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Individual XXX
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Annuity
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Contract
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This is a deferred annuity contract. It is a legal contract between you, as the
owner, and us, IDS Life Insurance Company, a stock company. PLEASE READ YOUR
CONTRACT CAREFULLY.
If the annuitant is living on the Settlement Date, we will begin to pay you
monthly annuity payments. Any payments made by us are subject to the Terms of
this contract.
We issue this contract in consideration of your application and payment of the
single purchase payment.
Signed for and issued by IDS Life Insurance Company, Minneapolis, Minnesota, as
of the contract date shown below.
THIS ANNUITY CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA WHICH MAY
RESULT IN BOTH UPWARD AND DOWNWARD ADJUSTMENTS IN CASH SURRENDER BENEFITS.
Surrenders are available without market value adjustment on the last day of each
contract guarantee period.
NOTICE OF YOUR RIGHT TO EXAMINE THIS CONTRACT FOR TEN DAYS. If for any reason
you are not satisfied with this contract, return it to us or our agent within
ten days after you receive it. We will then cancel this contract and refund all
purchase payments which you have made. This contract will then be considered
void from the start.
President:
[GRAPHIC OMITTED]
Xxxxxxx X. Xxxxx
Secretary:
[GRAPHIC OMITTED]
Xxxxxxx X. Xxxxxxxxxx
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[GRAPHIC OMITTED]
IDS Life Insurance Company
IDS Tower 10
Xxxxxxxxxxx, Xxxxxxxxx 00000
- Individual Annuity Contract
- Purchase payment is payable in a single sum.
- Annuity payments to begin on the settlement date.
- This contract is nonparticipating. Dividends are not payable.
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ANNUITANT: Xxxx Xxx
CONTRACT NUMBER: XXX-XXXXXX
CONTRACT DATE: March 18, 1999
CONTRACT SETTLEMENT DATE: March 18, 2049
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Guide to Contract Provisions
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Definitions Important words and meanings/Page 3
The Annuity Contract Entire contract; Modification;
Incontestability; Benefits based on
incorrect data/Page 4
Owner Owner's rights; Change of
ownership/Page 4
Beneficiary and Payments Who is the beneficiary; Change of
to Beneficiary beneficiary; Payments to
beneficiary/Page 5
Purchase Payment Payment of the purchase
payment/Page 6
Accumulation Value, How the accumulation value is determined;
Cash Surrender Value, Surrender of the contract for the cash
and Market Adjusted Value surrender value; How the market adjusted
value is determined; Annual statement of
value/Pages 7-8
Annuity Payment Plans When annuity payments begin;
Different ways to receive annuity
payments/Page 9
Table of Settlement Rates Table showing monthly annuity
payment amounts for the various
plans/Page 10
CONTRACT DATA
CONTRACT OWNER: Xxxx Xxx
PURCHASE PAYMENT: $100,000.00
INITIAL GUARANTEE RATE: 8.00%
INITIAL GUARANTEE PERIOD: 5 Years
SURRENDER CHARGE: There are no surrender charges.
MARKET VALUE ADJUSTMENT: Applied at any time other than the last
day of a Guarantee Period or for death
benefits.
ACCUMULATION VALUE AT END OF INITIAL GUARANTEE PERIOD: $146,932.81
ANNUITANT: Xxxx Xxx
CONTRACT NUMBER: XXX-XXXXXX
CONTRACT DATE: March 18, 1999
CONTRACT SETTLEMENT DATE: March 18, 2049
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Definitions
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The following words are used often in this contract. When we use these words,
this is what we mean:
the annuitant
The person on whose life monthly annuity payments depend.
you, your, owner
The owner of this contract. The owner is the same as the annuitant. The owner is
shown in the application unless the owner has been changed as provided in this
contract.
we, our, us
IDS Life Insurance Company
contract date
It is the date from which contract anniversaries, contract years, and contract
months are determined. Your contract date is shown under contract data, in the
contract.
contract anniversary
The same day and month as the contract date each year that the contract remains
in force.
initial guarantee period
The period during which the initial guarantee rate will be credited. It is shown
under contract data, in the contract.
initial guarantee rate
The rate of interest credited to the purchase payment as described in the
accumulation value section. It is shown under contract data, in the contract.
