INDIVIDUAL FLEXIBLE PREMIUM
VARIABLE ANNUITY CONTRACT
HARTFORD LIFE INSURANCE COMPANY
Hartford, Connecticut 06104-2999
(a stock life insurance company, herein called the "Company")
We will pay the first of a series of Annuity payments to the Payee as of the
Annuity Commencement Date, if You, the Annuitant, or the Joint Annuitant, if
any, are living. The manner in which the dollar amount of annuity payments is
determined is described in this contract.
This contract is issued in consideration of the payment of the initial premium
payment.
This contract is subject to the laws of the jurisdiction where it is delivered.
The Contract Specifications on Page 3 and the conditions and provisions on this
and the following pages are part of the contract.
RIGHT TO EXAMINE CONTRACT
We want You to be satisfied with the contract You have purchased. We urge
You to closely examine its provisions. If for any reason You are not
satisfied with Your purchase, You may cancel the contract by returning the
contract within ten days after You receive it. A written request for
cancellation must accompany the contract. In such event, We will pay You an
amount equal to the sum of (i) the difference between the premiums paid and
the amounts allocated to any Account under the contract and (ii) the Contract
Value on the date of surrender. You bear only the investment risk during the
period prior to Our receipt of request for cancellation.
Signed for the Company
/s/ Xxxxx Xxxxxx /s/ Lowndes X. Xxxxx
Xxxxx Xxxxxx, SECRETARY Lowndes X. Xxxxx, PRESIDENT
PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN.
NONPARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION
PROVISIONS, PAGES 11 AND 12.
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TABLE OF CONTENTS
PAGE
Contract Specifications 3
Definition of Certain Terms 4
Premium Payment Provisions 7
Transfers Between Accounts Provisions 7
Dollar Cost Averaging Provisions 8
Contract Control Provisions 8
General Provisions 9
Valuation Provisions 11
Surrender Provisions 12
Distribution at Time of Death Provisions 14
Calculation of the Death Benefit Provisions 14
Settlement Provisions 17
Annuity Tables 20
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CONTRACT SPECIFICATIONS
CONTRACT NUMBER [SPECIMEN] CONTRACT ISSUE DATE [FEBRUARY 8, 1999]
NAME OF ANNUITANT [XXXXX XXXXX] ANNUITY COMMENCEMENT DATE [JANUARY 1, 2029]
AGE OF ANNUITANT [35] INITIAL PREMIUM PAYMENT [$1,000]
SEX OF ANNUITANT [MALE] MINIMUM SUBSEQUENT PAYMENT $500
CONTINGENT ANNUITANT [XXXX XXXXX] MINIMUM FIXED ACCOUNT INTEREST RATE 3%
DESIGNATED BENEFICIARY [XXX XXXXX] (APPLIES TO ACCUMULATION PERIOD ONLY)
CONTRACT OWNER [XXXXX XXXXX]
DESCRIPTION OF BENEFITS
INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
SEPARATE ACCOUNT: [HARTFORD LIFE INSURANCE COMPANY
SEPARATE ACCOUNT THREE]
ANNUAL WITHDRAWAL AMOUNT CONTRACT YEARS 1-7
------------------
15% OF PREMIUM PAYMENTS ON A
NONCUMULATIVE BASIS
AFTER CONTRACT YEAR 7
---------------------
100% OF THE CONTRACT VALUE REDUCED BY
THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING
THE 7 YEARS PRIOR TO WITHDRAWAL;
AND
15% OF PREMIUM PAYMENTS MADE DURING THE 7
YEARS PRIOR TO WITHDRAWAL ON A
NONCUMULATIVE BASIS.
ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE
ON THE CONTRACT ANNIVERSARY.
$30 IF THE CONTRACT VALUE IS LESS THAN
$50,000 ON THE CONTRACT ANNIVERSARY.
MORTALITY AND EXPENSE RISK CHARGE: [1.35%] PER ANNUM OF THE DAILY SUB-ACCOUNTS
VALUE.
ADMINISTRATION CHARGE: [.15%] PER ANNUM OF THE DAILY SUB-ACCOUNTS
VALUE.
OPTIONAL DEATH BENEFIT CHARGE: [.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS
VALUE.
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CONTINGENT DEFERRED SALES CHARGES:
SUBJECT TO THE ANNUAL WITHDRAWAL AMOUNT, SURRENDERS OF CONTRACT VALUES
ATTRIBUTABLE TO PREMIUM PAYMENTS MAY BE MADE SUBJECT TO A CONTINGENT DEFERRED
SALES CHARGE ("CHARGE"). THE LENGTH OF TIME FROM RECEIPT OF THE PREMIUM
PAYMENT TO THE TIME OF SURRENDER DETERMINES THE CHARGE.
DURING THE FIRST SEVEN CONTRACT YEARS, ALL SURRENDERS WILL BE FIRST FROM
PREMIUM PAYMENTS AND THEN FROM EARNINGS. IF AN AMOUNT EQUAL TO ALL PREMIUM
PAYMENTS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE ASSESSED AGAINST THE
SURRENDER OF THE REMAINING CONTRACT VALUE.
AFTER THE SEVENTH CONTRACT YEAR, ALL SURRENDERS WILL FIRST BE FROM EARNINGS
AND THEN FROM PREMIUM PAYMENTS. A CHARGE WILL NOT BE ASSESSED AGAINST THE
SURRENDER OF EARNINGS. IF AN AMOUNT EQUAL TO ALL EARNINGS HAS BEEN
SURRENDERED, A CHARGE WILL NOT BE ASSESSED AGAINST PREMIUM PAYMENTS RECEIVED
MORE THAN SEVEN YEARS PRIOR TO SURRENDER, BUT WILL BE ASSESSED AGAINST
PREMIUM PAYMENTS RECEIVED LESS THAN SEVEN YEARS PRIOR TO SURRENDER. FOR THIS
PURPOSE, PREMIUM PAYMENTS WILL BE DEEMED TO BE SURRENDERED IN THE ORDER IN
WHICH THEY WERE RECEIVED.
THE CHARGE IS A PERCENTAGE OF THE AMOUNT SURRENDERED (NOT TO EXCEED THE
AGGREGATE AMOUNT OF THE PREMIUM PAYMENTS MADE) AND EQUALS:
LENGTH OF TIME FROM PREMIUM PAYMENTS
CHARGE (NUMBER OF YEARS)
7% 1
6% 2
6% 3
5% 4
4% 5
3% 6
2% 7
0% 8 AND THEREAFTER
NO CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF:
- THE CONTRACT TERMINATES DUE TO THE DEATH OF THE ANNUITANT OR CONTRACT OWNER
(AS APPLICABLE),
- ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE,
ONLY THE ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR
- AN ANNUITY OPTION IS ELECTED. (ANY SURRENDER OUT OF OPTION 6 MAY BE SUBJECT
TO CONTINGENT DEFERRED SALES CHARGES.)
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DEFINITION OF ACCOUNT - Any of the Sub-Accounts or the Fixed Account(s).
CERTAIN TERMS
ACCUMULATION UNIT - An accounting unit of measure used to
calculate the value of a Sub-Account of this contract
before annuity payments begin.
ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at
000 Xxxxxxxxx Xx., Xxxxxxxx, XX 00000. All correspondence
concerning this contract should be sent to our mailing
address: Hartford Life Individual Annuity Services,
X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000.
ANNIVERSARY VALUE - The value equal to the Contract Value
as of a Contract Anniversary, increased by the dollar
amount of any premium payments made since that anniversary
and reduced by the dollar amount of any partial
surrenders since that anniversary. If the Contract
Anniversary falls on a non-Valuation Day (weekend or
holiday), then the next Valuation Day will be the Contract
Anniversary for that Contract Year.
ANNUAL WITHDRAWAL AMOUNT - The amount that can
be withdrawn in any Contract Year prior to
incurring surrender charges.
ANNUAL MAINTENANCE FEE - An amount which, depending on
the amount of the Contract Value, may be deducted from the
value of the contract on each Contract Anniversary or upon
full surrender of this contract. The Annual Maintenance
Fee is shown on Page 3.
ANNUITANT - The person on whose life this contract is
issued. The Annuitant may not be changed. Also, see
Contingent Annuitant and Joint Annuitant.
ANNUITY - A contract issued by an insurance company that
provides, in consideration of premium payments, a series of
income payments. Your contract is a deferred Annuity
contract in which premium payments, less any partial
surrenders, accumulate until a full surrender is taken or
until the Annuity Commencement Date. Annuity payments
under Your contract will begin as of the Annuity
Commencement Date in accordance with the payment
option elected.
ANNUITY CALCULATION DATE - The date on which the first
annuity payment will be calculated. It will be no more
than five Valuation Days prior to the Annuity Commencement
Date.
ANNUITY COMMENCEMENT DATE - The date as of which Annuity
payments are to begin as described under Settlement
Provisions in this contract.
ANNUITY PAYMENT FREQUENCY - The frequency with which
Annuity payments will be made. The frequencies available
are monthly, quarterly, semi-annual, and annual.
ANNUITY UNIT - An accounting unit of measure used to
calculate the value of annuity payments under a variable
Annuity option.
ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed
Investment Return ("AIR") when determining the Annuity Unit
Value. When the AIR is 3%, the daily factor is 0.999919.
When the AIR is 5%, the daily factor is 0.999866. And when
the AIR is 6%, the daily factor is 0.999840.
