24(b)(4)(a)
XXXX XXXXXXX LIFE INSURANCE COMPANY (U.S.A.) (XXXX XXXXXXX(R) LOGO)
A STOCK COMPANY
OVERNIGHT MAILING ADDRESS: ANNUITIES SERVICE CENTER: HOME OFFICE
[000 Xxxxxxxxx Xxxxx [P.O. Box 9505 Bloomfield Hills, MI
Portsmouth, NH 03801-6815] Portsmouth, NH 03802-9505]
[0-000-000-0000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
WE AGREE to pay the benefits of this Contract in accordance with its terms.
THIS CONTRACT is issued in consideration of the Payments.
Xxxx Xxxxxxx Life Insurance Company (U.S.A.) agrees to pay a guaranteed
withdrawal amount beginning on the Lifetime Income Date and continuing for the
life of the Covered Person(s). We will pay an annuity benefit beginning on the
Maturity Date to the Annuitant, if living, unless otherwise directed by the
Owner, in accordance with the Annuity Payments provision of this Contract. If
any Owner dies while this Contract is in effect prior to the date Annuity
Payments begin, we will pay a death benefit in accordance with the Death Benefit
provision to the Beneficiary upon receipt at our Annuities Service Center of all
required claim forms and proof of the Annuitant's death.
RIGHT TO REVIEW
YOU HAVE [10] DAYS AFTER YOU RECEIVE THE CONTRACT TO EXAMINE IT. DURING THAT
[10] DAY PERIOD YOU MAY CANCEL THE CONTRACT BY RETURNING IT TO OUR ANNUITIES
SERVICE CENTER OR THE REGISTERED REPRESENTATIVE WHO SOLD IT TO YOU. WE WILL THEN
REFUND TO YOU [THE SUM OF YOUR PAYMENT(S), INCREASED OR DECREASED BY THE
INVESTMENT PERFORMANCE OF THE CONTRACT].
[IF YOUR CONTRACT IS ISSUED AS AN INDIVIDUAL RETIREMENT ANNUITY, AND YOU RETURN
IT WITHIN 7 DAYS AFTER YOU RECEIVE IT, WE WILL REFUND TO YOU THE SUM OF ALL
PAYMENT(S) IF THAT AMOUNT IS GREATER THAN THE REFUND AMOUNT DESCRIBED ABOVE.]
WE WILL PROCESS THE REFUND WITHIN 7 DAYS OF RECEIPT OF THE CONTRACT BY US.
DETAILS OF VARIABLE ACCOUNT PROVISIONS ON PAGE 5.1
DEATH BENEFITS, SURRENDER VALUES, AND OTHER VALUES PROVIDED BY THIS CONTRACT
WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE AND
NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
SIGNED FOR THE COMPANY at Boston, Massachusetts, on the Contract Date.
[/s/ Xxxxx X. Xxxxx] [/s/ Xxxxxxx Xxxxx]
------------------------------------- ----------------------------------------
[Xxxxx X. Xxxxx,] President [Xxxxxxx Xxxxx,] Secretary
MODIFIED SINGLE PAYMENT DEFERRED VARIABLE ANNUITY
GUARANTEED LIFETIME WITHDRAWAL BENEFIT
NON-PARTICIPATING
IVA-MSP.A.10 [NATIONAL]
INTRODUCTION
This is a modified single payment deferred variable annuity contract. This
Contract provides that, prior to the Maturity Date, the Contract Value will
accumulate on a variable basis. Subject to the provisions of the Contract, you
may take withdrawals of any amount up to the Contract Value. If you limit
withdrawals to the amounts described in the Lifetime Income Benefits provision,
we guarantee that the Lifetime Income Amount will be available for withdrawal
each Contract Year after the Lifetime Income Date and during the life of the
Covered Person(s). After the Maturity Date, Annuity Payments will be fixed in
amount.
The Contract Value will vary with the investment performance of your Investment
Options.
You must allocate Payments among one or more Investment Options. The Investment
Options are identified on the Specifications Page.