renewal guarantee period
A renewal guarantee period will begin at the end of each guarantee period. It is
determined in accordance with the terms of the contract.
renewal guarantee rate
The rate of interest credited to the renewal value as described in the
accumulation value section.
renewal date
The first day of a renewal guarantee period. It will always be on a contract
anniversary.
current rate
The applicable interest rate contained in a schedule of rates established by us
from time to time for various guarantee periods.
accumulation value
The value of the purchase payment plus interest credited, adjusted for any
surrenders.
market adjusted value
The accumulation value adjusted by the market adjusted value formula.
market value adjustment
The market adjusted value minus the accumulation value.
renewal value
The accumulation value at the end of the guarantee period.
cash surrender value
The market adjusted value is the cash surrender value. On the last day of a
guarantee period, the cash surrender value is the accumulation value.
written request
A request in writing signed by you and delivered to us at our corporate office.
settlement
If the settlement date is not the last day of a guarantee period, settlement is
the application of the market adjusted value of a contract to provide annuity
payments. On the last day of a guarantee period, settlement is the application
of the accumulation value of a contract to provide annuity payments.
settlement date
The date on which annuity payments are to begin under a contract. This date may
be changed as provided in the contract.
Code
The Internal Revenue Code of 1986, as amended, and all related laws and
regulations which are in effect during the term of this contract.
XXX
An Individual Retirement Annuity as described in Section 408(b) of the Code.
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The Annuity Contract
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What is the entire contract?
This contract form is the entire contract between you and us.
No one except one of our corporate officers (President, Vice President,
Secretary, or Assistant Secretary) can change or waive any of our rights or
requirements under the contract. That person must do so in writing. None of our
agents or other persons has the authority to change or waive any of our rights
or requirements under the contract.
Can this contract be modified?
We reserve the right to modify the contract to the extent necessary to qualify
it as an XXX as described in Section 408(b) of the Code or in any other
applicable section of the Code.
When will this contract become incontestable?
This contract is incontestable from its date of issue.
What if benefits are based on incorrect data?
If the amount of benefits is determined by data as to a person's age or sex that
is incorrect, benefits will be recalculated on the basis of the correct data.
Any underpayments made by us will be made up immediately. Any overpayments made
by us will be subtracted from the future payments under this contract and/or as
otherwise legally permissible.
What federal and state laws govern this contract?
This contract is intended to qualify as an annuity contract for Federal income
tax purposes. To that end, the provisions of this contract are to be interpreted
to ensure or maintain such tax qualification, despite any other provisions to
the contrary. We reserve the right to amend this contract to reflect any
clarifications that may be needed or are appropriate to maintain such
qualification or to conform the contract to any applicable changes in the tax
qualification requirements. We will send you a copy of any such amendments.
This contract is governed by the law of the state in which it is delivered. The
values and benefits of this contract is at least equal to those required by such
state.
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Owner
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What are your rights as owner of this contract?
As long as the annuitant is living and unless otherwise provided in this
contract, you may exercise all rights and privileges in the contract or allowed
by us. Your entire interest as owner is nonforfeitable. Can you change the
ownership of this contract?
Your right to change ownership of this contract is restricted. This contract may
not be sold, assigned, transferred, discounted, or pledged as collateral for a
loan or as security for the performance of an obligation or for any other
purpose to any person other than as may be required or permitted under Section
408 of the Code or under any other applicable section of the Code. Your interest
in this contract may be transferred to your former spouse, if any, under a
divorce decree or a written instrument incident to such divorce.
Any permitted transfers must be on a form approved by us. The change must be
made while the annuitant is living. Once the change is recorded by us, it will
take effect subject to any action taken or payment made by us before the
recording.
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Beneficiary and Payments
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to Beneficiary
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What death benefits are paid if the annuitant or owner dies before settlement?
If the annuitant or owner dies before settlement while this contract is in
force, we will pay the beneficiary the accumulation value.
The above amount will be payable in a lump sum upon receipt of due proof of
death of the annuitant. The beneficiary may elect to receive payment any time
within 5 years after the date of death of the annuitant.