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DEFINITION OF ASSUMED INVESTMENT RETURN ("AIR") - The investment return
CERTAIN TERMS upon which the variable Annuity payments in this contract
(CONTINUED) will be based. The annual rates available are 3%, 5%, and
6%. You may select one of these rates prior to the
Annuity Commencement Date.
BENEFICIARY - The person(s) entitled to receive benefits
as per the terms of the contract in the event of the death
of the Contract Owner or Annuitant, as applicable.
COMMUTED VALUE - The present value of the remaining
guaranteed Annuity Payments, under Option Six (Payment
for a Period Certain). The present value is computed
using the AIR for the Contract and the Annuity Unit
value(s) calculated as of the date that We receive a
fully completed request for surrender and, in the event
of the Annuitant's death, Due Proof of Death of the
Annuitant.
CONTINGENT ANNUITANT - The person You designate who, upon
the Annuitant's death, prior to the Annuity Commencement
Date, becomes the Annuitant.
CONTRACT ANNIVERSARY - An anniversary of the Contract
Issue Date.
CONTRACT ISSUE DATE - The date as of which an Account
is established for You by Us. The Contract Issue Date is
shown on Page 3.
CONTRACT OWNER(S) - The owner(s) or holder of the contract.
CONTRACT VALUE - The aggregate value of the Sub-Accounts
and the Fixed Account(s) on any Valuation Day.
CONTRACT YEAR - A period of 12 months commencing with
the Contract Issue Date or any other anniversary
thereafter.
DEATH BENEFIT - The amount that We will pay upon the
death of the Contract Owner or the Annuitant, as
applicable.
DCA PROGRAM FIXED ACCOUNT(S) - Account(s) established
to be used for the Dollar Cost Averaging program(s).
It is part of the Our General Account.
DOLLAR COST AVERAGING ("DCA") - Systematic transfers from
one Account to any other available Accounts.
DUE PROOF OF DEATH - A certified death certificate, an
order of a court of competent jurisdiction, or any
other proof acceptable to Us.
FIXED ACCOUNT - Part of Our General Account to which all
or a part of the Contract Value may be allocated. Any
transfers, deductions or surrenders from the Fixed Account
will be accounted for on a first in, first out basis.
FUNDS - The securities which underlie Your Sub-Accounts.
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DEFINITION OF GENERAL ACCOUNT - All of Our assets other than those
CERTAIN TERMS allocated to the Separate Account.
(CONTINUED)
JOINT ANNUITANT - Upon annuitization, a person other than
the Annuitant on whose continuation of life Annuity
payments may be made. The contract will have a Joint
Annuitant only if the Annuity settlement option selected
provides for a survivor. The Joint Annuitant may not be
changed.
MAXIMUM ANNIVERSARY VALUE - The highest attained
Anniversary Value prior to the earlier of the date of
death or the decedent's 81st birthday.
NET ASSET VALUE PER SHARE - The value per share of any
Fund on any Valuation Day. This amount will never be
less than that required by the Securities and Exchange
Commission.
PAYEE - The person, designated by You, to whom Annuity
payments will be made.
PREMIUM TAX - The amount of tax, if any, charged by a
federal, state, or other governmental entity on premium
payments or Contract Values. On any contract subject to
a Premium Tax, We may deduct the tax on a pro-rata basis
from the Accounts at the time We pay the tax to the
applicable taxing authorities, at the time the contract is
surrendered or on the Annuity Commencement Date.
SEPARATE ACCOUNT - An Account that We established to
separate the assets funding the variable benefits for this
type of contract from Our other assets. The assets in the
Separate Account are not chargeable with liabilities
arising out of any other business We may conduct. The
name of the Separate Account is shown on Page 3.
SUB-ACCOUNT - The subdivisions of the Separate Account
which are used to allocate Your Contract Value among the
corresponding Funds.
SURRENDER VALUE - The Contract Value prior to the Annuity
Commencement Date, less any applicable contingent deferred
sales charges, Premium Taxes, and/or Annual Maintenance
Fee.
VALUATION DAY - Every day the New York Stock Exchange is
open for trading. The value of the Separate Account is
determined at the close of the New York Stock Exchange
(generally 4:00 p.m. Eastern Time) on such days.
VALUATION PERIOD - The period of time between the close
of business on successive Valuation Days.
WE, US, OUR - The company referred to on the first page
of this contract.
YOU, YOUR - The Contract Owner(s).
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PREMIUM PREMIUM PAYMENTS
PAYMENT Premium payments are payable at the Administrative Office of
PROVISIONS the Company. Payments may be made by check or by any other
method that We deem acceptable.
The initial premium payment is shown on Page 3. This is a
flexible premium annuity. We may accept additional payments.
The additional payments must be at least equal to the minimum
subsequent premium payment shown on Page 3.
If you are exchanging from one of Our existing contracts,
You may be eligible for certain credits applied to the amount
exchanged. Eligibility for such credits will be extended to
all members of any class of business We designate.
ALLOCATION OF PREMIUM PAYMENTS
Premium payments will be allocated to each Account according
to Your instructions subject to Our minimum amount(s) then in
effect. Any subsequent premium payments will be allocated to
Accounts in accordance with the most recent premium allocation
instructions that We received.
TRANSFERS TRANSFERS BETWEEN SUB-ACCOUNTS
BETWEEN You may transfer Contract Values held in the Sub-Accounts into
ACCOUNTS other Sub-Accounts. We reserve the right to limit the number
PROVISIONS of transfers to no more than 12 per Contract Year with no two
transfers being made on consecutive Valuation Days.
The right to make transfers between Sub-Accounts is subject to
modification if We determine, in Our opinion, that exercising
that right by one or more Contract Owners is, or would be, to
the disadvantage of other Contract Owners. Any modification
could be applied to transfers to or from some or all of the
Sub-Accounts and could include, but not be limited to:
a) the requirement of a minimum time period between each
transfer;
b) not accepting transfer requests of an agent acting under a
power of attorney or on behalf of more than one Contract
Owner, or
c) limiting the dollar amount that may be transferred between
the Sub-Accounts by a Contract Owner at any one time.
Such restrictions may be applied in any manner reasonably
designed to prevent any use of the transfer right which is
considered by Us to be to the disadvantage of other Contract
Owners.
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TRANSFERS TRANSFERS BETWEEN THE FIXED ACCOUNT AND THE SUB-ACCOUNT(S)
BETWEEN The maximum amount transferable from the Fixed Account during
ACCOUNTS any Contract Year is the greater of:
PROVISIONS a) 30% of the Fixed Account value as of the last Contract
(CONTINUED) Anniversary, or
b) the greatest dollar value of any prior transfer from the
Fixed Account.
This limitation does not apply to Dollar Cost Averaging.
However, if any interest rate is renewed at a rate at least
one percentage point below the previous rate, You may transfer
a dollar amount up to 100% of the Fixed Account dollar value
receiving that reduced rate within 60 days of notification of
the interest rate decrease. We reserve the right to defer
transfers from the Fixed Account for up to six months from the
date of request.
Transfers may not be made from the Sub-Accounts into the Fixed
Account for the six month period following any transfer from
the Fixed Account into the other Sub-Accounts. Additionally
transfers may not be made into the DCA Program Fixed Account(s)
from either the Sub-Accounts or the Fixed Account(s).
DOLLAR COST DOLLAR COST AVERAGING
AVERAGING From time to time, We may offer and You may enroll in a Dollar
PROVISIONS Cost Averaging Program (the "Program"). Prior to enrollment,
you may obtain the available account(s), duration(s), or
credited rates.
You may terminate participation in the Program at any time
by calling or writing Us. In such event, the remaining
balance in the DCA Fixed Account will be transferred to the
Account(s) designated by You.
CONTRACT ANNUITANT, CONTINGENT ANNUITANT, CONTRACT OWNER
CONTROL The Annuitant may not be changed.
PROVISIONS
The designations of Contract Owner and Contingent Annuitant
will remain in effect until You change them. The designation of
the Contract Owner may be changed during the lifetime of the
Annuitant by written notice to Us. The designation of the
Contingent Annuitant may be changed at any time during
the lifetime of the Annuitant and prior to the Annuity
Commencement Date by written notice to Us. If no Contingent
Annuitant has been named and the Contract Owner/Annuitant's
spouse is the Beneficiary, the Contract Owner/Annuitant's
spouse will be presumed to be the Contingent Annuitant.
OWNERSHIP
You have the sole power to exercise all the rights, options,
and privileges granted by this contract or permitted by Us and
to agree with Us to any change in or amendment to the contract.
Your rights will be subject to the rights of any assignee of
record with Us and of any irrevocably designated Beneficiary.
In the case of joint Contract Owners, each Contract Owner
alone may exercise all rights, options, and privileges, except
with respect to the surrender, partial surrender, selection of
an Annuity option, and change of ownership.
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CONTRACT BENEFICIARY
CONTROLS The designated Beneficiary will remain in effect until You
PROVISIONS change it. The designated Beneficiary may be changed during
(CONTINUED) the lifetime of the Annuitant by written notice to Us at the
Administrative Office of the Company. If the designated
Beneficiary has been designated irrevocably, the designation
cannot be changed or revoked without such Beneficiary's written
consent. Upon receipt of written notice and consent, if
required by Us, the new designation will take effect as of the
date the notice is signed, whether or not the Annuitant or
Contract Owner is alive at the time of receipt. Any payments
made or other action taken by Us before the receipt of the
notice will not be subject to the requested change.
GENERAL THE CONTRACT
PROVISIONS This contract and the endorsements or riders, if any,
constitute the entire contract.
