1
EXHIBIT 4(a)
XXXXXX INVESTORS LIFE INSURANCE COMPANY [ZURICH XXXXXX LOGO]
A Stock Life Insurance Company
0 Xxxxxx Xxxxx
Long Grove, Illinois 60049-0001
We agree to pay an annuity to the Annuitant provided the Annuitant is living and
the Certificate is in force on the Annuity Date.
We further agree to pay the death benefit prior to the Annuity Date upon the
death of the Certificate Owner or, in certain circumstances, the death of the
Annuitant. Payment will be made upon our receipt of due proof of death and the
return of the Certificate.
This Contract is issued in consideration of the attached application and payment
of the initial purchase payment.
The provisions on this cover and the pages that follow are part of this
Contract.
Signed for Xxxxxx Investor Life Insurance Company at its home office in Long
Grove, Illinois.
/s/ XXXXX X. XXXXXXX /s/ XXXX X. XXXXXX
Secretary President
GROUP FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE SUBACCOUNTS ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR
AMOUNT. WITHDRAWALS AND TRANSFERS FROM THE GUARANTEED PERIOD VALUE BEFORE THE
END OF THE GUARANTEED PERIOD ARE SUBJECT TO A MARKET VALUE ADJUSTMENT.
This is a legal contract between the Contractholder and Xxxxxx Investors Life
Insurance Company.
READ YOUR CONTRACT CAREFULLY
Policy Form No. L-8613
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INDEX
Page
ANNUITY OPTION TABLE Follows page 19
ANNUITY PERIOD PROVISIONS 15 - 19
Election of Annuity Option 15 - 16
Annuity Options 16
Transfers During the Annuity Period 18 - 19
APPLICATION Follows Contract Schedule
CONTRACT SCHEDULE Follows Index
DEATH BENEFIT PROVISIONS 14 - 15
Amount Payable Upon Death 14
Payment of Death Benefits 14 - 15
DEFINITIONS 5 - 7
ENDORSEMENT, if any Follows Annuity Option Table
FIXED ACCOUNT PROVISIONS 10
Fixed Account 10
Fixed Account Certificate Value 10
GENERAL PROVISIONS 7 - 8
The Certificate 7
The Certificate 7
Incontestability 7
Assignment 7
Reports 8
Premium Taxes 8
GUARANTEE PERIOD PROVISIONS 10
Guarantee Period Value 10
OWNERSHIP PROVISIONS 8 - 9
Owner of Certificate 8
Change of Ownership 8
Beneficiary 9
PURCHASE PAYMENT PROVISIONS 9
Initial Purchase Payment 9
Purchase Payment Limitations 9
TRANSFER AND WITHDRAWAL PROVISIONS 13 - 14
Transfers During the Accumulation Period 13
Withdrawals During the Accumulation Period 13
Transfer and Withdrawal Procedures 13 - 14
VARIABLE ACCOUNT PROVISIONS 11 - 12
Separate Account 11
Liabilities Of Separate Account 11
Subaccounts 11
Rights Reserved By the Company 11 - 12
Accumulation Unit Value 12
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CONTRACT SCHEDULE
DESCRIPTION OF ANNUITY: GROUP FLEXIBLE PREMIUM MODIFIED
GUARANTEED, FIXED AND VARIABLE DEFERRED
ANNUITY
THE CERTIFICATE OWNER(S), BENEFICIARY(IES) AND ANNUITY DATE ARE AS
STATED IN THE APPLICATION FOR THE CERTIFICATE UNLESS SUBSEQUENTLY
CHANGED IN ACCORDANCE WITH THE CERTIFICATE PROVISIONS.
GUARANTEED PERIODS AVAILABLE ON CONTRACT DATE:
[ 1 THROUGH 10 ] YEARS
KILICO VARIABLE ANNUITY SEPARATE ACCOUNT
SUBACCOUNTS AVAILABLE ON CONTRACT DATE:
[XXXXXX MONEY MARKET
XXXXXX GOVERNMENT SECURITIES
XXXXXX HIGH YIELD
XXXXXX TOTAL RETURN
XXXXXX GROWTH
XXXXXX SMALL CAP GROWTH
XXXXXX INVESTMENT GRADE BOND
KEMPER TECHNOLOGY GROWTH
XXXXXXX VLIF BOND
XXXXXXX VLIF CAPITAL GROWTH
XXXXXXX VLIF INTERNATIONAL
JANUS ASPEN GROWTH
JANUS ASPEN BALANCED
JANUS ASPEN AGGRESSIVE GROWTH
JANUS ASPEN WORLDWIDE GROWTH
FIDELITY VIP II INDEX 500
FIDELITY VIP EQUITY-INCOME
FIDELITY VIP GROWTH
FIDELITY VIP II CONTRAFUND
XXXXX AMERICAN GROWTH
XXXXX AMERICAN SMALL CAPITALIZATION
XXXXX AMERICAN MIDCAP GROWTH
AMERICAN CENTURY VP INCOME & GROWTH
AMERICAN CENTURY VP VALUE
X.X. XXXXXX SMALL COMPANY
DREYFUS SOCIALLY RESPONSIBLE GROWTH FUND
WARBURG PINCUS EMERGING MARKETS]
PAGE 2
L-8613
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CONTRACT SCHEDULE
GROUP CONTRACT NUMBER: T001 CONTRACT DATE: JULY 1, 2000
OWNER: XYZ GROUP
MAXIMUM ANNUITIZATION AGE: [95]
MINIMUM INITIAL PURCHASE PAYMENT: [$25,000
MINIMUM SUBSEQUENT PURCHASE PAYMENT: $100
MAXIMUM PURCHASE PAYMENTS PER CERTIFICATE YEAR: $1,000,000]
SEPARATE ACCOUNT CHARGES:
DEDUCTED DAILY FROM THE SUBACCOUNTS
MORTALITY AND EXPENSE RISK CHARGE: [1.40% ANNUALLY]
[RECORD MAINTENANCE CHARGE:
WE WILL ASSESS A RECORDS MAINTENANCE CHARGE ON THE CERTIFICATE AT THE END OF
EACH CALENDAR QUARTER IN WHICH THE CERTIFICATE OWNER PARTICIPATES IN THE
SEPARATE ACCOUNT, UPON A FULL WITHDRAWAL, AND ON THE ANNUITY DATE. THIS CHARGE
WILL NOT BE ASSESSED AFTER THE ANNUITY DATE. THIS CHARGE WILL BE DEDUCTED ON A
PROPORTIONAL BASIS FROM AMOUNTS ALLOCATED TO THE SUBACCOUNTS. TO THE EXTENT
NEEDED, IT WILL BE DEDUCTED FROM THE GUARANTEE PERIODS. WE RESERVE THE RIGHT TO
MAKE THIS DEDUCTION FROM THE FIXED ACCOUNT. THE AMOUNT OF THIS CHARGE WILL
DEPEND ON THE SIZE OF THE CERTIFICATE VALUE ON THE DATE THE CHARGE IS MADE:
AMOUNT OF RECORDS MAINTENANCE
CERTIFICATE VALUE CHARGE
LESS THAN $25,000 $7.50
$25,000 TO $49,999.99 $3.75
$50,000 AND OVER NONE]
[TRANSFER CHARGE:
WE RESERVE THE RIGHT TO CHARGE ON THE CERTIFICATE $25 FOR EACH TRANSFER IN
EXCESS OF 12 IN A CERTIFICATE YEAR.]
