Exhibit (4)(a)(1)
FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
CONTRACT NUMBER [P9999999999]
OWNER [XXXX XXX]
EXECUTIVE OFFICE ANNUITY SERVICE CENTER
000 XXXXX XXXXXX, 0xx XXXXX XX XXX 00000
XXX XXXX, XXX XXXX 00000 XXX XXXXXXX, XX 00000-0000
FIRST SUNAMERICA LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "First
SunAmerica") agrees to provide benefits to the Owner in accordance with the
provisions set forth in this Contract and in consideration of the Application
and Purchase Payments We receive.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED, AND WILL INCREASE OR DECREASE BASED UPON
THE INVESTMENT EXPERIENCE OF THE VARIABLE PORTFOLIOS YOU CHOOSE.
THE SEPARATE ACCOUNT CHARGE IS CHARGED AGAINST THE ASSETS OF THE SEPARATE
ACCOUNT. THIS CHARGE INCLUDES FEES FOR MORTALITY AND EXPENSE RISK AND THE
DISTRIBUTION EXPENSE. ON AN ANNUALIZED BASIS THE CHARGE EQUALS 1.40%. THESE
CHARGES ARE ASSESSED, ON A SIMPLE INTEREST BASIS, AS A PERCENTAGE OF THE AVERAGE
DAILY ENDING VALUE OF THE ASSETS ATTRIBUTABLE TO THE ACCUMULATION UNITS OF THE
VARIABLE PORTFOLIOS TO WHICH YOUR CONTRACT VALUE IS ALLOCATED. THE DAILY CHARGE
IS 1/365TH OF THE ANNUALIZED CHARGE. THUS, THE SMALLEST ANNUAL EFFECTIVE RATE OF
THE INVESTMENT RETURN THAT WOULD HAVE TO BE EARNED ON ASSETS OF THE SEPARATE
ACCOUNT SO THAT THE DOLLAR AMOUNT OF VARIABLE ANNUITY PAYMENTS WILL NOT DECREASE
IS 4.96%, COMPOUNDED DAILY. THE CONTRACT'S RATE OF RETURN IS BASED ON COMPOUND
INTEREST.
RIGHT TO EXAMINE - IF, WITHIN 10 DAYS OF RECEIPT OF THIS CONTRACT (60 DAYS IF
THE CONTRACT REPLACED ANY OTHER LIFE INSURANCE OR ANNUITY CONTRACT(S)) YOU ARE
NOT SATISFIED WITH IT, YOU MAY RETURN THIS CONTRACT TO OUR ANNUITY SERVICE
CENTER OR TO THE AGENT THROUGH WHOM THE CONTRACT WAS PURCHASED. THE COMPANY WILL
REFUND THE PURCHASE PAYMENT OR THE CONTRACT VALUE, WHICHEVER IS GREATER,
COMPUTED AS OF THE BUSINESS DAY DURING WHICH WE RECEIVE THE CONTRACT. UPON SUCH
REFUND, THE CONTRACT SHALL BE VOID.
For Individual Retirement Annuities, or if a refund of the Purchase Payment(s)
is otherwise required We reserve the right to allocate your Purchase Payment(s)
to the Cash Management Portfolio until the end of the Right To Examine period.
Thereafter, allocations will be made as selected by You on Your Application.
THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY.
/s/ Xxx X. Xxxxxxx
----------------------------------------
Xxx X. Xxxxxxx
President
INDIVIDUAL VARIABLE ANNUITY CONTRACT
Nonparticipating
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TABLE OF CONTENTS
CONTRACT DATA PAGE.................................................... PAGE 3
DEFINITIONS........................................................... PAGE 4
PURCHASE PAYMENT PROVISIONS........................................... PAGE 7
ACCUMULATION PROVISIONS............................................... PAGE 7
CHARGES AND DEDUCTIONS................................................ PAGE 8
TRANSFER PROVISIONS................................................... PAGE 8
WITHDRAWAL PROVISIONS................................................. PAGE 9
DEATH PROVISIONS...................................................... PAGE 9
ANNUITY PROVISIONS.................................................... PAGE 11
GENERAL PROVISIONS.................................................... PAGE 13
ANNUITY PAYMENT OPTIONS............................................... PAGE 16
FIXED ANNUITY PAYMENT OPTIONS TABLE................................... PAGE 17
VARIABLE ANNUITY PAYMENT OPTIONS TABLE................................ PAGE 20
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CONTRACT DATA PAGE
CONTRACT NUMBER: ANNUITY SERVICE CENTER:
[P9999999999] P. O. XXX 00000
XXX XXXXXXX, XX 00000-0000
OWNER:
[XXXX XXX] AGE AT ISSUE: [35]
ANNUITANT: INITIAL PURCHASE PAYMENT: [$5,000.00]
[XXXX XXX]
CONTRACT DATE: [December 1, 2007]
SPECIFIED ANNUITY DATE:
[December 1, 2026] ANNUAL CONTRACT MAINTENANCE
FEE: Current: [$0.00]. Maximum: $50.00.
LATEST ANNUITY DATE:
[December 1, 2062]
BENEFICIARY:
As named by You
SEPARATE ACCOUNT:
[FS VARIABLE SEPARATE ACCOUNT]
SEPARATE ACCOUNT CHARGE: 1. 40%
Of the above percentage, the charge
for Guaranteed death benefit risk is
0.10%
TRANSFER FEE:
Current: [$25.00]. Maximum:
$25.00. Waived for systematic
transfers (i.e. DCA) and for
the first 15 transfers in any
Contract Year.
