Zurich Life Insurance Company of New York
000 X. 00xx Xxxxxx, Xxx Xxxx, Xxx Xxxx 00000
Administration Office:
0000 XxXxxxxx Xxxxxxx, Xxxxxxxxxx, Xxxxxxxx 00000-6801
0-000-000-0000
RIGHT TO CANCEL - FREE LOOK PROVISION - At any time within 10 days of receiving
this contract You may return it to Us or to the representative through whom it
was purchased. The date of surrender will be the date the contract is actually
mailed to Us or the date You actually deliver the contract to Us or to the
representative through whom it was purchased. Immediately upon Our receipt, this
contract will be voided as if it had never been in force. Within 10 days of the
surrender We will refund all Purchase Payments allocated to the Dollar Cost
Averaging Fixed Account plus the Separate Account Contract Value computed at the
end of the Valuation Period.
We agree to pay an Annuity to the Owner provided this contract is in force on
the Annuity Date.
We further agree to pay the death benefit prior to the Annuity Date when a death
benefit is payable. Payment will be made upon Our receipt of due proof of death
and the return of this contract.
This contract is issued in consideration of the initial Purchase Payment. The
provisions on this cover and the pages that follow are part of this contract.
Signed for Zurich Life Insurance Company of New York.
/s/ Xxxxxxx X. Xxxx /s/ Xxx Xxxxxx
-------------------------------------- ---------------------------------------
Secretary President
FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
THE INITIAL INTEREST RATE IS GUARANTEED FOR ONLY A LIMITED PERIOD OF TIME.
WITHDRAWALS MAY BE SUBJECT TO A WITHDRAWAL CHARGE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT AND MAY INCREASE OR DECREASE. REFER TO THE VARIABLE ACCOUNT AND
ANNUITY PERIOD PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the Owner and Zurich Life Insurance Company of
New York.
READ YOUR CONTRACT CAREFULLY.
TABLE OF CONTENTS
Page
----
CONTRACT SCHEDULE Follows Table of Contents
DEFINITIONS 1-2
GENERAL PROVISIONS 3
The Entire Contract 3
Modification of Contract 3
Incontestability 3
Change of Annuity Date 3
Assignment 3
Due Proof of Death 3
Reserves, Values and Benefits 3
Non-Participating 3
Reports 3
Premium Taxes 3
Creditors 3
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS 4
Owner 4
Change of Ownership 4
Beneficiary Designation and Change of Beneficiary 4
Death of Beneficiary 4
Annuitant 4
PURCHASE PAYMENT PROVISONS 5
Purchase Payment Limitations 5
Place of Payment 5
DOLLAR COST AVERAGING FIXED ACCOUNT PROVISIONS 5
Dollar Cost Averaging Fixed Account Contract Value 5
Interest 5
VARIABLE ACCOUNT PROVISIONS 5-7
Separate Account 5
Liabilities of the Separate Account 5
Subaccounts 5
Fund 6
Rights Reserved by the Company 6
Accumulation Unit Value 6
Investment Experience Factor 6-7
TRANSFER AND WITHDRAWAL PROVISIONS 7-8
Transfers During the Accumulation Period 7
Withdrawals During the Accumulation Period 7
Withdrawal Charges 8
Transfers and Withdrawal Procedures 8
Deferment of Withdrawal or Transfer 8
DEATH BENEFIT PROVISIONS 9
Amount Payable Upon Death 9
Payment of Death Benefits During the Accumulation Period 9
Spousal Continuation 9
TABLE OF CONTENTS
Page
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ANNUITY PERIOD PROVISIONS 10-14
Annuity Options 10
Option 1 Certain Period Annuity 10
Option 2 Life Annuity 10
Option 3 Life Annuity with Installments Guaranteed 10
Option 4 Joint and Survivor Annuity 10
Option 5 Joint and Survivor Annuity with Installments Guaranteed 10
Other Options 10
Election of Annuity Option 10
Electing a Fixed or Variable Annuity Option 11
Fixed Annuity 11
Variable Annuity 11
Annuity Unit Value 12
Basis of Annuity Options 12
Transfers Between Subaccounts 12
Conversions from a Fixed Annuity Payment 12-13
Conversions to a Fixed Annuity Payment 13
Payment of Death Benefits During the Annuity Period 14
Disbursement Upon Death of Annuitant: Under Options 1, 3 or 5 14
Supplementary Agreement 14
Date of First Payment 14
Evidence of Age, Sex and Survival 14
Misstatement of Age or Sex 14
ANNUITY OPTION TABLE Follows Page 14
ENDORSEMENTS, if any Follow Annuity Option Table
Contract Schedule
Contract Number: [003255] Issue Date: [October 1, 2003]
Initial Purchase Payment: [$10,000] Type of contract: [Nonqualified]
Owner: [Xxxx Xxx]
Owner date of birth
or trust inception date: [October 4, 1968]
Annuitant: [Xxxx Xxx]
Annuitant sex: [Male]
Annuitant date of birth: [October 4, 1968]
Joint Owner: [none]
Joint Owner date of birth: [N/A]
Joint Annuitant: [none]
Joint Annuitant sex: [N/A]
Joint Annuitant date of birth: [N/A]
Maximum Issue Age: 89
Annuity Date: [October 1, 2033]
Maximum Annuity Date:
Later of the Contract Anniversary
following the 90th birthday of the oldest
Owner or Annuitant initially designated
or the 10th Contract Anniversary
Minimum Annuity Date: 13 months from the Issue Date of this contract.
[Date of Continuance: N/A]
Riders issued with this contract:
Death Benefit Rider
Qualified Plan Rider
ERISA Loan Rider
XXXX XXX
SIMPLE IRA
457 Deferred Compensation
Agent: [Xxxx Xxxxx]
Page A
Contract Schedule
Beneficiary Information
Primary Beneficiary(ies):
[Xxxx Xxx]
Contingent Beneficiary(ies):
[Xxxxx Xxx]
Dollar Cost Averaging Fixed Account
We declare an interest rate and a dollar cost averaging period for each Purchase
Payment made to Dollar Cost Averaging Fixed Account. This interest rate will
never be less than the minimum guaranteed interest rate. This dollar cost
averaging period will not be less than 6 months and not more than 18 months from
the date of the Purchase Payment.
