FORM OF
| FORM OF | |
| ING Life Insurance and Annuity Company | |
| [Windsor, CT 06095-4774] | Important terms and definitions used in this |
| Contract appear on page _6_. | |
| [Customer Service Center | |
| P.O. Box 10450 | |
| 000 Xxxxxx Xxxxxx, Xxx Xxxxxx, Xxxx 00000-0450] | |
| [0-000-000-0000] [xxx.xxxxxxxxxxxxxxxxxxxxx.xxx] | |
| Contract Number | ||
| [R123456] | ||
| Annuitant | Age of Annuitant | Sex of Annuitant |
| [Xxxxxx X. Xxx] | [55] | [Male] |
| Owner | Age of Owner | Residence State |
| [Xxxxxx X. Xxx] | [55] | [Connecticut] |
| Contract Date | Issue State | |
| [December 1, 2012] | [Connecticut] | |
| Initial Premium | Department of Insurance Phone Number – Issue State | |
| [$5,000] | [(000) 000-0000] | |
| Annuity Commencement Date | ||
| [December 1, 2047] | ||
| Separate Account | ||
| [Variable Annuity Account B] | ||
| SINGLE PREMIUM DEFERRED INDIVIDUAL VARIABLE ANNUITY CONTRACT WITH MINIMUM |
| GUARANTEED WITHDRAWAL BENEFIT |
| In this Contract, “you” or “your” refers to the Owner shown above. “We”, “our”, or “us” refers to ING |
| Life Insurance and Annuity Company. |
| READ YOUR CONTRACT CAREFULLY. This is a legal Contract between you and us. |
| Payments and values under this Contract, when based on the investment experience of the Sub- |
| accounts may increase or decrease, depending on the investment results of the Sub-accounts; they |
| are not guaranteed as to dollar amounts. Provisions regarding the variable nature of this Contract are |
| found in Section 5. |
| RIGHT TO EXAMINE AND RETURN THIS CONTRACT |
| You may return this Contract by mailing or delivering it to our Customer Service Center at the address |
| shown above or to the producer through whom you purchased it within ten days (or thirty days if this |
| is a replacement contract as defined by applicable state regulation) after the date you receive it. If so |
| returned, we will promptly pay you the Accumulation Value plus any charges we have deducted which |
| may be more or less than the Premium paid depending on the investment results of the Sub-accounts. |
| If you are unsure whether your Contract is a replacement contract, please contact us at our Customer |
| Service Center at the phone number or address set forth above. |
| [DEFENSE OF MARRIAGE ACT DISCLOSURE |
| Pursuant to federal law (the Defense of Marriage Act of 1996), certain favorable federal tax treatment |
| available to opposite-sex spouses is not available to same-sex spouses. For instance, federal tax law |
| allows a surviving spouse who is designated the beneficiary under an annuity to continue the annuity |
| when the owner dies. This alternative death benefit option is not available to a same-sex spouse |
| beneficiary. If you are a same-sex spouse, we suggest that you consult with a tax advisor prior to |
| purchasing an annuity contract, such as this one, which provides spousal benefits.] |
| This Contract is non-participating which means it will not pay dividends resulting from any of the surplus or |
| earnings of ING Life Insurance and Annuity Company. |
| ICC12 IL-IA-4030 | 1 |
| TABLE OF CONTENTS | ||
| Page | ||
| 1. | CONTRACT SCHEDULE | 3 |
| 2. | IMPORTANT TERMS AND DEFINITIONS | 6 |
| 3. | INTRODUCTION TO THE CONTRACT | |
| 3.1 The Contract | 9 | |
| 3.2 The Owner | 9 | |
| 3.3 The Annuitant | 9 | |
| 3.4 The Beneficiary | 9 | |
| 4. | PREMIUMS AND TRANSFERS | |
| 4.1 Premiums | 11 | |
| 4.2 Premium Allocation | 11 | |
| 4.3 Transfers | 11 | |
| 4.4 Sub-account No Longer Available | 11 | |
| 5. | CONTRACT VALUE | |
| 5.1 The Separate Account | 12 | |
| 5.2 The Accumulation Value | 12 | |
| 5.3 Charges and Expenses | 13 | |
| 6. | CONTRACT BENEFITS | |
| 6.1 Contract Surrender | 15 | |
| 6.2 Withdrawals | 15 | |
| 6.3 The Death Benefit | 18 | |
| 6.4 Annuity Payments | 20 | |
| 7. | OTHER IMPORTANT INFORMATION | |
| 7.1 Report to Owner | 24 | |
| 7.2 Assignment | 24 | |
| 7.3 Misstatement Made by Owner in Connection with the Purchase of this Contract | 24 | |
| 7.4 Payments We May Defer | 24 | |
| 7.5 Incontestability | 24 | |
| 7.6 Basis of Computation | 24 | |
| 7.7 Rules for Interpreting this Contract | 25 | |
| 7.8 Non-Waiver | 25 | |
| 7.9 Conformity with Interstate Insurance Product Regulation Commission Standards | 25 | |
| ICC12 IL-IA-4030 | 2 |
| 1. CONTRACT SCHEDULE | |||
| X. | Xxxxxxx and Fees: | ||
| Annual Administrative Charge | [$0.00] | ||
| The Annual Administrative Charge will be waived if | |||
| at the time of the deduction the Accumulation Value | |||
| or the Premium received is at least equal to the | |||
| following amounts: | |||
| (1) | Accumulation Value - $[100,000]; or | ||
| (2) | Premium - $[100,000]. | ||
| Excess Transfer Charge | [$0.00] | ||
| Daily Mortality & Expense Risk Charge | [0.001098]%, equal to an annual rate of [0.40]% | ||
| Minimum Guaranteed Withdrawal Benefit | |||
| Charge Rate (MGWB Charge Rate) | [0.250]%, deducted quarterly (annual rate [1.00]%) | ||
| B. | Specially Designated Sub-account | ||
| [ING Money Market Portfolio] or its successor | |||
| C. | Minimum Guaranteed Withdrawal Benefit (MGWB) | ||
| Lifetime Withdrawal Eligibility Age | [62] | ||
| Ratchet Dates | [Each Annual Contract Anniversary before the | ||
| Lifetime Automatic Periodic Benefit Status | |||
| begins and the day the Contract enters the Lifetime | |||
| Withdrawal Phase.] | |||
| Maximum Annual Withdrawal (MAW) Percentage: | [4.0] % | ||
| MGWB Base | $[5,000] | ||
| Assumed Lifetime Withdrawal Commencement Age: | 65 when [100%] of the MAW is available | ||
| Early Lifetime Withdrawal Commencement: | The MAW is reduced to: | ||
| • | [95%] when starting at age 64 | ||
| • | [90%] when starting at age 63 | ||
| • | [85%] when starting at age 62 | ||
| Deferred Lifetime Withdrawal Commencement: | The MAW is increased to: | ||
| • | [102%] when starting at age 66 | ||
| • | [104%] when starting at age 67 | ||
| • | [106%] when starting at age 68 | ||
| • | [108%] when starting at age 69 | ||
| • | [110%] when starting at age 70 plus | ||
| The purpose of the Minimum Guaranteed Withdrawal Benefit (MGWB) provided under this Contract is to | |||
| provide security through a stream of monthly income payments to the Annuitant and, if applicable, the | |||
| Annuitant’s spouse. | |||
| D. | Attached Endorsements [Individual Retirement Annuity Endorsement] | ||
| [Xxxx Individual Retirement Annuity Endorsement] | |||
| ICC12 IL-IA-4030 | 3 |
| E. Joint and Survivor MGWB Elected: Yes [X] No [_] |
| Age of Xxxxxxxxx’s spouse on the Contract Date: [55] |
| Option Data Table (applicable only if Joint and Survivor MGWB has been elected). If a Joint and |
| Survivor MGWB is elected, when the MAW is requested the MAW shall be actuarially adjusted based on the |
| Xxxxxxxxx’s and the Annuitant’s spouse’s ages on the date of the request, following the adjustment for early |
| lifetime withdrawal commencement or deferred lifetime withdrawal commencement, if applicable, using the |
| following Joint and Survivor Equivalency Factors: |
| Annuity 2000 Basic Mortality / 3% Interest Joint and Survivor Equivalency Factors | |||||||||||||
| Annuitant’s | |||||||||||||
| Spouse’s | Age | ||||||||||||
| Age | 62 | 63 | 64 | 65 | 66 | 67 | 68 | 69 | 70 | 71 | 72 | 73 | 74 |
| 20 | 58% | 57% | 55% | 54% | 52% | 51% | 49% | 48% | 46% | 44% | 43% | 41% | 40% |
| 21 | 58% | 57% | 55% | 54% | 52% | 51% | 49% | 48% | 46% | 45% | 43% | 42% | 40% |
| 22 | 59% | 57% | 56% | 54% | 53% | 51% | 50% | 48% | 47% | 45% | 43% | 42% | 40% |
| 23 | 59% | 58% | 56% | 55% | 53% | 51% | 50% | 48% | 47% | 45% | 44% | 42% | 41% |
| 24 | 59% | 58% | 56% | 55% | 53% | 52% | 50% | 49% | 47% | 45% | 44% | 42% | 41% |
| 25 | 60% | 58% | 57% | 55% | 54% | 52% | 51% | 49% | 47% | 46% | 44% | 43% | 41% |
| 26 | 60% | 59% | 57% | 56% | 54% | 52% | 51% | 49% | 48% | 46% | 44% | 43% | 41% |
| 27 | 61% | 59% | 58% | 56% | 54% | 53% | 51% | 50% | 48% | 46% | 45% | 43% | 42% |
| 28 | 61% | 59% | 58% | 56% | 55% | 53% | 52% | 50% | 48% | 47% | 45% | 43% | 42% |
| 29 | 61% | 60% | 58% | 57% | 55% | 54% | 52% | 50% | 49% | 47% | 45% | 44% | 42% |
| 30 | 62% | 60% | 59% | 57% | 56% | 54% | 52% | 51% | 49% | 47% | 46% | 44% | 43% |
| 31 | 62% | 61% | 59% | 58% | 56% | 54% | 53% | 51% | 49% | 48% | 46% | 44% | 43% |
| 32 | 63% | 61% | 60% | 58% | 56% | 55% | 53% | 52% | 50% | 48% | 47% | 45% | 43% |
| 33 | 63% | 62% | 60% | 59% | 57% | 55% | 54% | 52% | 50% | 49% | 47% | 45% | 44% |
| 34 | 64% | 62% | 61% | 59% | 57% | 56% | 54% | 52% | 51% | 49% | 47% | 46% | 44% |
| 35 | 64% | 63% | 61% | 60% | 58% | 56% | 55% | 53% | 51% | 49% | 48% | 46% | 44% |
| 36 | 65% | 63% | 62% | 60% | 58% | 57% | 55% | 53% | 52% | 50% | 48% | 46% | 45% |
| 37 | 65% | 64% | 62% | 61% | 59% | 57% | 56% | 54% | 52% | 50% | 49% | 47% | 45% |
| 38 | 66% | 64% | 63% | 61% | 59% | 58% | 56% | 54% | 53% | 51% | 49% | 47% | 46% |
| 39 | 67% | 65% | 63% | 62% | 60% | 58% | 57% | 55% | 53% | 51% | 50% | 48% | 46% |
| 40 | 67% | 66% | 64% | 62% | 61% | 59% | 57% | 55% | 54% | 52% | 50% | 48% | 47% |
| 41 | 68% | 66% | 65% | 63% | 61% | 60% | 58% | 56% | 54% | 52% | 51% | 49% | 47% |
| 42 | 69% | 67% | 65% | 64% | 62% | 60% | 58% | 57% | 55% | 53% | 51% | 49% | 48% |
| 43 | 69% | 68% | 66% | 64% | 63% | 61% | 59% | 57% | 55% | 54% | 52% | 50% | 48% |
| 44 | 70% | 68% | 67% | 65% | 63% | 62% | 60% | 58% | 56% | 54% | 52% | 51% | 49% |
| 45 | 71% | 69% | 67% | 66% | 64% | 62% | 60% | 59% | 57% | 55% | 53% | 51% | 49% |
| 46 | 71% | 70% | 68% | 66% | 65% | 63% | 61% | 59% | 57% | 56% | 54% | 52% | 50% |
| 47 | 72% | 71% | 69% | 67% | 65% | 64% | 62% | 60% | 58% | 56% | 54% | 53% | 51% |
| 48 | 73% | 71% | 70% | 68% | 66% | 64% | 63% | 61% | 59% | 57% | 55% | 53% | 51% |
| 49 | 74% | 72% | 71% | 69% | 67% | 65% | 63% | 62% | 60% | 58% | 56% | 54% | 52% |
| 50 | 75% | 73% | 71% | 70% | 68% | 66% | 64% | 62% | 61% | 59% | 57% | 55% | 53% |
| 51 | 75% | 74% | 72% | 71% | 69% | 67% | 65% | 63% | 61% | 59% | 57% | 56% | 54% |
| 52 | 76% | 75% | 73% | 71% | 70% | 68% | 66% | 64% | 62% | 60% | 58% | 56% | 54% |
| 53 | 77% | 76% | 74% | 72% | 71% | 69% | 67% | 65% | 63% | 61% | 59% | 57% | 55% |
| 54 | 78% | 77% | 75% | 73% | 71% | 70% | 68% | 66% | 64% | 62% | 60% | 58% | 56% |
| 55 | 79% | 77% | 76% | 74% | 72% | 71% | 69% | 67% | 65% | 63% | 61% | 59% | 57% |
| 56 | 80% | 78% | 77% | 75% | 73% | 72% | 70% | 68% | 66% | 64% | 62% | 60% | 58% |
| 57 | 81% | 79% | 78% | 76% | 74% | 73% | 71% | 69% | 67% | 65% | 63% | 61% | 59% |
