]
Minimum Guaranteed Interest Rate: [1.00%-3.00%]
**Initial Maximum Total Interest Rate: |
||||
Total Purchase Payments (less withdrawals) less than [$100,000]: |
[X.XX%] | |||
Total Purchase Payments (less withdrawals) [$100,000 and above]: |
[X.XX%] |
* | The index applicable to this option is the [S & P 500®]. |
[“S&P 500®” is a trademark of the McGraw Hill Companies, Inc. and has been licensed for use by the
Company. This annuity is not sponsored, endorsed, sold or promoted by Standard & Poor’s and
Standard & Poor’s makes no representation regarding the advisability of purchasing the annuity.
The S&P 500 Index applicable to the Fixed Account Option does not include the payment or
reinvestment of dividends in the calculation of performance and the S&P 500 Index is not available
for direct investment.]
** | The Initial Maximum Total Interest Rates shown above will not change during the first six Contract Years. If the total Purchase Payments less withdrawals as of the first Contract Anniversary are [$100,000] or more, the Maximum Total Interest Rate (TIR) will be the higher interest rate and will apply to the Contract during the first six Contract Years. If the total Purchase Payments less withdrawals as of the first Contract Anniversary are less than [$100,000], then the Maximum TIR will be the lower interest rate. During the first six Contract Years, if, on any Contract Anniversary, the Contract Value equals [$100,000] or more, the higher interest rate will apply. Once the higher interest rate is applied, it will not be decreased during the first six Contract Years. Beginning with Contract Year seven, the Maximum TIRs for subsequent Contract Years will be determined annually, but will never be below [4.00%]. If the Contract Value on any Contract Anniversary equals [$100,000] or more, the higher interest rate will apply to the Contract for that Contract Anniversary interest calculation. If the Contract Value on the Contract Anniversary is less than [$100,000], the lower interest rate will apply to the Contract for that Contract Anniversary interest calculation. |
Service Center |
||
Send Forms and written requests to:
|
Send Payments to: | |
Pacific Life & Annuity Company
|
Pacific Life & Annuity Company | |
P.O. Box 2829
|
P.O. Box 2736 | |
Omaha, Nebraska 68103-2378
|
Omaha, Nebraska 68103-2290 | |
Toll-Free Number for Contract Owners:
|
0-000-000-0000 (between 6 a.m. — 5 p.m., Pacific Time) |
Toll-Free Number for Registered Representatives: 0-000-000-0000 (between 6 a.m. — 5 p.m., Pacific
Time)
Please use our toll-free number to present inquiries or obtain information about your coverage and
for us to provide assistance in resolving complaints.
10-2169
3A
DEFINITION OF TERMS
Account Value — The amount of the Contract Value allocated to any one of the Investment Options.
Add-In Amount — The amount added by us, if applicable, to the Contract Value on the Notice Date to
set the Contract Value equal to the death benefit proceeds less pro rata Index-Linked Interest, if
any, that would have been payable to the spouse as the deemed Beneficiary/designated recipient of
the death benefit.
Age — The Owner’s or Xxxxxxxxx’s age, as applicable, at his or her last birthday.
Annuitant — The person you name on whose life annuity payments may be determined. An Annuitant’s
life may also be used to determine certain increases in death benefits and to determine the Annuity
Date. If you designate Joint Annuitants or a Contingent Annuitant, “Annuitant” means the sole
surviving Annuitant, unless otherwise stated. If the Contract is owned by a Non-Natural Owner, you
may not designate a Joint or Contingent Annuitant. Any named Annuitant, Joint Annuitant, or
Contingent Annuitant must be equal to or less than the Maximum Issue Age as shown in the Contract
Specifications as of the Contract Date. If the Contract is a Non-Qualified Contract, you cannot
change the Annuitant or add a Joint Annuitant. If the Contract is a Qualified Contract, you may
add a Joint Annuitant only on the Annuity Date.
Annuity Date (“Annuity Start Date”) — The date shown in the Contract Specifications, or the date
you later elect, if any, for the start of annuity payments if the Annuitant is still living and the
Contract is in force; or if earlier, the date that annuity payments actually begin.
Annuity Options — Income options available for a series of payments after the Annuity Date.
Beneficiary — The person you name who may receive any death benefit proceeds or any remaining
annuity benefits in accordance with the provisions of this Contract.
Business Day — Any day on which the value of an amount invested in a Subaccount is required to be
determined by applicable law which currently includes each day that both the New York Stock
Exchange is open for trading and our administrative offices are open. If any transaction or event
under this Contract is scheduled to occur on a day that is not a Business Day, such transaction or
event will be effected using the next following Business Day’s Variable Account Values, Subaccount
Units and Subaccount Values, unless otherwise stated.
Calendar Year — A one-year period beginning January 1 and ending December 31.
Code — The Internal Revenue Code of 1986, as amended.
Contingent Annuitant — The person, if any, you select to become the Annuitant if the Annuitant
dies before the Annuity Date. You may add or change the Contingent Annuitant prior to the Annuity
Date provided the Contingent Annuitant is not the sole surviving Annuitant. The age of any
Contingent Annuitant you name must be equal to or less than the Maximum Issue Age as shown in the
Contract Specifications as of the Contract Date. If you add or change a Contingent Annuitant after
the Contract is issued, any newly-named or added Contingent Annuitant must be under Age 86 at the
time of such change or addition. If the Contract is owned by a Non-Natural Owner, you may not
designate a Contingent Annuitant.
Contingent Beneficiary — The person, if any, you select to become the Beneficiary if the
Beneficiary dies.
Contract Anniversary — The same date, in each subsequent year, as the Contract Date.
Contract Date — The date we issued this Contract, as shown in the Contract Specifications.
Contract Years, Contract Anniversaries, Contract Semiannual Periods, Contract Quarters and Contract
Months are measured from the Contract Date.
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4
Contract Value — As of the end of any Business Day, the Contract Value is equal to the sum of the
Variable Account Value and the FAO Value.
Fixed Account Option (“FAO”) — An Investment Option to which Purchase Payments and transfers may
be allocated. The FAO available under the Contract is shown in the Contract Specifications.
Amounts allocated to the FAO are held in our General Account.
Fixed Account Option Value (“FAO Value”) — The aggregate amount of the Contract Value allocated to
the FAO.
General Account — The General Account consists of our assets, other than those assets allocated to
Separate Account A or to any of our other separate accounts.
Index — Refers to the Index shown in the Contract Specifications and is used to determine any
Index-Linked Interest creditable on a Contract Anniversary, or upon death or annuitization. If the
Index is discontinued or if the calculation of the Index is substantially changed, we will
substitute an alternative Index, as approved by the New York Department of Insurance.
Investment Option — A Variable Account or the FAO offered under the Contract.
Minimum Guaranteed Interest Rate (MGIR) — The minimum interest rate, shown in the Contract
Specifications that will be credited to the FAO. This interest rate is set at the Issue Date and
will not change for the life of the Contract.
Non-Natural Owner — A corporation or other entity that is not a (natural) person.
Non-Qualified Contract — A Contract other than a Qualified Contract.
Notice Date — The day on which we receive, in a form satisfactory to us, proof of death and
instructions satisfactory to us regarding payment of death benefit proceeds.
Owner — The person(s) who has (have) all rights under this Contract. If the Contract names two
Owners, Owner means both Owners (“Joint Owners”). The age of any named Owner must be equal to or
less than the Maximum Issue Age as shown in the Contract Specifications as of the Contract Date. If
the Contract allows you to change or add Owners after the Contract is issued, the age of any
newly-named or added Owners, including Joint Owners, must be equal to or less than the Maximum
Issue Age as shown in the Contract Specifications at the time of such change or addition.
