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THE TRAVELERS INSURANCE COMPANY - ONE TOWER SQUARE - HARTFORD,
CONNECTICUT - 06183
A STOCK COMPANY
We are pleased to provide You the benefits of this contract. Please read
your contract and all attached forms carefully.
RIGHT TO EXAMINE THIS CONTRACT
IN ORDER TO RETURN THIS CONTRACT FOR CANCELLATION, IT MUST BE
GIVEN TO US IN A WRITTEN REQUEST AT OUR OFFICE OR TO OUR AGENT.
AFTER THE CONTRACT IS RETURNED, IT WILL BE CONSIDERED AS NEVER IN
EFFECT.
IF THIS CONTRACT IS ISSUED AS AN INDIVIDUAL RETIREMENT ANNUITY
(IRA), AND IS RETURNED FOR CANCELLATION WITHIN 7 DAYS AFTER ITS
DELIVERY TO YOU, WE WILL PAY YOU THE FULL AMOUNT OF ANY PURCHASE
PAYMENTS MADE, WITHOUT ADJUSTMENT FOR ANY PREMIUM TAX CHARGES OR
CONTRACT CHARGES PAID. IF THIS CONTRACT IS RETURNED WITHIN 8 TO 10
DAYS AFTER ITS DELIVERY TO YOU, WE WILL PAY YOU THE CONTRACT VALUE
AS STATED BELOW.
IF THIS CONTRACT IS ISSUED OTHER THAN AS AN IRA AND IS RETURNED
FOR CANCELLATION WITHIN 10 DAYS AFTER ITS DELIVERY TO YOU, WE WILL
PAY YOU THE CONTRACT VALUE DETERMINED AS OF THE NEXT VALUATION
DATE AFTER WE RECEIVE THE WRITTEN REQUEST AT OUR OFFICE, PLUS ANY
PREMIUM TAX CHARGES OR CONTRACT CHARGES PAID.
This contract is issued in consideration of the Purchase Payments. It is
subject to the terms and conditions stated on the attached pages, all of
which are a part of it.
Executed at Hartford, Connecticut
[SIG]
President
This is a legal contract between You and Us.
READ YOUR CONTRACT CAREFULLY.
FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
ELECTIVE OPTIONS NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED
ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND
MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR
AMOUNT.
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TABLE OF CONTENTS
Right to Examine this Contract Cover Page
Contract Specifications Pages 3-5
Definitions Page 7
Owner, Beneficiary and Annuitant Provisions Pages 8-9
Purchase Payment and Valuation Provisions Pages 10-12
Death Benefit Provisions Page 13-14
Settlement Provisions Pages 15-16
General Provisions Pages 17-18
Table of Values Page 19
Annuity Tables Pages 20-25
Any Riders or Endorsements follow the Annuity Tables.
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CONTRACT SPECIFICATIONS
OWNER Xxxx Xxx 12345 CONTRACT NUMBER
JOINT OWNER
CONTINGENT ANNUITANT
ANNUITANT Xxxx Xxx
CONTRACT DATE 11/1/1999
MATURITY DATE 11/1/2024
INITIAL PURCHASE PAYMENT $20,000
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IF YOU HAVE ANY QUESTIONS CONCERNING YOUR CONTRACT, PLEASE CONTACT US AT
-800-842-8573.
MINIMUM INITIAL PURCHASE PAYMENT: $5,000
MINIMUM SUBSEQUENT PURCHASE PAYMENT: $500
MAXIMUM PURCHASE PAYMENT WITHOUT OUR APPROVAL: $1,000,000
FIXED ACCOUNT GUARANTEED INTEREST PERIODS: The initial rate for any deposit is
guaranteed for one year from date of deposit. Subsequent renewal rates will be
guaranteed for a calendar quarter.
TRANSFERS: You may transfer up to 15% of the Fixed Account value to any of the
Funding Options twice per year during the 30 days following the semi-annual
Contract Date anniversary.
TRANSFER CHARGE: $0. We reserve the right to assess a transfer charge of up to
$10.00 on transfers exceeding 12 per year.
CONTRACT FEE: $30.00 per year. This fee will be waived if Your contract value is
equal to or greater than $40,000 on the date the charge is assessed. This fee is
assessed annually on fourth Friday of August. The contract fee will be prorated
upon full surrender or termination of the contract.
CONTINGENT DEFERRED SALES CHARGE: The contingent deferred sales charge is
calculated as a percentage of the Purchase Payments withdrawn on a first-in,
first-out basis. For the purpose of determining the contingent deferred sales
charge, the order of withdrawal will be deemed to be taken first from (a) any
Purchase Payments that are not subject to the contingent deferred sales charge;
(b) next from any remaining free withdrawal allowance (as described below) after
the reduction by the amount of (a); (c) next from remaining Purchase Payments
(on a first-in, first-out basis); and then (d) from contract earnings. Any free
withdrawals taken will not reduce Purchase Payments still subject to the
contingent deferred sales charge.
YEARS SINCE PURCHASE PERCENT OF PURCHASE PAYMENTS
PAYMENT WAS MADE (NOT PREVIOUSLY SURRENDERED)
1 - 3 6%
4 - 5 5%
6 4%
7 3%
8 + 0%
DISTRIBUTIONS ARE NOT SUBJECT TO THE CONTINGENT DEFERRED SALES CHARGE IF:
- A life annuity option has begun;
- Payments for a fixed period of at least 5 years' duration have begun;
- The Annuitant dies;
- Subject to Our approval, withdrawals of a specified amount are taken from
this contract to be deposited to other contracts issued by Us or Our
affiliates. Such withdrawals will be processed upon Our receipt of a
Written Request.
- Taken as minimum distributions as defined by the IRS made under Our Managed
Distribution Program then in effect if elected by the Owner in a Written
Request.
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FREE WITHDRAWAL ALLOWANCE: After the first Contract Year, You may withdraw up to
15% of Your contract value annually as of the first Valuation Date of any given
Contract Year without imposition of the contingent deferred sales charge. (If
You have Purchase Payments no longer subject to the contingent deferred sales
charge, the maximum You may withdraw without the contingent deferred sales
charge is the greater of (a) the free withdrawal allowance, or (b) the total
amount of Purchase Payments no longer subject to a contingent deferred sales
charge. Note: Any free withdrawal taken will reduce Purchase Payments no longer
subject to a contingent deferred sales charge.) The available amount will be
calculated as of the end of the previous Contract Year. The free withdrawal
allowance applies to any partial withdrawals and to full withdrawals, except
those transferred directly to annuity contracts issued by unaffiliated carriers
and financial institutions. We allow the 15% free withdrawal allowance during
the first Contract Year if taken under the systematic withdrawal program.
SETTLEMENT OPTION ELECTION: You cannot elect a settlement option during the
first Contract Year.
TERMINATION: We reserve the right to terminate this contract when the contract
value is less than $2,000 and no Purchase Payments have been made to the
contract for two years.
