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EXHIBIT 4
FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY NEW YORK, NEW YORK
CONTRACT NUMBER P9999999999
OWNER XXXX XXX
EXECUTIVE OFFICE ANNUITY SERVICE CENTER
000 XXXXX XXX., 0XX XXXXX P. O. XXX 00000
XXX XXXX, XX 00000 XXX XXXXXXX, XX 00000-0000
FIRST SUNAMERICA LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "First
SunAmerica") agrees to provide benefits to the Owner in accordance with the
provisions set forth in this Contract and in consideration of the Owner's
application and the Purchase Payment We received.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED. THE VALUE DURING THE ACCUMULATION AND
ANNUITY PERIODS WILL INCREASE OR DECREASE BASED UPON THE INVESTMENT EXPERIENCE
OF THE INVESTMENTS UNDERLYING THE VARIABLE PORTFOLIOS YOU CHOOSE. THE SMALLEST
ANNUAL RATE OF INVESTMENT RETURN THAT WOULD HAVE TO BE EARNED ON ASSETS OF THE
SEPARATE ACCOUNT SO THAT THE DOLLAR AMOUNT OF VARIABLE ANNUITY PAYMENTS WILL NOT
DECREASE IS 5.09%. THE CHARGES AGAINST THE ASSETS OF THE SEPARATE ACCOUNT ARE
THE EXPENSE RISK CHARGE, THE DISTRIBUTION EXPENSE CHARGE, THE MORTALITY RISK
CHARGE, AND THE GUARANTEED DEATH BENEFIT RISK CHARGE. THESE CHARGES ARE, ON AN
ANNUAL BASIS, 0.35%, 0.15%, 0.90%, AND 0.12%, RESPECTIVELY, OF THE AVERAGE DAILY
ENDING VALUE OF THE ASSETS ATTRIBUTABLE TO THE ACCUMULATION UNITS OF THE
VARIABLE PORTFOLIOS TO WHICH YOUR CONTRACT VALUE IS ALLOCATED. WE SUBTRACT THESE
CHARGES DAILY.
RIGHT TO EXAMINE - IF, WITHIN 10 DAYS OF RECEIPT OF THIS CONTRACT, YOU ARE NOT
SATISFIED WITH IT, YOU MAY RETURN THE CONTRACT TO OUR ANNUITY SERVICE CENTER, OR
THE AGENT THROUGH WHOM THE CONTRACT WAS PURCHASED. WE WILL REFUND THE CONTRACT
VALUE COMPUTED AS OF THE END OF THE BUSINESS DAY WE RECEIVE THE CONTRACT IN OUR
ANNUITY SERVICE CENTER. UPON SUCH REFUND, THE CONTRACT SHALL BE VOID.
For Contracts issued as an Individual Retirement Annuity, We reserve the right
to allocate Your Purchase Payment to the Cash Management Portfolio until the end
of the Right to Examine period. Thereafter, allocations will be made as shown on
the Purchase Payment Allocation Page.
THIS IS A LEGAL CONTRACT. READ IT CAREFULLY.
/s/ XXX XXXXX
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Xxx Xxxxx
President
INDIVIDUAL SINGLE PREMIUM
FIXED AND VARIABLE
ANNUITY CONTRACT
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Nonparticipating
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TABLE OF CONTENTS
CONTRACT DATA PAGE.................................................................PAGE 3
PURCHASE PAYMENT ALLOCATION........................................................PAGE 4
DEFINITIONS........................................................................PAGE 5
PURCHASE PAYMENT PROVISIONS........................................................PAGE 8
Purchase Payment; Substitution of Portfolio
ACCUMULATION PROVISIONS............................................................PAGE 8
Separate Account Accumulation Value; Number of Accumulation Units; Accumulation
Unit Value (AUV); Fixed Account Accumulation Value; Fixed Account Guarantee
Period Option And Interest Crediting
CHARGES AND DEDUCTIONS.............................................................PAGE 10
Expense Risk Charge; Distribution Expense Charge; Mortality Risk Charge;
Guaranteed Death Benefit Risk Charge
TRANSFER PROVISIONS................................................................PAGE 10
Transfers of Accumulation Units and Annuity Units Between Variable Portfolios;
Transfers of Accumulation Units To and From the Fixed Account
WITHDRAWAL PROVISIONS..............................................................PAGE 11
Deferment of Payments; Suspension of Payments
GENERAL PROVISIONS.................................................................PAGE 12
Entire Contract; Change of Annuitant; Death of Annuitant; Misstatement of Age or
Sex; Proof of Age, Sex or Survival; Conformity With State Laws; Changes in Law;
Assignment; Claims of Creditors; Premium Taxes or Other Taxes; Written Notice;
Periodic Reports; Incontestability; Nonparticipating
DEATH PROVISIONS...................................................................PAGE 13
Death of Owner Before the Annuity Date; Due Proof of Death; Amount of Death
Benefit; Death of Annuitant on or After the Annuity Date; Beneficiary
ANNUITY PROVISIONS.................................................................PAGE 16
Annuity Date; Payments to Owner; Deferment of Payments; Fixed Annuity Payments;
Amount of Fixed Annuity Payments; Amount of Variable Annuity Payments
ANNUITY PAYMENT OPTIONS............................................................PAGE 18
FIXED ANNUITY PAYMENT OPTIONS TABLE................................................PAGE 19
VARIABLE ANNUITY PAYMENT OPTIONS TABLE.............................................PAGE 21
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CONTRACT DATA PAGE
CONTRACT NUMBER: ANNUITY SERVICE CENTER:
P2899999999 X.X. XXX 00000
XXX XXXXXXX, XX 00000-0000
OWNER: AGE AT ISSUE:
XXXX XXX 35
ANNUITANT: PURCHASE PAYMENT:
XXXX XXX $10,000.00
ANNUITY DATE: CONTRACT DATE:
March 1, 2030 March 1, 2000