Primary Annuitant — The individual that is named in the Contract, the events in the life of whom
are of primary importance in affecting the timing or amount of the payout under the Contract.
Purchase Payment — An amount paid to us, by or on behalf of an Owner, as consideration for the
benefits provided under this Contract.
Qualified Contract — A Contract that qualifies under the Code as an individual retirement annuity
(“IRA”) or a Contract purchased under a Qualified Plan that qualifies for special tax treatment
under the Code.
Qualified Plan — A retirement plan that receives favorable tax treatment under Section 401, 403,
408, 408A or 457 of the Code.
SEC — Securities and Exchange Commission.
Separate Account or Separate Account A — The Company’s Separate Account, registered as a unit
investment trust under the Investment Company Act of 1940, as amended (“1940 Act”).
Service Center — Our mailing address shown in the Contract Specifications. We will notify you of
any change in our mailing address.
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5
Subaccount — An investment division of the Separate Account. Each Subaccount, (a “Variable
Investment Option” or “Variable Account”) invests its assets in a separate series or class of
shares of a designated investment company.
Subaccount Unit — Subaccount Units are used to measure the Variable Account Value in that
Subaccount.
Total Interest Rate (TIR) — The interest rate declared periodically, usually on a Contract
Anniversary, that sets the maximum interest rate that will be used to determine the interest amount
credited to the FAO for a Contract Year. The interest rate will be based on criteria as determined
by the Company and it includes the Minimum Guaranteed Interest Rate. The TIR is shown on the
Contract Specifications page and these TIRs do not change during the first six Contract Years.
Unit Value — The value of a Subaccount Unit (“Subaccount Unit Value”). The Unit Value of any
Subaccount is subject to change on any Business Day. The fluctuations in value reflect investment
results and daily deductions for the mortality and expense risk charge. The Unit Value of a
Subaccount Unit is determined each Business Day.
Variable Account (“Variable Investment Option”) — A Subaccount of the Separate Account or any
separate account of ours which is available under the Contract in which the assets of the Company
are segregated from the assets in our General Account and from the assets in our other separate
accounts.
Variable Account Value (“Subaccount Value”) — The aggregate amount of the Contract Value allocated
to the Variable Accounts.
You and Your — The person or persons named as Owner(s) in the Contract Specifications. If there
are Joint Owners, you and your mean both Joint Owners.
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6
GENERAL PROVISIONS
Report to Owner(s) — At least once per year prior to the Annuity Date, we will provide you with a
report that will show the beginning and ending dates of the current report period, the Contract
Value at the beginning and end of the report period, and the transactions that have occurred since
the last report (i.e., Purchase Payments received, transfers, withdrawals, applicable withdrawal
charges and/or charges and/or fees incurred since the last report, and any other information that
may be required. After the Annuity Date, we will provide you with any information that may be
required.
Payments, Instructions and Requests — Unless this Contract provides otherwise, all Purchase
Payments, instructions and requests must be received in a form satisfactory to us at our Service
Center. Any subsequent Purchase Payments, transfers or withdrawals received by us on any Business
Day usually will be processed the same Business Day, unless the transaction or event is scheduled
to occur on another day.
Generally, all other instructions and requests applicable to a Subaccount normally will be
effective as of the end of the Business Day following the day such instructions and requests are
received, in a form satisfactory to us, unless the transaction or event is scheduled to occur on
another day. If any transaction or event is scheduled to occur on a day that does not exist in a
given month, such transaction or event will occur on the last calendar day of the month, unless
otherwise stated.
We may require that you provide signature guarantees or other safeguards for any instruction,
request or other document you may send to our Service Center. You acknowledge and agree that we
will not be liable for any loss, liability, cost or expense of any kind or character for acting on
instructions or requests submitted to us that we reasonably believe to be genuine.
Entire Contract — This Contract, the attached application and any attached riders and
endorsements, constitute the entire Contract, and supersede any and all prior agreements, whether
oral or written, about the terms of this Contract and the application. All statements made in the
application are representations and not warranties.
Contract Modifications — Modifications to this Contract or any waiver of our rights or
requirements under this Contract can only be made if in writing by an authorized officer of the
Company. This Contract is intended to qualify as an annuity contract for federal income tax
purposes. In addition, if this Contract is a Qualified Contract, this Contract is intended to
qualify as part of a Qualified Plan. To that end, the provisions of this Contract are to be
interpreted and administered to ensure or maintain such tax qualification, notwithstanding any
other provisions to the contrary. We reserve the right to amend this Contract without the Owner’s
consent (except in those states where Owner’s consent is required) and/or our administrative
procedures to reflect any clarifications that may be needed or are appropriate to maintain its tax
qualification or to conform this Contract to any applicable changes in the tax qualification
requirements.
Basis of Values — A detailed statement showing how values are determined has been filed with the
state insurance departments. All values and reserves are at least equal to those required by the
laws of the state in which this Contract is delivered.
Minimum Benefits — The benefits provided under this contract are not less than the minimum
benefits required by NAIC Standard Non-Forfeiture Law for Individual Deferred Annuities, model
#805.
Claims of Creditors — The Contract Value and other benefits under this Contract are exempt from
the claims of creditors to the extent permitted by law.
Removal of Beneficiary or Contingent Annuitant — You may remove a Beneficiary or a Contingent
Annuitant from this Contract by providing proper written instructions to our Service Center.
Ownership — This Contract belongs to the Owner. The Owner is entitled to exercise all rights
available under this Contract. If this Contract names two Owners, both Owners must join in any
request to exercise these rights. The Owner may exercise these rights without the consent of the
Beneficiary or any other person, except as otherwise required by law.
10-2169
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Assignment — You may assign all rights and benefits under this Contract before the Annuity Date.
The assignment is effective on the date the notice of assignment is signed, subject to any payments
made or actions taken by us prior to our receipt of the notice. We are not responsible for the
validity of any assignment. If the Contract has been absolutely assigned, the assignee becomes the
Owner. You should consult with your tax adviser to determine the tax consequences of an assignment
before taking any action.
Delay of Payments — Generally, we will pay any amounts due from the Contract within seven (7) days
after our receipt of the request, in a form satisfactory to us. Payments or transfers to or from a
Variable Account may be delayed after our receipt of the request under certain circumstances. These
include:
• | a closing of the New York Stock Exchange other than on a regular holiday or weekend; | ||
• | a trading restriction by the SEC; or | ||
• | an emergency declared by the SEC. |
We may delay payments or transfers from our General Account (which would include payment of the
withdrawal proceeds, transfers from any FAO, fixed annuity payments and lump sum death benefit
payments, unless state law requires otherwise) for up to six (6) months after the requested
effective date of the transaction. Any amount delayed, so long as it is held under any FAO, will
earn interest at the GMIR on an annual basis thereafter while any delay continues.
If you make any Purchase Payment by check, other than a cashier’s check, we may delay making
payments to you until your check has cleared.
Incontestability — After this Contract has been issued, we will not contest the validity of this
Contract other than for misstatement of age, sex or identity.
Misstatement of Age and/or Sex — We may require proof of the Annuitant’s or Owner’s Age and/or sex
before any payments associated with the death benefit proceeds are made. If the Age and/or sex of
the Annuitant or Owner is incorrectly stated, we will base any such payment associated with the
death benefit proceeds on the Annuitant’s or Owner’s correct Age and/or sex.