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CONTRACT SPECIFICATIONS
SEPARATE ACCOUNT: THE TRAVELERS SEPARATE ACCOUNT NINE FOR VARIABLE ANNUITIES
INVESTMENT OPTIONS:
FUNDING OPTIONS:
Greenwich Street Series Fund
Equity Index Portfolio Class II
Appreciation Portfolio
Total Return Portfolio
Diversified Strategic Income Portfolio
Salomon Brothers Variable Series Fund Inc.
Investors Fund
Total Return Fund
Xxxxxxxxx Variable Products Series Fund
Franklin Small Cap Investments Fund Class II
Xxxxxxxxx International Fund Class II
The Travelers Series Trust
MFS Emerging Growth Portfolio
MFS Research Portfolio
Large Cap Portfolio
Equity Income Portfolio
Disciplined Small Cap
Strategic Stock
Travelers Series Fund, Inc.
Alliance Growth Portfolio
Xxxxx Xxxxxx High Income Portfolio
Xxxxx Xxxxxx Large Cap Growth Portfolio
Xxxxx Xxxxxx Large Cap Value Portfolio
Xxxxx Xxxxxx International Equity Portfolio
MFS Total Return Portfolio
Xxx Xxxxxx Enterprise Portfolio
Xxxxx Xxxxxx Money Market Portfolio
Travelers Managed Income Portfolio
American Variable Insurance Growth and Income Fund
American Variable Insurance Growth Fund
American Variable Insurance Global Fund
Alliance Premier Growth Fund
Xxxxx Xxxxxx Aggressive Growth Fund
Xxxxx Xxxxxx Mid Cap Fund
Xxx Xxxxxx Emerging Growth
FIXED ACCOUNT
ADMINISTRATIVE CHARGE: .15% on an annual basis
MORTALITY AND EXPENSE RISK CHARGE: [ 1.15% ]on an annual basis assuming a
365-day year.
The Administrative Charge and Mortality and Expense Risk Charge result in a
daily deduction of [.00003562] per fund.
ASSUMED DAILY NET INVESTMENT FACTOR upon annuitization is 1.000081 for Funding
Options. When expressed on an annual basis this equals 3%.
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DEFINITIONS
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ACCUMULATION UNIT - an accounting unit of measure used to calculate the value of
this contract before annuity payments begin.
AGE - age last birthday.
ANNUITANT - the person on whose life the Maturity Date and annuity payments
depend.
ANNUITY UNIT - an accounting unit of measure used to calculate the amount of
annuity payments.
BENEFICIARY - the person named to receive any death benefits under this
contract.
CODE - the Internal Revenue Code of 1986, as amended, and all related laws and
regulations that are in effect during the term of this contract.
CONTRACT DATE - the date on which the contract is issued.
CONTRACT YEARS - twelve-month periods beginning with the Contract Date.
DEATH REPORT DATE - the Valuation Date coincident with or next following the day
on which We have received 1) Due Proof of Death and 2) a Written Request for an
election of a single sum payment or an alternate Settlement Option as described
in the contract.
DUE PROOF OF DEATH - (i) a copy of a certified death certificate; (ii) a copy of
a certified decree of a court of competent jurisdiction as to the finding of
death; (iii) a written statement by a medical doctor who attended the deceased;
or (iv) any other proof satisfactory to Us.
FIXED ACCOUNT(s) - an account(s) that consists of the assets under this contract
other than those in the Separate Account.
FUNDING OPTION - that portion of the assets of a Separate Account which is
allocated to a particular Underlying Fund.
INVESTMENT OPTIONS - the Funding Options and/or the Fixed Accounts under this
contract.
MATURITY DATE - the date on which the annuity payments are to begin.
NONQUALIFIED CONTRACT - A contract other than a Qualified Contract.
OUR OFFICE - the Home Office of The Travelers Life and Annuity Company or any
other office which We may designate for the purpose of administering this
contract.
PREMIUM TAX - the amount of tax, if any, charged by the state or municipality.
We will deduct any applicable Premium Tax from the contract value either upon
surrender, annuitization, death, or at the time a Purchase Payment is made, but
no earlier than when We have the liability under state law.
PURCHASE PAYMENT(s) - payments of premium You make to Us under this contract.
QUALIFIED CONTRACT - a contract used in a retirement plan or program that is
intended to qualify under Sections 401, 403, 408 or 414(d) of the Code.
RECORDED - a Written Request is Recorded when the information is noted in Our
file for this contract.
SEPARATE ACCOUNT(s) - those Separate Account(s) indicated in the Contract
Specifications that We established for this class of contracts and certain other
contracts.
SETTLEMENT OPTIONS - an annuity option elected under this contract.
TERMINATION - discontinuance of this contract by Us or by Your Written Request.
UNDERLYING FUND - an open-end diversified management investment company
indicated in the Contract Specifications, which serves as a variable investment
option under the Separate Account.
VALUATION DATE - a date on which an Investment Option is valued.
VALUATION PERIOD - the period between successive valuations.
WE, US, OUR - The Travelers Insurance Company.
WRITTEN REQUEST - written information including requests for contract changes
sent to Us in a form and content satisfactory to Us and received at Our Office.
YOU, YOUR - the owner, including a joint owner.
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OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
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OWNER
This contract belongs to the owner shown on the Contract Specifications or to
any person subsequently named in a Written Request of transfer of owner as
provided below. As owner, You have sole power during the Annuitant's lifetime to
exercise any rights and to receive all benefits given in this contract provided
You have not named an irrevocable Beneficiary and provided the contract is not
assigned.
You will be the recipient of all payments while the Annuitant is alive unless
You direct them to an alternate recipient under a Recorded payment direction. An
alternate recipient under a payment direction does not become the owner. A
payment direction is revocable by You at any time by Written Request giving 30
days' advance notice.
JOINT OWNER
Joint Owners may be named in a Written Request prior to the Contract Date. Joint
owners may independently exercise transfers among Investment Options. All other
rights of ownership must be exercised by joint action. Joint owners own equal
shares of any benefits accruing or payments made to them. All rights of a joint
owner end at death if another joint owner survives.
If the owner dies and is survived by the Annuitant before payment of an annuity
option begins, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the Beneficiary named in a Written Request.
BENEFICIARY
The Beneficiary is the party named in a Written Request. The Beneficiary has the
right to receive any remaining contractual benefits upon the death of the
Annuitant, or under certain circumstances, upon the death of the owner. If there
is more than one Beneficiary surviving the Annuitant, the Beneficiaries will
share equally in benefits unless different shares are Recorded with Us by
Written Request prior to the death of the Annuitant.
If an owner dies and is survived by the Annuitant before payment of an annuity
option begins, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the Beneficiary named in a Written Request.
Unless an irrevocable Beneficiary has been named, You have the right to change
any Beneficiary by Written Request during the lifetime of the Annuitant and
while the contract continues.