The minimum guaranteed interest rate is:
Contract Years 1-7 1.50%
8+ 1.50%
Purchase Payment and allocation limits
Maximum Total Purchase Payments: $1,000,000
Maximum Dollar Cost Averaging Fixed Account Purchase Payments $1,000,000
Per Contract Year
Minimum Initial Account Allocation $500
Minimum Subsequent Account Allocation $50
Minimum Initial Purchase Payment: $2,000
Minimum amount of each Purchase Payment after the first: $500 ($100 for a Purchase Payment that is part of a
systematic investment program that has been
approved by Us)
Maximum Age at which a Purchase Payment may be made Age 89 of the oldest Owner or Annuitant
Minimum Contract Value remaining after a partial withdrawal: $1,000
Page B
Contract Schedule
Withdrawal Charge Table:
Withdrawal Charge as a Percentage
During Year of Contract Value Withdrawn
------------ ---------------------------------
1 5.00%
2 4.00%
3 3.00%
4 3.00%
5 2.00%
6 1.00%
7 and later 0.00%
Free withdrawal allowance
The free withdrawal allowance is 10% of the sum of (i) Contract Value on the
date of the withdrawal, and (ii) partial withdrawals and withdrawal charges
during the current Contract Year. The result is decreased by partial withdrawals
made during the Contract Year that were not subject to withdrawal charges.
Mortality and Expense Charges:
A daily equivalent of the following annual charges will be assessed each
Valuation Date on the Subaccounts:
Mortality and expense risk charge: 1.70%
Administrative charge: 0.15%
Rider Charges:
[ Death Benefit Rider 0%]
We reserve the right to charge $10 for each transfer in excess of 12 in a
Contract Year.
Page C
Contract Schedule
Initial Initial Annual Effective Allocation
Allocations Interest Rate(s) Percentage(s)
----------------------------------- ------------------------ -------------
One Group Investment Trust Mid Cap
Growth Portfolio N/A 80%
Dollar Cost Averaging Fixed Account
(6 month) 4.00% 20%
Page D
Contract Schedule
General Account options
Dollar Cost Averaging Fixed Account (6 month, 12 month)
[Separate Account: ZLICONY Variable Annuity Separate Account]
Subaccounts available on the Issue Date:
One Group Investment Trust Mid Cap Growth Portfolio
One Group Investment Trust Diversified Mid Cap Portfolio
One Group Investment Trust Mid Cap Value Portfolio
One Group Investment Trust Diversified Equity Portfolio
One Group Investment Trust Equity Index Portfolio
One Group Investment Trust Large Cap Growth Portfolio
One Group Investment Trust Balanced Portfolio
One Group Investment Trust Bond Portfolio
Dreyfus Money Market Portfolio
One Group Investment Trust Government Bond Portfolio
Page E
DEFINITIONS
ACCUMULATION PERIOD - The period between the Issue Date and the
Annuity Date.
ACCUMULATION UNIT - An accounting unit of measure used to
calculate the value of each Subaccount.
ADMINISTRATION CHARGE - A charge deducted in the calculation of
the Accumulation Unit value and the Annuity Unit value for a
portion of Our administrative costs. This charge is shown in the
Contract Schedule.
AGE - The attained age.
ANNIVERSARY VALUE - The Contract Value calculated on each
Contract Anniversary during the Accumulation Period.
ANNUITANT - The person during whose lifetime the Annuity is to be
paid. Joint Annuitants may be named under Nonqualified Plans and
any reference to Annuitant shall include Joint Annuitants.
ANNUITY - A series of payments paid in accordance with this
contract which begin on the Annuity Date.
ANNUITY DATE - The date on which Annuity payments begin. The
original Annuity Date is shown in the Contract Schedule. You may
change the Annuity Date as provided in this contract.
ANNUITY PERIOD - The period that starts on the Annuity Date.
ANNUITY UNIT - An accounting unit of measure used to calculate
the amount of Variable Annuity payments after the first Annuity
payment.
CONTRACT ANNIVERSARY - An anniversary of the Issue Date.
CONTRACT OWNER, OR OWNER - See "You, Your, Yours" below.
CONTRACT VALUE - The sum of the Dollar Cost Averaging Fixed
Account Contract Value plus the Separate Account Contract Value.
CONTRACT YEAR - A one-year period starting on the Issue Date and
successive Contract Anniversaries.
DOLLAR COST AVERAGING FIXED ACCOUNT - Our General Account to
which an Owner may allocate all or a portion of Purchase Payments
and Contract Value.
DOLLAR COST AVERAGING FIXED ACCOUNT CONTRACT VALUE - The value of
amounts allocated under this contract to the Dollar Cost
Averaging Fixed Account.
FIXED ANNUITY - An Annuity payment plan that does not vary as to
dollar amount.
FREE WITHDRAWAL ALLOWANCE - Amount of Contract Value that may be
withdrawn each Contract Year without incurring a withdrawal
charge as described in the Contract Schedule.
FUND - An investment company or separate series thereof, in which
the Subaccounts of the Separate Account invest.
GENERAL ACCOUNT - Our assets other than those allocated to the
Separate Account or any other separate account.
Page 1
Page 2
DEFINITIONS (Continued)
ISSUE DATE - The Issue Date stated in the Contract Schedule.
MORTALITY AND EXPENSE RISK CHARGE - A charge deducted in the
calculation of the Accumulation Unit value and the Annuity Unite
value. It is for Our assumption of mortality risks and expense
guarantees. This charge is shown in the Contract Schedule.
NONQUALIFED PLAN CONTRACT - This contract issued other than as a
Qualified Plan Contract.
PURCHASE PAYMENTS - The dollar amount We receive in U.S. currency
to buy the benefits this contract provides.
QUALIFIED PLAN CONTRACT - A contract issued under a retirement
plan which qualifies for favorable income tax treatment under
Section 401, 403, 408, 408A, or 457 of the Internal Revenue Code,
as amended.
If this contract is a Qualified Plan Contract, additional
provisions may apply. The rider or endorsement to this contract
used to qualify it under the applicable section of the Internal
Revenue Code will indicate the extent of change in the
provisions.
SEPARATE ACCOUNT - A unit investment trust registered with the
Securities and Exchange Commission under the Investment Company
Act of 1940 and identified in the Contract Schedule.
