EXHIBIT 4(b)
Form of Individual Variable Annuity Policy (21VAN0896NY)
American International Life Assurance
Company of New York
00 Xxxx Xxxxxx
Xxx Xxxx, Xxx Xxxx 00000
A capital stock company
This is a legal contract issued in consideration of the payment of the
Initial Premium. We will make annuity payments to the Annuitant as set
forth in this contract beginning on the Annuity Date.
READ YOUR CONTRACT CAREFULLY
RIGHT TO CANCEL THIS CONTRACT
This contract may be returned within 10 days after You receive it. It can
be mailed or delivered to either Us or Our agent. Return of this contract
by mail is effective as of the date of its postmark, properly addressed and
postage pre-paid. The returned contract will be treated as if We had never
issued it. We will promptly refund the Contract Value as of the date of
return; this may be more or less than the Premium paid.
This is a variable annuity contract. Annuity payments and Contract Value
may increase or decrease depending on the experience of the Variable
Account identified in the Contract Schedule.
Signed by the Company:
Xxxxxxxxx X. Xxxx XX X'Xxxxxxx
/s/ Xxxxxxxxx X.Xxxx /s/ XX X'Xxxxxxx
Secretary President
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY
NONPARTICIPATING
TABLE OF CONTENTS
PAGE
CONTRACT SCHEDULE 3
DEFINITIONS 4
GENERAL PROVISIONS 5
OWNERSHIP PROVISIONS 6
BENEFICIARY PROVISIONS 6
PREMIUM PROVISIONS 6
VARIABLE ACCOUNT 7
GUARANTEED ACCOUNT 7
TRANSFERS 8
CONTRACT CHARGES 9
DOLLAR COST AVERAGING 9
ANNUITY PROVISIONS 10
ANNUITY OPTIONS 10
DEATH BENEFIT 12
SURRENDER PROVISIONS 13
DELAY OF PAYMENTS 13
FIXED OPTIONS TABLE 14
VARIABLE OPTIONS TABLE 15
CONTRACT SCHEDULE
CONTRACT NUMBER: ( 12345 ) INITIAL PREMIUM: ($5,000)
OWNER(S): (XXXX XXX) MINIMUM SUBSEQUENT PREMIUM: $1,000
ANNUITANT: (XXXX XXX) EFFECTIVE DATE:( 10/01/1996)
BENEFICIARY: (XXXX XXX) ANNUITY DATE: ( 10/01/2036 )
CONTRACT MAINTENANCE CHARGE: $30.00 each Contract Year. Before the Annuity Date,
this charge will be waived for each year that the Contract Value exceeds $50,000
on the Contract Anniversary.
ADMINISTRATIVE CHARGE: Equal on an annual basis to .15% of the average daily net
assets of the Variable Account.
MORTALITY AND EXPENSE RISK CHARGE: Equal on an annual basis to 1.25% of the
average daily net assets of the Variable Account.
[ANNUAL RATCHET RIDER CHARGE: Equal on an annual basis to .10% of the average
daily net assets of the Variable Account; calculated and deducted monthly.]
The assets of the Variable Account must earn a minimum annual rate of 6.4% so
that the dollar amount of the variable annuity payments will not decrease below
the level shown in the Options On A Variable Basis Table on page 15.
TRANSFER FEE: $10.00 However, we will not make a charge for the first 12
transfers in any policy year.
SURRENDER CHARGE:
Number of Complete Years Percentage of Number of Complete Years Percentage of
Since Premium Payment Premium Since Premium Payment Premium
0 6% 4 4%
1 6% 5 3%
2 5% 6 2%
3 5% 7 0%
SEPARATE ACCOUNT ALLOCATIONS: [Variable Account A]
[%]
[%]
[%]
[%]
[%]
[%]
GENERAL ACCOUNT ALLOCATION:
ONE YEAR GUARANTEE PERIOD: [%]
ANNUITY SERVICE OFFICE:
[AI Life Assurance Company of New York
c/o Delaware Valley Financial Services
000 Xxxxxx Xxxx
P.O. Box 3031
Berwyn, PA 19312-0031
(000) 000-0000]
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DEFINITIONS
ACCUMULATION UNIT - An accounting unit of measure used to calculate the Contract
Value prior to the Annuity Date.
ADMINISTRATIVE OFFICE - The Annuity Service Office of the Company as designated
on the Contract Schedule.
ANNUITANT - The person designated by the Owner upon whose continuation of life
any annuity payment involving life contingencies depends.
ANNUITY DATE - The date on which annuity payments are to commence.
ANNUITY OPTION - An arrangement under which annuity payments are made under this
contract.
ANNUITY UNIT - An accounting unit of measure used to calculate annuity payments
after the Annuity Date.
CONTRACT ANNIVERSARY - An anniversary of the Effective Date of this contract.