Once a change in Beneficiary is Recorded by Us, it will take effect as of the
date of the Written Request, subject to any payments made or other actions taken
by Us before the recording.
When the Annuitant dies, if no Beneficiary has been named by You, or if no
Beneficiary is living, We will pay the death benefit to You or Your estate.
ANNUITANT
The Annuitant is the individual shown on the Contract Specifications on whose
life the first annuity payment is made. The Annuitant may not be changed after
the Contract Date.
CONTINGENT ANNUITANT
You may name one individual as a contingent annuitant by Written Request prior
to the Contract Date. A contingent annuitant may not be changed, deleted or
added to the contract after the Contract Date. For purposes of this provision,
the owner cannot be the Annuitant.
If the Annuitant dies prior to the Maturity Date while this contract is in
effect and while the contingent annuitant is living:
a. the death benefit will not be payable upon the Annuitant's death;
b. the contingent annuitant becomes the Annuitant; and
c. all other rights and benefits provided by this contract will
continue in effect.
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TRANSFER OF OWNER
You may transfer ownership by Written Request. You may not revoke any transfer
after the effective date. Once the transfer of owner is Recorded by Us, it will
take effect as of the date of Your Request, subject to any payments made or
other actions taken by Us before the recording.
Unless provided otherwise, a transfer of owner does not affect the interest of
any Beneficiary designated prior to the effective date of the transfer.
A transfer of ownership may have adverse tax consequences to You as the former
owner; please consult Your tax advisor.
ASSIGNMENT
You may collaterally assign ownership of all or a portion of this contract by
Written Request without the approval of any Beneficiary unless irrevocably
named. You may not exercise any rights of ownership while the assignment remains
in effect without the approval of the collateral assignee. We are not
responsible for the validity of any assignment. Once the collateral assignment
is Recorded by Us, it will take effect as of the date of Your Written Request,
subject to any payments made or other actions taken by Us before the Request is
received.
If a claim is made based on an assignment, We may require proof of interest of
the claimant. A Recorded assignment takes precedence over any rights of a
Beneficiary. Any amounts due under a Recorded assignment will be paid in a
single sum.
An assignment may have adverse tax consequences to You; please consult Your tax
advisor.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner or Beneficiary
under this contract shall be subject to the claims of creditors or any legal
process except as may be provided by an assignment.
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PURCHASE PAYMENT AND VALUATION PROVISIONS
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PURCHASE PAYMENT
PURCHASE PAYMENT
A Purchase Payment is any payment You make for this contract and the benefits it
provides. An initial lump sum Purchase Payment must be made to the contract and
is due and payable before the contract becomes effective. Each Purchase Payment
is payable as shown in the Contract Specifications to Us at Our Office or to one
of Our authorized representatives. No Purchase Payment after the initial
Purchase Payment is required to keep this contract in force, except as provided
in the Termination provision.
Net Purchase Payments are that part of Your Purchase Payments applied to the
contract value. A net Purchase Payment is equal to the Purchase Payment less any
applicable premium tax charge.
ALLOCATION OF PURCHASE PAYMENT
We will apply any net Purchase Payment to provide Accumulation Units of selected
Funding Options and/or the Fixed Account of this contract. The initial net
Purchase Payment will be applied within two business days following its receipt
in good order at Our Office. Subsequent net Purchase Payments will be applied on
the same business day if received in good order at Our Office on or before 4:00
pm., Eastern Standard Time. The net Purchase Payment will be allocated to the
Investment Options in the proportion specified by You for this contract. The
available Underlying Funds to which Funding Option assets are allocated are
shown on the Contract Specifications; Underlying Funds may be subsequently added
or deleted.
FUNDING OPTION VALUATION
NUMBER OF ACCUMULATION UNITS
The number of Accumulation Units to be credited to each Funding Option once a
Purchase Payment has been received by Us will be determined by dividing the net
Purchase Payment applied to that Funding Option by the then Accumulation Unit
value of that Funding Option.
ACCUMULATION UNIT VALUE
We determine the value of an Accumulation Unit in each Funding Option on each
Valuation Date by multiplying the value on the immediately preceding Valuation
Date by the net investment factor for that Funding Option for the Valuation
Period just ended.
The value of an Accumulation Unit on any date other than a Valuation Date will
be equal to its value as of the next Valuation Date.
NET INVESTMENT FACTOR
The net investment factor is a factor applied to measure the investment
performance of a Funding Option from one Valuation Period to the next. The net
investment factor for a Funding Option for any Valuation Period is equal to the
sum of 1.0000 plus the net investment rate.
Each Funding Option's net investment rate for a Valuation Period is equal to the
gross investment rate for that Funding Option, less the applicable Funding
Option deduction for the Valuation Period.
All Funding Option deductions are shown on the Contract Specifications.
The gross investment rate of a Funding Option for a Valuation Period is equal to
(1) divided by (2) where (1) is:
a) investment income, plus
b) capital gains and losses, whether realized or unrealized; less
c) a deduction for any tax levied against the Separate Account and its
Underlying Funds; and
(2) is the amount of the assets at the beginning of the Valuation Period.
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The gross investment rate for a Funding Option may be either positive or
negative. Since a Funding Option is invested in shares of an Underlying Fund,
assets are based on the net asset value of the Underlying Fund. Investment
income includes any distribution whose ex-dividend date occurs during the
Valuation Period.
FIXED ACCOUNT VALUATION
NUMBER OF ACCUMULATION UNITS - We will determine the number of Accumulation
Units to be credited to the Fixed Account on receipt of a Purchase Payment by
dividing the net Purchase Payment applied to the Fixed Account by the then
dollar value of one Accumulation Unit of the Fixed Account.
ACCUMULATION UNIT VALUE - We determine the value of an Accumulation Unit in the
Fixed Account on any day by multiplying the value on the immediately preceding
day by the net interest factor for the day on which the value is being
determined.
NET INTEREST FACTOR - The net interest factor for any day is the guaranteed net
interest rate that is equivalent to an effective annual interest rate of 0.03
(3%), plus 1.0000. The method of crediting additional interest will be at Our
discretion.
Interest is declared in advance. Before annuity payments begin, We may credit
the Fixed Account with annual interest rates higher than the minimum guaranteed
interest rate of 3%. Interest rates may be higher or lower than the initial
interest rates, but not less than the minimum guaranteed interest rate of 3%.
Additional amounts may be credited by Us at Our discretion for the guaranteed
interest periods shown on the Contract Specifications.
TRANSFER BETWEEN INVESTMENT OPTIONS
You may transfer all or any part of the contract value from one Funding Option
to any other Funding Option at any time up to 30 days before the due date of the
first annuity payment. Additionally, You may transfer a part of the Fixed
Account value to any of the Funding Options, twice a year during the 30 days
following the semi-annual Contract Date Anniversary in the amount shown on the
Contract Specifications.