We may require proof of the Annuitant’s Age and/or sex before starting annuity payments. If the Age
and/or sex (or both) of the Annuitant is incorrectly stated, we will correct the amount payable,
based upon the Annuitant’s correct Age and/or sex, if applicable. If we make the correction after
annuity payments have started and we have made overpayments, we will deduct the amount of the
overpayment, with interest at 3% per year, from any payments due then or later. If we have made
underpayments, we will add the amount, with interest at 3% per year, of the underpayments to the
next payment we make after we receive proof of the correct Age and/or sex.
Proof of Life or Death — Before we make a payment, we have the right to require proof of the life
or death of any person on whose life or death determines whether, to whom, or how much we must pay
any benefits under this Contract.
Withholding Taxes — We reserve the right to withhold from all payments made or deemed made under
this Contract, any taxes required to be withheld by applicable federal or state law, unless the
Owner or payee elects otherwise pursuant to applicable withholding rules.
Non-Participating — This Contract is classified as a non-participating contract. It does not
participate in our profits or surplus, and therefore no dividends are payable.
10-2169
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PURCHASE PAYMENTS
Initial Purchase Payment — This Contract will not be in force until we receive at our Service
Center the Initial Purchase Payment. The Initial Purchase Payment is shown in the Contract
Specifications.
Additional Purchase Payments — You may make additional Purchase Payments within the first 60 days
of the Contract Date, while the Annuitant is living and this Contract is in force. Each additional
Purchase Payment must be at least $1,000. We may limit the amount of any single Purchase Payment.
You must obtain our consent before making a Purchase Payment that will bring the aggregate
additional Purchase Payments or aggregate Purchase Payments over the Maximum Purchase Payment
amounts shown in the Contract Specifications.
Purchase Payments are payable in U.S. dollars either at our Service Center or through our agent.
Checks should be made payable to Pacific Life & Annuity Company. If you make Purchase Payments by
check other than a cashier’s check, withdrawal payments and any refund under the Right to Cancel
provision may be delayed until your check has cleared. On request, a receipt for the Purchase
Payment signed by an officer of the Company will be provided after payment.
Purchase Payment Allocation — You may allocate all or part of your Purchase Payments to one or
more of the Investment Options available under this Contract. The Investment Options available on
the Contract Date are shown in the Contract Specifications. The following conditions apply:
• | At least 80% of the Initial Purchase Payment must be allocated to the FAO. | ||
• | No more than 20% of the Initial Purchase Payment may be made to the Variable Investment Options. | ||
• | Subsequent Purchase Payments will be allocated at the same percentage to the investment options as the Initial Purchase Payment, unless otherwise instructed. However, any subsequent Purchase Payment is subject to the first two conditions listed above. |
Subject the above conditions, you may change the Purchase Payment allocation by providing us with
instructions in a form satisfactory to us. We will allocate any Purchase Payment according to your
most recent allocation instructions. We may reject any instruction or Purchase Payment if your
instructions are not clear or we cannot determine your allocation instructions.
Allocations During the Right to Cancel Period — We will allocate the Initial Purchase Payment in
accordance with your most recent allocation instructions.
Minimum Investment Option Value — We reserve the right to require that, as a result of any
allocation to an Investment Option, any transfer, or any withdrawal, the remaining Account Value in
any Investment Option must be at least $1,000.
We also reserve the right to transfer any remaining Account Value that does not meet such minimum
amount to your other Investment Options on a pro rata basis relative to your most recent allocation
instructions for those Investment Options.
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FIXED ACCOUNT OPTIONS
Fixed Account Options (FAOs) — You must, before the Annuity Date and subject to the provisions of
this section, allocate at least 80% of any Purchase Payment, amounts transferred from other
Investment Options, or a rollover, to the FAO, while the Annuitant is living and the Contract is in
force.
Amounts allocated to the FAO are held in our General Account. Subject to applicable law, we have
sole discretion over the investment of our General Account assets.
Minimum Allocation Amount — The minimum amount that may be allocated to a FAO is as shown in the
Contract Specifications.
Crediting Interest — The FAO will be credited interest by applying the Minimum Guaranteed Interest
Rate (MGIR) and the Index-Linked Interest Rate (XXXX), if applicable, to the FAO Value. The
interest rate applied will depend on a number of factors, including the purpose for calculating the
interest rate, the date it is calculated, and the general performance of the index used to
calculate the XXXX.
We will stop crediting interest on that portion of the FAO Value that is transferred, withdrawn or
applied to provide an annuity, including any:
• | withdrawal charges; and, |
• | charges for premium taxes and/or other taxes. |
We will do so as of the end of the Business Day any such transaction is effective.
Minimum Guaranteed Interest Rate (MGIR) — The MGIR is shown in the Contract
Specifications. Interest will be credited daily at a rate which compounds over one year to the
annualized effective rate for the MGIR.
Index-Linked Interest Rate — On certain days, we will determine if the amounts allocated
to a FAO are eligible to be credited with Index-Linked Interest (ILI). Usually a date when this
rate will be calculated will be the day on an event that requires the FAO Value to be determined.
The following are dates that these calculations would normally be done:
• | each Contract Anniversary; |
• | any day that the FAO Value must be calculated in order to pay or determine a death benefit; |
• | any day that the FAO Value will be applied to an annuity option provided by us; and, |
• | any other day as determined by us or if required by law. |
The formula for calculating ILI is as follows:
Step One — Determine Index Return
Index Return = (Ending Index Value** — Starting Index Value*) / Starting Index Value
If the Index Return is less than or equal to the Guaranteed Minimum Interest Rate, then no ILI will
be paid.
Step Two — Adjust Index Return
Adjusted Index Return = Lesser of Index Return or Maximum Total Interest Rate
Step Three — Determine Index-Linked Interest
Index-Linked Interest = (Net FAO Value*** X Pro-rata Factor X Adjusted Index Return) minus
GMIR credited during the contract year, where:
• | Net FAO Value equals FAO Value on the prior Contract Anniversary minus withdrawals during the contract year |
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• | Pro-rata Factor equals 1, unless there is a subsequent payment, a death benefit is payable or the contract is annuitized. If there is a subsequent payment, a death benefit is payable, or the contract is annuitized, the Pro-rata Factor is equal to the number of days invested during the contract year divided by 365 |
• | Adjusted Index Return, as determined in Step Two. |
*Starting Index Value for Purchase Payments made in the first Contract Year is the Index Value on
the day each Purchase Payment was received. After the first Contract Year, the Starting Index
Value is the prior Contract’s Years’ Ending Index Value.
** The Ending Index Value on the Contract Anniversary is the Index Value as of the end of the last
business day of the Contract Year. In the event of death, the Ending Index Value is the Index Value
at the market close on the Business Day prior to the date that the death claim is received in good
order. In the event of annuitization, the Ending Index Value is the Index Value at the market
close on the Business Day prior to the Annuity Start Date.
***On the first Contract Anniversary, ILI will be determined using Purchase Payment amount less
withdrawals instead of Net FAO Value. If there are subsequent Purchase Payments in the first
Contract Year, the formula will be applied against each subsequent Purchase Payment separately and
withdrawals will be deducted from Purchase Payments on a first-in, first-out (FIFO) basis.
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VARIABLE INVESTMENT OPTIONS
Variable Investment Options — The Variable Investment Options consist of Subaccounts of the
Separate Account. The available Subaccounts as of the Contract Date are shown in the Contract
Specifications.