PAGE 3
L-8613
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CONTRACT SCHEDULE
MARKET VALUE ADJUSTMENT FORMULA:
[THIS ADJUSTMENT IS MADE ON THE CERTIFICATE FOR AMOUNTS TRANSFERRED OR WITHDRAWN
BEFORE THE END OF A GUARANTEE PERIOD. THE ADJUSTMENT MAY BE POSITIVE OR NEGATIVE
BUT THE ADJUSTMENT IS NEVER MORE THAN THE AMOUNT TRANSFERRED OR WITHDRAWN. THE
MARKET VALUE ADJUSTMENT IS SUBTRACTED FROM THE AMOUNT THAT IS WITHDRAWN FROM THE
GUARANTEE PERIOD.
THE MARKET VALUE ADJUSTMENT IS THE PRODUCT OF (1), (2), (3) AND (4) WHERE:
(1) .075
(2) THE NUMBER OF MONTHS REMAINING IN THE GUARANTEE PERIOD
(3) THE INTEREST RATE BEING GUARANTEED ON NEW ALLOCATIONS TO A GUARANTEE
PERIOD WITH THE PERIOD EQUAL TO THE GUARANTEE PERIOD LESS THE RATE
GUARANTEED ON THE MONEY BEING WITHDRAWN OR TRANSFERRED.
(4) THE AMOUNT WITHDRAWN OR TRANSFERRED.]
PAGE 4
L-8613
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DEFINITIONS ACCUMULATION PERIOD: The period between the Issue Date
and the Annuity Date.
ACCUMULATION UNIT: An accounting unit of measure used
to calculate the value of each Subaccount.
AGE: The attained age of the Annuitant.
ANNUITANT: The person named in the application for the
Certificate during whose lifetime the Annuity is to be
paid. When two people are named as Joint Annuitants
the term "Annuitant" means the Joint Annuitants or the
survivor. Under qualified plans, only the spouse may
be named as Joint Annuitant. You may not change the
person(s) named as the Annuitant.
ANNUITY: A series of payments paid in accordance with
the Certificate which begins on the Annuity Date.
ANNUITY DATE: The date on which the Certificate
matures and Annuity payments begin. It must be at
least one year from the Issue Date and no later than
the maximum age at annuitization as stated in the
Certificate Schedule, unless otherwise agreed. The
Certificate Owner may change the Annuity Date, but not
beyond the maximum age.
ANNUITY PERIOD: This is the period that starts on the
Annuity Date.
ANNUITY UNIT: An accounting unit of measure used to
calculate the amount of variable Annuity payments
after the first Annuity payment.
CERTIFICATE: An individual Certificate which we issue
to each Certificate Owner as evidence of the rights
and benefits under the Certificate.
CERTIFICATE OWNER: The party(ies) named as Certificate
Owner in the application unless later changed as
provided in the Certificate. (See Change of
Ownership.) The Certificate Owner is the Annuitant
unless a different Certificate Owner is named in the
application. Under a nonqualified annuity when more
than one person is named as Certificate Owner, the
term Certificate Owner means Joint Certificate Owners.
The Certificate Owner may be changed during the
lifetime of the Certificate Owner and the Annuitant.
The Certificate Owner, prior to the Annuity Date or
any distribution of any death benefit, has the
exclusive right to exercise every option and right
conferred by the Certificate.
CERTIFICATE VALUE: The sum of the Fixed Account
Certificate Value plus the Separate Account
Certificate Value plus the Guarantee Period Value.
CERTIFICATE YEAR: A one-year period starting on the
Issue Date and successive Certificate anniversaries.
CONTRACT DATE, CONTRACT YEAR: The contract date is
stated in the contract schedule. Subsequent contract
years shall begin on anniversaries of the contract
date.
CONTRACTHOLDER: The Contractholder is the group trust
maintaining the certificates as stated in the contract
schedule. It is the entity to which the contract is
issued.
FIXED ACCOUNT: Our assets other than those allocated
to the Separate Account or any other separate account
under which we guarantee a fixed rate of return.
FIXED ACCOUNT CERTIFICATE VALUE: The Fixed Account
Certificate Value is the value of amounts allocated
under the Certificate to the Fixed Account.
Policy Form No. L-8613 Page 5
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Policy Form No. L-8613 Page 6
DEFINITIONS (CONTINUED)
FIXED ANNUITY: An Annuity payment that does not vary with
investment performance.
FUND: An investment company or separate series thereof,
in which the Subaccounts of the Separate Account invest.
GUARANTEE PERIOD: A period of time during which an amount
is to be credited with a guaranteed interest rate,
subject to a Market Value Adjustment prior to the end of
the Guarantee Period. The Guarantee Periods initially
offered are stated in the Certificate Schedule.
GUARANTEE PERIOD VALUE: The Guarantee Period Value is the
value of amounts allocated under the Certificate to a
Guarantee Period. It is equal to the (1) Purchase Payment
allocated or the amount transferred to a Guarantee
Period; plus (2) interest credited; minus (3) withdrawals
and transfers adjusted for (4) any applicable Market
Value Adjustment previously made. There is a $5000
minimum on the sum of Purchase Payments and amounts
transferred to any Guarantee Period Value.
ISSUE DATE: The Issue Date is stated in the Certificate
Schedule. It is the date your initial Purchase Payment is
available for use and your application has been accepted
by us. It is also the date on which your Purchase Payment
begins to be credited with interest and/or investment
experience.
MARKET ADJUSTED VALUE: A Guarantee Period Value adjusted
by the Market Value Adjustment formula prior to the end
of a Guarantee Period.
MARKET VALUE ADJUSTMENT: An adjustment of Guarantee
Period Values in accordance with the Market Value
Adjustment formula prior to the end of the Guarantee
Period. The adjustment reflects the change in the value
of the Guarantee Period Value due to changes in interest
rates since the date the Guarantee Period commenced. The
Market Value Adjustment formula is stated in the
Certificate Schedule.
MORTALITY AND EXPENSE RISK CHARGE: A charge deducted in
the calculation of the Accumulation Unit value and the
Annuity Unit value. It is for our assumption of mortality
risks and expense guarantees. The charge is shown on the
Certificate Schedule.
