Exhibit 24(b)(4)(a)(ii)
XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: [000 Xxxxxx Xxxx Xxxxx, 0xx Xxxxx
(XXXX XXXXXXX(R) LOGO) Valhalla, NY 10595]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
This Contract is issued in consideration of the Payments. Xxxx Xxxxxxx Life
Insurance Company of New York, a stock company, agrees to pay the benefits of
this Contract in accordance with its terms.
VARIABLE ACCOUNT PROVISIONS
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE, MAY INCREASE OR
DECREASE IN ACCORDANCE WITH THE FLUCTUATIONS IN THE INVESTMENT RESULTS, AS
APPLICABLE AND NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE
ACCOUNT PROVISIONS BEGIN ON PAGE 6.
The smallest annual rate of investment return which is required to be earned on
the assets of the separate account so that the dollar amount of variable annuity
payments will not decrease is [2.78%]. Explicit annual charges against the
assets of the separate account are as follows:
Contract Asset Fee Charge: Not greater than [1.75%]
RIGHT TO REVIEW
You may cancel the Contract by returning it to our Annuities Service Center or
the registered representative who sold it to you at any time within [10] days
after receipt of the Contract. Within 7 days of receipt of the Contract by us,
we will pay the Contract Value computed at the end of the Business Day on which
the Contract is delivered to us plus the sum of all fees and charges deducted
from the gross Payments to the Owner.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this [10] day period, we will return the greater of (i) Contract
Value computed at the end of the Business Day on which the Contract is delivered
to us plus the sum of all fees and charges deducted from the gross Payments or
(ii) sum of all Payments less any Withdrawals. If you return the Contract to us
after the first 7 days and before the [10]-day period has elapsed, we will
refund an amount determined as described in the paragraph above.
SIGNED FOR THE COMPANY at its Main Administration Office in Boston,
Massachusetts, on the Contract Date.
[ -s- Xxxxx X. Xxxxxxxxx ] [ -s- Xxxxxxx Xxxxx ]
[Xxxxx X. Xxxxxxxxx, President] [Xxxxxxx Xxxxx, Secretary]
INDIVIDUAL MODIFIED SINGLE PAYMENT DEFERRED VARIABLE ANNUITY
Variable Accumulation prior to Annuity Commencement Date
Variable and Fixed Annuity Options
Death Benefit Proceeds Payable prior to Annuity Commencement Date
Withdrawal Charge Waiver Benefit
Non-Participating
DOLLAR COST AVERAGING (DCA) ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE
DATE.
REFER TO THE AVAILABLE INVESTMENT OPTIONS ON THE SPECIFICATIONS PAGES FOR
DETAILS.
ANNUITIES SERVICE CENTER:
[P.O. Box 9506 Portsmouth, NH 03802-9506] [0-000-000-0000] [www.jhannuitiesnew
xxxx.xxx]
OVERNIGHT MAILING ADDRESS:
[000 Xxxxxxxxx Xxxxx Xxxxxxxxxx, XX 00000-0000]
VENTUREW-L.11-NY SAMPLE
Table of Contents
Specifications Pages ...................................................... S.1
Part 1 - Definitions ...................................................... 1
Part 2 - Parties to the Contract .......................................... 4
Part 3 - Payments ......................................................... 5
Part 4 - Fees And Deductions .............................................. 6
Part 5 - Variable Account Provisions ...................................... 6
Part 6 - Transfers ........................................................ 8
Part 7 - Withdrawal Provisions ............................................ 9
Part 8 - Death Benefits ................................................... 11
Part 9 - Contract Maturity ................................................ 13
Part 10 - Annuity Payments ................................................ 13
Part 11- Annuity Options .................................................. 15
Part 12 - General Provisions .............................................. 15
Part 13 - Contract Termination ............................................ 17
INTRODUCTION
This is an individual modified single payment deferred variable annuity
contract. This Contract provides that, prior to the Annuity Commencement Date,
the Contract Value will accumulate on a variable basis. You allocate Payments
among one or more Investment Options. The initial Investment Options are
identified on the Specifications Pages. The Contract Value will vary with the
investment performance of your Investment Account. Subject to the provisions of
the Contract, you may take withdrawals and transfer amounts among the Investment
Options.
After the Annuity Commencement Date, Annuity Payments may be either fixed or
variable, or a combination of fixed and variable. If you select Annuity Payments
on a variable basis, the payment amount will vary with the investment
performance of the Variable Account.
If the Owner (Annuitant if the Owner is not an individual) dies while this
Contract is in effect prior to the Annuity Commencement Date, we will pay a
Death Benefit to the Beneficiary upon receipt of all required claim forms and
proof of death of the Owner at the Annuities Service Center.
VENTUREW-L.11-NY SAMPLE
Specifications Page
TYPE OF CONTRACT: [Qualified] CONTRACT DATE: [06/15/2011]
CONTRACT NUMBER: [000000005] ISSUE STATE: NY
OWNER: [Xxxx X. Xxx] OWNER'S AGE & SEX: [55] [Male]
ANNUITANT: [Xxxx X. Xxx] ANNUITANT'S AGE & SEX: [55] [Male]
[CO-OWNER:] [ ] [CO-OWNER'S AGE & SEX:] [ ] [ ]
[CO-ANNUITANT:] [ ] [CO-ANNUITANT'S AGE & SEX:] [ ] [ ]
PLAN [Venture Frontier with Flex Access Option]
FEES AND CHARGES
CONTRACT ASSET FEE [1.75% years 1-4]
[1.25% years 5-7]
[1.15% years 8+]
ANNUAL CONTRACT FEE Electronic-Delivery of Financial
Owner Elects Electronic Delivery of Transaction Confirmations is
Financial Transaction Confirmations Not Elected by Owner
----------------------------------- --------------------------------
[$0] [$50]
[RIDER FEE(s) See Optional Riders section on page S.[4]]
PAYMENT LIMITS
PAYMENT LIMITS - Minimum Additional Payment Amount: [$30]
- Maximum Amount: [$1,000,000]
- Flex Access Option: No additional Payment will be
accepted on or after the [first] Contract Anniversary
S.1
VENTUREW-L.11-NY SAMPLE
LIMITS--TRANSFERS AND AMOUNT OF PARTIAL WITHDRAWALS
TRANSFER CHARGES AND LIMITATIONS-- - Minimum Transfer Amount: $300
BEFORE ANNUITY COMMENCEMENT - Minimum Investment Account Value: $ 100
DATE - Number of Transfers Per Contract Year:
two per month
- Transfer Charge: the lesser of $25 or
2% of the amount of each transfer in
excess of 12 per Contract Year
TRANSFER LIMITATIONS -- ON OR AFTER - Number of Transfers Per Contract Year: 4
ANNUITY COMMENCEMENT DATE
LIMITATIONS ON AMOUNT OF - Minimum Amount of Partial Withdrawal:
PARTIAL WITHDRAWALS [$300]
- Minimum Investment Account Balance: $100
- Minimum Remaining Contract Value: $1,000
WITHDRAWALS CHARGES
TABLE OF WITHDRAWAL CHARGES Number of Complete Years Withdrawal Charge
Payment has been in Contract Percentage
---------------------------- ---------------
0 8%
1 7%
2 6%
3 5%
4+ 0%
[Withdrawal Charges will be waived for any contract
issued to an employee of the Company.]