CONTRACT MODIFICATION
No modification of this contract will be made without the
signature of Our President, a Senior Vice President,
Executive Vice President, Vice President or Assistant Vice
President. No modification will affect the amount or term of
any Annuity begun prior to the modification unless it is
required to conform the contract to any federal or state
statute. No modification will affect the method by which the
Contract Value will be determined.
FUND MODIFICATION
We reserve the right, subject to any applicable law, to make
certain changes, including the right to add, eliminate or
substitute any investment options offered under the
Contract.
MINIMUM VALUE STATEMENT
Any Surrender Values, death benefits, or settlement provisions
available under this contract equal or exceed those required by
the state in which the the contract is delivered.
NON-PARTICIPATION
This contract does not share in Our surplus earnings. That
portion of the Separate Account assets equal to the reserves
and other contract liabilities will not be chargeable with
liabilities arising out of any other business We may conduct.
MISSTATEMENT OF AGE AND SEX
If the age or sex of the Annuitant has been misstated, the
amount of the Annuity payable by Us will be adjusted based on
the correct information without changing the date of the
first payment. Any underpayments by Us will be made up
immediately and any overpayments will be charged against
future amounts becoming payable.
If the age of the Annuitant or Contract Owner has been
misstated, the amount of any death benefit payable will be
determined based upon the correct age of the Annuitant or
Contract Owner.
INCONTESTABILITY
We cannot contest this Contract.
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GENERAL REPORTS TO THE CONTRACT OWNER
PROVISIONS You will be sent copies of any shareholder reports of the Funds
(CONTINUED) and of any other notices, reports or documents required by law
to be delivered to You. At least annually, a statement of the
Contract Value will be sent to the You.
VOTING RIGHTS
We will notify You of any Fund shareholder's meetings at which
the shares held for Your account may be voted. We will send
proxy materials and instructions for You to vote the shares
held for Your account. We will arrange for the handling and
tallying of proxies received from Contract Owners. We will
vote the Fund shares held by Us in accordance with the
instructions received from Contract Owners. You may attend
any meeting, where shares held for Your benefit, will be voted.
In the event that You give no instructions or leave the
manner of voting discretionary, We will vote such shares of
the appropriate Fund in the same proportion as shares of that
Fund for which instructions have been received. Also, We will
vote the Fund shares in this proportionate manner which are
held by Us for Our own account. After Annuity payments begin,
the number of votes will decrease.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At Our election and subject to any necessary vote by persons
having the right to give instructions on the voting of the Fund
shares held by the Sub-Accounts, the Separate Account may be
operated as a management company under the Investment Company
Act of 1940 or any other form permitted by law, may be
deregistered under the Investment Company Act of 1940 in the
event registration is no longer required, or may be combined
with one or more Separate Accounts.
PROOF OF SURVIVAL
The payment of any Annuity benefit will be subject to evidence
that the Annuitant is alive on the date such payment is
otherwise due.
TAX QUALIFICATION
This Contract is intended to qualify as an Annuity contract for
federal income tax purposes. To that end, the provisions of
this contract are to be interpreted to ensure and maintain such
tax qualification, notwithstanding any other provisions to the
contrary. We reserve the right to amend this Contract to
conform to any changes in the tax qualification requirements
under the applicable provisions of the Internal Revenue Code.
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VALUATION NET PREMIUM PAYMENTS
PROVISIONS The net premium payment is equal to the premium payment minus
any applicable Premium Taxes. The net premium payment is
applied to purchase Fixed Account values or Sub-Account
Accumulation Units with respect to the Sub-Account(s) that You
have selected.
The number of Accumulation Units credited to each Sub-Account
is determined by dividing the Net Premium payment allocated
to a Sub-Account by the dollar value of one Accumulation Unit
for such Sub-Account. This is computed in compliance with
Securities and Exchange Commission regulations. The number of
Accumulation Units will not be affected by any subsequent
change in the value of such Accumulation Units. The
Accumulation Unit value in any Sub-Account may increase or
decrease from day to day as described below.
We will determine the value of the Fixed Account(s) by
crediting interest to amounts allocated to the Fixed
Account(s). The Minimum Fixed Account Interest Rate is the rate
shown on Page 3, compounded annually. At Our discretion,
We may credit interest rates greater than the Minimum Fixed
Account Interest Rate. We may change the rate or rates
credited in accordance with applicable law.
NET INVESTMENT FACTOR
The net investment factor for each of the Sub-Accounts is equal
to:
a) The Net Asset Value Per Share of the corresponding Fund
at the end of the Valuation Period (plus the per share
amount of any unpaid dividends or capital gains by that
Fund); divided by
b) the Net Asset Value Per Share of the corresponding Fund at
the beginning of the valuation period; minus
c) the mortality and expense risk charge and any applicable
administration charge, shown on Page 3 adjusted for the
number of days in the Valuation Period; minus
d) the Optional Death Benefit Charge, if applicable, shown on
Page 3, adjusted for the number of days in the valuation
period.
The General Account net investment factor is guaranteed to
be at least equal to the Minimum Fixed Account Interest
Rate shown on Page 3.
ACCUMULATION UNIT VALUE
The value of an Accumulation Unit for each Sub-Account of
the Separate Account will vary to reflect the investment
experience of the applicable Funds. It will be determined
by multiplying:
a) the value of the Accumulation Unit for that Sub-Account
as of the preceding Valuation Day by
b) the Net Investment Factor for that Sub-Account for the
Valuation Day for which the Accumulation Unit value is
being calculated.
The value of the Sub-Account as of each Valuation Day is then
determined by multiplying:
a) the number of Accumulation Units in that Sub-Account by
b) the Accumulation Unit value as of that Valuation Day.
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VALUATION ANNUITY UNIT VALUE
PROVISIONS The value of an Annuity Unit for each Sub-Account of the
(CONTINUED) Separate Account will vary to reflect the investment experience
of the applicable Funds. It will be determined by multiplying:
a) the value of the Annuity Unit for that Sub-Account as of
the preceding Valuation Day by;
b) the Net Investment Factor for that Sub-Account for the
Valuation Day for which the Annuity Unit value is being
calculated; and by
c) the Annuity Unit Factor.
ANNUAL MAINTENANCE FEE
During each year that this contract is in force prior to the
Annuity Commencement Date, the Annual Maintenance Fee, if
applicable, will be deducted on the Contract Anniversary.
The fee will be charged against the Contract Value by
reducing the Fixed Account value, and with respect to the
Sub-Accounts, the number of Accumulation Units held as of
that date. The fee will be charged on a pro-rata basis with
respect to each active Account. The number of Accumulation
Units deducted from each Sub-Account is determined by
dividing the pro-rata portion of the Annual Maintenance Fee
by the value of an Accumulation Unit for the applicable
Sub-Account.
SURRENDER FULL SURRENDER PRIOR TO THE ANNUITY COMMENCEMENT DATE
PROVISIONS At any time prior to the Annuity Commencement Date, You have
the right to terminate the contract by submitting a written
request to Us at the Administrative Office of the Company. In
such event, the Surrender Value of the contract may be taken in
the form of a cash settlement.
The Surrender Value of the contract is equal to the Contract
Value less:
a) any applicable Premium Taxes not previously deducted;
b) the Annual Maintenance Fee as specified on Page 3; and
c) any applicable contingent deferred sales charge shown on
Page 3.
PARTIAL SURRENDERS PRIOR TO THE ANNUITY COMMENCEMENT DATE
You may request, in writing or other means acceptable to Us,
a partial surrender of Contract Values at any time prior to
the Annuity Commencement Date provided the Contract Value
remaining after the surrender is at least equal to Our
minimum amount rules then in effect. If the remaining
Contract Value following such surrender is less than Our
minimum amount rules, We may terminate the contract and pay
the Surrender Value.
The contingent deferred sales charge will be assessed
against any Contract Values surrendered as described on Page
3. However, on a noncumulative basis, You may make partial
surrenders during any Contract Year, up to the Annual
Withdrawal Amount shown on Page 3 and the contingent
deferred sales charge will not be assessed against such
amounts. Surrender of Contract Values in excess of the
Withdrawal Amount and additional surrenders made in any
Contract Year will be subject to the contingent deferred
sales charge, as described on Page 3, if applicable.
Generally, for federal tax purposes, any surrenders will be
deemed to be first from earnings, to the extent that they
exist, and then from the premium payments.
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SURRENDER WAIVER OF SURRENDER CHARGE
PROVISIONS We will waive any contingent deferred sales charge applicable
(CONTINUED) to a partial or full surrender of the Contract Value if the
covered person has met the requirements of Eligible Confinement
as described below. A covered person is:
a) the current Contract Owner if the Contract Owner has been
Contract Owner continuously since the date of issue and if
not confined at the time the contract was purchased; and
b) the Annuitant, if not confined at the time the contract was
purchased.
This benefit will be provided if the Contract Owner provides
written proof of confinement which is satisfactory to Us and
requests the partial surrender or full surrender of Account
Value within 91 days of the last day of confinement.
Confinement must be at the recommendation of a physician for
medically necessary reasons, for at least 180 consecutive
calendar days, to:
a) a hospital recognized as a general hospital by the proper
authority of the state in which it is located; or
b) a hospital recognized as a general hospital by the Joint
Commission on the Accreditation of Hospitals; or
c) a facility certified as a hospital by Medicare; or
d) a nursing home licensed by the state in which it is located
and which has a registered nurse on duty 24 hours a day; or
e) a facility certified by Medicare as a long term care
facility.