Separate Account — We established and maintain the Separate Account under the laws of the state of
Arizona. Any income, gains or losses (whether or not realized) from the assets of each Variable
Account are credited or charged against such Variable Account without regard to our other income,
gains or losses. Assets may be put in our Separate Account to support this Contract and other
variable annuity contracts. Assets may be put in our Separate Account for other purposes, but not
to support contracts other than variable annuity contracts. The assets of our Separate Account are
our property. The portion of the Separate Account assets equal to the reserves and other Contract
liabilities with respect to each Variable Account will not be chargeable with liabilities arising
out of any other business we conduct. We may transfer assets of a separate account in excess of the
reserves and other liabilities with respect to its Variable Accounts to another separate account or
to our General Account. We shall not transfer any investment, or asset held for investment, between
separate accounts or between separate and other accounts unless approved by the New York State
Insurance Department. All obligations arising under the Contract are our general corporate
obligations. We do not hold ourselves out to be trustees of the Separate Account assets.
We reserve the right, subject to compliance with the law then in effect, and after any required
regulatory approval, to:
• | cease offering any Subaccount; | ||
• | add or change designated investment companies or their portfolios, or other investment vehicles; | ||
• | add, delete or make substitutions for the securities and other assets that are held or purchased by the Separate Account or any Variable Account; | ||
• | permit conversion or exchanges between portfolios and/or classes of contracts on the basis of Owners’ requests; | ||
• | add, remove or combine Variable Accounts; | ||
• | combine the assets of any Variable Account with any of our other Separate Accounts or of any of our affiliates; | ||
• | register or deregister Separate Account A or any Variable Account under the 1940 Act; | ||
• | operate any Variable Account as a managed investment company under the 1940 Act, or any other form permitted by law; | ||
• | run any Variable Account under the direction of a committee, board, or other group; | ||
• | restrict or eliminate any voting rights of Owners with respect to any Variable Account or other persons who have voting rights as to any Variable Account; | ||
• | make any changes required by the 1940 Act or other federal securities laws; | ||
• | make any changes necessary to maintain the status of the Contracts as annuities under the Code; | ||
• | make other changes required under federal or state law relating to annuities; | ||
• | suspend or discontinue sale of the Contracts; and | ||
• | comply with applicable law. |
If any of these changes result in a material change in the underlying investments of a Variable
Account, we will notify you of such change.
We will not change the investment policy of the Separate Account without following the filing and
other procedures of the Insurance Superintendent of the State of New York. Unless required by law
or regulation, an investment policy may not be changed without our consent.
From time to time we may make other Investment Options available to you. Any new Investment Option
may invest in portfolios of the designated investment company, other designated investment
companies or their portfolios, or in other investment vehicles. New Investment Options will be made
available to existing Owners at our discretion. We will provide you with written notice of all
material details, including
investment objectives and charges. We will comply with the filing or other procedures established
by the Insurance Superintendent of the State of New York, to the
extent required by applicable law.
applicable state insurance regulators, to the extent required by applicable law.
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CONTRACT VALUES
Contract Value — The Contract Value on any Business Day is the sum of:
• | the FAO Value; plus | ||
• | the Variable Account Value. |
We generally determine values on each day that the New York Stock Exchange is open, provided our
administrative offices are also open on that day.
FAO Value — The FAO Value on any day is the FAO Value as of the prior day, increased by any
additions to the FAOs on that day as a result of any:
• | interest; | ||
• | Purchase Payments received by us and allocated the FAO; and | ||
• | transfers allocated to the FAO; |
and decreased by any deductions from the FAOs on that day as a result of any:
• | transfers from the FAO; | ||
• | withdrawals, including any applicable withdrawal charges; | ||
• | annual charges for expenses relating to any optional benefit riders attached to the Contract; and | ||
• | charges for premium taxes and/or other taxes. |
Variable Account Value — The Variable Account Value on any Business Day is the sum of the
Subaccount Values on that day.
Subaccount Value — Each Subaccount Value on any Business Day is equal to the number of Subaccount
Units in that Subaccount multiplied by the Unit Value of the Subaccount on that day.
We credit the Subaccount with Subaccount Units as a result of any:
• | Purchase Payments received by us and allocated to that Subaccount; | ||
• | transfers to that Subaccount; and | ||
• | additional amounts allocated to that Subaccount. |
We debit the Subaccount with Subaccount Units as a result of any:
• | transfers from that Subaccount; | ||
• | withdrawals, including any applicable withdrawal charges; | ||
• | annual charges for expenses relating to any optional benefit riders attached to the Contract; and | ||
• | charges for premium taxes and/or other taxes. |
The number of Subaccount Units we credit to, or debit from, a Subaccount in connection with a
transaction is equal to the amount of the transaction applicable to that Subaccount divided by that
Subaccount’s Unit Value at the end of the valuation period that includes that day. The number of
Subaccount Units in a Subaccount will change only if we credit or debit Subaccount Units for the
transactions specified above. The number of Subaccount Units will not change because of subsequent
changes in the Subaccount Unit Value.
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Subaccount Unit Value — The initial Unit Value of each Subaccount was $10 on the Business Day the
Subaccount began operations. At the end of each subsequent Business Day, the Unit Value for each
Subaccount is equal to (Y) times (Z), where:
(Y) | is the Unit Value for that Subaccount as of the end of the prior Business Day; and | ||
(Z) | is the Net Investment Factor for that Subaccount for the period (a “valuation period”) between the prior Business Day and that Business Day. |
Net Investment Factor — Each Subaccount’s Net Investment Factor for any valuation period is equal
to (A / B) — C, where:
(A) | equals: | ||
(a) | the net asset value per share of the corresponding portfolio shares held by the Subaccount as of the end of that valuation period; plus | ||
(b) | the per share amount of any dividend or capital gain distributions made during that valuation period on the portfolio shares held by the Subaccount; plus or minus | ||
(c) | any per share charge or credit for any income taxes, other taxes, or amounts set aside during that valuation period as a reserve for any income and/or any other taxes for which we determine to have resulted from the operations of the Subaccount or Contract, and/or any taxes attributable, directly or indirectly, to Purchase Payments; | ||
(B) | is the net asset value per share of the portfolio shares held by the Subaccount as of the end of the prior valuation period; and | ||
(C) | is a factor that we assess against the Subaccount’s net assets held by each Subaccount for the mortality and expense risk charge during that valuation period. |
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CHARGES, FEES AND DEDUCTIONS
Administrative Fee — We charge an administrative fee against the assets held in the Variable
Investment Option(s). This fee is assessed daily at the annual rate which is shown in the Contract
Specifications. This fee is guaranteed not to increase.
Mortality and Expense Risk Charge (“Risk Charge”) — We impose a Risk Charge against the assets
held in the Variable Investment Option(s). This charge is assessed daily at the annual rate which
is shown in the Contract Specifications. The Risk Charge compensates us for the risks we assume
that mortality and expenses will vary from those we assumed. This charge is guaranteed not to
increase.
Premium Taxes — From the Contract Value, we will deduct a charge for any taxes we pay that are
attributable to Purchase Payments or withdrawals. Such taxes may include, but are not limited to:
any federal, state or local premium or retaliatory taxes; and any federal, state or local income,
excise, business or any other type of tax (or component thereof), measured by or based upon,
directly or indirectly, the amount of Purchase Payments we receive from you. We will normally
deduct this charge upon annuitization. However, we may impose this charge on any withdrawal, at
the time any death benefit is paid, when the taxes are incurred or when we pay the taxes. We will
base this charge on the Contract Value, the amount of the transaction, the aggregate amount of
Purchase Payments we receive under the Contract; or any other amount that, in our sole discretion,
we deem appropriately reimburses us for premium taxes paid on this Contract.