LATEST ANNUITY DATE: FIXED ACCOUNT OPTION -
March 1, 2055 Minimum Guarantee Rate:
3.0%
BENEFICIARY:
As named by You
SEPARATE ACCOUNT:
FS Variable Separate Account
FOR INQUIRIES
CALL 0-000-000-0000
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PURCHASE PAYMENT ALLOCATION
Variable Portfolios
[SUNAMERICA SERIES TRUST]
[25.00% Cash Management]
[0.00% Corporate Bond]
[0.00% Global Bond]
[0.00% High-Yield Bond]
[0.00% Worldwide High Income]
[0.00% SunAmerica Balanced]
[0.00%] MFS Total Return]
[0.00% Asset Allocation]
[25.00% Growth-Income]
[0.00% MFS Growth and Income]
[0.00% Federated Value]
[0.00% Xxxxx Venture Value]
[0.00% Alliance Growth]
[0.00% Xxxxxxx Xxxxx Research]
[0.00% Xxxxxx Growth]
[0.00% Blue Chip Growth]
[0.00% MFS Mid-Cap Growth]
[0.00% Aggressive Growth]
[0.00% Growth Opportunities]
[0.00% International Growth & Income
[0.00% Global Equities]
[0.00% Intl Diversified Equities]
[0.00% Emerging Markets]
[0.00% Technology]
[ANCHOR SERIES TRUST]
[25.00% Government & Quality Bond]
[0.00% Growth]
[0.00% Capital Appreciation]
Fixed Account Option
Guarantee Initial
Period Interest Rate
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50.00% 1-Year Fixed 3.00%
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DEFINITIONS
In this section We define some of the words and phrases used in this Contract.
These terms are capitalized when used in the Contract. Other capitalized terms
in the Contract refer to the captioned paragraph explaining that particular
concept in the Contract.
ACCUMULATION UNIT
A unit of measurement used to compute the Contract Value in a Variable Portfolio
prior to the Annuity Date.
AGE
Age as of last birthday.
ANNUITANT
The natural person or persons (collectively, Joint Annuitants) whose life or
lives is/are used to determine the annuity benefits under the Contract. If the
Contract is in force and the Annuitant(s) is/are alive on the Annuity Date, We
will begin payments to the Payee. This Contract cannot have Joint Annuitants if
it is issued on a tax-qualified basis.
ANNUITY DATE
The date on which annuity payments ("income payments") to the Payee are to
start.
ANNUITY SERVICE CENTER As specified on the Contract Data Page.
ANNUITY UNIT
A unit of measurement used to compute annuity payments from the Variable
Portfolios.
BENEFICIARY
The Beneficiary is as designated on the application unless later changed by the
Owner in a written request to Us at Our Annuity Service Center.
CONTRACT DATE
The date Your Contract is issued, as shown on the Contract Data Page. It is the
date from which Contract Years and anniversaries are measured.
CONTRACT VALUE
The sum of: (1) the Accumulation Unit Values for Your amounts allocated to the
Variable Portfolios; and (2) the value of amounts allocated to the 1-Year Fixed
Account Option.
CONTRACT YEAR
A year starting from the Contract Date in one calendar year and ending on the
day preceding the anniversary of such date in the succeeding calendar year.
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FIXED ACCOUNT OPTION
The investment option under this Contract that is credited with a fixed rate of
interest declared by the Company. The amounts allocated to the 1-Year Fixed
Account Option become part of the Company's general asset account. The Company
guarantees amounts in the Fixed Account. The general asset account contains all
the assets of the Company except for the Separate Account and other segregated
asset accounts. The Fixed Account Option for this Contract is shown on page 4.
FIXED ANNUITY
A series of periodic annuity payments of predetermined amounts that do not vary
with investment experience. Such payments are made from the Company's general
asset account.
GUARANTEE PERIOD
The one-year period for which either the Initial Interest Rate or the Renewal
Interest Rate is credited to amounts allocated to the 1-Year Fixed Account
Option.
INITIAL INTEREST RATE
The rate of interest credited to any portion of the Purchase Payment initially
allocated to the 1-Year Fixed Account Option, as described in the Accumulation
Provisions section. The Initial Interest Rate for this Contract is listed on
page 4. The Initial Interest Rate may not be less than the Minimum Guarantee
Rate as shown on the Contract Data Page.
IRC
The Internal Revenue Code of 1986 as amended, or as it may be amended or
superseded.
JOINT OWNER
If Joint Owners are named, each Joint Owner has an equal ownership interest in
the Contract unless We are advised otherwise in writing.
NYSE
New York Stock Exchange.
OWNER
The person or entity named in the Contract who is entitled to exercise all
rights and privileges of ownership under the Contract.
PAYEE
The person receiving payment of annuity benefits under this Contract.
PURCHASE PAYMENT
Payment in U.S. currency made by or on behalf of the Owner to the Company for
the Contract.
RENEWAL INTEREST RATE
The rate of interest declared by Us applicable to transfers from the Variable
Portfolios into the 1-Year Fixed Account Option and to amounts remaining in the
1-Year Fixed Account Option after the Guarantee Period has expired. The Renewal
Interest Rate may not be less than the Minimum Guarantee Rate as shown on the
Contract Data Page.
