[LOGO OF XXXX XXXXXXX] Variable Life Insurance Company [Xxxx Xxxxxxx Place
Boston, Mass 02117
0-000-000-0000
xxxxxxxx.xxx]
The Xxxx Xxxxxxx Variable Life Insurance Company ("the Company") agrees to
provide the benefits, rights and privileges as stated in this contract. Benefits
available under this contract are not less than those required by any statute of
the state in which this contract is delivered.
If this contract is in force on the Date of Maturity, we will pay an Annuity to
the Annuitant, unless otherwise directed by the Owner. Each Annuity payment will
be determined in accordance with the "Conversion" provision of this contract.
Unless otherwise elected, Annuity payments will be payable at monthly intervals
for a period of 10 years and as long thereafter as the Annuitant lives. The
Annuity payments will not decrease if the annual effective rate of investment
return earned on assets of the Variable Investment Options is at least 3.5%
(unless otherwise elected) after deductions made directly to such Variable
Investment Options of .65% per annum.
By notice satisfactory to us, the Owner may elect the Date of Maturity at any
time, provided the Date elected is not later than the Annuitant's 95th birthday
without our prior approval. If no other election is made, the Date of Maturity
will be the Annuitant's 95th birthday.
A Death Benefit will be payable if the Annuitant's death occurs before the Date
of Maturity and before the Surrender Date, as stated in the "Death Benefit" and
other contract provisions. We are issuing this contract in consideration of
payment of premium.
Right to Cancel - The Owner may surrender this contract by delivering or mailing
it to the Company at its Servicing Office (or, if applicable, to the agent or
agency office through which it was delivered) within 10 days after receipt by
the Owner of this contract. Receipt by the Owner of this contract will be deemed
to occur (i) on the date the Company sends an electronic mail message ("e-mail")
to the Owner's address as provided confirming that this contract is available to
be viewed on the website used by the Company for document delivery or (ii) if
applicable, on the fifth day after this contract has been placed in the U.S.
Mail, first class postage prepaid, addressed to the Owner. Upon exercise of this
Right to Cancel, We will refund the sum of (i) the Accumulated Value at the end
of the Valuation Period immediately preceding cancellation notice and (ii) the
sum of all charges made with respect to this contract. Any Premium(s) received
during this Right to Cancel period will be allocated to the Money Market
Variable Investment Option.
Signed for the Company at Boston, Massachusetts.
/s/ Xxxxxxxx X. Xxxxxxx /s/ Xxxxx Xxxxxxxxxxx
------------------- -----------------
President Secretary
Flexible Premium Variable Deferred Annuity
Nonparticipating
Initial premium is shown in Section 1.
This form is a legal contract between the Applicant and the Insurer. Read this
contract carefully.
THE BENEFITS, PAYMENTS AND ACCUMULATED VALUE UNDER THIS CONTRACT, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND NOT GUARANTEED
AS TO DOLLAR AMOUNT. THE VALUES OF THE VARIABLE INVESTMENT OPTIONS MAY INCREASE
OR DECREASE. SEE SECTION 8 FOR DETAILS.
00DVA VA0100
CONTRACT PROVISIONS
Numerical Guide
Section
1. Contract Specifications
2. Definitions
3. Owner, Beneficiary
4. The Contract
5. Payment of Premiums
6. Investment and Variable Investment Option Transfers
7. Accumulation
8. Accumulation Unit and Annuity Unit Valuation
9. Death Benefit
10. Premium Taxes
11. Withdrawals
12. Surrender Provision
13. Conversion
14. Settlement Provisions
15. Proof Required for Payment
16. Misstatements
17. Incontestability
18. Assignment
19. Claims of Creditors
20. Right to Make Changes
21. Annual Statement
22. Miscellaneous
2 VA0200
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1. CONTRACT SPECIFICATIONS
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OWNER Xxxx Xxxxxxx
ANNUITANT [Xxxx Xxxxxxx]
BENEFICIARY [Xxxxxxx Xxxxxxx]
CONTRACT NUMBER [VA00 000 000]
ISSUE AGE [35]
DATE OF ISSUE [November 2, 2000]
DATE OF MATURITY [November 2, 2060]
INITIAL PREMIUM [$11,000.00]
SUBSEQUENT PREMIUMS MAY BE PAID IN ACCORDANCE WITH SECTION 5.
