Contract
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2 AS207A-ADV TABLE OF CONTENTS SECTION 1: DEFINITIONS 4 1.1 ACCUMULATION UNIT 4 1.2 ACCUMULATION UNIT VALUE 4 1.3 ACCUMULATION VALUE 4 1.4 ADMINISTRATION FEE 4 1.5 ADVISORY FEE 4 1.6 ANNUITANT 4 1.7 BENEFICIARY 4 1.8 BUSINESS DAY 4 1.9 CONTINGENT ANNUITNT 4 1.10 CONTINGENT BENEFICARY 4 1.11 CONTRACT 5 1.12 CONTRACT ANNIVERSAY 5 1.13 CONTRACT VALUE 5 1.14 CONTRACT YEAR 5 1.15 DEATH BENEFIT 5 1.16 ENDORSEMENT OR RIDER 5 1.17 FUND 5 1.18 GOOD ORDER 5 1.19 GROSS PARTIAL WITHDRAWAL AMOUNT(S) 5 1.20 INITIAL PURCHASE PAYMENT 5 1.21 INVESTMENT OPTION(S) 5 1.22 ISSUE AGE 6 1.23 ISSUE DATE 6 1.24 MATURITY DATE 6 1.25 MINIMUM GROSS PARTIAL WITHDRAWAL AMOUNT 6 1.26 CONTRACT OWNER 6 1.27 PARTIAL WITHDRWAL AMOUNTS 6 1.28 PAYEE 6 1.29 PURCHASE PAYMENT 6 1.30 PREMIUM TAX 6 1.31 PRIMARY BENEFICIARY 6 1.32 PROOF OF DEATH 6 1.33 SUBACCOUNT 7 1.34 SURRENDER VALUE 7 1.35 VALUATION PERIOD 7 1.36 WRITTEN NOTICE AND NOTICE 7 SECTION 2: GENERAL PROVISIONS 7 2.1 CHANGES TO THE CONTRACT 7 2.2 BENEFICIARY 8 2.3 CHANGE OF BENEFICIARY 8 2.4 INCONTESTABILITY 8 2.5 MISSTATEMENT OF AGE OR SEX 8 2.6 ANNUAL REPORTS 8 2.7 NON-PARTICIPATING 8 2.8 CLAIMS TO CREDITORS 9 2.9 ASSIGNMENT 9 2.10 CONFORMITY WITH STATE LAW 9 2.11 EFFECT OF THE INTERNAL REVENUE CODE 9
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3 AS207A-ADV SECTION 3: PURCHASE PAYMENT AND ALLOCATION 9 3.1 PURCHASE PAYMENT 9 3.2 ALLOCATIONS 9 3.3 TRANSFERS PRIOR TO MATURITY DATE 9 3.4 SUSPENSION OF PAYMENTS OR TRANSFERS 10 SECTION 4: SEPARATE ACCOUNT 10 4.1 SUBACCOUNTS 10 4.2 CHANGE IN INVESTMENT POLICY 10 4.3 CHANGE OF FUND 11 SECTION 5: CONTRACT VALUE 11 5.1 SEPARATE ACCOUNT VALUE 11 5.2 INVESTMENT OPTION(S) VALUE 11 5.3 ACCUMULATION UNITS 11 5.4 ACCUMULATION UNIT VALUE 11 5.5 NET INVESTMENT FACTOR 12 5.6 CHARGES AGAINST THE SEPARATE ACCOUNT 12 SECTION 6: SURRENDERS 12 6.1 SURRENDER 12 6.2 SURRENDER VALUE 12 SECTION 7: PARTIAL WITHDRAWALS 13 7.1 PARTIAL WITHDRAWALS 13 7.2 PARTIAL WITHDRAWAL AMOUNT 13 7.3 ADVISORY FEE WITHDRWAL 13 7.4 OTHER WITHDRAWAL OPTIONS 13 7.5 SYSTEMATIC WITHDRAWAL OPTION 13 SECTION 8: DEATH BENEFIT 14 8.1 DEATH OF THE CONTRACT OWNER BEFORE MATURITY DATE 14 8.2 DEATH OF ANNUITANT BEFORE MATURITY DATE 14 8.3 MULTIPLE BENEFICIARIES 14 8.4 SPOUSAL CONTINUANCE 14 8.5 PAYMENT OF DEATH PROCEEDS 14 8.6 NOTIFICATION OF DEATH 15 8.7 DEATH BENEFIT CALCULATION 15 SECTION 9: PAYOUT OPTIONS 15 SECTION 10: PAYOUT OPTION TABLES 16 SECTION 11: TERMINATION PROVISIONS 22
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12 AS207A-ADV deduction of any Contract transfer fees or Rider fees will decrease the number of Accumulation Units. The change in the number of Accumulation Units is equal to the net amount allocated to or deducted from the Subaccount, divided by that Subaccount’s Accumulation Unit Value. 5.4 ACCUMULATION UNIT VALUE The initial Accumulation Unit Value of each Separate Account Investment Option is set at [$10.00]. The Accumulation Unit Value for each subsequent Valuation Period is then determined at the end of the Valuation Period and will be equal to the Net Investment Factor for that period multiplied by the Accumulation Unit Value for the immediately preceding Valuation Period. The Accumulation Unit Value applies to each Valuation Period. The Accumulation Unit Value may increase or decrease from one Valuation Period to the next. 5.5 NET INVESTMENT FACTOR The net investment factor is an index used to measure the investment performance of a Separate Account Investment Option from one Valuation Period to the next. The net investment factor can be greater or less than one; therefore, the Accumulation Unit Value may increase or decrease. The net investment factor for each Separate Account Investment Option