[LOGO]
Mailing Address: Post Office Box 29564, Raleigh, North Carolina 27626-0564
Home Office: 0000 Xxxxxxxxxx Xxxxx, Xxxxxxx, Xxxxx Xxxxxxxx 00000
(000) 000-0000
LONDON PACIFIC LIFE & ANNUITY COMPANY (the "Company") in consideration of the
payment of the Contribution issued this Contract.
The Company will pay the benefits of this Contract, subject to all of its
provisions, terms and conditions.
RIGHT TO EXAMINE CONTRACT: Within 10 days of the date of receipt of this
Contract by the Owner, it may be returned by delivering or mailing it to the
Company at its Annuity Service Center. When this Contract is received by the
Company, it will be voided as if it had never been in force. A written request
for cancellation must accompany the contract. In such event, the Company will
refund the Contract Value, computed at the end of the Valuation Period during
which this Contract is received by the Company at its Annuity Service Center.
The Company has reserved the right to allocate the Contribution to the Money
Market Sub-Account until the expiration of the Right to Examine Contract period.
THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY
READ YOUR CONTRACT CAREFULLY
Xxxxxx X. Xxxxxxxxx, Xxx X. Xxxxxxxxx,
SECRETARY PRESIDENT
INDIVIDUAL VARIABLE SINGLE CONTRIBUTION IMMEDIATE ANNUITY CONTRACT
NONPARTICIPATING
ANNUITY PAYMENTS PROVIDED BY THIS CONTRACT ARE BASED ON THE INVESTMENT
EXPERIENCE OF A SUB-ACCOUNT AND WILL VARY IN ACCORDANCE WITH THE PERFORMANCE OF
THE SUB-ACCOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER
VALUATION PROVISIONS ON PAGE ____.
{policy #}
TABLE OF CONTENTS
PAGE
CONTRACT SCHEDULE
DEFINITIONS
CONTRIBUTION PROVISIONS
Contribution
Allocation of Contribution
SEPARATE ACCOUNT PROVISIONS
The Separate Account
Separate Account Charge
Valuation of Assets
VALUATION PROVISIONS
Accumulation Units
Accumulation Unit Value
Annuity Unit Value
Net Investment Factor
CONTRACT VALUE
TRANSFERS
Transfers Before the Annuity Date
Transfers After the Annuity Date
ANNUITY PROVISIONS
Annuity Date
Determination of Annuity Payments
Frequency and Amount of Annuity Payments
SUSPENSION OR DEFERRAL OF PAYMENT PROVISIONS
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
Owner
Annuitant
Assignment Of The Contract
PROCEEDS PAYABLE ON DEATH
Death Before Annuity Date
Distribution Requirements Before the Annuity Date
Death of Owner On or After the Annuity Date
Death of Annuitant On or After the Annuity Date
Non-Individual Owner
Beneficiary
Change Of Beneficiary
TABLE OF CONTENTS (CONTINUED)
GENERAL PROVISIONS
The Contract
Misstatement of Age and Sex
Incontestability
Modification
Non-Participating
Evidence Of Survival
Proof Of Age
Protection Of Proceeds
Reports
Taxes
Regulatory Requirements
Substitution
Change in the Operation of the Separate Account
CONTRACT SCHEDULE
OWNER: [Xxxx Xxxxx]
ANNUITANT: [Xxxx Xxxxx] AGE AND SEX: [50 Male]
PAYEE: [Xxxx Xxxxx] BENEFICIARY: [Xxxx Xxxxx]
CONTRACT NUMBER: [12345] ISSUE DATE: [July 1, 1998]
CONTRIBUTION: [$100,000] ANNUITY DATE: [August 1,1998]
ASSUMED INVESTMENT RETURN: [3%] ANNUITY UNIT FACTOR [.999866]
ANNUITY PAYMENT FREQUENCY: [Monthly] PAYMENT FACTOR [7.0]
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PORTFOLIO OPTIONS:
------------------
THE CONTRIBUTION WILL BE ALLOCATED AS SPECIFIED BY THE CONTRACT OWNER.
