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Exhibit 4(a)
[WESTERN SOUTHERN LIFE LOGO]
Western-Southern Life Assurance Company
Agrees to provide the benefits and rights set out on this and the pages
that follow which are a part of the Contract. They are provided as consideration
for the application and purchase payment(s) for the Contract.
The Contract, the attached application, and any amendments, riders or
endorsements make up the entire Contract. The Contract does not take effect
until the Contract Date and until we have received the initial purchase payment.
TEN DAY FREE LOOK. PLEASE EXAMINE THE CONTRACT. IF YOU ARE NOT SATISFIED,
YOU MAY CANCEL THE CONTRACT BY RETURNING IT TO US AT OUR VARIABLE ANNUITY
SERVICE CENTER LISTED ON PAGE 3 WITHIN 10 DAYS AFTER YOU RECEIVE IT. WE WILL
REFUND THE CONTRACT VALUE COMPUTED AT THE END OF THE VALUATION PERIOD DURING
WHICH THE CONTRACT WAS RECEIVED, PLUS ANY PREMIUM TAX DEDUCTED FROM THE PURCHASE
PAYMENT, WITHIN 7 DAYS OF OUR RECEIPT OF THE CONTRACT.
/s/ XXXXX X. XXXXX /s/ XXXX X. XXXXXXX
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Secretary President and
Chief Executive Officer
This Annuity Contract is a legal contract between the Contract Owner and the
Company.
READ YOUR CONTRACT CAREFULLY
ALL VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. THESE VALUES MAY INCREASE OR DECREASE TO REFLECT THE
INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT.
Issued by a Stock Company
Home Office: 000 Xxxxxxxx, Xxxxxxxxxx, Xxxx 00000
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
Income Payable at Income Date
Death Benefit Prior to Income Date
Non-Participating
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Contents
DATA PAGE......................................3
DEFINITIONS....................................4
ACCUMULATION PROVISIONS........................4
Purchase Payments............................4
Allocation of Purchase Payments..............4
Variable Account.............................5
Contract Value.............................5
Sub-Account................................5
Accumulation Units.........................5
Net Investment Factor......................6
Transfers....................................6
CONTRACT CHARGES AND DEDUCTIONS................7
Contract Maintenance Charge..................7
Mortality and Expense Risk Charge............7
Contract Administration Charge...............7
Premium Tax Deductions.......................7
SURRENDER AND WITHDRAWAL PROVISIONS............7
General Surrender Provisions.................7
Partial Withdrawals..........................8
Surrender....................................8
Delay in Payment.............................8
OWNERSHIP PROVISIONS...........................8
Contract Owner...............................8
Joint Owner..................................8
Contingent Owner.............................8
Beneficiary..................................9
Assignment...................................9
DEATH PROVISIONS...............................9
Death of Owner...............................9
Death of Annuitant...........................9
Death Benefit...............................10
Required Distributions......................10
Priority of Beneficiaries...................10
PAYOUT PROVISIONS.............................10
Income Date.................................10
Payout Plans................................11
Additional Interest.........................12
Choosing a Payout Plan......................12
Minimum Installment.........................13
Due Date....................................13
GENERAL PROVISIONS............................13
Reports.....................................13
Statements In Application...................13
Modification Of Contract....................13
Incontestability............................13
Incorrect Age Or Sex........................13
Place Of Payment............................13
Submission Of Contract......................13
Creditors' Claims...........................14
Proof Of Facts..............................14
Non-Participating...........................14
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DATA PAGE
Owner Region Number
Xxxxxxxxx Xxxxxxxxx's Birthdate
Contract Number Contract Date
Initial Purchase Payment Income Date
Western-Southern Life Assurance Company
Special Markets Service Center
P.O. Box 2850
Cincinnati, Ohio 45201-2850
ALLOCATION OF INITIAL PURCHASE PAYMENT (percentages must be in whole numbers not
less than 5% and must total 100%):
Emerging Growth Sub-Account 50%
International Equity Sub-Account
Value Plus Sub-Account
Growth & Income Sub-Account
Balanced Sub-Account 30%
Income Opportunity Sub-Account
Bond Sub-Account 20%
Standby Income Sub-Account
CURRENT ANNUAL MORTALITY AND
EXPENSE RISK CHARGE .70%
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DEFINITIONS
"The Company", "we", "our" and "us", is Western-Southern Life Assurance
Company.