Instead of a lump sum, payment may be made under an annuity payment plan
provided amounts are calculated in accordance with the Code and:
1. the beneficiary elects the plan within 60 days after we receive due proof of
death; and
2. payments begin no later than:
a. one year after the date of death, in the case of a non-spouse
beneficiary; or
b. the date on which the annuitant would have attained age 70 1/2 if later
than one year after the date of death, in case of a spouse beneficiary;
and
3. the plan provides equal or substantially equal payments over a period which
does not exceed the life of the beneficiary or the life expectancy of the
beneficiary.
In this event, the reference to "annuitant" in the annuity payment plans section
will apply to the beneficiary.
To whom are the death benefits payable?
Benefits will be paid equally to all primary beneficiaries surviving the
annuitant. If none survive, proceeds will be paid equally to all contingent
beneficiaries surviving the annuitant. If no beneficiary survives the annuitant,
we will pay the benefits to you, if living, otherwise to your estate.
Who is the beneficiary?
Beneficiaries are those you name, in a form satisfactory to us, to receive the
benefits of this contract if the owner or annuitant dies while this contract is
in force. You may change the beneficiary as provided below. If the beneficiary
has been changed, we will pay any benefits in accordance with your last change
of beneficiary request.
How do you change the beneficiary?
You may change the beneficiary any time while the annuitant is living by
satisfactory written request to us. Once the change is recorded by us, it will
take effect as of the date of your request, subject to any action taken or
payment made by us before the recording.
What is the spouse's option to continue this contract?
If the annuitant's death occurs before the settlement date, the annuitant's
spouse, if designated as sole beneficiary, may elect in writing to forego
receipt of the death benefit and instead continue this contract in force as its
owner and annuitant. The election by the spouse must be made within 60 days
after we receive due proof of death. In this event, the settlement date may not
be later than the April 1 following the calendar year in which the spouse
attains age 70 1/2.
What if the annuitant dies after settlement?
If the annuitant dies after settlement, the amount payable, if any, will be as
provided in the annuity payment plan then in effect.
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Purchase Payment
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What is the purchase payment for this contract?
The purchase payment for this contract is shown under contract data. It is
payable to us on or before the date we deliver this contract. It must be paid or
mailed to us at our corporate office or to an authorized agent.
Except as otherwise provided in this paragraph, a purchase payment is that
amount which is a qualified transfer contribution from another individual
retirement account or individual retirement annuity, or a qualified rollover
contribution described in Sections 402(c), 403(a)(4), 403(b)(8) or 408(d)(3) of
the Code. If this contract is maintained in connection with a Simplified
Employee Pension Plan or a SIMPLE Savings Plan, an employer's purchase payment
may not exceed the applicable contribution limits described in Section 408(k)
and 408(p) of the Code. In addition, if this contract is maintained in
connection with a Simple Savings Plan, no purchase payment may be made to this
contract other than an employer contribution described in Sections
408(p)(2)(A)(i) and (ii) of the Code, or a rollover contribution described in
Section 408(d)(3)(G) of the Code.
All purchase payments must be made in cash.
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Accumulation Value,
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Cash Surrender Value,
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Market Adjusted Value
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How is the accumulation value determined?
On the contract date the accumulation value of this contract is the purchase
payment. Thereafter interest accrues from day to day for the guarantee period at
the rate shown under contract data. This rate represents an effective annual
yield. At no time while the contract is in force shall interest accrue at a rate
less than 3% compounded annually. The accumulation value will be adjusted for
any amounts surrendered.
Are there premium tax charges?
We reserve the right to deduct an amount from the accumulation value of this
contract at the time that any applicable premium taxes not previously deducted
are payable. If a tax is payable at the time of your purchase payment and we
choose to not deduct it at that time, we further reserve the right to deduct it
at a later date.
How are renewal guarantee periods determined?
At the end of any guarantee period, a renewal guarantee period will begin. We
will notify you in writing 45 days before the renewal guarantee period. Each
renewal guarantee period will be one year unless you elect a different length
from those offered at the time. We must receive your written request at least 15
days before the renewal date. The renewal guarantee period may never extend
beyond the settlement date.
The accumulation value on the renewal date will be equal to the accumulation
value at the end of the guarantee period just ending. This value will earn
interest at the renewal guarantee rate. Upon written request, within 45 days of
the renewal guarantee period, we will notify you of the renewal guarantee rate
then in effect for contracts renewing at that time. The actual renewal guarantee
rate will be determined on the renewal date.
What is the market adjusted value and how is it determined?
