VA770NY Thank you for choosing Jackson National Life Insurance Company of New York®, hereinafter also referred to as "the Company" or "Jackson of NY®." READ YOUR CONTRACT CAREFULLY. This annuity contract is issued by the Company and is a legal...
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VA770NY Thank you for choosing Xxxxxxx National Life Insurance Company of New York®, hereinafter also referred to as "the Company" or "Xxxxxxx of NY®." READ YOUR CONTRACT CAREFULLY. This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and Xxxxxxx of New York. THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION AND ANNUITY PERIODS IS NOT GUARANTEED AND MAY INCREASE OR DECREASE BASED UPON THE INVESTMENT EXPERIENCE OF THE FUND(S) UNDERLYING THE SEPARATE ACCOUNT. IF THE ACTUAL INVESTMENT RATES EXPERIENCED BY THE SEPARATE ACCOUNT ASSETS (PRIOR TO DEDUCTION OF THE ASSET BASED CHARGES SPECIFIED IN THIS CONTRACT) ARE LESS THAN 1.30%, VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME. AMOUNTS ALLOCATED TO THE FIXED ACCOUNT(S) WILL EARN INTEREST AT THE CURRENT INTEREST RATE FOR THE DURATION OF THE FIXED ACCOUNT OPTION PERIOD. THE INTEREST RATE CREDITED FOR SUBSEQUENT PERIODS IS SUBJECT TO CHANGE AS DECLARED BY THE COMPANY. THE FIXED ACCOUNT OPTIONS ARE SUBJECT TO AN INTEREST RATE ADJUSTMENT FORMULA WHICH MAY INCREASE OR DECREASE AMOUNTS PAYABLE, TRANSFERRED OR WITHDRAWN, BUT THE FIXED ACCOUNT CONTRACT VALUE WILL NEVER DECREASE TO LESS THAN THE SUM OF THE FIXED ACCOUNT MINIMUM VALUES. THE CONTRACT VALUE HELD UNDER A FIXED ACCOUNT OPTION MAY BE WITHDRAWN WITHOUT AN INTEREST RATE ADJUSTMENT UPON RECEIPT OF WRITTEN NOTICE WITHIN 30 DAYS FOLLOWING THE END OF THE CORRESPONDING FIXED ACCOUNT OPTION. PLEASE READ THE IMPORTANT CONTRACT DISCLOSURES ON THE FOLLOWING PAGE. NOTICE OF RIGHT TO EXAMINE CONTRACT YOU MAY RETURN THIS CONTRACT TO THE SELLING PRODUCER OR THE COMPANY WITHIN 20 DAYS (60 DAYS IF IT WAS PURCHASED AS A REPLACEMENT CONTRACT) AFTER YOU RECEIVE IT. UPON RECEIPT OF THIS CONTRACT, THE COMPANY WILL REFUND THE FULL PREMIUM ALLOCATED TO THE FIXED ACCOUNTS LESS ANY WITHDRAWALS FROM THE FIXED ACCOUNT INCLUDING ANY FEES OR OTHER CHARGES, PLUS THE SEPARATE ACCOUNT CONTRACT VALUE. UPON SUCH REFUND, THIS CONTRACT SHALL BE VOID. THE EFFECTIVE DATE OF THE SURRENDER, AND THE DATE THE INVESTMENT DIVISIONS IN THE SEPARATE ACCOUNT WILL BE VALUED, WILL BE THE DATE THE CONTRACT WAS MAILED TO THE COMPANY, OR RETURNED TO THE SELLING PRODUCER. Please Note: The Company reserves the right to allocate initial Premium and any subsequent Premium received during the "Notice of Right to Examine Contract" period to a money market Investment Division or a Fixed Account and will allocate the Contract Value to the Investment Divisions specified by the Contract Owner when the "Notice of Right to Examine Contract" period has expired. Home Office: Service Center 0000 Xxxxxxxxxxx Xxxxxx P.O. Box 24068 Purchase, New York 10577 Lansing, MI 48909-4068 1-800-599-5651 xxx.xxxxxxx.xxx INDIVIDUAL DEFERRED VARIABLE AND FIXED ANNUITY CONTRACT WITH INTEREST RATE ADJUSTMENT (FLEXIBLE PREMIUM). DEATH BENEFIT AVAILABLE. INCOME OPTIONS AVAILABLE. NONPARTICIPATING. CONTAINS PROVISIONS WAIVING WITHDRAWAL CHARGES. This Contract is signed by the Company President Secretary