"Accumulation Unit" is an accounting unit of measure used to calculate the
Contract Value prior to the Income Date.
"Annuitant" is the natural person whose life is used to determine the
duration and amount of any annuity payments.
"Beneficiary" is the person, persons or entity to whom the death benefit
will be paid if the Annuitant dies before the Income Date.
"Contract Year" is a year starting with the Contract Date indicated on page
3 or with a Contract Anniversary. A "Contract Anniversary" is the same day
and month as the Contract Date in each subsequent year.
"Income Date" is the date annuity payments begin. The Income Date is shown
on page 3 and can be changed by written notice to us.
"Owner" is the person, persons or entity having all rights under this
Contract unless otherwise provided. If there are Joint Owners they own the
Contract equally with a right of survivorship. "Contingent Owner" is the
person, persons or entity who will own the Contract following the Owner's
death (or the death of both Joint Owners).
"Portfolio" is an investment portfolio of an open-end management investment
company registered under the Investment Company Act of 1940.
"Qualified Contracts" are Contracts purchased in connection with a plan
that qualifies for favorable tax treatment under Sections 401, 403(b) or
408 of the Internal Revenue Code.
"Sub-Account" is a division of the Variable Account which invests in a
Portfolio. Purchase payments allocated to the Variable Account are further
allocated to one or more of these Sub-Accounts, as designated by the Owner.
"Surrender Value" is the Contract Value less the Contract Maintenance
Charge.
"Valuation Date" is each day on which valuation of the Sub-Accounts is
required by applicable law, including every day that the New York Stock
Exchange is open.
"Valuation Period" is the period of time beginning at the close of a
Valuation Date and ending at the close of the next succeeding Valuation
Date.
"You" and "your" refer to the Owner or Owners if there are Joint Owners.
ACCUMULATION PROVISIONS
PURCHASE PAYMENTS
The initial purchase payment may not be less than $5,000. Subsequent
purchase payments must be at least $1,000, and may be made at any time.
The total of all purchase payments under this Contract may not exceed
$500,000 without prior approval of the Company.
ALLOCATION OF PURCHASE PAYMENTS
You elect to have purchase payments allocated to one or more Sub-Accounts
of the Variable Account. Each allocation must be in whole percentages of at
least 5%. The sum of the allocation percentages must equal 100%.
The allocation of the initial purchase payment is set forth on page 3.
Additional purchase payments will be allocated in the same manner as your
initial purchase payment unless
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changed by written request. All purchase payments received after a change
in allocation will be invested in the same manner as your most recent
allocation unless you instruct otherwise in writing.
VARIABLE ACCOUNT
The Variable Account is a separate investment account of the Company.
Assets of the Variable Account are the property of the Company and will be
used to provide values and benefits under this Contract and similar
contracts. The Variable Account may not be charged with liabilities arising
out of any other business the Company may conduct.
CONTRACT VALUE
The Contract Value is equal to the current value of all Accumulation Units
credited to the Sub-Accounts pursuant to this Contract.
SUB-ACCOUNT
The Variable Account is divided into Sub-Accounts, each of which invests in
a Portfolio. Purchase payments are allocated to one or more of these
Sub-Accounts as designated by you.
The Company may from time to time make additional Sub-Accounts available.