The market adjusted value is the accumulation value on any date before the end
of the current guarantee period adjusted by a formula. The formula adjustment
reflects the relationship between:
1. the interest rate we are then crediting for new contract sales and renewals
(Form 30486) for the time remaining in your contract's current guarantee
period; and
2. the guaranteed interest rate applicable to your contract's current guarantee
period.
The market adjusted value may be more or less than the accumulation value.
The market adjusted value formula is as follows:
market adjusted value = renewal value
(1 + ic + .0025)(N + t)
where: renewal value = the accumulation value at the end of your current
guarantee period.
N = the number of complete contract years to the end
of your guarantee period.
t = the fraction of the contract year remaining to
the end of your contract year (for example, if 180
days remain in a 365 day contract year, t would be
.493)
ic = the current rate offered for new contract sales
and renewals (Form 30486) for the number of years
left in your guarantee period (straight line
interpolation between whole year rates). If N is
zero, ic is the rate for one year guarantee
periods.
The market value adjustment is as follows:
market value adjustment =
market adjusted value __ accumulation value
There will be no market value adjustment made on the last day of a guarantee
period.
Can you request surrender of any amounts under this contract before settlement?
Yes. By written request to us and subject to the rules below you may:
1. surrender this contract for the total cash surrender value;
2. partially surrender this contract for a part of the cash surrender value.
How is the cash surrender value determined?
The cash surrender value is the market adjusted value. On the last day of a
guarantee period, the cash surrender value is the accumulation value.
What are the rules for a surrender or partial surrender?
The amount surrendered and any applicable market value adjustment will be
deducted from the accumulation value of the contract on the date of surrender.
You may surrender all or a portion of the cash surrender value. However, the
accumulation value that remains after a partial surrender must be at least
$2,000. Any partial surrender must be at least $250.
The surrender payment will normally be mailed to you within seven days of the
receipt of your written request.
Upon surrender of this contract for the total cash surrender value, this
contract will terminate. We may require that you return this contract to our
corporate office before we pay the total cash surrender value.
Can we delay or suspend payment of a partial or full surrender?
We may defer payment of any partial or full surrender for a period not to exceed
6 months from the date we receive your surrender request or the period permitted
by state insurance law, if less. If we defer payment more than 30 days, we will
pay annual interest of at least 3% on the amount deferred.
Will you receive information about your contract values?
Yes. Separate records are maintained for the interest of each XXX participant.
At least once a year we will send you a statement showing both the accumulation
value and the cash surrender value of this contract. The statement will specify
the market value adjustment used to determine the cash surrender value. This
statement will be based on any laws or regulations that apply.
We will also notify you 45 days before the end of a guarantee period concerning
renewal periods available and your right to surrender without a market value
adjustment on the last day of your guarantee period.
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Annuity Payment Plans
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When will annuity payments begin?
The first payment will be made as of the settlement date. Before payments begin,
we will require satisfactory proof that the annuitant is alive. We may also
require that you exchange this contract for a supplemental contract which
provides the annuity payments.
Can you change the settlement date?
Yes. Tell us the new date by written request. If you select a new date, it must
be at least 30 days after we receive your written request at our corporate
office. The settlement date cannot be later than the later of
1. the April 1 following the calendar year in which the annuitant attains age
70 1/2; or
2. such other date, provided the Code allows you to satisfy the minimum
distribution requirements of Section 408(b)(3) of the Code with respect to
this contract through a means other than settlement of this contract,
including the ability to satisfy such distribution requirements from other
individual retirement accounts and/or individual retirement annuities that
you may own.
Notwithstanding either of the above, the settlement date cannot be later than
the later of:
1. the contract anniversary nearest the annuitant's 85th birthday; or
2. the 10th contract anniversary.
What are the annuity payment plans?
There are different ways to receive annuity payments. We call these plans.
Plan A - This provides monthly annuity payments for the lifetime of the
annuitant. No payments will be made after the annuitant dies.
Plan B - This provides monthly annuity payments for the lifetime of the
annuitant with a guarantee by us that payments will be made for a period of at
least five, ten, or fifteen years. You must select the guaranteed period.
Plan C - This provides monthly annuity payments for the lifetime of the
annuitant with a guarantee by us that payments will be made for a certain number
of months. We determine the number of months by dividing the market adjusted
value applied under this plan by the amount of the monthly annuity payment.