CONTRACT VALUE - The dollar value as of any Valuation Date of all amounts
accumulated under this contract.
CONTRACT YEAR - Each period of twelve (12) months commencing with the Effective
Date.
EFFECTIVE DATE - The date shown on the Contract Schedule on which the first
Contract Year begins.
ELIGIBLE INVESTMENT(S) - Those investments available under the contract.
Eligible Investments, at the time this contract is issued, are shown in the
application for this Contract.
GUARANTEED ACCOUNT - A part of Our General Account which earns a Guaranteed Rate
of interest.
OWNER - The Owner is named in the Contract Schedule, unless changed, and has all
rights under this contract.
PREMIUM - Purchase payments are referred to in this contract as Premiums.
SUBACCOUNT - A division of the Variable Account established to invest in a
particular portfolio of Eligible Investments.
VALUATION DATE - Each day that the New York Stock Exchange is open for trading.
VALUATION PERIOD - The period between the close of business of the New York
Stock Exchange on any Valuation Date and the close of business for the next
succeeding Valuation Date.
VARIABLE ACCOUNT - The Separate Account designated on the Contract Schedule.
WE, OUR, US - American International Life Assurance Company of New York.
YOU, YOUR - The Owner of this contract.
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GENERAL PROVISIONS
THE CONTRACT - The entire contract consists of this form and any attached
endorsement, rider or application. This contract may be changed or altered only
by Our President or Secretary. Any change, modification or waiver must be made
in writing.
NON-PARTICIPATION IN SURPLUS - This contract does not share in any distribution
of Our profits or surplus.
INCONTESTABILITY - This contract is not contestable.
MISSTATEMENT OF AGE OR SEX - We will require proof of age and sex of the
Annuitant before making any life annuity payment provided for by this contract.
If the age or sex of the Annuitant has been misstated, the amount payable will
be the amount that the Contract Value would have provided at the true age or
sex.
Once annuity payments have begun, any underpayments will be made up in one sum
including interest at the annual rate of 3%, unless a higher interest rate is
required by the law of the jurisdiction where this contract is delivered, with
the next annuity payment. Overpayments including interest at the annual rate of
3%, unless a higher interest rate is required by the law of the jurisdiction
where this contract is delivered, will be deducted from the future annuity
payments until the total is repaid.
CONTRACT SETTLEMENT - This contract must be returned to Us upon settlement as a
death claim. Prior to any settlement as a death claim, due proof of death must
be submitted to Us.
REPORTS - We will furnish You with a report showing the Contract Value at least
once each calendar year. We will also furnish an annual report of the Variable
Account. These reports will be sent to Your last known address.
TAXES - Any taxes paid to any governmental entity will be charged against the
Premiums or the Contract Value, depending upon the Owner's state of residence.
We may, at Our sole discretion, pay taxes when due and deduct that amount from
the Contract Value at a later date. Our payment of such taxes at an earlier date
does not waive any right We may have to deduct amounts at a later date.
EVIDENCE OF SURVIVAL - Where any benefits under this contract are contingent
upon the recipient being alive on a given date, We will require proof
satisfactory to Us that the condition has been met.
PROTECTION OF PROCEEDS - No Beneficiary or payee may commute, or assign any
payments under this contract before they are due. To the extent permitted by
law, no payments will be subject to the debts of any Beneficiary or payee nor to
any judicial process for payment of those debts.
MODIFICATION OF CONTRACT - This contract may not be modified by Us, without Your
consent except as may be required by applicable law. If the state insurance laws
or regulations, the federal securities or tax laws or regulations, or any
regulations under which this contract would qualify as an annuity change, We may
amend this contract to comply with these changes.
MINIMUM BENEFITS - Any paid-up annuity, cash surrender or death benefit that may
be available under this contract is not less than the minimum benefits required
by statute in the jurisdiction in which this contract is delivered.
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OWNERSHIP PROVISIONS
OWNER - The Owner is named in the Contract Schedule.
The Owner may exercise all the rights of this contract, subject to the rights
of:
1. any assignee under an assignment filed with Our Administrative Office; and
2. any irrevocably named Beneficiary.
TRANSFER OF OWNERSHIP - You may transfer Ownership of this contract. A written
request, dated and signed by You, must be sent to and received by Our
Administrative Office. We may require this contract for endorsement. The
transfer will take effect as of the date the request was received and recorded
at Our Administrative Office.
Transfer of Ownership does not change the Beneficiary, nor transfer the
Beneficiary's interest. Any change or transfer of Ownership is subject to any
payment made by Us before the request is received and recorded at Our
Administrative Office.
ASSIGNMENT - You may assign this contract. A copy of any assignment must be
filed with Our Administrative Office. We are not responsible for the validity of
any assignment. If You assign this contract, Your rights and those of any
revocably-named person will be subject to the assignment. An assignment will not
affect any payments We may make or actions We may take before such assignment
has been recorded at Our Administrative Office. A change in ownership or an
assignment may result in adverse tax consequences.