INITIAL ALLOCATION OF NET PAYMENT (SEE FOLLOWING PAGE FOR ALL AVAILABLE
INVESTMENT OPTIONS)
INITIAL PAYMENT [$100,000.00]
[DCA ACCOUNT OPTIONS:] [INITIAL INTEREST RATE] [INITIAL GUARANTEE PERIOD EXPIRES]
[6 Month DCA Account] [25.00%] [1.00%] [12/15/2011]
[THE INTEREST RATE FOR THE DCA ACCOUNT OPTION ABOVE MAY CONTAIN AN ENHANCEMENT
THAT MAY NOT BE PROVIDED IN SUBSEQUENT GUARANTEE PERIODS.]
VARIABLE INVESTMENT OPTIONS:
[Lifestyle Balanced PS] [75.00%]
TOTAL 100.00%
S.2
VENTUREW-L.11-NY SAMPLE
AVAILABLE INVESTMENT OPTIONS
VARIABLE ACCOUNT: XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK SEPARATE
ACCOUNT A
VARIABLE INVESTMENT OPTIONS:
[Lifestyle Balanced]
[Lifestyle Balanced PS]
[Lifestyle Conservative]
[Lifestyle Conservative PS]
[Lifestyle Growth]
[Lifestyle Growth PS]
[Lifestyle Moderate]
[Lifestyle Moderate PS]
[Ultra Short Term Bond]
DOLLAR COST AVERAGING (DCA) ACCOUNT INVESTMENT OPTIONS:
6 Month DCA Account
[6 Month DCA Not Currently Available]
12 Month DCA Account
[12 Month DCA Not Currently Available]
S.3
VENTUREW-L.11-NY SAMPLE
OPTIONAL RIDERS
[ENHANCED DEATH BENEFIT RIDER: MARKETING NAME]
- [Rider Date:] [06/15/2011]
- [Rider Fee Percentage:] [0.30%]
- [Total Asset Fee Percentage [2.05% years 1-4]
(Contract Asset Fee from Pg S.1 + [1.55% years 5-7]
Rider Fee Percentage):] [1.45% years 8+]
[GUARANTEED MINIMUM WITHDRAWAL BENEFIT RIDER: MARKETING NAME]
- [Rider Date:] [06/15/2011]
- [Maximum Rider Fee Percentage:] [1.50%]
ANNUITY BENEFITS
MATURITY DATE: [10/25/2046]
ANNUITY OPTION: Life 10-Year Certain
ANNUITY PAYMENTS -- GENERAL The rates for Annuity Payments are determined
INFORMATION based on:
- Mortality Table: Annuity 2000 Table
projected from 2002 to date of
annuitization at Scale G, 100% female blend
- Fixed Annuity Payment Interest Rate: 1.00%
interest per year
- Variable Annuity Payment Assumed Interest
Rate: 1.00%
The amount of each Annuity Payment will
depend upon the age of the Annuitant, the
Co-Annuitant, if any, or other payee.
S.4
VENTUREW-L.11-NY SAMPLE
AMOUNT OF FIRST MONTHLY PAYMENT
PER $1000 OF CONTRACT VALUE
FOR AN ANNUITANT BORN IN 1952
OPTION 1: LIFE ANNUITY
Option 1(A): Non-Refund Option 1(B): 10 Year Certain
----------------------------------- -------------------------------
Age of Age of
Xxxxxxxxx Xxxxxxxxx
---------------------------------- -------------------------------
55 N/A 55 N/A
60 3.08 60 3.06
65 3.50 65 3.47
70 4.07 70 3.99
75 4.85 75 4.66
80 5.91 80 5.46
85 7.40 85 6.35
OPTION 2: JOINT AND SURVIVOR LIFE ANNUITY
Option 2(A): Non-Refund
Age of Co-Annuitant
---------------------------------------------------------
Age of 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
--------------------------------------------------------------------------------
55 N/A N/A N/A N/A N/A
60 2.29 2.46 2.62 2.77 2.88
65 2.51 2.72 2.93 3.11 3.26
70 2.78 3.05 3.33 3.57 3.77
75 3.13 3.49 3.86 4.19 4.45
80 3.59 4.08 4.58 5.03 5.38
85 4.22 4.88 5.57 6.17 6.62
Option 2(B): 10 Year Certain
Age of Co-Annuitant
---------------------------------------------------------
Age of 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
--------------------------------------------------------------------------------
55 N/A N/A N/A N/A N/A
60 2.29 2.46 2.62 2.77 2.88
65 2.51 2.72 2.93 3.11 3.26
70 2.78 3.05 3.32 3.57 3.75
75 3.13 3.49 3.85 4.16 4.40
80 3.58 4.06 4.53 4.93 5.20
85 4.18 4.80 5.38 5.83 6.12
Monthly installments for ages not shown and other years of birth will be
furnished on request.
S.5
VENTUREW-L.11-NY SAMPLE
BENEFICIARY INFORMATION
[Xxxx Xxx]
DISCLOSURES
PURSUANT TO SECTION 3 OF THE FEDERAL DEFENSE OF MARRIAGE ACT ("DOMA"), SAME
SEX-MARRIAGES, DOMESTIC PARTNERSHIPS AND CIVIL UNIONS CURRENTLY ARE NOT
RECOGNIZED FOR PURPOSES OF FEDERAL LAW. THEREFORE, THE FAVORABLE INCOME-DEFERRAL
OPTIONS AFFORDED BY FEDERAL TAX LAW TO AN OPPOSITE-SEX SPOUSE UNDER INTERNAL
REVENUE CODE SECTIONS 72(S) AND 401(A)(9) ARE CURRENTLY NOT AVAILABLE TO A
SAME-SEX SPOUSE, DOMESTIC PARTNER OR CIVIL UNION PARTNER. SAME-SEX SPOUSES,
DOMESTIC PARTNERS OR CIVIL UNION PARTNERS WHO OWN OR ARE CONSIDERING THE
PURCHASE OF ANNUITY PRODUCTS THAT PROVIDE BENEFITS BASED UPON STATUS AS A SPOUSE
SHOULD CONSULT A TAX ADVISOR. TO THE EXTENT THAT AN ANNUITY CONTRACT ACCORDS TO
SPOUSES OTHER RIGHTS OR BENEFITS THAT ARE NOT AFFECTED BY DOMA, SAME-SEX
SPOUSES, DOMESTIC PARTNERS AND CIVIL UNION PARTNERS RECOGNIZED BY THE ISSUE
STATE REMAIN ENTITLED TO SUCH RIGHTS OR BENEFITS TO THE SAME EXTENT AS ANY
ANNUITY HOLDER'S SPOUSE.