NONQUALIFIED: The Certificate issued to other than a
qualified plan.
PURCHASE PAYMENTS: The dollar amount we receive in U.S.
currency to buy the benefits the Certificate provides.
QUALIFIED PLAN: The Certificate issued under a retirement
plan which qualifies for favorable income tax treatment
under Section 401, 403, 408 or 457 of the Internal
Revenue Code as amended.
RECORDS MAINTENANCE CHARGE: A charge assessed against
your Certificate as specified in the Certificate
Schedule. We reserve the right to make this charge
against the Fixed Account Certificate Value or the
Guarantee Period Value.
RECEIVED: Received by Xxxxxx Investors Life Insurance
Company at its home office in Long Grove, Illinois.
SEPARATE ACCOUNT: A unit investment trust registered with
the Securities and Exchange Commission under the
Investment Act of 1940 known as the KILICO Variable
Annuity Separate Account.
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DEFINITIONS (CONTINUED)
SEPARATE ACCOUNT CERTIFICATE VALUE: The sum of the
Subaccount Values of the Certificate on Valuation
Date.
SUBACCOUNTS: The Separate Account has Subaccounts.
The Subaccounts initially available are stated in
the Certificate Schedule.
SUBACCOUNT VALUE: The value of each Subaccount
calculated separately according to the formulas
stated in the Certificate.
VALUATION DATE: Each business day that applicable
law requires that we value the assets of the
Separate Account. Currently this is each day that
the New York Stock Exchange is open for trading.
VALUATION PERIOD: The period that starts at the
close of a Valuation Date and ends at the close of
business the next succeeding Valuation Date.
VARIABLE ANNUITY: An Annuity payment which varies as
to dollar amount because of Subaccount investment
experience.
WE, OUR, US: Xxxxxx Investors Life Insurance
Company, Long Grove, Illinois.
GENERAL PROVISIONS
THE CONTRACT The Contract, Certificate, any application attached
to the Certificate, and any endorsements constitute
the entire contract between the parties. All
statements made in the application are deemed
representation and not warranties. No statement will
void this contract or be used as a defense of a
claim unless it is contained in the application.
THE CERTIFICATE We will issue an individual Certificate to each
Certificate Owner as evidence of his or her rights
and benefits under the Contract
SUCCESSOR CONTRACTHOLDER The Contractholder, with our consent, may at any
time appoint a successor contractholder. The
successor contractholder has all the rights, duties,
and obligations of the original Contractholder.
DISCONTINUANCE OF NEW By giving thirty days prior written notice to the
PARTICIPANTS Contractholder, we may limit or discontinue the
acceptance of new applications and the issuance of
new certificates under this contact. Such limitation
or discontinuance will have no effect on the rights
or benefits of any Certificate Owner whose
Certificate was issued prior to the effective date
of such limitation or discontinuance.
MODIFICATION OF CONTRACT Only our president, secretary and assistant
secretaries have the power to approve a change or
waive any provision of the Contract. Any such
modifications must be in writing. No agent or person
other than the officers named has the authority to
change or waive the provisions of the Contract.
Upon notice to the Certificate Owner or the payees
during the annuity period, the Certificate or
Contractholder may be modified by us as is necessary
to comply with any law or regulation issued by a
governmental agency to which we or the Separate
Account is subject or as is necessary to assure
continued qualification of the Certificate or
Contract under the Internal Revenue Code or other
laws relating to retirement plans or annuities or as
otherwise may be in the best interests of the
Contractholder and Certificate Owners. In the event
of a modification, we may make appropriate
endorsement to the Certificate or Contract and we
will obtain all required regulatory approvals.
Policy Form No. L-8613 Page 7
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Policy Form No. L-8613 Page 8
GENERAL PROVISIONS (CONTINUED)
INCONTESTABILITY We cannot contest the Contract after it has been in
force for two years from the Issue Date.
CHANGE OF ANNUITY DATE The Certificate Owner may write to us prior to
distribution of a death benefit or the first Annuity
payment date and request a change of the Annuity
Date.
ASSIGNMENT No assignment under the Contract or the Certificate
is binding unless we receive it in writing. We
assume no responsibility for the validity or
sufficiency of any assignment. Once filed, the
rights of the Contractholder, Certificate Owner,
Annuitant and beneficiary are subject to the
assignment. Any claim is subject to proof of
interest of the assignee.
DUE PROOF OF DEATH We must receive written proof upon the death of the
Certificate Owner or the Annuitant when a death
benefit is payable. The proof may be a certified
death Certificate, the written statement of a
physician, or any other proof satisfactory to us.
CERTIFICATE VALUES Any available Certificate Value and death benefit
AND DEATH BENEFITS will not be less than the DEATH minimum benefit
required by the statutes of the state in which the
Certificate is delivered.
NON-PARTICIPATING The Contract does not pay dividends. It will not
share in our surplus or earnings.
REPORTS At least once each Certificate Year we will send the
Certificate Owner a statement showing Purchase
Payments received, interest credited, investment
experience, and charges made since the last report,
as well as any other information required by
statute.
PREMIUM TAXES We will make a deduction for state premium taxes in
certain situations. On any Certificate subject to
premium tax, as provided under applicable law, the
tax will be deducted from: a. The Purchase Payments
when we receive them; b. the Certificate Value upon
total withdrawal; or c. from the total Certificate
Value applied to an annuity option at the time
Annuity payments start.
QUALIFIED PLANS If the Certificate is issued under a qualified plan
additional provisions may apply. The rider or
amendment to the Certificate used to qualify it
under the applicable section of the Internal Revenue
Code will indicate the extent of change in the
provisions.
DETERMINATION The method of determination by us of the investment
OF VALUES experience factor, the number and value of
Accumulation Units, and the number and value of
Annuity Units shall be conclusive upon the
Contractholder, Certificate Owner, any Payee, and
any Beneficiary.
GOVERNING LAW The Certificate will be governed by the laws of the
jurisdiction where the Certificate is delivered and
interpreted under the laws of Illinois.
CREDITORS The proceeds of the Contract or Certificate and any
payment under an annuity option will be exempt from
the claim of creditors and from legal process to the
extent permitted by law.
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OWNERSHIP PROVISIONS
OWNER OF CERTIFICATE The Annuitant is the original Certificate Owner
unless otherwise provided in the application.
Before the Annuity Date or any distribution of death
benefit, the Certificate Owner has the right to
cancel or amend the Certificate if we agree. The
Certificate Owner may exercise every option and
right conferred by the Certificate.