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BENEFICIARY PROVISIONS
BENEFICIARY - The Beneficiary will receive the death benefit. The Beneficiary is
named in the Contract Schedule.
DEATH OF BENEFICIARY - If no named beneficiary is living at the time a death
benefit becomes payable we will pay the death benefit to Your estate.
CHANGE OF BENEFICIARY - To change a beneficiary, a written request for a change
of beneficiary, dated and signed by You, must be received at Our Administrative
Office. If the request is received at Our Administrative Office after the death
of the Owner, it will be effective only if no payment has been made. After the
change is recorded, it will take effect as of the date the request was signed.
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PREMIUM PROVISIONS
PREMIUM - The Initial Premium is due on or before the Effective Date.
Thereafter, Premium payments may be made at any time prior to the Annuity Date,
in an amount equal to or greater than the Minimum Subsequent Premium amount,
shown on the Contract Schedule page.
ALLOCATION OF PREMIUM PAYMENTS - Premiums may be allocated to one or more of the
Subaccounts of the Variable Account or to the Guaranteed Account. Whole
percentages must be used. The allocation of the Initial Premium is shown on the
Contract Schedule. You may change the allocation by written request at any time.
Any subsequent Premium received will be allocated in accordance with the most
recently received allocation instructions.
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VARIABLE ACCOUNT
GENERAL DESCRIPTION - The name of the Variable Account is shown in the Contract
Schedule. The assets of the Variable Account and each Subaccount are Our
property but are not chargeable with the liabilities arising out of any other
business We may conduct, except to the extent that Variable Account assets
exceed Variable Account liabilities arising under the contracts supported by the
Variable Account. The Variable Account and each Subaccount is separate from the
Our General Account and any other separate account or Subaccount We may have.
INVESTMENT ALLOCATIONS TO THE VARIABLE ACCOUNT - The Variable Account consists
of Subaccounts and each Subaccount may invest its assets in a separate class of
shares of a designated investment company or companies.
We have the right to change, add or delete designated investment companies. We
have the right to add or remove Subaccounts. We also have the right to combine
any two or more Subaccounts.
VALUATION OF ASSETS - Assets within each Subaccount will be valued at their net
asset value on each Valuation Date.
CONTRACT VALUE - Premiums are allocated among the various Subaccounts within the
Variable Account. For each Subaccount, the Premiums are converted into
Accumulation Units. The number of Accumulation Units credited to the contract is
determined by dividing the Premiums allocated to the Subaccount by the value of
the Accumulation Unit for the Subaccount. Surrenders will result in the
cancellation of Accumulation Units. The value of the contract is the sum of the
values for the contract within each Subaccount and the Guaranteed Account. The
value of each Subaccount is determined by multiplying the number of Accumulation
Units attributable to the Subaccount by the Accumulation Unit value for the
Subaccount, independent of the value of any other Subaccount.
ACCUMULATION UNIT VALUES - The value of an Accumulation Unit will vary in
accordance with the investment experience of the underlying portfolio in which
the Subaccount invests. The value of Accumulation Units is expected to increase
or decrease from Valuation Period to Valuation Period. The value of Accumulation
Units in each Subaccount will change daily to reflect the investment experience
of the corresponding underlying portfolio as well as the daily deduction of the
Contract Charges. The number of Accumulation Units credited to a Contract will
not change as a result of any fluctuations in the value of an Accumulation Unit.
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GUARANTEED ACCOUNT
GENERAL DESCRIPTION - The Guaranteed Account is a part of Our General Account.
The amount You have in the Guaranteed Account at any time is a result of
Premiums You have allocated to it or any part of Your Contract Value you have
transferred to it.
GUARANTEE PERIOD - The portion of Your Contract Value within the Guaranteed
Account is credited with interest at rates guaranteed by Us for the Guarantee
Period of one year. Interest is credited on a daily basis at the then applicable
effective guaranteed interest rate for the Guarantee Period. If You have
allocated any part of Your Initial Premium to the Guaranteed Account, the amount
allocated is shown on the Contract Schedule.
The guaranteed interest rate applicable to an allocation of Premium or transfer
of Contract Value to the Guarantee Period is the rate in effect for that
Guarantee Period at the time of the allocation or transfer. If You have
allocated or transferred amounts at different times to the Guaranteed Account,
each allocation or transfer may have a unique effective guaranteed interest rate
associated with that amount. We guarantee that the effective annual rate of
interest for the Guaranteed Account will not be less than 3%.
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TRANSFERS
During the Accumulation Period, or after the Annuity Date, provided a variable
Annuity Option was selected, You may transfer all or part of Your interest, in a
Subaccount, or allocated to the Guaranteed Account, to another Subaccount or to
the Guaranteed Account. However, after the Annuity Date no transfers may be made
between a Subaccount and the Guaranteed Account.