SURRENDER AFTER THE ANNUITY COMMENCEMENT DATE
This contract may only be surrendered for its Commuted Value,
less any applicable contingent deferred sales charge, after the
commencement of variable Annuity payments under option Six
(Payment for a Period Certain) which is described in the
Settlement Provisions.
PAYMENT ON SURRENDER - DEFERRAL OF PAYMENT
Payment on any request for surrender will be made as soon as
possible and with respect to Contract Values in the
Sub-Accounts, within seven days after the written request is
received by Us in good order. However, such payment may be
subject to postponement:
a) for any period during which the New York Stock Exchange is
closed or during which trading on the New York Stock
Exchange is restricted;
b) for any period during which an emergency exists as a result
of which (i) disposal of the securities held in the
Sub-Accounts is not reasonably practicable, or (ii) it is
not reasonably practicable for the value of the net assets
of the Separate Account to be fairly determined; and
c) for such other periods as the Securities and Exchange
Commission may, by order, permit for the protection of the
Contract Owners. The conditions under which trading will be
deemed to be restricted or any emergency will be deemed to
exist will be determined by rules and regulations of the
Securities and Exchange Commission.
We may defer payment of any amounts from the Fixed Account for
up to six months from the date of the request to surrender. If
We defer payment for more than 30 days, We will pay interest of
at least 3% per annum on the amount deferred.
VA99-12/13 Page 13 PRINTED IN U.S.A.
R557R0.FRM
DISTRIBUTION DEATH BEFORE THE ANNUITY COMMENCEMENT DATE
AT TIME OF If the Contract Owner dies, and:
DEATH a) the joint Contract Owner is living, the joint Contract Owner
PROVISIONS will become the Beneficiary. In this case, the rights of
the designated Beneficiary are voided.
b) there is no surviving joint Contract Owner, the designated
Beneficiary will be the Beneficiary.
If the Annuitant dies, and:
a) is also the Contract Owner, the designated Beneficiary will
be the Beneficiary.
b) both the Contract Owner and the Contingent Annuitant are
living, the Contingent Annuitant will become the Annuitant.
The Contract will continue.
c) the Contract Owner is living, and there is no Contingent
Annuitant or the Contingent Annuitant is not living, the
Contract Owner will be the Beneficiary. In this case, the
rights of the designated Beneficiary are voided.
d) the Contract is owned by a corporation or other entity, the
Contract Owner will be the Beneficiary. In this case, the
rights of the designated Beneficiary are voided.
DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
If the Contract Owner dies, and the Annuitant is living, the
designated Beneficiary will become the Contract Owner.
If the Annuitant dies, the Contract Owner will be the
Beneficiary. If a Death Benefit is triggered, the rights of
the designated Beneficiary are voided. If the Annuitant who
is also the Contract Owner dies, the designated Beneficiary
will be the Beneficiary.
The Death Benefit will be calculated as of the date We receive
written notification of Due Proof of Death as in the manner
described in the settlement option then in effect.
CALCULATION CALCULATION OF THE DEATH BENEFIT
OF THE DEATH If a Death Benefit is triggered before the Annuity Commencement
BENEFIT Date, any Death Benefit payable will be calculated as of the
PROVISIONS date We receive written notification of Due Proof of Death.
If the calculated Death Benefit exceeds the Contract Value,
the difference will be allocated to the Sub-Account(s) in
accordance with the last Sub-Account allocation instructions
received from the Contract Owner.
During the time period between Our receipt of written
notification of Due Proof of Death and Our receipt of
complete settlement instructions from each Beneficiary, the
calculated Death Benefit amount will be subject to market
fluctuations.
VA99-14/15 Page 14 PRINTED IN U.S.A.
R558R0.FRM
CALCULATION DEATH BENEFIT
OF THE DEATH The Death Benefit is the greatest of:
BENEFIT a) the Contract Value; or
PROVISIONS b) 100% of all premium payments made under the Contract,
(CONTINUED) reduced by the gross amount of any partial surrenders
since the Contract Issue Date; or
c) the Maximum Anniversary Value, as described below.
MAXIMUM ANNIVERSARY VALUE
The Maximum Anniversary Value is based on a series of
calculations on Contract Anniversaries, of Contract Values,
premium payments and partial surrenders.
As of the date We receive notification of Due Proof of
Death, We will calculate an Anniversary Value for each
Contract Anniversary prior to the decedent's death and 81st
birthday. The Anniversary Value is equal to the Contract
Value as of a Contract Anniversary, increased by the dollar
amount of any premium payments made since that anniversary
and reduced by the dollar amount of any partial surrenders
since that anniversary. The Maximum Anniversary Value is
equal to the greatest Anniversary Value attained from this
series of calculations.
OPTIONAL DEATH BENEFIT
If this contract has an Optional Death Benefit, a charge for
the benefit will appear on page 3. The benefit must be
applied for at the time of applying for the contract and
cannot be discontinued once the contract has been issued.
The Optional Death Benefit is the greatest of:
a) the Contract Value; or
b) 100% of all premium payments made under the Contract,
reduced by the dollar amount of any partial surrenders
since the Contract Issue Date; or
c) the Maximum Anniversary Value, as described above, or
d) the Interest accumulation value, as described below.
INTEREST ACCUMULATION VALUE
Prior to the decedent's death or 81st birthday, the interest
accumulation value is equal to total premium payments, less
proportional adjustments for partial surrenders, compounded
daily at an annual interest rate of 5.0%. The proportional
adjustment for partial surrenders is calculated by:
a) dividing the gross amount of the partial surrender by the
prior day's Contract Value, and
b) multiplying the result of (a) by the prior Valuation Day's
interest accumulation value.
On or after the decedent's date of death or 81st birthday,
the interest accumulation value will no longer compound.
After that date, the interest accumulation value will be
adjusted by adding any subsequent payments and subtracting
proportional adjustments, as described above, for partial
surrenders.
The interest accumulation value will be limited to 200% of all
premium payments minus proportional adjustments for partial
surrenders.
VA99-14/15 Page 15 PRINTED IN U.S.A.
R559R0.FRM
CALCULATION SETTLEMENT OF THE DEATH BENEFIT
OF THE DEATH The Death Benefit may be taken in one sum or under any of the
BENEFIT settlement options then being offered by Us subject, however,
PROVISIONS to the Distribution Requirements below.
(CONTINUED)
As of the date of receipt of complete disbursement
instructions from the Beneficiary, the amount to be paid or
applied to a selected settlement option will be computed.
When there is more than one Beneficiary, the amount will be
calculated for each Beneficiary's share of the proceeds and
paid or applied to a selected settlement option according to
and upon each Beneficiary's instructions. If the date of
receipt of complete instructions falls on a non-Valuation
Day, the amount will be computed on the next Valuation Day.
When payment is taken in one sum, payment will be mailed
within 7 days of Our receipt of complete instructions,
except when We are permitted to defer such payment under the
Investment Company Act of 1940.
DISTRIBUTION REQUIREMENTS
Subject to the Alternative Election or Spouse Beneficiary
provisions below,
a) If any Contract Owner dies before the Annuity Commencement
Date, the entire interest in the Contract will be
distributed within five years after such death; and
b) If any Contract Owner dies on or after the Annuity
Commencement Date and before the entire interest in the
Contract has been distributed, the remaining portion of
such interest will be distributed at least as rapidly as
under the method of distribution being used as of the date
of such death.
If the Contract Owner is not an individual, then for purposes
of the preceding paragraph a or b, the primary Annuitant will
be treated as the Contract Owner.
ALTERNATIVE ELECTION TO SATISFY DISTRIBUTION REQUIREMENTS
If any portion of the interest of a Contract Owner described
above is payable to or for the benefit of a designated
Beneficiary, and the Beneficiary elects after the Contract
Owner's death to have the benefit distributed over a period
that:
a) does not extend beyond such Beneficiary's life (or life
expectancy); and
b) does commence within one year of the date of death then for
purposes of satisfying the Distribution Requirements above,
the benefit will be treated as distributed entirely on the
date such periodic distributions begin.
SPOUSE BENEFICIARY
In the event of the death of a Contract Owner where the sole
Beneficiary is the Contract Owner's spouse and the Annuitant
(or Contingent Annuitant, if applicable) is alive, the
contract will continue with the spouse as the Contract
Owner, unless the spouse elects to be paid a Death Benefit
option. This provision will apply only once with respect to
this contract.
If the contract continues with the spouse as the Contract
Owner, the death benefit will be calculated on receipt of
due proof of death. If the Contract Value is less than the
calculated death benefit amount, the Contract Value will be
increased appropriately.
VA99-16/17 Page 16 PRINTED IN U.S.A.
R560R0.FRM
SETTLEMENT ANNUITY COMMENCEMENT DATE
PROVISIONS The Annuity Commencement Date is shown on Page 3. You may
change the date by notifying Us within 30 days prior to the
Annuity Commencement Date. This date will not be deferred
beyond the Valuation Day immediately following the later of:
a) the Annuitant's 90th birthday; or
b) the end of the tenth Contract Year unless the Contract
Owner elects a later Annuity Commencement Date subject to
laws and regulations then in effect and Our approval.
If this contract is issued to the trustee of a charitable
remainder trust, the Annuity Commencement Date may be deferred
to the Annuitant's 100 birthday.
ELECTION OF ANNUITY OPTION
You may elect, in writing, without deduction of any
contingent deferred sales charge, any one of the Annuity
options described below (except the seventh option - Annuity
Proceeds Settlement Option) or any Annuity option then being
offered by Us. The Annuity option may not be changed on or
after the Annuity Commencement Date.