OPTIONAL ELECTIONS: OPTIONAL ELECTION DETAILS:
Maximum Anniversary Value See attached Endorsement XXX-0000-0
XXXXXXXXXX CHARGE SCHEDULE: NONE
FOR INQUIRIES
CALL 0-000-000-0000
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DEFINITIONS
Defined in this section are some of the words and phrases used in this Contract.
These terms are capitalized when used in the Contract with the meaning set forth
below.
ACCUMULATION UNIT
A unit of measurement used to compute the Contract Value in a Variable Portfolio
prior to the Annuity Date.
AGE
Age as of last birthday.
ANNUITANT
The natural person(s) whose life (lives) is (are) used to determine the annuity
benefits under the Contract. If the Contract is in force and the Annuitant(s) is
(are) alive on the Annuity Date, We will begin payments to the Payee. This
Contract cannot have Joint Annuitants if it is issued in connection with a
tax-qualified retirement plan.
ANNUITY DATE
The date on which annuity payments ("income payments") to the Payee begin. This
date cannot be later than the Latest Annuity Date.
ANNUITY SERVICE CENTER
As specified on the Contract Data Page.
ANNUITY UNIT
A unit of measurement determined on or after the Annuity Date used to compute
annuity payments from the Variable Portfolio(s).
BENEFICIARY
The Beneficiary is as named by You at issue to receive the death benefit under
this Contract upon your death. You may later change Your Beneficiary in a
written request to Us at Our Annuity Service Center.
CONTINUATION DATE
The Date on which We receive, at Our Annuity Service Center: (a) the Spousal
Beneficiary's written request to continue the Contract, and (b) Due Proof of
Death of the Owner. If We receive (a) and (b) on different dates, the
Continuation Date will be the later date.
CONTRACT DATE
The date Your Contract is issued, as shown on the Contract Data Page. It is the
date from which Contract Years and anniversaries are measured.
CONTRACT VALUE
Your share of the Variable Portfolios' Accumulation Unit Values.
CONTRACT YEAR
One year starting from the Contract Date in one calendar year and ending on the
day preceding the anniversary of such date in the succeeding calendar year.
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CONTRIBUTION YEAR
A year starting from the date a Purchase Payment is made in one calendar year
and ending on the day preceding the anniversary of such date in succeeding
calendar years.
DEATH BENEFIT ADJUSTMENT
Any increase or reduction to the amount of the death benefit payable to account
for Purchase Payment and/or Withdrawal activity after a specified point in time
which will equal (a), (b), or (c), whichever is applicable, as follows:
(a) Where only Purchase Payments are received after the specified
point in time, the dollar value of the Purchase Payments will be
added to the death benefit payable; or
(b) Where only Withdrawals are made after the specified point in
time, the Withdrawal will reduce the death benefit payable in the
same proportion that the Contract Value was reduced at the time
of the Withdrawal; or
(c) Where Purchase Payments have been received and Withdrawals made
after the specified point in time, the death benefit amount
payable will be adjusted by Purchase Payment(s) received after a
specified point in time, reduced by any Withdrawal, made after
that specified point in time in the same proportion that the
Contract Value was reduced at the time of the Withdrawal.
DOLLAR COST AVERAGING (DCA)
An optional program under which You authorize the systematic transfer of
specified amounts or percentages from any source account to any target account.
FIXED ANNUITIZATION
A series of periodic income payments of predetermined amounts that do not vary
with investment experience. Such payments are made from the Company's general
asset account. This Contract provides several fixed annuity payment options.
IRC
The Internal Revenue Code of 1986, as amended, or as it may be amended or
superseded.
JOINT OWNER
Any person named as Joint Owner on the Application and listed on the Contract
Data Page, unless subsequently changed. The Joint Owner, if any, possesses an
undivided interest in this Contract in conjunction with the Owner. All
references within this Contract to Owner will also apply to the Joint Owner.
LATEST ANNUITY DATE
The later of the Owner's 90th birthday or ten years after the Contract Date. If
the Owner is a non-natural person, the Latest Annuity Date is the later of the
Annuitant's 90th birthday or ten years after the Contract Date.
NET PURCHASE PAYMENT
The sum of all Purchase Payment(s), reduced for each Withdrawal in the same
proportion that the Contract Value is reduced by such Withdrawal.
NYSE
New York Stock Exchange.
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OWNER
The person or entity named in the Contract who is entitled to exercise all
rights and privileges of ownership under the Contract. Owner means both Joint
Owners, if applicable.
PAYEE
The person receiving payment of annuity benefits under this Contract.
PURCHASE PAYMENTS
Payments in U.S. currency made by or on behalf of the Owner to the Company to
fund the Contract.
REQUIRED DOCUMENTATION
Is: (a) Due Proof of Death that the Owner or the Spousal Beneficiary died before
the Annuity Date; and, (b) an election form specifying the payment options and
(c) any other documentation We may require.
SEPARATE ACCOUNT
A segregated asset account named on the Contract Data Page. The Separate Account
consists of several Variable Portfolios, each investing in shares of the
Underlying Fund(s) of the trust(s). The assets of the Separate Account are not
commingled with the general assets and liabilities of the Company. The value of
amounts allocated to the Variable Portfolios of the Separate Account is not
guaranteed.
SPECIFIED ANNUITY DATE
The anticipated Annuity Date specified by You as shown on the Application. This
date may be changed by You in writing prior to the Annuity Date, but in no event
can it be later than the Latest Annuity Date. If this date is not specified, it
will be the Latest Annuity Date.
SPOUSAL BENEFICIARY
The original deceased Owner's surviving spouse who is designated as the primary
Beneficiary at the time of the Owner's death and may continue the Contract as
the Owner on the Continuation Date.