Plan D - We call this a joint and survivor life annuity. Monthly payments will
be paid for the lifetime of the annuitant and a designated beneficiary. When
either the annuitant or designated beneficiary dies, we will continue to make
monthly payments for the lifetime of the survivor. No payments will be paid
after the death of both the annuitant and designated beneficiary.
Plan E - This provides monthly fixed dollar annuity payments for a period of
years. The period of years may be no less than 10 nor more than 30.
What are the requirements for selecting a plan?
You may elect by written notice to us at any time at least 30 days before the
settlement date to have the market adjusted value applied on the settlement date
to provide:
1. a lump sum payment as a result of a total surrender as provided
under the cash surrender value provision of this contract; or
2. one of the annuity payment plans shown herein. Amounts payable under any
such annuity payment plan will be calculated in accordance with the Code.
Any such annuity payment plan must be provided:
a. in equal or substantially equal payments over a period no longer than the
life of the annuitant or over the life of the annuitant and the
designated beneficiary; or
b. in equal or substantially equal payments over a period which does not
exceed the life expectancy of the annuitant, or the life expectancy of
the annuitant and the designated beneficiary.
c in the case of a non-spouse beneficiary, payments must be such that at
least 50% of the present value of the contract is expected to be
distributed within the life expectancy of the annuitant.
If at least 30 days before the settlement date we have not received at our
corporate office your written request to select a plan, we will make payments
according to Plan B with payments guaranteed for 10 years, unless otherwise
required by the Code.
If the amount to be applied to a plan is not at least $2,000, or if payments are
to be made to other than a natural person, we have the right to make a lump sum
payment of the cash surrender value.
How will payments be made?
Payments will be made by us by check. The check must be personally endorsed by
the payee or payees as well as the annuitant (or designated beneficiary under
Plan D). If the annuitant or designated beneficiary does not endorse the check,
other evidence must be furnished to show that the annuitant or designated
beneficiary is still alive.
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Table of Settlement Rates
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What will be the amount of the monthly annuity payments?
If the settlement date is the last day of a guarantee period, the amount applied
to provide a payment will be the accumulation value on that date. The market
adjusted value is applied if the settlement date is not the last day of a
guarantee period. The amount applied to provide a payment will be the
accumulation value on the settlement date. The amount of each monthly annuity
payment for each $1,000 applied under any payment plan will be based on our
Table of Settlement Rates in effect at the time of the first payment. The
amounts will not be less than those shown in the table below.
The amount of such payments under plans A, B, and C will depend on the sex and
the adjusted age of the annuitant on the settlement date. The amount of such
payments under plan D will depend on the sex and the adjusted age of the
annuitant and the designated beneficiary on the settlement date. Adjusted age
means the age on the annuitant's nearest birthday minus an "adjustment" based on
the calendar year of the birth of the annuitant as follows:
Calendar Calendar
Year of Year of
Annuitant's Adjust- Annuitant's Adjust-
Birth ment Birth ment
Prior to 1920 0 1945 through 1 6
1920 through 1924 1 1950 through 1959 7
1925 through 1929 2 1960 through 1969 8
1930 through 1934 3 1970 through 1979 9
1935 through 1939 4 1980 through 1989 10
1940 through 1944 5 After 1989 11
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Amount of Each Monthly Annuity Payment Per $1,000 Applied
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Plan A Plan B Plan C Plan D - Joint and Survivor
Adjusted Age of Female Designated
Beneficiary
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Life 5 Years 10 Years 15 Years With Adj.