SEPARATE ACCOUNT:
-----------------
LPLA SEPARATE ACCOUNT ONE
SUB-ACCOUNT: BASED ON:
------------ ---------
Value LPT Xxxxxx Associates Value Portfolio
Total Return LPT MFS Total Return Portfolio
U.S. Quality Bond LPT Berkeley U.S. Quality Bond Portfolio
Money Market LPT Berkeley Money Management Portfolio
Growth LPT Strong Growth Portfolio
Diversified Growth LPT Xxxxxxxxx Xxxxxxxx Diversified Growth Portfolio
Corporate Leaders LPT Lexington Corporate Leaders Portfolio
Emerging Markets Xxxxxx Xxxxxxx U. F. Emerging Markets Equity Portfolio
International Xxxxxx Xxxxxxx U. F. International Magnum Portfolio
High Yield Xxxxxx Xxxxxxx U. F. High Yield Portfolio
Equity 500 Index BT Equity 500 Index Fund
SEPARATE ACCOUNT CHARGE
-----------------------
A daily charge at an annual rate of [1.25%] (0.0000347693 daily) of the assets
held in the Separate Account.
ANNUITY SERVICE CENTER:
-----------------------
LONDON PACIFIC LIFE & ANNUITY COMPANY OR LONDON PACIFIC LIFE & ANNUITY COMPANY
ANNUITY SERVICE CENTER ANNUITY SERVICE CENTER
P.O. BOX 29596 0000 XXXXXXXXXX XXXXX
XXXXXXX, XXXXX XXXXXXXX 00000 XXXXXXX, XXXXX XXXXXXXX 00000
(000) 000-0000
(000) 000-0000
TRANSFER PROVISIONS AND CHARGES
-------------------------------
NUMBER OF TRANSFERS: SUBJECT TO ANY RESTRICTIONS IMPOSED BY THE COMPANY, THERE
ARE CURRENTLY NO RESTRICTIONS ON THE NUMBER OF TRANSFERS THAT CAN BE MADE. THE
COMPANY RESERVES THE RIGHT TO FURTHER LIMIT THE NUMBER OF
TRANSFERS IN THE FUTURE.
TRANSFER FEE: THE TRANSFER FEE IS CURRENTLY $20.00. CURRENTLY, THE COMPANY DOES
NOT ASSESS A TRANSFER FEE ON THE FIRST 12 TRANSFERS IN A CONTRACT YEAR.
TRANSFERS MADE AT THE END OF THE RIGHT TO EXAMINE CONTRACT PERIOD BY THE COMPANY
AND ANY TRANSFERS MADE PURSUANT TO AN APPROVED DOLLAR COST AVERAGING PROGRAM OR
PURSUANT TO AN APPROVED ASSET ALLOCATION PROGRAM WILL NOT BE COUNTED IN
DETERMINING THE APPLICATION OF THE TRANSFER FEE.
CONTRACT SCHEDULE (CONTINUED)
MINIMUM AMOUNT TO BE TRANSFERRED: $500 FROM ONE OR MULTIPLE SUB-ACCOUNTS OR THE
OWNER'S ENTIRE INTEREST IN THE SUB-ACCOUNT IF LESS. TRANSFERS MADE PURSUANT TO
AN APPROVED DOLLAR COST AVERAGING PROGRAM OR PURSUANT TO AN APPROVED ASSET
ALLOCATION PROGRAM WILL NOT BE SUBJECT TO THESE LIMITATIONS.