[THIS PLAN IS INTENDED TO QUALIFY UNDER THE INTERNAL REVENUE CODE FOR
TAX-FAVORED STATUS. LANGUAGE CONTAINED IN THIS CONTRACT REFERRING TO FEDERAL TAX
STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. PLEASE SEEK THE ADVICE OF
YOUR OWN TAX ADVISOR REGARDING YOUR INDIVIDUAL TAX TREATMENT.]
S.6
VENTUREW-L.11-NY SAMPLE
PART 1 DEFINITIONS
------------------------- -----------------------------------------------------
WE AND YOU "We", "us" and "our" means the Company. "You" or
"your" means the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the
value of the Variable Account of this Contract
before the Annuity Commencement Date.
ANNUITANT Any individual person or persons whose life is used
to determine the duration of Xxxxxxx Payments
involving life contingencies. The Annuitant is as
designated on the Specifications Pages, unless
changed.
ANNUITIES SERVICE CENTER Any office designated by us for the receipt of
Payments and processing of Owner requests.
ANNUITY COMMENCEMENT DATE The date Annuity Payments begin. This date may not
be earlier than six months following the Contract
Date or later than the Maturity Date. Annuity
Payments may not be scheduled under the Contract to
begin earlier than 12 months from the Contract Date.
ANNUITY OPTION The method selected by you for Annuity Payments made
by us.
ANNUITY PAYMENT(S) Payment(s) by us to you, in accordance with the
Annuity Option elected under the terms of this
Contract.
ANNUITY UNIT A unit of measure that is used after the Annuity
Commencement Date to calculate Variable Annuity
payments.
BENEFICIARY The person, persons or entity to whom certain
benefits are payable following the death of an
Owner, or in certain circumstances, an Annuitant.
For purposes of section 72(s) of the Internal
Revenue code, the "designated beneficiary" under the
Contract shall be the individual who is entitled to
receive the amounts payable on death of an Owner, or
if any Owner is not an individual, on any change in,
or death of, of an Annuitant
BUSINESS DAY Any date on which the New York Stock Exchange is
open for business and the net asset value of a
Portfolio is determined.
COMPANY The insurance company named on the first page of
this Contract (or any successor insurance company
named by endorsement to this Contract) that will pay
benefits in accordance with this Contract.
CONTRACT ANNIVERSARY The annual anniversary of the Contract beginning
twelve months from the Contract Date and each year
thereafter.
CONTRACT DATE The date of issue of this Contract as designated on
the Specifications Pages.
CONTRACT VALUE The total of your Investment Account Values.
CONTRACT YEAR The period of time measured twelve consecutive
months from the Contract Date or any Contract
Anniversary thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled
to receive the Contract proceeds if all
Beneficiaries die before the Owner dies.
1
VENTUREW-L.11-NY SAMPLE
ENDORSEMENT An Endorsement modifies the contract to which it is
attached. Endorsements must be signed by an officer
of the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are
predetermined and guaranteed as to dollar amount.
GOOD ORDER The standard we apply when we determine whether an
instruction is satisfactory. An instruction will be
considered in Good Order if it is received at our
Annuities Service Center: (a) in a manner that is
satisfactory to us such that it is sufficiently
complete and clear that we do not need to exercise
any discretion to follow such instruction and
complies with all relevant laws and regulations and
Company requirements; (b) on specific forms, or by
other means we then permit (such as via telephone or
electronic submission); and/or (c) with any
signatures and dates we may require. We will notify
you if an instruction is not in Good Order.
INTERNAL REVENUE CODE
(IRC) The Internal Revenue Code of 1986, as amended from
time to time, and any successor statute of similar
purpose.
INVESTMENT ACCOUNT An account established by us which represents your
interest in an Investment Option prior to the
Annuity Commencement Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment
Account.
INVESTMENT OPTIONS The Subaccount(s) of the Variable Account. The
Investment Options available under this Contract at
issue are shown on the Specifications Pages.
MATURITY DATE The latest date on which annuity benefits may
commence. It is the date listed on the
Specifications Pages, unless changed. Any extension
of the maximum Maturity Date beyond age 90 of the
oldest Annuitant or the 10th Conract Year will be
subject to the laws and regulations then in effect
and our prior approval.
NET PAYMENT The Payment less the amount of premium tax, if any,
deducted from the Payment.
NET SURRENDER VALUE The Surrender Value less any amount withheld by us
for income taxes.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified Plans.
OWNER The person, persons or entity entitled to the
ownership rights under this Contract. The Owner is
as designated on the Specifications Pages, unless
changed.
PORTFOLIO The investment choices available to the Variable
Account.
PAYMENT An amount paid to us by you as consideration for the
benefits provided by this Contract.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax
treatment under sections 401, 403, 408 or 457, of
the Internal Revenue Code of 1986, as amended.
RIDER A rider provides an optional benefit, which may
result in an additional charge to the Contract. A
rider supplements the contract to which it is
attached. Riders must be signed by an officer of the
Company in order to be effective.
2
VENTUREW-L.11-NY SAMPLE
SEPARATE ACCOUNT A segregated account of the Company that is not
commingled with our general assets and obligations.
SUBACCOUNT(S) A division of the Variable Account. Each Subaccount
is invested in shares of a different Portfolio.
SURRENDER VALUE The Contract Value on any Valuation Date, less, if
applicable, any contract fees, any rider charges,
any deduction for premium taxes or similar taxes,
and any Withdrawal Charge.
VALUATION PERIOD Any period from one Business Day to the next,
measured from the time on each such day that the net
asset value of each Portfolio is determined.
VARIABLE ACCOUNT The Company's Separate Account as shown on the
Specifications Pages.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount; and
(2) vary in relation to the investment experience of
one or more specified variable Subaccounts.
WITHDRAWAL AMOUNT The amount deducted from the Contract Value when you
take a withdrawal. This amount is the total of the
amount paid to you plus the following, if
applicable: any contract fees, any rider charges,
any deduction for premium taxes or similar taxes,
any amount for income taxes resulting from the
withdrawal, and any Withdrawal Charges. The
Withdrawal Amount may not exceed the Contract Value.