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SEPARATE ACCOUNT
The segregated asset account named on the Contract Data Page. The Separate
Account consists of the Variable Portfolios each investing in shares of the
Underlying Fund(s). The assets of the Separate Account are not commingled with
the general assets and liabilities of the Company. Each Variable Portfolio is
not chargeable with liabilities arising out of any other Variable Portfolio. The
value of amounts allocated to the Variable Portfolios of the Separate Account is
not guaranteed.
UNDERLYING FUND
The variable investment options in which the corresponding Variable Portfolio(s)
invest.
VARIABLE ANNUITY
A series of periodic annuity payments which vary in amount according to the
investment experience of one or more Variable Portfolios, as selected by You.
VARIABLE PORTFOLIO
One or more divisions of the Separate Account which invests in shares of the
corresponding Underlying Fund of the [Anchor Series Trust or the SunAmerica
Series Trust]. Each Variable Portfolio has its own investment objective and is
not chargeable with liabilities arising out of any other Variable Portfolio. The
available Variable Portfolios are shown on page 4. Additional Variable
Portfolios may become available in the future.
WE, OUR, US, THE COMPANY First
SunAmerica Life Insurance Company.
YOU, YOUR
The Owner.
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PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENT
The single Purchase Payment made in U. S. Currency. The Purchase Payment may be
allocated to the 1-Year Fixed Account Option and/or one or more Variable
Portfolio(s) in accordance with instructions from You.
SUBSTITUTION OF VARIABLE PORTFOLIO
If: (a) the shares of the Underlying Funds should no longer be available for
investment by the Separate Account; or (b) in the judgment of the Board of
Trustees for the [SunAmerica Series Trust and the Anchor Series Trust], further
investment in the shares of an Underlying Fund is no longer appropriate in view
of the purpose of the Contract, then We may substitute shares of another
Underlying Fund, for shares already purchased under the Contract. No
substitution of securities may take place without prior approval of the
Securities and Exchange Commission and under such requirements as it may impose.
ACCUMULATION PROVISIONS
SEPARATE ACCOUNT ACCUMULATION VALUE
The Separate Account Accumulation Value under the Contract shall be the sum of
the values of the Accumulation Units held in the Variable Portfolios for the
Owner.
NUMBER OF ACCUMULATION UNITS
Any portion of Your Purchase Payment allocated to the Variable Portfolios is
credited with Accumulation Units of the Separate Account. The number of
Accumulation Units credited is equal to the sum of that portion of the Purchase
Payment allocated to the Variable Portfolio, plus any amount transferred to that
Variable Portfolio, reduced by premium taxes, if any:
Divided by
The Accumulation Unit value for that Variable Portfolio as of the NYSE business
day in which the Purchase Payment or transfer amount is received.
The number of Accumulation Units will be similarly adjusted for withdrawals, and
transfers. Adjustments will be made as of the end of the NYSE business day in
which We receive all requirements for the transaction, as appropriate.
ACCUMULATION UNIT VALUE (AUV)
The AUV of a Variable Portfolio for any NYSE business day is calculated by
subtracting (2) from (1) and dividing the result by (3) where:
(1) is the total value at the end of the given NYSE business day of the
assets attributable to the Accumulation Units of the Variable Portfolio
minus the total liabilities;
(2) is the cumulative unpaid charge for assumption of Expense Risk,
Distribution Expense, Mortality Risk and Guaranteed Death Benefit Risk
charges (See CHARGES AND DEDUCTIONS);
(3) is the number of Accumulation Units outstanding at the end of the given
NYSE business day.
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FIXED ACCOUNT ACCUMULATION VALUE
Under the Contract, the 1-Year Fixed Account Accumulation Value shall be the sum
of all monies allocated or transferred to the 1-Year Fixed Account Option,
reduced by any applicable premium taxes, plus all interest credited on the
1-Year Fixed Account Option during the period that the Contract has been in
effect. This amount shall be adjusted for withdrawals, and transfers. The Fixed
Account Accumulation Value shall not be less than the minimum value required by
law in the state where this Contract is issued.
FIXED ACCOUNT GUARANTEE PERIOD OPTION AND INTEREST CREDITING
Amounts initially allocated to the 1-Year Fixed Account Option from the Purchase
Payment will earn interest at the Initial Interest Rate for a Guarantee Period
of one-year.
Transfers to the 1-Year Fixed Account Option from the Variable Portfolios and
amounts remaining in the 1-Year Fixed Account Option after the expiration of the
Guarantee Period will earn interest at the Renewal Interest Rate for a Guarantee
Period of one-year.
You may renew for the same Guaranteed Period at the Renewal Interest Rate or You
may transfer all or a portion of the amount to the Variable Portfolios. If a
renewal occurs within one year of the latest Annuity Date, We will credit
interest at the Renewal Interest Rate up to the Annuity Date.
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CHARGES AND DEDUCTIONS
We will deduct the following charges from Your Contract:
EXPENSE RISK CHARGE
On an annual basis, this charge equals 0.35% of the average daily ending value
of the assets attributable to the Accumulation Units of the Variable Portfolios
to which Your Contract Value is allocated. We subtract this charge daily. This
charge is to compensate Us for assuming the expense risks under the Contract.
DISTRIBUTION EXPENSE CHARGE
On an annual basis, this charge equals 0.15% of the average daily ending value
of the assets attributable to the Accumulation Units of the Variable Portfolios
to which Your Contract Value is allocated. We subtract this charge daily. This
charge is to compensate Us for all distribution expenses associated with the
Contract.