In the absence of an election by You, the Contract Value
will be used to calculate a fixed dollar Annuity under the
Third Option (Life Annuity with 10 Years Period Certain).
Some of the options may not be available if this contract is
issued to qualify under Section 401, 403, or 408 of the
Internal Revenue Code of 1986 as amended. The third, fifth
and sixth options (Life Annuity with Payments for a Period
Certain, Joint and Last Survivor Life Annuity with Payments
for a Period Certain, and Payment for a Period Certain) will
be available only if the guaranteed payment period is less
than the life expectancy of the Annuitant at the time the
option becomes effective. Such life expectancy will be
computed under the mortality table then in use by Us.
ELECTION OF ANNUITY PAYMENT FREQUENCY
You may elect the Annuity Payment Frequency. Available
Annuity Payment Frequencies include: monthly, quarterly,
semi-annual, and annual. In the event that You do not elect
a payment frequency, Annuity payments will be made monthly.
Annuity payments will be made according to the Annuity
Payment Frequency selected. You may elect to change the
Annuity Payment Frequency of your payments within 30 days
prior to the anniversary of any Annuity Commencement Date.
ANNUITY CALCULATION AND PAYMENT DATES
The Annuity Calculation Date will be no more than five
Valuation Days prior to the Annuity Commencement Date. You
may elect a variable Annuity, a fixed dollar Annuity or a
combination fixed and variable Annuity. The election may
not change on or after the Annuity Commencement Date.
If you elect a variable Annuity, the Contract Value (less
applicable Premium Taxes) is applied pro-rata to Your
selected Sub-Account(s). If You elect a Fixed Annuity,
Contract Values will be applied to the Fixed Account. The
Contract Value is determined on the basis of the
Accumulation Unit Value of each Sub-Account and the value of
the Fixed Account.
VA99-16/17 Page 17 PRINTED IN U.S.A.
R561R0.FRM
SETTLEMENT If You elect variable Annuity payments, Your election must
PROVISIONS specify the Assumed Investment Return upon which Your payments
(CONTINUED) are to be based. The available rates are 3%, 5%, and 6%.
If You elect a fixed Annuity payment, the payment will be the
guaranteed rates, based on 2.5% or the current rates, if
higher.
VARIABLE ANNUITY PAYMENTS - The contract contains tables
indicating the minimum dollar amount of the first monthly
payment under the optional forms of Annuity for each $1,000
of value of a Sub-Account under the contract. The first
monthly payment varies according to the variable Annuity
payment option selected.
The first Annuity payment is payable on the Annuity
Commencement Date. The remaining Annuity payments are
computed and payable as of the same day of the month as the
Annuity Commencement Date based on the elected Annuity
Payment Frequency.
The amount of the first variable Annuity payment is divided
by the Annuity Unit value for Your selected Sub-Account(s)
as of the Annuity Commencement Date. This number of Annuity
Units remains fixed for the selected Sub-Account during the
Annuity payment period. For each subsequent payment the
dollar amount of the Variable Annuity payment is determined
by multiplying the fixed number of Annuity Units by the
Annuity Unit value.
If subsequent payment dates fall on a non-Valuation Day
(weekend or holiday), the payment will be computed and
payable as of the prior Valuation Day. If the day of the
month elected does not occur in a given month (29th, 30th,
or 31st), the payments will be computed and payable as of
the last Valuation Day of the month.
FIXED ANNUITY PAYMENTS - Fixed Annuity payments are
determined at annuitization by multiplying the value of the
Fixed Account (less applicable Premium Taxes) by a rate to
be determined by Us, which is no less than the rate
specified in the fixed Annuity payment tables in the
contract. The fixed Annuity payment will remain level for
the duration of the Annuity.
EXCHANGE "TRANSFER" OF ANNUITY UNITS
After the Annuity Commencement Date, You may exchange
"Transfer" the value of the Annuity Unit for a specified
Sub-Account for the dollar value of Annuity Units in another
Sub-Account. Transfers may be made between the Sub-Accounts
and from the Sub-Account(s) to the Fixed Account. No
transfers of Fixed Account Annuity dollars into a
Sub-Account are allowed. For limitation and modification
guidelines see "Transfers Between Sub-Accounts."
MINIMUM PAYMENT
The first payment must be at least equal to the minimum
payment amount according to Our rules then in effect. If at
any time, payments become less than the minimum payment
amount, We have the right to change the payment frequency to
meet the minimum payment requirements. If any payment
amount is less than the minimum annual payment amount, We
may make an alternative arrangement with You.
VA99-18/19 Page 18 PRINTED IN U.S.A.
R562R0.FRM
SETTLEMENT ANNUITY OPTIONS
PROVISIONS FIRST OPTION - Life Annuity - An Annuity payable during the
(CONTINUED) lifetime of the Annuitant, ceasing with the last payment due
prior to the death of the Annuitant.
SECOND OPTION - Life Annuity With a Cash Refund - An Annuity
payable during the lifetime of the Annuitant. At the death
of the Annuitant, any remaining value will be paid to the
Beneficiary. The remaining value equals the Contract Value,
less Premium Tax used to purchase Annuity units, minus the
sum of all Annuity payments made. This option is only
available for variable Annuity payments using the 5% Assumed
Investment Return and for fixed Annuity payments.
THIRD OPTION - Life Annuity with Payments for a Period
Certain - An Annuity payable for a fixed number of years and
for as long as the Annuitant is living. If at the death of
the Annuitant, payments have been made for less than the
period selected, the remaining payments will be made to the
Beneficiary. The Beneficiary may elect to receive the
present value of the remaining payments in one sum. To
calculate the present value for fixed Annuity payments, We
will use the same interest rate that was used to determine
the amount of the Annuity payments. To calculate the
present value of variable Annuity payments, we will use the
AIR elected by the Contract Owner when this Annuity option
was selected and the Annuity Unit value on the date of
receipt of Due Proof of Death.
FOURTH OPTION - Joint and Last Survivor Life Annuity - An
Annuity payable during the lifetimes of the Annuitant and
the Joint Annuitant and thereafter during the remaining
lifetime of the survivor. At the time of electing this
Annuity option, the Contract Owner may elect reduced
payments over the remaining lifetime of the survivor.
Payments will cease with the last payment prior to the death
of the survivor.
FIFTH OPTION - Joint and Last Survivor Life Annuity with
Payments for a Period Certain - An Annuity during the
lifetimes of the Annuitant and the Joint Annuitant and
thereafter during the remaining lifetime of the survivor.
At the time of electing this Annuity option, the Contract
Owner may elect reduced payments over the remaining lifetime
of the survivor. If at the death of the survivor, payments
have been made for less than the period selected, the
remaining payments will be made to the Beneficiary. The
Beneficiary may elect to receive the present value of the
remaining payments in one sum. To calculate the present
value for fixed Annuity payments, We will use the same
interest rate that was used to determine the amount of the
Annuity payments. To calculate the present value of
variable Annuity payments, we will use the AIR elected by
the Contract Owner when this Annuity option was selected and
the Annuity Unit value on the date of receipt of Due Proof
of Death.
VA99-18/19 Page 19 PRINTED IN U.S.A.
R563R0.FRM
SETTLEMENT SIXTH OPTION - Payment for a Period Certain - An Annuity
PROVISION payable for a fixed number of years with periods of 10 years
(CONTINUED) or greater available at any time and periods of less than 10
years available on or after the second Contract Anniversary.
Payments will be made for the period and frequency selected
unless You surrender this contract after payments have
commenced by submitting a written request to Us (only
available with variable annuity payments). The amount available
to You is the Commuted Value, less any applicable contingent
deferred sales charge.
If at the death of the Annuitant, payments have been made
for less than the period selected, the remaining payments
will be made to the Beneficiary. The Beneficiary may elect
to receive the present value of the remaining payments in
one sum. To calculate the present value for fixed Annuity
payments, We will use the same interest rate that was used
to determine the amount of the Annuity payments. To
calculate the present value of variable Annuity payments, we
will use the AIR elected by the Contract Owner when this
Annuity option was selected and the Annuity Unit value on
the date of receipt of Due Proof of Death.
SEVENTH OPTION - Annuity Proceeds Settlement Option -
Proceeds from the Death Benefit can be left with Us for a
period not to exceed five years from the date of the
Contract Owner's or the Annuitant's death prior to the
Annuity Commencement Date. The proceeds will remain in the
Sub-Account(s) to which they were allocated at the time of
death unless the Beneficiary elects to reallocate them.
Full or partial withdrawals may be made at any time. In the
event of withdrawals, the remaining value will equal the
Contract Value of the proceeds left with Us, minus any
withdrawals.
ANNUITY TABLES DESCRIPTION OF TABLES
The attached tables show the minimum dollar amount of the
first monthly payment for each $1,000 applied to fixed
dollar Annuity payments, and the actual first monthly
payment for each $1,000 applied to variable Annuity
payments. Under the First and Second Options, the amount of
each payment will depend upon the age and sex of the
Annuitant at the time the first payment is due. Under the
Fourth and Fifth Options, the amount of the first payment
will depend upon the sex of both Annuitants and their ages
at the time the first payment is due.
Sex will not be used to determine the amount of the Annuity
payable if this contract is issued to qualify under certain
sections of the Internal Revenue Code. If sex is used to
determine the amount of Annuity payable, the Annuity tables
at the end of this contract will provide rates of payment
for male Annuitants and female Annuitants.
