Annuitant xXXXX XXX o35 - oMALE AGE - SEX
Contract Number oSPECIMEN oMAR. 1, 2000 ISSUE DATE
[GRAPHIC OMITTED-GUARDIAN]
Read this contract carefully. This contract is a legal contract between the
owner and The Guardian Insurance & Annuity Company, Inc. (GIAC).
GIAC will pay the benefits provided by this contract in accordance with its
provisions. The entire contract consists of the Basic Contract and any attached
endorsements, additional benefit riders, and application(s). This contract is
issued by GIAC at its Customer Service Office on the Issue Date. GIAC's home
office is 0000 Xxxxxx Xxxxxx, Xxxxxxxxxx, Xxxxxxxx 00000. However, GIAC receives
all communications at its Customer Service Office.
[ILLEGIBLE] [ILLEGIBLE]
Secretary President
Checked by
Under this contract, flexible premium payments may be made before the Annuity
Commencement Date. On the Annuity Commencement Date, GIAC will begin to make
monthly annuity payments. Benefits depend, among other things, on the number and
value of Accumulation Units and the annuity payout option elected. Death benefit
proceeds are payable on or before the Annuity Commencement Date.
ALL VALUES PROVIDED BY THIS CONTRACT WHICH ARE BASED ON THE INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE, MAY INCREASE OR DECREASE DAILY,
AND ARE NOT GUARANTEED. SEE "ACCUMULATION VALUE" ON PAGE 11 AND "PAYMENT OF
CONTRACT PROCEEDS" ON PAGE 13 FOR A DESCRIPTION OF THE VARIABLE VALUES AND
PAYMENTS PROVIDED UNDER THIS CONTRACT.
RIGHT TO CANCEL:
The owner has the right to examine this contract and return it for cancellation
to GIAC's Customer Service Office or to the agent from whom it was purchased
within 10 days after receiving it. The contract and a cancellation notice must
be delivered or mailed to cancel this contract. Any notice given by mail is
effective upon being postmarked, properly addressed, and postage prepaid. If
this contract is returned during this period, GIAC will pay to the owner the
amount described in "RIGHT TO CANCEL - CONTINUED" on Page 3. The contract will
be void from the beginning.
Individual Flexible Premium Deferred Variable Annuity Contract
o Premiums payable before the Annuity Commencement Date, in
accordance with contract provisions
o Monthly annuity payments begin on the Annuity Commencement
Date
o Benefits based on the investment experience of a Separate
Account are variable and are not guaranteed
o Non-participating - No dividends payable
GUIDE TO CONTRACT PROVISIONS
1. Definitions
2. Owner and Beneficiary
3. Annuity Benefit
4. Death Benefits
5. Premiums
6. The Separate Account
7. Transfers
8. Accumulation Value
9. Surrenders and Withdrawals
10. Payment of Contract Proceeds
11. General Provisions
Any endorsements, additional benefit riders, and applications which are attached
to this contract follow.
An Index appears on the inside of the back cover.
Page 2
CONTRACT DATA
(CONTINUED ON PAGE 3.1)
ANNUITANT [XXXX XXX] [35-MALE] AGE - SEX
CONTRACT NUMBER [SPECIMEN] [MAR. 1, 2000] ISSUE DATE
ANNUITY COMMENCEMENT DATE [MAR. 1, 2030]
OWNER [XXXX XXX]
BENEFICIARY THE BENEFICIARY(IES) NAMED IN THE APPLICATION ATTACHED TO
THIS CONTRACT, UNLESS SUBSEQUENTLY CHANGED.
RIGHT TO CANCEL - CONTINUED
IF THIS CONTRACT IS RETURNED DURING THE RIGHT TO CANCEL PERIOD, GIAC WILL PAY TO
THE OWNER AN AMOUNT EQUAL TO THE SUM OF:
o THE DIFFERENCE BETWEEN ANY PREMIUM(S) PAID, INCLUDING ANY CONTRACT
FEE OR CONTINGENT DEFERRED SALES CHARGE, AND THE AMOUNTS ALLOCATED
TO THE CONTRACT'S ALLOCATION OPTIONS; AND
o THE ACCUMULATION VALUE OF THE CONTRACT ON THE DATE GIAC RECEIVES THE
RETURNED CONTRACT AND CANCELLATION NOTICE AT ITS CUSTOMER SERVICE
OFFICE.
THE ABOVE AMOUNT PAYABLE WILL BE REDUCED BY THE VALUE OF ANY INVESTMENT
CREDIT(S) ON THE DATE GIAC RECEIVES THE RETURNED CONTRACT AND CANCELLATION
NOTICE. GIAC WILL RETURN TO THE OWNER ANY MORTALITY AND EXPENSE RISK CHARGE AND
ADMINISTRATIVE EXPENSE CHARGE ASSESSED ON THE VALUE OF THE INVESTMENT CREDIT
PRIOR TO RECEIPT OF THE RETURNED CONTRACT AND CANCELLATION NOTICE.
* * PREMIUMS * *
INITIAL CONTRACT PREMIUM [$25,000.00]
ADDITIONAL CONTRACT PREMIUMS MAY BE PAID TO GIAC BEFORE THE ANNUITY COMMENCEMENT
DATE IN ACCORDANCE WITH "PREMIUMS" ON PAGE 8. DURING THE FIRST CONTRACT YEAR, AN
INVESTMENT CREDIT OF 3% OF EACH NET PREMIUM PAYMENT MADE WILL BE CREDITED TO THE
CONTRACT.
* * INITIAL NET PREMIUM ALLOCATION INFORMATION * *
THE INITIAL NET PREMIUM IS THE INITIAL CONTRACT PREMIUM, LESS ANY APPLICABLE
ANNUITY TAXES. THE INITIAL NET PREMIUM IS ALLOCATED AS FOLLOWS:
[The Guardian Stock Fund XX%] [Aggressive Growth Portfolio of the
[The Guardian Bond Fund XX%] Janus Aspen Series XX%]
[The Guardian Cash Fund XX%] [Capital Appreciation Portfolio of the
[The Guardian Small Cap Stock Fund XX%] Janus Aspen Series XX%]
[The Guardian VC 500 Index Fund XX%] [Flexible Income Portfolio of the
[The Guardian VC Asset Allocation Fund XX%] Janus Aspen Series XX%]
[The Guardian VC High Yield Bond Fund XX%] [Growth and Income Portfolio of the
[Xxxxxxx Xxxxxxx International Fund XX%] Janus Aspen Series XX%]
[Xxxxxxx Xxxxxxx Emerging Markets Fund XX%] [Worldwide Growth Portfolio of the
[AIM V.I. Aggressive Growth Fund of AIM Janus Aspen Series XX%]
Variable Insurance Funds, Inc. XX%] [MFS Capital Opportunities Series of the
[AIM V.I. Growth Fund of AIM MFS Variable Insurance Trust XX%]
Variable Insurance Funds, Inc. XX%] [MFS Global Government Series of the
[AIM V.I. Government Securities Fund of AIM MFS Variable Insurance Trust XX%]
Variable Insurance Funds, Inc. XX%] [MFS Growth With Income Series of the
[AIM V.I. Value Fund of AIM MFS Variable Insurance Trust XX%]
Variable Insurance Funds, Inc. XX%] [MFS Emerging Growth Series of the
[Fidelity VIP Balanced Portfolio XX%] MFS Variable Insurance Trust XX%]
[Fidelity VIP II Contrafund Portfolio XX%] [MFS New Discovery Series of the
[Fidelity VIP Equity-Income Portfolio XX%] MFS Variable Insurance Trust XX%]
[Fidelity VIP III Growth Portfolio XX%] [Value Line Centurion Fund XX%]
[Value Line Strategic Asset Management Trust XX%]
Page 3
CONTRACT DATA
The following appears only if the Enhanced Death Benefit rider is attached to a
contract:
[* * ADDITIONAL BENEFIT RIDERS * *
THIS CONTRACT INCLUDES AN ENHANCED DEATH BENEFIT RIDER. SEE "CHARGES AND
EXPENSES" BELOW FOR ADDITIONAL INFORMATION.]