| 58 | 82% | 80% | 79% | 77% | 75% | 74% | 72% | 70% | 68% | 66% | 64% | 62% | 60% |
| 59 | 83% | 81% | 80% | 78% | 76% | 75% | 73% | 71% | 69% | 67% | 65% | 63% | 61% |
| 60 | 83% | 82% | 81% | 79% | 77% | 76% | 74% | 72% | 70% | 68% | 66% | 64% | 62% |
| ICC12 IL-IA-4030 | 4 |
| Annuity 2000 Basic Mortality / 3% Interest Joint and Survivor Equivalency Factors (continued) | |||||||||||||
| Annuitant’s | |||||||||||||
| Spouse’s | Age | ||||||||||||
| Age | 62 | 63 | 64 | 65 | 66 | 67 | 68 | 69 | 70 | 71 | 72 | 73 | 74 |
| 61 | 84% | 83% | 82% | 80% | 78% | 77% | 75% | 73% | 71% | 69% | 67% | 65% | 63% |
| 62 | 85% | 84% | 83% | 81% | 79% | 78% | 76% | 74% | 72% | 70% | 68% | 66% | 64% |
| 63 | 86% | 85% | 83% | 82% | 80% | 79% | 77% | 75% | 74% | 72% | 70% | 68% | 66% |
| 64 | 87% | 86% | 84% | 83% | 82% | 80% | 78% | 77% | 75% | 73% | 71% | 69% | 67% |
| 65 | 88% | 87% | 85% | 84% | 83% | 81% | 79% | 78% | 76% | 74% | 72% | 70% | 68% |
| 66 | 89% | 87% | 86% | 85% | 84% | 82% | 81% | 79% | 77% | 75% | 73% | 71% | 69% |
| 67 | 89% | 88% | 87% | 86% | 85% | 83% | 82% | 80% | 78% | 76% | 75% | 73% | 71% |
| 68 | 90% | 89% | 88% | 87% | 86% | 84% | 83% | 81% | 79% | 78% | 76% | 74% | 72% |
| 69 | 91% | 90% | 89% | 88% | 87% | 85% | 84% | 82% | 81% | 79% | 77% | 75% | 73% |
| 70 | 92% | 91% | 90% | 89% | 87% | 86% | 85% | 83% | 82% | 80% | 78% | 77% | 75% |
| 71 | 92% | 91% | 90% | 89% | 88% | 87% | 86% | 84% | 83% | 81% | 80% | 78% | 76% |
| 72 | 93% | 92% | 91% | 90% | 89% | 88% | 87% | 86% | 84% | 83% | 81% | 79% | 77% |
| 73 | 93% | 93% | 92% | 91% | 90% | 89% | 88% | 87% | 85% | 84% | 82% | 80% | 79% |
| 74 | 94% | 93% | 93% | 92% | 91% | 90% | 89% | 88% | 86% | 85% | 83% | 82% | 80% |
| 75 | 95% | 94% | 93% | 92% | 92% | 91% | 90% | 89% | 87% | 86% | 85% | 83% | 81% |
| 76 | 95% | 95% | 94% | 93% | 92% | 91% | 91% | 89% | 88% | 87% | 86% | 84% | 83% |
| 77 | 96% | 95% | 94% | 94% | 93% | 92% | 91% | 90% | 89% | 88% | 87% | 85% | 84% |
| 78 | 96% | 95% | 95% | 94% | 94% | 93% | 92% | 91% | 90% | 89% | 88% | 87% | 85% |
| 79 | 96% | 96% | 95% | 95% | 94% | 94% | 93% | 92% | 91% | 90% | 89% | 88% | 86% |
| 80 | 97% | 96% | 96% | 95% | 95% | 94% | 93% | 93% | 92% | 91% | 90% | 89% | 87% |
| 81 | 97% | 97% | 96% | 96% | 95% | 95% | 94% | 93% | 93% | 92% | 91% | 90% | 88% |
| 82 | 97% | 97% | 97% | 96% | 96% | 95% | 95% | 94% | 93% | 92% | 92% | 91% | 89% |
| 83 | 98% | 97% | 97% | 97% | 96% | 96% | 95% | 95% | 94% | 93% | 92% | 91% | 90% |
| 84 | 98% | 98% | 97% | 97% | 97% | 96% | 96% | 95% | 95% | 94% | 93% | 92% | 91% |
| 85 | 98% | 98% | 98% | 97% | 97% | 97% | 96% | 96% | 95% | 94% | 94% | 93% | 92% |
| 86 | 98% | 98% | 98% | 98% | 97% | 97% | 97% | 96% | 96% | 95% | 94% | 94% | 93% |
| 87 | 99% | 98% | 98% | 98% | 98% | 97% | 97% | 97% | 96% | 96% | 95% | 94% | 94% |
| 88 | 99% | 99% | 98% | 98% | 98% | 98% | 97% | 97% | 96% | 96% | 96% | 95% | 94% |
| 89 | 99% | 99% | 99% | 98% | 98% | 98% | 98% | 97% | 97% | 96% | 96% | 95% | 95% |
| 90 | 99% | 99% | 99% | 99% | 98% | 98% | 98% | 98% | 97% | 97% | 96% | 96% | 95% |
| For ages not shown, appropriate factors will be provided. | |||||||||||||
| ICC12 IL-IA-4030 | 5 |
| 2. IMPORTANT TERMS AND DEFINITIONS |
| Accumulation Value means the sum of the Accumulation Values in each of the Sub-accounts. See Section |
| 5.2 for additional details. |
| Annuitant means the individual designated by you and upon whose life the Minimum Guaranteed Withdrawal |
| Benefit, Death Benefit or Annuity Payments are based. |
| Annuity Commencement Date means the date on which Annuity Payments commence. |
| Annuity Payments means periodic Annuity Plan payments made by us to you or, subject to our consent in |
| the event the payee is not a natural person, to a payee designated by you. |
| Annuity Plan means an option elected by you (or, if none is elected, means the option described under |
| Electing an Annuity Plan in Section 6.4) that determines the frequency, duration and amount of the Annuity |
| Payments. |
| Beneficiary means the individual or entity you select to receive the Death Benefit. See Section 3.4 for |
| additional details. |
| Business Day means any day that the New York Stock Exchange is open for trading, exclusive of federal |
| holidays, or any day the Securities and Exchange Commission (“SEC”) requires that Investment Portfolios be |
| valued. |
| Cash Surrender Value means the amount you receive upon Surrender of this Contract, which equals the |
| Accumulation Value minus any applicable charges. See Sections 5.2, 5.3, and 6.1 for additional details. |
| Code means the Internal Revenue Code of 1986, as amended. |
| Contract means this Single Premium Deferred Individual Variable Annuity Contract with Minimum Guaranteed |
| Withdrawal Benefit, together with any attached application, amendments, or Endorsements. |
| Contract Anniversary means the same day and month each year as the Contract Date. If the Contract Date |
| is February 29th, in non-leap years, the Contract Anniversary shall be March 1st. |
| Contract Date means the date on which this Contract becomes effective. The Contract Date is shown on the |
| first page of this Contract. |
| Contract Year means the period beginning on a Contract Anniversary (or, in the first Contract Year only, |
| beginning on the Contract Date) and ending on the day preceding the next Contract Anniversary. |
| Death Benefit means the amount payable to the Beneficiary upon death of the Annuitant (1) prior to the |
| Annuity Commencement Date and before the Contract enters the Lifetime Automatic Periodic Benefit Status, |
| or (2) while the Payments for Life with Surrender Right and Death Benefit Annuity Plan is in effect and before |
| the Contract enters the Lifetime Automatic Periodic Benefit Status. |
| Endorsements mean attachments to the Contract that add to, amend, change, modify or supersede the |
| Contract’s terms or provisions. |
| Excess Transfer means any transfer between available Sub-accounts after twelve transfers have occurred |
| within any Contract Year. |
| Excess Transfer Charge means the charge we may assess on each Excess Transfer. The Excess Transfer |
| Charge amount is stated in the Contract Schedule. |
| ICC12 IL-IA-4030 | 6 |
| Excess Withdrawal means any Withdrawal taken before commencement of the Lifetime Withdrawal Phase or |
| any Withdrawal in a Contract Year exceeding the then current Maximum Annual Withdrawal on or after the |
| Lifetime Withdrawal Phase has begun. |
| General Account means an account which contains all of our assets other than those held in our Separate |
| Account. |
| Initial Premium means the payment made by you to us to put this Contract into effect. |
| Investment Portfolio means the mutual fund or unit investment trust in which a Sub-account invests. |
| Irrevocable Beneficiary means a Beneficiary whose rights and interests under this Contract cannot be |
| changed without his, her or its consent. |
| Joint and Survivor MGWB means the Minimum Guaranteed Withdrawal Benefit payable for the life of the |
| Annuitant and the life of the Annuitant’s spouse (as defined under federal law). |
| Lifetime Automatic Periodic Benefit Status means a period in time during which we will pay you MGWB |
| Periodic Payments. See Section 6.2 for details. |
| Lifetime Withdrawal Eligibility Age means the age of the Annuitant shown in the Contract Schedule on or |
| after which the Owner may begin the Lifetime Withdrawal Phase. See Section 6.2 for additional details. |
| Lifetime Withdrawal Phase means the period under the Minimum Guaranteed Withdrawal Benefit during |
| which the Maximum Annual Withdrawal is calculated and is available for withdrawal. The Lifetime Withdrawal |
| Phase begins on the date of the first Withdrawal on or after the date the Annuitant reaches the Lifetime |
| Withdrawal Eligibility Age. See Section 6.2 for additional details. |
| Maximum Annual Withdrawal or MAW means the maximum amount available for Withdrawal from the |
| Contract under the Minimum Guaranteed Withdrawal Benefit in any Contract Year without reducing the MGWB |
| Base in future Contract Years. |
| MGWB Base means the factor that is used for the sole purpose of calculating the MAW and the charge for the |
| Minimum Guaranteed Withdrawal Benefit. The MGWB Base has no cash value. |
| MGWB Charge Rate means the percentage of the MGWB Base as of the last Business Day immediately prior |
| to the date the MGWB Charge is deducted. The MGWB Charge Rate percentage is shown in the Contract |
| Schedule. |
| MGWB Periodic Payments mean the payments that occur after the Contract enters the Lifetime Automatic |
| Periodic Benefit Status. |
| Minimum Guaranteed Withdrawal Benefit or MGWB means the benefit available after the Annuitant |
| reaches the Lifetime Withdrawal Eligibility Age that guarantees that the Annuitant (and the Annuitant’s spouse |
| if a Joint and Survivor MGWB has been elected) will have a pre-determined amount, the MAW, available for |
| Withdrawals from the Contract each Contract Year, even if the Accumulation Value is reduced to zero (other |
| than by Excess Withdrawal or Surrender), as more fully described in Section 6.2 of the Contract. |
| Minimum Guaranteed Withdrawal Benefit Charge or MGWB Charge means the charge deducted from the |
| Accumulation Value and related to the Minimum Guaranteed Withdrawal Benefit available through the |
| Contract. The MGWB Charge is described in Section 5.3. |
| Net Return Factor means the value that reflects: (1) the investment experience of an Investment Portfolio in |
| which a Sub-account invests; and (2) the charges assessed against that Sub-account during a Valuation |
| Period. |
| Notice to Us means notice made in a form that: (1) is approved by, or is acceptable to, us; (2) has the |
| information and any documentation we determine in our discretion to be necessary to take the action |
| ICC12 IL-IA-4030 | 7 |
| requested or exercise the right specified; and (3) is received by us at our Customer Service Center at the |
| address specified on the first page of this Contract. Under certain circumstances, we may permit you to |
| provide Notice to Us by telephone or electronically. |
| Notice to You means written notification mailed to your last known address. A different means of notification |
| may also be used if you and we mutually agree. When action is required by you, the time frame and manner |
| for response will be specified in the notice. |