The variable payment Annuity tables for the First through
Fifth Options are based on the 1983a Individual Annuity
Mortality Table projected to the year 2000 using Projection
Scale G and the Assumed Investment Return. The table for
the Sixth Option is based on an Assumed Investment Return.
The fixed payment Annuity tables for the First through Fifth
Options are based on the 1983a Individual Annuity Mortality
Table projected to the year 2000 using Projection Scale G
and an interest rate of 2.5%. The table for the Sixth
Option is based on an interest rate of 2.5%. per annum.
VA99-20/21 Page 20 PRINTED IN U.S.A.
R564R0.FRM
ANNUITY TABLES The Annuity tables for the First through Fifth Options are
(CONTINUED) age dependent. If thefirst Annuity payment is made before
2000, the amount of that payment will be based on the
Annuitant's then-attained age (i.e., age as of last
birthday). For Annuity payments beginning after 2000, the
amount of the first payment will be based on an age a
specified number of years younger than the Annuitant's
then-attained age. The age setback is as follows:
DATE OF FIRST PAYMENT AGE SETBACK
Prior to 2005 1 year
2005 - 2014 2 years
2015 - 2019 3 years
2020 - 2029 4 years
2030 - 2039 5 years
2040 or later 6 years
VA99-20/21 Page 21 PRINTED IN U.S.A.
R565R0.FRM
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON A 2 1/2% ASSUMED INVESTMENT RETURN
Amount of First Monthly Payment For Each $1,000 Applied
Fixed Dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity Payment Frequency, Period
Certain, age, or combination of ages not shown will be quoted upon request.
The Second Option (Life Annuity with a Cash Refund) is not available with the
2 1/2% Assumed Investment Return.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MALE ANNUITANT FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
------------------------------------------------------------------------------------------------
35 $3.05 $3.05 $3.04 $3.03 $2.88 $2.88 $2.88 $2.87
40 3.25 3.24 3.23 3.21 3.04 3.03 3.03 3.02
45 3.49 3.48 3.45 3.42 3.23 3.22 3.22 3.20
50 3.80 3.77 3.73 3.68 3.47 3.46 3.45 3.42
51 3.87 3.84 3.79 3.73 3.53 3.52 3.50 3.47
52 3.94 3.91 3.86 3.79 3.59 3.57 3.56 3.52
53 4.02 3.98 3.93 3.85 3.65 3.64 3.61 3.58
54 4.10 4.06 4.00 3.91 3.72 3.70 3.67 3.63
55 4.19 4.14 4.07 3.97 3.79 3.77 3.74 3.69
56 4.28 4.22 4.15 4.04 3.86 3.84 3.80 3.75
57 4.37 4.31 4.23 4.10 3.94 3.91 3.87 3.81
58 4.48 4.41 4.31 4.17 4.02 3.99 3.94 3.88
59 4.59 4.51 4.40 4.23 4.10 4.07 4.02 3.94
60 4.70 4.61 4.49 4.30 4.20 4.16 4.10 4.01
61 4.83 4.72 4.58 4.37 4.29 4.25 4.18 4.08
62 4.96 4.84 4.67 4.44 4.40 4.35 4.27 4.15
63 5.10 4.96 4.77 4.50 4.51 4.45 4.36 4.22
64 5.25 5.09 4.87 4.57 4.62 4.56 4.46 4.30
65 5.41 5.23 4.97 4.64 4.75 4.67 4.55 4.37
66 5.59 5.37 5.08 4.70 4.88 4.79 4.66 4.45
67 5.77 5.51 5.18 4.76 5.03 4.92 4.76 4.52
68 5.97 5.66 5.29 4.82 5.18 5.05 4.87 4.59
69 6.18 5.82 5.39 4.87 5.34 5.19 4.98 4.66
70 6.40 5.98 5.49 4.92 5.52 5.34 5.09 4.73
75 7.76 6.85 5.97 5.12 6.64 6.21 5.67 5.02
80 9.67 7.73 6.32 5.23 8.29 7.20 6.15 5.19
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------------
35 $2.74 $2.81 $2.87 $2.92 $2.96 $2.99 $3.01 $3.03 $3.04 $3.04 $3.05 3.05
40 2.78 2.87 2.95 3.02 3.08 3.13 3.17 3.20 3.22 3.23 3.24 3.24
45 2.81 2.92 3.02 3.12 3.22 3.30 3.36 3.40 3.44 3.46 3.47 3.48
50 2.83 2.95 3.08 3.22 3.35 3.46 3.56 3.64 3.70 3.74 3.76 3.78
55 2.85 2.98 3.13 3.29 3.46 3.63 3.79 3.91 4.01 4.08 4.13 4.15
60 2.86 3.00 3.16 3.35 3.56 3.79 4.01 4.21 4.38 4.51 4.59 4.64
65 2.87 3.01 3.19 3.39 3.64 3.92 4.22 4.52 4.80 5.02 5.18 5.29
70 2.87 3.02 3.20 3.42 3.69 4.02 4.39 4.81 5.23 5.61 5.91 6.12
75 2.88 3.03 3.21 3.44 3.73 4.09 4.52 5.05 5.64 6.23 6.76 7.15
80 2.88 3.03 3.22 3.46 3.75 4.13 4.62 5.23 5.98 6.82 7.66 8.36
85 2.88 3.03 3.22 3.46 3.77 4.16 4.67 5.35 6.24 7.32 8.52 9.66
90 2.88 3.04 3.23 3.47 3.77 4.17 4.71 5.42 6.41 7.69 9.25 10.91
VA99SXD2.5 Page 22 PRINTED IN U.S.A.
R566R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 2 1/2% ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
--------------------------------------------------------------------------------------------------------------
35 $2.74 $2.81 $2.87 $2.92 $2.96 $2.99 $3.01 $3.02 $3.04 $3.04 $3.05 $3.05
40 2.78 2.87 2.95 3.02 3.08 3.13 3.17 3.20 3.22 3.23 3.23 3.24
45 2.81 2.92 3.02 3.12 3.22 3.29 3.36 3.40 3.43 3.45 3.47 3.47
50 2.83 2.95 3.08 3.22 3.35 3.46 3.56 3.64 3.70 3.73 3.75 3.76
55 2.85 2.98 3.13 3.29 3.46 3.63 3.78 3.91 4.01 4.07 4.11 4.13
60 2.86 3.00 3.16 3.35 3.56 3.78 4.01 4.21 4.37 4.49 4.56 4.59
65 2.87 3.01 3.19 3.39 3.64 3.91 4.21 4.51 4.78 4.98 5.11 5.18
70 2.87 3.02 3.20 3.42 3.69 4.01 4.38 4.79 5.19 5.53 5.76 5.89
75 2.88 3.03 3.21 3.44 3.72 4.08 4.51 5.01 5.56 6.07 6.46 6.68
80 2.88 3.03 3.22 3.45 3.75 4.12 4.59 5.17 5.85 6.54 7.10 7.46
85 2.88 3.03 3.22 3.46 3.76 4.14 4.63 5.27 6.04 6.88 7.61 8.09
90 2.88 3.03 3.22 3.46 3.76 4.15 4.66 5.32 6.14 7.07 7.92 8.51
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
-----------------------------------------------------------------------------------------------------------------------------------
NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF
YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY
PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS
-----------------------------------------------------------------------------------------------------------------------------------
5 $17.70 10 $9.39 15 $6.64 20 $5.27 25 $4.46 30 $3.93
6 14.93 11 8.64 16 6.30 21 5.08 26 4.34
7 12.95 12 8.02 17 6.00 22 4.90 27 4.22
8 11.47 13 7.49 18 5.73 23 4.74 28 4.12
9 10.32 14 7.03 19 5.49 24 4.60 29 4.02
VA99SXD2.5 Page 23 PRINTED IN U.S.A.