Other Taxes — We reserve the right to charge the Separate Account and/or deduct from the Contract
Value a charge for any federal, state or local taxes we pay that are or become attributable to the
Separate Account or Contract, including, but not limited to, income taxes attributable to our
operation of the Separate Account or to our operations with respect to the Contract, or taxes
attributable, directly or indirectly, to Purchase Payments or payments we make under this Contract.
Contingent Deferred Sales Charge (“Withdrawal Charge”) — Withdrawals from the Contract Value are
subject to a withdrawal charge which is shown in the Contract Specifications. This charge may apply
to amounts withdrawn under the Contract prior to the Annuity Date, depending on which Contract Year
the withdrawal is made in.
We will not apply the withdrawal charge on:
• | distributions resulting from the death of the first Owner or the sole surviving Annuitant before the Annuity Date, except as provided under the Death of Owner provision for certain Non-Natural Owners; | ||
• | after the first Contract Year, if the Contract Values is applied to provide an annuity option from us; | ||
• | withdrawals after 90 days from the Contract Date if the Owner or Annuitant has been confined to an accredited nursing home for 60 days, and was not confined to the nursing home on the Contract Date; | ||
• | withdrawals to meet required minimum distributions for Qualified Contracts as they apply to amounts held under the Contract; | ||
• | withdrawals after the first Contract Anniversary, if the Owner or Annuitant has been diagnosed as having a medically determinable condition that results in a life expectancy of twelve (12) months or less and we are provided with medical evidence satisfactory to us; or | ||
• | withdrawals as defined under the “Free Withdrawals” section below. |
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Amount of Withdrawal Charge — The amount of a withdrawal charge depends on which Contract Year the
withdrawal is taken in. The withdrawal charge percentage, as shown in the Contract Specifications
for the applicable Contract Year, will be applied to the amount withdrawn. Adjustments may be made
for any amounts eligible to be considered under the Free Withdrawals provision for that Contract
Year.
The withdrawal charge will be deducted proportionately from each Investment Option selected for
withdrawal, unless otherwise requested and agreed upon by us.
Free Withdrawals — During the first Contract Year, you may withdraw free of withdrawal charges
amounts up to 10% of the Purchase Payments, less previous withdrawals. During the second through
sixth Contract Years, you may withdraw 10% of the Contract Value as of the prior Contract
Anniversary, less any withdrawals taken during the current Contract Year, free of withdrawal
charges. There are no withdrawal charges beyond the sixth Contract Year.
The amount available for free withdrawal is not cumulative. Any amount eligible for free
withdrawal in a Contract Year that is no taken may not be carried over and be available to be taken
free of the withdrawal charge in a later Contract Year.
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TRANSFER PROVISIONS
Transfers — You may, on or before the Annuity Date and subject to the requirements, limitations
and restrictions described in this section, transfer the Account Value in any Investment Option
among other Variable Investment Options, while the Annuitant is living and the Contract is in
force.
Transfers
Between a Variable Investment Option and the Fixed Account Option — Transfers between a
Variable Investment Option and the FAO must take place on a Contract Anniversary. The following
conditions also apply to these transfers:
(a) | A transfer from the FAO to a Variable Investment Option can not result in the remaining FAO Value being less than 80% of the Contract Value. | ||
(b) | The entire amount of the Variable Account Value may be transferred to the FAO. | ||
(c) | In order to request a transfer between the FAO and a Variable Account Option, you must tell us the allocation percentages for each option and your instructions must adhere to the 80% minimum Fixed Account allocation rules. |
A rebalance will automatically occur on your Contract Anniversary according to your allocation
instructions, subject to the 80% Fixed Account allocation rule, unless you instruct us otherwise.
If you choose not to do automatic rebalancing and elect rebalancing on a later date, the rebalance
request must be received, in a form satisfactory to us, at our Service Center by the Contract
Anniversary, or before the end of business on the last Business Day prior to Contract Anniversary
if the Contract Anniversary is not a Business Day.
Transfers between the Variable Investment Options and the FAO will normally be effective on the
Contract Anniversary, provided the transfer request, in a form satisfactory to us, is received at
our Service Center by the Contract Anniversary, or before the end of business on the last Business
Day prior to Contract Anniversary if the Contract Anniversary is not a Business Day.
Transfers Among the Variable Investment Options — You may transfer all or part of the Variable
Account Value in any Variable Investment Option among other Variable Investment Options. Your
transfer request must specify:
(a) | the Investment Option (the “source account”) from which the transfer is to be made. You may choose one or more Investment Options as your source account(s). Your source account may not also be a target account; | ||
(b) | the amount of the transfer. If you select more than one source account, the amount of the transfer from each source account must be at least the lesser of $250 or the full source Account Value; and | ||
(c) | the Investment Option (the “target account”) to receive the transferred amount. You may choose one or more Investment Options as your target account(s). If you select more than one target account, your request must specify how the transferred amounts are to be allocated among the target accounts. Your source account may not also be a target account. |
Transfers among Variable Investment Options will normally be effective as of the end of the
Business Day the transfer request, in a form satisfactory to us, is received at our Service Center.
Transfer Limitations and Restrictions — The following limitations and restrictions apply to
transfers among Variable Investment Options:
(a) | Transfers are allowed thirty (30) days after the Contract Date. | ||
(b) | Transfers are limited to twenty-five (25) transfers during each Calendar Year and only two (2) per month, into or out, that affect any international Investment Options. For the purpose of applying this limitation, transfers that occur on the same day are considered one transfer and transfers that occur as a result of any systematic transfer option are excluded from the maximum twenty-five (25) transfers per Calendar Year limitation. |
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(c) | Transfers to or from an Investment Option cannot be made until the eighth (8th) calendar day (provided that day is a Business Day) from the last day of the most recent transfer to or from that Investment Option. The day of the most recent transfer is considered as the first (1st) calendar day for purposes of meeting this requirement. Transfers that occur as a result of any systematic transfer option are excluded from this requirement. | ||
(d) | If a transfer reduces the remaining Account Value in any Investment Option immediately after such transfer to an amount less than $1,000, we reserve the right to transfer such remaining Account Value to your other Investment Options on a pro rata basis relative to your most recent allocation instructions. | ||
(e) | We further reserve the right to restrict, in our sole discretion and without prior notice, transfers initiated by a market timing organization or individual or other party authorized to give transfer instructions on behalf of multiple Contract Owners. Such restrictions could include: |
(i) | not accepting transfer instructions from an individual or entity acting on behalf of more than one Contract Owner; and | ||
(ii) | not accepting preauthorized transfer forms from market timers or other entities acting on behalf of more than one Contract Owner at a time. |
(f) | We further reserve the right to modify the limits described in subparagraphs (a) through (e) above, to impose additional fees, restrictions or limitations on transfers or exchanges to or from a Separate Account or Subaccount in order to meet requirements imposed by any fund (investment company) offered to the Separate Account, or to comply with any applicable federal or state laws, rules and regulations. If the funds offered have different limitations and restrictions, we will impose the most restrictive requirements. In no event will transfers be limited to less than one per calendar quarter. |
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WITHDRAWAL PROVISIONS
Withdrawals — You may, on or before the Annuity Date and subject to the requirements, limitations
and restrictions described in this section, withdraw all or a portion of the amount available under
this Contract, while the Annuitant is living and the Contract is in force. However, no withdrawals
are allowed within thirty (30) days of the Contract Date.