SUBSEQUENT PURCHASE PAYMENTS
Purchase Payments made after the initial Purchase Payment.
UNDERLYING FUND
The variable investment options in which the corresponding Variable Portfolio(s)
invest.
VARIABLE ANNUITIZATION
A series of periodic income payments which vary in amount according to the
investment experience of one or more Variable Portfolios, as selected by You.
This Contract provides several variable annuity payment options.
VARIABLE PORTFOLIO
One or more divisions of the Separate Account which provides for the variable
investment options available under this Contract. Each Variable Portfolio has
its own investment objective and is invested in the Underlying Fund(s) of the
trusts. A Variable Portfolio is not chargeable with liabilities arising out of
any other Variable Portfolio. The available Variable Portfolios are shown on the
Application. Additional Variable Portfolios may become available in the future.
The Variable Portfolios may also be referred to as a Variable Subaccount and/or
Subaccount.
WE, OUR, US, THE COMPANY
First SunAmerica Life Insurance Company.
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WITHDRAWAL(S)
Amount(s) withdrawn from the Contract Value including any charges and fees
applicable to each such withdrawal.
YOU, YOUR
The Owner.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS
Purchase Payments are flexible. This means that, subject to Company disclosed
restrictions, You may change the amounts, frequency and/or timing of Purchase
Payments. Purchase Payments will be allocated in accordance with instructions
from You to the Variable Portfolio(s). The minimum Purchase Payment that may be
allocated to a Variable Portfolio under the Contract is $100. Subject to prior
Company approval, the maximum of all Purchase Payments made to the Contract may
not exceed $1,000,000.
SUBSTITUTION OF VARIABLE PORTFOLIO
If the shares of an Underlying Fund should no longer be available for investment
by the Separate Account, then We may substitute shares of another Underlying
Fund, for shares already purchased, or to be purchased in the future.
Substitutions of securities will be carried out in accordance with any
applicable state and/or federal laws or regulations.
ACCUMULATION PROVISIONS
Prior to the Annuity Date, the Contract Value is the Separate Account
Accumulation Value. If Your Contract Value falls below $2,500, subject to
applicable state and federal laws, rules and regulations, we may terminate Your
Contract and send you the remaining dollar amount.
SEPARATE ACCOUNT ACCUMULATION VALUE
The Separate Account Accumulation Value under the Contract shall be the sum of
the values of the Accumulation Units held in the Variable Portfolios for the
Owner.
NUMBER OF ACCUMULATION UNITS
Your Contract is credited with Accumulation Units of the Separate Account when
amounts are allocated to the Variable Portfolio(s). For that portion of each
Purchase Payment and/or transfer amount allocated to a Variable Portfolio, the
number of Accumulation Units credited is equal to the sum of each Purchase
Payment and/or transfer amount allocated to the Variable Portfolio reduced by
premium taxes, if any:
Divided by
The Accumulation Unit value for that Variable Portfolio for the NYSE business
day in which the Purchase Payment or transfer amount is allocated.
The number of Accumulation Units will be reduced for Withdrawals of Contract
Value, annuitizations, amounts transferred out of a Variable Portfolio, the
Contract Maintenance Fee and applicable charges for optional features as set
forth in endorsements to this Contract. Reductions will be made as of the NYSE
business day in which We receive all requirements for the transaction, as
appropriate.
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ACCUMULATION UNIT VALUE (AUV)
The AUV of a Variable Portfolio for any NYSE business day is calculated by
subtracting (2) from (1) and dividing the result by (3) where:
(1) is the total value at the end of the given NYSE business day of the assets
attributable to the Variable Portfolio minus any applicable liabilities
other than those owed to the Contractholders;
(2) is the amount equal to the daily Separate Account Charge plus the daily
charge for any optional features that impose a daily charge;
(3) is the number of Accumulation Units outstanding at the end of the given
NYSE business day.
CHARGES AND DEDUCTIONS
We will deduct the following charges from the Contract:
CONTRACT MAINTENANCE FEE
The charge specified on the Contract Data Page will be deducted on each Contract
anniversary that occurs on or prior to the Annuity Date. It will also be
deducted when the Contract Value is withdrawn in full if the Withdrawal is not
on the Contract anniversary. We also reserve the right to waive the fee for
Contracts with a value of $50,000.00 or greater on the Contract anniversary.
SEPARATE ACCOUNT CHARGE
This charge, as shown on the Contract Data Page, on an annualized basis equals a
percentage of the average daily ending value of the assets attributable to the
Accumulation Units of the Variable Portfolio(s) to which the Contract is
allocated. This charge compensates Us for mortality and expense risks, and
distribution expenses associated with the Contract. We subtract this charge
daily.
TRANSFER PROVISIONS
Prior to the Annuity Date, You may transfer all or part of Your Contract Value
from any Variable Portfolio to any other Variable Portfolio(s) subject to
applicable restrictions. The minimum amount that can be transferred and the
amount that can remain in a Variable Portfolio are subject to Company limits. We
reserve the right to charge a fee, as shown on the Contract Data Page, for
transfers if the number of transfers exceeds a limit of fifteen (15) in any
Contract Year. We further reserve the right to restrict Your transfer
privileges, including possible termination of those privileges, if we determine
that a pattern of transfers reflects a market timing strategy or is potentially
harmful to other contract owners.