* * CONTRACT CHARGES AND EXPENSES * *
CONTINGENT DEFERRED SALES CHARGES: IF THE OWNER MAKES A PARTIAL WITHDRAWAL OR
SURRENDERS THE CONTRACT, A CONTINGENT DEFERRED SALES CHARGE MAY BE INCURRED
AGAINST AMOUNTS WITHDRAWN OR SURRENDERED DURING THE FIRST FOUR CONTRACT YEARS. A
CONTINGENT DEFERRED SALES CHARGE WILL NOT APPLY TO AMOUNTS WITHDRAWN OR
SURRENDERED AFTER THE FIRST FOUR CONTRACT YEARS.
THE MAXIMUM CONTINGENT DEFERRED SALES CHARGE WHICH GIAC MAY IMPOSE IS 3% OF THE
LESSER OF: 1) THE TOTAL OF ALL PREMIUM PAYMENTS MADE WITHIN THE FIRST CONTRACT
YEAR; OR 2) THE AMOUNT WITHDRAWN OR SURRENDERED. SEE "CONTINGENT DEFERRED SALES
CHARGES" ON PAGE 12 FOR ADDITIONAL INFORMATION.
DAILY CHARGES: DURING THE FIRST FOUR CONTRACT YEARS, GIAC WILL ASSESS A DAILY
CHARGE OF .000042797 OF THE VALUE OF THE ASSETS ALLOCATED TO EACH VARIABLE
INVESTMENT OPTION FOR ITS ASSUMPTION OF MORTALITY AND EXPENSE RISKS. ON AN
ANNUAL BASIS, THIS CHARGE IS EQUAL TO 1.55% OF THE VALUE OF THE ASSETS ALLOCATED
TO THESE VARIABLE INVESTMENT OPTIONS.
DURING THE FIFTH AND LATER CONTRACT YEARS, GIAC WILL ASSESS A DAILY CHARGE OF
.000040016 OF THE VALUE OF THE ASSETS ALLOCATED TO EACH VARIABLE INVESTMENT
OPTION FOR ITS ASSUMPTION OF MORTALITY AND EXPENSE RISKS. ON AN ANNUAL BASIS,
THIS CHARGE IS EQUAL TO 1.45% OF THE VALUE OF THE ASSETS ALLOCATED TO THESE
VARIABLE INVESTMENT OPTIONS. GIAC WILL ASSESS A DAILY CHARGE OF .000005485 OF
THE VALUE OF THE ASSETS ALLOCATED TO EACH VARIABLE INVESTMENT OPTION FOR
ADMINISTRATIVE EXPENSES INCURRED BY GIAC. ON AN ANNUAL BASIS, THIS CHARGE IS
EQUAL TO .20% OF THE VALUE OF THE ASSETS ALLOCATED TO THESE VARIABLE INVESTMENT
OPTIONS. SEE "NET INVESTMENT FACTOR" ON PAGE 11 FOR ADDITIONAL INFORMATION.
The following appears only if the Enhanced Death Benefit rider is attached to a
contract:
[GIAC WILL ASSESS A DAILY CHARGE OF .000006858 OF THE VALUE OF THE ASSETS
ALLOCATED TO EACH VARIABLE INVESTMENT OPTION FOR EXPENSES RELATED TO THE
PROVISION OF THIS BENEFIT. ON AN ANNUAL BASIS, THIS CHARGE IS EQUAL TO .25% OF
THE VALUE OF THE ASSETS ALLOCATED TO THESE VARIABLE INVESTMENT OPTIONS. SEE THE
ENHANCED DEATH BENEFIT RIDER FOR ADDITIONAL INFORMATION.]
CONTRACT FEE: GIAC WILL DEDUCT AN ANNUAL CONTRACT FEE OF $35 ON EACH CONTRACT
ANNIVERSARY ON OR BEFORE THE ANNUITY COMMENCEMENT DATE. IF A CONTRACT IS
SURRENDERED ON A DATE OTHER THAN ON A CONTRACT ANNIVERSARY, GIAC WILL DEDUCT THE
CONTRACT FEE ON THE DATE OF SURRENDER. SEE "CONTRACT FEE" ON PAGE 11 FOR
ADDITIONAL INFORMATION.
TRANSFER CHARGE: GIAC RESERVES THE RIGHT TO CHARGE A MAXIMUM OF $25 FOR ANY
TRANSFER TRANSACTION.
* * *
ALL COMMUNICATIONS WITH GIAC SHOULD BE DIRECTED TO THE CUSTOMER SERVICE OFFICE
ADDRESS SHOWN ON THE FRONT COVER.
TO OBTAIN INFORMATION ABOUT YOUR COVERAGE YOU MAY CALL YOUR AGENT, OR GIAC AT:
[0-000-000-0000]
Page 3.1
1. DEFINITIONS
Certain important terms used in this contract are defined below. Additional
terms, not explained here, are defined in other parts of this contract.
Accumulation Unit: A unit of measure used to determine the value of the owner's
interest under this contract before the Annuity Commencement Date.
Accumulation Value: The value attributable to this contract. The Accumulation
Value is the sum of the values attributable to the Variable Investment Options.
Allocation Options: This contract's Allocation Options consist of the Variable
Investment Options.
Annuity Commencement Date: The date on which monthly annuity payments under this
contract begin. The Annuity Commencement Date is shown on page 3.
Annuity Unit: A unit of measure used to determine the amount of any variable
annuity payment.
Basic Contract: This contract excluding any additional benefit riders or
endorsements.
Contingent Annuitant: A contingent annuitant is the person named in the
application by the owner to become the annuitant if the annuitant dies before
the Annuity Commencement Date.
Contract Anniversary: The annual anniversary measured from this contract's Issue
Date.
Good Order: Notice from any party authorized to initiate a contract transaction
under this contract, received at the Customer Service Office in a format
satisfactory to GIAC, that includes all information required by GIAC to process
a transaction under this contract.
Internal Revenue Code: The Internal Revenue Code of 1986, as amended, and the
rules and regulations thereunder, and successor provisions thereto.
Investment Credit: During the first contract year, a credit of 3% of each Net
Premium payment that is credited to this contract, at the time a Net Premium
payment is allocated to this contract's Allocation Options.
Issue Date: The date this contract is issued by GIAC at its Customer Service
Office. The Issue Date is shown on page 3. Contract years are measured from the
Issue Date.
Monthly Anniversary: The same date of each calendar month as the Issue Date, or
the last date of a calendar month, if earlier.
Net Premium: A premium paid by the owner to GIAC in accordance with this
contract's provisions, less annuity taxes, if any.
Reset Date: The first reset date occurs on the seventh Contract Anniversary.
Thereafter, each reset date occurs on each subsequent seventh Contract
Anniversary.
Unliquidated Net Premiums: The total amount of all Net Premiums paid under this
contract that have not been withdrawn.
Valuation Date: A date on which Accumulation Unit values are determined.
Accumulation Unit values are determined on each date on which the New York Stock
Exchange or its successor is open for trading. Valuations for any date other
than a Valuation Date will be determined on the next Valuation Date.
Valuation Period: The period between two successive Valuation Dates, beginning
after 4:00 P.M. New York City time on each Valuation Date and ending at 4:00
P.M. New York City time on the next succeeding Valuation Date.
Variable Investment Options: The investment divisions of The Guardian Separate
Account F.
Page 4 oCONTRACT NUMBER
2. OWNER AND BENEFICIARY
Owner
The owner is named in the application or in any later change shown in GIAC's
records. While the annuitant is living, prior to the Annuity Commencement Date,
and subject to any assignment on file with GIAC, the owner alone has the right
to receive all benefits and exercise all rights this contract grants or GIAC
allows. After the death of the annuitant, the beneficiary is the owner.
Joint Owners
If more than one person is named as owner in the application or in any later
change shown in GIAC's records, GIAC considers them to be joint owners.
Each joint owner will possess an undivided interest in the contract. Any written
request for a contract transaction must be signed by each joint owner named in
GIAC's records. Unless otherwise provided, if a joint owner dies, ownership
passes to the surviving joint owner(s). When the last joint owner dies,
ownership passes to the beneficiary. If no beneficiary is named, ownership
passes to the estate of the last surviving joint owner. If there are joint
owners, all references to "owner" are deemed to include all joint owners, unless
otherwise specified.
Contingent Annuitant
The owner may name a contingent annuitant. If he or she wishes to do so, the
contingent annuitant must be named in the application. Only the owner may change
a contingent annuitant. If a contingent annuitant is named in the application
and the annuitant dies prior to the Annuity Commencement Date, the contingent
annuitant will become the annuitant.