Amounts may generally be transferred from the Funding Options to the Fixed
Account at any time, up to 30 days before the due date of the first annuity
payment. Xxxxxxx previously transferred from the Fixed Account to the Funding
Options may not be transferred back to the Fixed Account for a period of at
least 6 months from the date of transfer. We reserve the right to limit the
number of transfers from one Funding Option to any other Funding Option or to
the Fixed Account. We will not limit these transfers to less than one in any
six-month period.
Transfers between Investment Options will result in the addition or deletion of
Accumulation Units having a total value equal to the dollar amount being
transferred to or from a particular Investment Option. The number of
Accumulation Units will be determined by using the Accumulation Unit Value of
the Investment Options involved as of the next valuation after We receive
notification of request for transfer. Transfers will be subject to any
applicable Transfer charge stated on the Contract Specifications.
CONTRACT VALUES
CONTRACT VALUE
The contract value of this contract on any date equals the sum of the
accumulated values in the Investment Options. The accumulated value in a Funding
Option equals the number of outstanding Accumulation Units credited to that
Funding Option, multiplied by the then Accumulation Unit Value for that Funding
Option.
The guaranteed value of the Fixed Account equals the accumulated value of the
Fixed Account calculated by using the guaranteed net interest factor. The
guaranteed values of the Fixed Account are shown in the Table of Values.
CONTRACT FEE
A contract fee in the amount and for the period shown on the Contract
Specifications will be deducted from the contract value to reimburse Us for
administrative expenses relating to the contract. The contract fee will be
deducted by surrendering on a pro rata basis Accumulation Units from all Funding
Options in which You have an interest. No contract fee will be deducted from the
Fixed Account.
We will deduct the charge on a pro rata basis if the contract has been in effect
for less than a full period on the date a contract fee is deducted. The contract
fee will also be prorated upon full surrender or termination of the contract.
CASH SURRENDER VALUE
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The cash surrender value of this contract is equal to the contract value less
any contingent deferred sales charge which is shown on the Contract
Specifications and less any applicable contract fee and Premium Tax not
previously deducted.
The guaranteed cash surrender value of the Fixed Account equals the guaranteed
value of the Fixed Account less any contingent deferred sales charge which is
shown on the Contract Specifications, less any applicable Premium Tax not
previously deducted. For guaranteed cash surrender values of the Fixed Account,
see the Table of Values.
CASH SURRENDER
You may elect by Written Request to receive the cash surrender value of this
contract before the due date of the first annuity payment and without the
consent of any Beneficiary unless irrevocably named. You may elect either a full
or partial surrender of the cash surrender value. In the case of a full
surrender, this contract will be canceled. A partial surrender will result in a
reduction in Your contract value. If You have a balance in more than one
Investment Option, Your contract value will be reduced from all Your Investment
Options on a pro rata basis, unless You request otherwise.
The cash surrender value will be determined as of the next valuation following
receipt of Your Written Request. We may delay payment of the cash surrender
value of the Funding Options for a period of not more than five business days
after We receive Your Written Request. We may delay payment of the cash
surrender value of the Fixed Account for a period of not more than six months
after We receive Your Written Request.
CONTRACT CONTINUATION
Except as provided in the Termination provision, this contract does not require
continuing Purchase Payments and will automatically continue as a paid-up
contract during the lifetime of the Annuitant until the Maturity Date, or until
it is surrendered.
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DEATH BENEFIT PROVISIONS
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DEATH OF ANNUITANT
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a contingent annuitant surviving. A
death benefit is also payable under those Settlement Options which provide for
death benefits. We will pay the Beneficiary the death benefit in a single sum as
described below upon receiving Due Proof of Death. A Beneficiary may request
that a death benefit payable under this contract be applied to a Settlement
Option subject to the provisions of this contract and the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the owner is not the Annuitant, and the owner dies (including the first of
joint owners) before the Maturity Date and with the Annuitant surviving, We will
recalculate the value of the death benefit under the provisions of Death
Proceeds Prior To The Maturity Date below. The value of the death benefit, as
recalculated, will be paid in a single lump sum or by other election to the
party taking proceeds under the current tax laws. The party must take
distributions no later than under the applicable elections of that provision.
All references to Annuitant in the Death Proceeds Prior to Maturity Date
provision will be replaced with reference to the owner.
DEATH PROCEEDS PRIOR TO THE MATURITY DATE
If the Annuitant is younger than age 76 on the Contract Date, the death benefit
payable as of the Death Report Date will be the greatest of a), b) or c) below,
less any applicable premium tax and outstanding loans:
a) the contract value on the Death Report Date;
b) the total Purchase Payments less the total amount of any partial surrenders
made under this contract; or
c) the step-up value (if any, as described below).
STEP-UP VALUE
WHERE ANNUITANT WAS YOUNGER THAN AGE 68 ON THE CONTRACT DATE
A step-up value will be established on the seventh Contract Date
anniversary which occurs on or prior to the Death Report Date. The initial
step-up value will equal the contract value on that anniversary. Whenever a
Purchase Payment is made, the step-up value will be increased by the amount
of that Purchase Payment. Whenever a partial surrender is taken, the
step-up value will be reduced by a partial surrender reduction as described
below. On each Contract Date anniversary that occurs before the Annuitant's
76th birthday and before the Annuitant's death, if the contract value is
greater than the step-up value, the step-up value will be reset to equal
the contract value on that date. If the step-up value is greater than the
contract value, the step-up value will remain unchanged. The step-up value
will not be reduced on these anniversary recalculations (provided no
surrenders are made on that day). The only changes made to the step-up
value on or after the Annuitant's 76th birthday will be those related to
additional Purchase Payments or partial surrenders as described above. If
the Death Report Date is before the seventh Contract Date anniversary,
there is no step-up value.
WHERE ANNUITANT WAS AGE 68 THROUGH 75 ON THE CONTRACT DATE
A step-up value will be established on the seventh Contract Date
anniversary prior to the Death Report Date. The step-up value will equal
the contract value on that anniversary. Whenever a Purchase Payment is
made, the step-up value will be increased by the amount of that Purchase
Payment. Whenever a partial surrender is taken, the step-up value will be
reduced by a partial surrender reduction as described below. The only
changes made to the step-up value on or after the seventh Contract Date
anniversary will be those related to additional Purchase Payments or
partial surrenders as described above. If the Death Report Date is before
the seventh Contract Date anniversary, there is no step-up value.
PARTIAL SURRENDER REDUCTION
The partial surrender reduction is equal to 1) the step-up value in effect
immediately prior to the reduction for the partial surrender, multiplied
by 2) the amount of the partial surrender divided by 3) the contract
value immediately prior to the partial surrender.
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If the Annuitant is age 76 through 80 on the Contract Date, the death benefit
payable as of the Death Report Date will be the greater of a) or b) below, less
any applicable premium tax and outstanding loans:
a) the contract value on the Death Report Date; or
b) the total Purchase Payments less the total amount of any partial surrenders
made under this contract.