CHANGE OF CERTIFICATE The Certificate Owner may change the Certificate
OWNERSHIP Owner by written request at any time while the
Certificate Owner and Annuitant are alive. The
Certificate Owner must furnish information
sufficient to clearly identify the new Certificate
Owner. The change is subject to any existing
assignment of the Certificate. When we record the
effective date of the change, it will be the date
the notice was signed except for action taken by us
prior to receiving the request. Any change is
subject to the payment of any proceeds. We may
require the Certificate Owner to return the
Certificate to us for endorsement of a change.
DEATH OF BENEFICIARY The interest of a beneficiary who dies before the
distribution of the death benefit will pass to the
other beneficiaries, if any, share and share alike,
unless otherwise provided in the beneficiary
designation. If no beneficiary survives or is named,
the distribution will be made to the Certificate
Owner's estate when a Certificate Owner dies, or to
the estate of the annuitant upon the death of the
annuitant if the Certificate Owner is not also the
Annuitant. If a beneficiary dies within ten days of
the date of the Certificate Owner's death, the death
benefit will be paid as if the Certificate's Owner
had survived the beneficiary. If a beneficiary dies
within ten days of the death of the Annuitant and
the Certificate Owner is not the Annuitant, we will
pay the death benefit as if the Annuitant survived
the beneficiary. If the Certificate Owner, the
Annuitant, and the beneficiary die simultaneously,
we will pay the death benefit as if the Certificate
Owner had survived the Annuitant and the
beneficiary.
PURCHASE PAYMENT PROVISIONS
INITIAL PURCHASE PAYMENT The minimum initial Purchase Payment is shown on the
Certificate Schedule.
PURCHASE PAYMENT The minimum and maximum Purchase Payments that may
LIMITATIONS be made are shown on the Certificate Schedule. We
reserve the right to waive or modify these limits
and to not accept any Purchase Payment.
Subsequent Purchase Payments will be allocated
according to the Certificate Owners most recent
instructions at the time we receive the Certificate
Owners Purchase Payment.
PLACE OF PAYMENT All Purchase Payments under the Contract or
Certificate must be paid to us at our home office or
such other location as we may select. We will notify
the Contractholder and Certificate Owner and any
other interested parties in writing of such other
locations. Purchase Payments received by an agent
will begin earning interest after we receive it.
Policy Form No. L-8613 Page 9
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Policy Form No. L-8613 Page 10
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT The Fixed Account Certificate Value is increased by:
CERTIFICATE VALUE 1. the Certificate Owner's Purchase Payment
allocated to the Fixed Account; 2. amounts
transferred from a Guarantee Period or Subaccount to
the Fixed Account at the Certificate Owner's
request; and 3. the interest credited to amounts so
allocated or transferred. Transfers, charges, and
withdrawals from the Fixed Account reduce the Fixed
Account Certificate Value.
During the Accumulation Period, the Fixed Account is
restricted to allocations that will be
systematically transferred into the Subaccounts and
Guarantee Period Accounts. At the time that the
Certificate Owner allocates a Purchase Payment or
transfer money into the Fixed Account, the
Certificate Owner must choose a transfer schedule
that is acceptable to us. We will credit interest at
an annual effective interest rate of at least 3%. At
the time of each allocation, we will guarantee a
rate for at least one year or the period over which
the transfer is to be effected, if less. Different
interest rates may apply to different allocations.
Any rate above 3% will be at our discretion. We will
not unfairly discriminate between different classes
of Certificates.
GUARANTEE PERIOD PROVISIONS
GUARANTEE PERIOD We hold all amounts allocated to a Guarantee Period
in a non-unitized separate account. The assets of
this separate account equal to the reserves and
other liabilities of this separate account will not
be charged with liabilities arising out of any other
business we may conduct. The initial Guarantee
Periods available under the Certificate are shown in
the Certificate Schedule.
GUARANTEE PERIOD VALUE On any Valuation Date, the Guarantee Period Value
includes:
1. the Certificate Owners Purchase Payments or
transfers allocated to the Guarantee Period Value
at the beginning of its Guarantee Period; plus
2. interest credited; minus
3. withdrawals and transfers; minus
4. any applicable portion of the Records Maintenance
Charge and charges for other benefits; adjusted
for
5. any applicable Market Value Adjustment previously
made.
The Guarantee Period(s) initially elected and the
interest rate(s) initially credited are shown in the
Certificate Schedule. The initial interest rate
credited to subsequent Purchase Payments will be
declared at the time the payment is received.
At the end of a Guarantee Period, the Guarantee
Period Value will be transferred to a money market
Subaccount unless the Certificate Owner tells us to
do otherwise.
ACCUMULATED GUARANTEE On any Valuation Date, the Accumulated Guarantee
PERIOD VALUE Period Value is the sum of the Guarantee Period
Values. At any time during the Accumulation Period,
the Accumulated Guarantee Period Value may be
allocated to more than one Guarantee Period with our
agreement.
We calculate the interest credited to the Guarantee
Period Value by compounding daily, at daily interest
rates, rates which would produce at the end of a
Certificate Year a result identical to the one
produced by applying an annual interest rate.
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GUARANTEE PERIOD PROVISIONS (CONTINUED)
MARKET VALUE ADJUSTMENT The Market Value Adjustment formula is stated in the
Certificate Schedule. This formula is applicable for
both an upward or downward adjustment to a Guarantee
Period Value when, prior to the end of a Guarantee
Period, such value is:
1. taken as a total or partial withdrawal;
2. applied to purchase an Annuity; or
3. transferred to another Guarantee Period, the
Fixed Account or a Subaccount.
VARIABLE ACCOUNT PROVISIONS
SEPARATE ACCOUNT The variable benefits under the Certificate are
provided through the KILICO Variable Annuity
Separate Account. This is called the Separate
Account. The Separate Account is registered with the
Securities and Exchange Commission as a unit
investment trust under the Investment Company Act of
1940. It is a separate investment account maintained
by us into which a portion of the company's assets
have been allocated for the Certificates.
LIABILITIES OF SEPARATE The assets equal to the reserves and other
ACCOUNT liabilities of the Separate Account will not be
charged with liabilities arising out of any other
business we may conduct. We will value the assets of
the Separate Account on each Valuation Date.
SEPARATE ACCOUNT On any valuation Date the Separate Account
CERTIFICATE VALUE Certificate Value is the sum of its Subaccount
values.
SUBACCOUNTS The Separate Account consists of Subaccounts. The
initial Subaccounts available under the Certificate
are shown in the Certificate Schedule. We may, from
time to time, combine or remove Subaccounts in the
Separate Account and establish additional
Subaccounts of the Separate Account. In such event
we may permit the Certificate Owner to select other
Subaccounts under the Certificate. However, the
right to select any other Subaccount is limited by
the terms and conditions we may impose on such
transactions.
FUND Each Subaccount of the Separate Account will buy
shares of a separate series of a fund. Each fund is
registered under the Investment Company Act of 1940
as an open-end management investment company. Each
series of a fund represents a separate investment
portfolio which corresponds to one of the
Subaccounts of the Separate Account.