| Owner means the individual (or entity) that is entitled to exercise the rights incident to ownership. The terms |
| “you” or “your”, when used in this Contract, refer to the Owner. |
| Premium means the Initial Premium. |
| Proof of Death means the documentation we deem necessary to establish death including, but not limited to: |
| (1) a certified copy of a death certificate; (2) a certified copy of a statement of death from the attending |
| physician; (3) a finding of a court of competent jurisdiction as to the cause of death; or (4) any other proof we |
| deem in our discretion to be satisfactory to us. |
| Ratchet means an increase to the MGWB Base equal to the amount by which the Accumulation Value on the |
| applicable Ratchet Date is greater than the MGWB Base on such Ratchet Date. |
| Ratchet Date means the applicable date set forth in the Contract Schedule. |
| Right To Examine Period means the period of time during which you have the right to return the Contract for |
| any reason, or no reason at all, and receive the payment as described in the Right to Examine and Return |
| This Contract provision appearing on the first page of this Contract. Exercise of the Right to Examine will |
| result in termination of the Contract, including any MGWB. |
| Specially Designated Sub-account means a Sub-account that is used as a “holding” account or for |
| administrative purposes. The Specially Designated Sub-account is designated by us and identified in the |
| Contract Schedule. |
| Surrender means a transaction in which the entire Cash Surrender Value is taken from the Contract. |
| Separate Account means the separate account shown on the first page of this Contract. The Separate |
| Account is a segregated asset account established under Connecticut Law to fund variable annuity contracts. |
| The Separate Account is registered as a unit investment trust under the Investment Company Act of 1940 and |
| it also meets the definition of “separate account” under the federal securities laws. |
| Sub-account means a sub-account of the Separate Account that invests in an Investment Portfolio. |
| Valuation Period means the time from the close of regular trading on the New York Stock Exchange on one |
| Business Day to the close of regular trading on the next succeeding Business Day. |
| “We”, “our”, or “us”, when used in this Contract, means ING Life Insurance and Annuity Company, a stock |
| company domiciled in Connecticut. |
| Withdrawal means a transaction in which only a portion of the Cash Surrender Value is taken from the |
| Contract. Annuity Payments under the Payments for Life with Surrender Right and Death Benefit Annuity Plan |
| are treated as Withdrawals, as are required minimum distributions made in accordance with the requirements |
| of Sections 408(b)(3) or 408(a)(6) of the Code and the Treasury regulations thereunder. |
| ICC12 IL-IA-4030 | 8 |
| 3. INTRODUCTION TO THE CONTRACT |
| 3.1 The Contract |
| This Contract and any attached application, amendments, or Endorsements constitute the entire Contract |
| between you and us. The Contract is issued in consideration of the Initial Premium. If the application is |
| attached to the Contract, all statements made by the applicant for the issuance of the Contract shall, in the |
| absence of fraud, be deemed representations and not warranties. |
| Only our president, a vice president or secretary is authorized to amend, change or modify any of the |
| Contract’s terms, provisions or requirements. Any such amendment, change or modification must be in |
| writing. We may amend, change or modify this Contract if required by law, including any amendment, |
| change or modification necessary to continue to qualify such Contract as an annuity contract under |
| applicable law. An Endorsement added to comply with applicable law does not require your consent but is |
| subject to regulatory approval. Any such amendments, changes or modifications will apply uniformly to all |
| contracts that are affected. |
| The provisions of this Contract shall, in all events, be construed to comply with applicable U.S. federal |
| income tax requirements including the requirements of Section 72(s) of the Code. |
| 3.2 The Owner |
| The Owner owns the Contract and is entitled to exercise the rights incident of ownership. |
| You may change the ownership of this Contract at any time prior to the Annuity Commencement Date. |
| Except as noted in Section 6.3 for spousal continuation, ownership may only be changed to a custodian |
| for the benefit of the Annuitant or to the Annuitant. No other changes of ownership will be allowed. To |
| change ownership, you must provide Notice to Us of such change. Change of ownership will take effect |
| as of the date Notice to Us is signed by the Owner, subject to any payments we make or actions we take |
| prior to our receipt of such Notice to Us. |
| You may elect a Joint and Survivor MGWB, in which case, the Annuitant’s spouse (as defined under |
| federal law) will be entitled to MGWB. See Section 6.2. You may name a joint Annuitant on the Annuity |
| Commencement Date, but only if you elect a Joint and Last Survivor Life Payments Annuity Plan. |
| 3.3 The Annuitant |
| The Annuitant must be a natural person. The Annuitant cannot be changed while he or she is living, but |
| see Section 6.3 for details about situations in which the Annuitant’s surviving spouse (as defined under |
| federal law) may become the Annuitant. |
| 3.4 The Beneficiary |
| A Beneficiary’s status may be changed at any time prior to the Annuity Commencement Date unless you |
| designate such Beneficiary as an Irrevocable Beneficiary. An Irrevocable Beneficiary cannot be changed |
| without the consent of the Irrevocable Beneficiary. You may designate one or more classes of |
| Beneficiaries: (i) primary Beneficiaries and (ii) contingent Beneficiaries. The Death Benefit will be paid to |
| the primary Beneficiary. If all the primary Beneficiaries die before the Annuitant, the contingent Beneficiary |
| shall take the place of, and be deemed to be, the primary Beneficiary. If there are multiple Beneficiaries, |
| the Death Benefit shall be paid in equal shares to all primary Beneficiaries unless you provide Notice to Us |
| directing otherwise. |
| In the case of a single life MGWB, if the Annuitant is the Owner and no Beneficiaries are alive or have |
| been designated at the time of the Annuitant’s death, the Annuitant’s estate will be deemed to be the |
| primary Beneficiary. |
| ICC12 IL-IA-4030 | 9 |
| In the case of a Joint and Survivor MGWB, the Annuitant’s spouse will be deemed to be the sole primary | |
| Beneficiary notwithstanding any other Beneficiary designation made. In the case of a Joint and Survivor | |
| MGWB, if the Annuitant’s spouse is the Owner and no Beneficiaries are alive or have been designated at | |
| the time of the Annuitant’s spouse’s death, then the estate of the Annuitant’s spouse will be deemed to be | |
| the primary Beneficiary. | |
| If the Owner is not a natural person and all Beneficiaries die before the Annuitant (or the Annuitant’s | |
| spouse, if applicable), or if no Beneficiary has been designated at the time of the Annuitant’s death (or the | |
| Annuitant’s spouse’s death, if applicable), the Owner will be deemed to be the primary Beneficiary. | |
| We will deem any Beneficiary to have predeceased the Annuitant, if: | |
| (1) | Such Beneficiary died at the same time as the Annuitant; |
| (2) | Such Beneficiary died within twenty-four hours after the Annuitant’s death; or |
| (3) | There is not sufficient evidence to determine that the Beneficiary and Xxxxxxxxx died other than at the |
| same time. | |
| To make a Beneficiary change, you must provide Notice to Us. Unless you specify otherwise, such | |
| change cancels any existing Beneficiary designations in the same class (primary or contingent) and will | |
| take effect as of the date Notice to Us is signed by the Owner, subject to any payments we make or | |
| actions we take prior to receipt of such Notice to Us. | |
| The rights of any Beneficiary (if a natural person), including an Irrevocable Beneficiary, will end if he or she | |
| dies prior to the Annuitant and will pass to any other Beneficiary (which, if a natural person, must then be | |
| living) as described in this Section 3.4 unless you provide Notice to Us directing otherwise. | |
| ICC12 IL-IA-4030 | 10 |
| 4. PREMIUMS |
| 4.1 Premiums |
| The Initial Premium for this Contract is required to put this Contract into effect. The amount of the Initial |
| Premium is shown on the first page of this Contract. Additional Premium will not be accepted. |
| 4.2 Premium Allocation |
| You select how to allocate the Premium among the available Sub-account(s). We reserve the right to |
| allocate the Premium received before expiration of the Right to Examine Period to the Specially |
| Designated Sub-account. If we do so, upon expiration of the Right to Examine Period, the Accumulation |
| Value will be allocated proportionately in accordance with your directions. |
| Premium will be allocated as of the earlier of 4 P.M. Eastern Time and close of business on the Business |
| Day such Premium is received by us. Any Premium received by us after the close of regular trading on |
| the New York Stock Exchange will be allocated as of the close of business on the next Business Day. |
| 4.3 Transfers |
| Subject to the limitations set out herein, on any Business Day thirty days or more after the Contract Date |
| and prior to the Annuity Commencement Date, if more than one Sub-account is available, you may |
| transfer the Accumulation Value among such available Sub-accounts. You may also transfer the |
| Accumulation Value among available Sub-accounts on or after the Annuity Commencement Date but only |
| if you are eligible for and elect Payments for Life with Surrender Right and Death Benefit. You may not |
| transfer the Accumulation Value among available Sub-accounts on or after the Annuity Commencement |
| Date under any other Annuity Plan. To make a transfer, you must provide Notice to Us. |
| If you make an Excess Transfer, you may be assessed an Excess Transfer Charge. An Excess Transfer |
| is any transfer after twelve transfers in one Contract Year. Transferred values may be reduced by Excess |
| Transfer Charges. See Section 5.3. |
| Transfers will occur as of the close of business on the Business Day we receive your request. However, |