The owner's right to name a contingent annuitant may be restricted under the
provisions of a retirement or deferred compensation plan for which this contract
is issued. A contingent annuitant may be named only if the owner and annuitant
are not the same person, and if permitted by the laws of the jurisdiction in
which this contract is issued.
Beneficiary
The beneficiary is named by the owner(s) in the application or in any later
change shown in GIAC's records. If the annuitant dies before the Annuity
Commencement Date, GIAC will pay the death benefit to the beneficiary, as
described in "Death Benefits" on page 7. If the annuitant dies after the Annuity
Commencement Date, any remaining benefit payable under Options V-2 or V-4 of
"Variable Annuity Payout Options" on page 13 or Option F-2 of "Fixed Annuity
Payout Options" on page 14 that falls due after the annuitant's death will be
paid to the beneficiary.
Unless otherwise provided, in order to receive the death benefit at the
annuitant's death, a beneficiary must be living on the earlier of:
o the date proof of the annuitant's death is received in Good Order at
GIAC's Customer Service Office; or
o the 15th day after the death of the annuitant.
Unless otherwise provided, if no named beneficiary is living on such earlier
date, the owner is the beneficiary.
Contingent Beneficiary
A numbered sequence may be used to name contingent beneficiaries. The
beneficiary is the living person(s) designated by the lowest number in the
sequence.
Concurrent Beneficiary
If more than one person is named with no number or the same number, GIAC
considers them to be concurrent beneficiaries. Shares are equal, unless
otherwise specified. If shares are equal, the share of a concurrent beneficiary
who predeceases both the owner and the annuitant will be shared equally by the
surviving concurrent beneficiaries. If unequal shares are specified and a
concurrent beneficiary predeceases both the owner and the annuitant, the
beneficiary of that share will be the owner.
Change of Owner or Beneficiary
Before the Annuity Commencement Date, the owner may change the ownership of this
contract by a written request in Good Order. Such change may be subject to state
and federal gift taxes and federal income taxes. Subject to any existing
assignment, the owner may change the beneficiary during the lifetime of the
annuitant. The change will take effect as of the date the request is signed,
whether or not the owner or annuitant is living when GIAC receives the request
in Good Order at its Customer Service Office. However, the change will not apply
to any payments made or actions taken by GIAC before the request is received.
Assignment
No assignment will bind GIAC unless it is received at GIAC's Customer Service
Office in Good Order and is accepted by GIAC. An assignment must be signed and
dated by both the assignor and the assignee and, as applicable, by the
beneficiary. The rights of any owner or beneficiary and the entire contract, as
defined in "The Contract" on page 18, will be subject to the assignment. GIAC
will rely solely on the assignee's statement as to the amount of the assignee's
interest. GIAC will not be responsible for any tax consequences arising from or
the validity of any assignment, or for any actions taken in reliance on the
validity of the assignment.
Page 5 oCONTRACT NUMBER
OWNER AND BENEFICIARY - cont'd
Unless otherwise provided, the assignee may exercise all rights this contract
grants except:
o the right to change the owner or beneficiary; and
o the right to elect an annuity payout option.
Assignments are subject to all payments made or actions taken by GIAC on or
before the date GIAC accepts the assignment at its Customer Service Office.
3. ANNUITY BENEFIT
Annuity Benefit
GIAC will make monthly annuity payments to the owner starting on the Annuity
Commencement Date shown on page 3 if:
o the annuitant is then living; and
o this contract is in force on that date.
The Annuity Commencement Date cannot be later than the annuitant's 90th
birthday. On the Annuity Commencement Date, the amount of the first monthly
annuity payments will be calculated by applying the contract's Accumulation
Value, less annuity taxes, if any, under Option V-2 of "Variable Annuity Payout
Options" on page 13, unless another option is elected. The payment amounts will
vary according to the annuitant's age and sex. Under Option V-2, payments are
guaranteed for a period of 10 years. If the annuitant dies before the end of the
guaranteed period, GIAC will pay the balance of the payments to the beneficiary
for the remainder of that period, unless the beneficiary elects to be paid the
present value of the then current dollar amount of the remaining annuity
payments in a lump sum. GIAC will begin making such payment(s) to the
beneficiary upon GIAC's receipt at its Customer Service Office of proof of death
in Good Order. See "Payment of Contract Proceeds" on page 13 for an explanation
of how monthly annuity payments are determined.
Change of Annuity Commencement Date or Annuity Payout Option
If GIAC consents, the owner may change the Annuity Commencement Date to a date
not later than the annuitant's 90th birthday. The owner may also change any
elected annuity payout option before the Annuity Commencement Date. In order to
effect either of these changes, GIAC must receive the owner's request in Good
Order at its Customer Service Office at least 60 days before the Annuity
Commencement Date.
Page 6 oCONTRACT NUMBER
4. DEATH BENEFITS
Notwithstanding any provision of this contract to the contrary, no payment of
benefits provided under the contract will be allowed that does not satisfy the
requirements of section 72(s) of the Internal Revenue Code, as amended from time
to time, for contracts issued with a non-qualified status.
Death of Annuitant Before Annuity Commencement Date When the Annuitant is Not an
Owner
If the annuitant dies before the Annuity Commencement Date and the annuitant is
not an owner, a death benefit becomes payable to the beneficiary, unless the
owner has also named a contingent annuitant. In such case, the death benefit is
payable prior to the Annuity Commencement Date upon the death of the later to
survive of the annuitant and contingent annuitant.
If the beneficiary predeceases the annuitant, then the death benefit will be
paid to the contingent beneficiary, if any. If no contingent beneficiary(ies) is
named, then the death benefit will be paid to the owner or, if the owner is no
longer living, to the owner's estate. GIAC will make such payment upon receipt
at its Customer Service Office of proof in Good Order that the death occurred
before the Annuity Commencement Date.
If the annuitant's death occurs prior to attainment of age 85, the death benefit
payable will be the greatest of:
o the Accumulation Value of the contract as of the end of the
Valuation Period during which GIAC received proof of death in Good
Order, less annuity taxes, if any; or
o the total amount of premiums paid, less any partial withdrawals and
any contingent deferred sales charges paid thereon, and annuity
taxes, if any; or
o the Accumulation Value of the contract as of the Reset Date
immediately preceding the annuitant's date of death, plus any Net
Premiums paid subsequent to such Reset Date, less the amount of all
partial withdrawals subsequent to such Reset Date, any contingent
deferred sales charges paid thereon, and annuity taxes, if any.
If the annuitant is age 80 or older on the Issue Date, then the death benefit
payable will be the Accumulation Value as of the end of the Valuation Period
during which GIAC received proof of death in Good Order, less annuity taxes, if
any.
If the annuitant dies on or after attainment of age 85, the death benefit
payable will be the Accumulation Value as of the end of the Valuation Period
during which GIAC received proof of death in Good Order, less annuity taxes, if
any.
The death benefit will be paid in one sum unless:
o the owner has elected an annuity payout option for the death
benefit that is received at GIAC's Customer Service Office in
Good Order at least three business days prior to the date the
proceeds are paid; or
o the owner has not otherwise elected an annuity payout option
and the beneficiary has elected an annuity payout option for
the death benefit that is:
o received at GIAC's Customer Service Office in Good Order at
least three business days prior to the date the proceeds are
paid; and
o received at GIAC's Customer Service Office in Good Order
within one year of the annuitant's death.
Death of An Owner
If an owner and the annuitant are the same person, and such person dies before
the Annuity Commencement Date, then the death benefit becomes payable to the
beneficiary, as described in "Death of Annuitant Before Annuity Commencement
Date When the Annuitant is Not an Owner" above, except that the death benefit
must be distributed in accordance with the "Special Rules" described below. If
an owner and the annuitant are the same person and such person dies on or after
the Annuity Commencement Date, then any remaining benefit under Options V-2 or
V-4 of "Variable Annuity Payout Options" on page 13 or Option F-2 of "Fixed
Annuity Payout Options" on page 14, will be paid to the beneficiary.
If an owner and the annuitant are not the same person and that owner dies, then
the joint owner(s), if any, becomes the new owner(s). If no joint owner(s) is
named, then the beneficiary becomes the new owner.