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VA770NY Contract Cover Page Continued IMPORTANT - CONTRACT DISCLOSURES PLEASE READ CAREFULLY PLEASE REVIEW THE CONTRACT DATA PAGES FOR CONTRACT CHARGES. THE FIXED ACCOUNT MINIMUM INTEREST RATE FOR THIS CONTRACT WILL BE REDETERMINED ON THE REDETERMINATION DATE ANNUALLY EACH JANUARY. FUTURE PREMIUM PAYMENTS MAY BE RESTRICTED BY THE COMPANY WHICH WOULD LIMIT YOUR ABILITY TO INVEST IN THE CONTRACT AND COULD AFFECT YOUR VALUES AND BENEFITS. THE COMPANY RESERVES THE RIGHT TO RESTRICT THE AVAILABILITY OF THE FIXED ACCOUNT OPTION(S) ON OR AFTER ISSUE OF THIS CONTRACT. THE COMPANY RESERVES THE RIGHT TO RESTRICT THE AMOUNT AND FREQUENCY OF TRANSFERS INTO AND FROM ANY FIXED ACCOUNT OPTION. ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE DATE. PLEASE CHECK THE CONTRACT DATA PAGE TO DETERMINE WHICH DCA+ FIXED ACCOUNT OPTIONS ARE CURRENTLY AVAILABLE. THE COMPANY RESERVES THE RIGHT TO RESTRICT THE AVAILABILITY OF THE DCA+ FIXED ACCOUNT OPTIONS AFTER ISSUE OF THIS CONTRACT. Home Office: Service Center 0000 Xxxxxxxxxxx Xxxxxx P.O. Box 24068 Purchase, New York 10577 Lansing, MI 48909-4068 1-800-599-5651 xxx.xxxxxxx.xxx
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VA770NY 2 TABLE OF CONTENTS Provision Page Number Contract Data Pages 3a Definitions 4 General Provisions 8 Accumulation Provisions 13 Withdrawal Provisions 17 Death Benefit Provisions 21 Income Provisions 25 Termination Provision 29 If You have questions about this Contract including requests for information about coverage or complaint resolutions, You may contact our Service Center as specified on the cover page of the Contract.
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VA770NY 3a CONTRACT DATA PAGE Contract Number: 1234567890 Owner: Xxxx Xxx Owner Issue Age: 35 Joint Owner: Xxxx Xxx Joint Owner Issue Age: 35 Annuitant: Xxxx Xxx Annuitant Issue Age: 35 Joint or Contingent Annuitant: Xxxx Xxx Joint or Contingent Annuitant Issue Age: 35 Initial Premium: $25,000 Issue Date: September 1, 2016 Issue State: New York Income Date: September 1, 2076 Initial Fixed Account Minimum Interest Rate: 1.00% The Fixed Account Minimum Interest Rate will be redetermined on each Redetermination Date, as described under the Accumulation Provisions (Page 16). Initial Current Interest Rate: 1.00% for the 1-Year Fixed Option Period 1.00% for the 3-Year Fixed Option Period 1.00% for the 5-Year Fixed Option Period 1.00% for the 7-Year Fixed Option Period Initial Current DCA+ Interest Rate: 6-month X.XX% NOT AVAILABLE 12-month X.XX% NOT AVAILABLE ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE DATE. AVAILABILITY IS INDICATED ABOVE. Beneficiary(ies): Xxxxx Xxx
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VA770NY 3b CONTRACT DATA PAGE (CONT'D) Mortality and Expense On an annual basis, this charge equals 0.2500% of the daily Charge: net asset value of the Investment Divisions. Administration Charge: On an annual basis, this charge equals 0.050% of the daily net asset value of the Investment Divisions. This charge will not be assessed if the Contract Value on the later of the Issue Date or the most recent Contract Quarterly Anniversary is greater than or equal to $1,000,000. If the Contract Value subsequently falls below $1,000,000 on any Contract Quarterly Anniversary, this charge will be reinstated. Total Asset Based Charges: On an annual basis, the total of all asset based charges is equal to 0.3000% of the daily net asset value of the Investment Divisions. Asset based charges are deducted daily as part of the Accumulation Unit Value calculation. Total asset based charges include the Mortality and Expense Charge, the Administration Charge and asset based charges for optional benefits. Optional Benefits Elected at Issue: BENEFIT CHARGE