| any transfer requests received by us after the close of regular trading on the New York Stock Exchange |
| will take effect as of the close of business on the next Business Day. |
| We will monitor transfer activity and will restrict transfers that constitute excessive trading. You may not |
| make more than one purchase and sale of the same Sub-account within a sixty day period or more than |
| five such purchases and sales within any twelve month period. We may modify these restrictions, or the |
| standard as it may apply to a particular Sub-account, at any time without prior notice, depending on, |
| among other factors, the needs of the underlying Investment Portfolio(s) in which the Sub-account(s) |
| invest, the best interest of the contract Owners, and/or state and federal regulatory requirements. If this |
| standard is modified, it will be applied uniformly to all contracts or as applicable, to all contracts investing |
| in the underlying Investment Portfolio. We will notify you of any such modification. |
| 4.4 Investment Portfolio No Longer Available |
| If an Investment Portfolio in which a Sub-account invests is no longer available because it has been |
| substituted by or merged into another Investment Portfolio, we will execute your allocation or transfer |
| instructions using the substitute or proposed replacement Investment Portfolio. The substitute or |
| proposed replacement Investment Portfolio in which the Sub-account invests may have higher fees and |
| charges than the Investment Portfolio it replaces. |
| ICC12 IL-IA-4030 | 11 |
| 5. CONTRACT VALUE | |
| 5.1 The Separate Account | |
| The Separate Account is kept separate from our General Account and any other separate accounts we | |
| may have. We own the assets in the Separate Account. Assets equal to the reserves and other liabilities | |
| of the Separate Account will not be charged with liabilities that arise from any other business we conduct. | |
| We may transfer to our General Account assets of the Separate Account that exceed the reserves and | |
| other liabilities of the Separate Account. Income along with realized and unrealized gains or losses from | |
| assets in the Separate Account are credited to or charged against the Separate Account without regard to | |
| other income, gains or losses in our General Account and other separate accounts. | |
| Sub-accounts | |
| The Separate Account is divided into Sub-accounts, each of which invests in a designated Investment | |
| Portfolio that we determine to be suitable for the Contract’s purposes. The Investment Portfolios may be | |
| managed by separate investment advisers. Such adviser may be registered under the Investment | |
| Advisers Act of 1940. | |
| Changes Within the Separate Account | |
| We may, from time to time, make additional Sub-accounts available to you. We also have the right to | |
| eliminate Sub-accounts, combine two or more Sub-accounts or substitute a new Investment Portfolio for | |
| the Investment Portfolio in which a Sub-account invests. A substitution may become necessary if, in our | |
| judgment, an Investment Portfolio Sub-account no longer suits the purpose of the Contract. This may | |
| happen due to a change in laws or regulations, a change in an Investment Portfolio’s investment | |
| objectives or restrictions, because the Investment Portfolio or Sub-account is no longer available for | |
| investment or for some other reason. We will obtain any required regulatory approvals before making a | |
| substitution. We will send Notice to You in advance of any changes within the Separate Account. | |
| Subject to any required regulatory approvals, we reserve the right to transfer assets of the Separate | |
| Account or any Sub-account that we determine to be associated with the class of contracts to which this | |
| Contract belongs to another separate account or to another sub-account. The Investment Portfolio in | |
| which the transferred assets invest through the new separate account or sub-account may have higher | |
| fees than the prior Investment Portfolio. | |
| When permitted by law, we reserve the right to: | |
| (1) | Deregister the Separate Account under the Investment Company Act of 1940; |
| (2) | Operate the Separate Account as a management company under the Investment Company Act of |
| 1940 if it is operating as a unit investment trust; | |
| (3) | Operate the Separate Account as a unit investment trust under the Investment Company Act of 1940 if |
| it is operating as a managed separate account; | |
| (4) | Restrict or eliminate any voting rights of Owners or other persons who have voting rights to the |
| Separate Account; and | |
| (5) | Combine the Separate Account with other separate accounts. |
| 5.2 The Accumulation Value | |
| The Accumulation Value of this Contract is the sum of the Accumulation Values in each of the Sub- | |
| accounts. Each Sub-account is valued at the close of each Business Day for the preceding Valuation | |
| Period. | |
| On the Contract Date, the Accumulation Value in each Sub-account equals the Initial Premium allocated | |
| to that Sub-account, less premium tax if applicable. | |
| ICC12 IL-IA-4030 | 12 |
| At the close of each Business Day thereafter, the Accumulation Value in each Sub-account is calculated | |
| as follows: | |
| (1) | We start with the Accumulation Value in the Sub-account at the close of the preceding Business Day. |
| (2) | We multiply (1) by the Sub-account’s Net Return Factor, explained below, for the current Valuation |
| Period. | |
| (3) | We add or subtract transfers to or from that Sub-account during the current Valuation Period. |
| (4) | We subtract from (3) any Withdrawals during the current Valuation Period. |
| (5) | We subtract from (4) any charges, other than daily charges, or applicable taxes including any |
| premium taxes not previously deducted, allocated to that Sub-account for any deductions from | |
| Accumulation Value as shown in the Contract Schedule. | |
| Sub-account’s Net Return Factor | |
| The Net Return Factor for each Sub-account is calculated as follows: | |
| (1) | We take the net asset value of the Investment Portfolio in which the Sub-account invests at the close |
| of the current Business Day. | |
| (2) | We add to (1) the amount of any dividend or capital gains distribution declared for the Investment |
| Portfolio and reinvested in such Investment Portfolio during the current Valuation Period. | |
| (3) | We divide (2) by the net asset value of the Investment Portfolio at the close of the preceding Business |
| Day. | |
| (4) | We subtract the daily mortality & expense risk charge set forth in the Contract Schedule for each Sub- |
| account for each day in the current Valuation Period. | |
| Calculations for Sub-accounts investing in unit investment trusts are on a per unit basis. | |
| 5.3 Charges and Expenses | |
| Minimum Guaranteed Withdrawal Benefit Charge (“MGWB Charge”) | |
| The MGWB Charge is calculated daily but deducted on each quarterly Contract Anniversary from the | |
| Accumulation Value in the Sub-accounts, in the same proportion that the total Accumulation Value in each | |
| Sub-account bears to the total Accumulation Value in your Contract. The MGWB Charge is equal to the | |
| MGWB Base as of the previous Business Day multiplied by the MGWB Charge Rate shown in the | |
| Contract Schedule. The MGWB Charge will continue to be assessed for as long as the Minimum | |
| Guaranteed Withdrawal Benefit is in effect, unless the Accumulation Value is reduced to zero. | |
| If the Contract is terminated due to the Surrender, cancellation or application of the Accumulation Value to | |
| an Annuity Plan other than the Payments for Life with Surrender Right and Death Benefit Annuity Plan, the | |
| MGWB Charge for that portion of the current quarter completed will be deducted from the Accumulation | |
| Value prior to termination of the Contract. | |
| Annual Administrative Charge | |
| We may assess an annual administrative charge to cover a portion of our ongoing administrative | |
| expenses. The charge is deducted from the Accumulation Value in each Sub-account (1) on each | |
| Contract Anniversary prior to the Annuity Commencement Date, (2) on each Contract Anniversary on or | |
| following the Annuity Commencement Date if you elect the Payments for Life with Surrender Right and | |
| Death Benefit Annuity Plan, (3) on the Annuity Commencement Date or (4) at Surrender, each such | |
| deduction in the same proportion that the Accumulation Value in that Sub-account bears to the total | |
| Accumulation Value in all Sub-accounts on that date. If the Contract Anniversary, Annuity | |
| Commencement Date or Surrender falls on a non-business day, the charge is calculated at the close of | |
| business on the next Business Day. We may, at any time, charge less but will never charge more than | |
| the annual administrative charge shown in the Contract Schedule. At the time of deduction, this charge | |
| will be waived if the Accumulation Value or the Premium received is at least equal to the amounts shown | |
| in the Contract Schedule. | |
| At our discretion, we may reduce, but not increase the amounts shown in the Contract Schedule for | |
| waiving the annual administrative charge. | |
| ICC12 IL-IA-4030 | 13 |
| Excess Transfer Charge | |
| We may assess an Excess Transfer Charge for each Excess Transfer, which are all transfers after the | |
| first twelve in a Contract Year. Any Excess Transfer Charge will be deducted from the Accumulation | |
| Value in the Sub-account(s) from which an Excess Transfer is made. The transfer of Accumulation Value | |
| from any Sub-account is deemed to be one transfer regardless of the number of Sub-accounts into which | |
| the value is transferred. We may, at any time, charge less but will never charge more than the Excess | |
| Transfer Charge shown in the Contract Schedule. | |
| Mortality & Expense Risk Charge | |
| We assess a mortality & expense risk charge (“M & E charge”) against each Sub-account on a daily | |
| basis. We may, at any time, charge less but will never charge more than the daily M & E charge shown in | |
| the Contract Schedule. | |
| Premium Tax | |
| We may deduct from the Accumulation Value the amount of any premium tax or other state and local | |
| taxes levied by any state or local government entity when: | |
| (1) | Such premium tax is incurred by us; or |
| (2) | The Accumulation Value is applied to an Annuity Plan on the Annuity Commencement Date as |