If the Annuitant is age 81 or older on the Contract Date, the death benefit
payable as of the Death Report Date will be the contract value on the Death
Report Date, less any applicable premium tax and outstanding loans.
We must be notified no later than six months from the date of death in order for
Us to make payment of proceeds as described above. If notification is received
more than six months after the date of death, the death benefit payable will be
the contract value on the Death Report Date, less any applicable premium tax and
outstanding loans.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the annuity option
then in effect.
INTEREST ON DEATH PROCEEDS
Any interest on death proceeds will be paid only if required by law.
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SETTLEMENT PROVISIONS
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MATURITY DATE
The Maturity Date is shown on the Contract Specifications. This is the date on
which We will begin paying to You the first of a series of annuity payments in
accordance with the Settlement Option elected by You. Annuity payments will
begin under this contract on the Maturity Date unless the contract has been
fully surrendered or the proceeds have been paid to the Beneficiary prior to
that date. We may require proof that the Annuitant is alive before annuity
payments are made. If no Maturity Date is specified, the automatic Maturity Date
will be the greater of when the Annuitant reaches age 95 or ten years after the
Contract Date.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, You may change the Maturity Date by Written Request to
any time prior to the Annuitant's 95th birthday or to a later date with Our
consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, We will pay the amount payable
under this contract to You in one lump sum or in accordance with the Settlement
Option elected by You, subject to the conditions shown on the Contract
Specifications. While the Annuitant is alive, You may change Your Settlement
Option election by Written Request, but only before the Maturity Date. Once
annuity payments have commenced, no further election changes are allowed.
During the Annuitant's lifetime, if no election has been made on the Maturity
Date, We will pay to You the first of a series of monthly annuity payments based
on the life of the Annuitant, in accordance with annuity Option 2, with 120
monthly payments assured.
MINIMUM AMOUNTS
The minimum amount that can be placed under a Settlement Option is $2,000 unless
We consent to a lesser amount. If any periodic payments due are less than $100,
We reserve the right to make annuity payments at less frequent intervals,
resulting in a payment of at least $100 per year.
ALLOCATION OF ANNUITY
At the time an annuity option is elected, the person electing the option may
further elect to have the cash surrender value applied to provide a variable
annuity, a fixed annuity or a combination of both.
Unless You elect otherwise, when annuity payments start, the value of a Funding
Option will be applied to provide an annuity that varies with the investment
experience of that same Funding Option and the value of the Fixed Account will
be applied to provide a fixed annuity.
Before You begin receiving annuity payments, You may transfer contract value
from one Investment Option to another, as described in the provision "Transfer
Between Accounts," in order to reallocate the basis on which annuity payments
will be determined. Once annuity payments start, You may, with Our consent,
change the allocation of Your values in each Funding Option.
VARIABLE ANNUITY
AMOUNT OF BASIC FIRST PAYMENT
The Life Annuity Tables are used to determine the basic first monthly annuity
payment. They show the dollar amount of the basic first monthly annuity payment
that can be purchased with each $1,000 applied. The actual amount of the basic
annuity payments in each Funding Option is found by multiplying the number of
Annuity Units credited to the contract in that Funding Option by the Annuity
Unit value of the Funding Option as of the date 14 days prior to the date on
which the payment is due. We reserve the right to require satisfactory proof of
the age of any person on whose life annuity payments are based before making the
first payment under any of these options.
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ANNUITY UNIT VALUE
On any Valuation Date, the Annuity Unit value for a Funding Option equals the
Funding Option Annuity Unit value on the immediately preceding Valuation Date,
multiplied by the net investment factor for that Funding Option for the
Valuation Period just ended, divided by the assumed daily net investment factor.
The assumed daily net investment factor is shown on the Contract Specifications.
The value of an Annuity Unit as of any date other than a Valuation Date will be
equal to its value as of the next succeeding Valuation Date.
NUMBER OF ANNUITY UNITS
We determine the number of Annuity Units credited to this contract in each
Funding Option by dividing the basic first monthly annuity payment attributable
to that Funding Option by the Funding Option's Annuity Unit value as of 14 days
before the due date of the first annuity payment.
AMOUNT OF SECOND AND SUBSEQUENT BASIC PAYMENTS
The dollar amount of the second and subsequent payments may change from month to
month. The total amount of each annuity payment will be equal to the sum of the
basic payments in each Funding Option.
FIXED ANNUITY
A fixed annuity is an annuity with payments that remain fixed as to dollar
amount throughout the payment period. The Life Annuity Tables are used to
determine the monthly annuity payment. They show the dollar amount of monthly
annuity payment that can be purchased with each $1,000 applied. The amount
applied to the fixed annuity will be equal to the cash surrender value
applicable to the fixed annuity determined as of the date fixed annuity payments
start. If it would produce a larger payment, We agree that the fixed annuity
payment will be determined using the Life Annuity Tables in effect on the
Maturity Date.
ANNUITY OPTIONS
Subject to conditions stated in Elections Of Settlement Options and Minimum
Amounts, all or any part of the cash surrender value of this contract may be
paid under one or more of the annuity options below if available on the Maturity
Date. We may offer additional options.
OPTION 1. LIFE ANNUITY - NO REFUND
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based, ending with the last monthly payment preceding
death.
OPTION 2. LIFE ANNUITY WITH 120, 180 OR 240 MONTHLY PAYMENTS ASSURED
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based. If at the death of that person, payments have been
made for less than 120, 180, or 240 months, as elected, We will continue to make
payments to the Beneficiary during the remainder of the period.
OPTION 3. JOINT AND LAST SURVIVOR LIFE ANNUITY
We will make monthly annuity payments during the joint lifetime of two persons
on whose lives payments are based and during the lifetime of the survivor. No
more payments will be made after the death of the survivor.
OPTION 4. JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE
We will make monthly annuity payments during the joint lifetime of two persons
on whose lives payments are based. One of the two persons will be designated as
the primary payee. The other will be designated as the secondary payee. On the
death of the secondary payee, if survived by the primary payee, We will continue
to make monthly annuity payments to the primary payee in the same amount that
would have been payable during the joint lifetime of the two persons. On the
death of the primary payee, if survived by the secondary payee, We will continue
to make monthly annuity payments to the secondary payee in an amount equal to
50% of the payments that would have been made during the lifetime of the primary
payee. No further payments will be made following the death of the survivor.
OPTION 5. PAYMENTS FOR A FIXED PERIOD
We will make monthly payments for the period selected.
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GENERAL PROVISIONS
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THE CONTRACT
The entire contract between You and Us consists of the contract and all attached
pages.
CONTRACT CHANGES
The only way this contract may be changed is by a written endorsement signed by
one of Our officers.