The Transfer Fee is shown on the Contract Schedule.
All transfers are subject to the following:
1. The deduction of any Transfer Fee that may be imposed is shown in the
Contract Schedule. The Transfer Fee will be deducted from the amount which
is transferred. However, no Transfer Fee will be imposed on transfers
resulting from the expiration of a Guarantee Period.
2. If We have not received transfer instructions prior to the end of a
Guarantee Period in which You have Contract Value, We will automatically
transfer it to a new Guarantee Period and under the same restrictions as if
You had requested such transfer, if a new Guarantee Period is still
available.
3. The minimum amount which may be transferred is the lesser of (A) $1,000 or
(B) Your entire interest in the Subaccount or in the amount allocated to
the Guarantee Period of the Guaranteed Account.
4. No partial transfer will be made if, as a result of such transfer, Your
remaining Contract Value in the Subaccount or in the amount allocated to
the Guarantee Period of the Guaranteed Account would be less than $1,000.
5. Transfers will be effected during the Valuation Period next following
receipt by Us of a written transfer request containing all required
information. However, no transfer may be made effective within seven
calendar days of the date on which any annuity payment is due.
6. Any transfer request must clearly specify:
a. the amount which is to be transferred; and
b. the Subaccounts or Guarantee Period of the Guaranteed Account which
are to be affected.
7. After the Annuity Date, transfers may not take place between a fixed
Annuity Option and a variable Annuity Option.
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CONTRACT CHARGES
MORTALITY AND EXPENSE RISK CHARGE - We deduct a Mortality And Expense Risk
Charge equal, on an annual basis, to the amount shown on the Contract Schedule.
We guarantee that the dollar amount of each annuity payment after the first will
not be affected by variations in mortality or expense experience.
ADMINISTRATIVE EXPENSE CHARGE - We deduct an Administrative Expense Charge
equal, on an annual basis, to the amount shown on the Contract Schedule. The
Administrative Expense Charge compensates Us for some of the costs associated
with the administration of this contract and the Variable Account.
CONTRACT MAINTENANCE CHARGE - We deduct an annual Contract Maintenance Charge
shown on the Contract Schedule. The Contract Maintenance Charge will be deducted
from the Contract Value on each Contract Anniversary while this contract is in
force. Prior to the Annuity Date, the Contract Maintenance Charge will be
deducted from the Contract Value by canceling Accumulation Units. The number of
Accumulation Units to be canceled from each applicable Subaccount will be in the
ratio that the value of each Subaccount bears to the total Contract Value.
If this contract is surrendered for its full Surrender Value on other than a
Contract Anniversary, the full Contract Maintenance Charge due on the next
Contract Anniversary will be deducted at the time of surrender.
On and after the Annuity Date, the Contract Maintenance Charge will be pro-rated
and collected on a monthly basis and this will result in a reduction of the
monthly annuity payments.
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DOLLAR COST AVERAGING
Dollar Cost Averaging. Using Our Dollar Cost Averaging Plan Request Form, You
may elect automatic monthly transfers from the Money Market Subaccount or
Guaranteed Account into Subaccounts for a specified dollar amount or specified
number of months in accordance with the following:
1. the allocation to the Subaccounts will be based on the premium
allocation that is in effect at the time of each transfer;
2. if you elect Dollar Cost Averaging in conjunction with Your
application for this Policy, the automatic transfers will begin on the
first Monthly Anniversary following the end of the period described in
the Right To Cancel This Contract provision in the first page
allowing for the return of the contract.
3. if you elect Dollar Cost Averaging after this Policy has been issued,
the automatic transfers will begin on the second Monthly Anniversary
following Our receipt of Your election;
4. this option may be elected at any time provided there is a minimum
balance of $12,000 in the Money Market Subaccount or Guaranteed
Account;
5. all premiums received after the date you elect Dollar Cost Averaging
will be applied to the Money Market Subaccount or Guaranteed Account
for the purpose of Dollar Cost Averaging.
If you elect to transfer a specific dollar amount each month, automatic
transfers will continue until Your Money Market Subaccount or Guaranteed Account
is depleted. If you elect to transfer based on a specific number of months, each
month We will transfer a fraction of the balance in the Money Market Fund or
Guaranteed Account equal to one divided by the number of months remaining in the
period. For example, if You elect to transfer over a 12 month period, the first
transfer will be1/12th of the balance in the Money Market Fund or Guaranteed
Account, the second transfer will be 1/11th of the balance, the third transfer
will be 1/10th of the balance and so on until the end of the requested period.