TABLE OF CONTENTS
PAGE
----
SPECIFICATIONS PAGES .................................................... S.1
PART 1 - DEFINITIONS .................................................... 1.1
PART 2 - OWNER, BENEFICIARY ............................................. 2.1
PART 3 - PAYMENTS ....................................................... 3.1
PART 4 - FEES AND DEDUCTIONS ............................................ 4.1
PART 5 - VARIABLE ACCOUNT PROVISIONS .................................... 5.1
PART 6 - WITHDRAWALS .................................................... 6.1
PART 7 - LIFETIME INCOME BENEFIT ........................................ 7.1
PART 8 - SETTLEMENT PHASE ............................................... 8.1
PART 9 - DISTRIBUTIONS AFTER DEATH ...................................... 9.1
PART 10 - ANNUITY PAYMENTS .............................................. 10.1
PART 11 - ANNUITY OPTIONS ............................................... 11.1
PART 12 - GENERAL PROVISIONS ............................................ 12.1
[NATIONAL]
PART 1 DEFINITIONS
WE AND YOU "We", "us" and "our" means the Company. "You" or "your" means the
Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the value of the
Variable Account of this Contract before the Maturity Date.
ANNUITANT A person whose age and life is used to determine the duration of
the Lifetime Income Benefit, Death Benefit and the amount and
duration of Annuity Payments. The Annuitant is as designated on the
Specifications Page.
ANNUITY OPTION The method selected by you for Annuity Payments made by us.
ANNUITY PAYMENT(S) Payment(s) by us to you on or after the Maturity Date under the
terms of this Contract.
ANNUITIES SERVICE CENTER Any office designated by us for the receipt of Payments and
processing of Owner requests.
BENEFICIARY The person, persons or entity to whom benefits are payable
following the death of an Owner or Annuitant.
COMPANY The insurance company named on the first page of this Contract (or
any successor insurance company named by endorsement to this
Contract) that will pay benefits in accordance with this Contract.
CONTRACT ANNIVERSARY The annual anniversary of the Contract beginning twelve months from
the Contract Date and each year thereafter.
CONTRACT DATE The date of issue of this Contract as designated on the
Specifications Page.
CONTRACT VALUE The total of your Investment Account Values at any time before
Annuity Payments begin.
CONTRACT YEAR The period of time measured twelve consecutive months from the
Contract Date or any Contract Anniversary thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes the Beneficiary if the
Beneficiary is not alive.
COVERED PERSON(S) The person or persons whose life (or joint lives) determine the
duration of the Lifetime Income Amount payments. For a single
lifetime income benefit, the Covered Person must be the Annuitant.
For a joint lifetime income benefit, the Covered Persons must be
the Annuitant and the Annuitant's spouse who is either Co-Owner or
sole, primary beneficiary. The Annuitant's spouse may also be a
Co-Annuitant. The Covered Person(s) are named at issue of the
Contract and listed in the Specifications Page. A person who is
removed as Annuitant or Co-Owner or is no longer sole primary
Beneficiary will no longer be a Covered Person. An Annuitant,
Co-Owner or primary beneficiary added after the Contract Date will
not be a Covered Person.
ENDORSEMENT An Endorsement modifies the contract to which it is attached.
Endorsements must be signed by an officer of the Company in order
to be effective.
EXCESS WITHDRAWAL The Excess Withdrawal is any Withdrawal after the Lifetime Income
Date that exceeds the LIA or causes the total of all Withdrawals
during the Contract Year to exceed the XXX.
FIXED ANNUITY An Annuity Option with payments which are predetermined and
guaranteed as to dollar amount.
1.1
GENERAL ACCOUNT All the assets of the Company other than assets in Separate
Accounts.
INTERNAL REVENUE CODE (IRC) The Internal Revenue Code of 1986, as amended from time to time,
and any successor statute of similar purposes.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment Option.
INVESTMENT OPTION The Sub-Account of the Variable Account to which You allocate your
Contract Value. The Investment Options initially available under
this Contract are shown on the Specifications Page. The Sub-Account
of the Variable Account invests in a corresponding Portfolio.
LIFETIME INCOME AMOUNT (LIA) The Lifetime Income Amount is the amount that is guaranteed to be
available for withdrawal each Contract Year after the Lifetime
Income Date and during the life of the Covered Person(s) while this
Contract is in effect.
LIFETIME INCOME DATE The Lifetime Income Date is the date on which the initial LIA is
calculated.
LIFETIME INCOME PERCENTAGE The percentage used to determine your Lifetime Income Amount. The
percentage is shown on the Specifications Page.
MATURITY DATE The latest date on which Annuity Payments may commence. It is the
date specified on the Specifications Page, unless changed.
NET PAYMENT The Payment less the amount of Sales Charge and premium tax, if
any, deducted from the Payment.