SUBSTITUTION OF SEPARATE ACCOUNT, FUNDING OPTION OR UNDERLYING FUNDS
If it is not possible to continue to offer a Separate Account, Funding Option or
Underlying Fund, or, if, in Our judgment, it becomes inappropriate for the
purposes of this contract, We may substitute another Separate Account, Funding
Option or Underlying Fund without Your consent. Substitution may be made with
respect to both existing investments and investment of future premium payments.
However, no such substitution will be made without notice to You and without
prior approval of the Securities and Exchange Commission, to the extent required
by law.
MISSTATEMENT
If the Annuitant's sex, if applicable, or date of birth was misstated, all
benefits of this contract are what the Purchase Payments paid would have
purchased at the correct sex and age. Proof of the Annuitant's and owner's age
may be filed at any time at Our Office.
INCONTESTABILITY
We will not contest this contract from its Contract Date.
TERMINATION
We reserve the right to terminate this contract on any Valuation Date if the
contract value as of the date is less than the termination amount shown on the
Contract Specifications. Termination will not occur until 31 days after We have
mailed notice of termination to You at Your last known address. If this contract
is terminated, We will pay You the cash surrender value, if any.
REQUIRED REPORTS
We will furnish a report to the owner as often as required by law, but at least
once in each Contract Year before the due date of the first annuity payment. The
report will show the number of Accumulation Units credited to the contract in
each Investment Option and the corresponding Accumulation Unit value as of the
date of the report.
VOTING RIGHTS
If required by federal law, You may have the right to vote at the meetings of
the Shareholders of the Underlying Funds. If You have voting rights, We will
send a notice to You telling You the time and place of a meeting. The notice
will also explain matters to be voted upon and how many votes You may exercise.
MORTALITY AND EXPENSES
Our actual mortality and expense experience will not affect the amount of any
annuity payments or any other values under this contract.
NON-PARTICIPATING
This contract does not share in Our surplus earnings, so You will receive no
dividends under it.
TAXES BASED UPON PREMIUM OR VALUE
If there is a law or change in law assessing taxes against Us based upon the
premium or value of this contract, We reserve the right to charge You
proportionately for that tax. This would include a tax based upon Our realized
net capital gains in the Funding Options and on earnings in the Fixed Account,
on which We are not currently taxed.
CONFORMITY WITH STATE AND FEDERAL LAWS
This contract is governed by the law of the state in which it is delivered. Any
paid-up annuity, cash surrender or death benefits that are available under this
contract are not less than the minimum benefits required by the statutes of the
state in which this contract is delivered.
Upon receiving appropriate state approval, We may at any time make any changes,
including retroactive changes, in this contract to the extent that the change is
required to meet the requirements of any law or regulation issued by an
governmental agency to which We or You are subject.
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EMERGENCY PROCEDURE
We reserve the right to suspend or postpone the date of any payment of any
benefit or values for any Valuation Period (1) when the New York Stock Exchange
is closed; (2) when trading on the Exchange is restricted; (3) when an emergency
exists as determined by the Securities and Exchange Commission so that disposal
of the securities held in the Funding Options is not reasonably practicable or
it is not reasonably practicable to determine the value of the Funding Option's
net assets, or (4) during any other period when the Securities and Exchange
Commission, by order, so permits for the protection of security holders. Any
provision of this contract which specifies a Valuation Date will be superseded
by this Emergency Procedure.
RELATION OF THIS CONTRACT TO THE SEPARATE ACCOUNTS AND FUNDING OPTIONS
We will have exclusive and absolute ownership and control of the assets of Our
Separate Account and the Funding Options. That portion of the assets of a
Separate Account or Funding Option equal to the reserves and other contract
liabilities with respect to such Separate Account or Funding Option shall not be
chargeable with liabilities arising out of any other business We conduct. Our
determination of the value of an Accumulation Unit and an Annuity Unit by the
method described in this contract will be conclusive.
REDUCTION OR ELIMINATION OF CONTRACT CHARGES
All charges and fees under the contract may be reduced or eliminated when
certain sales or administration of the contract result in savings or reduction
of expenses, and/or risks.
TRANSFERS TO OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer funds held by You to
another contract issued by Us without incurring charges deducted upon surrender
as shown on the Contract Specifications page. Once the transfer is complete and
We have established a new contract at Your direction, new deferred sales charges
or surrender charges may apply to the new contract in accordance with the
provisions of such contract.
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TABLE OF VALUES
GUARANTEED VALUES OF THE FIXED ACCOUNT PER $1,000 OF NET PURCHASE PAYMENT
APPLIED
NO. OF
YEARS FROM GUARANTEED NO. OF YEARS FROM
DATE PAYMENT GUARANTEED CASH SURRENDER DATE PAYMENT IS GUARANTEED CASH
IS APPLIED VALUE VALUE APPLIED GUARANTEED VALUE SURRENDER VALUE
1 1030 970 36 2898 2898
2 1060 1000 37 2985 2985
3 1092 1032 38 3074 3074
4 1125 1075 39 3167 3167
5 1159 1109 40 3262 3262
6 1194 1154 41 3359 3359
7 1229 1199 42 3460 3460
8 1266 1266 43 3564 3564
9 1304 1304 44 3671 3671
10 1343 1343 45 3781 3781
11 1384 1384 46 3895 3895
12 1425 1425 47 4011 4011
13 1468 1468 48 4132 4132
14 1512 1512 49 4256 4256
15 1557 1557 50 4383 4383
16 1604 1604 51 4515 4515
17 1652 1652 52 4650 4650
18 1702 1702 53 4790 4790
19 1753 1753 54 4934 4934
20 1806 1806 55 5082 5082
21 1860 1860 56 5234 5234
22 1916 1916 57 5391 5391
23 1973 1973 58 5553 5553
24 2032 2032 59 5720 5720
25 2093 2093 60 5891 5891
26 2156 2156 61 6068 6068
27 2221 2221 62 6250 6250
28 2287 2287 63 6437 6437
29 2356 2356 64 6631 6631
30 2427 2427 65 6829 6829
31 2500 2500 66 7034 7034
32 2575 2575 67 7245 7245
33 2652 2652 68 7463 7463
34 2731 2731 69 7687 7687
35 2813 2813 70 7917 7917
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1, AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS
MALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.59 3.57 3.56 3.53
46 3.64 3.62 3.60 3.57
47 3.69 3.67 3.65 3.62
48 3.75 3.73 3.70 3.67
49 3.81 3.78 3.76 3.71
50 3.87 3.84 3.81 3.77
51 3.93 3.90 3.87 3.82
52 4.00 3.97 3.93 3.87
53 4.07 4.04 3.99 3.93
54 4.15 4.11 4.06 3.99
55 4.23 4.19 4.13 4.05
56 4.32 4.27 4.20 4.11
57 4.41 4.35 4.28 4.17
58 4.50 4.44 4.36 4.24
59 4.61 4.53 4.44 4.31
60 4.72 4.63 4.53 4.37
61 4.83 4.74 4.62 4.44
62 4.96 4.85 4.71 4.51
63 5.09 4.97 4.81 4.58
64 5.24 5.09 4.90 4.65
65 5.39 5.22 5.01 4.72
66 5.56 5.36 5.11 4.79
67 5.73 5.50 5.21 4.86
68 5.92 5.64 5.32 4.93
69 6.12 5.80 5.43 4.99
70 6.34 5.96 5.53 5.05
71 6.56 6.12 5.64 5.11
72 6.81 6.29 5.75 5.16
73 7.07 6.46 5.85 5.21
74 7.35 6.64 5.95 5.26
75 7.64 6.82 6.05 5.30
Dollar amounts of the monthly annuity payments for the first and second options
are based on the Annuity 2000 Table. The above tables assume a year 2000 issue,
and project mortality improvements into the future using Projection Scale G.