Special Rules
If any owner dies before the Annuity Commencement Date, this contract's entire
interest must be distributed within five years of that owner's date of death. If
any owner dies on or after the Annuity Commencement Date but before the entire
contract has been distributed, the remaining portion must be distributed at
least as rapidly as under the method of distribution in effect as of the date of
such owner's death. The distribution requirements set forth above will be
considered satisfied as to any portion of the deceased owner's interest which:
o is payable to or for the benefit of any new owner; and
o will be distributed over the life of any such new owner, or over a
period not extending beyond the life expectancy of any new owner;
provided such distributions begin within one year of the deceased owner's death.
Page 7 oCONTRACT NUMBER
DEATH BENEFITS - cont'd
In addition, if any new owner is the surviving spouse of the deceased owner:
o this contract may be continued in the name of the spouse as owner;
and
o these distribution rules will be applied by treating the spouse as
the owner.
If any owner is not an individual, the annuitant will be treated as owner for
purposes of these distribution requirements and any change in or death of the
annuitant will be treated as the death of an owner.
5. PREMIUMS
GIAC will accept premiums under this contract at any time before the Annuity
Commencement Date while the annuitant and all owners are living. All premiums
are payable at GIAC's Customer Service Office. Upon request, GIAC will give the
owner a receipt signed by one of its officers. The initial contract premium
shown on page 3 is due on the Issue Date and is payable in advance.
The minimum amount of any additional premium payment is $100, unless this
contract is purchased by or in connection with an employer-sponsored plan or
through employee payroll deductions. In such cases, there is no minimum
additional premium payment amount. The maximum amount of total premiums paid in
any contract year after the first is $1,000,000. This maximum may only be
exceeded with GIAC's written consent.
Allocation of Net Premiums
The owner may allocate all or part of a Net Premium to this contract's
Allocation Options. GIAC reserves the right to limit the number of Allocation
Options into which the value of the contract and any Net Premiums paid may be
invested at a given time.
Allocation will be based on the percentages designated in the application, or as
subsequently changed by the owner. GIAC will change the allocation percentages
applicable to future payments of Net Premiums upon receipt of the owner's
request in Good Order at its Customer Service Office.
Net Premiums will be applied to purchase Accumulation Units as described on page
11.
Investment Credits
GIAC credits an Investment Credit of 3% of each Net Premium payment to the
contract during the first contract year. Each Investment Credit is credited to
the contract when the applicable Net Premium payment is allocated to the
Allocation Options. Investment Credits are applied pro-rata to the Allocation
Options in the same ratio as the applicable Net Premium payment. If this
contract is returned during the Right to Cancel period, GIAC will return to the
owner any mortality and expense risk charge and any administrative expense
charge assessed on the value of the Investment Credit prior to receipt of the
returned contract and cancellation notice.
Page 8 oCONTRACT NUMBER
6. THE SEPARATE ACCOUNT
The Guardian Separate Account F
The Variable Investment Options under this contract are funded by The Guardian
Separate Account F (Account F). Account F is a separate investment account
established by GIAC under the laws of the state of Delaware. Account F is
subject to the laws of the jurisdiction in which this contract is issued.
Account F is registered as a unit investment trust with the Securities and
Exchange Commission (SEC) under the Investment Company Act of 1940 (the 1940
Act).
Account F is treated as a division of GIAC and is used to provide values and
benefits for variable annuity contracts only. GIAC owns the assets in Account F.
The assets in Account F are kept separate from:
o GIAC's general account; and
o GIAC's other separate accounts.
Assets equal to the reserves and contract liabilities of Account F will not be
charged with liabilities that arise from any other business GIAC may conduct.
GIAC may transfer assets in excess of the reserves and contract liabilities of
Account F to the general account. Xxxxxx and realized and unrealized gains and
losses from assets in each Variable Investment Option in Account F are credited
to or charged against such Variable Investment Option without regard to income
and realized and unrealized gains or losses in Account F's other Variable
Investment Options or GIAC's general account or other separate accounts. The
valuation of all assets in Account F will be determined in accordance with all
applicable laws and regulations.
Investment Divisions
Account F consists of several investment divisions or Variable Investment
Options. Each investment division of Account F invests in shares of a registered
investment company. Such a company may include a mutual fund or a separate
investment portfolio of a mutual fund, each of which is managed by an investment
adviser registered under the Investment Advisers Act of 1940.
The investment divisions available on the Issue Date are listed in the then
current prospectus for Account F as it relates to this contract. Each underlying
investment company is more fully described in a separate prospectus. Any
investment adviser's fee, if applicable, is described in the appropriate
prospectus.
Rights Reserved
GIAC reserves the right to take certain actions which it deems:
o necessary to serve the best interests of the owner and any
beneficiary; and
o appropriate to carry out the purposes of this contract.
GIAC will exercise its reserved rights only when permitted by applicable law.
When required by law, GIAC will obtain approval by the owner, the SEC, or any
appropriate regulatory authority. Examples of actions GIAC may take include:
o deregistering Account F under the 1940 Act;
o operating Account F in any form permitted under the 1940 Act, or in
any other form permitted by law;
o taking any action necessary to comply with or obtain and continue
any exemptions from the 1940 Act;
o transferring any assets in an investment division:
o into another investment division; or
o into one or more separate accounts; or
o into GIAC 's general account;
o adding, combining, or removing investment divisions in Account F;
o substituting, for the contract values held in any investment
division, the shares of another class issued by a mutual fund in
which such values are invested or the shares of another investment
company or any other investment permitted by law;
o making any other necessary technical changes in this contract in
order to conform with any action this provision permits GIAC to
take;
o adding to, eliminating, or suspending the owner's ability to
allocate Net Premiums or transfer Accumulation Value amounts into
any Variable Investment Option;
o modifying this contract as necessary in order to preserve the
favorable tax treatment currently accorded this contract, including
to prevent the owner from being considered the owner of the assets
in Account F.
GIAC will notify the owner if any of these actions result in a material change
in the underlying investments of any investment division to which part of this
contract's Accumulation Value is allocated. Details of any such change in the
underlying investments of an investment division of Account F will be filed with
any regulatory authority where required and will be subject to any required
approval.
Page 9
7. TRANSFERS
The owner may transfer all or a portion of this contract's value among the
Variable Investment Options, subject to the restrictions described below. GIAC
must receive the owner's written request for transfer at its Customer Service
Office in Good Order. GIAC reserves the right:
o to limit transfers among the Variable Investment Options to once
every 30 days; and
o to charge for each transfer. The maximum amount of any transfer
charge is $25. GIAC will deduct any transfer charge on a pro rata
basis from the Variable Investment Options from which the amounts
were transferred.
GIAC also reserves the right to limit the number of transfers in any contract
year, or to refuse any transfer request if:
o GIAC is concerned that excessive trading by the owner(s) or a
specific transfer request or group of transfer requests may have a
detrimental effect on the unit value or the share prices of the
underlying Variable Investment Options; or
o GIAC is informed by an underlying Variable Investment Option that
the purchase or redemption of shares should be restricted due to
excessive trading or that a specific transfer or group of transfers
is deemed to have a detrimental effect on share prices of the
affected underlying Variable Investment Option.
Transfers Before the Annuity Commencement Date
During the period up to 30 days before the Annuity Commencement Date, the owner
may transfer all or a portion of the Accumulation Units credited under this
contract among the Variable Investment Options, subject to the limit set by GIAC
on the number of Variable Investment Options into which the Accumulation Value
of the contract may be invested, if any.
Transfers After the Annuity Commencement Date
After the Annuity Commencement Date, if the owner has elected a variable annuity
payout option, the owner may transfer all or a portion of the Annuity Units
credited under such option among the Variable Investment Options. Transfers may
be made only once each month. GIAC must receive transfer instructions in Good
Order at least 15 days before the due date of the first variable annuity payment
to which the transfer will apply.
The number of additional Annuity Units credited to a newly elected Variable
Investment Option will be equal to (a) divided by (b), where:
o (a) is the dollar amount of the monthly variable annuity payment
that is to be transferred as of the transfer date; and
o (b) is the value of an Annuity Unit in the newly elected Variable
Investment Option as of the transfer date.
After the Annuity Commencement Date, the owner who has elected a fixed annuity
payout may not transfer into or out of such option.
Page 10 oCONTRACT NUMBER
8. ACCUMULATION VALUE
Accumulation Value
The portion of the Accumulation Value attributable to a particular Variable
Investment Option is determined by multiplying (a) by (b), where:
o (a) is the number of Accumulation Units credited to this contract
for that particular Allocation Option; and
o (b) is the then current Accumulation Unit value for that Allocation
Option.