MORTALITY RISK CHARGE
On an annual basis, this charge equals 0.90% of the average daily ending value
of the assets attributable to the Accumulation Units of the Variable Portfolios
to which Your Contract Value is allocated. We subtract this charge daily. This
charge is to compensate Us for assuming the mortality risks under the Contract.
GUARANTEED DEATH BENEFIT RISK CHARGE
On an annual basis, this charge equals 0.12% of the average daily ending value
of the assets attributable to the Accumulation Units of the Variable Portfolios
to which Your Contract Value is allocated. We subtract this charge daily. This
charge is to compensate Us for the risk assumed as a result of contractual
obligations to provide a minimum guaranteed death benefit prior to the Annuity
Date.
TRANSFER PROVISIONS
Prior to the Annuity Date, You may transfer all or part of Your Contract Value
to any of the Variable Portfolios or the 1-Year Fixed Account Option. We do not
currently limit the number of transfers per Contract Year. In the future we
reserve the right to charge a fee for transfers in excess of a certain number
per Contract Year. If we do charge a fee in the future, it will never exceed
$25.00. The minimum amount that can be transferred is $100 and the minimum
amount that can remain in a Variable Portfolio or a Fixed Account Option is
$100, or $0 in the case of full transfer.
TRANSFERS OF ACCUMULATION AND ANNUITY UNITS BETWEEN VARIABLE PORTFOLIOS
Prior to the Annuity Date, You may transfer all or a portion of Your Contract
Value from one Variable Portfolio to another Variable Portfolio. A transfer will
result in the purchase of Accumulation Units in a Variable Portfolio and the
redemption of Accumulation Units in the other Variable Portfolio. Transfers will
be effected at the end of the NYSE business day in which We receive Your request
for the transfer.
After the Annuity Date, if You choose a variable annuitization, You may transfer
all or a portion of Your Contract Value from one Variable Portfolio to another
Variable Portfolio. A transfer will result in the purchase of Annuity Units in a
Variable Portfolio and the redemption of Annuity Units in the other
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Variable Portfolio. Transfers will be effected at the end of the last NYSE
business day of the month in which We receive Your request for the transfer.
TRANSFERS OF ACCUMULATION UNITS TO AND FROM THE FIXED ACCOUNT
Prior to the Annuity Date, You may transfer all or any part of Your Contract
Value from the Variable Portfolio(s) to the 1-Year Fixed Account Option or from
the 1-Year Fixed Account Option to the Variable Portfolio(s) of the Contract.
After the Annuity Date, transfers into or out of the 1-Year Fixed Account Option
are not allowed.
WITHDRAWAL PROVISIONS
On or before the Annuity Date and while the Owner is living, You may withdraw
all or part of Your Contract Value under this Contract by informing Us at Our
Annuity Service Center. For a full withdrawal, this Contract must be returned to
Our Annuity Service Center. You can elect to schedule withdrawals on a monthly,
quarterly, semi-annual or annual basis. If you elect scheduled withdrawals, the
minimum withdrawal amount is $250.00 per payment. Scheduled withdrawals, like
any other withdrawal are taxable and may be subject to 10% premature withdrawal
penalties. We reserve the right to eliminate, modify or suspend the availability
of scheduled payments at any time. Except in connection with scheduled
withdrawals, the minimum partial withdrawal amount is $1,000 and the minimum
amount that must remain in the Contract after a partial withdrawal is $500.00.
Without a written notice to the contrary, withdrawals will be deducted from the
Contract Value in proportion to their allocation among the Fixed Account Option
and the Variable Portfolios. Withdrawals will be based on values for the NYSE
business day in which the request for withdrawal and the Contract (in the case
of a full withdrawal) are received at Our Annuity Service Center. Unless the
DEFERMENT OF PAYMENTS or SUSPENSION OF PAYMENTS sections is in effect, payment
of withdrawals will be made within seven calendar days.
DEFERMENT OF PAYMENTS
We may defer making payments from the 1-Year Fixed Account Option for up to six
(6) months. Interest, subject to state requirements, will be credited during the
deferral period.
SUSPENSION OF PAYMENTS
We may suspend or postpone any payments from the Variable Portfolios if any of
the following occur:
(a) the NYSE is closed;
(b) trading on the NYSE is restricted;
(c) an emergency exists such that it is not reasonably practical to dispose
of securities in the Portfolios or to determine the value of its assets;
or
(d) the Securities and Exchange Commission, by order, so permits for the
protection of Owners.
Conditions in (b) and (c) will be decided by or in accordance with rules of the
Securities and Exchange Commission.
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GENERAL PROVISIONS
ENTIRE CONTRACT
The entire Contract between You and Us consists of the application as completed
by You at the time of purchase, this Contract and any attached endorsement(s).
An agent cannot change the terms or conditions of this Contract. Any change must
be in writing and approved by Us. Only Our President, Secretary, or one of Our
Vice-Presidents can give Our approval.
CHANGE OF ANNUITANT
If the Owner is an individual, the Owner may change the Annuitant at any time
prior to the Annuity Date. To make a change, the Owner must send a written
notice to Us at least 30 days before the Annuity Date. If the Owner is not an
individual, the Owner may not change the Annuitant.
DEATH OF ANNUITANT
If the Owner and Annuitant are different, and the Annuitant dies before the
Annuity Date, the Owner becomes the Annuitant until the Owner elects a new
Annuitant. If there are Joint Annuitants, upon the death of any Annuitant prior
to the Annuity Date, the Owner may elect a new Joint Annuitant. However, if the
Owner is a non-natural person, We will treat the death of any Annuitant as the
death of the "Primary Annuitant" and as the death of the Owner, see DEATH
PROVISIONS.