WRITTEN REQUEST A notice provided in a form acceptable to Us based
on the type of request and received in Good Order at
our Annuities Service Center.
3
VENTUREW-L.11-NY SAMPLE
PART 2 PARTIES TO THE CONTRACT
------------------------- -----------------------------------------------------
OWNER Before the Annuity Commencement Date, the Owner of
this Contract shall be the person, persons or entity
designated on the Specifications Pages or the latest
change filed with us. A co-Owner is not permitted
under this Contract if any Owner is an entity. On
the Annuity Commencement Date the Annuitant will
become the Owner of this Contract, unless the Owner
is a trust or custodian. If amounts become payable
to the Beneficiary under this Contract, the
Beneficiary becomes the Owner of this Contract.
Unless indicated otherwise, references to the Owner
will also include the co-Owner.
ANNUITANT The Annuitant is the person designated as such on
the Specifications Pages or the latest change filed
with us. If you name more than one Xxxxxxxxx, the
second Annuitant is referred to as the co-Annuitant.
Unless indicated otherwise, references to the
Annuitant will also include the co-Annuitant.
BENEFICIARY The Beneficiary is as designated on the
Specifications Pages, unless changed. However, if
there is a surviving Owner, that person will be
treated as the Beneficiary. If no such Beneficiary
is living, the Beneficiary is the Contingent
Beneficiary. If no Beneficiary or Contingent
Beneficiary is living, the Beneficiary is the estate
of the deceased Owner.
CHANGE OF OWNER, Subject to the rights of an irrevocable Beneficiary,
ANNUITANT, BENEFICIARY you may change the Owner, Annuitant, or Beneficiary
by Written Request. Any change will take effect on
the date the request is signed. Any change of Owner
or Annuitant is subject to our issue age limitations
based on age at the date of the change. The
Annuitant may not be changed after the Annuity
Commencement Date. You need not send us the Contract
unless we request it. We will not be liable for any
payments or actions we take before the Written
Request is received.
The addition of any Owner may result in the
resetting of the Guaranteed Minimum Death Benefit to
an amount equal to the Contract Value as of the date
of such change. For purposes of subsequent
calculations of the Guaranteed Minimum Death
Benefit, we will treat the Contract Value on the
date of the change as a Payment made on that date.
In addition, all anniversary values, all Payments
made and all amounts deducted in connection with
partial withdrawals prior to the date of the
addition of the Owner will not be considered in the
determination of the Guaranteed Minimum Death
Benefit.
If any Annuitant is changed and any Owner is not an
individual, the entire interest in the Contract must
be distributed to the Owner within five years of the
change.
ASSIGNMENT You may assign this Contract, except as otherwise
provided, at any time prior to the Annuity
Commencement Date. No assignment will be binding on
us unless it is in the form of a Written Request. We
will not be liable for any payments made or actions
we take before the assignment is received by us. An
absolute assignment will revoke the interest of any
revocable Beneficiary. We will not be responsible
for the validity of any assignment.
If this Contract is issued in a 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 as collateral for a loan or as security for
the performance of an obligation or for any other
purpose, to any person other than us.
4
VENTUREW-L.11-NY SAMPLE
PART 3 PAYMENTS
------------------------- -----------------------------------------------------
GENERAL The Contract is not effective until the Initial
Payment is received by us at our Annuities Service
Center or such other place designated by us. All
Payments under this Contract are payable at our
Annuities Service Center or such other place as we
may designate.
PAYMENT LIMITS The Initial Payment is shown on the Specifications
Pages. Each additional Payment must be at least
equal to the Minimum Additional Payment Amount shown
on the Specifications Pages. If a Payment would
cause the Contract Value on the date of such Payment
to exceed the Maximum Amount shown on the
Specifications Pages, or the Contract Value on the
date of such Payment already exceeds the Maximum
Amount, no additional Payments will be accepted
without our prior approval. The Payment period is
also limited as shown on the Specifications Pages.
ALLOCATION OF NET When we receive Payments, the Net Payments will be
PAYMENTS allocated among Investment Options in accordance
with the allocation percentages shown on the
Specifications Pages. You may change the allocation
of subsequent Net Payments at any time, without
charge, by Written Request.
5
VENTUREW-L.11-NY SAMPLE
PART 4 FEES AND DEDUCTIONS
------------------------- -----------------------------------------------------
CONTRACT ASSET FEE To compensate us for assuming mortality and expense
risks, and administration expenses, we deduct from
each variable Investment Option a fee each Valuation
Period at an annual rate set forth on the
Specifications Pages. A portion of this Asset Fee
may also be used to reimburse us for distribution
expenses. This fee is reflected in the Net
Investment Factor used to determine the value of
Accumulation Units and Annuity Units of the
Contract.
ANNUAL CONTRACT FEE To compensate us for assuming administration
expenses, we charge an Annual Contract Fee as set
forth on the Specifications Pages. Prior to the
Annuity Commencement Date, the Annual Contract Fee
is deducted on each Contract Anniversary. We
withdraw the Annual Contract Fee from each
Investment Option in the same proportion that the
value of the Investment Accounts of each Investment
Option bears to the Contract Value. If the Contract
Value is totally withdrawn on any date other than
the Contract Anniversary, we will deduct the total
amount of the Annual Contract Fee from the amount
paid. After the Annuity Commencement Date, we deduct
the Annual Contract Fee on a pro rata basis from
each Annuity Payment.
TAXES We reserve the right to charge certain taxes against
your Payments (either at the time of payment or
liquidation due to withdrawals, annuitization or
death benefit), or against the Contract Value, Death
Benefit proceeds, or Annuity Payments, as
appropriate. Such taxes may include premium taxes or
other taxes levied by any government entity which
we, in our sole discretion, determine have resulted
from the establishment or maintenance of the
Variable Account, or from the receipt by us of
Payments, or from the issuance of this Contract, or
from the commencement or continuance of Annuity
Payments under this Contract.
RIDER FEE(S) We charge an additional fee to compensate us for the
additional benefits provided by any optional benefit
riders elected by you. The Rider Fee for each rider
you elect is shown on the Specifications Pages or in
the Rider. Rider Fees are deducted as described in
the applicable benefit Rider issued by us.
PART 5 VARIABLE ACCOUNT PROVISIONS
------------------------- -----------------------------------------------------
INVESTMENT ACCOUNT We will establish a separate Investment Account for
you for each variable Investment Option to which you
allocate amounts. The Investment Account represents
the number of your Accumulation Units in an
Investment Option.
INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment
Account is determined by (a) times (b) where:
(a) equals the number of Accumulation Units credited
to the Investment Account; and;
(b) equals the value of the appropriate Accumulation
Unit.
ACCUMULATION UNITS We will credit Net Payments to your Investment
Accounts in the form of Accumulation Units. The
number of Accumulation Units we will credit to each
Investment Account of the Contract will be
determined by dividing the Net Payment allocated to
that Investment Account by the Accumulation Unit
value for that Investment Account.
6
VENTUREW-L.11-NY SAMPLE
Accumulation Units will be adjusted for any
transfers and will be canceled on payment of a death
benefit, withdrawal, maturity or assessment of
certain charges based on their value for the
Business Day on which such transaction occurs.
VALUE OF ACCUMULATION We will determine the Accumulation Unit value for a
UNIT particular Investment Account for any Business Day
by multiplying the Accumulation Unit value for the
immediately preceding Business Day by the net
investment factor for the Valuation Period for which
the value is being determined. The value of an
Accumulation Unit may increase, decrease or remain
the same from one Business Day to the next.
NET INVESTMENT FACTOR The net investment factor is an index that measures
the investment performance of a Subaccount from one
Business Day to the next (" the Valuation Period").
The net investment factor for any Valuation Period
is determined by dividing (a) by (b) and subtracting
(c) from the result where:
(a) is the net result of:
(i) the net asset value per share of a
Portfolio share held in the Subaccount
determined as of the end of the current
Valuation Period, plus
(ii) the per share amount of any dividend or
capital gain distributions made by the
Portfolio on shares held in the Subaccount
and received during the current Valuation
Period; and
(b) is the net asset value per share of a Portfolio
share held in the Subaccount determined as of
the end of the immediately preceding Valuation
Period; and
(c) is the Contract Asset Fee shown on the
Specifications Pages divided by 365 and
multiplied by the number of calendar days in the
Valuation Period.
The net investment factor may be greater or less
than, or equal to, one.
ADDITION, DELETION, We reserve the right, subject to prior approval of
SUBSTITUTION OR the New York Superintendent of Insurance and in
RESTRICTION OF compliance with applicable law, to make additions
INVESTMENT OPTIONS to, deletions from, or substitutions for the
Portfolio shares that are held by the Variable
Account or that the Variable Account may purchase.
We reserve the right to eliminate the shares of any
of the eligible Portfolios and to substitute shares
of another Portfolio. We will not substitute any
shares attributable to your interest in a Subaccount
without notice to you and prior approval of the
Securities and Exchange Commission to the extent
required by the Investment Company Act of 1940.
Nothing contained herein shall prevent the Variable
Account from purchasing other securities for other
series or classes of contracts, or from effecting a
conversion between shares of another open-end
investment company.
We reserve the right, subject to prior approval of
the New York Superintendent of Insurance and in
compliance with applicable law, to establish
additional Subaccounts which would invest in shares
of a new Portfolio. We also reserve the right to
eliminate existing Subaccounts, to restrict or
prohibit additional allocations to a Subaccount, to
combine Subaccounts or to transfer assets in a
Subaccount to another Separate Account established
by us or an affiliated company. In the event of any
such substitution or change, we may, by appropriate
endorsement, make such changes in this and other
Contracts as may be necessary or appropriate to
reflect such substitutions or change. If deemed by
us to be in the best interests of persons having
voting rights under the Contracts, the Variable
Account may be operated as a management company
under the Investment Company Act of 1940 or it may
be de-registered under such Act in the event such
registration is no longer required.
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VENTUREW-L.11-NY SAMPLE
INSULATION The portion of the assets of the Variable Account
equal to the reserves and other contract liabilities
with respect to such account shall not be charged
with liabilities arising out of any other business
we may conduct. Moreover, the income, gains and
losses, realized or unrealized, from assets
allocated to the Variable Account shall be credited
to or charged against such account without regard to
our other income, gains or losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets
with a value at least equal to the amounts
accumulated in accordance with the terms of the
applicable agreements with respect to the Separate
Account and the reserves for annuities, in the
course of payment that vary with the investment
experience of the Separate Account.
PART 6 TRANSFERS
------------------------- -----------------------------------------------------
TRANSFERS BEFORE ANNUITY While this Contract is in effect prior to the
COMMENCEMENT DATE Annuity Commencement Date, you may transfer amounts
among the Investment Accounts of the Contract,
subject to the limitations below. Amounts will be
canceled from the Investment Accounts from which
amounts are transferred and credited to the
Investment Account to which amounts are transferred.
We will effect such transfers so that the Contract
Value on the date of transfer will not be affected
by the transfer.
You must transfer at least the Minimum Transfer
Amount shown on the Specifications Pages or, if
less, the entire amount in the Investment Account
each time you make a transfer. If, after the
transfer, the amount remaining in the Investment
Account from which the transfer is made is less than
Minimum Investment Account Value shown on the
Specifications Pages, then we will transfer the
entire amount instead of the requested amount.
We limit the number of transfers you may make each
Contract Year among each Variable Investment Option
as shown in the Transfers Before Annuity
Commencement Date section on the Specifications
Pages.
We do not impose a charge for the first 12 transfers
in a Contract Year. For each additional transfer
during a Contract Year, the Transfer Charge is shown
on the Specifications Pages.
TRANSFERS ON OR AFTER Once variable Annuity Payments have begun, you may
ANNUITY COMMENCEMENT transfer all or part of the investment upon which
DATE your variable Annuity Payments are based from one
Subaccount to another. To do this, we will convert
the number of variable Annuity Units you hold in the
Subaccount from which you are transferring to a
number of variable Annuity Units of the Subaccount
to which you are transferring so that the next
Annuity Payment, if it were made at that time, would
be the same amount that it would have been without
the transfer. After the transfer, the variable
Annuity Payments will reflect changes in the values
of your new variable Annuity Units. You must give us
notice at least 30 days before the due date of the
first variable Annuity Payment to which the transfer
will apply.
We reserve the right, upon notice, to limit the
number of transfers that can be made after variable
annuity payments have begun. If such a limit is
imposed, the number of transfers per Contract Year
will be no less than the Minimum Number of Transfers
Per Contract Year shown in the Transfers On Or After
Annuity Commencement Date section on the
Specifications Pages.
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VENTUREW-L.11-NY SAMPLE
After the Annuity Commencement Date,
transfers will not be allowed from a fixed
to a variable Annuity Option, or from a
variable to a fixed Annuity Option.
DEFERRAL, MODIFICATION OR We reserve the right to defer, modify or
TERMINATION OF TRANSFER PRIVILEGE terminate the transfer privilege at any time
that we are unable to purchase or redeem
shares of the Portfolios. Transfer charges
and limitations are identified above and in
the Suspension of Payments provision in the
Withdrawals Provisions section.