These Sub-Accounts will invest in investment portfolios that the Company
deems suitable for the Contracts. The Company also has the right to
eliminate Sub-Accounts from the Variable Account, to combine two or more
Sub-Accounts, or to substitute a new Portfolio or similar investment option
for the Portfolio in which a Sub-Account invests. A substitution may become
necessary if, in the Company's judgment, the Portfolio or other investment
option no longer suits the purposes of the Contracts. This may happen due
to unsatisfactory investment performance, a change in laws or regulations,
a change in a Portfolio's investment objectives or restrictions, because
the Portfolio is no longer available for investments, or for some other
reason. The Company will obtain prior approval from The Securities and
Exchange Commission to the extent required and any other required approvals
before making such a change or substitution.
ACCUMULATION UNITS
The Company will use amounts allocated or transferred to a Sub-Account to
buy Accumulation Units. The number of Accumulation Units is determined by
dividing the amount allocated or transferred to the Sub-Account by the
Accumulation Unit Value for the Sub-Account for the Valuation Period during
which the purchase payment was received or the transfer was made.
The Accumulation Unit Value for each Sub-Account was arbitrarily set at $10
when the first Portfolio interest was purchased by the Sub-Account. The
Accumulation Unit Value for any subsequent Valuation Period is equal to:
o The Accumulation Unit Value for the Sub-Account for the immediately
preceding Valuation Period; multiplied by
o The Net Investment Factor for the Sub-Account for such subsequent
Valuation Period.
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NET INVESTMENT FACTOR
The Net Investment Factor is an index applied to measure the investment
performance of a Sub-Account from one Valuation Period to the next. The Net
Investment Factor may be greater or less than one; therefore, the
Accumulation Unit Value may increase or decrease.
For all Sub-Accounts (except the Growth & Income Sub-Account and the Bond
Sub-Account), the Net Investment Factor for each Sub-Account for any
Valuation Period is determined by dividing (a) by (b) and subtracting (c)
from the result, where
(a) is:
(1) the net asset value per share of the corresponding Portfolio at the
end of the current Valuation Period, plus
(2) the per share amount of a dividend or capital gain distribution
made by the Portfolio on shares held in the Sub-Account if the
"ex-dividend" date occurs during the current Valuation Period, plus
or minus
(3) a per share charge or credit for any taxes reserved, which is
determined by the Company to have resulted from the investment
operations of the Sub-Account during the current Valuation Period;
and
(b) is:
(1) the net asset value per share of the corresponding Portfolio at the
end of the immediately preceding Valuation Period, plus or minus
(2) a per share charge or credit for any taxes reserved for the
immediately preceding Valuation Period; and
(c) is:
a factor representing the charges deducted from the Sub-Account on
a daily basis for the daily portion of the annual Mortality and
Expense Risk Charge and the annual Contract Administration Charge.
For the Growth & Income Sub-Account and the Bond Sub-Account, the Net
Investment Factor for any Valuation Period is equal to one plus the net
result of (a) divided by (b) where:
(a) is the accrued gain or loss in the corresponding Sub-Account for the
Valuation Period, including investment income, capital gains and
losses, adjusted by:
(1) a charge to the Sub-Account on a daily basis representing the
portion of the annual Mortality and Expense Risk Charge and the
annual Contract Administration Charge that is allocable to the
Sub-Account for the Valuation Period, and
(2) a charge or credit to the Sub-Account for any tax charge or tax
credit determined by the Company to have resulted from the
investment operations of the Sub-Account during the Valuation
Period; and
(b) is the value of the Sub-Account as of the close of the immediately
preceding Valuation Period.
TRANSFERS
You may transfer all or a portion of the Contract Value among the
Sub-Accounts. A transfer request must be in writing unless telephone
transfer authorization has been received and approved by the Company.
Transfers must be in amounts not less than $250 and may be made among
Sub-Accounts once every thirty days.
When transferring Contract Value to more than one Sub-Account, not less
than 5% of the total amount being transferred can be directed to each such
Sub-Account.