MISSTATEMENT OF AGE OR SEX
If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment of the Fixed
Annuity Payment Option, plus interest at the rate of 4% per year, will be
deducted from the next payment due. Any underpayment of the Fixed Annuity
Payment Option, plus interest at the rate of 4% per year, will be paid in full
with the next payment due. Any overpayment of the Variable Annuity Payment
Option will be deducted from the next payment due. Any underpayment of the
Variable Annuity Payment Option will be paid in full with the next payment due.
PROOF OF AGE, SEX, OR SURVIVAL
The Company may require satisfactory proof of correct Age or sex at any time. If
any payment under this Contract depends on the Annuitant being alive, the
Company may require satisfactory proof of survival.
CONFORMITY WITH STATE LAWS
The laws of the state in which it was delivered will interpret the provisions of
this Contract. Any provision which, on the Contract Date, is in conflict with
the laws of such state is amended to conform to the minimum requirements of such
law.
CHANGES IN LAW
If the laws governing this Contract or the taxation of benefits under the
Contract change, We will amend this Contract, subject to New York Department of
Insurance approval, to comply with these changes.
ASSIGNMENT
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You may assign this Contract before the Annuity Date, but We will not be bound
by an assignment unless it is received by Us in writing. Your rights and those
of any other person referred to in this Contract will be subject to the
assignment. Certain assignments may be taxable. We do not assume any
responsibility for the validity or tax consequences of any assignment.
CLAIMS OF CREDITORS
To the extent permitted by law, no right or proceeds payable under this Contract
will be subject to claims of creditors or legal process.
PREMIUM TAXES OR OTHER TAXES
The Company may deduct from Your Contract Value any premium tax or other taxes
payable to a state or other government entity, if applicable. Should We advance
any amount so due, We are not waiving any right to collect such amount at a
later date. The Company will deduct any withholding taxes required by applicable
law.
WRITTEN NOTICE
Any notice We send to You will be sent to Your address shown in the application
unless You request otherwise. Any written request or notice to Us must be sent
to Our Annuity Service Center, as specified on the Contract Data Page.
PERIODIC REPORTS
During each Contract Year, We will send You quarterly statements of the account
activity of the Contract. The statement will include all transactions that have
occurred during the quarterly accounting period shown on the statement.
INCONTESTABILITY
This Contract will be incontestable from the Contract Date.
NONPARTICIPATING
This Contract does not share in Our surplus.
DEATH PROVISIONS
Notwithstanding any provision of this Contract to the contrary, all payments of
benefits under this Contract will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time. If a trust or
other non-natural person owns the Contract, We will treat the death of any
Annuitant as the death of the "Primary Annuitant" and as the death of any Owner.
DEATH OF OWNER BEFORE THE ANNUITY DATE
We will pay a death benefit to the Beneficiary upon Our receiving all required
documentation including: (a) due proof that any Owner died before the Annuity
Date; and (b) an election form selecting the death benefit option. If no
election is received within 60 days of Our receipt of due proof of death, the
death benefit will be paid in accordance with option 1 below. The Beneficiary
must select one of the following options:
1. Immediately collect the death benefit in a lump sum payment. If a lump
sum payment is elected, payment will be in accordance with any
applicable laws and regulations governing payments and death; or
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2. Collect the death benefit in the form of one of the Annuity Payment
Options. The payments must be over the life of the Beneficiary or over a
period not extending beyond the life expectancy of the Beneficiary.
Payments under this death benefit option must commence within one year
after the Owner's death, otherwise, the death benefit will be paid in
accordance with option 1 above; or
3. If the Beneficiary is the Owner's spouse, the Beneficiary may elect to
become the Owner and continue the Contract in force. If this option is
elected, no death benefit is paid. Upon the new Owner's subsequent
death, the entire interest must be distributed immediately under option
1 or 2 above.
In any event, the entire interest in the Contract will be distributed within
five years from the date of death of the Owner.
DUE PROOF OF DEATH
Due Proof of Death means:
1. a certified copy of a death certificate; or
2. a certified copy of a decree of a court of competent jurisdiction as to
the finding of death; or
3. a written statement by a medical doctor who attended the deceased Owner
at the time of death; or
4. any other proof satisfactory to Us.
AMOUNT OF DEATH BENEFIT
If, upon the death of the Owner and prior to the Annuity Date, the Owner had not
attained his or her 90th birthday, the Beneficiary will receive the greatest of:
1. the Contract Value at the end of the NYSE business day during which We
receive at Our Annuity Service Center the required Due Proof of Death
documentation of the Owner and an election of the type of payment to be
made; or
2. the Purchase Payment, reduced for partial withdrawals in the same
proportion that the Contract Value was reduced on the date of any such
withdrawals; or
3. the maximum anniversary value preceding the date of death. The maximum
anniversary value is equal to the greatest anniversary value attained
from the following:
On the date We receive at Our Annuity Service Center Due Proof of Death
and an election of the type of payment to be made, We will calculate an
anniversary value for each Contract anniversary prior to the Owner's
81st birthday. The anniversary value is the Contract Value at each
Contract anniversary, reduced for partial withdrawals in the same
proportion that the Contract Value was reduced on the date of any such
withdrawals since that anniversary.
If the deceased Owner had attained age 90, then the death benefit will be the
Contract Value as defined in (1) above.