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VA770NY 3c CONTRACT DATA PAGE (CONT'D) Annual Contract An annual charge of no more than $30.00 will be deducted Maintenance Charge: on each Contract Anniversary from those Contracts where the Contract Value is less than $50,000. Withdrawal Charge Completed Years Since Withdrawal Charge Schedule: Receipt of Premium Percentage 0 2.00% 1 2.00% 2 1.00% 3+ 0.00% The Company may reduce or waive the Withdrawal Charge when the Contract is purchased by employees, agents, and financial representatives of the Company or its affiliates. These transactions will be conducted in a nondiscriminatory manner and under circumstances that reduce the Company's sales expense. Withdrawals: Minimum partial withdrawal amount: $500 Minimum Contract Value remaining after withdrawal: $100 Minimum partial withdrawal made in connection with a systematic withdrawal program: $50 Additional Free Withdrawal Percentage: 10% Interest Rate Adjustment: Certain payments, transfers and withdrawals from a Fixed Account Option are subject to an Interest Rate Adjustment, the calculation of which may result in an increase or decrease in amounts payable. In no event will a total withdrawal from a Fixed Account Option be less than the Fixed Account Minimum Value. (See Fixed Account section of the Contract for details.)
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VA770NY 3e CONTRACT DATA PAGE (CONT'D) Premium(s): Premiums are flexible. This means that the Owner may change the amounts, frequency or timing of Premiums, subject to the minimum and maximum Premium amounts and the Company's reserved rights specified below. The initial Premium must be at least $25,000 for Non-Qualified Plan Contracts and $25,000 for Qualified Plan Contracts. Subsequent Premiums must be at least $500 ($50 if made in connection with an automatic payment plan). Total Premiums under a Contract may not exceed $1,000,000, or such lesser amount established by the Company pursuant to the reserved rights specified below. The Company may waive the minimums or maximums at any time. The Company reserves the right to limit, restrict, suspend or reject any or all subsequent Premium payments and to limit the amount, frequency or timing of Premium payments at any time on a nondiscriminatory basis. Written notice will be sent to You at least thirty (30) days in advance of any limitation, restriction, or suspension placed on subsequent Premium payments. The Owner may allocate Premiums among the Fixed Account Option(s) and Investment Divisions, subject to the approval of the Company, which will be granted in advance on a nondiscriminatory basis. Allocations may be made in any percent from 0% to 100%. The minimum that may be allocated to a Fixed Account Option or an Investment Division is $100. The Company reserves the right to restrict or refuse any Premium allocation to a Fixed Account Option(s) at any time on a nondiscriminatory basis. Any subsequent Premium will be allocated according to the most recent instructions on file with the Company, provided that each allocation meets the minimums and restrictions described above, regardless of such instructions. The Company reserves the right to require, in advance, the automatic transfer of amounts allocated to the 1-Year Fixed Account Option to the Investment Division(s) of Your choice in regular installments over a specified period from the date of allocation on a nondiscriminatory basis. A pre-determined amount will be transferred from the 1-Year Fixed Account Option to the Investment Division(s) selected by the Owner such that at the end of the specified period all amounts in the 1-Year Fixed Account Option will have been transferred. The Company reserves the right to specify in advance the transfer amount, the transfer frequency, and the length of the period over which the transfers will be completed. The funds being transferred will be allocated to the Investment Division(s) elected by You. You may change the selected Investment Division(s) at any time. These automatic transfers will not count against the 15 free transfers in a Contract Year.
