Prudential The Prudential
------------ Insurance Company
of America
Annuitant Contract No.
--------------------------------------------------------------------------------
LIMITATION PROVISIONS
The contract is amended at issue to include the following provisions. They apply
even though the contract may state otherwise.
A. RIGHTS
As stated in the retirement plan under which this contract is issued, the
Employer is________________________________________________________________
The administrator is [_] the Employer [_] _________________________________
Except as we state below, any right or privilege granted by the contract or
by us may be exercised by the Annuitant only with the written consent of
the Administrator
The Annuitant, with no one else's consent, may designate and change the
beneficiary and may exercise the voting rights.
If we receive written notice from the Administrator that the Internal
Revenue Service has stated that the retirement plan initially fails to
qualify under Sections 401 or 403(a) of the Code, this will be the effect.
Within one year after the date of denial of qualification, the Employer
will have the right to liquidate the contract for its cash value less the
annual maintenance charge.
The retirement plan might be amended so that it is not in accord with this
Limitation Provision. If so, the Administrator, with only our consent, will
have the right to amend this form accordingly.
B. NON-TRANSFERABLE
This contract may not be sold, assigned, discounted, or pledged for any
purpose to anyone except us.
C. RETIREMENT OPTIONS
For settlements which start while the Annuitant is living:
1. A last survivor type settlement may be chosen only if the Annuitant's
then spouse is the contingent payee.
2. Payment will be made under Option C if, on the annuity starting date,
all of these statements are true:
a. The Annuitant is married.
b. His or her spouse is then living.
c. No contrary form of payment, chosen by the Annuitant in
writing, has been received at our Service Office.
But the amount of any payment under Option C to the Annuitant's spouse
after the Annuitant's death will be one-half the amount that was
payable while both of them were living.
3. Option D may be chosen only if the period will not exceed the life
expectancy, as we determined for persons of the same age and sex, of
the Annuitant. If the Annuitant's then spouse is the contingent payee
the period may not exceed their joint life and last survivor
expectancy, as we determine for persons of the same age and sex.
D. DEATH OPTIONS
Except for one made in accord with the Retirement Options above, a
settlement may not be chosen unless the amount available for settlement
with the beneficiary or contingent payee will be distributed within five
years of the date of death of the person by reason of whose death the
amount became available.
E. ANNUITY DATE
In the case of a key employee, as defined in the Code, the annuity date may
not be changed to a date which is later than the contract anniversary on or
just before the date six months after the Annuitant's 70th birthday.
A change might be needed later to conform this contract to the requirements
of the Internal Revenue Code, regulations or published rulings or to the
requirements of the Employee Retirement Income Security Act of 1974. If so,
we will have the right to make the change(s) without a signed request and
to provide a form of amendment to the contract.
Endorsed by attachment on the contract Date
The Prudential Insurance Company of America,
By /s/ Xxxxxxxx X. Xxxxxxxx
Secretary.
II-45
Printed in U.S.A.