SEPARATE ACCOUNT CONTRACT VALUE - The sum of the Subaccount
Values of this contract on a Valuation Date.
SUBACCOUNTS - The subdivisions of the Separate Account, the
assets of which consist solely of shares of the corresponding
Funds.
SUBACCOUNT VALUE - The value of Your interest in each Subaccount.
VALUATION DATE - Each business day that applicable law requires
that We value the assets of the Separate Account. Currently, this
is each day that the New York Stock Exchange is open for trading.
VALUATION PERIOD - The period that starts at the close of a
Valuation Date and ends at the close of the next succeeding
Valuation Date.
VARIABLE ANNUITY - An Annuity payment plan which varies as to
dollar amount because of Subaccount investment experience.
WE, OURS, US - Zurich Life Insurance Company of New York.
YOU, YOUR, YOURS - The party(s) named as Owner, unless later
changed as provided in this contract. Under a Nonqualified Plan
Contract, when more than one person is named as Owner, the terms
"You, Your, Yours," mean joint Owners.
GENERAL PROVISIONS
The Entire Contract This contract (including the Contract Schedule),
any written application attached to this contract,
and any endorsements and riders constitute the
entire contract between the parties. All
statements in any attached application are deemed
representations and not warranties. No statement
will void this contract or be used as a defense of
a claim unless it is contained in an attached
written application.
Modification of Contract Only Our president, secretary and assistant
secretaries have the power to approve a change or
waive any provisions under this contract. Any such
modifications must be in writing. No agent or
person other than those officers named has the
authority to change or waive the provisions of
this contract.
Upon notice to You, this contract may be modified
by Us as is necessary to comply with any law or
regulation issued by a governmental agency to
which We or the Separate Account is subject or as
is necessary to assure continued qualification of
this contract under the Internal Revenue Code or
other laws relating to retirement plans or
annuities or as otherwise may be in Your best
interest. In the event of a modification, We may
make appropriate endorsement to this contract and
We will obtain all required regulatory approvals.
Incontestability We cannot contest this contract after it has been
in force for two years after the Issue Date.
Change of Annuity Date You may write to Us prior to the death of the
Owner and the first Annuity payment date and
request a change of the Annuity Date. The new
Annuity Date must not be earlier than the minimum
annuity date or later than the maximum annuity
date stated in the Contract Schedule.
Assignment No assignment under this contract is binding
unless We receive it in writing. We assume no
responsibility for the validity or sufficiency of
any assignment. The rights of the Owner and
beneficiary are subject to the assignment after We
have recorded it. Any assignments will be subject
to the interest of any previously named
irrevocable beneficiary. Any claim is subject to
proof of the assignee's interest.
Due Proof of Death We must receive written proof of the Owner's or
Xxxxxxxxx's death in the form of a certified death
certificate when a death benefit is payable.
Reserves, Values All reserves are equal to or greater than those
and Benefits required by applicable statute. Any available
contract values and benefits are not less than the
minimum required by the statutes of the state of
New York.
Non-Participating This contract does not pay dividends. It will not
share in Our surplus or earnings.
Reports At least once each Contract Year, We will send You
a statement showing Purchase Payments received,
interest credited, investment experience, and
charges made since the last report, as well as any
other information required by applicable statute.
Premium Taxes We will make a deduction for state premium taxes
in certain situations. On any contract subject to
premium tax, as provided under applicable law, the
tax will be deducted from: a. the Purchase
Payments when We receive them; b. the Contract
Value upon total withdrawal; or c. from the total
Contract Value applied to any Annuity option at
the time Annuity payments start.
In no event will an amount be deducted for premium
taxes before the Company has incurred a tax
liability under applicable state law.
Creditors The proceeds of this contract and any payment
under an Annuity option will be exempt from the
claims of creditors and from legal process to the
extent permitted by law.
Page 3
Page 4
OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
Owner Before the Annuity Date and prior to the death of
an Owner, You may exercise every option and right
conferred by this contract including the right of
assignment. The joint Owners must agree to the
exercise of any option or right if more than one
Owner is named.
Change of Ownership You may change the Owner by written request before
the Annuity Date and prior to the death of an
Owner. You must furnish information sufficient to
clearly identify the new Owner to Us. The new
Owner must be less than 90 years old on the date
the change becomes effective. The change is
subject to any existing assignment of this
contract. After We receive the change, it will
take effect as of the date the written request was
signed. However, any action taken by Us before the
change is recorded by Us remains in effect. Any
change is subject to the payment of any proceeds.
We may require You to return this contract to Us
for endorsement of a change.
Beneficiary Designation The beneficiary initially designated is shown in
and Change of the Contract Schedule. In the case of joint
Beneficiary Owners, the surviving joint Owner is automatically
the primary beneficiary of any death benefit
resulting from the death of a joint Owner. You may
change the beneficiary if You send Us written
notice in a form satisfactory to Us. Beneficiary
designation and changes of Beneficiary are subject
to the following conditions:
1. In the case of joint Owners, the surviving
joint Owner is the primary beneficiary. If
other beneficiaries are designated, they will
be deemed to be contingent beneficiaries;
2. Prior to the Annuity Date, the change must be
filed while You are alive;
3. After the Annuity Date, the change must be
filed while You and the Annuitant(s) are
alive;
4. This contract must be in force at the time
You file a change;
5. Such change must not be prohibited by the
terms of an existing assignment, beneficiary
designation or other restriction;
6. After We receive the change, it will take
effect as of the date the written notice was
signed. However, any action taken by Us
before the change is recorded by Us remains
in effect; and
7. The request for change must provide
information sufficient to clearly identify
the new beneficiary.
We may require You to return this contract to Us
for endorsement of a change.
Death of Beneficiary The interest of a beneficiary who dies before the
distribution of the death benefit will pass to the
other beneficiaries, if any, share and share
alike, unless otherwise provided in the
beneficiary designation. If no beneficiary
survives or is named, the distribution will be
made to Your estate when You die.
Annuitant The initially designated Annuitant is shown in the
Contract Schedule. Prior to the Annuity Date, an
Annuitant may be replaced or added unless the
Owner is a non-natural person. At all times there
must be at least one Annuitant. If the Annuitant
dies, the youngest Owner will become the new
Annuitant unless a new Annuitant is otherwise
named. Upon the death of an Annuitant prior to the
Annuity Date, a death benefit is not paid unless
the Owner is a non-natural person.