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VA770NY 3f CONTRACT DATA PAGE (CONT'D) Systematic Investment The minimum allocation amount to participate in the enhanced Allocation Amount: dollar cost averaging program is $15,000. CONTRACT OPTIONS: Investment Division(s): Availability is indicated in the Contract, application, current prospectus and any supplements. The Company may periodically add or delete Investment Divisions. Contract Option The number of Contract Options that the Contract Value can Allocation(s) Allowed: be allocated to may not exceed 99. Separate Account: JNLNY Separate Account I Fixed Account Options: 1-Year Period; 3-Year Period; 5-Year Period; and 7-Year Period. The 1-Year, 3-Year, 5-Year, and 7-Year periods may not be available at all times. Availability is indicated in the current prospectus and any supplements or related Fixed Account documents. The Contract Options You have selected will be detailed in a confirmation sent to You by the Company on or after the Issue Date and are stated in the Contract application attached to the Contract.
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VA770NY 4 DEFINITIONS ACCUMULATION UNIT. A unit of measure used to calculate the value in an Investment Division prior to the Income Date. ANNUITANT. The natural person(s) on whose life annuity payments for this Contract are based. Any reference to Annuitant includes any Joint Annuitant. The Company reserves the right to limit the number of Joint Annuitants to two (2). ANNUITY UNIT. A unit of measure used to calculate the amount of a variable annuity payment. BASE INTEREST RATE. The rate of interest declared by the Company for a specified Fixed Account Option period. BENEFICIARY(IES). The natural person(s) or entity(ies) designated by the Owner to receive any death benefit payable under this Contract. BUSINESS DAY. Any day that the New York Stock Exchange (NYSE) is open for business. The Business Day ends when the NYSE closes, which is usually at 4 p.m. Eastern Time. CONTINGENT ANNUITANT. The natural person that is designated as a covered life for purposes of electing an optional endorsement on a Qualified Plan custodial account contract only. Any reference to the Annuitant does not include any Contingent Annuitant. CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract described herein. CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date. CONTRACT OPTION(S). The allocation options offered under this Contract. Each Contract Option is more fully explained in the Accumulation Provisions. CONTRACT QUARTERLY ANNIVERSARY. Each three-month anniversary of the Issue Date. CONTRACT VALUE. The Contract Value equals the sum of the Separate Account Contract Value and the Fixed Account Contract Value. CONTRACT YEAR. The twelve-month period beginning on the Issue Date or on any Contract Anniversary thereafter while the Contract remains in force. CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate credited by the Company, less any charges due under any optional endorsements to the Contract. In no event will the Current Interest Rate be less than the Fixed Account Minimum Interest Rate.
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VA770NY 5 DEFINITIONS (CONT'D) DESIGNATED OPTION(S). The Investment Division(s) and/or Fixed Account Option(s) made available by the Company and selected by the Owner to which amounts will be transferred from a Source Option pursuant to one of the Company's systematic investment programs. DUE PROOF. Evidence of death, including but not limited to a certified death certificate issued by the governmental authority where the death occurred, or other evidence satisfactory to the Company. FIXED ACCOUNT. Contract Values allocated to one or more of the Fixed Account Options. Allocations made to Fixed Account Options are part of the general account of the Company. The general account is made up of all general assets of the Company, other than those in the Separate Account and other segregated asset accounts. FIXED ACCOUNT CONTRACT VALUE. The sum of all amounts allocated or transferred to the Fixed Account Options under the Contract, reduced by any applicable taxes, plus all interest credited to the Fixed Account Options, adjusted for withdrawals (including any applicable charges and adjustments for such withdrawals), transfers and charges. FIXED ACCOUNT MINIMUM INTEREST RATE. The interest rate used to determine the Fixed Account Minimum Value. The Fixed Account Minimum Interest Rate may vary by Redetermination Period as described in the Accumulation Provisions. The Initial Fixed Account Minimum Interest Rate is shown on the Contract Data Page. FIXED ACCOUNT MINIMUM VALUE. Premiums, net of any applicable premium tax, and transfers allocated to the Fixed Account Option, less transfers, withdrawals, and charges from the Fixed Account Option, accumulated at the Fixed Account Minimum Interest Rate, less any Withdrawal Charge or tax due. FIXED ACCOUNT OPTION. A Contract Option within the Fixed Account for a specific period under which the Current Interest Rate will be credited. GOOD ORDER. The receipt by the Company of any and all information, documentation, instructions and/or Premium deemed necessary by the Company to issue the Contract or execute any transaction pursuant to the terms of the Contract. INCOME DATE. The date on which annuity payments are to begin as described in the Income Provisions. INTEREST RATE ADJUSTMENT. An adjustment applied, with certain exceptions, to amounts withdrawn, transferred or annuitized from a Fixed Account Option prior to the end of the applicable Fixed Account Option period. INVESTMENT DIVISIONS. Separate and distinct divisions of the Separate Account to which specific Underlying Mutual Fund shares are allocated, and for which Accumulation Units and Annuity Units are separately maintained. The Contract Value in the Investment Divisions will go up or down depending on the performance of the Underlying Mutual Funds.