If we establish additional Subaccounts each new
Subaccount will invest in a new series of a fund or
in shares of another investment company. We may also
substitute other investment companies.
Policy Form No. L-8613 Page 11
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Policy Form No. L-8613 Page 12
VARIABLE ACCOUNT PROVISIONS (CONTINUED)
RIGHTS RESERVED BY THE We reserve the right, subject to compliance with the
COMPANY current law or as it may be changed in the future:
1. To operate the Separate Account in any form
permitted under the Investment Company Act of 1940
or in any other form permitted by law;
2. To take any action necessary to comply with or
obtain and continue any exemptions from the
Investment Company Act of 1940 or to comply with any
other applicable law;
3. To transfer any assets in any Subaccount to
another Subaccount or to one or more separate
accounts, or the General Account, or to add, combine
or remove Subaccounts in the Separate Account;
4. To delete the shares of any of the portfolios of
a fund or any other open-end investment company and
to substitute, for the fund shares held in any
Subaccount, the shares of another portfolio of a
fund or the shares of another investment company or
any other investment permitted by law; and
5. To change the way we assess charges, but not to
increase the aggregate amount above that currently
charged to the Separate Account and the funds in
connection with the Certificate.
When required by law, we will obtain your approval
of such changes and the approval of any regulatory
authority.
ACCUMULATION UNIT VALUE Each Subaccount has an Accumulation Unit Value. When
Purchase Payments or other amounts are allocated to
a Subaccount, a number of units are purchased based
on the Accumulation Unit Value of the Subaccount at
the end of the Valuation Period during which the
allocation is made. When amounts are transferred out
of or deducted from a Subaccount, units are redeemed
in a similar manner.
The value of a Subaccount on any Valuation Date is
the number of units held in the Subaccount times the
Accumulation Unit Value on that Valuation Date.
The Accumulation Unit Value for each subsequent
Valuation Period is the investment experience factor
for that period multiplied by the Accumulation Unit
Value for the period immediately preceding. Each
Valuation Period has a single Accumulation Unit
Value that is applied to each day in the period. The
number of Accumulation Units will not change as a
result of investment experience.
INVESTMENT EXPERIENCE Each Subaccount has its own investment experience
FACTOR factor. The investment experience of the Separate
Account is calculated by applying the investment
experience factor to the value in each Subaccount
during a Valuation Period.
The investment experience factor of a Subaccount for
a Valuation Period is determined by dividing 1. by
2. and subtracting 3. from the result, where:
1. is the net result of;
a. the net asset value per share of the investment
held in the Subaccount determined at the end of the
current Valuation Period; plus
b. the per share amount of any dividend or capital
gain distributions made by the investments held in
the Subaccount, if the "ex-dividend" date occurs
during the current Valuation Period; plus or minus
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TRANSFER AND WITHDRAWAL PROVISIONS (CONTINUED)
c. a charge or credit for taxes reserved for the
current Valuation Period which we determine resulted
from the investment operations of the Subaccount.
2. is the net asset value per share of the
investment held in the Subaccount, determined at the
end of the last Valuation Period.
3. is the factor representing the sum of the
Separate Account charges stated in the Certificate
Schedule for the number of days in the Valuation
Period.
TRANSFERS DURING THE All or part of the Separate Account Certificate
ACCUMULATION PERIOD Value or a Guarantee Period Value may be transferred
to the Fixed Account or to another Subaccount or
Guarantee Period. We will allow the first transfer
at the end of the free look period.
The Certificate Value transferred into or out of the
Guarantee Periods must be at least $5,000 unless the
entire Guarantee Period Value is transferred. Any
transfer from a Guarantee Period is subject to a
Market Value Adjustment unless the transfer is
effective on the Guarantee Period maturity date.
No transfer may be made within seven calendar days
of the date on which the first annuity payment is
due.
We reserve the right to charge for transfers as
described in the Certificate Schedule.
Any transfer request must clearly specify: 1. the
amount which is to be transferred; and 2. the names
of the accounts which are affected. We will only
honor a telephone transfer request if a properly
executed telephone transfer authorization is on file
with us. Such request for a transfer must comply
with the conditions of the authorization.
We reserve the right at any time and without notice
to any party, to terminate, suspend, or modify these
transfer rights.
WITHDRAWALS DURING THE During the Accumulation Period, the Certificate
ACCUMULATION PERIOD Owner may withdraw all or part of the Certificate
Value reduced by any applicable premium taxes and
adjusted by any applicable Market Value Adjustment.
The Market Value Adjustment formula will be applied
to the applicable portion of the total value
withdrawn. We must receive a written request that
indicates the amount of the withdrawal from the
Fixed Account and each Subaccount and Guarantee
Period. The Certificate Owner must return the
Certificate to us if the Certificate Owner elects a
total withdrawal.
Withdrawals are subject to these conditions:
Withdrawals from the Subaccounts will reduce the
amounts in each Subaccount on a proportional basis,
unless the Certificate Owner tells us otherwise.
Each withdrawal from a Guarantee Period must be at
least $5,000 or the value that remains in the
Guarantee Period, if smaller;
The maximum the Certificate Owner may withdraw from
any account is the value of the respective account.
We reserve the right to restrict partial withdrawals
from the Fixed Account in the first Certificate
Year.
Policy Form No. L-8613 Page 13
15
Policy Form No. L-8613 Page 14
TRANSFER AND WITHDRAWAL PROVISIONS (CONTINUED)
TRANSFER AND WITHDRAWAL We will withdraw or transfer from the Fixed Account
PROCEDURES or Guarantee Periods as of the Valuation Date that
follows the date we receive the Certificate Owners
written or telephone transfer request. Amounts to be
withdrawn or transferred from the Fixed Account or
Guarantee Periods will be done on a first in - first
out basis, unless the Certificate Owners requesst
otherwise. To process a withdrawal, the request must
contain all required information.
We will redeem the necessary number of Accumulation
Units to achieve the dollar amount when the
withdrawal or transfer is made from a Subaccount. We
will reduce the number of Accumulation Units
credited in each Subaccount by the number of
Accumulation Units redeemed. The reduction in the
number of Accumulation Units is determined on the
basis of the Accumulation Unit Value at the end of
the Valuation Period when we receive the request,
provided the request contains all required
information. We will pay the amount within seven
calendar days after the date we receive the request,
except as provided below.
DEFERMENT OF WITHDRAWAL If the withdrawal or transfer is to be made from a
TRANSFER Subaccount, we may suspend the right of withdrawal
or transfer or delay payment more than seven
calendar days if: 1. during any period when the New
York Stock Exchange is closed other than customary
weekend and holiday closings; 2. when trading
markets normally utilized are restricted, or an
emergency exists as determined by the Securities and
Exchange Commission, so that disposal of investments
or determination of the Accumulation Unit Value is
not practical; or 3. for such other periods as the
Securities and Exchange Commission by order may
permit for protection of Certificate Owners.