Automatic monthly transfers will continue until one of the following conditions
occur:
1. the balance in the Money Market subaccount or Guaranteed Account is
depleted;
2. We receive Your written request to cancel future transfers;
3. We receive notification of the death of the Insured Person;
4. this Policy lapses.
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ANNUITY PROVISIONS
CHANGE IN ANNUITY DATE - You may, upon at least thirty (30) days prior written
notice to Us, at any time prior to the Annuity Date, change the Annuity Date
shown on the Contract Schedule. The Annuity Date must always be the first day of
a calendar month.
Unless We approve otherwise, the new Annuity Date must be at least one year
after the effective Date. The latest Annuity Date is the first day of the first
calendar month following the Annuitant's 90th birthday or such earlier date as
may be set by applicable law.
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ANNUITY OPTIONS
SELECTION OF ANNUITY OPTION - If the Annuitant is alive on the Annuity Date, We
will apply the Contract Value to provide an income on the basis of a life income
with 10 years guaranteed, unless another annuity option has been selected. You
may however, upon at least thirty (30) days prior written notice to Us, at any
time prior to the Annuity Date, select and/or change the Annuity Option. The
Annuity Option you select may be on a fixed or variable basis, or a combination
thereof. If, at the time of election of an Annuity Option, We are using more
favorable rates, they will be used in lieu of those here guaranteed.
We may also make available other options.
OPTION 1 - LIFE INCOME. Monthly annuity payments are paid during the life of an
Annuitant ceasing with the last Annuity Payment due prior to the Annuitant's
death.
OPTION 2 - LIFE INCOME WITH 10 YEAR GUARANTEE. Monthly annuity payments are paid
during the life of an Annuitant, but at least for a 10 year minimum period.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. Monthly annuity payments are paid
during the joint lifetime of the Annuitant and a designated second person and
are paid thereafter during the remaining lifetime of the survivor ceasing with
the last annuity payment due prior to the survivor's death.
FIXED OPTIONS
The amount of each fixed annuity payment is determined by multiplying the
available Contract Value (after the deduction of any premium taxes not
previously deducted) by the factor in the Fixed Option Table for the option
chosen, using the age and sex of the Annuitant and Joint Annuitant, if any,
divided by 1,000. The tables are determined from the 1983 Individual Annuity
Mortality Table with interest at the rate of 3% per annum. If, when annuity
payments are elected, We are using tables of annuity rates for these contracts
which result in larger annuity payments, We will use those tables instead.
VARIABLE OPTIONS
The amount of the first variable annuity payment depends on the Annuity Option
elected and the age and sex of the Annuitant. This contract contains a Variable
Options Table indicating the dollar amount of the first monthly payment under
each optional annuity form for each $1,000 of value applied. The tables are
determined from the 1983 Individual Annuity Mortality Table with interest at the
rate of 5% per annum. If, when annuity payments are elected, We are using tables
of annuity rates for these contracts which result in larger annuity payments, We
will use those tables instead.
The 5% interest rate assumed in the annuity tables would produce level annuity
payments if the net investment rate remained constant at 5% per year. Subsequent
payments will be less than, equal to, or greater than the first payment
depending upon whether the actual net investment rate is less than, equal to, or
greater than 5%.
The dollar amount of the first variable annuity payment is determined by
applying the available value (after deduction of any premium taxes not
previously deducted) to the table using the age and sex of the Annuitant and any
joint Annuitant. The number of Annuity Units is then determined by dividing this
dollar amount by the then current Annuity Unit value. Thereafter, the number of
Annuity Units remains unchanged during the period of annuity payments. This
determination is made separately for each Subaccount of the Variable Account.
The number of Annuity Units is determined for each Subaccount and is based upon
the available value in each Subaccount as of the date annuity payments are to
begin. The dollar amount determined for each Subaccount will then be aggregated
for purposes of making payments. The dollar amount of the second and later
variable annuity payments is equal to the number of Annuity Units determined for
each Subaccount times the Annuity Unit value for that Subaccount as of the due
date of the payment. This amount may increase or decrease from month to month.
The value of an Annuity Unit for a Subaccount is determined as shown below, by
subtracting item 2. from item 1. and dividing the result by item 3. and
multiplying the result by a factor to neutralize the assumed net investment
rate, discussed above, of 5% per annum (which is built into the annuity rate
tables below and which is not applicable because the actual net investment rate
is credited instead) where:
1. is the net result of:
a) the assets of the Subaccount attributable to the Annuity Units; plus
or minus
b) the cumulative charge or credit for taxes reserved which is determined
by Us to have resulted from the operation of the Subaccount;
2. is the cumulative unpaid charge for the Mortality and Expense Risk Charge
and for the Administrative Expense Charge, which are shown in the Contract
Schedule; and
3. is the number of Annuity Units outstanding at the end of the Valuation
Period.
The value of an Annuity Unit may increase or decrease from Valuation Period to
Valuation Period.