3 VA0300
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2. DEFINITIONS
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"Accumulated Value", unmodified, means the value of this contract on any date
prior to the commencement of annuity payments. This value equals the sum of this
contract's accumulated values for all Variable Investment Options. The
accumulated value for each Variable Investment Option as of any date will equal
the number of Accumulation Units for that Variable Investment Option then
credited to this contract multiplied by the Accumulation Unit Value for that
Variable Investment Option on that date.
"Accumulation Unit" means a unit of measurement used in determining the value of
this contract prior to the commencement of life annuity payments. The
Accumulation Unit Value for each Variable Investment Option will reflect the
investment experience of that Variable Investment Option. It will vary in dollar
amount.
"Annuitant" means the person(s) upon whose life this contract is issued. The
individual(s) will be designated as such in Section 1 of this contract and
defined in Section 3.
"Annuity Unit" means a unit of measurement used in determining the amount of the
variable portion of each Annuity payment. The value of an Annuity Unit for each
Variable Investment Option will depend on the assumed investment rate and the
investment experience of that Variable Investment Option. It will vary in dollar
amount.
"Contract Year" means the 12 month period beginning on the Date of Issue and
each 12 month period thereafter.
"Date of Maturity" is the date specified in Section 1. This is the date annuity
payments under this contract begin. This date may be changed.
"In force" means that the Annuitant is living and the Accumulated Value of the
contract has not become payable.
"Measuring Person" means the person on whose life Annuity payments will be
based.
"Net Premium" means the premium paid less any applicable taxes based on the
amount of premium payment.
"Payment" means, unless otherwise stated, payment at our Servicing Office.
"Fund" means each division of a Trust, which has a specific investment
objective.
"Separate Account", unmodified, means a separate investment account, established
by us under Massachusetts law, in which you are eligible to invest under this
contract.
"Servicing Office" means our administrative office and the designated Internet
site the Company maintains to provide contract and other information to you.
"Surrender Date" means the date of receipt of written notice of surrender under
Section 12.
"Trust" means a series type mutual fund registered under the 1940 Act as an
open-end diversified management investment company.
"Valuation Date" means any date on which the New York Stock Exchange is open for
trading and on which the Fund values its shares.
"Valuation Period" means that period of time from the beginning of the day
following a Valuation Date to the end of the next following Valuation Date.
"Variable Investment Option" means each division of a Separate Account. The
assets of each Variable Investment Option are invested solely in shares of the
corresponding Fund of a Trust.
"We", "us", "our" refer only to the Company.
"Written notice" means, unless otherwise stated, a written notice received at
our Servicing Office.
"You" and "your" refer only to the Owner of this contract.
"1940 Act" means the Investment Company Act of 1940, as amended.
4 VA0400
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3. OWNER, BENEFICIARY
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The Owner and the Beneficiary will be as shown in Section 1 unless you change
them or they are changed by the terms of this provision.
If the Annuitant dies and there is no surviving Beneficiary or surviving
Annuitant, you will be the Beneficiary; but if you were the Annuitant, your
estate will be the Beneficiary. If the Annuitant dies and there is a surviving
Annuitant, the surviving Annuitant becomes the Annuitant.
The Owner shall have the sole and absolute power to exercise all rights and
privileges without the consent of any other person except as otherwise provided
by this contract or unless you provide otherwise by written notice.