OWNER The person, persons or entity entitled to the ownership rights
under this Contract. The Owner is as designated on the
Specifications Page, unless changed.
PAYMENT An amount You pay to Us as consideration for the benefits provided
by this Contract.
PORTFOLIO The investment choice(s) available to the Variable Account.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax treatment under
sections 401 or 408 of the Internal Revenue Code of 1986, as
amended.
SEPARATE ACCOUNT A segregated account of the Company that is not commingled with our
general assets and obligations.
SUB-ACCOUNT(S) The Variable Account is divided into Sub-Accounts. Each Sub-Account
is invested in shares of a different Portfolio.
SURRENDER VALUE The Contract Value on any Valuation Date, less, if applicable, any
deduction for premium taxes or similar taxes.
VALUATION DATE Any date on which the New York Stock Exchange is open for business
and the net asset value of a Portfolio is determined.
VALUATION PERIOD Any period from one Valuation Date to the next, measured from the
time on each such date that the net asset value of each Portfolio
is determined.
VARIABLE ACCOUNT The Company's Separate Account as shown in the Specifications Page.
WITHDRAWAL AMOUNT The amount deducted from the Contract Value as the result of a
withdrawal. This amount is the total of the amount paid to you plus
any deduction for premium taxes or similar taxes, and any income
taxes resulting from the withdrawal and withheld by us. The
Withdrawal Amount may not exceed the Contract Value.
1.2
PART 2 OWNER, BENEFICIARY
GENERAL Before the Maturity Date, the Owner of this Contract shall be the
person, persons or entity designated on the Specifications Page or
the latest change filed with us. On the Maturity Date, the
Annuitant becomes the Owner of this Contract.
OWNER The Owner must be a natural person who is primary Owner of the
Contract, a custodian, or a trust established for the exclusive
benefit of the Annuitant or his or her Beneficiaries. This Contract
is established for the exclusive benefit of the Annuitant or his or
her beneficiaries.
BENEFICIARY The Beneficiary is as designated on the Specifications Page, unless
changed. If there is a surviving Owner, that person will be treated
as the Beneficiary. If no such Beneficiary is living, the
Beneficiary is the Contingent Beneficiary. If no Beneficiary or
Contingent Beneficiary is living, the Beneficiary is the estate of
the deceased Owner.
CHANGE OF OWNER, Subject to the right of an irrevocable Beneficiary, you may change
ANNUITANT, BENEFICIARY the Owner or Beneficiary by written request in a form acceptable to
us and which is received at our Annuities Service Center.
The substitution or addition of any Owner is subject to our
underwriting rules in effect at the time of the request and may
result in the elimination of the Lifetime Income Amount guarantee
and minimum guaranteed death benefit at the date of such change.
If approved, any change of Beneficiary will take effect on the date
the request is signed.
You may not change the Annuitant unless the change is pursuant to a
court order. Any change to a new Annuitant will result in the
elimination of the Lifetime Income Amount guarantee and minimum
guaranteed death benefit. If any Annuitant is changed and any Owner
is not an individual, the entire interest in the Contract must be
distributed to the Owner within five years of the change.
You need not send us the Contract unless we request it. We will not
be liable for any payments or actions we take before any change is
approved.
2.1
PART 3 PAYMENTS
GENERAL The Contract is not effective until Payment is received by us at
our Annuities Service Center. Generally, the Contract will be
purchased with a single payment. If Payments will be paid from
different sources, we will accept multiple Payments subject to the
Payment Limits identified in the Specifications Page. All Payments
under this Contract are payable at our Annuities Service Center.
Payment Limits are identified on the Specifications Page.
ALLOCATION OF NET PAYMENTS When we receive Payments, the Net Payments will be allocated among
the Investment Options. We will allocate the Net Payment among the
Investment Options in accordance with the instructions you provide.
You may change the allocation of subsequent Net Payments at any
time, without charge, by giving us notice in a form acceptable to
us.
3.1
PART 4 FEES AND DEDUCTIONS
CONTRACT ASSET FEE We assess a Contract Asset Fee to compensate us for assuming
certain administration expenses, expense risks and mortality risks.
We deduct the fee from the variable Investment Option(s) each
Valuation Period at an annual rate shown in the Specifications
Page. A portion of this Contract Asset Fee may also be used to
reimburse us for distribution expenses. This fee is reflected in
the Net Investment Factor used to determine the value of
Accumulation Units and Annuity Units of the Contract.