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We may at any time revoke or modify the transfer provisions. Any change
will be confirmed in writing to you.
CONTRACT CHARGES AND DEDUCTIONS
The following contract charges may be imposed and are designed to reimburse
the Company for expenses incurred that relate to the Contract. The Company
guarantees that these charges will not increase, with the exception of the
premium tax deduction.
CONTRACT MAINTENANCE CHARGE
On each Contract Anniversary prior to the Income Date we will deduct a
Contract Maintenance Charge of $35. The charge will also be deducted on any
date that is not a Contract Anniversary on which you fully surrender the
Contract or on the Income Date.
MORTALITY AND EXPENSE RISK CHARGE
On each Valuation Date we will deduct from the Accumulation Unit Value a
Mortality and Expense Risk Charge equal to a percentage of such value that
is the daily equivalent of a maximum effective annual rate of .90%. The
current Mortality and Expense Risk Charge is shown on the Data Page. The
Company assumes a "mortality risk" from our promise to pay a death benefit
prior to the Income Date and from our obligation to make annuity payments
to each annuitant regardless of how long he or she lives. For assuming this
risk, we deduct a charge equal to a maximum annual rate of .60% of the
assets in the Sub-Account. The Company assumes an "expense risk" from the
possibility that amounts deducted for administrative expenses may be
insufficient to cover the actual costs. For assuming this risk, we deduct a
charge at a maximum annual rate of .30% of the assets in the Sub-Account.
CONTRACT ADMINISTRATION CHARGE
On each Valuation Date we will deduct from the Accumulation Unit Value a
Contract Administration Charge equal to a percentage of such value that is
the daily equivalent of an effective annual rate of .10%.
PREMIUM TAX DEDUCTIONS
The Company will deduct the amount of any premium taxes levied by a state
or any other governmental entity. The Company currently deducts the
applicable amount of premium taxes from the Contract Value on the Income
Date except in those states which require such taxes to be paid when
purchase payments are made. In those states, the Company deducts the
applicable amount of premium taxes upon receipt of a purchase payment.
SURRENDER AND WITHDRAWAL PROVISIONS
GENERAL SURRENDER PROVISIONS
The Owner may withdraw part or surrender all of the Contract Value at any
time this Contract is in force and prior to the earlier of the Income Date
and the Annuitant's death, subject to the conditions set forth below. The
withdrawal or surrender will be effective on the Valuation Date on or next
following the date we receive your request at our Variable Annuity Service
Center. The Company is not responsible for the tax consequences of any
withdrawals or surrender.
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PARTIAL WITHDRAWALS
You may request in writing to withdraw part of the Contract Value in
amounts not less than $250. Your request must be received before the Income
Date. The Contract Value may not be reduced to below $5,000 by a partial
withdrawal. The amount withdrawn from the Contract Value will include any
charges.
The Company will process the withdrawals, unless instructed otherwise, by
liquidating, on a pro rata basis, Accumulation Units from all Sub-Accounts
in which Contract Value is allocated.
SURRENDER
The Surrender Value is the amount that will be paid if the full Contract
Value is surrendered. When written request for surrender and the Contract
are received, the Company will pay the Contract Value on the date the
surrender is effective less any Contract Maintenance Charge which applies.
DELAY IN PAYMENT
Payment of a surrender or withdrawal from the Variable Account will be made
within seven days. The Company has the right to suspend or delay
calculation or payment of any surrender or withdrawal from the Variable
Account for any of the following reasons:
1. The New York Stock Exchange is closed other than for customary weekend
and holiday closings; or
2. Trading on the New York Stock Exchange is restricted; or
3. An emergency exists as a result of which disposal of the securities is
not reasonably practicable or it is not reasonably practicable to
fairly determine the value of the net assets of the Variable Account;
or
4. The Securities and Exchange Commission, by order, permits postponement
of payments for the protection of security holders; or
5. The request for surrender or withdrawal is not made in writing.
Rules and regulations of the Securities and Exchange Commission will govern
as to whether the conditions set forth in numbers 2 and 3 above exist.