| described in Section 6.4. | |
| We have the right to change the amount we charge for any premium tax to conform to changes in the | |
| applicable law or if you change your state of residence. Unless you direct otherwise, any premium taxes | |
| will be deducted from all Sub-accounts on a pro rata basis. | |
| Other Taxes | |
| We do not expect any U.S. federal income tax liability attributable to the Separate Account. However, | |
| changes in federal laws, Treasury regulations and/or their interpretation thereof may result in our being | |
| taxed on income or gains attributable to the Separate Account. In this case, a charge may be deducted | |
| from the Separate Account to provide for the payment of such taxes. | |
| ICC12 IL-IA-4030 | 14 |
| 6. CONTRACT BENEFITS | |
| 6.1 Contract Surrender | |
| At any time prior to the Annuity Commencement Date, you may Surrender this Contract for its Cash | |
| Surrender Value. You may also Surrender this Contract for its Cash Surrender Value on or after the | |
| Annuity Commencement Date but only if you elected Payments for Life with Surrender Right and Death | |
| Benefit. You may not Surrender this Contract for a Cash Surrender Value on or after the Annuity | |
| Commencement Date under any other Annuity Plan. To Surrender this Contract for its Cash Surrender | |
| Value, you must provide Notice to Us. If we receive your Notice to Us before the close of business on any | |
| Business Day, the Cash Surrender Value will be determined at the close of business on such Business | |
| Day; otherwise, the Cash Surrender Value will be determined as of the close of the next Business Day. | |
| We may require that this Contract be returned to us before we pay you the Cash Surrender Value. If you | |
| have lost the Contract, we may require that you complete and return to our Customer Service Center a lost | |
| contract form. Upon payment of the Cash Surrender Value, this Contract will terminate and cease to have | |
| any further value. | |
| To calculate the Cash Surrender Value, we start with the Accumulation Value at the time of Surrender. | |
| We subtract any charges that have been incurred but not deducted, including but not limited to, any annual | |
| administrative charges and the pro rata portion of any MGWB Charges. | |
| 6.2 Withdrawals | |
| At any time prior to the Annuity Commencement Date, you may withdraw a portion of the Accumulation | |
| Value, subject to the terms and conditions stated below, by providing Notice to Us. If we receive your | |
| Notice to Us before the close of business on any Business Day, the Withdrawal will be taken at the close | |
| of business on such Business Day; otherwise, the Withdrawal will be taken as of the close of the next | |
| Business Day. Unless you direct otherwise, Withdrawals will be withdrawn from all Sub-accounts on a pro | |
| rata basis. Any Excess Withdrawal will be deemed to be a full Surrender and the Cash Surrender Value | |
| will be paid if, at the time of the Withdrawal, the Contract Date is more than 24 months in the past and the | |
| remaining Cash Surrender Value as of the close of that Business Day is less than $2,500. | |
| The minimum amount that may be withdrawn at any one time is the lesser of $1,000 or the Maximum | |
| Annual Withdrawal amount. | |
| The Minimum Guaranteed Withdrawal Benefit (MGWB) | |
| The Minimum Guaranteed Withdrawal Benefit is effective as of the Contract Date and guarantees that a | |
| pre-determined amount, the MAW, may be withdrawn from the Contract annually after the Annuitant | |
| reaches the Lifetime Withdrawal Eligibility Age regardless of market performance and even if the | |
| Accumulation Value is zero (other than by an Excess Withdrawal or Surrender), until the date of the | |
| Xxxxxxxxx’s death (and the Annuitant’s spouse’s death in the case of a Joint and Survivor MGWB) or the | |
| MGWB is otherwise terminated. | |
| MGWB Base | |
| The initial MGWB Base on the Contract Date is shown in the Contract Schedule and is based on the | |
| Owner’s MGWB Base under the retirement plan annuity contract rolled into this Contract. Thereafter, the | |
| MGWB Base will increase as a result of any Ratchets as described below, and may decrease due to | |
| Withdrawal adjustments. | |
| Ratchets | |
| A Ratchet is an increase to the MGWB Base equal to the amount by which the Accumulation Value on the | |
| applicable Ratchet Date is greater than the MGWB Base on such Ratchet Date. On each Ratchet Date | |
| following the Contract Date, if the current Accumulation Value is greater than the current MGWB Base, the | |
| MGWB Base will be set equal to the current Accumulation Value. If the Accumulation Value on the | |
| applicable Ratchet Date is equal to or less than the MGWB Base on such Ratchet Date, no Ratchet | |
| occurs. | |
| Ratchet Dates are shown in the Contract Schedule. If a Ratchet Date falls on a non-Business Day, the | |
| determination of whether a Ratchet occurs will take place on the next Business Day using the | |
| Accumulation Value as of the close of that day. | |
| Lifetime Withdrawal Phase | |
| ICC12 IL-IA-4030 | 15 |
| The Lifetime Withdrawal Phase is the period under the Minimum Guaranteed Withdrawal Benefit during | |
| which the Maximum Annual Withdrawal is calculated and is available for withdrawal. The Contract will | |
| enter the Lifetime Withdrawal Phase of the Minimum Guaranteed Withdrawal Benefit on the date of the | |
| first Withdrawal on or following the date the Annuitant reaches the Lifetime Withdrawal Eligibility Age as | |
| shown in the Contract Schedule. The Contract will remain in the Lifetime Withdrawal Phase until the | |
| earlier of: | |
| (1) | The date the Contract is Surrendered or otherwise terminated, at which time the Minimum Guaranteed |
| Withdrawal Benefit also is terminated; | |
| (2) | The Annuitant’s death in the case of single life MGWB, or the later of the date of the Annuitant’s death |
| and the Annuitant’s spouse’s death in the case of a Joint and Survivor MGWB, at which time the | |
| Minimum Guaranteed Withdrawal Benefit will terminate and no further Minimum Guaranteed | |
| Withdrawal Benefits will be payable (see Section 6.3 for details about spousal continuation); | |
| (3) | The Contract’s Annuity Commencement Date unless you elect the Payments for Life with Surrender |
| Right and Death Benefit Annuity Plan; | |
| (4) | The date the Accumulation Value is reduced to zero by an Excess Withdrawal, at which time the |
| Minimum Guaranteed Withdrawal Benefit will terminate and no further Minimum Guaranteed | |
| Withdrawal Benefits will be payable; and | |
| (5) | The date the Contract enters the Lifetime Automatic Periodic Benefit Status. |
| Maximum Annual Withdrawal (MAW) Calculation | |
| On the day the Contract enters the Lifetime Withdrawal Phase or on any other date the MGWB Base is | |
| recalculated, the Maximum Annual Withdrawal (MAW) will be set equal to: | |
| (1) | The MAW percentage, as shown in the Contract Schedule, which is based on the MAW Percentage |
| under the retirement plan annuity contract rolled into this Contract; multiplied by | |
| (2) | The MGWB Base, after any calculations occurring on that day that would result in a change to the |
| MGWB Base. | |
| The MAW is subject to downward or upward adjustment when the Lifetime Withdrawal Phase is elected at | |
| an age that is earlier or later than the Assumed Lifetime Withdrawal Commencement Age as shown in the | |
| Contract Schedule. The adjustment factors for early and for deferred Lifetime Withdrawal | |
| Commencements are shown in the Contract Schedule. | |
| If the Annuitant was receiving MAW payments under the retirement plan annuity contract at the time that | |
| the Annuitant rolled their interest in that contract into this Contract, then the first Contract Year MAW | |
| payments under this Contract will be adjusted to take into account the MAW payments received during the | |
| withdrawal year prior to the rollover. The amount of the first Contract Year MAW payments under this | |
| Contract in this circumstance will equal the sum of MAW payments remaining for the withdrawal year | |
| under the retirement plan annuity contract at the time of the rollover, plus the pro-rata portion of the full | |
| MAW amount for the first Contract Year under this Contract. The pro-rata portion will be based on the | |
| period of time from the Annuitant’s birthday in the first Contract Year to the first Contract Anniversary. | |
| The MAW amount will be paid in monthly installments unless some other frequency of payment is | |
| requested and agreed to by us, and the frequency of MAW installments within a Contract Year may be | |
| changed subject to our approval. If a MAW installment is less than $100, we reserve the right to adjust | |
| the frequency so that the installment will be at least $100. | |
| Joint and Survivor MGWB | |
| In the case of a Joint and Survivor MGWB, the MAW is subject to further downward adjustment by the | |
| Joint and Survivor Equivalency Factors shown in the Joint and Survivor MGWB Option Data Table in the | |
| Contract Schedule. The ages of the Annuitant and the Annuitant’s spouse at the time the Contract enters | |
| the Lifetime Withdrawal Phase will be used when making this adjustment. If the Annuitant or the | |
| Xxxxxxxxx’s spouse is not alive when the Contract enters the Lifetime Withdrawal Phase, we will use the | |
| age that the Annuitant or Xxxxxxxxx’s spouse, as applicable, would have been had he or she still been | |
| living when making this adjustment. If the Annuitant dies before he or she attains the Lifetime Withdrawal | |
| Eligibility Age, the Contact will not enter the Lifetime Withdrawal Phase and the Annuitant’s spouse will not | |
| be eligible to receive MAW payments until such time as the Annuitant would have reached the Lifetime | |
| Withdrawal Eligibility Age had he or she remained alive. | |
| ICC12 IL-IA-4030 | 16 |
| Lifetime Automatic Periodic Benefit Status | |
| The Lifetime Automatic Periodic Benefit Status is the period during which periodic payments, called | |
| MGWB Periodic Payments, will be paid to you. If the Accumulation Value is reduced to zero (other than | |
| by an Excess Withdrawal or Surrender), the Contract will enter the Lifetime Automatic Periodic Benefit | |
| Status on the date of the first MGWB Periodic Payment. The MGWB Periodic Payment is an annual | |