for a Valuation Period is determined by taking a) divided by b) minus c) minus d) where: a) Is the total of: 1) the net asset value per share at the end of the current Valuation Period; plus 2) any dividend or capital gains per share reinvested during the current Valuation Period; plus 3) total accrued, but not yet reinvested, capital gains per share as of the current Valuation Period; b) Is the total of: 1) the net asset value per share at the end of the preceding Valuation Period; plus 2) total accrued, but not yet reinvested, capital gains per share as of the preceding Valuation Period; c) Is the Mortality and Expense Fee for each day in the current Valuation Period; and d) Is the Administration Fee for each day in the current Valuation Period. 5.6 CHARGES AGAINST THE SEPARATE ACCOUNT In determining the Accumulation Unit Value, We deduct the Mortality and Expense Fee and Administration Fee, as shown on the Specifications Page, from the assets of each Investment Option in the Separate Account. The earnings of the Separate Account are taxed as part of Our operations. At the present time, We do not expect to incur taxes on earnings of any Separate Account Investment Option to the extent that earnings are credited under this Contract. If We incur additional taxes due to the operation of the Separate Account, We may make charges for such taxes against the Separate Account Investment Option(s). SECTION 6: SURRENDERS 6.1 SURRENDER You may surrender this Contract for its Surrender Value at any time before the Maturity Date. The Surrender Value will be processed as of the Valuation Period that We receive Written Notice prior to the that We receive Written Notice in Good order prior to the close of that Valuation Period’s Business Day. If Written Notice is received after the close of that Valuation Period’s Business Day, the Transfer will be processed as of the close of the next Valuation Period’s Business Day.
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17 AS207A-ADV at the end of twenty (20) years. Payments will begin upon election of a payment plan and will continue until the Accumulation Value, at the rate specified in [Table 1] compounded per annum, is exhausted. Option 4 - Joint and Survivor Income We will pay monthly payments during the lifetime of the Annuitant and the named joint life. We determine the payment amount by the sex and age of each person according to [Table 3]. The Annuitant must be at least [fifty (50)] years old, and the joint life must be at least [forty-five (45)] years old, at the time of the first monthly payment. Upon request, We will furnish values for age or sex combinations not shown in Table 3. Income under this option is based on the age of each person. We require proof of age. We reserve the right to require proof of survival under these options. SECTION 10: PAYOUT OPTION TABLES Upon request, We will furnish rates for ages and guaranteed periods applicable to the Payout Option for the calendar year You elect to begin payments. [TABLE 1] INCOME FOR SPECIFIED PERIOD FACTORS Payments shown are for each $1,000.00 of net proceeds applied. Interest is [ 1.00] % and is subject to change as described in the Pay-Out Provisions Section. Specified Period not to exceed twenty (20) years. Payment will begin upon valid election. ANNUAL YEARS ANNUAL SEMI-ANNUAL QUARTERLY MONTHLY 1 N/A N/A N/A N/A 2 N/A N/A N/A N/A 3 N/A N/A N/A N/A 4 N/A N/A N/A N/A 5 203.99 102.25 51.19 17.07 6 170.83 85.63 42.86 14.30 7 147.15 73.76 36.92 12.31 8 129.39 64.85 32.46 10.83 9 115.58 57.93 29.00 9.67 10 104.53 52.39 26.23 8.75 11 95.49 47.86 23.96 7.99 12 87.96 44.09 22.07 7.36 13 81.59 40.90 20.47 6.83 14 76.13 38.16 19.10 6.37 15 71.40 35.79 17.91 5.97 16 67.27 33.71 16.88 5.63 17 63.62 31.89 15.96 5.32 18 60.37 30.26 15.15 5.05 19 57.47 28.80 14.42 4.81 20 54.86 27.50 13.76 4.59