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VA770NY 7 DEFINITIONS (CONT'D) SOURCE OPTION. The Investment Division or Fixed Account Option made available by the Company and selected by the Owner from which amounts will be transferred to a Designated Option(s) pursuant to one of the Company's systematic investment programs. UNDERLYING MUTUAL FUNDS. The registered management investment companies in which assets of the Investment Divisions of the Separate Account will be invested. WITHDRAWAL CHARGE. The charge assessed against certain withdrawals from the Contract. The Withdrawal Charge Schedule is shown on the Contract Data Page. WITHDRAWAL VALUE. The Contract Value, less any tax payable, applicable Withdrawal Charges, Annual Contract Maintenance Charges, and charges due under any optional endorsement to the Contract, adjusted for any applicable Interest Rate Adjustment.
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VA770NY 12 GENERAL PROVISIONS (CONT'D) WRITTEN NOTICE. Written information or instructions given to the Company by You must be in a form satisfactory to the Company, referred to as Good Order. Any written request or notice You make to the Company must be sent to the Service Center, unless the Company advises You otherwise. A notice relating to Owner, Beneficiary designation or assignment changes shall take effect on the date signed by the Owner, subject to action taken by the Company prior to receipt in writing at the Company's Service Center. Otherwise, any other notice takes effect on the date it was received and it is recorded at the Service Center. Any notice the Company sends to the Owner will be sent to the Owner's last known address unless the Owner requests otherwise in writing. It is Your responsibility to promptly provide the Company notice of Your address change or any error in a Company notice sent to You.
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VA770NY 13 ACCUMULATION PROVISIONS An Owner may not allocate Contract Values to more than the maximum number of Contract Options, specified on the Contract Data Page at any one time. The Company may waive this restriction. SEPARATE ACCOUNT. The Separate Account consists of assets the Company has set aside and has kept separate from the Company's general account assets and other segregated asset accounts. The Separate Account assets will not be charged with liabilities arising out of any other business the Company may conduct. All the income, gains, and losses resulting from these assets are credited to or charged against the contracts supported by the Separate Account, and not against any other contracts the Company may issue. The assets of the Separate Account will be available to cover the liabilities of the Company's general account only to the extent that the assets of the Separate Account exceed the liabilities of the Separate Account arising under the Contracts supported by the Separate Account. The Separate Account consists of several Investment Divisions. The assets of the Separate Account shall be valued at least as often as any benefits of this Contract, but in no event will such valuation be less frequently than monthly. Accumulation Units. The Separate Account Contract Value may increase or decrease depending on the performance of the Investment Divisions. In order to monitor the Separate Account Contract Value during the accumulation phase, the Company uses a unit of measure called an Accumulation Unit. The value of an Accumulation Unit may increase or decrease from Business Day to Business Day. Adjustments to the Contract Value, such as withdrawals, transfers, and charges, result in the redemption of Accumulation Units. However, these adjustments do not affect the value of the Accumulation Units. When You make an allocation to the Investment Divisions, the Company credits Your Contract with Accumulation Units. The number of Accumulation Units credited is determined by dividing the amount allocated to any Investment Division by the Accumulation Unit Value for that Investment Division at the close of the Business Day when the allocation is made. Accumulation Unit Value. The Company determines the value of an Accumulation Unit for each of the Investment Divisions by: 1. determining the total amount of money invested in the particular Investment Division; 2. subtracting from that amount any Mortality and Expense Charge, Administration Charge, and any other asset based charge for optional benefits and taxes; 3. dividing the remainder by the number of outstanding Accumulation Units. FIXED ACCOUNT. For any amounts allocated to the Fixed Account, the Owner will select the duration of the Fixed Account Option from those made available by the Company. Such amounts will earn interest at the Current Interest Rate for the chosen duration, compounded annually during the entire Fixed Account Option period. Subsequent Base Interest Rates may be higher or lower than the Base Interest Rates previously declared by the Company.