| amount equal to the MAW. MGWB Periodic Payments will begin on the Contract Anniversary following the | |
| later of the date the Accumulation Value is reduced to zero (other than by an Excess Withdrawal or | |
| Surrender) and the date the Annuitant reaches the Lifetime Withdrawal Eligibility Age. | |
| At the time the Accumulation Value is reduced to zero (other than by an Excess Withdrawal or Surrender), | |
| if the MAW exceeds the Withdrawals for that Contract Year, including the Withdrawal that reduced the | |
| Accumulation Value to zero, a payment will be paid immediately to the Owner equal to the excess of the | |
| MAW over such Withdrawals. Thereafter, MGWB Periodic Payments will be payable on Contract | |
| Anniversaries as described above. | |
| When the Contract enters the Lifetime Automatic Periodic Benefit Status, the Contract is modified so that | |
| the Contract will provide no further benefits other than as provided in connection with the Minimum | |
| Guaranteed Withdrawal Benefit. | |
| While in the Lifetime Automatic Periodic Benefit Status, MGWB Periodic Payments will continue to be paid | |
| until the Annuitant’s death or, in the case of Joint and Survivor MGWB, the later of the date of the | |
| Xxxxxxxxx’s death and the death of the Annuitant’s spouse. The MGWB Periodic payment will be paid in | |
| annual installments unless some other frequency of payment is requested and agreed to by us, and the | |
| frequency of installments within a Contract Year may be changed subject to our approval. If a MGWB | |
| Periodic Payment installment is less than $100, we reserve the right to adjust the frequency so that the | |
| installment will be at least $100. After the Contract enters the Lifetime Automatic Periodic Benefit Status, | |
| the Contract including the Minimum Guaranteed Withdrawal Benefit will terminate when the Annuitant dies | |
| in the case of single life MGWB, or the later of the date of the Annuitant’s death and the Annuitant’s | |
| xxxxxx’s death in the case of a Joint and Survivor MGWB,. If MGWB Periodic Payments are disbursed | |
| after the Annuitant’s and Xxxxxxxxx’s spouse’s date(s) of death, if applicable, but before we are notified of | |
| such death(s), the Owner or, if applicable, the Owner’s estate is obligated to return such MGWB Periodic | |
| Payments. | |
| Withdrawal Adjustments to MGWB Base | |
| The amount of any Withdrawal adjustments will be calculated as follows: | |
| (1) | For any Excess Withdrawals requested, the Withdrawal adjustment to the MGWB Base will be applied |
| on a pro rata basis as described below; and | |
| (2) | Any Withdrawals that are not Excess Withdrawals requested while the Contract is in the Lifetime |
| Withdrawal Phase will have no impact to the MGWB Base. | |
| Excess Withdrawals | |
| On the date that any Excess Withdrawal occurs, an immediate pro rata reduction will be applied to the | |
| MGWB Base. The proportion of any such pro rata reduction will equal: | |
| A |
| {B – (C – A)} |
| Where: A is the amount of the Excess Withdrawal; B is the Accumulation Value immediately prior to the |
| Withdrawal; and C is the total amount of the current Withdrawal. This means the MGWB Base is reduced |
| by the same percentage that the Accumulation Value is reduced by the Excess Withdrawal. |
| Excess Withdrawals can reduce future benefits by more than the dollar amount of the Excess |
| Withdrawal. |
| ICC12 IL-IA-4030 | 17 |
| Change of Owner | |
| Only the following ownership changes are allowed: | |
| (1) | A change of ownership pursuant to spousal continuation as set forth in the Section 6.3 below; |
| (2) | A change of ownership from one custodian to another custodian for the benefit of the Annuitant; |
| (3) | A change of ownership from a custodian for the benefit of the Annuitant to the Annuitant; |
| (4) | A change of ownership from the Annuitant to a custodian for the benefit of the Annuitant; |
| (5) | Collateral assignments; and |
| (6) | A change of ownership executed pursuant to a court order. |
| Minimum Guaranteed Withdrawal Benefit Termination | |
| The Minimum Guaranteed Withdrawal Benefit may not be cancelled unless the Contract is Surrendered or | |
| terminated or upon election of certain annuity payment options. | |
| The Minimum Guaranteed Withdrawal Benefit has no Surrender value or other non-forfeiture benefits upon | |
| termination. | |
| 6.3 The Death Benefit | |
| The Death Benefit is payable to the Beneficiary as determined under Section 3.4 if the Annuitant dies (1) | |
| before the Annuity Commencement Date and before the Contract enters the Lifetime Automatic Periodic | |
| Benefit Status or (2) while the Payments for Life with Surrender Right and Death Benefit Annuity Plan is in | |
| effect and before the Contract enters Lifetime Automatic Periodic Benefit Status. Only one Death Benefit | |
| is payable under this Contract. If there are multiple Beneficiaries, the Death Benefit will be paid in equal | |
| shares to all primary Beneficiaries unless you previously provided Notice to Us directing otherwise. | |
| The Death Benefit will be the Accumulation Value and will be determined as of the date we receive Proof | |
| of Death. If we receive Proof of Death and all required claim forms on the same date, the Death Benefit | |
| will be paid on that date. | |
| This paragraph applies if the Payments for Life with Surrender Right and Death Benefit Annuity Plan is not | |
| in effect at the time the Death Benefit becomes payable. If the Death Benefit becomes payable, it may be | |
| received in a single lump sum or applied to any Annuity Plan described in Section 6.4 except the | |
| Payments for Life with Surrender Right and Death Benefit Annuity Plan, subject to the requirements of and | |
| time limits prescribed by Section 72(s) of the Code and the provisions of this Section 6.3 relating to | |
| spousal Beneficiaries and non-spousal Beneficiaries. If the Death Benefit is applied to an Annuity Plan, | |
| the Beneficiary is deemed to be the Annuitant. If the Payments for Life with Surrender Right and Death | |
| Benefit Annuity Plan is in effect at the time the Death Benefit becomes payable, you may receive the | |
| Death Benefit as described under that Annuity Plan in Section 6.4. | |
| Except in the case of spousal continuation where a Joint and Survivor MGWB has been elected, the death | |
| of the Annuitant will terminate the Minimum Guaranteed Withdrawal Benefit and, upon payment of the | |
| Death Benefit, the Contract. In the case of spousal continuation where a Joint and Survivor MGWB has | |
| been elected, the death of both the Annuitant and the Annuitant’s spouse, will terminate the Minimum | |
| Guaranteed Withdrawal Benefit and, upon payment of the Death Benefit, the Contract. Upon Proof of | |
| Death, any charges for the Minimum Guaranteed Withdrawal Benefit which are due but unpaid for any | |
| period of time the Minimum Guaranteed Withdrawal Benefit was active and in force prior to the date of | |
| death will be deducted or any charges for the Minimum Guaranteed Withdrawal Benefit that have been | |
| deducted for any period of time after the date of death will be refunded. | |
| If the Contract is in the Lifetime Automatic Periodic Benefit Status at the time of the Annuitant’s death, or in | |
| the case of a Joint and Survivor MGWB the later of the Annuitant’s or the Annuitant’s spouse’s death, the | |
| Minimum Guaranteed Withdrawal Benefit and the Contract will terminate. | |
| ICC12 IL-IA-4030 | 18 |
| Spousal Beneficiaries - Continuation | ||
| In the case of a single life MGWB, if the Annuitant’s death occurs before the Annuity Commencement Date | ||
| and the Contract is not in Lifetime Automatic Periodic Benefit Status and the sole primary Beneficiary is | ||
| the deceased Xxxxxxxxx’s “spouse” (as defined by federal law), upon Notice to Us from your surviving | ||
| spouse, in lieu of receiving the Death Benefit, the Contract may be continued with the surviving spouse as | ||
| the new Owner, pursuant to Section 72(s) of the Code and the following will apply: | ||
| (1) | The surviving spouse will become the Annuitant; | |
| (2) | The age of the surviving spouse will be used as the Owner’s age under the continued Contract; | |
| (3) | The MGWB will terminate and may not be continued; and | |
| (4) | At the subsequent death of the new Owner/Annuitant (i.e., the surviving spouse), the Death Benefit | |
| must be distributed as required for non-spousal Beneficiaries as stated below, after which, the | ||
| continued Contract will terminate. | ||
| In the case of a Joint and Survivor MGWB, if the Annuitant’s death occurs before the Annuity | ||
| Commencement Date and the sole primary Beneficiary is the deceased Annuitant’s “spouse” (as defined | ||
| by federal law), upon Notice to Us from the deceased Annuitant’s surviving spouse, in lieu of receiving the | ||
| Death Benefit, the Contract may be continued with the surviving spouse as the new Owner, pursuant to | ||
| Section 72(s) of the Code and the following will apply: | ||
| (1) | The surviving spouse will become the Annuitant; | |
| (2) | Eligibility to enter the Lifetime Withdrawal Phase will be continue to be based on the deceased | |
| Xxxxxxxxx’s age (as if he or she were still living); | ||
| (3) | The applicable MAW Percentage, as shown in the Contract Schedule, will be adjusted based on the | |
| deceased Xxxxxxxxx’s age (as if he or she were still living) and continuing spouse’s age at the time the | ||
| Lifetime Withdrawal Phase begins following continuation; | ||
| (4) | MGWB Charges will resume upon the first quarterly Contract Anniversary following continuation and | |
| will be deducted starting on the second quarterly Contract Anniversary; | ||
| (5) | On the day the Contract is continued, the MGWB Base will be set equal to the MGWB Base existing at | |
| the time of the deceased Xxxxxxxxx’s death, reduced pro rata for any Withdrawals taken since the | ||
| deceased Xxxxxxxxx’s death; | ||
| (6) | Any Withdrawals taken in the Contract Year in which the Contract is continued will be included in | |
| determining whether any Excess Withdrawals have been taken in that Contract Year as well as used | ||
| in calculating any pro rata reductions of the MGWB Base as described in the Section 6.2; and | ||
| (7) | Calculation of the MGWB Base will resume as stated in the Section 6.2. | |