PURCHASE PAYMENT PROVISIONS
Purchase Payment Purchase Payment and allocation limits are shown
Limitations in the Contract Schedule.
We reserve the right to waive or modify these
limits and to aggregate multiple contracts with
the same Owner and/or Annuitant in applying these
limits. We reserve the right to refuse to accept
any Purchase Payment.
Place of Payment All Purchase Payments under this contract must be
paid to Us at Our home office or such other
location as We may select. We will notify You and
any other interested parties in writing of such
other locations. Purchase Payments received by an
agent will not be considered received by Us.
DOLLAR COST AVERAGING FIXED ACCOUNT PROVISIONS
Dollar Cost Averaging Fixed Dollar Cost Averaging Fixed Account Contract Value
Account Contract Value includes:
1. Purchase Payments allocated to the
Dollar Cost Averaging Fixed Account;
plus
2. Interest credited; minus
3. Withdrawals, previously assessed
withdrawal charges and transfers
from the Dollar Cost Averaging
Fixed Account.
Interest The initial annual effective interest rate for the
Dollar Cost Averaging Fixed Account and the
minimum guaranteed interest rate are shown in the
Contract Schedule.
We reserve the right to declare interest rates
based upon the Issue Date, the date a Purchase
Payment is received by Us, and the amount of the
Purchase Payment we receive.
We calculate interest credited to the Dollar Cost
Averaging Fixed Account by compounding daily, at
daily interest rates, rates that would produce at
the end of 12 months a result identical to the one
produced by applying an annual interest rate.
VARIABLE ACCOUNT PROVISIONS
Separate Account The variable benefits under this contract are
provided through the Separate Account identified
in the Contract Schedule. The Separate Account is
registered with the Securities and Exchange
Commission as a unit investment trust under the
Investment Company Act of 1940. It is a separate
investment account maintained by Us into which a
portion of Our assets has been allocated for this
contract. We may also allocate to the Separate
Account assets attributable to certain other
contracts and certificates We issue.
We will maintain in the Separate Account assets
with a value at least equal to the amounts
accumulated in accordance with the applicable
agreements with respect to the Separate Account
and the reserves for annuities in the course of
payment that vary with the investment experience
of the Separate Account.
Liabilities of the The assets equal to the reserves and other
Separate Account liabilities of the Separate Account will not be
charged with liabilities arising out of any other
business We may conduct. Income, gains and losses,
realized or unrealized, from assets allocated to
the Separate Account will be credited to or
charged against the Separate Account, without
regard to Our other income, gains or losses. We
will value the assets of the Separate Account on
each Valuation Date.
Subaccounts The Separate Account consists of multiple
Subaccounts. We may, from time to time, combine or
remove Subaccounts in the Separate Account and
establish additional Subaccounts of the Separate
Account. In such event, We may permit You to
select other Subaccounts under the contract.
However, the right to select any other Subaccount
is limited by the terms and conditions We may
impose on such transactions.
Page 5
Page 6
VARIABLE ACCOUNT PROVISIONS (continued)
Fund Each Subaccount of the Separate Account will buy
shares of a Fund. Each Fund is registered under
the Investment Company Act of 1940 as an open-end
management investment company. Each series of Fund
represents a separate investment portfolio that
corresponds to one of the Subaccounts of the
Separate Account.
If we establish additional Subaccounts, each new
Subaccount will invest in a new series of a Fund
or in shares of another investment company. We may
also substitute other investment companies.
Rights Reserved by We reserve the right, subject to compliance with
the Company the current law or as it may be changed in the
future:
1. To operate the Separate Account in any form
permitted under the Investment Company Act of
1940 or in any other form permitted by law;
2. To change the name of the Separate Account
and any Subaccounts thereof;
3. To take any action necessary to comply with
or obtain and continue any exemptions from
the Investment Company Act of 1940 or to
comply with any other applicable law;
4. To transfer any assets in any Subaccount to
another Subaccount or to one or more Separate
Accounts, or the General Account, or to add,
combine or remove Subaccounts in the Separate
Account;
5. To delete the shares of any of the portfolios
of a Fund or any other open-end investment
company and to substitute, for the Fund
shares held in any Subaccount, the shares of
another portfolio of a Fund or the shares of
another investment company or any other
investment permitted by law; and
6. To change the way We assess charges, but not
to increase the aggregate amount above that
currently charged to the Separate Account and
the Funds in connection with this contract.
When required by law, We will obtain Your approval
of such changes and the approval of any regulatory
authority.
Accumulation Unit Value Each Subaccount has an Accumulation Unit value for
each combination of charges. When Purchase
Payments or other amounts are allocated to a
Subaccount, a number of units is purchased based
on the relevant Accumulation Unit value of the
Subaccount at the end of the Valuation Period
during which the allocation is made. When amounts
are transferred out of or deducted from a
Subaccount, units are redeemed in a similar
manner. The value of a Subaccount on any Valuation
Date is the number of units held in the Subaccount
times the relevant Accumulation Unit value on that
Valuation Date.
An Accumulation Unit value for each subsequent
Valuation Period is the relevant investment
experience factor for that period multiplied by
the Accumulation Unit value for the Valuation
Period immediately preceding. The Accumulation
Unit value for each Valuation Period is applied to
each day in a Valuation Period. The number of
Accumulation Units will not change as a result of
investment experience; however, adding, deleting
or modifying a rider for this contract may result
in a change in the number of Accumulation Units.
Investment Experience Each Subaccount has an investment experience
Factor factor for each combination of charges. The
investment experience factor of a Subaccount for a
combination of charges for a Valuation Period is
determined by dividing 1. by 2. and subtracting 3.
from the result, where:
1. is the net result of:
a. the net asset value per share of the
investments held in the Subaccount
determined at the end of the current
Valuation Period; plus
VARIABLE ACCOUNT PROVISIONS (continued)
b. the per share amount of any dividend or
capital gain distributions made by the
investments held in the Subaccount, if
the "ex-dividend" date occurs during the
current Valuation Period; plus or minus
c. a credit or charge for any taxes
reserved for the current Valuation
Period which We determine resulted from
the investment operations of the
Subaccount;
2. is the net asset value per share of the
investments held in the Subaccount,
determined at the end of the preceding
Valuation Period; and
3. is the factor representing the sum of the
Separate Account charges currently applicable
for the number of days in the Valuation
Period.