MINIMUM AMOUNT WHICH MUST REMAIN IN A SUB-ACCOUNT AFTER A TRANSFER: $500 OR $0
IF THE ENTIRE AMOUNT IN THE SUB-ACCOUNT IS TRANSFERRED. TRANSFERS MADE PURSUANT
TO AN APPROVED DOLLAR COST AVERAGING PROGRAM OR PURSUANT TO AN APPROVED ASSET
ALLOCATION PROGRAM WILL NOT BE SUBJECT TO THIS LIMITATION
DESCRIPTION OF ANNUITY BENEFIT:
-------------------------------
PAYMENT FOR [25] YEARS CERTAIN
AN ANNUITY PAYABLE ACCORDING TO THE ANNUITY PAYMENT FREQUENCY SELECTED FOR A
FIXED PERIOD OF [25] YEARS. IF, AT THE DEATH OF THE ANNUITANT, PAYMENTS HAVE
BEEN MADE FOR LESS THAN THE [25 ] YEAR PERIOD, THE BENEFICIARY WILL HAVE THE
OPTION OF RECEIVING THE REMAINING PAYMENTS FOR THE REMAINDER OF THE PERIOD OR
TAKING THE DEATH BENEFIT IN A LUMP SUM. THE LUMP SUM PAYMENT WILL BE EQUAL TO
THE PRESENT VALUE OF THE REMAINING PAYMENTS DISCOUNTED AT THE ASSUMED INVESTMENT
RETURN SHOWN ON THE CONTRACT SCHEDULE PLUS 1.00% USING THE ANNUITY UNIT VALUES
AS OF THE DATE THE COMPANY RECEIVES WRITTEN NOTIFICATION OF DUE PROOF OF DEATH
JOINT AND SURVIVOR LIFE ANNUITY
AN ANNUITY PAYABLE ACCORDING TO THE ANNUITY PAYMENT FREQUENCY SELECTED DURING
THE JOINT LIFETIME OF THE ANNUITANT AND THE JOINT ANNUITANT, CEASING WITH THE
LAST PAYMENT DUE PRIOR TO THE DEATH OF THE ANNUITANT OR JOINT ANNUITANT,
WHICHEVER DEATH IS LAST. THE FIRST ANNUITY PAYMENT IS BASED ON THE ASSUMED
INVESTMENT RETURN, THE AGES AND SEXES OF THE ANNUITANT AND JOINT ANNUITANT AND
{TBD} PROJECTED TO YEAR [___].
LIFE ANNUITY
AN ANNUITY PAYABLE ACCORDING TO THE ANNUITY PAYMENT FREQUENCY SELECTED DURING
THE LIFETIME OF THE ANNUITANT, CEASING WITH THE LAST PAYMENT DUE PRIOR TO THE
DEATH OF THE ANNUITANT. THE FIRST ANNUITY PAYMENT IS BASED ON THE ASSUMED
INVESTMENT RETURN, THE AGE AND SEX OF THE ANNUITANT, AND THE {TBD TABLE}
PROJECTED TO YEAR [ ] .
LIFE ANNUITY WITH PERIOD CERTAIN
AN ANNUITY PAYABLE ACCORDING TO THE ANNUITY PAYMENT FREQUENCY SELECTED DURING
THE LIFETIME OF THE ANNUITANT, CEASING WITH THE LAST PAYMENT DUE PRIOR TO THE
DEATH OF THE ANNUITANT. THE FIRST ANNUITY PAYMENT IS BASED ON THE ASSUMED
INVESTMENT RETURN, THE AGE AND SEX OF THE ANNUITANT, AND THE {TBD TABLE}
PROJECTED TO YEAR [ ]. IF, AT THE DEATH OF THE ANNUITANT, PAYMENTS HAVE BEEN
MADE FOR LESS THAN THE [ ] YEAR PERIOD, THE BENEFICIARY WILL HAVE THE OPTION OF
RECEIVING THE REMAINING PAYMENTS FOR THE REMAINDER OF THE PERIOD OR TAKING THE
DEATH BENEFIT IN A LUMP SUM. THE LUMP SUM PAYMENT WILL BE EQUAL TO THE PRESENT
VALUE OF THE REMAINING PAYMENTS DISCOUNTED AT THE ASSUMED INVESTMENT RETURN
SHOWN ON THE CONTRACT SCHEDULE PLUS 1.00% USING THE ANNUITY UNIT VALUES AS OF
THE DATE THE COMPANY RECEIVES WRITTEN NOTIFICATION OF DUE PROOF OF DEATH.
SURRENDER AFTER THE ANNUITY DATE (TERM CERTAIN ONLY) THE OWNER MAY SURRENDER
THIS CONTRACT AFTER THE ANNUITY DATE BY SUBMITTING A WRITTEN REQUEST TO THE
ANNUITY SERVICE CENTER. THE AMOUNT AVAILABLE TO THE OWNER IS THE PRESENT VALUE
OF THE REMAINING GUARANTEED ANNUITY PAYMENTS, DISCOUNTED AT THE ASSUMED
INVESTMENT RETURN SHOWN ON THE CONTRACT SCHEDULE PLUS 1.00% USING THE ANNUITY
UNIT VALUES AS OF THE DATE THE COMPANY RECEIVES THE SURRENDER REQUEST. NO
PARTIAL SURRENDERS ARE ALLOWED.
DEFINITIONS
ACCUMULATION UNIT: A unit of measure used to calculate the value of an Owner's
interest in a Sub-Account of the Separate Account prior to the Annuity Date.