R567R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 3% ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
The second and subsequent annuity payments under a variable annuity are based
on the investment experience of a Separate Account and are not guaranteed
as to fixed dollar amount. Payments for any available Annuity Payment
Frequency, Period Certain, age, or combination of ages not shown will
be quoted upon request. The Second Option (Life Annuity with a Cash
Refund) is not available with the 3% Assumed Investment Return.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MALE ANNUITANT FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
---------------------------------------------------------------------------------------------------------
35 $3.35 $3.35 $3.34 $3.33 $3.18 $3.18 $3.18 $3.17
40 3.54 3.53 3.52 3.50 3.33 3.33 3.32 3.31
45 3.78 3.76 3.74 3.71 3.52 3.51 3.50 3.49
50 4.08 4.05 4.01 3.95 3.76 3.75 3.73 3.70
51 4.15 4.12 4.07 4.01 3.81 3.80 3.78 3.75
52 4.23 4.19 4.14 4.06 3.87 3.86 3.84 3.80
53 4.30 4.26 4.20 4.12 3.93 3.92 3.89 3.85
54 4.38 4.34 4.27 4.18 4.00 3.98 3.95 3.91
55 4.47 4.42 4.35 4.24 4.07 4.04 4.01 3.96
56 4.56 4.50 4.42 4.30 4.14 4.11 4.08 4.02
57 4.66 4.59 4.50 4.37 4.22 4.19 4.15 4.08
58 4.76 4.68 4.58 4.43 4.30 4.26 4.22 4.15
59 4.87 4.78 4.67 4.50 4.38 4.35 4.29 4.21
60 4.98 4.89 4.76 4.56 4.47 4.43 4.37 4.28
61 5.11 5.00 4.85 4.63 4.57 4.52 4.45 4.35
62 5.24 5.11 4.94 4.69 4.67 4.62 4.54 4.42
63 5.38 5.23 5.04 4.76 4.78 4.72 4.63 4.49
64 5.54 5.36 5.13 4.83 4.90 4.83 4.72 4.56
65 5.70 5.50 5.23 4.89 5.03 4.94 4.82 4.63
66 5.87 5.63 5.34 4.95 5.16 5.06 4.92 4.70
67 6.06 5.78 5.44 5.01 5.30 5.19 5.02 4.78
68 6.25 5.93 5.54 5.07 5.45 5.32 5.13 4.85
69 6.46 6.08 5.64 5.12 5.62 5.46 5.24 4.92
70 6.69 6.24 5.74 5.17 5.80 5.61 5.35 4.98
75 8.05 7.10 6.21 5.36 6.92 6.46 5.91 5.26
80 9.97 7.97 6.56 5.47 8.57 7.45 6.39 5.42
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
--------------------------------------------------------------------------------------------------------------
35 $3.04 $3.11 $3.16 $3.21 $3.25 $3.28 $3.30 $3.32 $3.33 $3.34 $3.34 $3.35
40 3.08 3.16 3.24 3.31 3.37 3.42 3.46 3.49 3.51 3.52 3.53 3.53
45 3.11 3.21 3.31 3.41 3.50 3.58 3.64 3.69 3.72 3.74 3.76 3.77
50 3.13 3.25 3.37 3.50 3.62 3.74 3.84 3.92 3.98 4.02 4.05 4.06
55 3.15 3.27 3.41 3.57 3.74 3.90 4.06 4.19 4.29 4.36 4.41 4.43
60 3.16 3.29 3.45 3.63 3.84 4.06 4.28 4.48 4.65 4.78 4.87 4.92
65 3.17 3.31 3.47 3.67 3.91 4.19 4.48 4.78 5.06 5.29 5.46 5.56
70 3.17 3.32 3.49 3.71 3.97 4.29 4.66 5.07 5.49 5.88 6.18 6.39
75 3.18 3.32 3.50 3.73 4.01 4.36 4.79 5.31 5.90 6.49 7.02 7.42
80 3.18 3.33 3.51 3.74 4.03 4.40 4.88 5.49 6.24 7.08 7.92 8.63
85 3.18 3.33 3.51 3.75 4.05 4.43 4.94 5.62 6.50 7.58 8.78 9.92
90 3.18 3.33 3.52 3.75 4.05 4.45 4.98 5.70 6.68 7.96 9.52 11.18
VA99SXD3 Page 24 PRINTED IN U.S.A.
R568R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 3% ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------------------------------------------------------------------------------------------------------------
35 $3.04 $3.11 $3.16 $3.21 $3.25 $3.28 $3.30 $3.32 $3.33 $3.34 $3.34 $3.34
40 3.08 3.16 3.24 3.31 3.37 3.42 3.46 3.49 3.51 3.52 3.53 3.53
45 3.11 3.21 3.31 3.41 3.50 3.58 3.64 3.69 3.72 3.74 3.75 3.76
50 3.13 3.25 3.37 3.50 3.62 3.74 3.84 3.92 3.97 4.01 4.03 4.05
55 3.15 3.27 3.41 3.57 3.74 3.90 4.05 4.18 4.28 4.35 4.39 4.40
60 3.16 3.29 3.45 3.63 3.83 4.05 4.27 4.47 4.64 4.76 4.83 4.86
65 3.17 3.31 3.47 3.67 3.91 4.18 4.48 4.77 5.04 5.24 5.38 5.45
70 3.17 3.31 3.49 3.70 3.97 4.28 4.65 5.05 5.45 5.79 6.02 6.16
75 3.18 3.32 3.50 3.72 4.00 4.35 4.77 5.27 5.82 6.32 6.71 6.94
80 3.18 3.32 3.51 3.73 4.02 4.39 4.86 5.43 6.10 6.79 7.35 7.70
85 3.18 3.33 3.51 3.74 4.04 4.41 4.90 5.53 6.30 7.12 7.85 8.33
90 3.18 3.33 3.51 3.74 4.04 4.42 4.93 5.58 6.40 7.32 8.16 8.74
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
-----------------------------------------------------------------------------------------------------------------------------------
NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF
YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY
PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS
-----------------------------------------------------------------------------------------------------------------------------------
5 $17.91 10 $9.61 15 $6.87 20 $5.51 25 $4.71 30 $4.18
6 15.14 11 8.86 16 6.53 21 5.32 26 4.59
7 13.16 12 8.24 17 6.23 22 5.15 27 4.47
8 11.68 13 7.71 18 5.96 23 4.99 28 4.37
9 10.53 14 7.26 19 5.73 24 4.84 29 4.27
VA99SXD3 Page 25 PRINTED IN U.S.A.
R569R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 5% ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Second and subsequent Annuity payments under a variable annuity are based on
the investment experience of a Separate Account and are not guaranteed as to
fixed dollar amount. Payments for any available Annuity Payment Frequency,
Period Certain, age, or combination of ages not shown will be quoted upon
request.
FIRST, SECOND, AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
----------------------------------------------------------------------------------------------------------------
MALE ANNUITANT FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 CASH REFUND NONE 120 180 240 CASH REFUND
-----------------------------------------------------------------------------------------------------------------------
35 $4.63 $4.62 $4.61 $4.60 $4.60 $4.48 $4.48 $4.47 $4.47 $4.46
40 4.80 4.78 4.77 4.74 4.74 4.60 4.60 4.59 4.58 4.58
45 5.02 4.99 4.96 4.91 4.92 4.77 4.75 4.74 4.72 4.72
50 5.30 5.25 5.20 5.13 5.16 4.98 4.96 4.94 4.90 4.91
51 5.36 5.31 5.26 5.18 5.21 5.03 5.01 4.98 4.94 4.95
52 5.43 5.38 5.31 5.23 5.27 5.08 5.06 5.03 4.99 5.00
53 5.51 5.45 5.37 5.28 5.33 5.14 5.11 5.08 5.03 5.05
54 5.58 5.52 5.44 5.33 5.39 5.20 5.17 5.13 5.08 5.10
55 5.67 5.59 5.50 5.38 5.46 5.26 5.23 5.19 5.13 5.16
56 5.75 5.67 5.57 5.44 5.53 5.33 5.29 5.25 5.18 5.21
57 5.85 5.75 5.64 5.49 5.60 5.40 5.36 5.31 5.24 5.27
58 5.95 5.84 5.72 5.55 5.68 5.48 5.43 5.37 5.29 5.34
59 6.05 5.94 5.80 5.61 5.76 5.56 5.51 5.44 5.35 5.41
60 6.17 6.04 5.88 5.67 5.85 5.65 5.59 5.51 5.41 5.48
61 6.29 6.14 5.96 5.73 5.94 5.74 5.67 5.59 5.47 5.55
62 6.42 6.25 6.05 5.78 6.04 5.84 5.76 5.67 5.53 5.63
63 6.56 6.37 6.14 5.84 6.14 5.95 5.86 5.75 5.59 5.72
64 6.71 6.49 6.23 5.90 6.24 6.06 5.96 5.84 5.66 5.81
65 6.87 6.62 6.32 5.96 6.36 6.18 6.07 5.93 5.72 5.91
66 7.05 6.75 6.41 6.01 6.47 6.31 6.18 6.02 5.79 6.01
67 7.23 6.89 6.51 6.06 6.60 6.46 6.30 6.11 5.85 6.12
68 7.43 7.03 6.60 6.11 6.73 6.61 6.43 6.21 5.92 6.23
69 7.65 7.18 6.69 6.16 6.87 6.77 6.57 6.31 5.98 6.35
70 7.87 7.33 6.79 6.21 7.01 6.95 6.71 6.42 6.04 6.48
75 9.25 8.14 7.21 6.38 7.85 8.08 7.53 6.94 6.29 7.25
80 11.20 8.97 7.53 6.47 8.92 9.75 8.47 7.37 6.43 8.27
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
--------------------------------------------------------------------------------------------------------------------
35 $4.35 $4.40 $4.44 $4.48 $4.52 $4.55 $4.57 $4.59 $4.60 $4.61 $4.62 $4.63
40 4.38 4.44 4.50 4.56 4.61 4.66 4.70 4.73 4.75 4.77 4.78 4.79
45 4.41 4.48 4.56 4.64 4.72 4.79 4.85 4.90 4.94 4.97 4.99 5.00
50 4.42 4.51 4.61 4.71 4.82 4.93 5.02 5.10 5.17 5.21 5.25 5.27
55 4.44 4.54 4.65 4.78 4.92 5.07 5.21 5.34 5.45 5.53 5.58 5.62
60 4.45 4.55 4.68 4.83 5.01 5.21 5.41 5.61 5.78 5.92 6.02 6.08
65 4.46 4.57 4.71 4.88 5.09 5.33 5.60 5.89 6.17 6.40 6.58 6.70
70 4.47 4.58 4.73 4.91 5.14 5.43 5.78 6.17 6.58 6.97 7.29 7.52
75 4.47 4.59 4.74 4.94 5.19 5.51 5.91 6.41 6.98 7.57 8.11 8.53
80 4.48 4.59 4.75 4.95 5.21 5.56 6.01 6.60 7.33 8.16 9.00 9.72
85 4.48 4.60 4.76 4.96 5.23 5.60 6.08 6.73 7.60 8.66 9.86 11.01
90 4.48 4.60 4.76 4.97 5.25 5.62 6.12 6.82 7.79 9.05 10.61 12.27
VA99SXD5 Page 26 PRINTED IN U.S.A.