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DEATH BENEFIT
DEATH OF THE OWNER - In the event of Your death prior to the Annuity Date, a
death benefit is payable to the Beneficiary. The value of the death benefit will
be determined as of the date We receive proof of death in a form acceptable to
Us. If there has been a change of Owner from one natural person to another
natural person, the death benefit will be the Contract Value unless the change
of ownership results from the election, made by a surviving spouse as designated
Beneficiary to continue the contract. Otherwise, We will pay the death benefit
equal to the greatest of:
1. the total of all Premiums paid reduced proportionally by any surrenders in
the same proportion that the Contract Value was reduced on the date of a
surrender; or
2. the Contract Value; or
3. the greatest Contract Value at any seventh Contract Anniversary reduced
proportionally by any surrenders subsequent to that Contract Anniversary in
the same proportion that the Contract Value was reduced on the date of a
surrender, plus any Premium paid subsequent to that Contract Anniversary.
The amount of the reduction in the death benefit under items 1 and 3 above would
be determined as "A" multiplied by the result of "B" divided by "C" where:
"A" is the death benefit prior to the partial surrender,
"B" is the partial surrender amount, and
"C" is the Contract Value prior to the partial surrender.
Example:
If the death benefit prior to the partial surrender is $50,000, the Contract
Value prior to the partial surrender is $40,000, and a $10,000 partial surrender
is requested, the reduction in the death benefit as of the date of the partial
surrender would be determined as follows
$10,000
$50,000 x ------------- = $12,500
$40,000
The new death benefit would be:
$50,000 - $12,500 = $37,500.
The Beneficiary may elect the death benefit to be paid as follows:
1. payment of the entire death benefit within 5 years of the date of the
Owner's death; or
2. payment over a period not extending beyond the life expectancy of such
designated Beneficiary based on Tables V and VI of section 1.72-9 of the
Income Tax Regulation with distribution beginning within 1 year of the date
of death of the Owner; or
3. if the designated Beneficiary is Your spouse, he/she can continue the
contract in his/her own name.
If no payment option is elected within 60 days of Our receipt of proof of the
Owner's death, a single sum settlement will be made at the end of the sixty (60)
day period following such receipt. Upon payment of the death benefit, this
contract will end.
If the Owner is a person other than the Annuitant, and if the Owner's death
occurs on or after the Annuity Date, no death benefit will be payable under this
contract. Any guaranteed payments remaining unpaid will continue to be paid to
the Annuitant pursuant to the Annuity Option in force at the date of the Owner's
death. If the Owner is not an individual, the Annuitant shall be treated as the
Owner and any change of such first named Annuitant, will be treated as if the
Owner died.
DEATH OF THE ANNUITANT - If the Annuitant is a person other than the Owner, and
if the Annuitant dies before the Annuity Date, a new Annuitant may be named by
the Owner. If no new Annuitant is named within sixty (60) days of Our receipt of
proof of death, the Owner will be the new Annuitant. If the Annuitant dies after
the Annuity Date, the remaining payments, if any, will be as specified in the
Annuity Option elected. We will require proof of the Annuitant's death. Death
benefits, if any, will be paid to the designated Beneficiary at least as rapidly
as under the method of distribution in effect at the Annuitant's death.
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SURRENDER PROVISIONS
SURRENDER - While this contract is in force and before the Annuity Date, We
will, upon written request, allow the surrender of all or a portion of this
contract for its Surrender Value. Surrenders will result in the cancellation of
Accumulation Units from each applicable Subaccount and the reduction in the
Guaranteed Account in the ratio that the value of each bears to the total
Contract Value. You must specify in writing in advance which units are to be
canceled or what amount is to be taken from the Guaranteed Account if other than
the above mentioned method of cancellation is desired. We will pay the amount of
any surrender within seven (7) days of receipt of a request unless the "Delay of
Payments" provision is in effect.
The Surrender Value will be the Contract Value as of the date of Our receipt of
Your written surrender request, reduced by the sum of:
1. any applicable premium taxes not previously deducted; plus
2. any applicable Contract Maintenance Charge; plus
3. any applicable Surrender Charge.
CALCULATION OF SURRENDER CHARGE - If all or a portion of the Surrender Value is
surrendered, a Surrender Charge will be calculated at the time of each surrender
and will be deducted from the Contract Value. In calculating the Surrender
Charge, Premiums will be allocated at the time of surrender on a first-in,
first-out basis.
The amount of the Surrender Charge is calculated by:
1. reducing the amount to be surrendered by the greater of:
a) the accumulated earnings of this contract (i.e., the Contract Value
minus Premiums which have not been allocated to amounts previously
surrendered); or
b) 10% of all remaining unsurrendered Premiums, decreased by any
surrender made since the last Contract Anniversary; then
2. allocating Premiums to the remaining amount to be surrendered; and
3. multiplying each such allocated Premium by the applicable Percentage of
Premium shown in the Contract Schedule for the period since such Premium
was paid; and
4. adding the products of each multiplication in (3) above.