SALES CHARGE We assess a Sales Charge to compensate us for assuming certain
distribution expenses. The Sales Charge is equal to the applicable
Sales Charge Percentage shown in the Specifications Page multiplied
by the Payment. We deduct a Sales Charge from each Payment. The Net
Payment will be applied to your Investment Options as described in
the Allocation of Net Payments provision in the Payments section
TAXES Certain taxes may be charged against your Payments (either at the
time of payment or liquidation), Contract Value, payment of Death
Benefit, withdrawals, or Annuity Payments, as appropriate. Such
taxes may include premium taxes or other taxes levied by any
government entity which we determine have resulted from the
establishment or maintenance of the Variable Account, or from the
receipt by us of Payments, or from the issuance of this Contract,
or from the commencement or continuance of Annuity Payments under
this Contract.
4.1
PART 5 VARIABLE ACCOUNT PROVISIONS
INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment Option is determined
by multiplying (a) times (b) where:
(a) equals the number of Accumulation Units credited to the
Investment Option; and,
(b) equals the appropriate Accumulation Unit Value.
ACCUMULATION UNITS We will credit Net Payments to your Investment Options in the form
of Accumulation Units. The number of Accumulation Units we will
credit to each Investment Option will be determined by dividing the
Net Payment allocated to that Investment Option by the Accumulation
Unit Value for that Investment Option.
Accumulation Units will be adjusted for any transfers and will be
canceled on payment of a death benefit, withdrawal, maturity or
assessment of certain charges based on their value for the
Valuation Period in which such transaction occurs.
ACCUMULATION UNIT VALUE We will determine the Accumulation Unit Value for a particular
Investment Option for any Valuation Period by multiplying the
Accumulation Unit Value for the immediately preceding Valuation
Period by the net investment factor for the corresponding
Sub-Account for the Valuation Period for which the value is being
determined. The Accumulation Unit Value may increase, decrease or
remain the same from one Valuation Period to the next.
NET INVESTMENT FACTOR The net investment factor is an index that measures the investment
performance of a Sub-Account from one Valuation Period to the next.
The net investment factor for any Valuation Period is determined by
dividing (a) by (b) and subtracting (c) from the result where:
(a) is the net result of:
i. the net asset value per share of a Portfolio share held
in the Sub-Account determined as of the end of the
current Valuation Period, plus:
ii. the per share amount of any dividend or capital gain
distributions made by the Portfolio on shares held in the
Sub-Account if the ex-dividend date occurs during the
current Valuation Period, and
(b) is the net asset value per share of a Portfolio share held in
the Sub-Account determined as of the end of the immediately
preceding Valuation Period, and
(c) is the Contract Asset Fee shown on the Specifications Page.
The net investment factor may be greater or less than, or equal to,
one.
TRANSFERS Before the Maturity Date (or the date Annuity Payments begin, if
earlier), you may transfer amounts among such Investment Options.
Amounts will be canceled from the Investment Option(s) from which
amounts are transferred and credited to the Investment Option(s) to
which amounts are transferred. We will effect such transfers so
that the Contract Value on the date of transfer will not be
affected by the transfer.
We may defer, modify or terminate the transfer privilege at any
time that we are unable to purchase or redeem shares of the
Portfolios or when a portfolio requires us to impose restrictions
due to violation of its short term trading policy. Transfer charges
and limitations are identified in Specifications Page and in the
Suspension of Payments provision below.
5.1
After the Maturity Date (or the date Annuity Payments begin, if
earlier), transfers are not applicable under a Fixed Annuity
option.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from, or postpone the date of
payments or transfers from, the variable Investment Option(s) for
any period when:
(a) the New York Stock Exchange is closed (other than customary
weekend and holiday closings);
(b) trading on the New York Stock Exchange is restricted;
(c) an emergency exists as a result of which disposal of
securities held in the Variable Account is not reasonably
practicable or it is not reasonably practicable to determine
the value of the Variable Account's net assets; or
(d) the Securities and Exchange Commission, by order, permits such
deferral or postponement for the protection of security
holders.
Applicable rules and regulations of the Securities and Exchange
Commission shall govern whether the conditions described in (b) and
(c) exist.
5.2
PART 6 WITHDRAWALS
GENERAL You may request withdrawal of part or all of the Surrender Value,
at any time before the death of the Owner or the Maturity Date by
sending us a written request. We will pay all withdrawals within
seven days of receipt of the request at the Annuities Service
Office subject to postponement in certain circumstances, as
specified in the Suspension of Payments provision above.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the entire Contract Value,
we will terminate the Contract and pay you the Surrender Value.