This contract does not have any Accumulation Value on or after the Annuity
Commencement Date.
Accumulation Units
Amounts allocated or transferred to a Variable Investment Option before the
Annuity Commencement Date are used to purchase variable Accumulation Units.
Accumulation Units are redeemed and cancelled when amounts are deducted,
withdrawn, or transferred from a Variable Investment Option. The number of
Accumulation Units purchased or redeemed in a Variable Investment Option equals
(a) divided by (b), where:
o (a) is the dollar value of the transaction; and
o (b) is the value of an Accumulation Unit for the applicable Variable
Investment Option as of the Valuation Date on which the transaction
is processed.
Accumulation Unit Value for a Variable Investment Option
The Accumulation Unit value for a Variable Investment Option depends on the
investment experience of that option and therefore may increase or decrease
daily.
GIAC determines the Accumulation Unit value for each Variable Investment Option
for every Valuation Period. The Accumulation Unit value for a Variable
Investment Option for any Valuation Period is (a) multiplied by (b), where:
o (a) is the Accumulation Unit value for that Variable Investment
Option for the immediately preceding Valuation Period; and
o (b) is the net investment factor, as described below, for the
current Valuation Period.
Net Investment Factor
During the first four contract years, GIAC will assess a daily charge of
.000042797 of the value of the assets allocated to each Variable Investment
Option for its assumption of mortality and expense risks. On an annual basis,
the charge is equal to 1.55% of the value of the assets allocated to these
Variable Investment Options.
During the fifth and later contract years, GIAC will assess a daily charge of
.000040016 of the value of the assets allocated to each Variable Investment
Option for its assumption of mortality and expense risks. On an annual basis,
this charge is equal to 1.45% of the value of the assets allocated to these
Variable Investment Options.
GIAC will assess a daily charge of .000005485 of the value of the assets
allocated to each Variable Investment Option for administrative expenses
incurred by GIAC. On an annual basis, this charge is equal to .20% of the value
of the assets allocated to these Variable Investment Options.
The net investment factor is used to calculate the value of an Accumulation Unit
in any Variable Investment Option for a Valuation Period. The net investment
factor is determined by dividing the sum of (a) and (b) by (c), and subtracting
(d) from the result, where:
o (a) is the net asset value per share of the investments held by the
Variable Investment Option for the current Valuation Period;
o (b) is the per share amount of any dividends or other distributions
made by the investments held by the Variable Investment Option
during the current Valuation Period;
o (c) is the net asset value per share of the investments held by the
Variable Investment Option for the immediately preceding Valuation
Period;
o (d) is the sum of the daily charges GIAC deducts from the Variable
Investment Options for:
o the mortality and expense risks and administrative expenses
assumed by GIAC; and
o annuity taxes, if any.
The net investment factor may be less than 1.00 since it is based on the
investment experience of Account F.
Contract Fee
On each Contract Anniversary on or before the Annuity Commencement Date, GIAC
will deduct a contract fee of $35 from the Accumulation Value of this contract.
This fee will be deducted from each Variable Investment Option in proportion to
the portion of the Accumulation Value attributable to each particular Allocation
Option on that Contract Anniversary. However, if this contract is surrendered on
a date other than a Contract Anniversary, GIAC will deduct the contract fee on
the date of surrender. GIAC will waive the contract fee if the Accumulation
Value on the Contract Anniversary or upon total surrender is $100,000 or more.
Tax Charge
In jurisdictions in which a tax is payable when premium payments are received,
GIAC will deduct the amount of tax payable from the contract's Accumulation
Value when it is applied under a payout option or upon surrender.
In jurisdictions which do not require payment of a tax, the above paragraph will
not apply.
Page 11 oCONTRACT NUMBER
9. SURRENDERS AND WITHDRAWALS
Surrender of Contract
Before the Annuity Commencement Date and while the annuitant is living, the
owner may surrender this contract for its surrender value as defined below. The
contract will then terminate. The owner's request for such surrender must be
received in Good Order by GIAC at its Customer Service Office. This contract
must be sent to GIAC's Customer Service Office for cancellation.
The surrender value is determined by deducting (b), (c) and (d) from (a), where:
o (a) is the Accumulation Value as of the Valuation Date on which GIAC
receives the owner's written request for surrender in Good Order;
o (b) is any applicable contingent deferred sales charge, as described
below;
o (c) is any applicable contract fee; and
o (d) is annuity taxes, if any.
Partial Withdrawals
Before the Annuity Commencement Date and while the annuitant is living, the
owner may withdraw part of this contract's Accumulation Value, subject to the
conditions described below. The owner's request for any partial withdrawal must
be received in Good Order by GIAC at its Customer Service Office.
Any partial withdrawal payment will be reduced by any contingent deferred sales
charges (described below) and any applicable annuity taxes. The amount of any
partial withdrawal and any applicable contingent deferred sales charge and
annuity taxes, if any, will be deducted from the Variable Investment Options in
proportion to the amount of the Accumulation Value attributable to each Variable
Investment Option as of the Valuation Date on the date GIAC receives the owner's
written request for withdrawal in Good Order.
The total Accumulation Value remaining after a partial withdrawal must be at
least $500. If a partial withdrawal results in the Accumulation Value falling
below $500, then GIAC reserves the right to cancel the contract and pay the
surrender value to the owner.
Contingent Deferred Sales Charges
If the owner makes a partial withdrawal or surrenders the contract, a contingent
deferred sales charge may be incurred against amounts withdrawn or surrendered
during the first four contract years. A contingent deferred sales charge will
not apply to amounts withdrawn or surrendered during the fifth contract year or
later. If this contract is surrendered, GIAC will deduct, if applicable, a
contingent deferred sales charge and the contract fee from the amount otherwise
payable (See "Surrender of Contract" provision above). The amount of the
contingent deferred sales charge, if any, will be a percentage, as shown in the
table below, of the amount withdrawn or surrendered:
Contingent Deferred
Contract Sales Charge
Year Percentage
1 3%
2 2%
3 1%
4 1%
5 0%
and later.
The maximum contingent deferred sales charge will be equal to 3% of the lesser
of:
o the total of all premium payments made within the first contract
year; or
o the amount withdrawn or surrendered.
However, in the first four contract years, the owner may make a partial
withdrawal, without incurring a contingent deferred sales charge, of an amount
equal to the greater of:
o the excess of the Accumulation Value on the date of withdrawal over
the Unliquidated Net Premium payments made in the first contract
year; or
o 10% of the total premium payments made during the first contract
year, minus the aggregate amount of all prior partial withdrawals
made during the current contract year.
For the purpose of calculating the contingent deferred sales charge and in order
to minimize the applicable contingent deferred sales charge, all amounts
withdrawn are deemed to be withdrawn on a last-in first-out basis. Premium
payments made in the second contract year and later will not be subject to a
contingent deferred sales charge upon withdrawal.
Page 12 oCONTRACT NUMBER
10. PAYMENT OF CONTRACT PROCEEDS
Annuity Payments
If the annuitant is living and this contract is in force on the Annuity
Commencement Date, GIAC will make monthly variable annuity payments to the owner
under Variable Annuity Payout Option V-2, as stated in "Annuity Benefit" on page
6, or, if elected, one of the other annuity payout options. Payment of any
annuity benefit or death benefit may be made under either a fixed or variable
annuity payout option or a combination of both. If annuity payout option F-3 or
V-3 is chosen, the owner must also select a joint annuitant during the
annuitant's lifetime.
All monthly annuity payments are based on:
o the sex and age of the annuitant at the birthday nearest the
date payments are to begin; and
o the annuity payout option elected.
The Annuity Payout Option Tables are based on the Annuity 2000 Mortality Table.
Payees
While the annuitant is living, the owner may name or change one or more
beneficiaries who will be the payee or payees under an annuity payout option
after the death of the annuitant.
Only individuals who are to receive payments in their own behalf may be named as
payees, unless XXXX agrees otherwise.
Variable Annuity Payout Options
The amount of any variable annuity payments after the first will increase or
decrease according to the value of the variable Annuity Units, which reflect the
investment experience of the Variable Investment Option(s) elected.
The amount of each variable annuity payment under a variable annuity payout
option depends on an assumed investment return. In the election of any of these
options, the effective annual assumed investment return chosen can be:
o 0%; or
o 3 1/2%; or
o 5%, if allowed by applicable law or regulation.