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VA770NY 16 ACCUMULATION PROVISIONS (CONT'D) Fixed Account Minimum Interest Rate. On the Issue Date, the Initial Fixed Account Minimum Interest Rate is shown on the Contract Data Page. On each subsequent Redetermination Date, the Fixed Account Minimum Interest Rate will be redetermined. The redetermined rate will apply for that Redetermination Period. The Fixed Account Minimum Interest Rate will be equal to: 1. the average of all of the daily reported five-year Constant Maturity Treasury Rates during October of the previous year, rounded to the nearest 1/20th of a percent; less, 2. 1.25%. The Fixed Account Minimum Interest Rate determined by this calculation may not be less than 1% nor greater than 3%. The Company will send You an annual notice of the redetermined Fixed Account Minimum Interest Rate.
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VA770NY 17 WITHDRAWAL PROVISIONS At or before the Income Date, and while the Owner is living, the Owner may request a total or partial withdrawal of the Contract Value by submitting a request to the Service Center on a withdrawal form available from the Company. For a total withdrawal, this Contract must be returned to the Company's Service Center. Amounts withdrawn from the Contract Value may be subject to a Withdrawal Charge. In addition to a Withdrawal Charge, a withdrawal from a Fixed Account Option may also incur an Interest Rate Adjustment. Upon a total withdrawal, the Owner will receive the Withdrawal Value. The Withdrawal Value will be based on values at the end of the Business Day on which the request for withdrawal is received at the Company's Service Center in Good Order. In no event shall the amount withdrawn, whether a total withdrawal or partial withdrawal, exceed the Withdrawal Value. Each partial withdrawal must be for an amount which is not less than the minimum partial withdrawal amount specified on the Contract Data Page or, if less, the Owner's entire interest in the Investment Division or Fixed Account Option. If the Contract Value is less than the minimum partial withdrawal amount specified on the Contract Data Page, any withdrawal will be treated as a total withdrawal and the Withdrawal Value will be paid. The minimum withdrawal amount may vary in connection with an automatic withdrawal program. The Owner's interest in each Investment Division or Fixed Account Option from which the withdrawal is requested must be at least equal to the minimum Contract Value specified on the Contract Data Page after the withdrawal is completed or the Owner's entire interest in that Investment Division or Fixed Account Option will be withdrawn. The withdrawal will be made from each Investment Division and each Fixed Account Option in proportion to their current value, unless otherwise specified. Withdrawals will be based on values at the end of the Business Day on which the request for withdrawal is received in Good Order at the Service Center. The Company will waive the Withdrawal Charge and Interest Rate Adjustment on any withdrawal necessary to satisfy the minimum distribution requirements of the Internal Revenue Code. Any withdrawal in excess of the required minimum distribution will cause the entire amount to be subject to any applicable Withdrawal Charge and/or Interest Rate Adjustment. You may elect to take a systematic withdrawal by surrendering a specific sum or a certain percentage on a monthly, quarterly, semiannual or annual basis, subject to the minimum partial withdrawal amount made in connection with a systematic withdrawal program specified on the Contract Data Page. Such withdrawals will be counted in determining the portion of the Contract Value taken as an Additional Free Withdrawal. Systematic withdrawals in excess of the Additional Free Withdrawal amount may be subject to a Withdrawal Charge and/or an Interest Rate Adjustment.