PARTIAL WITHDRAWAL If you request to withdraw an amount less than the Surrender Value,
we will pay you the amount requested and deduct the Withdrawal
Amount from the Contract Value. Unless you specify the amount to be
withdrawn from each Investment Option, the Withdrawal Amount will
be withdrawn from each Investment Option on a pro rata basis.
You may take as many partial withdrawals as you wish. Limitations
on the amount of partial withdrawals are set forth on the
Specifications Page
IMPACT OF WITHDRAWALS ON All withdrawals, including withdrawals under the Lifetime Income
OTHER BENEFITS Benefit, will reduce the Contract Value on a dollar-for-dollar
basis. Withdrawals, including withdrawals under the Lifetime Income
Benefit, will reduce the Death Benefit as described in the Death
Benefit before Maturity Date provision. Withdrawals may also reduce
or eliminate LIA payments as described in the Lifetime Income
Benefit provision.
6.1
PART 7 LIFETIME INCOME BENEFIT
GENERAL This Contract guarantees that each Contract Year after the Lifetime
Income Date and during the life of the Covered Person (or the life
of either Covered Person if a Joint Lifetime benefit is shown on
the Specifications Page) you may take withdrawals up to the
Lifetime Income Amount (LIA), even if your Contract Value reduces
to zero. The LIA is described below.
The Lifetime Income Date is shown on the Specifications Page
LIFETIME INCOME AMOUNT (LIA) The initial LIA is equal to the Lifetime Income Percentage
multiplied by the greater of (a) the Contract Value on the Lifetime
Income Date or (b) gross Payments reduced in the same proportion as
any withdrawal after the Contract Date and prior to the Lifetime
Income Date divided by the Contract Value immediately prior to the
withdrawal.
On or after the Lifetime Income Date, withdrawals during the
Contract Year that are less than or equal to the LIA will not
reduce the LIA. Any Excess Withdrawal during the Contract Year will
decrease the LIA in the same proportion as the Excess Withdrawal
amount divided by the Contract Value immediately prior to the
withdrawal. Notwithstanding the previous sentence, withdrawals in
connection with Life Expectancy Distributions that are paid under
an automated distribution program will not cause recalculation of
the LIA. (See the "Life Expectancy Distributions" provision below).
STEP-UP If the Contract Value on any Step-Up-Date multiplied by the
Lifetime Income Percentage results in an amount greater than the
current LIA, the LIA will automatically step-up to the greater
amount. (See "Step-Up Date" in the Specifications Page).
LIFE EXPECTANCY DISTRIBUTIONS For purposes of this Contract, Life Expectancy Distributions are
distributions within a calendar year that:
(a) are part of a series of substantially equal period payments
over the Owner's Life Expectancy (or, if applicable, the joint
Life Expectancy of the Owner and the Owner's spouse); and
(b) in the case of a Qualified contract, are paid to the Owner:
(i) as required or contemplated by Code Section 401(a)(9),
Section 408(a)(6), or Section 408(b)(3), as the case may
be ("Qualified Death Benefit Stretch Distributions" and
"Required Minimum Distributions"); and
(ii) are the Contract's proportional share of all such
distributions as determined by the Company and based on
the Company's understanding of the Code; or
(c) In the case of a Non-Qualified contract, are paid to the Owner
pursuant to Code Section 72(s)(2) upon the request of the
Owner ("Non-Qualified Death Benefit Stretch Distributions").
For purposes of this "Life Expectancy Distributions" provision,
references to Owner also include Beneficiary,
"Life Expectancy" will be determined using the applicable tables
approved by the Internal Revenue Service for such purpose under the
latest guidance or regulations issued under the relevant section of
the Code referred to above.
We may make any changes necessary to comply with the Code and
Treasury Regulations.
7.1
IMPACT OF DEATH OF COVERED Upon the death of the Covered Person under a Single Lifetime Income
PERSON(S) benefit, LIA payments terminate.
Under a Joint Lifetime Income benefit, LIA payments will terminate
upon the death of the last Covered Person.
7.2
PART 8 SETTLEMENT PHASE
BENEFITS DURING THE The Contract will enter its Settlement Phase if
SETTLEMENT PHASE
(a) the Contract Value reduces to zero, and
(b) there were no Excess Withdrawals during the Contract Year, and
(c) the LIA is greater than zero.