We may defer the payment of a withdrawal or transfer
from the Fixed Account or Guarantee Periods, for the
period permitted by law. This can never be more than
six months after the Certificate Owner sends us a
written request. During the period of deferral, we
will continue to credit interest, at the then
current interest rate(s), to the Fixed Account
Certificate Value and/or each Guarantee Period
Value.
DEATH BENEFIT PROVISIONS
AMOUNT PAYABLE UPON DEATH We compute the death benefit at the end of the
Valuation Period following our receipt of due proof
of death and the return of the Certificate.
If death occurs prior to attaining age 75, we will
pay the greater of: a. the Certificate Value; or b.
the total amount of Purchase Payments, less the
aggregate dollar amount of all previous withdrawals
or c. the amount that would have been payable in the
event of a full surrender. We will pay the larger of
the Certificate Value or the amount that would have
been payable in the event of a full surrender if
death occurs at age 75 or later.
PAYMENT OF DEATH BENEFITS If a Certificate Owner or the last surviving
annuitant dies while the Certificate is in effect
and before the Annuity Date, we will pay a death
benefit. If a Certificate Owner is a non-natural
person, the death of an annuitant will be considered
as the death of a Certificate Owner for purposes of
this death benefit provision.
If an annuitant dies after the Annuity Date, the
death benefit, if any, will depend on the Annuity
Option in effect. If a Certificate Owner dies after
the Annuity Date, income payments will be made at
least as rapidly as under the method of distribution
being used as of the date of such death.
We will pay the death benefit to the beneficiary
when we receive due proof of death. We will then
have no further obligation under the Certificate.
16
DEATH BENEFIT PROVISIONS (CONTINUED)
When the Certificate Owner dies, we will pay the
death benefit in a lump sum. The entire interest in
the Certificate must be distributed within five
years from the date of death unless it is applied
under an Annuity Option or the spouse continues the
Certificate as described below.
Instead of a lump sum payment the beneficiary may
elect to have the death benefit distributed as
stated in Option 1 for a period not to exceed the
beneficiary's life expectancy; or Options 2, or 3
based upon the life expectancy of the beneficiary as
prescribed by federal regulations. The beneficiary
must make this choice within sixty days of the time
we receive due proof of death and distribution must
commence within one year of the date of death.
If the beneficiary is not a natural person, the
beneficiary must elect that the entire death benefit
be distributed within five years of the Certificate
Owner's death.
Distribution of the death benefit must start within
one year after your death. It may start later if
prescribed by federal regulations.
If the primary beneficiary is the surviving spouse
when the Certificate Owner dies, the surviving
spouse may elect to be the successor Certificate
Owner of the Certificate, in lieu of receiving a
death benefit. There will be no requirement to start
a distribution of death benefits.
ANNUITY PERIOD PROVISIONS
ELECTION OF ANNUITY OPTION We must receive an election of Annuity option in
writing. The Certificate Owner may make an election
before the Annuity Date providing the Annuitant is
alive. The Annuitant may make an election on the
Annuity Date unless the Certificate Owner has
restricted the right to make such an election. The
beneficiary may make an election when we pay the
death benefit.
An election will be revoked by 1. a subsequent
change of beneficiary; or 2. an assignment of the
Certificate unless the assignment provides
otherwise.
Subject to the terms of the death benefit provision,
the beneficiary may elect to have the death benefit
remain with us under one of the Annuity options.
If an Annuity option is not elected, an Annuity will
be paid under Option 3 for a guaranteed period of
ten years and for as long thereafter as the
Annuitant is alive.
If the total Certificate Value is applied under one
of the Annuity options, the Certificate must be
surrendered to us.
An option cannot be changed after the first Annuity
payment is made.
If, on the seventh calendar day before the first
Annuity payment due date, all the Certificate Value
is allocated to the Fixed Account or Guarantee
Periods, the Annuity will be paid as a Fixed
Annuity. The Fixed Annuity is funded in our General
Account, which consists of our assets other than
those allocated to the Separate Account or any other
separate account. If all of the Certificate Value on
such date is allocated to the Separate Account, the
Annuity will be paid as a Variable Annuity. If the
Certificate Value on such date is allocated to both
the Fixed Account or a Guarantee Period and a
Subaccount, then the Annuity will be paid as a
combination of a Fixed and a Variable Annuity. A
Fixed and Variable Annuity payment will reflect the
investment performance of the Subaccounts in
accordance with the allocation of the Certificate
Values existing on such date. Allocations will not
be changed thereafter, except as provided in the
Transfers During the Annuity Period provision of the
Certificate.
Policy Form No. L-8613 Page 15
17
Policy Form No. L-8613 Page 16
ANNUITY PERIOD PROVISIONS (CONTINUED)
Payments for all options are derived from the
applicable tables. Current Annuity rates will be
used if they produce greater payments than those
quoted in the Certificate. The age in the tables is
the age of the payee on the last birthday before the
first payment is due. We reserve the right to deduct
one year from the age for each 10 calendar years
that have elapsed since the year 2000.
The option selected must result in a payment that is
at least equal to our minimum payment, according to
our rules, at the time the Annuity option is chosen.
If at any time the payments are less than the
minimum payment, we have the right to increase the
period between payment to quarterly, semi-annual or
annual so that the payment is at least equal to the
minimum payment or to make payment in one lump sum.
OPTION 1
SPECIFIED PERIOD We will make monthly payments for a fixed number of
installments. Payments must be made for at least 5
years, but not more than 30 years.
OPTION 2
LIFE ANNUITY We will make monthly payments while the payee is
alive.
OPTION 3
LIFE ANNUITY WITH We will make monthly payments for a guaranteed
INSTALLMENTS GUARANTEED period and thereafter while the payee is alive. The
guaranteed period must be selected at the time the
Annuity option is chosen. The guaranteed periods
available are 5, 10, 15 and 20 years.
OPTION 4
JOINT AND SURVIVOR ANNUITY We will pay the full monthly income while both
payees are alive. Upon the death of either payee, we
will continue to pay the surviving payee a
percentage of the original monthly payment. The
percentage payable to the surviving payee must be
selected at the time the Annuity option is chosen.
The percentages available are 50%, 66 2/3%, 75% and
100%.
OTHER OPTIONS We may make other Annuity options available.
Payments are also available on a quarterly,
semi-annual or annual basis.
FIXED ANNUITY The Certificate Value allocated to the Fixed Account
or the Guarantee Periods on the first day preceding
the date on which the first Annuity Payment is due
is first reduced by any premium taxes and charges
that apply. The value that remains will be used to
determine the Fixed Annuity monthly payment in
accordance with the Annuity option selected.