TRANSFER AND WITHDRAWAL PROVISIONS
Transfers During the During the Accumulation Period, any transfer
Accumulation Period request must clearly specify:
1. the amount which is to be transferred; and
2. the name of the accounts which are affected.
We reserve the right at any time and without
notice to any party, to terminate, suspend, or
modify the following transfer provision.
Transfers of Separate Account Contract Value are
subject to the following conditions:
1. The minimum amount which may be transferred
out of or into a Subaccount is the minimum
subsequent account allocation stated in the
Contract Schedule or, if smaller, the
remaining value of the Subaccount. No partial
transfer may be made if the remaining value
of the Subaccount will be less than the
minimum initial account allocation shown in
the Contract Schedule.
2. No transfer may be made within seven calendar
days before the date on which the first
Annuity payment is due.
3. We reserve the right to impose a 15 calendar
day waiting period between transfers for any
transfer in excess of 12 in a Contract Year.
4. Transfers to the Dollar Cost Averaging Fixed
Account are not permitted.
Withdrawals During the During the Accumulation Period, You may withdraw
Accumulation Period all or part of the Contract Value reduced by any
withdrawal charge and applicable premium taxes.
Withdrawals are subject to all of the following
conditions:
1. you must return this contract to Us if You
elect a total withdrawal;
2. each withdrawal must be at least $500 or the
value of this contract that remains in the
Dollar Cost Averaging Fixed Account or
Subaccount if smaller;
3. the minimum subsequent account allocation
stated in the Contract Schedule must remain
in the account after You make a withdrawal
unless the account is eliminated by such
withdrawal;
4. we must receive a written request that
indicates the amount of the withdrawal from
the Dollar Cost Averaging Fixed Account and
each Subaccount;
5. withdrawals will reduce each investment
option on a proportional basis unless You
direct Us otherwise; and
6. if a partial withdrawal would reduce the
Contract Value to less than the minimum
contract value remaining after a partial
withdrawal stated in the Contract Schedule,
the partial withdrawal will be processed as a
total withdrawal.
Page 7
Page 8
TRANSFER AND WITHDRAWAL PROVISIONS (continued)
Withdrawal Charges Withdrawal charges are set out in the Withdrawal
Charge Table shown in the Contract Schedule. A
withdrawal charge applies to each Purchase Payment
and to all Contract Value attributable to each
Purchase Payment. We calculate withdrawal charges
as a percentage of the Contract Value withdrawn in
excess of the free withdrawal allowance shown in
the Contract Schedule.
Year one in the Withdrawal Charge Table begins on
the first day of the calendar quarter during which
each Purchase Payment is received. Each later year
begins on the next succeeding anniversary of the
first day of the calendar quarter during which
each Purchase Payment is received.
The withdrawal charge percentage corresponding to
each year in the Withdrawal Charge Table applies
to Contract Value withdrawn in excess of the free
withdrawal allowance. Each withdrawal charge
percentage begins to apply on the first day of the
corresponding year.
All Contract Value to be withdrawn and any
applicable withdrawal charges will be charged
first against Purchase Payments and all Contract
Value attributable to such Purchase Payments in
the chronological order in which We receive such
Purchase Payments.
In the event of a partial withdrawal, any free
withdrawal allowance is calculated and applied
first against Purchase Payments and all Contract
Value attributable to such Purchase Payments in
the chronological order in which We received such
Purchase Payments even though such Purchase
Payments and related Contract Value may no longer
be subject to a withdrawal charge.
Transfer and Withdrawal We will withdraw or transfer from the Dollar Cost
Procedures Averaging Fixed Account as of the Valuation Date
that follows the date We receive in good order the
Owner's written request. To process a withdrawal,
the request must contain all required information.
We will redeem the necessary number of
Accumulation Units to achieve the requested dollar
amount when the withdrawal or transfer is made
from a Subaccount. We will reduce the number of
Accumulation Units credited in each Subaccount by
the number of Accumulation Units redeemed. The
reduction in the number of Accumulation Units is
determined based on the Accumulation Unit value at
the end of the Valuation Period when We receive
the request, provided the request contains all
required information. We will pay the withdrawal
amount within seven calendar days after the date
We receive the request, except as provided below.
Deferment of Withdrawal or If the withdrawal or transfer is to be made from a
Transfer Subaccount, We may suspend the right of withdrawal
or transfer or delay payment more than seven
calendar days:
1. during any period when the New York Stock
Exchange is closed other than customary
weekend and holiday closings;
2. when trading in the markets normally utilized
is restricted, or an emergency exists as
determined by the Securities and Exchange
Commission, so that disposal of investments
or determination of the Accumulation Unit
value is not practical; or
3. for such other periods as the Securities and
Exchange Commission by order may permit for
protection of Owners.
We may defer the payment of a withdrawal or
transfer from the Dollar Cost Averaging Fixed
Account for the period permitted by law. This can
never be more than six months after the Owner
sends Us a written request in good order. During
the period of deferral, We will continue to credit
interest, at the then current interest rate(s), to
the Dollar Cost Averaging Fixed Account Contract
Value.
DEATH BENEFIT PROVISIONS
Amount Payable The amount payable upon death is the Contract
Upon Death Value as of the end of the Valuation Period
following Our receipt of due proof of death, the
return of this contract, and such other
information We may require to process the death
benefit.
Payment of Death Benefits A death benefit will be paid to the beneficiary
During Accumulation Period upon the death of the Owner. Upon the death of a
joint Owner during the accumulation period, a
death benefit will be paid to the surviving joint
Owner. If the Contract Owner is a non-natural
person, a death benefit will be paid to the
beneficiary upon the death of an Annuitant prior
to the Annuity Date.
We will pay the death benefit to the beneficiary
after We receive due proof of death, the return of
this contract, and such other information we may
require to process the death benefit. We will then
have no further obligation under this contract.
The entire interest in this contract must be
distributed within five years from the date of
death unless it is applied under an Annuity option
or the spouse continues this contract as described
below.
The beneficiary may elect to have the death
benefit distributed as stated in the Annuity
Period Provisions Option 1 provided the
beneficiary's life expectancy is not less than 10
years; or Options 2 or 3 as described in the
Annuity Period Provisions of this contract, based
on the life expectancy of the beneficiary as
prescribed by federal regulations unless You have
restricted the right to make such an election. The
beneficiary must make this choice within 60 days
of the time We receive due proof of death, and
distributions must commence within one year of the
death of death.