While the Annuitant is alive, you may change the Owner by written notice. You
may change the Beneficiary by written notice no later than receipt of the
required due proof of the Annuitant's death. A change will take effect upon
receipt of notice satisfactory to us. The change will take effect whether or not
you or the Annuitant is then alive. A change shall be subject to the rights of
any assignee of record with us and subject to any payment made or other action
taken by us before we received and filed the notice. If more than one Annuitant
is listed on Section 1, the term "Annuitant" as used in this contract shall mean
the following:
. In relation to the death of the Annuitant or the continuing life of the
Annuitant, "Annuitant" shall mean the last to die of those individuals
listed as Annuitants who have not reached age 95.
. In relation to annuitization under Section 13, "Annuitant" shall mean the
youngest of the individuals listed as Xxxxxxxxxx who is still alive at any
given point in time.
JOINT OWNERS
If joint Owners are elected, each joint Owner will be considered the primary
Beneficiary of the other joint Owners. Should another person or entity be
designated as Beneficiary, such Beneficiary will be deemed a contingent
Beneficiary for all Owners with rights subordinate to the rights of each joint
Owner. If the surviving joint Owner, as spouse of the deceased joint Owner,
continues the contract in lieu of receiving the Death Benefit, the designated
Beneficiary(s) will receive the Death Benefit on the death of the surviving
spouse. Signatures of all joint Owners are required for any exercise of
ownership rights requiring written notification.
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4. THE CONTRACT
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This contract is an agreement between the Owner and the Company. The entire
contract consists of this contract, any riders, and any attachments.
Contract years, contract months and contract anniversaries are measured from the
Date of Issue.
Only the President, a Vice President, the Secretary, or an Assistant Secretary
of the Company has authority to waive or agree to change in any respect any of
the conditions or provisions of this contract.
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5. PAYMENT OF PREMIUMS
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All premium payments shall be made to us at our Servicing Office. Premium
payments are subject to the following conditions:
(a) The minimum initial premium payment must be $5000. Each subsequent
premium payment must be at least $100.
(b) The maximum premium that may be deposited to this contract in any
Contract Year is $1,000,000.
(c) We reserve the right to limit the maximum premium that may be
allocated in any Variable Investment Option in any Contract Year.
(d) No premium payments may be made to this contract after the Annuitant's
85th birthday.
Upon request we will consider waiving any of the above conditions.
5 VA0500
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6. INVESTMENT AND VARIABLE INVESTMENT OPTION TRANSFERS
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INVESTMENT ALLOCATION
The Net Premium will be allocated to the Variable Investment Options according
to the Investment Option then in effect. Allocations of all premiums received
during the Right to Cancel period, as described on the cover page of this
contract, will be made to the Money Market Variable Investment Option.
Thereafter, the Investment Option is that elected by you. You may elect to
change the Investment Option. The change will be effective as to the application
of any premium made on or after the date of receipt of notice satisfactory to
us. The minimum percentage that may be allocated to any Variable Investment
Option and the maximum number of Variable Investment Options in which amounts
may be held will be subject to our administrative rules in effect at the time of
the election. All percentages you elect must be whole numbers.
VARIABLE INVESTMENT OPTION TRANSFERS and RESTRICTIONS
Up to 12 times during each Contract Year, you may transfer amounts among
Variable Investment Options by notice satisfactory to us. Such election may be
made at any time by notice satisfactory to us. For transfers beyond 12 in any
Contract Year, the Company reserves the right impose a transfer charge, not to
exceed $25, for each such transfer or to prohibit any such transfer altogether.
Options will be effective on the date of receipt of the required notice. The
number of Accumulation Units or Annuity Units transferred to or from each
Variable Investment Option will reflect the respective values in each Variable
Investment Option.
You may not transfer more than $500,000 in a Contract Year from any one Variable
Investment Option, without our prior approval.
The Company reserves the right to revise, suspend, or eliminate the transfer
privileges described in this section at any time without prior notice. This
includes the right, without limitation, to impose a limit on the amount that may
be transferred into a Variable Investment Option in any Contract Year.