OWNERSHIP PROVISIONS
CONTRACT OWNER
The Annuitant is the Owner of the Contract unless some other person(s)
is(are) named as Owner on page 3. The Owner has all rights under the
Contract unless otherwise provided.
JOINT OWNER
The Contract may be owned by two persons as Joint Owners. In this case,
both Joint Owners must consent to any withdrawals, surrenders or changes to
the Contract or beneficiary.
CONTINGENT OWNER
If you are the Owner but are not the Annuitant, you may name a Contingent
Owner to take over as Owner upon your death. The naming of a Contingent
Owner will not take effect until we record it at the Home Office. We are
not responsible for the tax consequences resulting from the change of the
Owner.
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BENEFICIARY
You may designate a beneficiary and change any designated beneficiary any
time during the lifetime of the Annuitant by written notice satisfactory to
us. The change will take effect on the date the notice is signed. A change
will not apply to any payment we make or any other action we take before
the notice is received and recorded by us at our Home Office.
ASSIGNMENT
You may assign the Contract in writing. The assignment will not bind us
until our Home Office records show that we have received a copy. Your
rights and those of any beneficiary or Contingent Owner will be subject to
the assignment. We are not responsible for the validity or tax consequences
of the assignment.
DEATH PROVISIONS
DEATH OF OWNER
If the Contract is owned by Joint Owners and one of them dies, the
surviving Owner will become the sole Owner. If the Contract is owned by one
person and a Contingent Owner has been named, the Contingent Owner will
become the Owner if the sole Owner dies. If there is no Joint Owner or
Contingent Owner at the time of the Owner's death, the estate of the Owner
becomes Owner.
If an Owner who is not also the Annuitant dies before the Annuitant and
before the Income Date, the Surrender Value must be paid to the new Owner
(or surviving Joint Owner) within 5 years of the deceased Owner's death.
Alternatively, the new Owner (or surviving Joint Owner) may elect to
receive periodic payments to begin within one year of the deceased Owner's
death in the form of a life annuity or an annuity for a period certain not
exceeding the new Owner's (or surviving Joint Owner's) life expectancy. (If
the Annuitant dies prior to payment of the Surrender Value or commencement
of periodic payments, no death benefit shall be payable.) In addition, if
the new Owner (or surviving Joint Owner) is the surviving spouse of the
deceased Owner, then the Contract may continue in the name of the surviving
spouse who may exercise all rights of ownership under the Contract.
If an Owner or Joint Owner who is the Annuitant dies before the Income
Date, the Death of Annuitant provision shall apply.
If an Owner dies on or after the Income Date, any payments that remain to
be made must be made at least as rapidly as under the payout plan in effect
on the date of the Owner's death.
DEATH OF ANNUITANT
If the Annuitant dies before the Income Date, the beneficiary will be paid
a death benefit. The death benefit will be paid to the beneficiary either
in one sum or in the form of an annuity if the beneficiary should so elect
within 60 days of the Annuitant's death. However, if the Annuitant is the
Owner and the surviving spouse is the sole beneficiary, then the spouse may
elect to continue the Contract and become the new Owner and Annuitant.
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DEATH BENEFIT
If the Annuitant dies prior to the first day of the calendar month after
his or her 80th birthday, the death benefit will equal the greater of (1)
the Contract Value on the date both due proof of death and death benefit
payout instructions are received by the Company; and (2) the sum of all
purchase payments less any amounts previously withdrawn. If the Annuitant
dies on or after the first day of the calendar month after his or her 80th
birthday, the death benefit will equal the Contract Value on the date both
due proof of death and death benefit payout instructions are received by
the Company.
REQUIRED DISTRIBUTIONS
An Owner or beneficiary who is required to surrender this Contract within a
specified time or begin to receive payments in the form of a life annuity
or annuity for a period certain not exceeding the recipient's life
expectancy may choose a Payout Plan in the Payout Provisions of the
Contract that meets those requirements.