If no choice is made, an effective annual interest rate of 3 1/2% will be used
as the assumed investment return. The variable annuity payout rates shown on the
following pages for the variable annuity payout options are based on the 3 1/2%
rate. The amount of the first monthly payment for the 3 1/2% assumed investment
return payout options will be based on rates not less than the rates shown in
the Variable Annuity Payout Option Tables on page 16. The interest rate used to
compute the present value of any remaining unpaid payments will be the assumed
investment return.
Option V-1 - Life Annuity without Guaranteed Period
GIAC will make monthly variable annuity payments during the lifetime of the
annuitant. GIAC does not guarantee a minimum number of annuity payments under
this option. This option does not provide a death benefit to any beneficiaries
upon the annuitant's death.
Option V-2 - Life Annuity with 10 Year Guaranteed Period
GIAC will make monthly variable annuity payments during the lifetime of the
annuitant. Payments are guaranteed for a period of 10 years. If the annuitant
dies before the end of the guaranteed period, GIAC will pay the balance of the
payments to the beneficiary for the remainder of that period, unless the
beneficiary elects to be paid the present value of the current dollar amount of
the then remaining annuity payments in a lump sum. If the beneficiary dies while
receiving such payments, the present value of the remaining number of variable
annuity payments will be paid in one sum to the beneficiary's estate.
Option V-3 - Joint and Survivor Annuity
GIAC will make monthly variable annuity payments while the annuitant and the
joint annuitant are living and during the survivor's remaining lifetime. When an
annuitant dies, payments based on two-thirds of the number of Annuity Units in
effect while both were living will continue for the lifetime of the survivor.
Option V-4 - Variable Annuity Payments to Age 100
GIAC will make monthly variable annuity payments, which will continue for a
whole number of years. The number of years will equal 100 minus the annuitant's
age on the Annuity Commencement Date. If the annuitant dies before age 100, GIAC
will pay the balance of the payments to the beneficiary for the remainder of
that period, unless the beneficiary elects to be paid the present value of the
current dollar amount of the then remaining annuity payments in a lump sum. If
the beneficiary dies while receiving such payments, the present value of the
remaining number of variable annuity payments will be paid in one sum to the
beneficiary's estate. Under this option, the payee has the right to change to
Option V-1, the Life Annuity without Guaranteed Period option.
Page 13 oCONTRACT NUMBER
PAYMENT OF CONTRACT PROCEEDS - cont'd
Under this option, the payee also has the right to withdraw the present value of
the remaining payments. If a contingent deferred sales charge was waived when
the contract proceeds were applied to the payout option, the present value will
be reduced by a portion of the charge that was waived. The amount deducted from
the present value will be i. times (ii. divided by iii.):
o i. the charge that was waived;
o ii. the number of whole months of any remaining unpaid payments
until the date when the charge would be zero;
o iii. the number of whole months remaining when the contract proceeds
were applied to the payout option until the date when the charge
would be zero.
Fixed Annuity Payout Options
Option F-1 - Life Annuity without Guaranteed Period GIAC will make monthly fixed
annuity payments during the lifetime of the annuitant. GIAC does not guarantee a
minimum number of annuity payments under this option. This option does not
provide a death benefit to any beneficiaries upon the annuitant's death. The
amount of the monthly payment will be based on the Option F-1 table on page 17.
The guaranteed monthly payments shown in the Option F-1 table include interest
at a rate of 3% a year.
Option F-2 - Life Annuity with 10 Year Guaranteed Period
GIAC will make monthly fixed annuity payments during the lifetime of the
annuitant. The amount of the monthly payment will be based on the Option F-2
table on page 17. The guaranteed monthly payments shown in the Option F-2 table
include interest at a rate of 3% a year. Payments are guaranteed for a period of
10 years. If the annuitant dies before the end of the guaranteed period, GIAC
will pay the balance of the payments to the beneficiary for the remainder of
that period, unless the beneficiary elects to be paid the present value of the
then remaining annuity payments in a lump sum. If the beneficiary dies while
receiving such payments, the present value of the remaining number of annuity
payments will be paid to the beneficiary's estate.
Option F-3 - Joint and Survivor Annuity
GIAC will make monthly fixed annuity payments while the annuitant and the joint
annuitant are living and during the survivor's remaining lifetime. When an
annuitant dies, payments based on two-thirds of the amount of the payment in
effect while both were living will continue for the lifetime of the survivor.
The amount of the monthly payment will be based on the Option F-3 table on page
17. The guaranteed monthly payments shown in the Option F-3 table include
interest at a rate of 3% a year.
Determination of Annuity Payments
On the Annuity Commencement Date, GIAC will determine the Accumulation Value.
The portion of the Accumulation Value attributable to each Allocation Option is
determined by multiplying (a) by (b), and deducting (c) from the result, where:
o (a) is the Accumulation Unit value on the Valuation Date 10 days
before the date the first annuity payment is due;
o (b) is the number of Accumulation Units credited to the owner's
account as of the date the first annuity payment is due; and
o (c) is any applicable annuity taxes not previously deducted.
The Variable Annuity Payment Option Tables on page 16 indicate the dollar amount
of the first monthly annuity payment for each Variable Annuity Payout Option
which can be purchased with each $1,000 of Accumulation Value. The Fixed Annuity
Payout Option Tables on page 17 indicate the dollar amount of the guaranteed
monthly annuity payment for each Fixed Annuity Payout Option which can be
purchased with each $1,000 of Accumulation Value. The first guaranteed variable
annuity payment and guaranteed fixed annuity payments are determined by
multiplying (a) by (b), where:
o (a) is the amount shown in the applicable table for the annuitant's
sex and age on the Annuity Commencement Date; and
o (b) is the number of thousands of dollars of Accumulation Value.
Annuity Unit Values
If a Variable Annuity Payout Option has been elected, the Accumulation Value of
this contract will be applied to purchase Annuity Units. Annuity Units are used
to determine the amount of each variable annuity payment after the first.
The value of an Annuity Unit is determined independently for each Variable
Investment Option. The dollar value of Annuity Units may increase or decrease
depending upon the investment experience of the Variable Investment Option(s)
elected.
The value of an Annuity Unit in each Variable Investment Option was established
at $1.00 on the date operations began for each such Variable Investment Option.
The value of an Annuity Unit at the end of any subsequent Valuation Period is
equal to (a) multiplied by (b), where:
o (a) is the Annuity Unit value for the immediately preceding
Valuation Period; and
o (b) is the annuity change factor for the current Valuation Period.
Page 14 oCONTRACT NUMBER
PAYMENT OF CONTRACT PROCEEDS - cont'd
The annuity change factor is equal to the net investment factor (as described in
"Net Investment Factor" on page 11) for the same Valuation Period, adjusted to
recognize the assumed investment return used in determining the amounts of
variable annuity payments. The valuation of all assets in Account F will be
determined in accordance with all applicable laws and regulations.
Determination of Variable Annuity Payments After the First
The amount of each variable annuity payment made after the first is determined
by multiplying (a) by (b), where:
o (a) is the number of Annuity Units in each Variable Investment
Option; and
o (b) is the appropriate Annuity Unit value as of the Valuation Date
10 days prior to the date the variable annuity payment is due.
The number of Annuity Units in each option is determined by dividing (a) by (b),
where:
o (a) is the amount of the first monthly variable annuity payment for
each Variable Investment Option; and
o (b) is the value of the Annuity Unit on the date the first variable
annuity payment is made.
The number of Annuity Units remains fixed during the annuity payment period,
provided no transfers among Variable Investment Options are made.
GIAC guarantees that the dollar amount of each variable annuity payment after
the first will not be adversely affected by:
o the actual administrative expenses it incurs; or
o variations in mortality experience from the mortality assumptions
upon which the first payment is based.
Annuity Payout Options: General Provisions
o At least $2,000 must be applied under an Annuity Payout Option.
Proceeds of a smaller amount will be paid in one sum.
o GIAC reserves the right to change the frequency of payment if
monthly annuity payments are or become $20 or less.
o GIAC requires satisfactory proof of the age and sex of the annuitant
prior to the date annuity payments begin.
o The annuity payout options will not be available with respect to any
part of the proceeds payable to an assignee or to other than a
natural person entitled to receive proceeds, except with the consent
of GIAC.
o The owner or any payee does not have the right to advance or assign
payments made under an annuity payout option.
o To the extent permitted by law, the death benefit and the payments
made under an annuity payout option will not be subject to
encumbrance, or to the claims of creditors or legal process.