If the beneficiary is a non-natural person, the
beneficiary must elect that the entire death
benefit be distributed within five years after the
date of death.
Spousal Continuation If this contract was issued as a Nonqualified Plan
Contract or an Individual Retirement Annuity
("IRA") and Your spouse is the primary beneficiary
when You die before the Annuity Date, Your spouse
may elect to be the successor Owner of this
contract. This is known as a Spousal Continuation.
No more than one Spousal Continuation is available
under this contract.
Upon Spousal Continuation, Your surviving spouse
waives claim to the death benefit otherwise
payable; therefore, no death benefit will be
payable upon Your death. Electing to continue this
contract under the Spousal Continuation provision
of this contract will affect how the charges and
benefits under this contract, and applicable
riders, are calculated or determined.
A Spousal Continuation has the following impact on
this contract:
A. The Contract Value will be adjusted to equal
the amount of the death benefit that would
otherwise be payable. If the death benefit
otherwise payable exceeds the Contract Value
one day prior to the date of continuance,
such excess will be credited to the money
market Subaccount listed in the Contract
Schedule. The Owner may subsequently transfer
this amount from the money market Subaccount
to other options then available under this
contract.
B. After the Spousal Continuation, the death
benefit payable will be determined as if: (1)
this contract was issued on the date of
continuance; and (2) the Contract Value
applied on the date of continuance resulted
from Our receipt of an initial Purchase
Payment.
X. Xxxxxxxxxx charges will not apply to
withdrawals made from the Contract Value
credited on the date of continuance.
Withdrawal charges will apply to Purchase
Payments made after the date of continuance.
We may make certain riders available to the
surviving spouse at the time of continuance.
Page 9
Page 10
ANNUITY PERIOD PROVISIONS
Annuity Options You may annuitize this contract under one of the
following Annuity options:
Option 1 We will make monthly payments for a 10 year
Certain Period Annuity certain period.
Option 2 We will make monthly payments while the Annuitant
Life Annuity is alive.
Option 3 We will make monthly payments for a 10 year
Life Annuity with certain period and thereafter while the Annuitant
Installments Guaranteed is alive.
Option 4 We will make full monthly payments while both
Joint and Annuitants are alive. Upon the death of either
Survivor Xxxxxxx Xxxxxxxxx, We will continue to pay a percentage of
the original monthly payment until the death of
the surviving Annuitant. The percentage payable
must be selected at the time this Annuity option
is chosen. The percentages available are 50%, 66
2/3%, 75% and 100%.
Option 5 We will make full monthly payments for a 10 year
Joint and Survivor certain period and thereafter while both
Xxxxxxx with Annuitants are alive. Upon the death of either
Installments Guaranteed Annuitant, We will continue to pay a percentage of
the original monthly payment until the death of
the surviving Annuitant. The percentage payable
must be selected at the time this Annuity option
is chosen. The percentages available are 50%, 66
2/3%, 75% and 100%.
Other Options We may make other Annuity options available.
Election of Annuity We must receive an election of an Annuity option
Option in writing. You may make an election on or before
the Annuity Date.
A subsequent change of beneficiary or an
assignment of this contract will revoke an
election unless the assignment provides otherwise.
Upon election of an Annuity option, We agree to
pay the Owner on the payment due dates as stated
in the specifications page of the supplementary
agreement. The Owner may direct Us, in writing, to
make payments to another person. An option cannot
be changed after the first Annuity payment is
made.
If an Annuity option is not elected on or before
the Annuity Date, an Annuity will be paid under
Option 3 if there is one Annuitant on the Annuity
Date and Option 5 if there are joint Annuitants on
the Annuity Date.
Payments for all options are derived from the
applicable section of the Annuity Option Table.
The Age in the Annuity Option Table is the Age of
the Annuitant on the last birthday before the
first payment is due. At the time of their
commencement, the payments will not be less than
those that would be provided by the application of
the greater of (1) or (2) below, less debt, to any
single consideration immediate annuity contract
offered for sale by Us at the time payments
commence to the same class of Annuitants where:
1. is the Contract Value, reduced by withdrawal
charges and applicable premium taxes; and
2. is 95% of the Contract Value.
ANNUITY PERIOD PROVISIONS (Continued)
If We do not offer for sale a single consideration
immediate annuity contract when the Annuity
payments under this contract commence, it is Our
intention to provide rates for use with this
provision that are reasonable in relation to such
rates that may be available in the market at that
time.
Electing a Fixed or You may elect a Fixed Annuity, a Variable Annuity
Variable Annuity Option or a combination of both. The portion of the
Contract Value You elect to be paid as a Fixed
Annuity, if any, will be transferred to Our
General Account. We must receive Your Fixed and
Variable Annuity allocation election in writing
at least seven days prior to the Annuity Date. If
We do not receive an election from You, the
Dollar Cost Averaging Fixed Account Contract
Value, less any withdrawal charge and charges for
other benefits, will be used to determine the
Fixed Annuity monthly payment, and the Separate
Account Contract Value at the end of the
Valuation Period immediately preceding the
Annuity Date, less any withdrawal charge and
charges for other benefits, will be used to
determine the first monthly Annuity payment under
a Variable Annuity.
If your allocation election includes a Variable
Annuity payment, payments will reflect the
investment performance of the Subaccounts in
accordance with the allocation on the Annuity
Date. Allocations will not be changed thereafter,
except as provided in the Transfers Between
Subaccounts section.
The option selected must result in a payment that
is at least equal to Our minimum payment,
according to Our rules, at the time the Annuity
option is chosen. If at any time the payment is
less than the minimum payment, We have the right
to increase the period between payments to
quarterly, semi-annual or annual so that the
payment is at least equal to the minimum payment
or to make payment in one lump sum.
Fixed Annuity The portion of the Contract Value You elect to
have paid to you as a Fixed Annuity will be used
to determine the Fixed Annuity monthly payment in
accordance with the Annuity option selected.
Current annuity rates will be used if they produce
greater payments than those quoted in this
contract.