When the Contract enters its Settlement Phase the Lifetime Income
Benefit will continue, however all other rights and benefits under
the Contract, including Death Benefits, will terminate.
We will automatically pay settlement payments equal to the LIA each
Contract Year of the Settlement Phase during the life of the
Covered Person (or either Covered Person if a Joint Lifetime
benefit is shown in the Specifications). If the Settlement Phase is
entered prior to the Lifetime Income Date, then settlement payments
will begin on or after the Lifetime Income Date. Settlement
payments will be paid no less frequently than annually.
If the Covered Person (or last covered Person if a Joint Lifetime
benefit is shown in the Specifications) dies during the Settlement
Phase, then the Lifetime Income Benefit terminates and no
additional settlement payments will be paid.
8.1
PART 9 DISTRIBUTIONS AFTER DEATH
DEATH BENEFIT BEFORE MATURITY We will pay the Death Benefit to the Beneficiary if any Owner dies
DATE prior to the Maturity Date. If any Owner is not an individual the
death of any Annuitant is treated as the death of an Owner and the
Death Benefit will be determined by substituting the Annuitant for
the Owner.
We will determine the Death Benefit (as described below) as of the
date on which written notice and proof of death and all required
claims forms are received at the Annuities Service Office.
The Death Benefit may be taken in one sum immediately, in which
case the Contract will terminate. If the Death Benefit is not taken
in one sum immediately, the Contract will continue subject to the
following provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit over the Contract
Value will be allocated to and among the Investment Options in
proportion to their values as of the date on which the Death
Benefit is determined.
(c) No additional Payments may be applied to the Contract.
(d) If the Beneficiary is not the deceased Owner's spouse, the
entire interest in the Contract must be distributed under one
of the following options:
(i) The entire interest in the Contract must be distributed
over the life of the Beneficiary, or over a period not
extending beyond the life expectancy of the Beneficiary,
with distributions beginning within one year of the
Owner's death; or
(ii) the entire interest in the Contract must be distributed
within 5 years of the Owner's Death, or
(iii)as Annuity Payments under one of the options described in
the Annuity Options section.
If the Beneficiary dies before the distributions required by
(i) or (ii) are complete, the entire remaining Contract Value
must be distributed in a lump sum immediately.
(e) If the Beneficiary is the deceased Owner's spouse, the
Contract will continue with the surviving spouse as the new
Owner. The surviving spouse may name a new Beneficiary (and,
if no Beneficiary is so named, the surviving spouse's estate
will be the Beneficiary).
The spouse may also elect distributions under one of the
following options:
(i) the entire interest in the Contract may be distributed
over the life of the Beneficiary, or over a period not
extending beyond the life expectancy of the Beneficiary,
with distributions beginning within one year of the
Owner's death; or
(ii) as Annuity Payments under one of the options described in
the Annuity Options section.
If there is more than one Beneficiary, the foregoing provisions
will independently apply to each Beneficiary, to the extent of that
Beneficiary's share.
We will permit the Owner to limit the Death Benefit option(s) to be
offered to any named Beneficiary, if the Owner provides written
notice to the Company prior to death and the desired option(s) is
one provided for in this Contract.
9.1
DETERMINATION OF DEATH BENEFIT UPON THE DEATH OF AN OWNER WHO IS THE LAST SURVIVING COVERED
PERSON, the LIA will reduce to zero and the Death Benefit will be
determined as the greater of the Contract Value or a minimum
guaranteed death benefit equal to the sum of all Payments made,
less an amount deducted in connection with partial withdrawals as
follows.
(a) Before the Lifetime Income Date: Each time a withdrawal is
taken, the sum of all Payments is reduced in the same
proportion as the amount of the withdrawal divided by the
Contract Value immediately prior to the withdrawal.
(b) After the Lifetime Income Date: Each time a withdrawal equal
to or less than the LIA is taken, the sum of all Payments is
reduced on a dollar for dollar basis. Any Excess Withdrawals
reduce the sum of all Payments in the same proportion as the
Excess Withdrawal Amount divided by the Contract Value
immediately prior to the withdrawal. Notwithstanding the
above, a withdrawal that is a Life Expectancy Distribution
paid under an automated distribution program, will reduce the
sum of all Payments on a dollar-for-dollar basis.