Page 15 oCONTRACT NUMBER
VARIABLE ANNUITY PAYOUT OPTION TABLES
DOLLAR AMOUNT OF THE FIRST MONTHLY VARIABLE ANNUITY PAYMENT PURCHASED
WITH EACH $1,000 OF PROCEEDS APPLIED
Nearest Option V-1 Option V-2 Option V-3 Joint and Survivor Annuity Option V-4
Age of Life Annuity Life Annuity Nearest Nearest Age of Female Annuitant Period Certain
Annuitant No period 10 years Age of Male at Date of First Payment to Age 100
at Date certain certain Annuitant
of First at Date of
Payment First Age 10 Age 5 Age
M F M F Payment Yrs Yrs Same 5 Yrs Age Years
Less Less Age Older to 100
45 3.93 3.70 3.92 3.70 45 3.50 3.57 3.64 45 55 3.37
46 3.98 3.74 3.96 3.73 46 3.53 3.59 3.68 46 54 3.39
47 4.03 3.78 4.01 3.77 47 3.55 3.63 3.71 47 53 3.41
48 4.08 3.82 4.06 3.81 48 3.58 3.66 3.75 48 52 3.44
49 4.13 3.86 4.11 3.85 49 3.61 3.69 3.78 49 51 3.46
50 4.19 3.90 4.17 3.89 50 3.64 3.73 3.83 50 50 3.49
51 4.25 3.95 4.22 3.94 51 3.67 3.76 3.87 51 49 3.51
52 4.31 4.00 4.28 3.99 52 3.71 3.80 3.91 52 48 3.54
53 4.38 4.05 4.35 4.04 53 3.74 3.84 3.96 53 47 3.57
54 4.45 4.11 4.41 4.09 54 3.78 3.89 4.01 54 46 3.60
55 4.52 4.16 4.48 4.15 55 3.82 3.93 4.06 55 45 3.64
56 4.60 4.22 4.56 4.21 56 3.86 3.98 4.11 56 44 3.67
57 4.68 4.29 4.63 4.27 57 3.90 4.03 4.17 57 43 3.71
58 4.77 4.36 4.71 4.33 58 3.95 4.08 4.23 58 42 3.75
59 4.86 4.43 4.80 4.40 59 4.00 4.14 4.30 59 41 3.79
60 4.96 4.51 4.89 4.48 60 4.05 4.19 4.36 60 40 3.83
61 5.07 4.59 4.99 4.55 61 4.10 4.26 4.44 61 39 3.88
62 5.18 4.67 5.09 4.64 62 4.16 4.32 4.51 62 38 3.92
63 5.30 4.77 5.20 4.72 63 5.22 4.39 4.59 63 37 3.98
64 5.43 4.86 5.31 4.81 64 4.28 4.46 4.68 64 36 4.03
65 5.57 4.97 5.42 4.91 65 4.35 4.54 4.77 65 35 4.09
66 5.71 5.08 5.55 5.01 66 4.42 4.62 4.87 66 34 4.15
67 5.87 5.20 5.67 5.12 67 4.49 4.71 4.97 67 33 4.22
68 6.04 5.33 5.81 5.24 68 4.57 4.80 5.08 68 32 4.29
69 6.22 5.46 5.95 5.36 69 4.65 4.90 5.20 69 31 4.37
70 6.40 5.61 6.09 5.49 70 4.74 5.01 5.33 70 30 4.45
71 6.60 5.77 6.24 5.62 71 4.83 5.12 5.46 72 29 4.53
72 6.82 5.94 6.39 5.76 72 4.93 5.24 5.61 72 28 4.63
73 7.04 6.12 6.55 5.91 73 5.03 5.36 5.76 73 27 4.73
74 7.28 6.32 6.71 6.07 74 5.14 5.50 5.92 74 26 4.84
75 7.54 6.53 6.87 6.23 75 5.26 5.64 6.10 75 25 4.96
76 7.81 6.76 7.04 6.40 76 5.38 5.79 6.29 76 24 5.09
77 8.10 7.01 7.21 6.58 77 5.51 5.95 6.49 77 23 5.24
78 8.41 7.27 7.38 6.76 78 5.65 6.13 6.70 78 22 5.39
79 8.75 7.55 7.56 6.95 79 5.80 6.31 6.93 79 21 5.56
80 9.10 7.86 7.73 7.13 80 5.96 6.51 7.18 80 20 5.75
81 9.48 8.19 7.90 7.33 81 6.13 6.73 7.44 81 19 5.97
82 9.89 8.54 8.07 7.52 82 6.31 6.96 7.73 82 18 6.20
83 10.33 8.93 8.23 7.71 83 6.50 7.20 8.03 83 17 6.47
84 10.79 9.34 8.39 7.89 84 6.71 7.47 8.36 84 16 6.76
85 11.28 9.79 8.54 8.07 85 6.93 7.75 8.71 85 15 7.10
86 11.81 10.27 8.68 8.25 86 7.17 8.05 9.08 86 14 7.49
87 12.38 10.79 8.82 8.41 87 7.42 8.37 9.48 87 13 7.94
88 13.00 11.35 8.95 8.57 88 7.70 8.72 9.92 88 12 8.46
89 13.65 11.95 9.07 8.71 89 7.99 9.09 10.38 89 11 9.09
90 14.34 12.56 9.18 8.85 90 8.30 9.50 10.89 90 10 9.83
The variable income rates shown above are based on an effective annual assumed
investment return of 3 1/2% per year. The dollar amount of the monthly annuity
payment purchased for ages not shown in the tables is available upon request.
Page 16 oCONTRACT NUMBER
FIXED ANNUITY PAYOUT OPTION TABLES
DOLLAR AMOUNT OF THE MONTHLY FIXED ANNUITY PAYMENT PURCHASED
WITH EACH $1,000 OF PROCEEDS APPLIED
Option F-1 Option F-2 Option F-3 - Joint and Survivor Annuity
Life Annuity Life Annuity Nearest Nearest Age of Female Annuitant
Nearest Age No Period 10 Years Age of at Date of First Payment
of Annuitant Certain Certain Male Annuitant
at Date of at Date of
First Payment First Payment Age Age Age
M F M F 10 Years 5 Years Same 5 Years
Less Less Age Older
45 3.63 3.40 3.62 3.39 45 3.19 3.26 3.34 3.37
46 3.68 3.44 3.66 3.43 46 3.21 3.29 3.37 3.41
47 3.73 3.48 3.71 3.47 47 3.24 3.32 3.41 3.45
48 3.78 3.52 3.76 3.51 48 3.27 3.35 3.45 3.49
49 3.83 3.56 3.82 3.55 49 3.30 3.39 3.48 3.53
50 3.89 3.61 3.87 3.60 50 3.33 3.42 3.53 3.57
51 3.95 3.65 3.93 3.65 51 3.37 3.46 3.57 3.62
52 4.02 3.70 3.99 3.69 52 3.40 3.50 3.62 3.66
53 4.08 3.76 4.06 3.75 53 3.44 3.54 3.66 3.72
54 4.16 3.81 4.12 3.80 54 3.48 3.59 3.71 3.77
55 4.23 3.87 4.19 3.86 55 3.52 3.63 3.77 3.82
56 4.31 3.93 4.27 3.92 56 3.56 3.68 3.82 3.88
57 4.39 4.00 4.35 3.98 57 3.60 3.73 3.88 3.94
58 4.48 4.07 4.43 4.05 58 3.65 3.79 3.94 4.01
59 4.57 4.14 4.52 4.12 59 3.70 3.84 4.01 4.08
60 4.67 4.22 4.61 4.19 60 3.75 3.90 4.08 4.15
61 4.78 4.30 4.71 4.27 61 3.80 3.96 4.15 4.23
62 4.89 4.39 4.81 4.35 62 3.86 4.03 4.23 4.31
63 5.01 4.48 4.92 4.44 63 3.92 4.10 4.31 4.40
64 5.14 4.58 5.03 4.53 64 3.98 4.17 4.39 4.49
65 5.28 4.68 5.15 4.63 65 4.05 4.25 4.49 4.59
66 5.43 4.80 5.27 4.74 66 4.12 4.34 4.58 4.69
67 5.58 4.92 5.40 4.84 67 4.19 4.42 4.69 4.81
68 5.75 5.04 5.53 4.96 68 4.27 4.52 4.80 4.93
69 5.93 5.18 5.67 5.08 69 4.36 4.62 4.92 5.05
70 6.11 5.33 5.82 5.21 70 4.44 4.72 5.05 5.19
71 6.31 5.49 5.97 5.35 71 4.54 4.83 5.18 5.34
72 6.53 5.66 6.12 5.49 72 4.64 4.95 5.32 5.49
73 6.75 5.84 6.28 5.64 73 4.74 5.08 5.48 5.66
74 6.99 6.04 6.44 5.80 74 4.85 5.21 5.64 5.83
75 7.24 6.25 6.61 5.97 75 4.97 5.35 5.82 6.02
76 7.51 6.48 6.78 6.14 76 5.09 5.51 6.00 6.23
77 7.81 6.72 6.95 6.31 77 5.22 5.67 6.21 6.44
78 8.12 6.99 7.13 6.50 78 5.36 5.84 6.42 6.67
79 8.45 7.27 7.30 6.68 79 5.51 6.03 6.65 6.92
80 8.80 7.57 7.48 6.88 80 5.67 6.23 6.89 7.19
81 9.18 7.90 7.65 7.07 81 5.83 6.44 7.16 7.47
82 9.59 8.25 7.82 7.26 82 6.02 6.67 7.44 7.78
83 10.02 8.64 7.99 7.45 83 6.21 6.91 7.74 8.10
84 10.48 9.05 8.15 7.64 84 6.42 7.18 8.07 8.46
85 10.98 9.49 8.30 7.83 85 6.64 7.46 8.42 8.83
86 11.50 9.97 8.45 8.00 86 6.87 7.76 8.79 9.24
87 12.07 10.49 8.58 8.17 87 7.13 8.08 9.19 9.67
88 12.69 11.05 8.72 8.33 88 7.40 8.43 9.63 10.14
89 13.34 11.64 8.84 8.48 89 7.69 8.80 10.09 10.63
90 14.02 12.25 8.95 8.62 90 8.00 9.20 10.59 11.16
The dollar amount of the monthly annuity payment purchased for ages not shown in
the tables are available upon request.