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18 AS207A-ADV [TABLE 2] MONTHLY INCOME FOR LIFE AND LIFE WITH GUARANTEED PERIODS Equal monthly payments for life only, for guaranteed periods of ten (10) or twenty (20) years as elected, and for life thereafter as shown in the table below. Amount of each monthly payment shown is per $1,000.00 of net proceeds. Amounts are based on the [2012 Individual Annuity Reserve Table] and [1.00] % interest. Payment will begin upon valid election. Unisex Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2030 55 2.76 2.75 2.71 65 3.62 3.57 3.42 75 5.26 5.05 4.23 85 9.16 7.28 4.57 Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2040 55 2.71 2.70 2.67 65 3.54 3.50 3.37 75 5.12 4.94 4.20 85 8.89 7.20 4.57 Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2050 55 2.67 2.66 2.64 65 3.47 3.44 3.32 75 4.99 4.84 4.17 85 8.64 7.11 4.57
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19 AS207A-ADV [TABLE 2 (continued)] MONTHLY INCOME FOR LIFE AND LIFE WITH GUARANTEED PERIODS Equal monthly payments for life only, for guaranteed periods of ten (10) or twenty (20) years as elected, and for life thereafter as shown in the table below. Amount of each monthly payment shown is per $1,000.00 of net proceeds. Amounts are based on the [2012 Individual Annuity Reserve Table] and [1.00] % interest. Payment will begin upon valid election. Female Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2030 55 2.76 2.75 2.71 65 3.62 3.57 3.42 75 5.26 5.05 4.23 85 9.16 7.28 4.57 Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2040 55 2.71 2.70 2.67 65 3.54 3.50 3.37 75 5.12 4.94 4.20 85 8.89 7.20 4.57 Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2050 55 2.67 2.66 2.64 65 3.47 3.44 3.32 75 4.99 4.84 4.17 85 8.64 7.11 4.57
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20 AS207A-ADV [TABLE 2 (continued)] MONTHLY INCOME FOR LIFE AND LIFE WITH GUARANTEED PERIODS Equal monthly payments for life only, for guaranteed periods of ten (10) or twenty (20) years as elected, and for life thereafter as shown in the table below. Amount of each monthly payment shown is per $1,000.00 of net proceeds. Amounts are based on the [2012 Individual Annuity Reserve Table] and [1.00] % interest. Payment will begin upon valid election. Male Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2030 55 2.87 2.85 2.80 65 3.80 3.75 3.54 75 5.67 5.36 4.33 85 10.18 7.64 4.58 Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2040 55 2.80 2.79 2.75 65 3.70 3.65 3.48 75 5.47 5.21 4.30 85 9.81 7.55 4.58 Year Age Life Only Life with 10 Year Certain Life with 20 Year Certain 2050 55 2.75 2.74 2.70 65 3.60 3.57 3.42 75 5.30 5.08 4.27 85 9.47 7.45 4.58
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AS207A-ADV 21 [TABLE 3] JOINT AND SURVIVOR INCOME FACTORS Payments shown are monthly and are for each $1,000.00 of net proceeds applied. Based on the [2012 Individual Annuity Reserve Table], and [1.00] % interest. Payment will begin upon valid election. Male Age 2030 45 50 55 60 65 70 45 2.06 2.13 2.17 2.20 2.22 2.23 50 2.14 2.24 2.32 2.38 2.41 2.44 Female Age 55 2.20 2.34 2.47 2.57 2.64 2.69 60 2.24 2.42 2.60 2.76 2.89 2.98 65 2.27 2.47 2.69 2.92 3.14 3.32 70 2.28 2.50 2.76 3.05 3.36 3.66 2040 45 50 55 60 65 70 45 2.05 2.11 2.15 2.18 2.19 2.20 50 2.12 2.22 2.30 2.35 2.38 2.41 Female Age 55 2.18 2.32 2.44 2.54 2.61 2.65 60 2.21 2.38 2.56 2.72 2.85 2.94 65 2.24 2.43 2.65 2.88 3.09 3.26 70 2.25 2.46 2.71 2.99 3.30 3.59 Male Age 2050 45 50 55 60 65 70 45 2.03 2.09 2.13 2.15 2.17 2.18 50 2.10 2.20 2.28 2.33 2.36 2.38 Female Age 55 2.15 2.29 2.41 2.51 2.57 2.61 60 2.19 2.36 2.53 2.69 2.81 2.89 65 2.21 2.40 2.61 2.84 3.04 3.21 70 2.22 2.43 2.67 2.94 3.24 3.53