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7. ACCUMULATION
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PURCHASE OF ACCUMULATION UNITS
The Net Premium will be allocated to each elected Variable Investment Option for
investment with other funds in each such Variable Investment Option and applied
to the purchase of Accumulation Units to the credit of this contract. The number
of Accumulation Units in each Variable Investment Option purchased by each
premium payment will be determined by dividing the applicable portion of the Net
Premium by the applicable Accumulation Unit Value of the Variable Investment
Option on the first Valuation Date which is the same as or next follows the
receipt of the premium payment at our Servicing Office.
6 VA0600
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8. ACCUMULATION UNITS AND ANNUITY UNIT VALUATION
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ACCUMULATION UNIT VALUE
The Accumulation Unit Value is calculated separately for each Variable
Investment Option. The value of one Accumulation Unit was set at $10.00 on the
date assets were first allocated to each Variable Investment Option. The value
of one Accumulation Unit on any Valuation Date thereafter will be determined for
each Variable Investment Option by multiplying the immediately preceding
Accumulation Unit Value by the applicable Net Investment Factor for the
Valuation Period ending on that Valuation Date. On any date other than a
Valuation Date, the Accumulation Unit Value will be the same as that on the next
following Valuation Date.
ANNUITY UNIT VALUE
The Annuity Unit Value is calculated separately for each Variable Investment
Option. The value of one Annuity Unit was set at $1.00 on the date assets were
first allocated to each Variable Investment Option. The value of one Annuity
Unit on any Valuation Date thereafter will be determined for each Variable
Investment Option by multiplying (1) the immediately preceding Annuity Unit
Value by (2) the applicable Net Investment Factor for the Valuation Period
ending on the Valuation Date reduced by no less than 0.00009425 times the
applicable Net Investment Factor for each calendar day in the Valuation Period.
On any date other than a Valuation Date, the Annuity Unit Value will be the same
as that on the next following Valuation Date.
NET INVESTMENT FACTOR
The Net Investment Factor for each Variable Investment Option for any Valuation
Period is equal to one plus the applicable net investment rate for such period.
A Net Investment Factor may be more or less than one. The net investment rate
for each Variable Investment Option for any Valuation Period will be determined
by: (1) taking the sum of the accrued investment income and capital gains and
losses, realized or unrealized, of the Variable Investment Option for the
Valuation Period; (2) subtracting the sum of (i) an amount for any applicable
income taxes and (ii) an amount for mortality and expense risks and
administrative expenses computed by multiplying an amount not to exceed
[0.00001781] times the value of the Variable Investment Option at the beginning
of the Valuation Period times the number of calendar days in the Valuation
Period; and (3) dividing the result by the value of the Variable Investment
Option at the beginning of the Valuation Period.
VALUATION OF ASSETS
The values of the assets in the Variable Investment Options shall be determined
at a fair value in accordance with applicable law. Liabilities attributable to
the Variable Investment Option will be deducted to determine the value of the
Variable Investment Option.
ADJUSTMENT OF UNITS AND VALUES
We reserve the right to change the number and value of the Accumulation Units or
Annuity Units or both without your consent or the consent of any other person,
provided strict equity is preserved and the change does not affect the benefits,
provisions or investment return of this contract.
7 VA0700
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9. DEATH BENEFIT
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If the Annuitant dies before the Date of Maturity, we will pay the Death Benefit
to the Beneficiary. The Death Benefit will equal the greater of: (i) the
Accumulated Value as of the date of receipt of due proof of the Annuitant's
death; and (ii) the amount of the premiums paid less the amount of all
withdrawals made, if any. Notwithstanding any of the above, the following will
apply upon the death of the Owner or of any joint Owner, if this contract has
not already been converted into an annuity in accordance with Section 13:
(i) If the Beneficiary is the spouse of the Owner, the Beneficiary may
continue this contract in force as Owner.