Adj. Income Certain Certain Certain Refund Male 10 Years 5 Years Same 5 Years
10 Years
Age* M F M F M F M F M F Age* Younger Younger Age Older Older
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55 4.70 4.25 4.68 4.25 4.62 4.22 4.53 4.18 4.42 4.10 55 3.51 3.69 3.88 4.06 4.23
60 5.28 4.72 5.25 4.70 5.14 4.66 4.96 4.57 4.86 4.48 60 3.76 3.99 4.24 4.49 4.72
65 6.10 5.35 6.03 5.32 5.81 5.22 5.46 5.05 5.43 4.97 65 4.07 4.38 4.72 5.07 5.39
66 6.29 5.51 6.21 5.47 5.96 5.36 5.56 5.16 5.56 5.08 66 4.15 4.48 4.84 5.21 5.55
67 6.50 5.67 6.41 5.63 6.11 5.50 5.66 5.26 5.70 5.20 67 4.23 4.58 4.97 5.36 5.73
68 6.73 5.85 6.62 5.80 6.28 5.65 5.76 5.37 5.85 5.33 68 4.31 4.69 5.10 5.53 5.92
69 6.97 6.04 6.84 5.98 6.44 5.80 5.86 5.49 6.00 5.47 69 4.40 4.80 5.25 5.70 6.12
70 7.23 6.25 7.07 6.18 6.61 5.96 5.96 5.60 6.16 5.61 70 4.50 4.93 5.40 5.89 6.34
71 7.51 6.47 7.32 6.39 6.78 6.14 6.05 5.71 6.33 5.76 71 4.60 5.06 5.57 6.10 6.57
72 7.80 6.71 7.58 6.62 6.96 6.31 6.14 5.83 6.51 5.93 72 4.71 5.20 5.75 6.31 6.82
73 8.12 6.97 7.85 6.86 7.14 6.50 6.23 5.94 6.70 6.10 73 4.83 5.35 5.94 6.55 7.09
74 8.45 7.26 8.14 7.12 7.32 6.69 6.31 6.04 6.90 6.28 74 4.95 5.51 6.15 6.80 7.37
75 8.82 7.56 8.44 7.39 7.49 6.89 6.38 6.14 7.11 6.48 75 5.08 5.68 6.37 7.07 7.68
76 9.21 7.90 8.76 7.69 7.67 7.09 6.45 6.24 7.33 6.68 76 5.22 5.87 6.61 7.36 8.01
77 9.62 8.26 9.09 8.01 7.84 7.29 6.51 6.33 7.56 6.90 77 5.37 6.07 6.87 7.67 8.36
78 10.07 8.65 9.44 8.34 8.01 7.49 6.57 6.41 7.80 7.13 78 5.54 6.29 7.15 8.01 8.74
79 10.55 9.07 9.80 8.69 8.17 7.69 6.62 6.48 8.05 7.38 79 5.71 6.52 7.45 8.37 9.14
80 11.06 9.53 10.17 9.07 8.33 7.89 6.66 6.55 8.32 7.64 80 5.90 6.78 7.77 8.76 9.57
81 11.61 10.03 10.55 9.46 8.48 8.08 6.70 6.61 8.60 7.91 81 6.10 7.05 8.12 9.17 10.02
82 12.19 10.57 10.94 9.87 8.61 8.26 6.73 6.66 8.89 8.21 82 6.32 7.34 8.49 9.61 10.51
83 12.81 11.16 11.33 10.30 8.74 8.43 6.76 6.70 9.20 8.51 83 6.55 7.65 8.90 10.08 11.02
84 13.46 11.79 11.72 10.74 8.86 8.59 6.79 6.74 9.52 8.83 84 6.80 7.99 9.33 10.58 11.56
85 14.16 12.48 12.12 11.19 8.97 8.74 6.81 6.77 9.85 9.18 85 7.07 8.36 9.78 11.11 12.13
90 18.25 16.68 14.04 13.42 9.36 9.26 6.86 6.85 11.81 11.11 90 8.79 10.65 12.57 14.22 15.63
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*Adjusted age of annuitant. M = Male F = Female
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The table above is based on the "1983 Individual Annuitant Mortality Table A"
assuming an interest rate of 3% per year compounded annually. Settlement rates
for any age, or any combination of age and sex not shown above, will be
calculated on the same basis as those rates shown in the table above. Such rates
will be furnished by us upon request. Amounts shown in the Table below are based
on an assumed interest rate of 3% per year compounded annually.
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Plan E Dollar Amount of Each Monthly Fixed Dollar Annuity Payment Per $1,000 Applied
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Years Monthly Years Monthly Years Monthly
Payable Payment Payable Payment Payable Payment
------- ------- ------- ------- ------- -------
10 $9.61 17 $6.23 24 $4.84
11 8.86 18 5.96 25 4.71
12 8.24 19 5.73 26 4.59
13 7.71 20 5.51 27 4.47
14 7.26 21 5.32 28 4.37
15 6.87 22 5.15 29 4.27
16 6.53 23 4.99 30 4.18
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