| If the deceased Xxxxxxxxx’s spouse does not choose to continue the Contract, the Minimum Guaranteed | ||
| Withdrawal Benefit will terminate and the Death Benefit will be distributed as stated below for non-spousal | ||
| Beneficiaries. If the deceased Xxxxxxxxx’s spouse has attained age 90 on the date of the Annuitant’s | ||
| death, the deceased Xxxxxxxxx’s spouse may not choose to continue the Contract and the Death Benefit | ||
| will be distributed as stated below for non-spousal Beneficiaries. | ||
| Non-spousal Beneficiaries | ||
| If death occurs before the Annuity Commencement Date and the Contract is not in the Lifetime Automatic | ||
| Periodic Benefit Status and the deceased Annuitant’s spouse is not a primary Beneficiary, the primary | ||
| Beneficiary will become the Annuitant, the Death Benefit will be payable to the Beneficiary, and the | ||
| following will apply: | ||
| (1) | The MGWB will terminate; and | |
| (2) | The remaining interest in the Contract must be distributed to the Beneficiary: | |
| (a) | Within five years of the primary Beneficiary’s death; or | |
| (b) | Beginning within one year after the primary Beneficiary’s death: | |
| (i) Over the life of the Beneficiary or | ||
| (ii) Over a period not greater than the Beneficiary’s life expectancy. | ||
| If any Beneficiary dies before all Death Benefit payments have been distributed, any remaining | ||
| distributions will be paid to such Beneficiary’s estate or as otherwise directed by the Beneficiary in a Notice | ||
| to Us. | ||
| ICC12 IL-IA-4030 | 19 |
| How to Claim the Death Benefit |
| We shall pay the Death Benefit upon our receipt of Proof of Death and all required claim forms. The |
| claimant should contact our Customer Service Center at the address or phone number on the first page of |
| this Contract for further instructions. |
| 6.4 Annuity Payments |
| If the Accumulation Value is less than $2,000 on the Annuity Commencement Date as shown on the first |
| page of this Contract or as later changed subject to the restrictions described below, we will pay you or, |
| subject to our consent in the event the payee is not a natural person, a payee designated by you, such |
| Accumulation Value in one lump sum payment as directed by you and this Contract will have no further |
| value. If the Accumulation Value is equal to or greater than $2,000 on the Annuity Commencement Date |
| as shown on the first page of this Contract or as later changed as provided below and the Annuitant is |
| living on the Annuity Commencement Date, we will begin making Annuity Payments as described below. |
| Upon application of the Accumulation Value to an Annuity Plan, unless you are eligible for and elect the |
| Payments for Life with Surrender Right and Death Benefit Annuity Plan, this Contract will cease to have |
| any further value other than that provided under the Annuity Plan you elected and will terminate when |
| Annuity Payments cease under the Annuity Plan. |
| We will make Annuity Payments beginning on the Annuity Commencement Date, on a monthly basis |
| unless you deliver Notice to Us directing us to pay at a different frequency. However, requests for periodic |
| payments other than monthly, quarterly, semi-annually or annually require our consent. You may not |
| change the payment frequency after Annuity Payments begin. |
| If the day an Annuity Payment is scheduled to be paid is not a Business Day, for instance, a weekend, or |
| does not exist in any month in which an Annuity Payment is due, for instance a month that does not |
| contain twenty-nine, thirty, or thirty-one days, such Annuity Payment will be paid on the next Business |
| Day. |
| The amount applied to an Annuity Plan will be the Accumulation Value calculated as set forth in Section |
| 5.2, less any applicable premium tax. The Annuity Payment amount will be determined by the amount |
| applied to the Annuity Plan you have elected. |
| Each Annuity Payment must equal at least $20. If Annuity Payments would be less than $20, we have the |
| right to make such Annuity Payments less frequently as necessary to make the Annuity Payment equal to |
| at least $20. |
| We have the right to change the $2,000 and $20 minimums stated in this provision, if allowed by law, |
| based upon increases reflected in the Consumer Price Index for All Urban Consumers (CPI-U) since |
| September 1, 2012. |
| Selecting an Annuity Commencement Date |
| You select the Annuity Commencement Date. The Annuity Commencement Date may be any date |
| following the first Contract Anniversary but not later than January first on or next following the Annuitant’s |
| 90th birthday, unless we agree to a later date. You may select an Annuity Commencement Date by |
| providing Notice to Us at least thirty days in advance of the date you select. If you do not select an |
| Annuity Commencement Date, the Annuity Commencement Date will be January first on or next following |
| the Annuitant’s 90th birthday. |
| Lifetime Income Annuity Option |
| On the Annuity Commencement Date if the Minimum Guaranteed Withdrawal Benefit is in effect and you |
| choose the Life Only Payments Annuity Plan (in the case of a single life MGWB) or the Joint and Last |
| Survivor Life Payments Annuity Plan (in the case of a Joint and Survivor MGWB), each which is described |
| below, we will pay the greater of the Annuity Payments or annual payments equal to the MAW. If you |
| choose any other Annuity Plan, with the exception of the Payments for Life with Surrender Right and |
| Death Benefit Annuity Plan described below, we will begin Annuity Payments on the Annuity |
| Commencement Date and no payments under the Minimum Guaranteed Withdrawal Benefit will be |
| payable thereafter. |
| ICC12 IL-IA-4030 | 20 |
| Electing an Annuity Plan | ||
| You may elect any of the Annuity Plans described below. In addition, you may elect any other Annuity | ||
| Plan we may be offering thirty days prior to the Annuity Commencement Date, the latest date by which you | ||
| must provide your election. You may change the Annuity Plan you have elected at any time before the | ||
| Annuity Commencement Date by providing at least thirty days prior Notice to Us. Upon request, we will | ||
| send you the proper forms to elect or change the Annuity Plan. The elected Annuity Plan will become | ||
| effective when we receive satisfactorily completed forms indicating your election. Once Annuity Payments | ||
| begin, the Annuity Plan may not be changed. | ||
| If you select an Annuity Commencement Date that is earlier than the latest Annuity Commencement Date | ||
| permitted under the Contract but you do not elect an Annuity Plan by the Annuity Commencement Date, | ||
| payments, calculated based on the Annuitant’s life, will be made to you or a payee designated by you | ||
| automatically each month for a minimum of 120 months and as long thereafter as the Annuitant lives | ||
| unless otherwise limited by applicable law. If the Annuity Commencement Date is the latest date | ||
| permitted under the Contract and you have not elected an Annuity Plan, Annuity Payments will begin | ||
| under the Payments for Life with Surrender Right and Death Benefit Annuity Plan. | ||
| Your election of the Annuity Plan is subject to the following additional terms and conditions: | ||
| (1) | If you do not direct otherwise, Annuity Payments will be paid to you; | |
| (2) | Our consent is necessary if the payee is not a natural person; and | |
| (3) | Any change in payee will take effect as of the date we receive Notice to Us. | |
| If any Annuitant or payee dies on or after the Annuity Commencement Date but before all Annuity | ||
| Payments have been paid, we will pay the primary Beneficiary the remaining value of any such Annuity | ||
| Payments at least as rapidly as under the Annuity Plan that is in effect at the time of death. | ||
| The Annuity Payments received under an Annuity Plan through this Contract will not be less than the | ||
| payments that would be provided from the application of the Cash Surrender Value to a single premium | ||
| immediate annuity under the same Annuity Plan offered by us on the Annuity Commencement Date. | ||
| The Annuity Plans | ||
| (1) | Payments for a Period Certain - | |
| Annuity Payments are paid in equal installments for a fixed number of years as shown in Table A | ||
| below. The number of years cannot be less than ten or, subject to any limitations under applicable | ||
| law, more than thirty. | ||
| (2) | Payments for Life with Period Certain - | |
| Annuity Payments are paid for a fixed number of years and as long thereafter as the Annuitant is living | ||
| as shown in Table B below. However, the number of years cannot be less than ten or more than thirty | ||
| unless otherwise required by applicable law. | ||
| (3) | Life Only Payments - | |
| Annuity Payments are paid for as long as the Annuitant is living as shown in Table B below. | ||
| (4) | Joint and Last Survivor Life Payments - | |
| Annuity Payments are paid for as long as either of two Annuitants is living as shown in Table C below. | ||
| (5) | Payments for Life with Surrender Right and Death Benefit - | |
| If Annuity Payments have not commenced by the latest Annuity Commencement Date permitted under | ||
| the Contract, you may elect, in lieu of any other Annuity Plan, Annuity Payments that will begin on or | ||
| about January 25th following the Annuity Commencement Date and be paid for as long as the | ||
| Annuitant is living. Annuity Payments under this Annuity Plan will equal, on an annual calendar year | ||
| basis after the Annuity Commencement Date, the greater of: | ||
| (a) | The MAW; and | |
| (b) | The Accumulation Value as of the end of the prior calendar year, determined as if the Contract | |
| had not been annuitized, divided by the life expectancy of the Annuitant, based on the Annuitant’s | ||
| age, as determined under the Single Life Table under Treasury Regulation Section 1.401(a)(9)-9 | ||
| as shown in Table D. | ||
| Under this option, the Accumulation Value will remain allocated among the available Sub-accounts as | ||
| you direct. The Owner may Surrender the Contract at any time but Withdrawals or a subsequent | ||
| election of a different Annuity Plan will not be permitted. | ||
| ICC12 IL-IA-4030 | 21 |
| Upon the death of the Annuitant, if the Contract is not in Lifetime Automatic Periodic Benefit Status the | ||