UPON THE DEATH OF ANY OWNER WHO IS NOT THE LAST SURVIVING COVERED
PERSON, the Death Benefit will be equal to the Contract Value.
DEATH BENEFIT ON OR AFTER On or after the date Annuity Payments begin, if the Annuitant dies,
MATURITY DATE the Death Benefit will depend on the Annuity Option selected in
accordance with Part 11 (Annuity Options).
PROOF OF DEATH We will require proof of death upon the death of the Annuitant or
the Owner. Proof of death is one of the following received at the
Annuities Service Center:
(a) A certified copy of a death certificate.
(b) A certified copy of a decree of a court of competent
jurisdiction as to the finding of death.
(c) Any other proof satisfactory to us.
9.2
PART 10 ANNUITY PAYMENTS
GENERAL Benefits payable under this Contract may be applied in accordance
with one or more of the Annuity Options described below, subject to
any restrictions of Internal Revenue Code sections 72(s) (or
section 401(a)(9) and 408(b)(3) if this Contract is issued in a
Qualified Plan). Once Annuity Payments commence, the Annuity Option
may not be changed.
We will send you information about Annuity Options before the
Maturity Date. If by the Maturity Date, you are not receiving LIA
payments, do not choose an Annuity Option, make a total Withdrawal
of the Surrender Value, or ask us to change the Maturity Date, we
will automatically pay you Annuity Payments under the Annuity
Option shown in the Specifications Page. You can change the Annuity
Option at any time before Annuity Payments begin.
We will provide Fixed Annuity payments. The method used to
calculate the amount of the Fixed Annuity payments is described
below.
If the monthly Annuity Payment is less than $20, we may pay the
greater of the Contract Value or the commuted value of the Lifetime
Income Benefit in one lump sum on the Maturity Date, or the date
Annuity Payments would begin, if earlier.
FIXED ANNUITY PAYMENTS We will determine the amount of each Fixed Annuity payment by
applying the Contract Value as of a date not more than 10 business
days prior to the date Annuity Payments begin (minus any applicable
premium taxes) to the Annuity Option elected based on the mortality
table and interest rate shown on the Specifications Page. The Fixed
Annuity payment will not be less than that available by applying
the Contract Value to purchase a single premium immediate annuity
then offered by us or a company affiliated with us to the same
class of annuitants.
We guarantee the dollar amount of Fixed Annuity payments.
10.1
PART 11 ANNUITY OPTIONS
GENERAL Benefits payable under this Contract may be applied in accordance
with one of the Annuity Options described below. We may revise the
availability of these options to comply with state laws and
regulations or with federal Code or Treasury regulations.
DESCRIPTION OF ANNUITY OPTIONS Life Annuity with Cash Refund: We will make payments during the
lifetime of the Annuitant. After the death of the Annuitant, we
will pay the Beneficiary a lump sum amount equal to the excess, if
any, of the Contract Value at the election of this option over the
sum of the Annuity Payments made under this option.
The annual amount of the annuity payments will equal the greater of
(a) the Lifetime Income Amount, or
(b) the annual amount determined by applying the Contract Value to
a Cash Refund Annuity Option based on the Mortality Table and
Fixed Annuity Payment Interest Rate listed in the
Specifications.
Joint Life Annuity with Cash Refund: This option is available if
both Covered Persons remain under Contract and they are the
Annuitant and Co-Annuitant at election of this option. If you elect
this option, we will make payments during the joint lifetime of the
Annuitant and Co-Annuitant. Payments will then continue during the
remaining lifetime of the survivor. After the death of the
surviving Annuitant, we will pay the Beneficiary a lump sum amount
equal to the excess, if any, of the Contract Value at the election
of this option over the sum of the annuity payments made under this
option.
The annual amount of the annuity payments will equal the greater of
(a) the Lifetime Income Amount, or
(b) the annual amount determined by applying the Contract Value to
a Joint Life Cash Refund Annuity Option based on the Mortality
Table and Fixed Annuity Payment Interest Rate listed in the
Specifications.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the Annuity Options
described above, you may choose an alternate form of settlement
acceptable to us. Once Annuity Payments commence, the form of
settlement may not be changed.
11.1
PART 12 GENERAL PROVISIONS
ENTIRE CONTRACT The entire Contract consists of this Contract and Endorsements, if
any, and the application, if one is attached to this Contract.
BENEFITS AND VALUES The benefits and values available under this Contract are not less
than the minimum required by any statute of the state in which this
Contract is delivered.