R570R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 5% ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------------
35 $4.35 $4.40 $4.44 $4.48 $4.52 $4.55 $4.57 $4.59 $4.60 $4.61 $4.62 $4.62
40 4.38 4.44 4.50 4.56 4.61 4.66 4.70 4.73 4.75 4.77 4.78 4.78
45 4.41 4.48 4.56 4.64 4.72 4.79 4.85 4.90 4.93 4.96 4.98 4.99
50 4.42 4.51 4.61 4.71 4.82 4.93 5.02 5.10 5.16 5.20 5.23 5.24
55 4.44 4.53 4.65 4.78 4.92 5.07 5.21 5.33 5.44 5.51 5.55 5.58
60 4.45 4.55 4.68 4.83 5.01 5.20 5.41 5.60 5.76 5.89 5.97 6.01
65 4.46 4.57 4.71 4.88 5.08 5.33 5.60 5.88 6.14 6.35 6.49 6.57
70 4.47 4.58 4.73 4.91 5.14 5.42 5.76 6.14 6.52 6.86 7.10 7.24
75 4.47 4.59 4.74 4.93 5.18 5.49 5.89 6.36 6.88 7.37 7.75 7.98
80 4.47 4.59 4.75 4.95 5.20 5.54 5.97 6.52 7.16 7.82 8.36 8.70
85 4.48 4.60 4.75 4.95 5.22 5.57 6.03 6.62 7.35 8.14 8.83 9.29
90 4.48 4.60 4.75 4.96 5.23 5.58 6.05 6.68 7.46 8.34 9.13 9.68
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
-----------------------------------------------------------------------------------------------------------------------------------
NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF
YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY
PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS
-----------------------------------------------------------------------------------------------------------------------------------
5 $18.74 10 $10.51 15 $7.82 20 $6.51 25 $5.76 30 $5.28
6 15.99 11 9.77 16 7.49 21 6.33 26 5.65
7 14.02 12 9.16 17 7.20 22 6.17 27 5.54
8 12.56 13 8.64 18 6.94 23 6.02 28 5.45
9 11.42 14 8.20 19 6.71 24 5.88 29 5.36
VA99SXD5 Page 27 PRINTED IN U.S.A.
R571R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 6% ASSUMED INVESTMENT RETURN
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Second and subsequent Annuity payments under a variable annuity are based on
the investment experience of a Separate Account and are not guaranteed as to
fixed dollar amount. Payments for any available Annuity Payment Frequency,
Period Certain, age, or combination of ages not shown will be quoted upon
request. The Second Option (Life Annuity with a Cash Refund) is not
available with the 6% Assumed Investment Return.
FIRST AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
MALE ANNUITANT FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
------------------------------------------------------------------------------------------------
35 $5.31 $5.30 $5.29 $5.27 $5.17 $5.17 $5.16 $5.15
40 5.46 5.45 5.43 5.40 5.28 5.27 5.26 5.25
45 5.67 5.64 5.60 5.56 5.43 5.42 5.40 5.38
50 5.94 5.89 5.83 5.75 5.63 5.60 5.58 5.54
51 6.00 5.94 5.88 5.80 5.67 5.65 5.62 5.58
52 6.07 6.00 5.93 5.84 5.72 5.70 5.66 5.62
53 6.14 6.07 5.99 5.89 5.78 5.75 5.71 5.66
54 6.22 6.14 6.05 5.94 5.84 5.80 5.76 5.70
55 6.30 6.21 6.11 5.99 5.90 5.86 5.81 5.75
56 6.38 6.28 6.18 6.04 5.96 5.92 5.87 5.80
57 6.47 6.36 6.24 6.09 6.03 5.98 5.92 5.85
58 6.57 6.45 6.32 6.14 6.10 6.05 5.98 5.90
59 6.67 6.54 6.39 6.19 6.18 6.12 6.05 5.95
60 6.78 6.64 6.47 6.25 6.27 6.20 6.12 6.01
61 6.90 6.74 6.55 6.30 6.36 6.28 6.19 6.06
62 7.03 6.84 6.63 6.36 6.46 6.37 6.26 6.12
63 7.17 6.96 6.71 6.41 6.56 6.46 6.34 6.18
64 7.32 7.07 6.80 6.47 6.67 6.56 6.42 6.24
65 7.48 7.20 6.88 6.52 6.79 6.66 6.51 6.30
66 7.66 7.33 6.97 6.57 6.92 6.77 6.59 6.36
67 7.84 7.46 7.06 6.62 7.06 6.89 6.69 6.42
68 8.04 7.60 7.15 6.67 7.21 7.01 6.78 6.48
69 8.25 7.74 7.24 6.71 7.37 7.14 6.88 6.54
70 8.48 7.89 7.33 6.75 7.54 7.28 6.97 6.59
75 9.86 8.68 7.73 6.91 8.67 8.08 7.47 6.83
80 11.81 9.47 8.04 7.00 10.35 8.99 7.89 6.96
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
--------------------------------------------------------------------------------------------------------
35 $5.05 $5.09 $5.13 $5.16 $5.19 $5.22 $5.25 $5.27 $5.28 $5.29 $5.30 $5.30
40 5.08 5.13 5.18 5.23 5.28 5.32 5.36 5.39 5.41 5.43 5.45 5.45
45 5.10 5.16 5.23 5.30 5.37 5.43 5.49 5.54 5.58 5.61 5.64 5.65
50 5.11 5.19 5.27 5.36 5.46 5.56 5.65 5.73 5.80 5.85 5.88 5.91
55 5.13 5.21 5.31 5.42 5.55 5.69 5.82 5.95 6.06 6.14 6.20 6.24
60 5.14 5.23 5.34 5.48 5.64 5.82 6.01 6.20 6.37 6.52 6.62 6.69
65 5.15 5.24 5.36 5.52 5.71 5.94 6.20 6.47 6.75 6.99 7.17 7.30
70 5.16 5.26 5.38 5.55 5.77 6.04 6.36 6.74 7.15 7.54 7.86 8.10
75 5.16 5.26 5.40 5.58 5.81 6.11 6.50 6.98 7.54 8.13 8.67 9.10
80 5.17 5.27 5.41 5.60 5.84 6.17 6.60 7.17 7.89 8.71 9.55 10.28
85 5.17 5.27 5.42 5.61 5.86 6.21 6.68 7.31 8.16 9.22 10.41 11.56
90 5.17 5.28 5.42 5.61 5.88 6.23 6.72 7.40 8.36 9.62 11.16 12.81
VA99SXD6 Page 28 PRINTED IN U.S.A.
R572R0.FRM
ANNUITY TABLES FOR
VARIABLE PAYMENTS,
BASED ON A 6% ASSUMED INVESTMENT RETURN
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-----------------------------------------------------------------------------------------------------------
35 $5.05 $5.09 $5.13 $5.16 $5.19 $5.22 $5.25 $5.26 $5.28 $5.29 $5.30 $5.30
40 5.08 5.13 5.18 5.23 5.28 5.32 5.36 5.39 5.41 5.43 5.44 5.44
45 5.10 5.16 5.23 5.30 5.37 5.43 5.49 5.54 5.58 5.61 5.62 5.63
50 5.11 5.19 5.27 5.36 5.46 5.56 5.65 5.72 5.79 5.83 5.86 5.88
55 5.13 5.21 5.31 5.42 5.55 5.69 5.82 5.94 6.04 6.12 6.17 6.19
60 5.14 5.23 5.34 5.47 5.63 5.82 6.01 6.19 6.36 6.48 6.56 6.61
65 5.15 5.24 5.36 5.52 5.71 5.93 6.19 6.46 6.71 6.92 7.07 7.14
70 5.16 5.25 5.38 5.55 5.76 6.03 6.35 6.71 7.08 7.42 7.66 7.79
75 5.16 5.26 5.40 5.57 5.80 6.10 6.47 6.93 7.43 7.91 8.29 8.51
80 5.17 5.27 5.41 5.59 5.83 6.15 6.56 7.09 7.71 8.35 8.88 9.21
85 5.17 5.27 5.41 5.60 5.84 6.17 6.62 7.19 7.90 8.67 9.34 9.78
90 5.17 5.27 5.41 5.60 5.85 6.19 6.64 7.25 8.01 8.86 9.63 10.16
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
-----------------------------------------------------------------------------------------------------------------------------------
NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF NO. OF AMOUNT OF
YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY YEARS MONTHLY
PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS
-----------------------------------------------------------------------------------------------------------------------------------
5 $19.17 10 $10.97 15 $8.31 20 $7.04 25 $6.32 30 $5.87
6 16.42 11 10.24 16 7.99 21 6.86 26 6.21
7 14.46 12 9.63 17 7.71 22 6.70 27 6.11
8 13.00 13 9.12 18 7.46 23 6.56 28 6.02
9 11.87 14 8.69 19 7.24 24 6.43 29 5.94
VA99SXD6 Page 29 PRINTED IN U.S.A.
R573R0.FRM
INDIVIDUAL FLEXIBLE PREMIUM
VARIABLE ANNUITY CONTRACT
HARTFORD LIFE INSURANCE COMPANY
X.X. Xxx 0000
Xxxxxxxx, Xxxxxxxxxxx 00000-0000
ADMINISTRATIVE OFFICE:
Attn: Individual Annuity Services
X.X. Xxx 0000
Xxxxxxxx, XX 00000-0000
[GRAPHIC OMITTED]
HL-VA99 Printed in U.S.A.
R379R0.FRM