| Beneficiary will be entitled to receive the Death Benefit, as described in Section 6.3, according to one | ||
| of the following: | ||
| (a) | In a lump sum on or before the end of the calendar year in which the Annuitant’s death occurs; or | |
| (b) | Periodic payments, in the same frequency and at least as rapidly as under this Annuity Plan at the | |
| time of death, equal to, on an annual basis as determined as of the end of the prior year | ||
| immediately preceding the Contract Year in which the payments will be made, the Accumulation | ||
| Value divided by the remaining life expectancy of the Annuitant at the time of death (or the life | ||
| expectancy of the Beneficiary at the time of the Annuitant’s death if shorter) as determined under | ||
| the Single Life Table under Treasury Regulation Section 1.401(a)(9)-9. On each December 31st | ||
| following the first periodic payment under this distribution option, the periodic payment will be | ||
| calculated using the remaining Accumulation Value and the life expectancy factor used in | ||
| calculating the prior payment to the Beneficiary reduced by one. | ||
| To calculate the guaranteed payments for a fixed Annuity Plan, we will use the Annuitant's adjusted age | ||
| and, if applicable, the second Annuitant's adjusted age. The Annuitant's adjusted age and, if applicable, | ||
| the second Annuitant's adjusted age is the person's age as of the birthday closest to the day Xxxxxxx | ||
| Payments begin, reduced as follows: | ||
| (1) | Reduced by one year for payments beginning before January 1, 2014; | |
| (2) | Reduced by two years for payments beginning during the period from January 1, 2014 through | |
| December 31, 2023; and | ||
| (3) | Starting on January 1, 2024, reduced by one additional year for payments beginning in each | |
| succeeding ten year period. | ||
| Annuity Plan Tables | ||
| Tables A, B, and C show the minimum monthly payments for each $1,000 applied under the Annuity Plan, | ||
| assuming fixed payments with a net investment return of 1.0%, using the Annuity 2000 Mortality Tables. | ||
| We may pay a higher rate at our discretion. | ||
| In Tables B and C, the amount of each payment will depend on the Annuitant’s sex and age, as | ||
| determined by the nearest birthday, at the Annuity Commencement Date. Annuity Payments made on a | ||
| basis other than monthly and for ages or number of years not shown will be calculated on the same basis | ||
| as those shown and may be obtained from us by contacting our Customer Service Center at the address | ||
| or phone number set forth on the first page of the Contract. | ||
| Table D contains the life expectancy factors to be applied to the Annuitant Payments for Life with | ||
| Surrender Right and Death Benefit Annuity Plan. | ||
| Table A: Monthly Payments for a Period Certain | |||||
| Years | Years | Years | |||
| 10 | $8.75 | 17 | $5.33 | 24 | $3.90 |
| 11 | 7.99 | 18 | 5.05 | 25 | 3.76 |
| 12 | 7.36 | 19 | 4.81 | 26 | 3.64 |
| 13 | 6.83 | 20 | 4.59 | 27 | 3.52 |
| 14 | 6.37 | 21 | 4.40 | 28 | 3.41 |
| 15 | 5.98 | 22 | 4.22 | 29 | 3.31 |
| 16 | 5.63 | 23 | 4.05 | 30 | 3.21 |
| Table B: Monthly Life Payments (Single Annuitant) | |||
| Annuitant’s | Life Only | Life with 10 Year Period | Life with 20 Year Period |
| Adjusted Age | Male/Female | Certain Male/Female | Certain Male/Female |
| 55 | 3.37/3.08 | 3.34/3.07 | 3.20/2.99 |
| 60 | 3.89/3.52 | 3.82/3.49 | 3.55/3.34 |
| 65 | 4.58/4.11 | 4.44/4.04 | 3.91/3.72 |
| 70 | 5.54/4.93 | 5.20/4.75 | 4.22/4.10 |
| 75 | 6.87/6.12 | 6.09/5.67 | 4.43/4.38 |
| 80 | 8.72/7.88 | 7.00/6.71 | 4.54/4.53 |
| ICC12 IL-IA-4030 | 22 |
| Table C: Monthly Joint and Last Survivor Life Payments (Joint Annuitants) | |||||||
| Male | |||||||
| Adjusted | |||||||
| Age | |||||||
| Female | |||||||
| Adjusted | 50 | 55 | 60 | 65 | 70 | 75 | 80 |
| Age | |||||||
| 50 | $2.47 | $2.55 | $2.62 | $2.67 | $2.70 | $2.72 | $2.73 |
| 55 | 2.60 | 2.73 | 2.85 | 2.93 | 2.99 | 3.03 | 3.05 |
| 60 | 2.71 | 2.90 | 3.08 | 3.22 | 3.33 | 3.41 | 3.46 |
| 65 | 2.81 | 3.05 | 3.30 | 3.53 | 3.73 | 3.87 | 3.97 |
| 70 | 2.87 | 3.16 | 3.49 | 3.83 | 4.15 | 4.41 | 4.61 |
| 75 | 2.92 | 3.25 | 3.64 | 4.09 | 4.56 | 5.01 | 5.39 |
| 80 | 2.95 | 3.30 | 3.74 | 4.28 | 4.91 | 5.58 | 6.23 |
| Table D: Single Life Table under Treasury Regulation Section 1.401(a)(9)-9 | |||||
| Age | Life | Age | Life | Age | Life |
| Expectancy | Expectancy | Expectancy | |||
| 90 | 5.5 | 98 | 3.4 | 106 | 1.7 |
| 91 | 5.2 | 99 | 3.1 | 107 | 1.5 |
| 92 | 4.9 | 100 | 2.9 | 108 | 1.4 |
| 109 | 1.2 | ||||
| 93 | 4.6 | 101 | 2.7 | 110 | 1.1 |
| 94 | 4.3 | 102 | 2.5 | 111 | 1.0 |
| 95 | 4.1 | ||||
| 96 | 3.8 | 103 | 2.3 | ||
| 97 | 3.6 | 104 | 2.1 | ||
| 105 | 1.9 | ||||
| ICC12 IL-IA-4030 | 23 |
| 7. OTHER IMPORTANT INFORMATION | |
| 7.1 Reports to Owner | |
| We will provide you a report at least once during each Contract Year. The report will show the current | |
| Accumulation Value, the Cash Surrender Value, the MGWB Base and the Maximum Annual Withdrawal, | |
| as well as amounts deducted from, or added to, the Accumulation Value since the last report. | |
| This report will be sent to you at your last known address within sixty days after the report date. Upon | |
| your request, we will provide additional reports but we reserve the right to assess a charge not to exceed | |
| $50 for each additional report. We will also provide you with copies of any shareholder reports of the | |
| portfolios in which the Sub-accounts invest as well as any other notices, reports or documents as required | |
| by law or regulation. You may contact us at any time to determine your Withdrawal options. | |
| 7.2 Assignment | |
| You may assign this Contract as security for a loan or other obligation. Such an assignment is not a | |
| change of ownership. However, your rights, and those of any Beneficiary, are subject to the terms of any | |
| assignment. Written consent of any Irrevocable Beneficiary is required before any assignment is effective. | |
| You shall provide Notice to Us in order to make, modify or release any assignment. An assignment will | |
| take effect as of the date Notice to Us is signed by the Owner, unless otherwise specified by the Owner, | |
| subject to any payments we make or actions we take prior to our receipt of such Notice to Us. We are not | |
| responsible for the validity, or other effects, of an assignment. | |
| 7.3 Misstatement Made by Owner in Connection with the Purchase of this Contract | |
| We may require proof of the age and/or sex of any person upon whose life the MGWB, Death Benefit or | |
| Annuity Payments are determined. If you have misstated the age or sex of such person, we will adjust | |
| future benefit payments to reflect those that would have been provided at the correct age or sex. We will | |
| include in the next payment any underpayments due to such misstatement with interest credited at the rate | |
| of 1.5% annually. We will deduct any overpayments plus interest at the rate of 1.5% annually from future | |
| payments until the overpayment has been repaid in full. | |
| 7.4 Payments We May Defer | |
| We may not be able to determine the value of the assets in the Sub-accounts when: | |
| (1) | The New York Stock Exchange is closed for trading; or |
| (2) | An emergency exists as determined by the SEC so that the sale of securities held in the Separate |
| Account may not reasonably occur or so that we may not reasonably determine the value of the | |
| Separate Account’s net assets. | |
| During such times, as to amounts allocated to the Sub-accounts, we may delay: | |
| (1) | Determination and payment of the Cash Surrender Value; |
| (2) | Determination and payment of any Death Benefit; |
| (3) | Allocation changes of the Accumulation Value; or |
| (4) | Application of the Accumulation Value under an Annuity Plan. |
| 7.5 Incontestability | |
| Except in the case of fraud, when permitted by applicable law in the state where the Contract is delivered | |
| or issued for delivery, if the application is attached to and made a part of the Contract, this Contract shall | |
| be incontestable after it has been in force for two years from the Contract Date. | |
| 7.6 Basis of Computation | |
| We have filed a detailed statement of our computations with the Interstate Insurance Product Regulation | |
| Commission. The reserves and guaranteed values will at no time be less than the minimums required by | |
| Section 7 of the NAIC Model Variable Annuity Regulation model #250. | |
| ICC12 IL-IA-4030 | 24 |
| 7.7 Rules for Interpreting this Contract | |
| In this Contract, headings and captions are intended for convenience in reference only and do not affect | |
| interpretation of the Contract’s provisions. Unless the context clearly indicates otherwise: | |
| (1) | All language which implies the singular will also include the plural (and vice versa) and any words |
| indicating one gender will also include the other gender, as appropriate; and | |
| (2) | Where a word or phrase is given a defined meaning, any other part of speech or grammatical form of |
| that word or phrase will have a corresponding meaning. | |
| 7.8 Non-Waiver | |
| We may, in our discretion, elect not to exercise a right, privilege, or option under the Contract. Such | |
| election will not constitute a waiver of the right to exercise such right, privilege, or option at any | |
| subsequent time, nor will it constitute a waiver of any provision in the Contract. | |
| 7.9 Conformity with Interstate Insurance Product Regulation Commission Standards | |
| This Contract has been approved under the authority of the Interstate Insurance Product Regulation | |
| Commission (“IIPRC”) and is issued under the IIPRC standards. Any provision of the Contract that is in | |
| conflict with IIPRC standards on the Contract Date is hereby amended to conform to those standards for | |
| this product type as of the provision’s effective date. | |
| ICC12 IL-IA-4030 | 25 |
| ING Life Insurance and Annuity Company |
| [Windsor, CT 06095-4774] |
| [Customer Service Center |
| P.O. Box 10450 |
| 000 Xxxxxx Xxxxxx, Xxx Xxxxxx, Xxxx 00000-0450] |
| [0-000-000-0000] [xxx.xxxxxxxxxxxxxxxxxxxxx.xxx] |
|
|
| SINGLE PREMIUM DEFERRED INDIVIDUAL VARIABLE ANNUITY CONTRACT WITH |
| MINIMUM GUARANTEED WITHDRAWAL BENEFIT |
| This Contract is non-participating which means it will not pay dividends resulting from any of the |
| surplus or earnings of ING Life Insurance and Annuity Company. |
| ICC12 IL-IA-4030 | 26 |