AGE: The age of any Owner or Xxxxxxxxx on his/her last birthday as of the
Annuity Date
ANNUITANT: The natural person on whose life annuity payments are based. On or
after the Annuity Date, the Annuitant shall also include any Joint Annuitant.
ANNUITY DATE: The date on which annuity payments begin. The Annuity Date is
shown on the Contract Schedule.
ANNUITY CALCULATION DATE: The date on which the first annuity payment will be
calculated. It will be no more than 5 days prior to the Annuity Date.
ANNUITY PAYMENT FREQUENCY: The frequency with which annuity payments will be
made. The frequencies available are monthly and annually. Once selected, the
Annuity Payment Frequency may not be changed.
ANNUITY PERIOD The period of time beginning with the Annuity Date during which
annuity payments are made.
ANNUITY SERVICE CENTER: The office indicated on the Contract Schedule of this
Contract to which notices, requests and the Contribution must be sent. All sums
payable to the Company under this Contract are payable only at the Annuity
Service Center.
ANNUITY UNIT An accounting unit of measure used in the calculation of annuity
payments.
ANNUITY UNIT FACTOR: The factor applied daily to neutralize the effect of the
Assumed Investment Return.
ASSUMED INVESTMENT RETURN: The investment return upon which the annuity payments
in the contract are based.
BENEFICIARY: The person entitled to receive benefits as per the terms of the
contract in case of the death of the Owner or the later death of the Annuitant
or Joint Annuitant, as applicable.
COMPANY: London Pacific Life & Annuity Company.
CONTRACT VALUE: The value of the Sub-Accounts prior to the Annuity Date.
CONTRIBUTION: A payment made by or on behalf of an Owner with respect to this
Contract.
DUE PROOF OF DEATH: A certified copy of the death certificate, an order of a
court of competent jurisdiction, a statement from a physician who attended the
deceased or any other proof acceptable to the Company.
DEFINITIONS (CONTINUED)
ELIGIBLE FUND(S): Currently the investment entities shown on the Contract
Schedule or any other investment entities that may be added by the Company.
ISSUE DATE: The date on which the Contract became effective. Similarly, Contract
years are measured from the Issue Date.
JOINT ANNUITANT: A person other than the Annuitant on whose continuation of life
annuity payments may be made. The contract will have a Joint Annuitant only if
the Description of Annuity Benefit on the Contract Schedule provides for a
survivor. The Joint Annuitant may not be changed.
OWNER/JOINT OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in this Contract.
PAYEE: The person, designated by the Owner, to whom annuity payments will be
made.
PAYMENT FACTOR: The factor shown on the Contract Schedule which is used on the
Annuity Calculation Date to calculate the first annuity payment.
PORTFOLIO: A segment of an Eligible Fund which constitutes a separate and
distinct class of shares.
PREMIUM TAX: Any premium taxes paid to any governmental entity and assessed
against the Contribution . The Company will deduct the tax on the Issue Date.
SEPARATE ACCOUNT: An account established by the Company to separate the assets
funding the variable benefits for the class of Contracts to which this contract
belongs from the Company's other assets. The assets in the Separate Account are
not chargeable with liabilities arising out of any other business the Company
may conduct. The Separate Account and the Sub-Accounts are listed on the
Contract Schedule.
SUB-ACCOUNT: The subdivisions of the Separate Account. They are shown on the
Contract Schedule.
VALUATION DATE: Each day on which the Company and the New York Stock Exchange
("NYSE") are open for business.
VALUATION PERIOD: The period of time beginning at the close of business of the
NYSE on each Valuation Date and ending at the close of business for the next
succeeding Valuation Date.
DEFINITIONS (CONTINUED)
WRITTEN REQUEST: A request in writing, in a form satisfactory to the Company,
which is received by the Annuity Service Center.
CONTRIBUTION PROVISIONS
CONTRIBUTIONS: The Contribution is shown on the Contract Schedule. This is a
single Contribution Contract. The Company reserves the right to reject any
Application or Contribution.
ALLOCATION OF CONTRIBUTIONS: The Contribution is allocated to one or more
Sub-Accounts of the Separate Account in accordance with the selections made by
the Owner. The allocation of the Contribution is made in accordance with the
selection made by the Owner at the Issue Date and must be in accordance with the
Allocation Guidelines set forth on the Contract Schedule. Allocation of the
Contributions is subject to the terms and conditions imposed by the Company. The
Company has reserved the right to allocate the Contribution to the Money Market
Sub-Account until the expiration of the Right to Examine Contract period.