TRANSFERS OF ACCUMULATION AND ANNUITY UNITS BETWEEN VARIABLE PORTFOLIOS
Prior to and after the Annuity Date, transfers are subject to certain
restrictions. You may transfer all or a portion of Your Contract Value from one
Variable Portfolio to another Variable Portfolio(s). Prior to the Annuity Date,
a transfer will result in the redemption of Accumulation Units in a Variable
Portfolio and the purchase of Accumulation Units in the other Variable
Portfolio. Transfers will be effected at the end of the NYSE business day in
which We receive Your completed request for the transfer.
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After the Annuity Date, a transfer will result in the redemption of Annuity
Units in a Variable Portfolio and the purchase of Annuity Units in the other
Variable Portfolio. Transfers will be effected for the last NYSE business day of
the month in which We receive Your request for the transfer.
WITHDRAWAL PROVISIONS
On or before the Annuity Date and while the Owner is living, You may withdraw
all or part of Your Contract Value under this Contract by informing Us at Our
Annuity Service Center, subject to the requirement that the amount remaining
after withdrawal must be at least $500. For a full withdrawal, this Contract
must be returned to Our Annuity Service Center. The minimum amount that can be
withdrawn is $1,000, subject to the minimums set forth by the laws of the State
of New York.
Unless You tell Us otherwise in writing, Withdrawals will be deducted from the
Contract Value in proportion to their allocation among any available Variable
Portfolios. Withdrawals will be based on values for the NYSE business day in
which the request for withdrawal and the Contract (in the case of a full
withdrawal), are received at Our Annuity Service Center. Unless the SUSPENSION
OF PAYMENTS section is in effect, payment of withdrawals will be made within
seven calendar days.
SYSTEMATIC WITHDRAWAL PROGRAM
Prior to the Annuity Date, You may elect to participate in a Systematic
Withdrawal Program by informing Us at Our Annuity Service Center. The Systematic
Withdrawal Program allows You to make automatic withdrawals from Your account
monthly, quarterly, semiannually or annually. The minimum systematic withdrawal
amount is $100, provided that the amount remaining after withdrawal is $500. You
may terminate Your participation in the Systematic Withdrawal Program at any
time by sending Us a written request. We reserve the right to modify, suspend or
terminate the Systematic Withdrawal Program at any time.
DEATH PROVISIONS
Notwithstanding any provision of this Contract to the contrary, all payments of
benefits under this Contract will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time, and complies
with requirements set forth by the laws of the State of New York. If the
Contract is owned by a trust or other non-natural person, We will treat the
death of any Annuitant as the death of the "Primary Annuitant" and as the death
of any Owner.
DUE PROOF OF DEATH
Due Proof of Death means:
1. a certified copy of a death certificate; or
2. a certified copy of a decree of a court of competent jurisdiction
as to the finding of death; or
3. a written statement by a medical doctor who attended the deceased
Owner at the time of death; or
4. any other proof satisfactory to Us.
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DEATH OF OWNER BEFORE THE ANNUITY DATE
We will pay a death benefit to the Beneficiary upon Our receiving all Required
Documentation. Unless You have previously designated a payment option on behalf
of the Beneficiary, the Beneficiary must select one of the following options:
1. Immediately collect the death benefit in a lump sum payment. If a
lump sum payment is elected, payment will be in accordance with
any applicable laws and regulations governing payments on death;
or
2. Collect the death benefit in the form of one of the Annuity
Payment Options. If an Annuity Payment Option is desired, an
option must be elected within 60 days of Our receipt of: (a) Due
Proof of Death of the Owner; (b) an election form specifying the
payment option and (c) any other documentation We may require.
The payments must be over the life of the Beneficiary or over a
period not extending beyond the life expectancy of the
Beneficiary. Payments under this option must commence within one
year after the Owner's death, otherwise, the death benefit will
be paid in accordance with option 1 above; or
3. If eligible, continue the Contract as the Spousal Beneficiary. On
the Continuation Date, We will contribute to the Contract any
amount by which the death benefit exceeds the Contract Value,
calculated as of the Owner's date of death. This amount is not
considered a Purchase Payment except in the calculation of
certain death benefits upon the death of the Spousal Beneficiary.
If this option is elected, no death benefit is paid.
Upon the Spousal Beneficiary's death, the entire interest of the Contract must
be distributed immediately under option 1 or 2 as provided under DEATH OF OWNER
BEFORE THE ANNUITY DATE
AMOUNT OF DEATH BENEFIT
If the Owner was age 82 or younger on the Contract Date, upon Our receipt of all
Required Documentation at Our Annuity Service Center, We will calculate the
death benefit and it will be the greater of:
(1) The Contract Value as of the later of (a) the date of death of the
Owner and (b) the NYSE business day during which We receive all
Required Documentation at Our Annuity Service Center; or
(2) Net Purchase Payment(s) received prior to the Owner's 86th birthday.
NOTE: In declining market environments, the death benefit payable may be
less than the Net Purchase Payments received.
SPOUSAL BENEFICIARY CONTINUATION
If the Spousal Beneficiary was age 82 or younger on the Continuation Date, upon
Our receipt of all Required Documentation at Our Annuity Service Center, We will
calculate the death benefit and it will be the greater of:
(1) The Contract Value as of the later of (a) the date of death of the
Spousal Beneficiary and (b) the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center; or
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(2) The Contract Value on the Continuation Date, and a Death Benefit
Adjustment for Purchase Payment(s) transacted after the Continuation
Date but prior to the Spousal Beneficiary's 86th birthday and/or
Withdrawals transacted after the Continuation Date.
If the Spousal Beneficiary was age 83 or older on the Continuation Date, the
death benefit will be the Contract Value as of the later of (a) the date of
death of the Spousal Beneficiary and (b) the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center.