You may specify that the withdrawal be taken from a specific Variable Investment Option(s) or pro
rata from all Investment Options. If your request does not specify the Variable Investment
Option(s) from which the withdrawal is to be made, the withdrawal will be taken pro rata from all
Investment Options relative to the Account Value in each option.
Withdrawals will normally be effective as of the end of the Business Day the withdrawal request, in
a form satisfactory to us, is received at our Service Center.
Withdrawals from the Fixed Account Option will be considered to be taken from on a first-in,
first-out basis for purpose of determining and crediting interest. The earlier Purchase Payments
and associated earnings are deducted first.
Minimum Withdrawal Amount — The minimum amount that may be withdrawn is $500. If the withdrawal
reduces the Account Value in any Investment Option to an amount less than $1,000, we reserve the
right to transfer such remaining Account Value to your other Investment Options on a pro rata basis
relative to your most recent allocation instructions.
If the withdrawal reduces the Contract Value to an amount less than $1,000, we may terminate this
Contract and pay you the withdrawal proceeds (see Amount Available for Withdrawal provision).
Payment of the withdrawal proceeds will end this Contract and we will have no further obligations
under the Contract.
Amount Available for Withdrawal — The amount available for withdrawal is the Contract Value as of
the end of the Business Day on which the withdrawal request is effective, less any:
• | withdrawal charge; | ||
• | charges for expenses relating to any optional riders attached to the Contract; and | ||
• | charges for premium taxes and/or other taxes. |
The amount we send you (the “withdrawal proceeds”) will also reflect any required or requested
federal and/or state income tax withholding.
Termination of Contract — You may, on or before the Annuity Date, terminate this Contract for its
withdrawal proceeds, while the Annuitant is living and the Contract is in force. We will require
the return of this Contract or a signed Lost Contract Affidavit with your request. The withdrawal
proceeds will be determined under the Amount Available for Withdrawal provision.
Your request to terminate the Contract will normally be effective as of the end of the Business Day
such request, in a form satisfactory to us, is received at our Service Center. Payment of the
withdrawal proceeds will end this Contract and we will have no further obligations under the
Contract.
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DEATH BENEFIT PROVISIONS
Death Benefit — A death benefit will be payable only if the sole surviving Annuitant or any Owner
dies before the Annuity Date and while this Contract is in force.
The proceeds of any death benefit will be payable upon receipt of, in a form satisfactory to us,
proof of death and instructions regarding payment of the death benefit proceeds (the “Notice
Date”). Such proceeds will equal the Death Benefit Amount reduced by any charges for premium taxes
and/or other taxes, if proceeds are used to purchase on Annuity Option from us.
These proceeds may be payable in a lump sum, as periodic payments under an Annuity Option available
under this Contract, towards the purchase of any other Annuity Option we then offer, or in
accordance with the Code (see Death of Owner Distribution Rules).
If there are multiple Beneficiaries, the Death Benefit Amount will be calculated when we first
receive proof of death and instructions, in proper form, from any Beneficiary. Any Death Benefit
Amount still remaining to be paid to any other Beneficiary will fluctuate with the performance of
the underlying Investment Options.
Death
Benefit Amount — The Death Benefit Amount as of any Business Day prior to the Annuity Date
is equal to the greater of:
(a) | the Contract Value including any pro-rata Index-Linked Interest, as of that day; or | ||
(b) | the aggregate Purchase Payments reduced by an amount for each withdrawal that has occurred, which is calculated by multiplying the aggregate Purchase Payments received prior to each withdrawal by the ratio of the amount of the withdrawal, including any withdrawal charge to the Contract Value immediately prior to the withdrawal. |
Death of Xxxxxxxxx — If the Annuitant dies before the Owner and before the Annuity Date, the death
benefit proceeds will be equal to the Death Benefit Amount as of the Notice Date. Unless there is a
surviving Joint Annuitant or Contingent Annuitant, we will pay the death benefit proceeds to the
first person among the following who is (1) living; or (2) an entity designated to receive the
death benefit proceeds; following the death of the sole surviving Annuitant:
(a) | the Owner; | ||
(b) | the Joint Owner; | ||
(c) | the Beneficiary; | ||
(d) | the Contingent Beneficiary; or | ||
(e) | the Owner’s estate. |
If an Annuitant dies and there is a surviving Joint Annuitant, the surviving Joint Annuitant
becomes the Annuitant. If there is no surviving Joint Annuitant and there is a Contingent
Annuitant, the Contingent Annuitant becomes the Annuitant. No death benefit will be paid, except
as otherwise provided under the Death Benefit provision.
If you are the Annuitant and you die, we will determine the amount of any death benefit and to whom
it will be paid under this Death of Annuitant provision. If the Contract is issued as a
Non-Qualified Contract, we will distribute any death benefit proceeds under the Death of Owner
Distribution Rules provision.
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Death of Owner — If you are not the Annuitant and you die before the Annuitant and before the
Annuity Date, the death benefit proceeds will be equal to the Death Benefit Amount as of the Notice
Date.
If you die while the Annuitant is living and prior to the Annuity Date, we will pay the death
benefit proceeds to the first among the following who is (1) living; or (2) an entity designated to
receive the death benefit proceeds:
(a) | the Joint Owner; | ||
(b) | the Beneficiary; | ||
(c) | the Contingent Beneficiary; or | ||
(d) | the Owner’s estate. |
If you are a Non-Natural Owner of a Contract other than a Contract issued under a Qualified Plan as
defined in Section 401 or 403 of the Code, the Primary Annuitant will be treated as the Owner of
the Contract for purposes of the Death of Owner Distribution Rules.
Death of Owner Distribution Rules — The following rules will determine when a distribution must be
made under this Contract. These rules do not affect our determination of the amount of death
benefit proceeds payable or distribution proceeds. If there is more than one Owner, these rules
apply on the date on which the first of these Joint Owners die.
If the Owner dies before the Annuity Date, the designated recipient of the death benefit proceeds
may elect to receive the death benefit proceeds:
• | in a lump sum payment; | ||
• | within five (5) years following the Owner’s death; or | ||
• | in the form of an annuity for life or over a period that does not exceed the life expectancy of the designated recipient, with annuity payments that start within one (1) year after the Owner’s death. |
Unless otherwise required by law, an election to receive an annuity (in lieu of a lump sum payment)
must be made within such time frames as we may prescribe from time to time, or the lump sum payment
option will be deemed elected. We will consider that deemed election as our receipt of
instructions regarding payment of the death benefit proceeds.
The Owner may designate that the Beneficiary is to receive the death benefit proceeds either
through an annuity for life or over a period that does not exceed the life expectancy of the
Beneficiary. Such designation must be made in writing in a form acceptable to us, and may only be
revoked by the Owner in writing in a form acceptable to us. Upon death of the Owner, the
Beneficiary cannot revoke or modify any designation made by the Owner on how the death benefit
proceeds are to be paid.
If the spouse of the deceased Owner is the sole surviving Beneficiary, or is the sole surviving
Joint Owner, and has an unrestricted right to receive the death benefit proceeds in a lump sum,
the spouse may continue this Contract as Owner rather than receive the death benefit proceeds,
provided that we receive instructions to continue the Contract within such time frames as we may
prescribe from time to time.