SEPARATE ACCOUNT PROVISIONS
THE SEPARATE ACCOUNT: The Separate Account is designated on the Contract
Schedule and consists of assets set aside by the Company, which are kept
separate from that of the general assets and all other separate account assets
of the Company. The assets of the Separate Account equal to reserves and other
liabilities will not be charged with liabilities arising out of any other
business the Company may conduct. The Separate Account assets are divided into
Sub-Accounts. The Sub-Accounts which are available under this Contract are
listed on the Contract Schedule. The assets of the Sub-Accounts are allocated to
the Eligible Fund(s) and the Portfolio(s), if any, within an eligible Fund,
shown on the Contract Schedule. The Company may, from time to time, add an
additional Eligible Fund(s) or Portfolio(s) to those shown on the Contract
Schedule. The Owner may be permitted to transfer Contract Values to the
additional Sub-Account(s) within the Separate Account. However, the right to
make such transfers or allocations will be limited by the terms and conditions
imposed by the Company.
Should the shares of any such Eligible Fund(s) or any Portfolio(s) within an
Eligible Fund become unavailable for investment by the Separate Account, or the
Company's Board of Directors deems further investment in these shares
inappropriate, the Company may limit further purchase of such shares or
substitute shares of another Eligible Fund or Portfolio for shares already
purchased under this Contract.
SEPARATE ACCOUNT CHARGE: Each Valuation Period, the Company deducts a Separate
Account Charge from each Sub-Account of the Separate Account which are equal, on
an annual basis, to the amounts shown on the Contract Schedule. The Separate
Account Charge compensates the Company for assuming the mortality and expense
risks under this Contract and the costs associated with the administration of
this Contract and the Separate Account.
VALUATION OF ASSETS: The assets of the Separate Account are valued at their fair
market value in accordance with procedures of the Company.
VALUATION PROVISIONS
ACCUMULATION UNITS: Prior to the Annuity Date, Accumulation Units shall be used
to account for all amounts allocated to or withdrawn from the Sub-Accounts of
the Separate Account as a result of the Contribution, transfers, or fees and
charges. The Company will determine the number of Accumulation Units of a
Sub-Account purchased or cancelled. This will be done by dividing the amount
allocated to (or the amount withdrawn from) the Sub-Account by the dollar value
of one Accumulation Unit of the Sub-Account as of the end of the Valuation
Period during which the request for the transaction is received at the Annuity
Service Center.
ACCUMULATION UNIT VALUE: The Accumulation Unit Value for each Sub-Account for
any Valuation Period is determined by subtracting (2) from (1) and dividing the
result by (3) where:
1. is the result of:
a. the assets of the Sub-Account attributable to Accumulation Units;
plus or minus
b. the cumulative charge or credit for taxes reserved which is
determined by the Company to have resulted from the operation of
the Sub-Account.
2. is the cumulative unpaid charge for the Separate Account Charge, which
is shown on the Contract Schedule; and
3. is the number of Accumulation Unit outstanding at the end of the
Valuation Period.
The Accumulation Unit Values may increase or decrease from Valuation Period to
Valuation Period.
ANNUITY UNIT VALUE: The value of an Annuity Unit for each Sub-Account of the
Separate Account will vary to reflect the investment experience of the
applicable Eligible Funds and will be determined by multiplying the value of the
Annuity Unit for that Sub-Account on the preceding day by the product of (a) the
Net Investment Factor for that Sub-Account for the day for which the Annuity
Unit Value is being calculated, and (b) the Annuity Unit Factor which
neutralizes the Assumed Investment Return. Both the Annuity Unit Factor and the
Assumed Investment Return appear on the Contract Schedule.
NET INVESTMENT FACTOR: The Net Investment Factor for each Sub-Account is equal
to:
(a) the value of a share of the corresponding Eligible Fund at the end of
the Valuation Period (plus the per share amount of any unpaid
dividends or capital gains by that Eligible Fund ); divided by
(b) the value of a share of the corresponding Eligible Fund at the
beginning of the Valuation Period: and
(c) subtracting from that amount the daily Separate Account Charge shown
on the Contract Schedule.