MODIFICATION Only the President, a Vice President, or the Secretary of the
Company has authority to change or waive the provisions of this
Contract. Any change or waiver must be in writing and signed by one
of these officers of the Company. We will not change this Contract
without your consent unless the change is required to make it
conform to any applicable law or regulation or any ruling issued by
a government agency; or unless we have reserved the right to change
the terms herein.
CHANGE IN MATURITY DATE Prior to the Maturity Date, you may request a change of the
Maturity Date. Any extension of the Maturity Date will be subject
to our prior approval and any applicable law or regulation then in
effect.
ASSIGNMENT You may assign this Contract prior to the Maturity Date. No
assignment will be binding on us unless it is written in a form
acceptable to us, received at our Annuities Service Center and
approved by us under our underwriting rules in effect at the time
of the request. An assignment may result in the elimination of the
Lifetime Income Amount guarantee as of the date of such change. We
will not be liable for any payments made or actions taken before
the assignment is accepted by us. An absolute assignment will
revoke the interest of any revocable Beneficiary. We will not be
responsible for the validity of any assignment.
CLAIMS OF CREDITORS All benefits and payments under this Contract shall be exempt from
the claims of creditors to the extent permitted by law.
MISSTATEMENT AND PROOF OF We may require proof of age or survival of any person upon whose
AGE OR SURVIVAL age or survival any Lifetime Income Benefit, Annuity Payments or
other benefits provided by this Contract or any Endorsement
attached thereto depend. If the age of the Annuitant has been
misstated, the benefits will be those which would have been
provided for the correct age. If we have made incorrect benefit
payments, we will immediately pay the amount of any underpayment.
We will deduct the amount of any overpayment from future benefit
payments.
ADDITION, DELETION OR We may:
SUBSTITUTION OF INVESTMENT
OPTIONS (a) add, delete or substitute Portfolio shares held or purchased
by the Variable Account;
(b) eliminate shares of one Portfolio and substitute shares of
another Portfolio;
(c) establish additional Sub-Accounts to invest in a new
Portfolio, eliminate or combine existing Sub-Accounts or
transfer Sub-Account assets to another Separate Account of the
Company or an affiliated company.
We will obtain prior approval required from the Securities and
Exchange Commission before making these changes. We will provide
you with notice of these substitutions or changes.
If deemed by us to be in the best interests of persons having
voting rights under the Contracts, the Variable Account may be
operated as a management company under the Investment Company Act
of 1940 or it may be de-registered under such Act in the event such
registration is no longer required.
NON-PARTICIPATING Your Contract is non-participating. This means the Contract will
not share in our profits or surplus earnings. We will pay no
dividends on your Contract.
12.1
REPORTS We will send you annual reports without charge, containing the
Investment Account Value and the Contract Value. The report will
include the number of Accumulation Units credited to the Variable
Account, the Accumulation Unit value and the dollar value of the
Accumulation Unit of the Variable Account no more than 4 months
prior to the date of the mailing of the report. We will provide
annual calendar year reports concerning the status of the Contract
and such information concerning required minimum distributions as
is prescribed by the Commissioner of Internal Revenue.
INSULATION The assets of the Variable Account equal to the reserves and other
contract liabilities applicable to that account are not chargeable
with liabilities from any other business we may conduct. Moreover,
the income, gains and losses, realized or unrealized, applicable to
the assets of the Variable Account shall be applied to that account
regardless of our other income, gains or losses.
CURRENCY AND PLACE OF PAYMENTS All payments made to or by us shall be made in the lawful currency
of the United States of America at the Annuities Service Center or
elsewhere if we consent.
NOTICES AND ELECTIONS Notices and elections are any form of communication that provides
information needed by us to process your request. A notice or
election may be provided to us in a written and signed format or in
another manner that we approve in advance. To be effective, all
notices and elections you make under this Contract must be received
by us at the Annuities Service Center. Unless otherwise provided in
this Contract, all notices, requests and elections will be
effective when received by us at our Annuities Service Center,
complete with all necessary information.
GOVERNING LAW This Contract will be governed by the laws of the jurisdiction
indicated on the Specifications Page.
SECTION 72(S) The provisions of this Contract shall be interpreted so as to
comply with the requirements of Section 72(s) of the Internal
Revenue Code.
12.2
XXXX XXXXXXX LIFE INSURANCE COMPANY (U.S.A.) (XXXX XXXXXXX(R) LOGO)
A STOCK COMPANY