For a partial surrender, the Surrender Charge will be deducted from the
remaining Contract Value, if sufficient; otherwise it will be deducted from the
amount surrendered. Partial surrenders will be considered in calculation any
death benefit payable under this contract.
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DELAY OF PAYMENTS
We will make any payments under this contract within 7 days (or any shorter
period, if required by law) of a request received in good order. We reserve the
right to suspend or postpone any type of payment from the Variable Account for
any period when:
1. the New York Stock Exchange is closed for other than customary weekend and
holiday closings:
2. trading on the Exchange is restricted;
3. an emergency exists as a result of which it is not reasonably practicable
to dispose of securities held in the Variable Account or determine their
value; or
4. the Securities and Exchange Commission so permits delay for the protection
of security holders.
The applicable rules of the Securities and Exchange Commission will govern
as to whether the conditions in 2. or 3. exist.
We reserve the right to delay any type of payment from the General Account for
up to six (6) months from the date we receive the request for payment.
Options On A Fixed Basis
Option 1: Life Income*
Monthly Income per $1,000
Age Male Female Age Male Female Age Male Female Age Male Female
30 3.16 3.03 44 3.65 3.42 58 4.61 4.18 72 6.84 5.93
31 3.19 3.05 45 3.70 3.46 59 4.71 4.26 73 7.09 6.14
32 3.21 3.07 46 3.75 3.50 60 4.82 4.35 74 7.35 6.36
33 3.24 3.10 47 3.81 3.54 61 4.94 4.44 75 7.63 6.59
34 3.27 3.12 48 3.86 3.59 62 5.06 4.53 76 7.93 6.85
35 3.30 3.14 49 3.92 3.63 63 5.19 4.63 77 8.26 7.13
36 3.33 3.17 50 3.98 3.68 64 5.33 4.74 78 8.60 7.42
37 3.37 3.20 51 4.05 3.73 65 5.48 4.86 79 8.97 7.74
38 3.40 3.22 52 4.12 3.79 66 5.64 4.98 80 9.37 8.09
39 3.44 3.25 53 4.19 3.85 67 5.81 5.11 81 9.79 8.47
40 3.48 3.28 54 4.26 3.91 68 5.99 5.25 82 10.25 8.88
41 3.52 3.32 55 4.34 3.97 69 6.18 5.40 83 10.73 9.32
42 3.56 3.35 56 4.43 4.04 70 6.39 5.56 84 11.25 9.80
43 3.61 3.38 57 4.52 4.11 71 6.61 5.74 85 11.81 10.32
Option 2: Life Income with 10 years Payments Guaranteed*
Monthly Income per $1,000
Age Male Female Age Male Female Age Male Female Age Male Female
30 3.16 3.03 44 3.64 3.42 58 4.55 4.16 72 6.35 5.72
31 3.18 3.05 45 3.69 3.45 59 4.65 4.23 73 6.51 5.88
32 3.21 3.07 46 3.74 3.49 60 4.74 4.31 74 6.68 6.05
33 3.24 3.09 47 3.79 3.54 61 4.85 4.40 75 6.86 6.23
34 3.27 3.12 48 3.84 3.58 62 4.96 4.49 76 7.03 6.42
35 3.30 3.14 49 3.90 3.62 63 5.07 4.58 77 7.21 6.60
36 3.33 3.17 50 3.96 3.67 64 5.19 4.68 78 7.39 6.80
37 3.36 3.19 51 4.02 3.72 65 5.32 4.79 79 7.56 7.00
38 3.40 3.22 52 4.09 3.78 66 5.45 4.90 80 7.74 7.20
39 3.43 3.25 53 4.15 3.83 67 5.58 5.02 81 7.91 7.40
40 3.47 3.28 54 4.23 3.89 68 5.73 5.14 82 8.08 7.61
41 3.51 3.31 55 4.30 3.95 69 5.88 5.28 83 8.25 7.80
42 3.55 3.35 56 4.38 4.02 70 6.03 5.42 84 8.40 8.00
43 3.60 3.38 57 4.46 4.08 71 6.19 5.56 85 8.55 8.19
Option 3: Joint (Male and Female) and Last Survivor*
Monthly Income per $1,000
Female Age - 40 45 50 55 60 65 70 75
Male Age
40 3.13 3.20 3.27 3.32 3.37 3.40 3.43 3.45
45 3.17 3.27 3.36 3.44 3.52 3.57 3.62 3.65
50 3.20 3.32 3.44 3.56 3.67 3.76 3.83 3.89
55 3.23 3.36 3.51 3.67 3.82 3.96 4.08 4.18
60 3.25 3.39 3.57 3.76 3.96 4.17 4.35 4.51
65 3.26 3.42 3.61 3.83 4.08 4.36 4.64 4.89
70 3.27 3.43 3.63 3.88 4.17 4.52 4.90 5.29
75 3.27 3.44 3.65 3.91 4.24 4.64 5.12 5.66
* Values are based on the 1983 Individual Annuity Mortality Table projected with
scale G to the year 2010 and interest at the rate of 3.00% per annum.