CONTRACT VALUE
The Contract Value for any Valuation Period is the sum of the Contract Value in
each of the Sub-Accounts of the Separate Account.
The Contract Value in a Sub-Account of the Separate Account prior to the Annuity
Date is determined by multiplying the number of Accumulation Units allocated to
the Sub-Account by the Accumulation Unit Value.
There is no Contract Value after the Annuity Date.
TRANSFERS
TRANSFERS BEFORE THE ANNUITY DATE: Prior to the Annuity Calculation Date, the
Owner may transfer all or part of the Contract Values held in the Sub-Accounts
into other Sub-Accounts by Written Request without the imposition of any fee or
charge. Owners can elect to make transfers by telephone. To do so Owners must
complete a Written Request. Subsequent transfers will be subject to the Transfer
Provisions and Charges described on the Contract Schedule.
The Company reserves the right, at any time and without prior notice to any
party, to terminate, suspend or modify the transfer privilege described above.
If the Owner elects to use this transfer privilege, the Company will not be
liable for transfers made in accordance with the Owner's instructions. All
amounts and Accumulation Units will be determined as of the end of the Valuation
Period during which the request for transfer is received at the Annuity Service
Center.
TRANSFERS AFTER THE ANNUITY DATE: After the Annuity Date the Owner may make
transfers, by Written Request, as follows:
1. The Owner may make transfers between Sub-Accounts, subject to the
Transfer Provisions and Charges described on the Contract Schedule.
2. Transfers between Sub-Accounts will be made by converting the number
of Annuity Units being transferred to the number of Annuity Units of
the Sub-Account to which the transfer is made, so that the next
Annuity Payment if it were made at the time would be the same amount
that it would have been without the transfer. Thereafter, annuity
payments will reflect changes in the value of the new Annuity Units.
The Company reserves the right, at any time and without prior notice to any
party, to terminate, suspend or modify the transfer privilege described above.
If the Owner elects to use this transfer privilege, the Company will not be
liable for transfers made in accordance with the Owner's instructions. All
amounts and Annuity Unit Values will be determined as of the end of the
Valuation Period during which the request for transfer is received at the
Annuity Service Center.
ANNUITY PROVISIONS
ANNUITY DATE: The Annuity Date must be the thirtieth (30th) day after the Issue
Date shown on the Contract Schedule. The Annuity Date is shown on the Contract
Schedule.
DETERMINATION OF ANNUITY PAYMENTS: The first annuity payment will be calculated
on the Annuity Calculation Date which will be no more than 5 days prior to the
Annuity Date. Annuity payments reflect the investment performance of the
Separate Account in accordance with the allocation of the Contract Value to the
Sub-Accounts during the Annuity Period. On the Annuity Calculation Date, a fixed
number of Annuity Units will be purchased, determined as follows:
ANNUITY PROVISIONS (CONTINUED)
The first annuity payment is equal to the Contract Value, divided first by
$1,000 and then multiplied by the Payment Factor shown on the Contract Schedule.
In each Sub-Account the fixed number of Annuity Units is determined by dividing
the amount of the initial annuity payment determined for each Sub-Account by the
Annuity Unit Value on the Annuity Calculation Date. Thereafter, the number of
Annuity Units in each Sub-Account remains unchanged unless the Owner elects to
transfer between Sub-Accounts. All calculations shall appropriately reflect the
Annuity Payment Frequency selected.
Once annuity payments have begun, the number of Annuity Units remains fixed with
respect to a particular Sub-Account. If the Owner elects that continuing annuity
payments be based on a different Sub-Account, the number will change effective
with that election but will remain fixed in number following such election. The
method of calculating the Annuity Unit Value is described under Valuation
Provisions.
The dollar amount of annuity payments for each Sub-Account after the first
annuity payment is determined as follows:
1. The dollar amount of the first annuity payment is divided by the value
of an Annuity Unit for each applicable Sub-Account as of the Annuity
Date. This sets the number of Annuity Units for each monthly payment
for the applicable Sub-Account. The number of Annuity Units for each
applicable Sub-Account remains fixed after the Annuity Calculation
Date;
2. The fixed number of Annuity Units in each Sub-Account is multiplied by
the Annuity Unit Value for that Sub-Account for the last Valuation
Period . This result is the dollar amount of the payment for each
applicable Sub-Account.