These tables assume a net investment rate of 3% per Annum assuming a 365 day
year.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1, AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS
FEMALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.39 3.39 3.38 3.37
46 3.43 3.43 3.42 3.40
47 3.48 3.47 3.46 3.44
48 3.52 3.52 3.50 3.48
49 3.57 3.56 3.55 3.53
50 3.62 3.61 3.60 3.57
51 3.68 3.66 3.65 3.62
52 3.74 3.72 3.70 3.67
53 3.80 3.78 3.76 3.72
54 3.86 3.84 3.81 3.78
55 3.93 3.90 3.88 3.83
56 4.00 3.97 3.94 3.89
57 4.07 4.05 4.01 3.95
58 4.15 4.12 4.08 4.01
59 4.24 4.20 4.15 4.08
60 4.33 4.29 4.23 4.15
61 4.43 4.38 4.32 4.22
62 4.53 4.48 4.40 4.29
63 4.64 4.58 4.49 4.36
64 4.76 4.69 4.59 4.44
65 4.89 4.80 4.69 4.52
66 5.02 4.92 4.79 4.59
67 5.17 5.05 4.89 4.67
68 5.32 5.19 5.00 4.75
69 5.49 5.33 5.12 4.82
70 5.68 5.48 5.23 4.90
71 5.87 5.64 5.35 4.97
72 6.09 5.81 5.47 5.04
73 6.32 5.99 5.59 5.10
74 6.57 6.18 5.71 5.16
75 6.84 6.37 5.83 5.22
Dollar amounts of the monthly annuity payments for the first and second options
are based on the Annuity 2000 Table. The above tables assume a year 2000 issue,
and project mortality improvements into the future using Projection Scale G.
These tables assume a net investment rate of 3% per Annum assuming a 365 day
year.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1, AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR QUALIFIED CONTRACTS
UNISEX NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.49 3.48 3.47 3.45
46 3.54 3.53 3.51 3.49
47 3.59 3.57 3.56 3.53
48 3.64 3.62 3.60 3.58
49 3.69 3.68 3.65 3.62
50 3.75 3.73 3.71 3.67
51 3.81 3.79 3.76 3.72
52 3.87 3.85 3.82 3.77
53 3.94 3.91 3.88 3.83
54 4.01 3.98 3.94 3.88
55 4.08 4.05 4.01 3.94
56 4.16 4.12 4.07 4.00
57 4.24 4.20 4.15 4.07
58 4.33 4.28 4.22 4.13
59 4.42 4.37 4.30 4.20
60 4.52 4.46 4.38 4.27
61 4.63 4.56 4.47 4.34
62 4.75 4.67 4.56 4.41
63 4.87 4.78 4.65 4.48
64 5.00 4.89 4.75 4.55
65 5.14 5.01 4.85 4.62
66 5.29 5.14 4.95 4.70
67 5.45 5.28 5.06 4.77
68 5.62 5.42 5.17 4.84
69 5.81 5.57 5.28 4.91
70 6.00 5.72 5.39 4.98
71 6.22 5.89 5.50 5.04
72 6.44 6.06 5.62 5.10
73 6.69 6.23 5.73 5.16
74 6.95 6.41 5.84 5.21
75 7.24 6.60 5.95 5.26
Dollar amounts of the monthly annuity payments for the first and second options
are based on the Annuity 2000 Table (blended 50%/50% female/male). The above
tables assume a year 2000 issue, and project mortality improvements into the
future using Projection Scale G. These tables assume a net investment rate of 3%
per Annum assuming a 365 day year.
Calendar Year in which 1st payment is due:
Adjusted age is Actual age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR NONQUALIFIED CONTRACTS
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.18 3.27 3.35 3.42 3.47 3.51 3.54
50 3.24 3.36 3.47 3.58 3.66 3.73 3.78
55 3.29 3.43 3.59 3.74 3.87 3.99 4.08
60 3.32 3.49 3.69 3.89 4.09 4.28 4.43
65 3.35 3.54 3.76 4.02 4.31 4.59 4.84
70 3.36 3.57 3.82 4.13 4.49 4.89 5.29
75 3.37 3.59 3.86 4.21 4.63 5.14 5.71
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY MALE
AND SECONDARY FEMALE DOLLAR AMOUNT
45 3.37
50 3.60
55 3.88
60 4.26
65 4.79
70 5.52
75 6.54
Dollar amounts of the monthly annuity payments for the third and fourth options
are based on the Annuity 2000 Table. The above tables assume a year 2000 issue,
and project mortality improvements into the future using Projection Scale G.
These tables assume a net investment rate of 3% per Annum assuming a 365 day
year.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR QUALIFIED CONTRACTS
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
UNISEX
ADJUSTED UNISEX ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.19 3.26 3.33 3.38 3.41 3.44 3.46
50 3.26 3.37 3.46 3.54 3.61 3.66 3.69
55 3.33 3.46 3.60 3.72 3.83 3.91 3.98
60 3.38 3.54 3.72 3.90 4.07 4.22 4.33
65 3.41 3.61 3.83 4.07 4.32 4.56 4.75
70 3.44 3.66 3.91 4.22 4.56 4.91 5.23
75 3.46 3.69 3.98 4.33 4.75 5.23 5.74
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY
AND SECONDARY UNISEX DOLLAR AMOUNT
45 3.34
50 3.55
55 3.82
60 4.19
65 4.70
70 5.40
75 6.40
Dollar amounts of the monthly annuity payments for the third and fourth options
are based on the Annuity 2000 Table (blended 50%/50% female/male). The above
tables assume a year 2000 issue, and project mortality improvements into the
future using Projection Scale G. These tables assume a net investment rate of 3%
per Annum assuming a 365 day year.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTION 5 - PAYMENTS FOR A FIXED PERIOD
MONTHLY MONTHLY
NUMBER OF PAYMENT NUMBER OF PAYMENT
YEARS AMOUNT YEARS AMOUNT
5 17.91 18 5.96
6 15.14 19 5.73
7 13.16 20 5.51
8 11.68 21 5.32
9 10.53 22 5.15
10 9.61 23 4.99
11 8.86 24 4.84
12 8.24 25 4.71
13 7.71 26 4.59
14 7.26 27 4.47
15 6.87 28 4.37
16 6.53 29 4.27
17 6.23 30 4.18
The dollar amounts of the monthly annuity payments for the fifth option are
based on a net investment rate of 3% per annum assuming a 365 day year.