The values shown have not been adjusted for the annual contract maintenance
charge described on pages 3 and 9.
Values not shown are available from Our Administrative Office on request.
Options On A Variable Basis
Option 1: Life Income*
Monthly Income per $1,000
Age Male Female Age Male Female Age Male Female Age Male Female
30 4.47 4.36 44 4.90 4.68 58 5.80 5.37 72 8.02 7.07
31 4.49 4.38 45 4.94 4.71 59 5.90 5.44 73 8.27 7.28
32 4.51 4.39 46 4.99 4.74 60 6.00 5.52 74 8.54 7.50
33 4.54 4.41 47 5.04 4.78 61 6.12 5.61 75 8.82 7.74
34 4.56 4.43 48 5.09 4.82 62 6.24 5.70 76 9.12 8.00
35 4.59 4.45 49 5.14 4.86 63 6.37 5.80 77 9.45 8.28
36 4.61 4.47 50 5.20 4.91 64 6.51 5.90 78 9.80 8.57
37 4.64 4.49 51 5.26 4.95 65 6.65 6.01 79 10.17 8.90
38 4.67 4.51 52 5.33 5.00 66 6.81 6.13 80 10.57 9.25
39 4.70 4.54 53 5.40 5.05 67 6.98 6.26 81 11.00 9.63
40 4.74 4.56 54 5.47 5.11 68 7.17 6.40 82 11.46 10.04
41 4.78 4.59 55 5.54 5.17 69 7.36 6.55 83 11.95 10.49
42 4.81 4.62 56 5.62 5.23 70 7.57 6.71 84 12.47 10.98
43 4.85 4.64 57 5.71 5.30 71 7.79 6.88 85 13.03 11.50
Option 2: Life Income with 10 years Payments Guaranteed*
Monthly Income per $1,000
Age Male Female Age Male Female Age Male Female Age Male Female
30 4.47 4.36 44 4.88 4.67 58 5.72 5.33 72 7.43 6.81
31 4.49 4.38 45 4.92 4.70 59 5.81 5.40 73 7.59 6.97
32 4.51 4.39 46 4.97 4.74 60 5.90 5.48 74 7.75 7.13
33 4.53 4.41 47 5.01 4.77 61 6.00 5.55 75 7.91 7.30
34 4.55 4.43 48 5.06 4.81 62 6.10 5.64 76 8.08 7.48
35 4.58 4.44 49 5.11 4.85 63 6.21 5.73 77 8.24 7.66
36 4.61 4.46 50 5.17 4.89 64 6.32 5.82 78 8.41 7.84
37 4.63 4.49 51 5.22 4.94 65 6.44 5.92 79 8.58 8.03
38 4.66 4.51 52 5.28 4.98 66 6.57 6.03 80 8.74 8.23
39 4.70 4.53 53 5.34 5.03 67 6.70 6.14 81 8.91 8.42
40 4.73 4.56 54 5.41 5.09 68 6.84 6.26 82 9.07 8.61
41 4.76 4.58 55 5.48 5.14 69 6.98 6.39 83 9.22 8.80
42 4.80 4.61 56 5.56 5.20 70 7.12 6.52 84 9.37 8.98
43 4.84 4.64 57 5.63 5.26 71 7.27 6.66 85 9.51 9.16
Option 3: Joint (Male and Female) and Last Survivor*
Monthly Income per $1,000
Female Age - 40 45 50 55 60 65 70 75
Male Age
40 4.41 4.47 4.52 4.57 4.61 4.65 4.68 4.70
45 4.45 4.52 4.60 4.67 4.73 4.79 4.83 4.87
50 4.48 4.57 4.66 4.76 4.86 4.95 5.02 5.08
55 4.50 4.60 4.72 4.86 4.99 5.12 5.24 5.34
60 4.52 4.63 4.78 4.94 5.12 5.31 5.49 5.65
65 4.53 4.66 4.82 5.01 5.23 5.48 5.75 6.00
70 4.54 4.67 4.85 5.06 5.32 5.64 6.00 6.38
75 4.55 4.69 4.87 5.10 5.39 5.77 6.22 6.74
* Values are based on the 1983 Individual Annuity Mortality Table projected with
scale G to the year 2010 and interest at the rate of 5.00% per annum.
The values shown have not been adjusted for the annual contract maintenance
charge described on pages 3 and 9.
Values not shown are available from Our Administrative Office on request.