The death benefit payable will accrue interest at Our current rate from the date
of death to the date the death benefit is distributed.
In any event, the entire interest in the Contract will be distributed within
five years from the date of Owner's death.
DEATH OF OWNER OR ANNUITANT ON OR AFTER THE ANNUITY DATE
If any Owner or Annuitant dies on or after the Annuity Date and before the
entire interest in the Contract has been distributed, We will pay the remaining
portion of the annuity payout to the Beneficiary upon Our receipt of Required
Documentation. For further information pertaining to death of the Annuitant, see
ANNUITY PAYMENT OPTIONS.
BENEFICIARY
The Beneficiary is selected by the Owner. While the Owner is living and before
the Annuity Date, the Owner may change the Beneficiary by written notice in a
form satisfactory to Us. A change in Beneficiary will take effect on the date
the notice is signed by the Owner, subject to any action We have taken before
receipt of such notice. If two or more persons are named as Beneficiaries under
the Contract, those surviving the Owner will share equally unless otherwise
stated; and each must elect to receive their respective portions of the death
benefit according to the options listed under DEATH OF OWNER BEFORE THE ANNUITY
DATE. If the Annuitant survives the Owner, and there are no surviving
Beneficiaries, the Annuitant will be deemed the Beneficiary.
Joint Owners, if applicable, shall be each other's primary Beneficiary. Joint
Annuitants, if any, when the Owner is a non-natural person, shall be each
other's primary Beneficiary. Any other Beneficiary designation will be treated
as a contingent Beneficiary.
If the Owner is also the Annuitant and dies before the Annuity Date, with no
surviving Beneficiaries, upon Our receipt of all Required Documentation we will
calculate the death benefit, and we will pay the death benefit to the estate of
the Owner in accordance with option 1, under DEATH OF OWNER BEFORE THE ANNUITY
DATE.
ANNUITY PROVISIONS
ANNUITY DATE
The Owner specifies an anticipated Annuity Date on the Application. The Owner
may change the Annuity Date at any time, at least seven days prior to the
Annuity Date, by written notice to the Company at its Annuity Service Center.
The Annuity Date must always be the first day of the calendar month and must be
at least thirteen (13) months after the Contract Date, but not beyond the Latest
Annuity Date. If no Annuity Date is specified on the Application, the Annuity
Date will be the Latest Annuity Date, as set by the Company.
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PAYMENTS TO OWNER
Unless You request otherwise, We will make annuity payments to You. If You want
the annuity payments to be made to some other Payee, We will make such payments
subject to receipt of a written request filed at the Annuity Service Center no
later than thirty (30) days before the due date of the first annuity payment.
All payments will comply with the laws of the State of New York.
Any such request is subject to the rights of any assignee. No payments available
to or being paid to the Payee while the Annuitant is alive can be transferred,
commuted, anticipated or encumbered.
BETTERMENT OF RATES
The amount of the Owner's monthly payment will be at least equal to the monthly
payment produced by the application of an amount equal to the Contract Value of
this Contract to purchase any single consideration immediate annuity contract
offered by the Company at the same time to the same class of annuitants. We are
not currently offering any single premium immediate annuity contracts.
FIXED ANNUITIZATION
If a Fixed Annuitization has been elected, the Contract Value, less any
applicable premium taxes, shall be applied to the payment of the fixed annuity
payment option elected at rates which are at least equal to the annuity rates
based upon the applicable tables in the Contract. In no event will the Fixed
Annuitization be changed once it begins.
AMOUNT OF FIXED ANNUITY PAYMENTS
The amount of each fixed annuity payment will be determined by applying the
portion of the Contract Value allocated by You for Fixed Annuitization, less any
applicable premium taxes, to the annuity table applicable to the fixed annuity
payment option chosen.
AMOUNT OF VARIABLE ANNUITY PAYMENTS
(a) FIRST VARIABLE ANNUITY PAYMENT: The dollar amount of the first Variable
Annuitization payment will be determined by applying the portion of the
Contract Value allocated to the Variable Portfolio(s), less any applicable
premium taxes, to rates which are at least equal to the annuity rates based
upon the annuity table applicable to the variable annuity payment option
chosen. If the Contract Value is allocated to more than one Variable
Portfolio, the value of Your interest in each Variable Portfolio is applied
separately to the variable annuity payment option table to determine the
amount of the first annuity payment attributable to each Variable
Portfolio.
(b) NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
applicable Variable Portfolio is the amount of the first annuity payment
attributable to that Variable Portfolio divided by the value of the
applicable Annuity Unit for that Variable Portfolio as of the Annuity Date.
The number will not change as a result of investment experience.
(c) VALUE OF EACH VARIABLE ANNUITY UNIT: The value of an Annuity Unit may
increase or decrease from one month to the next. For any month, the value
of an Annuity Unit of a particular Variable Portfolio is the value of that
Annuity Unit as of the last NYSE business day of the preceding month,
multiplied by the Net Investment Factor for that Variable Portfolio for the
last NYSE business day of the current month.
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The Net Investment Factor for any Variable Portfolio for a certain month is
determined by dividing (1) by (2) and multiplying by (3) where:
(1) is the Annuity Unit Value of the Variable Portfolio determined as
of the last business day at the end of that month,
(2) is the Annuity Unit Value of the Variable Portfolio determined as
of the last business day at the end of the preceding month., and
(3) is a factor that neutralizes the assumed investment rate of 3.5%
per annum upon which the annuity payment tables are based. The
monthly factor that neutralizes the assumed investment rate of
3.5% per annum is: 1/1.035(1/12)=0.99713732.