DEATH OF ANNUITANT ON OR AFTER THE ANNUITY DATE
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If the Annuitant(s) dies on or after the Annuity Date and before the entire
interest in the Contract has been distributed, We will pay the remaining portion
of the interest of the Contract as under the annuity payment option being used
on the date of death, to the Beneficiary. For further information pertaining to
death of the Annuitant, see ANNUITY PAYMENT OPTIONS.
BENEFICIARY
The Owner selects the Beneficiary. While (a) the Owner is living; and (b) before
the Annuity Date, the Owner may change the Beneficiary by written notice in a
form satisfactory to Us. A change in Beneficiary will take effect on the date
the notice of change was signed. Such change, however, will not apply to any
payment or action taken by Us before the notice was received at Our Annuity
Service Center. If two or more persons are named, (a) those surviving the Owner
will share equally unless otherwise stated; and (b) the Beneficiaries must elect
to receive their respective portions of the death benefit according to the
options listed under DEATH OF OWNER BEFORE THE ANNUITY DATE. If the Annuitant
survives the Owner, and there are no surviving Beneficiaries, the Annuitant will
be deemed the Beneficiary.
Joint Owners, if applicable, shall be each other's primary Beneficiary. Joint
Annuitants, if any, when the Owner is a non-natural person, shall be each
other's primary Beneficiary. Any other Beneficiary designation will be treated
as a contingent Beneficiary.
If the Owner is also the Annuitant and there are no surviving Beneficiaries at
the death of the Owner, the death benefit will be paid to the estate of the
Owner in accordance with option 1, under DEATH OF OWNER BEFORE THE ANNUITY DATE.
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ANNUITY PROVISIONS
ANNUITY DATE
The Owner selects an Annuity Date (the date on which annuity payments are to
begin) at the time of application. The Owner may change the Annuity Date at any
time, at least seven days prior to the Annuity Date, by written notice to the
Company at Our Annuity Service Center. The Annuity Date must be at least two
years after the Contract Date, but not beyond the Annuitant's 90th birthday. If
no Annuity Date is selected, the Annuity Date will be the latest Annuity Date,
as set by the Company.
At the time the annuity payments commence, payments will not be less than those
that would be provided if the same amount was applied to purchase a single
premium immediate annuity contract offered by the Company.
PAYMENTS TO OWNER
Unless You request otherwise, We will make annuity payments to You. If You want
the annuity payments to be made to some other Payee, We will make such payments
subject to receipt of a written request filed at the Annuity Service Center no
later than thirty (30) days before the due date of the first annuity payment.
Any such request is subject to the rights of any assignee. No payments available
to or being paid to the Payee while the Annuitant is alive can be transferred,
commuted, anticipated, or encumbered.
DEFERMENT OF PAYMENTS
We may defer making payments from the 1-Year Fixed Account Option for up to six
(6) months. Interest, subject to state requirements, will be credited during the
deferral period.
FIXED ANNUITY PAYMENTS
If a Fixed Annuity payment option has been elected, the proceeds payable under
this Contract less any applicable premium taxes, shall be applied to the payment
of the Fixed Annuity payment option elected at rates which are at least equal to
the annuity rates based upon the applicable tables in the Contract. In no event
will the Fixed Annuity Payments be changed once they begin.
AMOUNT OF FIXED ANNUITY PAYMENTS
The amount of each Fixed Annuity Payment will be determined by applying the
portion of the Contract Value allocated to Fixed Annuity Payments less any
applicable premium taxes to the annuity table applicable to the Fixed Annuity
Payment option chosen.
AMOUNT OF VARIABLE ANNUITY PAYMENTS
(a) FIRST VARIABLE ANNUITY PAYMENT: The dollar amount of the first Variable
Annuity Payment will be determined by applying the portion of the
Contract Value allocated to the Variable Portfolio, less any applicable
premium taxes, to the annuity table applicable to the Variable Annuity
payment option chosen. If the Contract Value is allocated to more than
one Variable Portfolio, the value of Your interest in each Variable
Portfolio is applied separately to the Variable Annuity payment option
table to determine the amount of the first annuity payment attributable
to each Variable Portfolio.
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(b) NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
applicable Variable Portfolio is the amount of the first annuity payment
attributable to that Variable Portfolio divided by the value of the
applicable Annuity Unit for that Variable Portfolio as of the Annuity
Date. The number will not change as a result of investment experience.
(c) VALUE OF EACH VARIABLE ANNUITY UNIT: The value of an Annuity Unit may
increase or decrease from one month to the next. For any month, the
value of an Annuity Unit of a particular Variable Portfolio is the value
of that Annuity Unit as of the last NYSE business day of the preceding
month, multiplied by the Net Investment Factor for that Variable
Portfolio for the last NYSE business day of the current month.
The Net Investment Factor for any Variable Portfolio for a certain month is
determined by dividing (1) by (2) where:
(1) is the Accumulation Unit Value of the Variable Portfolio
determined as of the last business day at the end of that month,
and
(2) is the Accumulation Unit Value of the Variable Portfolio
determined as of the last business day at the end of the
preceding month.
The result is then multiplied by a factor that neutralizes the assumed
investment rate of 3.5%.
(d) SUBSEQUENT VARIABLE ANNUITY PAYMENTS: After the first Variable Annuity
payment, payments will vary in amount according to the investment
performance of the applicable Variable Portfolio(s) to which Your
Purchase Payment is allocated. The amount may change from month to
month. The amount of each subsequent payment for each Variable Portfolio
is:
The number of Annuity Units for each Variable Portfolio as determined for the
first annuity payment
Multiplied by
The value of an Annuity Unit for that Variable Portfolio at the end of the month
immediately preceding the month in which payment is due.