18
ANNUITY PERIOD PROVISIONS (CONTINUED)
VARIABLE ANNUITY The Separate Account Certificate Value, at the end
of the Valuation period preceding the Valuation
Period that includes the date on which the first
Annuity payment is due, is first reduced by any
Records Maintenance Charge, charges for other
benefits if any that may be added by a rider to the
Certificate and any premium taxes that apply. The
value that remains is used to determine the first
monthly Annuity payment. The first monthly Annuity
payment is based upon the guaranteed Annuity option
shown in the Annuity Option Table. The Certificate
Owner may elect any option available.
The dollar amount of subsequent payments may
increase or decrease depending on the investment
experience of each Subaccount. The number of Annuity
Units per payment will remain fixed for each
Subaccount unless a transfer is made. If a transfer
is made, the number of Annuity Units per payment
will change. Some annuity options provide for a
reduction in the income level upon the death of an
annuitant, which will reduce the number of Annuity
Units.
The number of Annuity Units for each Subaccount is
calculated by dividing a. by b. where:
a. is the amount of the monthly payment that can be
attributed to that Xxxxxxxxxx, and
b. is the Annuity Unit Value for that Subaccount at
the end of the Valuation Period. The Valuation
Period includes the date on which the payment is
made.
Monthly Annuity payments, after the first payment,
are calculated by summing up, for each Subaccount,
the product of a. times b. where:
a. is the number of Annuity Units per payment in
each Subaccount; and
b. is the Annuity Unit Value for that Subaccount at
the end of the Valuation Period. The Valuation
Period includes the date on which the payment is
made.
After the first payment, we guarantee that the
dollar amount of each Annuity payment will not be
affected adversely by actual expenses or changes in
mortality experience from the expense and mortality
assumptions on which we based the first payment.
ANNUITY UNIT VALUE The value of an Annuity Unit for each Subaccount, at
the end of any subsequent Valuation Period is
determined by multiplying the result of a. times b.
by c. where:
a. is the Annuity Unit Value for the immediately
preceding Valuation Period; and
b. is the net investment factor for the Valuation
Period for which the Annuity Unit Value is being
calculated; and
c. is the interest factor of .99993235 per calendar
day of such subsequent Valuation Period to offset
the effect of the assumed rate of 2.50% per year
used in the Annuity Option Table.
Policy Form No. L-8613 Page 17
19
Policy Form No. L-8613 Page 18
ANNUITY PERIOD PROVISIONS (CONTINUED)
The net investment factor for each Subaccount for
any Valuation Period is determined by dividing a. by
b. where:
a. is the value of an Annuity Unit of the applicable
Subaccount as of the end of the current Valuation
Period plus or minus the per share charge or credit
for taxes reserved.
b. is the value of an Annuity Unit of the applicable
Subaccount as of the end of the immediately
preceding Valuation Period, plus or minus the per
share charge or credit for taxes reserved.
TRANSFERS DURING THE During the Annuity Period, the payee(s) may not
ANNUITY PERIOD convert Fixed Annuity payments to Variable Annuity
payments. However, during the Annuity Period, the
payee(s), by sending us a written notice in a form
satisfactory to us, may convert Variable Annuity
payments to Fixed Annuity payments; or have Variable
Annuity payments reflect the investment experience
of other Subaccounts. A transfer may be made subject
to the following:
1. Transfers from a Subaccount to the General
Account can be effective only on an anniversary of
the first Annuity payment date. We must receive
notice of such transfer at least thirty days prior
to the effective date of the transfer. Unless the
Certificate Owner specifies otherwise, transfers to
the General Account from the Separate Account will
be proportional among the Subaccounts.
2. Transfers from one Subaccount to another
Subaccount will be effective during the Valuation
Period next succeeding the date the notice is
received by us. However, if the notice for the
transfer is received within seven days immediately
preceding an Annuity payment date, the transfer will
be effective during the Valuation Period next
succeeding that Annuity payment date.
3. We reserve the right to limit the number of
transfers between Subaccounts to no less than once
each Certificate Year.
4. We reserve the right to limit the number of
Subaccounts that may be used at one time to no less
than 3.
5. Requests for transfers must meet our current
rules and be in a form acceptable to us.
The number of Annuity Units per payment attributable
to a Subaccount to which transfer is made is equal
to, in the case of a transfer between Subaccounts,
the number of Annuity Units per payment in the
Subaccount from which transfer is being made
multiplied by the Annuity Unit Value for that
Subaccount divided by the Annuity Unit Value for the
Subaccount to which transfer is being made.
20
ANNUITY PERIOD PROVISIONS (CONTINUED)
The amount of money allocated to the General Account
in the event of a transfer from a Subaccount equals
the annuity reserve for the payee's interest in such
Subaccount. The annuity reserve is the product of a.
multiplied by b. multiplied by c. where: a. is the
number of Annuity Units representing the payee's
interest in such Subaccount per Annuity payment; b.
is the Annuity Unit Value for such Subaccount; and
c. is the present value of $1.00 per payment period
using the attained age(s) of the payee(s) and any
remaining guaranteed payment that may be due at the
time of the transfer. The fixed monthly payments
resulting from the transfer will not be less than
the amount purchased using the guarantees under the
Certificate. Money allocated to the General Account
upon such transfer will be applied under the same
Annuity option as originally elected. Any guaranteed
period payments will be adjusted to reflect the
number of guaranteed payments that have already been
made. If all guaranteed payments have already been
made, no further payments will be guaranteed.
All amounts and Annuity Unit Values are determined
as of the end of the Valuation Period which precedes
the effective date of the transfer.
We reserve the right at any time and without notice
to any party to terminate, suspend or modify the
transfer privileges.
SUPPLEMENTARY AGREEMENT A supplementary agreement will be issued to reflect
payments that will be made under a settlement
option. If payment is made as a death benefit
distribution, the effective date will be the date of
death. Otherwise the effective date will be the date
chosen by the Certificate Owner.
DATE OF FIRST PAYMENT Interest, under an option, will start to accrue on
the effective date of the supplementary agreement.
The supplementary agreement will provide details on
the payments to be made.
EVIDENCE OF AGE, SEX We may require satisfactory evidence of the age, sex
AND SURVIVAL and the continued survival of any person on whose
life the income is based.
MISSTATEMENT OF AGE OR SEX If the age or sex of the payee has been misstated,
the amount payable under the Certificate will be
such as the Purchase Payments sent to us would have
purchased at the correct age or sex. Interest not to
exceed 6% compounded each year will be charged to
any overpayment or credited to any underpayment
against future payments we may make under the
Certificate.