oCONTRACT NUMBER
11. GENERAL PROVISIONS
The Contract
The entire contract consists of the basic contract and any attached
endorsements, additional benefit riders, and application(s). GIAC relied upon
the application(s) in issuing this contract. All statements in the
application(s) are assumed to be true to the best knowledge and belief of the
person(s) making them. These statements are representations and not warranties.
Only the President, a Vice President, or the Secretary of GIAC may make or
modify this contract, and then only in writing. No agent is authorized to:
o change this contract;
o waive any of GIAC's requirements; or
o waive an answer to any question in the application(s).
GIAC will not be bound by any promise or statement made by any agent or other
person except as stated above.
GIAC may at any time make any change in this contract to the extent that such
change is required in order to make this contract conform with any law or any
regulation issued by any governmental authority to which it is subject.
Any paid-up annuity benefit, surrender value, or death benefit payable under
this contract is not less than the minimum required by the jurisdiction in which
this contract is delivered.
Age and Sex
If the age or sex of the annuitant has been misstated, GIAC will adjust any
benefit payable under this contract, based on the correct age and sex.
Overpayments made by GIAC because of such misstatement, with interest at 6% a
year, compounded annually, will be charged against benefits falling due after
the adjustment. If underpayments are made by GIAC because of such misstatement,
GIAC will pay the balance immediately, with 6% interest, compounded annually.
Proof of Age and Survival
GIAC has the right to require satisfactory proof:
o of the age of the payee or payees; and
o that a payee is living when a payment is contingent upon the payee's
survival.
Communications with GIAC
GIAC receives all communications only at its Customer Service Office. Please
include the contract number, full names of any owner(s) and annuitant, and each
owner's current address in all correspondence with GIAC.
Payments by GIAC
Any payment by GIAC under this contract is payable at its Customer Service
Office. GIAC reserves the right to require surrender of this contract prior to
payment of the death benefit.
Nonparticipating
This contract is not eligible for dividends and will not share in the surplus
earnings of GIAC.
Ownership of the Assets
GIAC shall have ownership and control of its assets, including all assets
allocated to Account F.
Deferment
GIAC will ordinarily pay any partial withdrawals or surrender proceeds within
seven (7) days after the date the owner's request for withdrawal or surrender is
received in Good Order by GIAC at its Customer Service Office. However, when
permitted by law, GIAC may defer payment of any partial withdrawals or surrender
proceeds for up to 6 months after written request for such withdrawal or
surrender is received in Good Order by GIAC at its Customer Service Office.
The amount payable will be determined as of the date written request is received
by GIAC in Good Order at its Customer Service Office. Interest will accrue
daily, starting on the date deferment begins, at the rate of 3% on any amount
deferred 30 days or more.
GIAC may defer calculation or payment of any partial withdrawals or surrender
proceeds or the transfer of amounts based on separate account performance if:
o the New York Stock Exchange is closed for trading or trading has
been suspended; or
o the Securities and Exchange Commission restricts trading or
determines that a state of emergency exists which may make such
calculation, payment, or transfer impracticable.
Page 18 oCONTRACT NUMBER
GENERAL PROVISIONS - cont'd
Reports to the Owner
GIAC will provide a written report to the owner once each contract year while
this contract has an Accumulation Value. No reports will be sent after monthly
annuity payments begin. The annual report will include the following information
as of the most recent Contract Anniversary:
o the Accumulation Value; and
o the surrender value.
The report will also include any other information required by the jurisdiction
in which this contract is delivered.
Page 19 oCONTRACT NUMBER
ALPHABETICAL INDEX
Subject Page
Accumulation Units ......................................... 4, 11
Accumulation Unit Value for a Variable Investment Option ... 11
Accumulation Value ......................................... 4, 11
Age and Sex ................................................ 3, 18
Allocation of Net Premiums ................................. 8
Annuity Benefit ............................................ 6
Annuity Commencement Date .................................. 3, 6
Annuity Payments ........................................... 13
Annuity Unit Values ........................................ 14
Assignment ................................................. 5
Beneficiary ................................................ 5
Change of Owner or Beneficiary ............................. 5
Change of Annuity Commencement Date or Annuity Payout Option 6
Communications with GIAC ................................... 18
Contingent Annuitant ....................................... 4, 5
Contingent Deferred Sales Charge ........................... 12
Contract Anniversary ....................................... 4
Contract Data .............................................. 3
Contract Fee ............................................... 11
Contract, The .............................................. 18
Death Benefits ............................................. 7
Death of Annuitant Before Annuity Commencement Date
When the Annuitant is Not an Owner ......................... 7
Death of an Owner .......................................... 7
Deferment .................................................. 18
Definitions ................................................ 4
Determination of Annuity Payments .......................... 14
Determination of Variable Annuity Payments After the First . 14
Fixed Annuity Payout Options ............................... 14
Fixed Annuity Payout Option Tables ......................... 17
Guardian Separate Account F ................................ 9
Investment Divisions ....................................... 9
Issue Date ................................................. 3, 4
Joint Owners ............................................... 5
Monthly Anniversary ........................................ 4
Net Investment Factor ...................................... 11
Nonparticipating ........................................... 18
Owner ...................................................... 3, 5
Ownership of the Assets .................................... 18
Partial Withdrawals ........................................ 12
Payees ..................................................... 13
Payments by GIAC ........................................... 18
Payment of Contract Proceeds ............................... 13
Premiums ................................................... 8
Proof of Age and Survival .................................. 18
Reports to the Owner ....................................... 19
Rights Reserved ............................................ 9
Special Rules .............................................. 7
Surrender of Contract ...................................... 12
Transfers After the Annuity Commencement Date .............. 10
Transfers Before the Annuity Commencement Date ............. 10
Valuation Date ............................................. 4
Valuation Period ........................................... 4
Variable Annuity Payout Options ............................ 13, 14
Variable Annuity Payout Option Tables ...................... 16
Page 20
Individual Flexible Premium Deferred Variable Annuity Contract
o Premiums payable before the Annuity Commencement Date, in
accordance with contract provisions
o Monthly annuity payments begin on the Annuity Commencement
Date
o Benefits based on the investment experience of a Separate
Account are variable and are not guaranteed
o Non-participating - No dividends payable
[GRAPHIC OMITTED-GUARDIAN]