The Company guarantees that the dollar amount of annuity payments will not be
adversely affected by variations in the expense results and in the actual
mortality experience of Annuitants from the mortality assumptions, including any
age adjustment, used in determining the first monthly payment.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS: If the annuity payment would be or
becomes less than $100, the Company will reduce the frequency of the annuity
payment to an interval which will result in each payment being at least $100.
SUSPENSION OR DEFERRAL OF PAYMENT PROVISIONS
The Company reserves the right to suspend or postpone payments from the Separate
Account for a benefit payment or transfer:
(a) for any period during which the New York Stock Exchange is closed or
during which trading on the New York Stock Exchange is restricted;
(b) for any period during which an emergency exists as a result of which
(i) disposal of the securities held in the Sub-Accounts is not
reasonably practicable, or (ii) it is not reasonably practicable for
the value of the net assets of the Separate Account to be fairly
determined; and
(c) for such other periods as the Securities and Exchange Commission may,
by order, permit for the protection of the contract owners. The
conditions under which trading shall be deemed to be restricted or any
emergency shall be deemed to exist shall be determined by rules and
regulations of the Securities and Exchange Commission.
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
OWNER: The Owner has all interest and right to amounts held in his or her
Contract. The Owner/Joint Owner is the person designated as such on the Issue
Date, unless changed.
The Owner may change owners of the Contract at any time prior to the Annuity
Date by Written Request. A Change of Owner will automatically revoke any prior
designation the Owner. The change will become effective as of the date the
Written Request is signed. A new designation of Owner will not apply to any
payment made or action taken by the Company prior to the time it was received.
Any change to the Owner of the Contract will be subject to the Company's
underwriting rules then in effect.
This Contract may be owned by Joint Owners. The Owners must jointly exercise all
of the rights contained in this contract except for transfers, which may be
exercised individually.
ANNUITANT: The Annuitant and Joint Annuitant, if any, is the person or persons
on whose life annuity payments are based. The Annuitant and Joint Annuitant, if
any, is the person or persons designated by the Owner at the Issue Date.
ASSIGNMENT OF THE CONTRACT: A Written Request specifying the terms of an
assignment of the Contract must be provided to the Annuity Service Center. Until
the Written Request is received, the Company will not be required to take notice
of or be responsible for any transfer of interest in the Contract by assignment,
agreement, or otherwise.
The Company will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with the Company's consent.
If the Contract is assigned, the Owner's rights may only be exercised with the
consent of the assignee of record.
PROCEEDS PAYABLE ON DEATH
DEATH BEFORE ANNUITY DATE: If an Owner or an Annuitant dies before the Annuity
Date, the Company will pay the Beneficiary the death benefit described below.
The death benefit is calculated as of the date the Company receives written
notification of Due Proof of Death. The death benefit is equal to the Contract
Value.
DISTRIBUTION REQUIREMENTS BEFORE THE ANNUITY DATE: The Beneficiary must elect
the death benefit to be paid under one of the options below:
(a) The entire interest in the Contract will be distributed within 5 years
of the date of death, or
(b) The Beneficiary elects to have the death benefit distributed over a
period that does not extend beyond such Beneficiary's life or life
expectancy and payments start within 1 year after the date of death,
or
(c) In the event of death of an Owner who is not an Annuitant, if the
designated Beneficiary is the spouse of the deceased owner, he or she
may elect to continue the Contract.
The death benefit will be paid after the death of the Owner, the Joint Owner, if
any, the Annuitant, or the Joint Annuitant, if any, whichever death is first.
Payment to the Beneficiary, other than in a single lump sum, may only be elected
during the sixty-day period beginning with the date of receipt of Due Proof of
Death.
PROCEEDS PAYABLE ON DEATH (CONTINUED)
DEATH OF OWNER ON OR AFTER THE ANNUITY DATE: If the Owner, or any Joint Owner,
dies on or after the Annuity Date any remaining payments as described on the
Contract Schedule will continue at least as rapidly as under the method of
distribution in effect at such Owner's death. Upon the Owner's death on or after
the Annuity Date the Beneficiary becomes the Owner.
DEATH OF ANNUITANT ON OR AFTER THE ANNUITY DATE: Upon the death of the Annuitant
on or after the Annuity Date, the Beneficiary will have the option of having
payments, if any, continue to the Beneficiary for the remainder of the period or
taking the death benefit in a lump sum as provided on the Contract Schedule.
Death benefits will be paid at least as rapidly as under the method of
distribution in effect at the Annuitant's death.