BASIS OF ANNUITY OPTIONS The guaranteed monthly payments are based on an
interest rate of 2.50% per year and where mortality
is involved, the A2000 Table developed by the
Society of Actuaries. We may also make available
Variable Annuity payment options based on assumed
investment rates other than 2.50%.
DISBURSEMENT OF FUNDS When the payee dies, the value of any unpaid
UPON DEATH OF PAYEE: installments will be paid in one sum, to the estate
UNDER OPTIONS 1 OR 3 of the payee unless otherwise provided in the
agreement. The commuted value for fixed installments
based upon a minimum interest rate of not less than
2.50% will be paid. The commuted value of any
variable installments will be determined by applying
the Annuity Unit Value next determined following our
receipt of due proof of death and will be based on
the Assumed Investment Return.
PROTECTION OF BENEFITS Unless otherwise provided in the supplementary
agreement, the payee may not commute, anticipate,
assign, alienate or otherwise hinder the receipt of
any payment.
Policy Form No. L-8613 Page 19
21
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
OPTION ONE - SPECIFIED PERIOD
Number Number Number Number
of years Monthly of years Monthly of years Monthly of years Monthly
selected Payment selected Payment selected Payment selected Payment
5 17.69 12 8.01 19 5.48 26 4.33
6 14.92 13 7.48 20 5.27 27 4.22
7 12.94 14 7.03 21 5.08 28 4.11
8 11.46 15 6.64 22 4.90 29 4.02
9 10.31 16 6.29 23 4.74 30 3.92
10 9.39 17 5.99 24 4.59
11 8.64 18 5.72 25 4.46
OPTION TWO AND THREE - LIFE ANNUITY WITH INSTALLMENTS GUARANTEED
Age of Monthly Payments Guaranteed Age of Monthly Payments Guaranteed
Male Female
Payee NONE 60 120 180 240 Payee NONE 60 120 180 240
55 4.17 4.16 4.13 4.06 3.96 55 3.87 3.86 3.84 3.81 3.75
56 4.27 4.25 4.21 4.14 4.03 56 3.95 3.94 3.92 3.88 3.82
57 4.36 4.35 4.30 4.22 4.09 57 4.03 4.02 4.00 3.95 3.88
58 4.46 4.45 4.40 4.30 4.16 58 4.11 4.11 4.08 4.03 3.95
59 4.57 4.55 4.50 4.39 4.22 59 4.21 4.20 4.17 4.11 4.01
60 4.69 4.67 4.60 4.48 4.29 60 4.30 4.29 4.26 4.19 4.08
61 4.81 4.79 4.71 4.57 4.36 61 4.41 4.40 4.35 4.28 4.15
62 4.94 4.92 4.83 4.66 4.43 62 4.52 4.50 4.46 4.37 4.23
63 5.09 5.05 4.95 4.76 4.49 63 4.64 4.62 4.56 4.46 4.30
64 5.24 5.20 5.08 4.86 4.56 64 4.76 4.74 4.68 4.56 4.37
65 5.40 5.35 5.21 4.96 4.62 65 4.90 4.87 4.80 4.66 4.45
66 5.57 5.52 5.35 5.06 4.69 66 5.04 5.01 4.93 4.77 4.52
67 5.75 5.69 5.49 5.17 4.75 67 5.19 5.16 5.06 4.87 4.59
68 5.95 5.87 5.64 5.27 4.81 68 5.36 5.32 5.20 4.98 4.66
69 6.15 6.07 5.80 5.37 4.86 69 5.53 5.49 5.35 5.10 4.73
70 6.38 6.27 5.96 5.48 4.91 70 5.72 5.68 5.51 5.21 4.80
71 6.61 6.49 6.12 5.58 4.96 71 5.93 5.87 5.67 5.33 4.86
72 6.86 6.72 6.29 5.68 5.00 72 6.15 6.08 5.85 5.44 4.92
73 7.13 6.96 6.47 5.77 5.04 73 6.39 6.31 6.03 5.56 4.97
74 7.42 7.21 6.64 5.86 5.08 74 6.65 6.55 6.21 5.67 5.02
75 7.72 7.48 6.82 5.95 5.11 75 6.93 6.81 6.41 5.78 5.06
76 8.05 7.76 7.00 6.03 5.14 76 7.24 7.08 6.60 5.88 5.10
77 8.40 8.06 7.18 6.11 5.17 77 7.57 7.38 6.80 5.98 5.13
78 8.77 8.37 7.35 6.18 5.19 78 7.92 7.69 7.01 6.07 5.16
79 9.18 8.69 7.53 6.25 5.20 79 8.31 8.02 7.21 6.15 5.18
80 9.60 9.03 7.70 6.31 5.22 80 8.72 8.37 7.41 6.23 5.20
81 10.06 9.38 7.86 6.36 5.23 81 9.17 8.74 7.61 6.30 5.22
82 10.55 9.74 8.02 6.41 5.24 82 9.66 9.13 7.80 6.35 5.23
83 11.07 10.12 8.17 6.45 5.25 83 10.20 9.54 7.98 6.41 5.24
84 11.63 10.50 8.32 6.49 5.26 84 10.77 9.96 8.15 6.45 5.25
85 12.22 10.89 8.45 6.52 5.26 85 11.39 10.40 8.31 6.49 5.26
22
ANNUITY OPTION TABLE
(CONTINUED)
OPTION FOUR - JOINT AND 100% SURVIVOR ANNUITY
Age of Age of Female Payee
Male
Payee 55 60 65 70 75 80 85
55 3.49 3.66 3.81 3.93 4.02 4.08 4.12
60 3.61 3.83 4.05 4.24 4.40 4.52 4.59
65 3.69 3.97 4.28 4.57 4.84 5.05 5.20
70 3.76 4.09 4.47 4.89 5.31 5.67 5.95
75 3.80 4.17 4.63 5.16 5.75 6.34 6.83
80 3.83 4.23 4.73 5.37 6.14 6.99 7.80
85 3.84 4.26 4.80 5.51 6.44 7.55 8.75
Rates for ages not shown here will be provided upon request.
23
GROUP FLEXIBLE PREMIUM MODIFIED GUARANTEED, FIXED AND VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE SUBACCOUNTS ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR
AMOUNT. WITHDRAWALS AND TRANSFERS FROM THE GUARANTEED PERIOD VALUE BEFORE THE
END OF THE GUARANTEED PERIOD ARE SUBJECT TO A MARKET VALUE ADJUSTMENT.
This is a legal contract between the Contactholder and Xxxxxx Investors Life
Insurance Company.
READ YOUR CONTRACT CAREFULLY
XXXXXX INVESTORS LIFE INSURANCE COMPANY
A Stock Life Insurance Company
0 Xxxxxx Xxxxx,
Xxxx Xxxxx, Xxxxxxxx 00000-0000
Policy Form No. L-8613