Variable Annuity The portion of the Contract Value You elect to
have paid to you as a Variable Annuity will be
used to determine the first monthly Annuity
payment. The first monthly Annuity payment is
based on the guaranteed Annuity option shown in
the Annuity Option Table.
The dollar amount of subsequent payments may
increase or decrease depending on the investment
experience of each Subaccount to which Contract
Value is allocated. If the actual net investment
rate experienced exceeds the assumed rate, the
variable payments will increase over time. If the
actual net investment rate experienced is less
than the assumed rate, the variable payments will
decrease over time. You may not have more than
three Subaccounts at one time. The number of
Annuity Units per payment will remain fixed for
each Subaccount unless a transfer is made. If a
transfer is made, the number of Annuity Units per
payment will change. Some Annuity options provide
for a reduction in the income level upon the death
of an Annuitant, which will reduce the number of
Annuity Units.
The number of Annuity Units for each Subaccount is
calculated by dividing a. by b. where:
a. is the amount of the monthly payment that can
be attributed to that Xxxxxxxxxx; and
b. is the Annuity Unit value for that Subaccount
at the end of the Valuation Period. The
Valuation Period includes the date on which
the payment is made.
Monthly Annuity payments, after the first payment,
are calculated by adding, for each Subaccount, the
product of a. multiplied by b. where:
a. is the number of Annuity Units per payment in
each Subaccount; and
b. is the Annuity Unit value for that Subaccount
at the end of the Valuation Period. The
Valuation Period includes the date on which
the payment is made.
Page 11
Page 12
ANNUITY PERIOD PROVISIONS (Continued)
Annuity Unit Value The value of an Annuity Unit for each Subaccount
at the end of any Valuation Period is determined
by multiplying a. times b., with the result
multiplied by c., where:
a. is the Annuity Unit value for the immediately
preceding Valuation Period;
b. is the net investment experience factor for
the Valuation Period for which the Annuity
Unit value is being calculated; and
c. is the interest factor of .99993235 per
calendar day of such subsequent Valuation
Period to offset the effect of the assumed
rate of 2.5% per year used in the Annuity
Option Table. A different interest rate
factor will be used if an assumed rate other
than 2.5% is used in the Annuity Option
Table.
Basis of Annuity Options The guaranteed monthly payments are based on an
interest rate of 2.5% per year and, where
mortality is involved, the "Annuity 2000 Table"
developed by the Society of Actuaries projected
using Scale G to the year 2015. We may also make
available Variable Annuity payment options based
on assumed investment rates other than 2.5%, but
not greater than 5.00%.
Transfers Between During the Annuity Period, You may make transfers
Subaccounts between Subaccounts subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. Transfers between Subaccounts are prohibited
during the first year of the Annuity Period;
subsequent transfers are limited to one per
year.
3. You may not have more than three Subaccounts
at any time.
4. At least $5,000 of Annuity Unit value must be
transferred from a Subaccount, unless the
transfer will eliminate Your interest in the
Subaccount.
5. At least $5,000 of Annuity Unit value must
remain in the Subaccount after a transfer,
unless the transfer will eliminate Your
interest in the Subaccount.
6. If we receive notice of a transfer between
Subaccounts more than seven days before an
Annuity payment date, the transfer is
effective during the Valuation Period after
the date We receive the notice.
7. No transfer may be made within seven days
before an Annuity payment date.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these transfer privileges.
When a transfer is made between Subaccounts, the
number of Annuity Units per payment attributable
to a Subaccount to which the transfer is made is
equal to a. multiplied by b. divided by c. where:
a. is the number of Annuity Units per payment in
the Subaccount from which the transfer is
being made;
b. is the Annuity Unit value for the Subaccount
from which the transfer is being made; and
c. is the Annuity Unit value for the Subaccount
to which the transfer is being made.
Conversions from a During the Annuity Period, You may convert Fixed
Fixed Annuity Payment Annuity payments to Variable Annuity payments
subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of annuity reserve value
must be transferred from Our General Account,
unless the transfer will eliminate the
annuity reserve value.
ANNUITY PERIOD PROVISIONS (Continued)
3. At least $30,000 of annuity reserve value
must remain in Our General Account after a
transfer, unless the transfer will eliminate
the annuity reserve value.
4. Conversions from a Fixed Annuity payment are
available only on an anniversary of the
Annuity Date.
5. We must receive notice at least 30 days prior
to the anniversary.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these conversion privileges.
When a conversion is made from a Fixed Annuity
payment to a Variable Annuity payment, the number
of Annuity Units per payment attributable to a
Subaccount to which the conversion is made is
equal to a. divided by b. divided c. where:
a. is the annuity reserve value being
transferred from Our General Account;
b. is the Annuity Unit value for the Subaccount
to which the transfer is being made; and
c. is the present value of $1.00 per payment
period using the Age(s) of the Annuitant(s)
and any remaining payment that may be due at
the time of the transfer.
The annuity reserve value equals the present value
of the remaining Fixed Annuity payments using the
same interest and mortality basis used to
calculate the Fixed Annuity payments.
Conversions to a Variable Annuity payment will be
applied under the same Annuity option as
originally selected.
Conversions to a During the Annuity Period, You may convert
Fixed Annuity Payment Variable Annuity payments to Fixed Annuity
payments subject to the following:
1. You must send Us written notice in a form
satisfactory to Us.
2. At least $30,000 of Annuity Unit value must
be transferred to Our General Account from
the Subaccounts.
3. At least $5,000 of Annuity Unit value must
remain in a Subaccount after a transfer,
unless the transfer will eliminate Your
interest in the Subaccount.
4. Conversions to a Fixed Annuity payment are
available only on an anniversary of the
Annuity Date.
5. We must receive notice at least 30 days prior
to the anniversary.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify these conversion privileges.
When a conversion is made from a Variable Annuity
payment to a Fixed Annuity payment, the number of
Annuity Units per payment attributable to a
Subaccount from which the conversion is made is
the product of a. multiplied by b. multiplied by
c. where:
a. is the number of Annuity Units representing
Your interest in such Subaccount per Annuity
payment;
b. is the Annuity Unit value for such
Subaccount; and
c. is the present value of $1.00 per payment
period using the Age(s) of the Annuitant(s)
and any remaining payment that may be due at
the time of the transfer.
Conversions to a Fixed Annuity payment will be
applied under the same Annuity option as
originally selected.