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FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
ELECTIVE OPTIONS NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND MAY
INCREASE OR DECREASE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT.
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DEATH BENEFIT ENDORSEMENT II
THIS ENDORSEMENT IS NOT AVAILABLE WHEN EITHER THE ANNUITANT OR OWNER IS AGE 76
OR OLDER ON THE CONTRACT DATE.
This endorsement is made a part of this contract as of the date it is attached
to the contract.
The "DEATH PROCEEDS PRIOR TO THE MATURITY DATE" provision is amended by deleting
the provision and replacing it with the following:
DEATH PROCEEDS PRIOR TO MATURITY DATE
If the Annuitant dies before age 80 and before the Maturity Date, the death
benefit payable as of the Death Report Date will be the greatest of a), b) or c)
below, less any applicable premium tax and outstanding loans:
a) the contract value on the Death Report Date
b) the roll-up death benefit value (as described below) available at the Death
Report Date; or
c) the step-up value (if any, as described below).
If the Annuitant dies on or after age 80 and before the Maturity Date, the death
benefit payable as of the Death Report Date will be the greatest of a), b) or c)
below, less any applicable premium tax and outstanding loans:
a) the contract value on the Death Report Date
b) the roll-up death benefit value (as described below) available at the
Annuitant's 80th birthday, plus any additional Purchase Payments and minus
any partial surrender reductions (as described below) which occur after the
Annuitant's 80th birthday; or
c) the step-up value (if any, as described below).
ROLL-UP DEATH BENEFIT VALUE
On the Contract Date, the roll-up death benefit value is equal to the
Purchase Payment. On each Contract Date anniversary, the roll-up death
benefit value will be recalculated to equal a) plus b) minus c),
increased by 5%, where:
a) is the Roll-Up Death Benefit as of the previous Contract Date
anniversary
b) any Purchase Payments made during the previous Contract Year
c) any partial surrender reductions (as described below) during the
previous Contract Year
On dates other than the Contract Date anniversary, the roll-up death
benefit value will equal a) plus b) minus c), where:
a) the roll-up death benefit value on the previous Contract Date
anniversary
b) any Purchase Payments made since the previous Contract Date
anniversary
c) any partial surrender reductions (as described below) since the
previous Contract Date anniversary.
The maximum roll-up death benefit equals 200% of the difference between all
Purchase Payments and all partial surrender reductions (as described
below).
STEP-UP VALUE
A step-up value will be established on each Contract Date anniversary which
occurs on or prior to the Death Report Date. The initial step-up value will
equal the contract value on that anniversary. Whenever a Purchase Payment
is made, the step-up value will be increased by
L-22272 TIC Ed. 07-99
30
the amount of that Purchase Payment. Whenever a partial surrender is taken,
the step-up value will be reduced by a partial surrender reduction as
described below. On each Contract Date anniversary that occurs before the
Annuitant's 80th birthday and before the Annuitant's death, if the contract
value is greater than the step-up value, the step-up value will be reset to
equal the contract value on that date. If the step-up value is greater than
the contract value, the step-up value will remain unchanged. The step-up
value will not be reduced on these anniversary recalculations (provided no
surrenders are made on that day). The only changes made to the step-up
value on or after the Annuitant's 80th birthday will be those related to
additional Purchase Payments or partial surrenders as described above. If
the Death Report Date is before the first Contract Date anniversary, there
is no step-up value.
PARTIAL SURRENDER REDUCTION
The partial surrender reduction is equal to 1) the death benefit value
(contract, step-up or roll-up value) in effect immediately prior to the
reduction for the partial surrender, multiplied by 2) the amount of the
partial surrender divided by 3) the contract value immediately prior to the
partial surrender.
We must be notified no later than six months from the date of death in order for
Us to make payment of proceeds as described above. If notification is received
more than six months after the date of death, the death benefit payable will be
the contract value on the Death Report Date, less any applicable premium tax and
outstanding loans.
THE TRAVELERS INSURANCE COMPANY
[SIG]
Chairman
L-22272 TIC Ed. 07-99
31
DEATH BENEFIT ENDORSEMENT I
THIS ENDORSEMENT IS NOT AVAILABLE WHEN EITHER THE ANNUITANT OR OWNER IS AGE 76
OR OLDER ON THE CONTRACT DATE.
This endorsement is made a part of this contract as of the date it is attached
to the contract.
The "DEATH PROCEEDS PRIOR TO THE MATURITY DATE" provision is amended by deleting
the provision and replacing it with the following:
DEATH PROCEEDS PRIOR TO MATURITY DATE
If the Annuitant dies before the Maturity Date, the death benefit payable as of
the Death Report Date will be the greatest of a), b) or c) below, less any
applicable premium tax and outstanding loans:
a) the contract value on the Death Report Date
b) the total Purchase Payments less the total amount of any partial surrenders
made under this contract; or
c) the step-up value (if any, as described below).
STEP-UP VALUE
A step-up value will be established on each Contract Date anniversary which
occurs on or prior to the Death Report Date. The initial step-up value will
equal the contract value on that anniversary. Whenever a Purchase Payment
is made, the step-up value will be increased by the amount of that Purchase
Payment. Whenever a partial surrender is taken, the step-up value will be
reduced by a partial surrender reduction as described below. On each
Contract Date anniversary that occurs before the Annuitant's 80th birthday
and before the Annuitant's death, if the contract value is greater than the
step-up value, the step-up value will be reset to equal the contract value
on that date. If the step-up value is greater than the contract value, the
step-up value will remain unchanged. The step-up value will not be reduced
on these anniversary recalculations (provided no surrenders are made on
that day). The only changes made to the step-up value on or after the
Annuitant's 80th birthday will be those related to additional Purchase
Payments or partial surrenders as described above. If the Death Report Date
is before the first Contract Date anniversary, there is no step-up value.
PARTIAL SURRENDER REDUCTION
The partial surrender reduction is equal to 1) the step-up value in effect
immediately prior to the reduction for the partial surrender, multiplied by
2) the amount of the partial surrender divided by 3) the contract value
immediately prior to the partial surrender.
We must be notified no later than six months from the date of death in order for
Us to make payment of proceeds as described above. If notification is received
more than six months after the date of death, the death benefit payable will be
the contract value on the Death Report Date, less any applicable premium tax and
outstanding loans.
THE TRAVELERS INSURANCE COMPANY
[SIG]
President
L-22271 TIC Ed. 07-99