PRIORITY OF BENEFICIARIES
You may designate the beneficiaries as primary or contingent to indicate
the order in which they will receive any death benefit payable. If you name
two or more beneficiaries of the same class, they will share equally unless
you state how they are to share. If you identify a beneficiary as a
relative, we will interpret that to mean a relative of the Annuitant unless
you state that the relationship is to another person.
Any death benefit will be paid to the primary beneficiaries who are living
when payment is due. If there are no living primary beneficiaries, payment
will be made to the contingent beneficiaries who are living when payment is
due. If all beneficiaries have predeceased the Annuitant, the death benefit
will be paid to the Owner if different than the Annuitant and, if not, to
the Annuitant's estate.
Any beneficiary who dies within 10 days after the Annuitant's death will
not be entitled to any benefits payable on such a death unless that
beneficiary is living when we receive due proof of the Annuitant's death.
PAYOUT PROVISIONS
INCOME DATE
We will start annuity payments on the Income Date shown on page 3 unless
you request a change in the Income Date. The Income Date is the Contract
Anniversary on or following the Annuitant's 80th birthday or the 10th
Contract Anniversary, if later, unless otherwise indicated on page 3. The
Income Date can be changed by written notice to us. Your written request
must be received by us at least 31 days prior to the existing Income Date.
Upon receipt of your request, the Income Date will be the date you select.
Annuity payments will be paid to the Annuitant unless you designate another
payee. You may change the payee at any time by written notice to us. Such
notice must be received at our Home Office at least 31 days prior to a
payment due date for the change to be effective on such date. An executor,
administrator, trustee, corporation, partnership or association other than
the Owner may not be a payee without our approval. A payee designation is
automatically revoked by the death of the designated payee.
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PAYOUT PLANS
You may apply the Surrender Value, less any applicable premium tax, under
any of the following payout plans. You may also request quarterly,
semiannual, or annual payments in place of monthly payments, or, with our
approval, choose another plan that is not listed below.
1) Installment Income Plans
A) Fixed Period - Paid in equal monthly payments for the number of
years you select (1-30). The payments for each $1,000 applied will
not be less than those shown in the Fixed Period Table.
B) Fixed Amount - Paid in equal monthly payments of $5 or more for
each $1,000 applied until the full amount with compound interest at
not less than 3% a year is used up.
2) Life Income Plans
A) One Life - Paid in equal monthly payments during the lifetime of a
designated person. We will guarantee payments for either 10 years
or 20 years and for as long as that person lives. Payments for each
$1,000 applied will not be less than those shown in the One Life
Table. The amount paid is based on the person's sex and age on the
date of the first payment. Payments may not be commuted.
B) Joint and Survivor - Paid in equal monthly payments during the
lifetimes of two designated persons. Payments will continue as long
as either person is living. The amount of each payment is based on
both persons' sex and age on the date of the first payment. If
either one dies before the due date of the first payment, we will
make payments during the survivor's lifetime under Life Income Plan
A with payments guaranteed for 10 years. Payments may not be
commuted.
If you do not elect a payout plan by the Income Date, we will apply the
Surrender Value, less any applicable premium tax, on the Income Date under
Life Income Plan A with monthly payments guaranteed for 10 years. When a
payee dies, any remaining payments will be paid to the Owner unless the
Owner names another payee.
FIXED PERIOD MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
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Number Monthly Number Monthly Number Monthly
of Install- of Install- of Install-
Years ments Years ments Years ments
----------------------------------------------------
1 $84.47 11 $8.86 21 $5.32
2 42.86 12 8.24 22 5.15
3 28.99 13 7.71 23 4.99
4 22.06 14 7.26 24 4.84
5 17.91 15 6.87 25 4.71
6 15.14 16 6.53 26 4.59
7 13.16 17 6.23 27 4.47
8 11.68 18 5.96 28 4.37
9 10.53 19 5.73 29 4.27
10 9.61 20 5.51 30 4.18
----------------------------------------------------
*Values are based on compound interest at 3% a year.