PART 7 WITHDRAWAL PROVISIONS
------------------------- -----------------------------------------------------
PAYMENTS OF WITHDRAWALS You may withdraw part or all of the
Surrender Value, at any time before the
earlier of the death of an Owner, the
Annuity Commencement Date or the Maturity
Date, by sending us a Written Request. We
will pay all withdrawals within seven days
of receipt at the Annuities Service Center
subject to postponement in certain
circumstances, as specified below.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw
the entire Contract Value, we will terminate
the Contract and pay you the Net Surrender
Value.
PARTIAL WITHDRAWAL If you request to withdraw an amount less
than the Surrender Value, we will pay you
the amount requested and deduct the
Withdrawal Amount from the Contract
Value. Unless you specify the amount to be
withdrawn from each Investment Option, the
Withdrawal Amount will be withdrawn from
each Investment Option on a pro rata basis.
Partial withdrawals will reduce the Death
Benefit, as described in the Death Benefit
section.
FREQUENCY AND AMOUNT OF PARTIAL You may make as many partial withdrawals as
WITHDRAWALS you wish. Limitations on the amount of
partial withdrawals are as follows.
(a) Any withdrawal from an Investment
Account must be at least equal to the
Minimum Amount of Partial Withdrawal
shown on the Specifications Pages or
the entire balance in the Investment
Account, if less.
(b) If after the withdrawal, the amount
remaining in the Investment Account is
less than the Minimum Investment
Account Balance shown on the
Specifications Pages, then we will
consider the withdrawal request to be
a request for withdrawal of the entire
amount held in the Investment Account.
(c) If a partial withdrawal reduces the
Contract Value to less than the
Minimum Remaining Contract Value shown
on the Specifications Pages, or if the
amount requested is greater than or
equal to the amount available as a
total withdrawal, then we will treat
the partial withdrawal as a total
withdrawal of the Contract Value.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from,
or postpone the date of payments from, the
variable Investment Accounts for any period
when: (1) the New York Stock Exchange is
closed (other than customary weekend and
holiday closings); (2) trading on the New
York Stock Exchange is restricted; (3) an
emergency exists as a result of which
disposal of securities held in the Variable
Account is not reasonably practicable or it
is not reasonably practicable to determine
the value of the Variable Account's net
assets; or (4) the Securities and Exchange
Commission, by order, so permits for the
protection of security holders; provided
that applicable rules and regulations of
the Securities and Exchange Commission
9
VENTUREW-L.11-NY SAMPLE
shall govern as to whether the conditions
described in (2) and (3) exist.
WITHDRAWAL CHARGE If a withdrawal is made from the Contract
we may assess a Withdrawal Charge against
Payments. The amount of the Withdrawal
Charge and when it is assessed is discussed
below.
(a) A Free Withdrawal Amount may be
withdrawn free of a Withdrawal Charge.
The Free Withdrawal Amount is the
greater of:
(i) Earnings, which for purposes of
these Withdrawal Charge
provisions, means the excess of
the Contract Value on the date of
withdrawal over the unliquidated
Payments; or
(ii) the excess of a. over b. where
a. equals 10% times the total
Payments; and
b. equals 100% of all prior
partial withdrawals in that
Contract Year.
(b) Amounts will be withdrawn from the
Contract in the following order for
purposes of calculating the Withdrawal
Charge:
(i) Earnings; then
(ii) any Free Withdrawal Amount in
excess of Earnings; then
(iii) Payments not previously
liquidated, in the order such
Payments were received.
(c) Payments are liquidated when the
Withdrawal Amount exceeds Earnings.
The amount of Payments liquidated
equals
(i) the lesser of the Withdrawal
Amount or the total unliquidated
Payments; minus
(ii) Earnings.
(d) A total withdrawal will liquidate all
unliquidated Payments. Any Payments
liquidated may be subject to a
Withdrawal Charge based on the length
of time the Payment has been in the
Contract. The Withdrawal Charge is
determined by multiplying the amount of
the Payment being liquidated by the
applicable Withdrawal Charge percentage
obtained from the table shown on
the Specifications Pages.
(e) The total Withdrawal Charge will be the
sum of the Withdrawal Charges for
the Payments being liquidated.
WAIVER OF WITHDRAWAL CHARGE A Withdrawal Charge is not applied if the
withdrawal is:
(a) payment of the Death Benefit; or
(b) due to the application of the Contract
Value to an Annuity Option; or
(c) taken at the Maturity Date of the
Contract; or
(d) a distribution required to satisfy
Federal Income Tax minimum distribution
requirements that apply to this
Contract; or
(e) a withdrawal guaranteed under certain
riders attached to the Contract, as
specified in the rider.
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VENTUREW-L.11-NY SAMPLE
PART 8 DEATH BENEFITS
------------------------- -----------------------------------------------------
DEATH BENEFIT BEFORE ANNUITY Prior to the Maturity Date or Annuity
COMMENCEMENT DATE Commencement Date, if earlier, we will
determine the Death Benefit as of the date on
which written notice and proof of
death and all required claim forms are
received in Good Order at the Company's
Annuities Service Center as follows:
The Death Benefit will be determined as the
greater of the Contract Value or the
Guaranteed Minimum Death Benefit.
The Guaranteed Minimum Death Benefit is the
sum of all Payments made, less any amount
deducted in connection with partial
withdrawals. For purposes of calculating the
Guaranteed Minimum Death Benefit, the amount
deducted in connection with partial
withdrawals will be equal to (i) times (ii),
where (i) is equal to the Guaranteed Minimum
Death Benefit prior to the withdrawal, and
(ii) is equal to the amount of the partial
withdrawal divided by the Contract Value
prior to the partial withdrawal.
We will permit the Owner to limit the Death
Benefit option(s) to be offered any named
Beneficiary, if the Owner provides written
notice to the Company prior to death and the
desired option(s) is one provided for in this
Contract.
Death benefit distributions prior to the
Annuity Commencement Date are governed by
Internal Revenue Code Section 72(s). Pursuant
to Section 72(s) any reference in this
provision to "spouse" means a spouse as
defined in federal law.
DEATH OF ANNUITANT: On the death of the last
surviving Annuitant, the Owner becomes the
new Annuitant, if the Owner is an individual.
If the Owner is not an individual the death
of any Annuitant is treated as the death of
an Owner and the Death Benefit will be
determined by substituting the Annuitant for
the Owner as described below.