We guarantee that the amount of each Variable Annuity payment will not be
affected by variations in expenses or mortality experience.
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ANNUITY PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Contract to the Company at its Annuity Service Center, the Contract Value may be
applied to provide one of the following options or any annuity payment option
that is mutually agreeable. After two years from the Contract Date, and prior to
the Annuity Date, You can choose one of the options described below. If no
option has been selected by the Annuity Date, You will automatically receive
option 4, below, with 120 monthly payments guaranteed.
OPTIONS 1 & 1V - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED
Payments are payable to a Payee during the lifetime of the Annuitant. No further
payments are payable after the death of the Annuitant.
OPTIONS 2 & 2V - JOINT AND SURVIVOR LIFE ANNUITY
Payments are payable to the Payee during the lifetime of the Annuitant and
during the lifetime of a designated second person. No further payments are
payable after the deaths of both the Annuitant and the designated second person.
OPTIONS 3 & 3V - JOINT AND SURVIVOR LIFE ANNUITY - 120 MONTHLY PAYMENTS
GUARANTEED
Payments are payable to the Payee during the lifetime of the Annuitant and
during the lifetime of a designated second person. If, at the death of the
survivor, payments have been made for less than 120 monthly periods, the
remaining guaranteed annuity payments will be continued to the Beneficiary.
OPTIONS 4 & 4V - LIFE ANNUITY WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED
Payments are payable to the Payee during the lifetime of the Annuitant. If, at
the death of the Annuitant, payments have been made for less than the 120 or 240
monthly periods, as selected at the time of annuitization, the remaining
guaranteed annuity payments will be continued to the Beneficiary.
OPTIONS 5 & 5V - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
Payments are payable to the Payee for any specified period of time of five (5)
years or more, but not exceeding thirty (30) years, as selected at the time of
annuitization. The selection must be made for full twelve-month periods. In the
event of death of the Annuitant, any remaining annuity payments will be
continued to the Beneficiary. If Variable Annuity Payments are elected under
this Annuity Payment Option, any remaining guaranteed Variable Annuity payments
may be redeemed for a discounted value determined by Us.
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FIXED ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the 1983a Individual
Annuity Mortality Table with projection and a guaranteed interest rate of 3%.
The mortality table is projected using Projection Scale G factors, assuming
annuitization in the year 2000. The Fixed Annuity Payment Options Table does not
include any applicable premium tax.
OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
OPTION 4 OPTION 4
OPTION 1 LIFE ANNUITY LIFE ANNUITY
LIFE ANNUITY (W/120 PAYMENTS GUARANTEED) (W/240 PAYMENTS GUARANTEED)
AGE OF ------------- --------------------------- ---------------------------
ANNUITANT MALE FEMALE MALE FEMALE MALE FEMALE
--------- ---- ------ ---- ------ ---- ------
55 4.23 3.84 4.19 3.82 4.05 3.76
56 4.32 3.91 4.27 3.88 4.11 3.81
57 4.41 3.98 4.35 3.95 4.17 3.87
58 4.51 4.05 4.44 4.02 4.24 3.93
59 4.61 4.13 4.54 4.10 4.31 4.00
60 4.72 4.22 4.64 4.18 4.37 4.06
61 4.84 4.31 4.74 4.27 4.44 4.13
62 4.96 4.40 4.85 4.36 4.51 4.20
63 5.10 4.51 4.97 4.45 4.58 4.27
64 5.24 4.62 5.10 4.55 4.65 4.35
65 5.40 4.73 5.22 4.66 4.72 4.42
66 5.56 4.86 5.36 4.78 4.79 4.50
67 5.74 4.99 5.50 4.90 4.86 4.57
68 5.93 5.14 5.65 5.02 4.92 4.65
69 6.13 5.29 5.80 5.16 4.99 4.73
70 6.35 5.46 5.96 5.30 5.05 4.80
71 6.58 5.64 6.13 5.46 5.10 4.88
72 6.82 5.84 6.29 5.62 5.16 4.95
73 7.08 6.05 6.47 5.78 5.20 5.02
74 7.36 6.28 6.64 5.96 5.25 5.08
75 7.66 6.53 6.82 6.14 5.29 5.14
76 7.98 6.80 7.00 6.33 5.33 5.19
77 8.33 7.09 7.19 6.53 5.36 5.24
78 8.69 7.41 7.37 6.73 5.39 5.29
79 9.09 7.75 7.55 6.94 5.41 5.33
80 9.51 8.11 7.73 7.14 5.43 5.36
81 9.97 8.51 7.91 7.35 5.45 5.39
82 10.45 8.94 8.08 7.55 5.47 5.42
83 10.97 9.41 8.24 7.76 5.48 5.44
84 11.52 9.92 8.40 7.95 5.49 5.46
85 12.10 10.47 8.54 8.13 5.50 5.48
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OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.54 3.69 3.84 3.96 4.06 4.13 4.17
60 3.63 3.83 4.04 4.23 4.39 4.52 4.60
65 3.70 3.95 4.23 4.51 4.78 5.00 5.16
70 3.75 4.04 4.39 4.78 5.18 5.56 5.85
75 3.78 4.11 4.51 5.01 5.57 6.14 6.65
80 3.81 4.15 4.60 5.18 5.89 6.70 7.52
85 3.82 4.18 4.66 5.30 6.14 7.18 8.35
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.54 3.69 3.83 3.96 4.05 4.12 4.16
60 3.63 3.83 4.03 4.22 4.38 4.50 4.57
65 3.70 3.95 4.22 4.50 4.76 4.97 5.10
70 3.75 4.04 4.38 4.76 5.15 5.48 5.72
75 3.78 4.10 4.50 4.98 5.50 6.00 6.40
80 3.80 4.14 4.58 5.13 5.78 6.46 7.04
85 3.81 4.16 4.62 5.22 5.97 6.80 7.55
OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000
FIXED PAYMENT FOR SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 9.61 17 6.23 24 4.84
11 8.86 18 5.96 25 4.71
5 17.91 12 8.24 19 5.73 26 4.59
6 15.14 13 7.71 20 5.51 27 4.47
7 13.16 14 7.26 21 5.32 28 4.37
8 11.68 15 6.87 22 5.15 29 4.27
9 10.53 16 6.53 23 4.99 30 4.18
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VARIABLE ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Table of Annuity Rates is the 1983a Individual
Annuity Mortality Table with projection and an effective annual Assumed
Investment Rate of 3.5%. The mortality table is projected using Projection Scale
G factors, assuming annuitization in the year 2000. The Variable Annuity Payment
Options Table does not include any applicable premium tax.