On the Notice Date, if the surviving spouse is deemed to have continued the Contract, we will set
the Contract Value equal to the death benefit proceeds, less pro-rata Index-Linked Interest, that
would have been payable to the spouse as the deemed Beneficiary/designated recipient of the death
benefit. The amount that the Death Benefit Amount, less pro-rata Index-Linked Interest, exceeds
the Contract Value will be added to the Contract Value in the form of the Add-In Amount on the
Notice Date. The Add-In Amount will be allocated among Investment Options in accordance with the
current allocation instructions for the Contract and will be considered earnings. There will not
be an adjustment to the Contract Value if the Contract Value is equal to the death benefit
proceeds, less pro-rata Indexed-Linked Interest, as of the Notice Date. If the Contract is
continued by the spouse, it will be credited with Index-Linked Interest on subsequent Contract
Anniversaries as if the Owner’s death had not occurred.
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If the Owner dies on or after the Annuity Date, but payments have not yet been completed, then
distributions of the remaining amounts payable under this Contract must be made at least as rapidly
as the rate that was being used at the date of the Owner’s death. All of the Owner’s rights
granted by the Contract will be assumed by the first person among the following who is (1) living;
or (2) an entity or corporation entitled to assume the Owner’s rights granted by the contract:
(a) | the Joint Owner; | ||
(b) | the Beneficiary; or | ||
(c) | the Contingent Beneficiary. |
If none are living (or if there is no entity or corporation entitled to assume the Owner’s rights
granted by the Contract), all of the Owner’s rights granted by the Contract will be assumed by the
Owner’s estate.
This Contract incorporates all applicable provisions of Code Section 72(s) and any successor
provision, as deemed necessary by us to qualify this Contract as an annuity contract for federal
income tax purposes, including the requirement that, if the Owner dies before the Annuity Date, any
death benefit proceeds under this Contract shall be distributed within five (5) years of the
Owner’s death (or such other period that we offer and that is permitted under the Code or such
shorter period as we may require).
These Death of Owner Distribution Rules do not apply to Qualified Contracts issued under Qualified
Plans as defined in Section 401, 403, 408 or 408A of the Code or to an annuity that is a qualified
funding asset as defined in Code Section 130(d) (but without regard to whether there is a qualified
assignment).
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BENEFICIARY PROVISIONS
Designation of Beneficiary — The Beneficiary is the person you name who may receive the Death
Benefit Amount, or any remaining annuity payments after the Annuity Date, if the Annuitant or Owner
dies. If you leave no surviving Beneficiary, your estate may receive the death benefit proceeds. If
the Beneficiary is a trustee, we will neither be responsible for verifying a trustee’s right to
receive any Death Benefit Amount, nor for how the trustee disposes of any Death Benefit Amount. If
before payment of any Death Benefit Amount, we receive proper notice that the trust has been
revoked or is not in effect, then any Death Benefit Amount payable will be paid to the Contingent
Beneficiary, if living; if not to the Owner’s estate.
Adding or Changing Your Beneficiary — You may add, change, or remove any Beneficiary subject to
the terms of any assignment, at any time prior to the death of the Annuitant or Owner, by providing
us with a written request in a form satisfactory to us. Qualified Contracts may have additional
restrictions on naming and changing Beneficiaries. Any change or addition will take effect on the
date the notice of change is signed by the Owner, subject to any payments made or actions taken by
us prior to receipt of the notice.
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ANNUITY PROVISIONS
Date Annuity Payments Begin — Annuity payments will begin on the Annuity Date, if the Annuitant is
living and the Contract has not been terminated. Once annuity payments begin, no changes can be
made to the Annuity Option and no further withdrawals will be allowed.
Default Annuity Date and Annuity Option — If you did not choose an Annuity Date when you submitted
your application for this Contract, the Annuity Date will be the Annuitant’s 95th
birthday. If there are Joint Annuitants, the Annuity Date will be based on the younger Xxxxxxxxx’s
birthday, unless otherwise required by law.
For all Non-Qualified Contracts and those Qualified Contracts where you are not married, the
Annuity Option will be Life with 10 Year Period Certain. If this is a Qualified Contract and you
are married, the Annuity Option will be Joint and Survivor Life, with survivor payments of 50%, and
your spouse will automatically be named as the secondary Annuitant.
Change of Annuity Date and Annuity Option — You may change the Annuity Date and/or Annuity Option
by providing proper notice to us at least ten (10) days prior to the current Annuity Date or new
Annuity Date, whichever is earlier.
The Annuity Date may not be earlier than the first Contract Anniversary and must occur on or before
the day the younger Xxxxxxxxx reaches his or her 95th birthday, or earlier as required
by state law or the Code.
Prior to the Annuity Date, the Annuity Option in effect may be changed to any other Annuity Option
contained in this Contract or allowed by us, subject to any state law or the Code.
If this is a Qualified Contract, additional restrictions under your Qualified Plan may apply. You
should consult with your Qualified Plan administrator before making your selection.
Application of Contract Value — On the Annuity Date, unless directed otherwise, we will apply the
Contract Value plus pro-rata Index-Linked Interest, less any applicable premium taxes, to provide
fixed annuity payments under the Annuity Option selected. This Contract does not provide for a
variable annuity payments option.
Annuity benefits will not be less than those that would have been provided by the application of an
amount to purchase any single consideration immediate annuity offered by us at the time annuity
payments commence to the same class of annuitants.
Minimum Amount — The minimum amount that may be applied to provide annuity payments is $5,000. You
may elect to have annuity payments made monthly, quarterly, semiannually, or annually. Regardless
of the frequency of payments, the minimum annuity payment that you may elect to receive is $240. We
reserve the right to reduce the frequency of payments or the period certain if the initial annuity
payment is less than $240.
Conversion to Current Rates — Annuity payments will be based on the greater of:
• | our current income factors in effect for this Contract; or | ||
• | our guaranteed income factors. |
The dollar amount of any payments after the first annuity payment is specified during the annuity
payment period according to the provisions of the elected Annuity Option.
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ANNUITY OPTIONS
The following Fixed Annuity Options are available under this Contract. Variable Annuity payout
options are not available. Additional options may become available in the future:
Option 1 — Life Only. Periodic payments are made to the designated payee during the Annuitant’s
lifetime. Payments stop when the Annuitant dies.
Option 2 — Life with Period Certain. Periodic payments are made to the designated payee during
the Annuitant’s lifetime, with payments guaranteed for a specified period. You may choose to have
payments guaranteed five (5) through thirty (30) years (in full years only). If the Annuitant dies
before the guaranteed payments are completed, we will pay the remainder of the guaranteed payments
to the first person among the following who is (1) living; or (2) an entity designated to receive
the remainder of guaranteed payments:
(a) | the Owner; | ||
(b) | the Joint Owner; (c) the Beneficiary; | ||
(d) | the Contingent Beneficiary; or | ||
(e) | the Owner’s estate. |
If the Annuitant dies after all of the payments under the period certain have been paid, payments
will stop when the Annuitant dies.
Option 3 — Joint and Survivor Life. Periodic payments are made to the designated payee during the
lifetime of the Primary Annuitant. After the death of the Primary Annuitant, periodic payments are
based on the life of the secondary Annuitant named in the election if and so long as such secondary
Annuitant lives. Payments made based on the life of the secondary Annuitant may be in installments
equal to 50%, 66-2/3% or 100% (as specified in the election) of the original payment amount payable
during the lifetime of the Primary Annuitant.
Option 4 — Period Certain Only. Periodic payments are made to the designated payee for a
specified period. You may choose to have payments guaranteed five (5) through thirty (30) years (in
full years only). If the Annuitant dies before the guaranteed payments are completed, we will pay
the remainder of the guaranteed payments to the first person among the following who is (1) living;
or (2) an entity designated to receive the remainder of the guaranteed payments:
(a) | the Owner; | ||
(b) | the Joint Owner; | ||
(c) | the Beneficiary; | ||
(d) | the Contingent Beneficiary; or | ||
(e) | the Owner’s estate. |
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ANNUITY OPTION TABLES
Applicability of Rates — The annuity rates contained in the tables on the following pages will be
used to provide a minimum guaranteed monthly annuity. The rates shown are for each $1,000 of value
applied under the applicable Annuity Option and does not include any applicable premium taxes.