(ii) If the Beneficiary is not the spouse of the Owner, or if the
Beneficiary is the spouse of the Owner but does not choose to continue
this contract, we will pay the Death Benefit (or the Accumulated Value
if the Owner is not the Annuitant) in full to the Beneficiary within 5
years of the Owner's death or apply the Accumulated Value in full
towards the purchase of a life annuity on the Beneficiary with
payments beginning within 1 year of the Owner's death.
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10. PREMIUM TAXES
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A deduction for a premium tax or a similar tax will be made either from premiums
or from the Accumulated Value if and when we incur such a tax. However, if
premium taxes or similar taxes are incurred by us at the time premiums are paid
and we decide to defer the deduction for such taxes by waiving the deduction in
accordance with the immediately preceding sentence then a deduction will be made
upon any withdrawal under Section 11 and either on the Surrender Date, the Date
of Maturity, or the date of payment of the Death Benefit. Such deduction will be
equal to the tax percentage multiplied by (i) in the case of withdrawals, the
withdrawal amount requested, (ii) in the case of surrender or annuitization, the
Accumulated Value as of the Surrender Date or the Date of Maturity as the case
may be, or (iii) in the case of death, the Death Benefit as of the date of
receipt of due proof of the Annuitant's death. The "tax percentage" is equal to
the percentage of premium which the premium tax or similar tax in question
constitutes.
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11. WITHDRAWALS
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Subject to the limits described in this Section, you may request a withdrawal of
less than the Accumulated Value. We will pay the requested amount on receipt of
notice acceptable to us while this contract is in force. The amount of the
withdrawal will then be deducted from the Accumulated Value. Unless otherwise
instructed, we will withdraw the amount requested on a pro-rata basis from each
Variable Investment Option. Without our prior approval, we will not permit a
withdrawal of less than $300 nor will we permit a withdrawal if the Accumulated
Value after such requested withdrawal would be less than $1,000. You may not
withdraw amounts after the Date of Maturity.
We may defer the payment of any withdrawal in the same manner as described in
the Surrender Provision.
8 VA0800
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12. SURRENDER PROVISION
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Upon receipt of notice from you before the Annuitant's death and before the
commencement of Annuity payments, we will surrender this contract and pay the
Accumulated Value. Such notice must be in a form satisfactory to us. We will pay
any Accumulated Value from the Variable Investment Options within 7 days (plus
any period of extension under the applicable laws, rules and regulations
governing the redemption of variable annuities) after the date of receipt of the
written notice unless a different method of settlement is mutually agreed upon,
in writing, between you and us.
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13. CONVERSION
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CONVERSION OF ACCUMULATION UNITS TO ANNUITY UNITS
On the Date of Maturity or other date elected under Section 14 for commencement
of annuity payments, the Accumulation Units credited to this contract will be
converted into Annuity Units. Annuity payments will then commence subject to the
limitations specified in Section 14 and all other applicable provisions. The
number of Annuity Units credited to each Variable Investment Option will be
determined by: (1) multiplying the number of Accumulation Units credited to that
Variable Investment Option on the date of conversion by the Accumulation Unit
Value for the Variable Investment Option as of the Date of Maturity or other
date elected under Section 14 for commencement of annuity payments; (2)
subtracting any applicable premium tax; (3) dividing the resulting value by
1,000; (4) multiplying the value from (3) by the applicable factor from the
Table of First Variable Annuity Payment Factors in Section 14 for the option
elected, or if no option is elected the applicable factor for Option A
(Variable) with a guaranteed period of ten years, to determine that Variable
Investment Option's portion of the variable portion of the first monthly annuity
payment, and (5) dividing the value from (4) by the Annuity Unit Value for the
Variable Investment Option as of the Date of Maturity or other date elected
under Section 14 for commencement of annuity payments.