NON-INDIVIDUAL OWNER: If the Owner is a non-individual then the death of an
Annuitant shall be treated as the death of the Owner for purposes of the
distribution of the death benefit.
BENEFICIARY: The Beneficiary designation in effect on the Issue Date will remain
in effect until changed. The Beneficiary is entitled to receive the benefits to
be paid at the death of the Owner, the Joint Owner, or the Annuitant or the
Joint Annuitant.
Unless the Owner provided otherwise, the death benefit will be paid in equal
shares to the survivor(s) as follows:
1. to the Primary Beneficiary(ies) who survive the Owner's, the Joint
Owner's, the Annuitant's or the Joint Annuitant's death, as
applicable; or if there are none
2. to the Contingent Beneficiary(ies) who survive the Owner's, the Joint
Owner's, the Annuitant's or the Joint Annuitant's death, as
applicable; or if there are none
3. to the Owner, or if deceased, to the estate of the Owner.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), the Owner and the Joint Owner, if any, may change the Primary
Beneficiary(ies) or Contingent Beneficiary(ies). A change may be made by Written
Request. The change will take effect as of the date the Written Request is
signed. The Company will not be liable for any payment made or action taken
before it records the change
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, the Application, if
any, and any riders or endorsements attached to this Contract. It is intended to
qualify as an annuity contract for Federal Tax purposes. To that end, the
provisions of the Contract are interpreted and administered to ensure and
maintain such tax qualifications. This Contract may be changed or altered only
by the President and the Secretary of the Company. A change or alteration must
be made in writing. No modification will affect the amount or term of any
annuity begun prior to the modification unless it is required to conform the
contract to any Federal or State statute. No modification of the contract will
affect the method by which the Contract Value will be determined.
MISSTATEMENT OF AGE AND SEX: If the Age or sex of any Annuitant has been
misstated, any Annuity benefits payable will be the Annuity benefits provided by
the correct information. After Annuity Payments have begun, any underpayments
will be made up in one sum with the next Annuity Payment. Any overpayments will
be deducted from future Annuity Payments until the total is repaid.
GENERAL PROVISIONS (CONTINUED)
INCONTESTABILITY: This Contract will not be contestable after it has been in
force for a period of two years from the Issue Date.
MODIFICATION: This Contract may be modified in order to maintain compliance with
applicable state and federal law.
NON-PARTICIPATING: This Contract will not share in any distribution of
dividends.
EVIDENCE OF SURVIVAL: The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments are based.
PROOF OF AGE: The Company may require evidence of Age of any Annuitant .
PROTECTION OF PROCEEDS: To the extent permitted by law, death benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
if the person is entitled to them under this Contract. No payment and no amount
under this Contract can be taken or assigned in advance of its payment date
unless the Company receives the Owner's written consent.
REPORTS: The Company will furnish an annual report of the Portfolios or Funds
and any other notices, reports or documents required by law to be delivered to
the Owner and Joint Owner, if any. Reports will be sent to the last known
address of the Owner and Joint Owner, if any.
TAXES: Any taxes paid to any governmental entity relating to this Contract will
be deducted as incurred. The Company will, in its sole discretion, determine
when taxes have resulted from: the investment experience of the Separate
Account; receipt by Company of the Contribution; or commencement of Annuity
Payments. The Company will deduct any withholding taxes required by applicable
law.
The Company reserves the right to establish a provision for federal income taxes
if it determines, in its sole discretion, that it will incur a tax as a result
of the operation of the Separate Account. The Company will deduct for any income
taxes incurred by it as a result of the operation of the Separate Account
whether or not there was a provision for taxes and whether or not it was
sufficient.
REGULATORY REQUIREMENTS: All values payable under this Contract will not be less
than the minimum benefits required by the laws and regulations of the states in
which this Contract is delivered.
SUBSTITUTION: The Company reserves the right to substitute the shares of any
other registered investment company for the shares of any Portfolio already
purchased or to be purchased in the future by the Separate Account provided that
the substitution has been approved in accordance with applicable law.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT: At the Company's election, in
accordance with applicable law, the Separate Account may be operated as a
management company under the Investment Company Act of 1940 or it may be
deregistered under the Investment Company Act of 1940 in the event registration
is no longer required. Deregistration of the Separate Account requires an order
by the Securities and Exchange Commission.