DEATH OF OWNER: We will pay the Death Benefit
to the Beneficiary if any Owner dies prior to
the Maturity Date or Annuity Commencement
Date, if earlier. The Death Benefit may be
taken in one sum immediately, in which case
the Contract will terminate. If the Death
Benefit is not taken in one sum immediately,
the Contract will continue subject to the
following provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit
over the Contract Value will be allocated
to and among the Investment Accounts in
proportion to their values as of the date
on which the Death Benefit is determined.
(c) No additional Payments may be applied to
the Contract.
(d) If the Beneficiary is not the deceased
Owner's spouse, the entire interest in
the Contract must be distributed under
one of the following options:
(i) The entire interest in the Contract
must be distributed over the life of
the Beneficiary, or over a period not
extending beyond the life expectancy
of the Beneficiary, with
distributions beginning within one
year of the Owner's death; or
11
VENTUREW-L.11-NY SAMPLE
(ii) the entire interest in the
Contract must be distributed
within 5 years of the Owner's
Death, or
(iii) as Annuity Payments under one of
the options described in the
Annuity Options section.
If the Beneficiary dies before the
distributions required by (i) or (ii)
are complete, the entire remaining
Contract Value must be distributed in
a lump sum immediately.
(e) If the Beneficiary is the deceased
Owner's spouse, the Contract will
continue with the surviving spouse as
the new Owner, subject to the
provisions of Internal Revenue Code
Section 72(s). The surviving spouse may
name a new Beneficiary (and, if no
Beneficiary is so named, the surviving
spouse's estate will be the
Beneficiary).
The spouse may also elect distributions
under one of the following options:
(i) the entire interest in the
Contract may be distributed over
the life of the Beneficiary, or
over a period not extending beyond
the life expectancy of the
Beneficiary, with distributions
beginning within one year of the
Owner's death; or
(ii) as Annuity Payments under one of
the options described in the
Annuity Options section.
(f) We will waive Withdrawal Charges
on any withdrawals.
If there is more than one Beneficiary,
the foregoing provisions will
independently apply to each Beneficiary,
to the extent of that Beneficiary's
share.
DEATH BENEFIT ON OR AFTER ANNUITY If Annuity Payments have been selected based
COMMENCEMENT DATE on an Annuity Option providing for payments
for a guaranteed period, and the Annuitant
dies on or after the Annuity Commencement
Date, we will make the remaining guaranteed
payments to the Beneficiary. Any remaining
payments will be made at least as rapidly as
under the method of distribution being used
as of the date of the Annuitant's death. If
no Beneficiary is living, we will commute
any unpaid guaranteed payments to a single
sum (on the basis of the interest rate used
in determining the payments) and pay that
single sum to the estate of the last to die
of the Annuitant and the Beneficiary.
PROOF OF DEATH We will require Proof of death upon the
death of the Annuitant or the Owner. Proof
of death is one of the following received at
the Annuities Service Center:
(a) A certified copy of a death
certificate;
(b) A certified copy of a decree of a court
of competent jurisdiction as to the
finding of death; or
(c) Any other proof satisfactory to us.
12
VENTUREW-L.11-NY SAMPLE
PART 9 CONTRACT MATURITY
------------------------- -----------------------------------------------------
CHANGE IN MATURITY DATE Prior to the Maturity Date, an Owner may make
a Written Request to change the Maturity
Date. Any extension of the Maturity Date will
be subject to our prior approval and any
applicable law or regulation then in effect.
OPTIONS AT MATURITY DATE We will send You information about Your
available options prior to the Maturity Date.
If by the Maturity Date, you do not
choose an Annuity Option, make a total
withdrawal of the Surrender Value, or ask us
to change the Maturity Date, we will
automatically pay you Annuity Payments under
the Annuity Option shown on the
Specifications Pages and the Annuity
Commencement Date is considered to be the
Maturity Date.
We will provide variable Annuity Payments
unless otherwise elected. You can change the
Annuity Option at any time before the Annuity
Commencement Date.
PART 10 ANNUITY PAYMENTS
------------------------- -----------------------------------------------------
GENERAL The entire Contract Value or the entire
amount of the Beneficiary's portion of the
Death Benefit may be applied in accordance
with one or more of the Annuity Options
described below, subject to any restrictions
of Internal Revenue Code section 72(s). Once
Annuity Payments commence, the Annuity Option
may not be changed. The "Life 10-Year
Certain" Annuity Option described under Part
11, Option 1 is the default Annuity Option
unless you request another option on or prior
to the Maturity Date or unless otherwise
required by the Internal Revenue Code.
You may select a Fixed or Variable Annuity.
We will provide variable Annuity Payments
unless otherwise elected. Once Annuity
Payments commence, the Annuity Option may not
be changed.
The method used to calculate the amount of
the initial and subsequent Annuity Payments
is described below.
We may pay the Contract Value or Death
Benefit, on the Annuity Commencement Date in
one lump sum if the corresponding monthly
income is less than $20.
VARIABLE ANNUITY PAYMENTS We will determine the amount of the first
Variable Annuity Payment by applying the
portion of the Contract Value used to effect
a Variable Annuity (minus any applicable
premium taxes) to the Annuity Option elected
based on the mortality table and assumed
interest rate shown in the Specifications
Pages. We will provide a table of the annuity
factors upon Written Request. If the current
rates in use by us on the Annuity
Commencement Date are more favorable to you,
we will use the current rates. The portion of
the Contract Value used to effect a Variable
Annuity will be measured as of a date not
more than 10 business days prior to the
Annuity Commencement Date.
13
VENTUREW-L.11-NY SAMPLE
Subsequent payments will be based on the
investment performance of one or more
Subaccounts as you select. The amount of such
payments is determined by the number of
Annuity Units credited for each Subaccount.
Such number is determined by dividing the
portion of the first payment allocated to
that Subaccount by the Annuity Unit value for
that Subaccount determined as of the same
date that the Contract Value used to effect
Annuity Payments was determined. We then
multiply this number of Annuity Units for
each Subaccount by the appropriate Annuity
Unit value for each subsequent determination
date, which is a uniformly applied date not
more than 10 business days before the payment
is due.
Variable Annuity payments, at the time of
their commencement, will not be less than
those that would be provided by the
application of the amount described below to
purchase a single premium immediate annuity
then offered to the same class of annuitants
by us or a company affiliated with us. Since
no such annuity currently exists, we will
apply rates that are reasonable in relation
to the market single premium immediate
annuity rates. The amount applied to a single
premium immediate annuity would be equal to
the greater of;
(a) the Contract Value less applicable
Withdrawal Charges; or
(b) 95% of the Contract Value.