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VA770NY 20 WITHDRAWAL PROVISIONS (CONT'D) Physician - means an individual who is licensed to practice medicine and treat illness or injury in the state where treatment is received and who is acting within the scope of his or her license. The term Physician only refers to a Physician licensed and currently practicing in the United States or its territories. Physician does not include: 1. an Annuitant or Joint Annuitant; 2. an Owner or Joint Owner; 3. Beneficiary(ies); 4. a person who is part of the Annuitant's or Joint Annuitant's, Owner's or Joint Owner's Immediate Family. Physician's Statement - means a written statement, acceptable to the Company, signed by a Physician which gives the Physician's diagnosis of the Owner's medical condition. Once Your eligibility has been established, You may request one withdrawal or multiple withdrawals subject to the maximum allowed. You are not eligible for this waiver if: 1. You are confined to a Nursing Home or Hospital during the thirty-day period following the Issue Date, unless such confinement is not related to a subsequent confinement for which You request the waiver; or, 2. You are no longer confined to a Nursing Home or Hospital. Confinement to the Nursing Home or Hospital must be prescribed by a Physician and be medically necessary, meaning the confinement is appropriate and consistent with the diagnosis in accordance with accepted standards of practice, and which could not have been omitted without adversely affecting the confined Owner's condition. Claim Requirements. Written Notice and proof of claim of the Owner's confinement must be submitted to the Company at its Service Center ninety (90) days after the date the Owner becomes confined to a Nursing Home or Hospital before a waiver will be considered pursuant to this provision. Written proof includes: (1) a properly completed Company claim form, (2) Your signed medical records release; and (3) a Physician's statement of condition satisfactory to the Company. The Company reserves the right to request additional medical information from any Physician, Hospital or Nursing Home. The Company may require, at its expense, an additional examination by a Physician of its choice. If there is a discrepancy between medical opinions, the opinion of the Company's Physician will govern. A PAYMENT UNDER THIS PROVISION MAY BE TAXABLE. AS WITH ALL TAX MATTERS, YOU ARE ENCOURAGED TO SEEK LEGAL AND/OR TAX ADVICE.
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VA770NY 22 DEATH BENEFIT PROVISIONS (CONT'D) Any portion of the death benefit not applied under Option 3 within one (1) year of the date of the Owner's death must be distributed within five (5) years of the date of the Owner's death. If a single lump-sum payment is requested, the amount will be paid within seven (7) calendar days of receipt of proof of death and the election in Good Order at the Company's Service Center, unless either the Suspension of Payments or Deferment of Payments under the General Provisions is in effect. Payment to the Beneficiary, other than in a single lump-sum, may only be elected during the sixty-day period beginning with the date of receipt of Due Proof of death by the Service Center. Spousal Continuation Option. If the Joint Owner, if any, or the Beneficiary is the spouse of the deceased Owner, he or she may elect to continue the Contract in his or her own name, at the current Contract Value, and exercise all the Owner's rights under the Contract in lieu of taking the death benefit as a lump-sum payment. Optional guaranteed minimum death benefits will be terminated upon utilization of the Spousal Continuation Option. Special Spousal Continuation Option. In lieu of taking the death benefit as a lump-sum payment or continuing the Contract at the then current Contract Value, if the Beneficiary is the spouse of the Contract Owner, he or she may elect to continue the Contract at an adjusted Contract Value as described below. The spouse will then exercise all the Contract Owner's rights under the Contract. The date that the Company receives the spouse's written request to continue the Contract, under this Special Spousal Continuation Option, and proof of the death of the Contract Owner in Good Order will be referred to as the Continuation Date. The Contract Value for the continuing Contract will be adjusted so that it will equal the amount of the death benefit that would have been payable as a lump-sum payment at Your death. If the Contract Value on the Continuation Date is less than the death benefit, an amount will be added to the Contract Value to make up the difference. This amount is referred to as the Continuation Adjustment. The Continuation Adjustment will be allocated among the Contract Options in accordance with the current instructions for the Contract, subject to any minimum allocation restrictions unless the Company receives other allocation instructions with the Special Spousal Continuation Option election. Withdrawal Charges will continue with the same schedule as prior to the initial Owner's death. However, no Withdrawal Charge schedule will apply to the Continuation Adjustment. For purposes of determining future death benefits under the continuing Contract, the Contract Value following the application of any Continuation Adjustment will be considered as the initial Premium of the continuing Contract. Any future death benefit will be determined on that basis and will use the age of the surviving spouse on the Continuation Date. This Special Spousal Continuation Option can only be exercised one time under this Contract, but may not be available if the Owner elected to pre-select the death benefit option. Any benefit available under this Special Spousal Continuation Option will end upon the change of ownership or assignment of the Contract. Optional guaranteed minimum death benefits will be terminated upon utilization of the Special Spousal Continuation Option.