Page 13
Page 14
ANNUITY PERIOD PROVISIONS (Continued)
Payment of Death If an Annuitant dies after the Annuity Date, the
Benefits During the death benefit, if any, will depend on the Annuity
Annuity Period option in effect.
If an Owner, who is not also the Annuitant, dies
after the Annuity Date, the following provisions
apply:
1. If the Owner was the sole Owner, the
remaining Annuity payments will be payable to
the beneficiary in accordance with the
Annuity option in effect. The beneficiary
will become the Owner.
2. If the contract has joint Owners, the Annuity
payments will be payable to the surviving
joint Owner in accordance with the terms of
the Annuity option in effect. Upon the death
of the surviving joint Owner, the beneficiary
becomes the Owner.
Disbursement Upon When the Annuitant or surviving joint Annuitant
Death of Annuitant: dies during the 10 year certain period, We will
Under Options 1, 3 or 5 automatically continue to pay the Owner any unpaid
installments for the remainder of the certain
period under Option 1, Option 3 or Option 5.
However, if You elect within 60 days of Our
receipt of due proof of death, We will pay a
commuted value of the remaining payments in the
certain period. In determining the commuted value,
the present value of the remaining payments in the
certain period will be calculated based on the
interest rate used to calculate payments upon
annuitization for the fixed installments and the
assumed rate for the variable installments.
For purposes of determining the present value of
any variable installments, the amount of each
payment will be determined by applying the Annuity
Unit value next determined following Our receipt
of due proof of death.
Supplementary A supplementary agreement will be issued to
Agreement reflect payments that will be made under an
Annuity option. Interest, under an Annuity option,
will start to accrue on the effective date of the
supplementary agreement.
Date of First Payment The supplementary agreement will provide details
on the payments to be made.
Evidence of Age, Sex We may require satisfactory evidence of the Age,
and Survival sex and the continued survival of any person on
whose life the income is based.
Misstatement of Age If the Age or sex of the Annuitant has been
or Sex misstated, the amount payable under the contract
will be such as the Purchase Payments sent to Us
would have purchased at the correct Age or sex.
Interest not to exceed 6% compounded each year
will be charged to any overpayment or credited to
any underpayment against future payments We may
make under this contract.
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
Option 1 - Certain Period Annuity
Number
of years Monthly
selected Payment
10 9.39
Options 2 and 3 - Life Annuity and Life Annuity With Installments Guaranteed
Age of Age of
Male Female
Annuitant Monthly Payments Guaranteed Annuitant Monthly Payments Guaranteed
--------- --------------------------- --------- ---------------------------
None 120 None 120
---- --- ---- ---
55 4.00 3.96 55 3.71 3.70
56 4.08 4.04 56 3.78 3.76
57 4.17 4.12 57 3.86 3.83
58 4.26 4.21 58 3.93 3.91
59 4.36 4.30 59 4.02 3.99
60 4.46 4.40 60 4.10 4.07
61 4.57 4.50 61 4.20 4.16
62 4.69 4.60 62 4.29 4.25
63 4.81 4.71 63 4.40 4.35
64 4.95 4.83 64 4.51 4.45
65 5.09 4.95 65 4.63 4.56
66 5.24 5.08 66 4.75 4.68
67 5.41 5.22 67 4.89 4.80
68 5.58 5.36 68 5.03 4.93
69 5.76 5.50 69 5.19 5.06
70 5.96 5.65 70 5.36 5.21
71 6.17 5.81 71 5.54 5.36
72 6.39 5.97 72 5.73 5.52
73 6.62 6.13 73 5.94 5.69
74 6.88 6.30 74 6.17 5.86
75 7.14 6.47 75 6.41 6.04
76 7.43 6.65 76 6.68 6.23
77 7.73 6.83 77 6.96 6.42
78 8.06 7.01 78 7.26 6.62
79 8.41 7.18 79 7.59 6.82
80 8.79 7.36 80 7.95 7.02
81 9.19 7.54 81 8.34 7.23
82 9.62 7.71 82 8.76 7.43
83 10.08 7.88 83 9.21 7.62
84 10.57 8.04 84 9.71 7.81
85 11.10 8.20 85 10.24 8.00
Option 4 - Joint and Survivor Annuity
Age of Age of Female Annuitant
Male ----------------------------------------------
Annuitant 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.38 3.53 3.67 3.77 3.86 3.91 3.95
60 3.48 3.68 3.88 4.06 4.20 4.30 4.37
65 3.56 3.81 4.08 4.35 4.59 4.77 4.91
70 3.62 3.92 4.26 4.63 4.99 5.32 5.57
75 3.65 3.99 4.39 4.87 5.39 5.90 6.34
80 3.68 4.03 4.49 5.05 5.73 6.46 7.18
85 3.69 4.06 4.55 5.18 5.99 6.96 8.01
Option 5 - Joint and Survivor Annuity with Installments Guaranteed
Age of Age of Female Annuitant
Male ----------------------------------------------
Annuitant 55 60 65 70 75 80 85
--------- ---- ---- ---- ---- ---- ---- ----
55 3.38 3.53 3.66 3.77 3.85 3.91 3.94
60 3.48 3.68 3.88 4.05 4.19 4.29 4.35
65 3.56 3.81 4.08 4.34 4.57 4.74 4.86
70 3.61 3.91 4.25 4.61 4.96 5.26 5.46
75 3.65 3.98 4.38 4.84 5.33 5.78 6.13
80 3.67 4.03 4.47 5.01 5.63 6.26 6.78
85 3.69 4.05 4.52 5.12 5.84 6.63 7.34
Page 15
FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
THE INITIAL INTEREST RATE IS GUARANTEED FOR ONLY A LIMITED PERIOD OF TIME.
WITHDRAWALS MAY BE SUBJECT TO A WITHDRAWAL CHARGE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT AND MAY INCREASE OR DECREASE. REFER TO THE VARIABLE ACCOUNT AND
ANNUITY PERIOD PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the Owner and Zurich Life Insurance Company of
New York.
READ YOUR CONTRACT CAREFULLY.
Zurich Life Insurance Company of New York
000 X. 00xx Xxxxxx, Xxx Xxxx, Xxx Xxxx 00000
Administration Office:
0000 XxXxxxxx Xxxxxxx, Xxxxxxxxxx, Xxxxxxxx 00000-0000