OPTIONS 1V& 4V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
OPTION 4V OPTION 4V
LIFE ANNUITY LIFE ANNUITY
AGE OF OPTION 1V (W/120 PAYMENTS (W/240 PAYMENTS
ANNUITANT LIFE ANNUITY GUARANTEED) GUARANTEED)
--------- -------------- --------------------- ---------------------
MALE FEMALE MALE FEMALE MALE FEMALE
---- ------ ---- ------ ---- ------
55 4.53 4.13 4.48 4.11 4.33 4.05
56 4.62 4.20 4.56 4.18 4.39 4.10
57 4.71 4.27 4.64 4.24 4.45 4.16
58 4.80 4.34 4.73 4.31 4.52 4.22
59 4.90 4.42 4.82 4.39 4.58 4.28
60 5.01 4.51 4.92 4.47 4.65 4.34
61 5.13 4.60 5.03 4.55 4.71 4.41
62 5.26 4.69 5.14 4.64 4.78 4.48
63 5.39 4.80 5.25 4.74 4.85 4.55
64 5.54 4.91 5.38 4.84 4.92 4.62
65 5.69 5.02 5.51 4.94 4.99 4.69
66 5.86 5.15 5.64 5.06 5.05 4.77
67 6.03 5.28 5.78 5.18 5.12 4.84
68 6.22 5.43 5.93 5.30 5.18 4.92
69 6.43 5.58 6.08 5.44 5.24 4.99
70 6.64 5.75 6.23 5.58 5.30 5.06
71 6.87 5.93 6.40 5.73 5.36 5.14
72 7.12 6.13 6.56 5.89 5.41 5.21
73 7.38 6.34 6.73 6.06 5.46 5.27
74 7.66 6.57 6.91 6.23 5.50 5.33
75 7.96 6.82 7.09 6.41 5.54 5.39
76 8.28 7.09 7.27 6.60 5.57 5.44
77 8.63 7.38 7.45 6.79 5.61 5.49
78 9.00 7.70 7.63 6.99 5.63 5.54
79 9.40 8.04 7.81 7.19 5.66 5.58
80 9.82 8.41 7.98 7.40 5.68 5.61
81 10.28 8.81 8.16 7.60 5.70 5.64
82 10.76 9.24 8.32 7.81 5.71 5.66
83 11.28 9.71 8.48 8.00 5.72 5.69
84 11.83 10.23 8.64 8.19 5.73 5.70
85 12.42 10.78 8.78 8.38 5.74 5.72
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OPTION 2V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.83 3.98 4.12 4.24 4.34 4.42 4.46
60 3.92 4.11 4.32 4.51 4.67 4.80 4.89
65 3.99 4.23 4.50 4.79 5.05 5.28 5.44
70 4.04 4.33 4.67 5.05 5.46 5.83 6.13
75 4.07 4.39 4.79 5.28 5.84 6.41 6.93
80 4.10 4.44 4.88 5.45 6.16 6.97 7.79
85 4.11 4.47 4.94 5.57 6.41 7.45 8.61
OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------------------------------------------------------
55 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
55 3.83 3.98 4.12 4.24 4.34 4.40 4.45
60 3.92 4.11 4.31 4.50 4.66 4.78 4.86
65 3.99 4.23 4.50 4.78 5.03 5.24 5.38
70 4.04 4.32 4.66 5.03 5.41 5.75 5.99
75 4.07 4.38 4.78 5.25 5.77 6.26 6.66
80 4.09 4.43 4.86 5.40 6.05 6.72 7.29
85 4.10 4.45 4.90 5.50 6.24 7.05 7.80
OPTION 5V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
PAYMENTS FOR A SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 9.83 17 6.47 24 5.09
11 9.09 18 6.20 25 4.96
5 18.12 12 8.46 19 5.97 26 4.84
6 15.35 13 7.94 20 5.75 27 4.73
7 13.38 14 7.49 21 5.56 28 4.63
8 11.90 15 7.10 22 5.39 29 4.53
9 10.75 16 6.76 23 5.24 30 4.45
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FIRST SUNAMERICA LIFE INSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
INDIVIDUAL SINGLE PREMIUM
FIXED AND VARIABLE
ANNUITY CONTRACT
Nonparticipating
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