(d) SUBSEQUENT VARIABLE ANNUITY PAYMENTS: After the first Variable
Annuitization payment future payments will vary in amount according to the
investment performance of the applicable Variable Portfolio(s) to which
Your Purchase Payments are allocated. The amount may change from month to
month. The amount of each subsequent payment for each Variable Portfolio
is:
The number of Annuity Units for each Variable Portfolio as determined for the
first annuity payment
Multiplied by
The value of an Annuity Unit for that Variable Portfolio at the end of the month
immediately preceding the month in which payment is due.
We guarantee that the amount of each Variable Annuitization payment will not be
affected by variations in expenses or mortality experience.
GENERAL PROVISIONS
ENTIRE CONTRACT
The Entire Contract between You and Us consists of this Contract, the
Application completed by You and attached to this Contract, and any attached
endorsement(s) or rider(s). An agent cannot change the terms or conditions of
this Contract. Any change must be in writing and approved by Us. Only Our
President, Secretary, or one of Our Vice-Presidents can give Our approval.
CHANGE OF ANNUITANT
If the Owner is an individual, the Owner may change the Annuitant(s) at any time
prior to the Annuity Date. To make a change, the Owner must send a written
notice to Us at least 30 days before the Annuity Date. The change will become
effective on the date the notice is signed by the Owner, subject to any action
We have taken before receipt of such notice. If the Owner is a non-natural
person, the Owner may not change the Annuitant.
DEATH OF ANNUITANT
If the natural Owner and Annuitant are different, and the Annuitant dies before
the Annuity Date, the Owner becomes the Annuitant until the Owner elects a new
Annuitant. If there are Joint Annuitants, upon the death of any Annuitant prior
to the Annuity Date, the Owner may elect a new Joint Annuitant. However, if the
Owner is a non-natural person, We will treat the death of any Annuitant as the
death of the "Primary Annuitant" and as the death of the Owner, see DEATH
PROVISIONS.
13
MISSTATEMENT OF AGE OR SEX
If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment, plus
interest at the rate of 4% per year, will be deducted from the next payment(s)
due. Any underpayment, plus interest at the rate of 4% per year, will be paid in
full with the next payment due.
PROOF OF AGE, SEX, OR SURVIVAL
The Company may require satisfactory proof of correct Age or sex at any time. If
any payment under this Contract depends on the Annuitant being alive, the
Company may require satisfactory proof of survival.
SUSPENSION OF PAYMENTS
We may suspend or postpone any payments from the Variable Portfolios if any of
the following occur:
(a) the NYSE is closed;
(b) trading on the NYSE is restricted;
(c) an emergency exists such that it is not reasonably practical to dispose of
securities in the Variable Portfolios or to determine the value of its
assets; or
(d) the Securities and Exchange Commission, by order, so permits for the
protection of Owners. Conditions in (b) and (c) will be decided by or in
accordance with rules of the Securities and Exchange Commission.
CONFORMITY WITH STATE LAWS
The provisions of this Contract will be interpreted by the laws of the State of
New York, the state in which this Contract is delivered. Any provision which, on
the Contract Date, is in conflict with the law of such state is amended to
conform to the minimum requirements of such law.
CHANGES IN LAW
If the laws governing this Contract or the taxation of benefits under the
Contract change, We will amend this Contract, subject to New York Insurance
Department approval, to comply with any changes.
ASSIGNMENT
You may assign this Contract before the Annuity Date, but We will not be bound
by an assignment unless it is received by Us in writing. Your rights and those
of any other person referred to in this Contract will be subject to the
assignment. Certain assignments may be taxable. We do not assume any
responsibility for the validity or tax consequences of any assignment. We
reserve the right to not recognize assignments if it changes the risk profile of
the Owner of the Contract as determined in Our sole discretion.
CLAIMS OF CREDITORS
To the extent permitted by law, no right or proceeds payable under this Contract
will be subject to claims of creditors or legal process.
PREMIUM TAXES OR OTHER TAXES
The Company may deduct from Your Contract Value any premium tax or other taxes
payable to a state or other government entity, if applicable. Should We advance
any amount so due, We are not waiving any right to collect such amount at a
later date. The Company will deduct any withholding taxes required by applicable
law.
WRITTEN NOTICE
Any notice We send to You will be sent to Your address shown in the Application
unless You request otherwise. Any written request or notice to Us must be sent
to Our Annuity Service Center, as specified on the Contract Data Page.
14
PERIODIC REPORTS
At least once during each Contract Year, We will send You a statement of the
account activity of the Contract. The statement will include all transactions
which have occurred during the accounting period shown on the statement.
INCONTESTABILITY
This Contract shall be incontestable after it has been in force for a period of
two years from the Contract Date during Your lifetime or during the lifetimes of
each of the persons who are required to provide Us with information concerning
their age, sex and identity. The incontestability of this Contract applies to
any statements You make, except as otherwise stated in the Misstatement of Age
or Sex provision. Accurate statements as to Your age, sex and identity are
required as a condition of issuing this Contract.
NONPARTICIPATING
This Contract does not share in Our surplus.
WAIVER
Our waiver of any of the terms and conditions under this Contract will not be
deemed to constitute waiver of the right to enforce strict compliance.
15
ANNUITY PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Contract to the Company at its Annuity Service Center, the Contract Value may be
applied to provide one of the following options or any annuity payment option
that is mutually agreeable. After one year from the Contract Date, and prior to
the Annuity Date, You can choose one of the options described below. If no
option has been selected by the Annuity Date, You will automatically receive
Option 4 below, with payments for 10 years guaranteed.