MORTALITY AND EXPENSE GUARANTEE We guarantee that the dollar amount of each
Variable Annuity payment will not be
affected by changes in mortality and expense
experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each
Subaccount for any Business Day is
determined as follows:
(a) The net investment factor for the
Subaccount for the Valuation Period
ending on the Business Day for which the
Annuity Unit value is being calculated is
multiplied by the value of the Annuity
Unit for the preceding Business Day; and
(b) The result is adjusted to compensate for
the interest rate used to determine the
first Variable Annuity payment.
The dollar value of Annuity Units may
increase, decrease or remain the same from
one Valuation Period to the next.
FIXED ANNUITY PAYMENTS We will determine the amount of each Fixed
Annuity payment by applying the portion of
the Contract Value used to effect a Fixed
Annuity measured as of a date not more than
10 business days prior to the Annuity
Commencement Date (minus any applicable
premium taxes) to the Annuity Option elected
based on the mortality table and interest
rate shown on the Specifications Pages. The
Fixed Annuity payment will not be less than
that available by applying the amount
described below to purchase a single premium
immediate annuity then offered to the same
class of annuitants by us or a company
affiliated with us. Such an amount would be
equal to the greater of:
(c) the Contract Value less applicable
Withdrawal Charges; or
(d) 95% of the Contract Value.
We guarantee the dollar amount of Fixed
Annuity payments.
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VENTUREW-L.11-NY SAMPLE
PART 11 ANNUITY OPTIONS
------------------------- -----------------------------------------------------
DESCRIPTION OF ANNUITY OPTIONS Option 1: Life Annuity
a) Life Non-Refund. We will make Annuity
Payments during the lifetime of the
Annuitant. No payments are due after the
death of the Annuitant.
b) Life with 10-Year Certain. We will make
Annuity Payments for 10 years and after
that during the lifetime of the Annuitant.
No payments are due after the death of the
Annuitant or, if later, the end of the
10-year period.
Option 2: Joint and Survivor Life Annuity
The second Annuitant named shall be referred
to as the Co-Annuitant.
a) Joint and Survivor Non-Refund. We will
make Annuity Payments during the joint
lifetime of the Annuitant and
Co-Annuitant. Payments will then continue
during the remaining lifetime of the
survivor. No payments are due after the
death of the last survivor of the
Annuitant and Co-Annuitant.
b) Joint and Survivor with 10-Year Certain.
We will make Annuity Payments for 10 years
and after that during the joint lifetime
of the Annuitant and Co-Annuitant.
Payments will then continue during the
remaining lifetime of the survivor. No
payments are due after the death of the
survivor of the Annuitant and Co-Annuitant
or, if later, the end of the 10-year
period.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the
Annuity Options described above, you may
choose an alternate form of settlement
acceptable to us. Once Annuity Payments
commence, the form of settlement may not be
changed.
PART 12 GENERAL PROVISIONS
------------------------- -----------------------------------------------------
ENTIRE CONTRACT The entire Contract consists of this
Contract, Endorsements and Riders, if any,
and the application, if one is attached to
this Contract.
BENEFITS AND VALUES The benefits and values available under this
Contract are not less than the minimum
required by any statute of the state in which
this Contract is delivered. We have filed a
detailed statement of the method used to
calculate the benefits and values with the
Department of Insurance in the state in which
this Contract is delivered, if required by
law.
MODIFICATION Only the President, a Vice President, or the
Secretary of the Company has authority to
agree on our behalf to any alteration of the
Contract or to any waiver of our rights or
requirements. The change or waiver must be in
writing. We will not change or modify this
Contract without prior approval of the New
York Superintendent of Insurance. No change
that reduces benefits will be made without
your written consent.
15
VENTUREW-L.11-NY SAMPLE
CLAIMS OF CREDITORS All benefits and payments under this Contract
shall be exempt from the claims of creditors
to the extent permitted by law.
MISSTATEMENT AND PROOF OF AGE We may require proof of age or survival of
OR SURVIVAL any person upon whose age or survival any
Annuity Payments or other benefits provided
by this Contract or any Rider attached
thereof depend. If the age of the Annuitant
has been misstated, the benefits will be
those which would have been provided for the
correct age. If we have made incorrect
benefit payments, we will immediately pay the
amount of any underpayment adjusted with
interest at 3% per annum. We will deduct the
amount of any overpayment from future benefit
payments without adjustment for interest.
INCONTESTABILITY This Contract is not contestable.
NON-PARTICIPATING Your Contract is non-participating and will
not share in our profits or surplus earnings.
We will pay no dividends on your Contract.
REPORTS We provide periodic reports no less
frequently than annually without charge,
containing the Investment Account Value, the
Contract Value and Death Benefit. The report
will include the number of Accumulation Units
credited to the Variable Account, the
Accumulation Unit value and the dollar value
of the Accumulation Unit of the Variable
Account no more than 4 months prior to the
date of the delivery of the report. We will
provide annual calendar year reports
concerning the status of the Contract and
such information concerning required minimum
distributions as is prescribed by the
Commissioner of Internal Revenue. We will
provide additional status reports upon
request for a charge not to exceed $25 per
request.
CURRENCY AND PLACE OF PAYMENTS All payments made to or by us shall be made
in the lawful currency of the United States
of America at the Annuities Service Center or
elsewhere if we consent.
NOTICES AND ELECTIONS To be effective, all notices and elections
you make under this Contract must be in the
form of a Written Request. All notices,
requests and elections will be effective when
signed. We will not be liable for any
payments made or actions taken before the
Written Request is received by us.
GOVERNING LAW This Contract will be governed by the laws of
the jurisdiction indicated on the
Specifications Pages.
SECTION 72(S) The provisions of this Contract shall be
interpreted so as to comply with the
requirements of Section 72(s) of the Internal
Revenue Code.
16
VENTUREW-L.11-NY SAMPLE
PART 13 CONTRACT TERMINATION
------------------------- -----------------------------------------------------
CANCELLATION FOR NONPAYMENT & If, prior to the Annuity Commencement Date,
MINIMUM ACCOUNT VALUE no Payments have been made for two
consecutive Contract Years, and if both:
(a) the total Payments made, less any partial
withdrawals, are less then $2,000; and
(b) the Contract Value at the end of such two
year period is less than $2,000;
we may cancel this Contract and pay you the
Contract Value (measured as of the Valuation
Period during which the cancellation occurs),
less the Annual Contract Fee.
OTHER This Contract will terminate on the earliest
of :
(a) receipt of your request to withdraw the
entire Contract Value;
(b) the date a Death Benefit is payable and
the Beneficiary takes the Death Benefit
as a lump sum; or
(c) the date the Contract Value reduces to
zero, subject to the provisions of any
benefit rider attached to this Contract.
17
VENTUREW-L.11-NY SAMPLE
XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: Valhalla, New York [XXXX XXXXXXX(R) LOGO]
VENTUREW-L.11-NY SAMPLE