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VA770NY 26 INCOME PROVISIONS (CONT'D) OPTION 2 - JOINT AND SURVIVOR. An annuity payable monthly while both the Annuitant and a designated second person are living. Upon the death of either person, the monthly annuity payments will continue during the lifetime of the survivor at either the full amount previously payable or as a percentage (either one-half or two-thirds) of the full amount, as chosen at the time of election of the income options. If a reduced annuity payment to the survivor is desired, variable annuity payments will be determined using either one-half or two-thirds of the number of each type of Annuity Unit credited. Fixed annuity payments will be equal to either one-half or two-thirds of the fixed annuity payment payable during the joint life of the Annuitant and the designated second person. Annuity payments terminate automatically and immediately upon the death of the surviving person without regard to the number or total amount of payments received. There is no minimum number of fixed annuity payments, and it is possible to have only one (1) annuity payment if both the Annuitant and the designated second person die before the due date of the second payment. In the event of the death of the Annuitant after the Income Date and prior to the first monthly annuity payment, the amount allocated to the income option will be paid to the Owner or the Owner's Beneficiary. OPTION 3 - LIFE ANNUITY WITH 120 OR 240 MONTHLY PERIODS GUARANTEED. An annuity payable monthly during the lifetime of the Annuitant with the guarantee that if, at the death of the Annuitant, payments have been made for fewer than the guaranteed 120 or 240 monthly periods, as elected, the balance of the guaranteed number of payments will continue to be made to the Owner as scheduled. In the event the Owner dies before the specified number of guaranteed payments has been made, the Beneficiary(ies) may elect to continue receiving the fixed and variable payments according to the terms of this Contract or may alternatively elect to receive the present value of any remaining guaranteed payments in a single lump-sum, the amount of which is calculated by the Company. The present value of any remaining guaranteed payments will be based on the total annuity payment as of the date of the calculation. OPTION 4 - INCOME FOR A SPECIFIED PERIOD. Under this income option, the Owner can elect monthly payments for any number of years from 5 to 30. This election must be made for full 12-month periods. In the event the Owner dies before the specified number of payments has been made, the Beneficiary(ies) may elect to continue receiving the fixed and variable payments according to the terms of this Contract or may alternatively elect to receive the present value of any remaining guaranteed payments in a single lump-sum, the amount of which is calculated by the Company. The present value of any remaining guaranteed payments will be based on the total annuity payment as of the date of the calculation. ADDITIONAL OPTIONS. Other income options may be made available by the Company.
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VA770NY 28 INCOME PROVISIONS (CONT'D) For each Investment Division, the value of an Annuity Unit for any Business Day is determined by multiplying the Annuity Unit Value for the immediately preceding Business Day by the net investment factor for the Business Day for which the Annuity Unit Value is being calculated. The result is then multiplied by a second factor which offsets the effect of the assumed net investment rate. The net investment factor, which reflects changes in the net asset value of Investment Divisions, is determined by dividing 1. by 2., and then subtracting 3. from the result, where: 1. Is the net result of: a. the net asset value of an Investment Division determined as of the end of the Business Day, plus b. the per share amount of any dividend or other distribution declared by the Investment Division if the "ex-dividend" date occurs on the Business Day, plus or minus c. a per share credit or charge with respect to any taxes paid or reserved for by the Company which are determined by the Company to be attributable to the operation of the Investment Division (no federal income taxes are applicable under present law); 2. Is the net asset value of the Investment Division determined as of the end of the preceding Business Day; and 3. Is the asset charge factor determined by the Company for the Business Day to reflect the applicable Mortality and Expense Charge, and the Administration Charge. Neither expenses actually incurred, other than taxes on the investment return, nor mortality actually experienced, shall adversely affect the dollar amount of variable annuity payments after such payments have commenced.