VARIABLE ANNUITY PAYMENTS
The amount of the monthly annuity payment due on the first payment date is equal
to the sum of the portions for each Variable Investment Option determined as
described in the preceding paragraph. The amount of any monthly annuity payment
subsequent to the first will be determined by adding together for each Variable
Investment Option the product of the number of Annuity Units credited to the
Variable Investment Option and the Annuity Unit Value for the Variable
Investment Option on the monthy anniversary of the Date of Maturity or other
date elected under Section 14 for commencement of annuity payments. We guarantee
that the Annuity Unit Values used in determining annuity payments will not be
affected by variations in our mortality experience or our actual expenses from
those assumed.
9 VA0900
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14. SETTLEMENT PROVISIONS
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ANNUITY ON DATE OF MATURITY
We shall make the annuity payments automatically as a Life Annuity with Payments
for a Guaranteed Period of 10 Years in accordance with the provisions of Option
A unless another option is elected. We shall determine the amounts of the
annuity payments in accordance with the provisions of this Section and Section
13. Amounts in the Variable Investment Options will be used to provide variable
benefits.
If the amount of the first monthly annuity payment would be less than $20, we
will make a single payment equal to the Accumulated Value on the Date of
Maturity. This single payment shall be in place of all other benefits provided
by this contract. If the amount of the first monthly annuity payment would be at
least $20 but less than $50, we may make payments at quarterly, semi-annual or
annual intervals.
OPTIONAL METHODS OF SETTLEMENT
In place of (i) the annuity on the Date of Maturity specified in the first
sentence of this Section 14 or (ii) a single payment in case of death prior to
the date annuity payments commence or (iii) a single payment in case of
surrender which occurs at least 6 months after the date the first premium is
applied to this contract, proceeds payable under this contract may be left with
us in accordance with one of the optional methods of settlement then available
for contracts of this type and the terms of a supplementary agreement to be
issued when the option becomes effective, but only if (i) such proceeds are in
an amount of $5,000 or more and (ii) the amount of the first monthly annuity
payment would be $50 or more. The following settlement options will always be
available.
Option A- Life Annuity on a Variable Basis with Payments for a Guaranteed Period
of 5, 10, or 20 Years. If the Measuring Person's death occurs within the
guaranteed period, payments will be made for the remainder of the guaranteed
period in accordance with the terms of the supplementary agreement.
Option B- Life Annuity on a Variable Basis Without Further Payment on Death of
the Measuring Person. You may elect an option by notice satisfactory to us
before the death of the Annuitant and before the commencement of annuity
payments. If you have made no election before the death of the Annuitant, the
Beneficiary may make an election by written notice before the proceeds become
payable.
ANNUITY PAYMENT AND OPTION LIMITATIONS
While the Annuitant is living (i) the Measuring Person will be the Annuitant;
(ii) the Payee will be the Annuitant unless otherwise directed by you; and (iii)
the Contingent Payee will be the Beneficiary unless otherwise provided by notice
satisfactory to us.
If the Annuitant dies and Death Benefit proceeds are left with us in accordance
with a settlement option election (i) the Measuring Person will be the
Beneficiary; (ii) the Payee will be the Beneficiary unless otherwise designated
in the election; and (iii) the Contingent Payee will be the person or persons so
designated in the election and in accordance with the terms of the supplementary
agreement.
Other options may be available and may require our consent if the proceeds are
payable to an executor, administrator, trustee, corporation, partnership or
association. If the Owner of this contract dies on or after annuity payments
have begun, any remaining benefit under such annuity on the date of the Owner's
death must be paid out at least as rapidly as under the method of making annuity
payments then in effect.