OPTIONS 1 & 1V - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED
Payments payable to a Payee during the lifetime of the Annuitant. No further
payments are payable after the death of the Annuitant.
OPTIONS 2 & 2V - JOINT AND SURVIVOR LIFE ANNUITY
Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. No further payments are payable
after the deaths of both the Annuitant and the designated second person.
OPTIONS 3 & 3V - JOINT AND SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10
YEARS
Payments are payable to the Payee during the lifetime of the Annuitant and
during the lifetime of a designated second person. If, at the death of the
survivor, payments have been made for less than 10 years, the remaining
guaranteed annuity payments will be continued to the Beneficiary.
OPTIONS 4 & 4V - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 OR 20 YEARS
Payments payable to the Payee during the lifetime of the Annuitant. If, at the
death of the Annuitant, payments have been made for less than the 10 or 20
years, as selected at the time of annuitization, the remaining guaranteed
annuity payments will be continued to the Beneficiary.
OPTIONS 5 & 5V - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
Payments payable to the Payee for any specified period of time for [5] years or
more, but not exceeding [30] years, as selected at the time of annuitization.
The selection must be made for full twelve month periods. In the event of death
of the Annuitant, any remaining annuity payments will be continued to the
Beneficiary. If Variable Annuity Payments are elected under this Annuity Payment
Option, any remaining guaranteed Variable Annuity payments may be redeemed for a
discounted value determined by Us.
16
FIXED ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with a guaranteed interest rate of [1.50%], with quinquennial age
setbacks. For every five years that the Contract has been in effect at the time
of annuitization, the Annuitant's age will be set back by one year to determine
the applicable factors. The Fixed Annuity Payment Options Table does not include
any applicable premium tax.
OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 4 OPTION 4
LIFE ANNUITY LIFE ANNUITY
(W/120 (W/240
OPTION 1 PAYMENTS PAYMENTS
LIFE ANNUITY GUARANTEED) GUARANTEED)
AGE OF -------------- ------------- -------------
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
--------- ----- ------ ---- ------ ---- ------
55 3.68 3.38 3.64 3.35 3.48 3.27
56 3.77 3.46 3.73 3.43 3.55 3.34
57 3.87 3.54 3.82 3.51 3.62 3.40
58 3.98 3.63 3.92 3.60 3.69 3.47
59 4.09 3.73 4.02 3.69 3.76 3.54
60 4.21 3.83 4.13 3.78 3.83 3.62
61 4.34 3.93 4.24 3.89 3.90 3.69
62 4.47 4.05 4.36 3.99 3.97 3.77
63 4.62 4.17 4.49 4.10 4.04 3.84
64 4.77 4.30 4.62 4.22 4.10 3.92
65 4.93 4.44 4.76 4.35 4.17 4.00
66 5.11 4.58 4.90 4.48 4.24 4.07
67 5.30 4.74 5.05 4.62 4.30 4.15
68 5.49 4.91 5.20 4.76 4.36 4.22
69 5.71 5.09 5.36 4.92 4.41 4.29
70 5.93 5.29 5.53 5.08 4.47 4.36
71 6.17 5.50 5.70 5.25 4.51 4.42
72 6.43 5.73 5.87 5.43 4.56 4.48
73 6.70 5.98 6.05 5.62 4.60 4.53
74 6.99 6.24 6.23 5.81 4.63 4.58
75 7.31 6.53 6.41 6.01 4.67 4.62
76 7.64 6.84 6.59 6.21 4.69 4.65
77 8.00 7.18 6.78 6.41 4.72 4.69
78 8.38 7.55 6.96 6.62 4.74 4.71
79 8.79 7.94 7.13 6.83 4.75 4.74
80 9.23 8.37 7.31 7.03 4.77 4.75
81 9.70 8.84 7.47 7.23 4.78 4.77
82 10.20 9.34 7.63 7.42 4.79 4.78
83 10.73 9.88 7.78 7.60 4.80 4.79
84 11.30 10.47 7.93 7.77 4.80 4.80
85 11.90 11.10 8.06 7.93 4.81 4.80
17
OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.01 3.18 3.33 3.45 3.54 3.60 3.64
60 3.12 3.36 3.59 3.78 3.94 4.05 4.12
65 3.21 3.51 3.83 4.13 4.40 4.61 4.75
70 3.27 3.63 4.03 4.46 4.89 5.26 5.53
75 3.32 3.70 4.18 4.74 5.35 5.95 6.45
80 3.34 3.76 4.29 4.95 5.75 6.62 7.45
85 3.36 3.79 4.35 5.09 6.05 7.20 8.44
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.01 3.18 3.33 3.45 3.53 3.59 3.62
60 3.12 3.36 3.58 3.78 3.93 4.03 4.09
65 3.21 3.51 3.82 4.12 4.38 4.56 4.67
70 3.27 3.62 4.02 4.44 4.84 5.16 5.36
75 3.31 3.70 4.16 4.70 5.26 5.76 6.11
80 3.33 3.74 4.25 4.88 5.59 6.28 6.80
85 3.35 3.77 4.31 4.99 5.81 6.66 7.35
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.00 3.16 3.30 3.39 3.45 3.47 3.48
60 3.11 3.33 3.53 3.68 3.77 3.81 3.82
65 3.18 3.46 3.72 3.94 4.08 4.15 4.17
70 3.23 3.54 3.86 4.14 4.33 4.43 4.46
75 3.26 3.59 3.94 4.27 4.50 4.62 4.66
80 3.27 3.61 3.98 4.33 4.58 4.71 4.76
85 3.27 3.62 3.99 4.35 4.61 4.75 4.80
18
OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
FIXED PAYMENT FOR SPECIFIED PERIOD
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
5 17.28
6 14.51
7 12.53
8 11.04
9 9.89
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
10 8.96
11 8.21
12 7.58
13 7.05
14 6.59
15 6.20
16 5.85
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
17 5.55
18 5.27
19 5.03
20 4.81
21 4.62
22 4.44
23 4.28
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
24 4.13
25 3.99
26 3.86
27 3.75
28 3.64
29 3.54
30 3.44
19
VARIABLE ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with an effective annual Assumed Investment Rate of 3.50%, with
quinquennial age setbacks. For every five years that the Contract has been in
effect at the time of annuitization, the Annuitant's age will be set back by one
year to determine the applicable factors. The Variable Annuity Payment Options
Table does not include any applicable premium tax.