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ONE LIFE MINIMUM INCOME TABLE*
Monthly Payments for each $1,000 applied
Age of Life Life Age of Life Life
Payee 10 Years 20 Years Payee 10 Years 20 Years
Last Certain Certain Last Certain Certain
Birth- -------------------------------- Birth- --------------------------------
day Male Female Male Female day Male Female Male Female
-------------------------------------------------------------------------------------
15 and
under $2.84 $2.77 $2.84 $2.76 50 $4.04 $3.71 $3.92 $3.66
16 2.86 2.78 2.85 2.78 51 4.11 3.77 3.98 3.71
17 2.87 2.79 2.87 2.79 52 4.18 3.83 4.04 3.76
18 2.89 2.80 2.88 2.80 53 4.26 3.89 4.10 3.82
19 2.90 2.82 2.90 2.81 54 4.35 3.96 4.16 3.87
20 2.92 2.83 2.91 2.83 55 4.43 4.03 4.23 3.93
21 2.94 2.84 2.93 2.84 56 4.53 4.10 4.29 4.00
22 2.96 2.86 2.95 2.85 57 4.62 4.18 4.36 4.06
23 2.97 2.87 2.97 2.87 58 4.73 4.27 4.43 4.13
24 2.99 2.89 2.99 2.88 59 4.83 4.36 4.50 4.20
25 3.02 2.90 3.01 2.90 60 4.95 4.45 4.57 4.27
26 3.04 2.92 3.03 2.92 61 5.07 4.55 4.64 4.34
27 3.06 2.94 3.05 2.94 62 5.20 4.66 4.71 4.42
28 3.08 2.96 3.07 2.95 63 5.33 4.77 4.78 4.49
29 3.11 2.98 3.10 2.97 64 5.47 4.89 4.84 4.57
30 3.14 3.00 3.12 2.99 65 5.62 5.01 4.91 4.64
31 3.16 3.02 3.15 3.01 66 5.77 5.15 4.97 4.72
32 3.19 3.04 3.18 3.04 67 5.93 5.29 5.04 4.80
33 3.22 3.07 3.21 3.06 68 6.09 5.44 5.09 4.87
34 3.26 3.09 3.24 3.08 69 6.26 5.59 5.15 4.94
35 3.29 3.12 3.27 3.11 70 6.43 5.76 5.20 5.01
36 3.32 3.15 3.30 3.13 71 6.61 5.93 5.24 5.08
37 3.36 3.17 3.33 3.16 72 6.79 6.11 5.29 5.14
38 3.40 3.20 3.37 3.19 73 6.97 6.30 5.32 5.20
39 3.44 3.24 3.41 3.22 74 7.16 6.50 5.36 5.25
40 3.48 3.27 3.45 3.25 75 7.34 6.70 5.39 5.30
41 3.53 3.30 3.49 3.29 76 7.53 6.91 5.41 5.34
42 3.58 3.34 3.53 3.32 77 7.71 7.12 5.43 5.37
43 3.63 3.38 3.57 3.36 78 7.89 7.33 5.45 5.40
44 3.68 3.42 3.62 3.39 79 8.06 7.54 5.47 5.43
45 3.73 3.46 3.66 3.43 80 8.23 7.75 5.48 5.45
46 3.79 3.51 3.71 3.47 81 8.39 7.95 5.49 5.47
47 3.85 3.55 3.76 3.52 82 8.53 8.15 5.50 5.48
48 3.91 3.60 3.81 3.56 83 8.67 8.33 5.50 5.49
49 3.97 3.65 3.87 3.61 84 8.80 8.50 5.51 5.50
85 and 8.92 8.66 5.51 5.50
over
*Values are based on the "1983 Table a" adjusted for
age last birthday, with compound interest at 3% a year.