Any applicable premium taxes will be withdrawn as described in the Premium Taxes provision.
For some Qualified Plans and in some states, the use of sex-distinct income factors is prohibited.
Therefore, we use blended (50% male and 50% female) unisex income factors for life payment options,
for both male and female Annuitants.
Basis of Computations — The actuarial basis for the annuity rates contained in the tables is the
2000 Individual Annuity Mortality Table with the ages set back 8 years and with interest at an
annual rate of 3%.
Rates Not Shown — Any rates and/or ages not shown in the tables contained in this Contract will be
provided by the Company upon request.
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OPTIONS 1 AND 2
LIFE ONLY OR LIFE WITH GUARANTEED PERIOD CERTAIN OF 10 AND 20 YEARS
LIFE ONLY OR LIFE WITH GUARANTEED PERIOD CERTAIN OF 10 AND 20 YEARS
Male at 3% | Female at 3% | Unisex at 3% | ||||||||||||||||||||||||||||||||||
Life with | Life with | Life with | ||||||||||||||||||||||||||||||||||
Guaranteed | Guaranteed | Guaranteed | ||||||||||||||||||||||||||||||||||
Life | Period Certain | Life | Period Certain | Life | Period Certain | |||||||||||||||||||||||||||||||
Age | Only | 10 Yr. | 20 Yr. | Only | 10 Yr. | 20 Yr. | Only | 10 Yr. | 20 Yr. | |||||||||||||||||||||||||||
30 |
[3.02 | 3.02 | 3.01 | 2.94 | 2.94 | 2.94 | 2.98 | 2.98 | 2.97 | |||||||||||||||||||||||||||
35 |
3.13 | 3.12 | 3.11 | 3.03 | 3.03 | 3.02 | 3.08 | 3.08 | 3.07 | |||||||||||||||||||||||||||
40 |
3.26 | 3.25 | 3.24 | 3.14 | 3.14 | 3.13 | 3.20 | 3.19 | 3.18 | |||||||||||||||||||||||||||
45 |
3.42 | 3.41 | 3.39 | 3.28 | 3.27 | 3.26 | 3.35 | 3.34 | 3.33 | |||||||||||||||||||||||||||
50 |
3.63 | 3.62 | 3.58 | 3.45 | 3.44 | 3.42 | 3.53 | 3.53 | 3.50 | |||||||||||||||||||||||||||
55 |
3.89 | 3.87 | 3.80 | 3.67 | 3.66 | 3.62 | 3.77 | 3.76 | 3.71 | |||||||||||||||||||||||||||
60 |
4.22 | 4.19 | 4.07 | 3.95 | 3.93 | 3.87 | 4.08 | 4.05 | 3.96 | |||||||||||||||||||||||||||
65 |
4.65 | 4.59 | 4.38 | 4.31 | 4.28 | 4.16 | 4.47 | 4.43 | 4.26 | |||||||||||||||||||||||||||
70 |
5.23 | 5.12 | 4.71 | 4.80 | 4.74 | 4.51 | 5.00 | 4.92 | 4.61 | |||||||||||||||||||||||||||
75 |
6.04 | 5.79 | 5.04 | 5.47 | 5.35 | 4.88 | 5.73 | 5.55 | 4.96 | |||||||||||||||||||||||||||
80 |
7.16 | 6.61 | 5.31 | 6.44 | 6.14 | 5.22 | 6.76 | 6.36 | 5.26 | |||||||||||||||||||||||||||
85 |
8.70 | 7.53 | 5.49 | 7.85 | 7.13 | 5.45 | 8.23 | 7.31 | 5.47 | |||||||||||||||||||||||||||
90 |
10.86 | 8.43 | 5.57 | 9.96 | 8.19 | 5.56 | 10.35 | 8.30 | 5.57 | |||||||||||||||||||||||||||
95 |
13.85 | 9.17 | 5.60 | 13.08 | 9.06 | 5.60 | 13.40 | 9.11 | 5.60] |
OPTION 3 — JOINT AND 50% SURVIVOR LIFE
Male Age (Primary Annuitant)
60 | 65 | 70 | 75 | 80 | 85 | |||||||||||||||||||
Female Age |
||||||||||||||||||||||||
60 |
[3.90 | 4.13 | 4.39 | 4.70 | 5.03 | 5.39 | ||||||||||||||||||
65 |
3.97 | 4.24 | 4.55 | 4.90 | 5.29 | 5.70 | ||||||||||||||||||
70 |
4.04 | 4.35 | 4.70 | 5.11 | 5.57 | 6.07 | ||||||||||||||||||
75 |
4.10 | 4.44 | 4.85 | 5.33 | 5.89 | 6.49 | ||||||||||||||||||
80 |
4.14 | 4.51 | 4.97 | 5.54 | 6.21 | 6.96 | ||||||||||||||||||
85 |
4.17 | 4.56 | 5.07 | 5.71 | 6.50 | 7.44] |
Unisex Age (Primary Annuitant)
60 | 65 | 70 | 75 | 80 | 85 | |||||||||||||||||||
Unisex Age |
||||||||||||||||||||||||
60 |
[3.84 | 4.07 | 4.34 | 4.65 | 5.01 | 5.40 | ||||||||||||||||||
65 |
3.90 | 4.17 | 4.48 | 4.84 | 5.25 | 5.70 | ||||||||||||||||||
70 |
3.95 | 4.25 | 4.61 | 5.03 | 5.51 | 6.05 | ||||||||||||||||||
75 |
3.99 | 4.32 | 4.72 | 5.21 | 5.79 | 6.44 | ||||||||||||||||||
80 |
4.02 | 4.38 | 4.82 | 5.37 | 6.05 | 6.86 | ||||||||||||||||||
85 |
4.05 | 4.41 | 4.89 | 5.50 | 6.29 | 7.25] |
OPTION 4 — PERIOD CERTAIN ONLY
Years | Income | |
5 | [17.91 | |
6 | 15.14 | |
7 | 13.16 | |
8 | 11.68 | |
9 | 10.53 | |
10 | 9.61 | |
11 | 8.86 | |
12 | 8.24 | |
13 | 7.71 | |
14 | 7.26 | |
15 | 6.87 | |
16 | 6.53 | |
17 | 6.23 | |
18 | 5.96 | |
19 | 5.73 | |
20 | 5.51 | |
21 | 5.32 | |
22 | 5.15 | |
23 | 4.99 | |
24 | 4.84 | |
25 | 4.71 | |
26 | 4.59 | |
27 | 4.47 | |
28 | 4.37 | |
29 | 4.27 | |
30 | 4.18] |
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Pacific Life & Annuity Company l 000 Xxxxxxx Xxxxxx Xxxxx x Xxxxxxx Xxxxx, XX 00000
INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Investment Experience Reflected in Benefits
Variable and Fixed Accumulation Before Annuity Date
Annuities Payable in Fixed Dollar Amounts
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating — No Dividends are Payable
Investment Experience Reflected in Benefits
Variable and Fixed Accumulation Before Annuity Date
Annuities Payable in Fixed Dollar Amounts
Death Benefit Proceeds Payable Before Annuity Date
Non-Participating — No Dividends are Payable