OPTIONS 1V& 4V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
OPTION 4V OPTION 4V
LIFE ANNUITY LIFE ANNUITY
(W/120 (W/240
OPTION 1V PAYMENTS PAYMENTS
LIFE ANNUITY GUARANTEED) GUARANTEED)
AGE OF -------------- ------------- -------------
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
--------- ----- ------ ---- ------ ---- ------
55 4.80 4.48 4.74 4.45 4.54 4.34
56 4.89 4.56 4.82 4.52 4.60 4.40
57 4.99 4.64 4.91 4.60 4.67 4.46
58 5.09 4.73 5.01 4.68 4.73 4.53
59 5.21 4.82 5.11 4.77 4.79 4.59
60 5.33 4.92 5.21 4.86 4.86 4.66
61 5.45 5.03 5.32 4.96 4.92 4.73
62 5.59 5.14 5.44 5.06 4.98 4.80
63 5.73 5.26 5.56 5.17 5.05 4.87
64 5.89 5.39 5.69 5.29 5.11 4.94
65 6.06 5.53 5.83 5.41 5.17 5.01
66 6.24 5.68 5.97 5.54 5.23 5.08
67 6.43 5.84 6.11 5.67 5.29 5.14
68 6.63 6.01 6.26 5.82 5.34 5.21
69 6.84 6.19 6.42 5.97 5.39 5.28
70 7.07 6.39 6.57 6.12 5.44 5.34
71 7.32 6.60 6.74 6.29 5.48 5.39
72 7.58 6.84 6.91 6.46 5.52 5.45
73 7.86 7.09 7.08 6.64 5.56 5.49
74 8.16 7.36 7.25 6.83 5.59 5.54
75 8.47 7.65 7.42 7.02 5.62 5.57
76 8.82 7.97 7.59 7.22 5.64 5.61
77 9.18 8.31 7.77 7.41 5.67 5.64
78 9.57 8.69 7.94 7.61 5.68 5.66
79 9.99 9.09 8.11 7.81 5.70 5.68
80 10.43 9.53 8.27 8.00 5.71 5.70
81 10.91 10.00 8.43 8.19 5.72 5.71
82 11.42 10.51 8.58 8.38 5.73 5.72
83 11.96 11.07 8.72 8.55 5.74 5.73
84 12.53 11.67 8.85 8.71 5.74 5.74
85 13.15 12.31 8.98 8.86 5.75 5.74
20
OPTION 2V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 4.09 4.25 4.40 4.52 4.62 4.69 4.74
60 4.20 4.42 4.64 4.84 5.00 5.13 5.21
65 4.29 4.56 4.87 5.17 5.45 5.67 5.83
70 4.35 4.68 5.07 5.49 5.92 6.30 6.60
75 4.40 4.77 5.23 5.78 6.38 6.99 7.50
80 4.43 4.83 5.34 6.00 6.79 7.66 8.50
85 4.45 4.87 5.42 6.15 7.10 8.25 9.49
OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 4.08 4.25 4.40 4.52 4.61 4.68 4.71
60 4.19 4.41 4.63 4.83 4.99 5.10 5.16
65 4.28 4.56 4.86 5.15 5.41 5.61 5.73
70 4.35 4.68 5.05 5.46 5.86 6.18 6.40
75 4.39 4.76 5.20 5.72 6.27 6.76 7.11
80 4.42 4.81 5.30 5.91 6.60 7.26 7.77
85 4.44 4.84 5.36 6.03 6.82 7.63 8.29
OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)
AGE OF AGE OF FEMALE ANNUITANT
MALE ----------------------------------------------
ANNUITANT 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 4.07 4.22 4.36 4.45 4.51 4.53 4.54
60 4.17 4.38 4.56 4.71 4.80 4.84 4.85
65 4.25 4.50 4.74 4.95 5.08 5.14 5.17
70 4.30 4.58 4.88 5.14 5.31 5.40 5.43
75 4.32 4.63 4.96 5.25 5.46 5.57 5.61
80 4.34 4.65 4.99 5.31 5.54 5.66 5.70
85 4.34 4.66 5.00 5.33 5.57 5.69 5.74
21
OPTION 5V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
PAYMENTS FOR A SPECIFIED PERIOD
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
5 17.28
6 14.51
7 12.53
8 11.04
9 9.89
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
10 8.96
11 8.21
12 7.58
13 7.05
14 6.59
15 6.20
16 5.85
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
17 5.55
18 5.27
19 5.03
20 4.81
21 4.62
22 4.44
23 4.28
NUMBER MONTHLY
OF YEARS PAYMENT
-------- -------
24 4.13
25 3.99
26 3.86
27 3.75
28 3.64
29 3.54
30 3.44
22
FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
INDIVIDUAL VARIABLE ANNUITY CONTRACT
NONPARTICIPATING