FIRST VARIABLE ANNUITY PAYMENT FACTORS
The Table of First Variable Annuity Payment Factors in this Section 14 shows the
amount of the first monthly annuity payment under Option A and Option B for each
$1,000 applied. The factors in this table are based on the 1983a Individual
Annuity Mortality Table with mortality and age adjustments and annual effective
interest at the rate of 3 1/2%. The amount of the first payment will depend on
the sex and adjusted age of the Measuring Person. The adjusted age is determined
from the actual age on the Measuring Person's birthday nearest the date the
first annuity payment is due, by subtracting one year for each complete 10 year
period elapsed since the Date of Issue.
10 VA1000
TABLE OF FIRST VARIABLE ANNUITY PAYMENT FACTORS
Monthly life annuity with payments on a variable basis for each $1,000 applied.
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Adjusted Option A Option B
Age of Measuring Life Annuity with Payments Life Annuity Without
Person on Birthday for a Guaranteed Period Further Payment on
Nearest Date ----------------------- Death
of First Payment 5 Years 10 Years 20 Years of Measuring Person
---------------- ------- -------- -------- -------------------
Male Female Male Female Male Female Male Female
---- ------ ---- ------ ---- ------ ---- ------
55 4.50 4.13 4.46 4.11 4.32 4.05 4.51 4.13
56 4.58 4.19 4.54 4.18 4.38 4.10 4.59 4.20
57 4.67 4.26 4.62 4.24 4.44 4.16 4.68 4.27
58 4.76 4.33 4.71 4.31 4.50 4.22 4.78 4.34
59 4.86 4.41 4.80 4.39 4.57 4.28 4.88 4.42
60 4.96 4.49 4.90 4.46 4.63 4.35 4.98 4.50
61 5.08 4.58 5.00 4.55 4.70 4.41 5.10 4.59
62 5.20 4.67 5.11 4.64 4.77 4.48 5.22 4.69
63 5.32 4.77 5.23 4.73 4.84 4.55 5.36 4.79
64 5.46 4.88 5.35 4.83 4.91 4.62 5.50 4.89
65 5.61 4.99 5.47 4.94 4.97 4.69 5.65 5.01
66 5.76 5.11 5.61 5.05 5.04 4.77 5.81 5.13
67 5.93 5.24 5.74 5.17 5.11 4.84 5.99 5.27
68 6.10 5.38 5.89 5.29 5.17 4.92 6.17 5.41
69 6.29 5.53 6.04 5.43 5.24 5.00 6.37 5.56
70 6.49 5.69 6.20 5.57 5.30 5.07 6.59 5.73
71 6.69 5.86 6.36 5.72 5.35 5.15 6.81 5.91
72 6.91 6.05 6.52 5.88 5.41 5.22 7.05 6.10
73 7.14 6.25 6.69 6.04 5.46 5.29 7.31 6.32
74 7.39 6.46 6.87 6.22 5.50 5.35 7.58 6.55
75 7.65 6.70 7.05 6.40 5.54 5.41 7.88 6.79
76 7.92 6.94 7.23 6.59 5.58 5.47 8.19 7.06
77 8.21 7.20 7.41 6.78 5.61 5.52 8.53 7.35
78 8.52 7.48 7.59 6.98 5.64 5.56 8.90 7.66
79 8.84 7.78 7.78 7.19 5.67 5.61 9.29 8.00
80 9.17 8.10 7.96 7.40 5.69 5.64 9.71 8.36
81 9.52 8.44 8.14 7.61 5.71 5.67 10.16 8.76
82 9.88 8.81 8.31 7.82 5.73 5.70 10.64 9.20
83 10.26 9.19 8.48 8.03 5.74 5.72 11.16 9.67
84 10.65 9.59 8.64 8.23 5.74 5.73 11.71 10.18
85 and over 11.05 10.02 8.79 8.42 5.75 5.74 12.30 10.74
11 VA1100
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15. PROOF REQUIRED FOR PAYMENT
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Before making the first annuity payment, we shall have the right to require
proof of the correct age of the Measuring Person. We shall also have the right
to require proof that the Measuring Person is living on the date each annuity
payment is due.