ADDITIONAL INTEREST
We guarantee interest under all Installment Income and Life Income Plans at
a minimum rate of 3% per year. We may increase the interest rate above the
minimum on these plans. Monthly payments under these plans will be based on
the interest rate in effect on the due date of the first payment.
CHOOSING A PAYOUT PLAN
You may choose or change a payout plan any time before the Income Date. The
choice or later change of a payout plan must be in writing and in
satisfactory form to us. If you make the request, it must be received
before the Income Date. The minimum amount which may be applied under a
payout plan is $1,000. Any choice involving more than one payout plan must
have our approval.
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MINIMUM INSTALLMENT
Each payment must be at least $50. We may change the number of payments we
make in a year so that each payment is at least $50. If the amount to be
applied is less than $1,000 or an annual payment would be less than $50,
the payout plan will not take effect or will terminate.
DUE DATE
The first payment under a payout plan chosen by the beneficiary will be due
on the date the plan is selected. The first payment under a payout plan
chosen by you for the beneficiary will be due on the date of the
Annuitant's death. The first payment under a payout plan chosen by you upon
withdrawal of the Surrender Value will be due when the request to withdraw
is received.
GENERAL PROVISIONS
REPORTS
At least once each Contract Year prior to the Income Date, we will mail a
report to you at your last address known to us. This report shall include a
statement of the Variable Account Value. The information in this report
shall be as of the date not more than 4 months prior to the date the report
is mailed. We will also send you confirmations of transactions under the
Contract, such as purchase payments, transfers and withdrawals and, at
least semi-annually, a report of the investments held in the Sub-Accounts
and any other information required by applicable law or regulation.
STATEMENTS IN APPLICATION
All statements made in the application are considered to be representations
and not warranties. No statement will be used in defense of a claim unless
it is in the application.
MODIFICATION OF CONTRACT
Any change in the Contract or waiver of its provisions must be in writing
and signed by our Chairman, President or Secretary. No other person can
change or waive any of its provisions.
INCONTESTABILITY
The Contract will be incontestable after it has been in force during the
Annuitant's lifetime for two years from the Contract Date.
INCORRECT AGE OR SEX
If the age or sex of the Annuitant has been misstated, we will adjust all
benefits to those that the purchase payment(s) for the Contract would have
purchased for the correct age and sex. Any overpayments we make will be
charged with compound interest against subsequent payments. Any amounts we
owe as a result of underpayments will be paid with compound interest upon
receipt of notice of the underpayment. The rate will be the rate we used to
determine the number or amount of the payments.
PLACE OF PAYMENT
We will make all payments due under the contract at our Home Office.
SUBMISSION OF CONTRACT
We may ask you to relinquish the Contract or send it to us for endorsement
before we make any payment. Failure to have you relinquish the Contract or
to note payment on it does not indicate that we have not made payment.
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CREDITORS' CLAIMS
All payments under the Contract will be exempt from the claims of creditors
and legal process to the extent permitted by law. No payment will be
transferred, assigned or withdrawn before it becomes payable unless we
agree.
Proof Of Facts
We may ask any person claiming the right to payments for proof satisfactory
to us of such person's right to payment. Any payment we make relying on
that proof discharges us from any obligation to make that payment to
another person. We will require proof of date of birth of the person(s) on
whose life (or lives) payments are based.
NON-PARTICIPATING
This contract does not participate in surplus earnings of the Company.
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Western-Southern Life Assurance Company
Cincinnati, Ohio
Issued by a Stock Company
Home Office: 000 Xxxxxxxx, Xxxxxxxxxx, Xxxx 00000
FLEXIBLE PURCHASE PAYMENT DEFERRED VARIABLE ANNUITY
Income Payable at Income Date
Death Benefit Prior to Income Date
Non-Participating