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16. MISSTATEMENTS
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If the age or sex of the Measuring Person has been misstated, we will adjust the
amount of each Annuity payment and every other benefit to that which the premium
paid would have purchased at the correct age and sex. Any overpayment will be
repaid to us. If it is not repaid, we will deduct the overpayment from future
payments we make under this contract. Any underpayment will be added to future
payments we make under this contract. Interest will be paid on any overpayment
or underpayment at a rate equal to the greater of (i) the rate required by law;
and (ii) the rate declared by us.
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17. INCONTESTABILITY
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This contract shall be incontestable from its Date of Issue.
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18. ASSIGNMENT
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This contract may not be sold, assigned, discounted or pledged as loan
collateral, security for the performance of an obligation, or for any other
purpose without our consent.
If this contract is issued in a tax qualified plan, this contract is subject to
assignment restrictions for Federal Income Tax purposes. In such event, this
contract shall not be sold, assigned, discounted, or pledged loan collateral,
security for the performance of an obligation or for any other purpose, to any
person other than us.
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19. CLAIMS OF CREDITORS
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The proceeds and all other payments under this contract will be exempt from the
claims of creditors to the extent permitted by law. The proceeds and payments
may not be assigned or withdrawn before becoming payable without our agreement.
12 VA1200
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20. RIGHT TO MAKE CHANGES
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We reserve the right to make certain changes if, in our judgment, they would
best serve the interest of the owners of contracts such as this or would be
appropriate in carrying out the purposes of such contracts. Any changes will be
made only to the extent and in the manner permitted by applicable laws. Also,
when required by law, we will obtain your approval of the changes and approval
from any appropriate regulatory authority.
If any changes result in a material change in the underlying investment of
Variable Investment Options, to which any amounts for this contract are
allocated, we will notify you of such change. You may then make a new election
under the Investment and Variable Investment Option Transfer and Restrictions
provision.
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21. ANNUAL STATEMENT
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We will furnish you with reports annually, or more frequently, as required by
applicable law. They will include: (i) a statement of the investments held in
each Fund; and (ii) a statement of the condition and value of this contract
which will show the number of Accumulation Units, if any, credited to each
Variable Investment Option, the value of each Accumulation Unit, and the
Accumulated Value of this contract.
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22. MISCELLANEOUS
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If the Accumulated Value of this contract becomes zero, we reserve the right to
terminate this contact.
Under applicable law, all income, gains and losses, realized or unrealized, of
the Separate Accounts shall be credited to or charged against the amounts placed
in the Separate Accounts without regard to our other income, gains and losses.
The assets of the Separate Accounts are owned solely by us. We are not a trustee
with respect to any part or the whole of those assets. The portion of the assets
in the Separate Accounts equal to the reserves and other liabilities under this
contract with respect to the Separate Accounts shall not be chargeable with
liabilities arising out of any other business we may conduct.
In place of operating each Separate Account as a unit investment trust, we
reserve the right to make investments directly, operating the Separate Account
as a "management-type investment company" under the 1940 Act, or in any other
form permitted by law, the investment adviser of which would be us or an
affiliate. The Separate Account assets would be invested as provided with
respect to the investment objectives of the Separate Account.
13 VA1300
Communications about this contract should be sent to the Company at its
Servicing Office.
Flexible Premium Variable Deferred Annuity -- monthly Annuity payable to
Annuitant beginning on Date of Maturity for a guaranteed period of 10 years and
thereafter for life, unless otherwise elected.
Nonparticipating
Initial premium is shown in Section 1.
THE BENEFITS, PAYMENTS AND ACCUMULATED VALUE UNDER THIS CONTRACT, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND NOT GUARANTEED
AS TO DOLLAR AMOUNT. THE VALUES OF THE VARIABLE INVESTMENT OPTIONS MAY INCREASE
OR DECREASE.
00DVA VABP00
