VA780NY 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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VA780NY
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 NY.
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
ARE LESS THAN 1.00%, VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME.
PLEASE REVIEW THE CONTRACT DATA PAGES FOR CONTRACT CHARGES.
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 SEPARATE
ACCOUNT CONTRACT VALUE DETERMINED AS OF THE BUSINESS DAY ON WHICH THE
CONTRACT IS RETURNED TO THE SELLING PRODUCER OR THE COMPANY, INCLUDING ANY
FEES OR OTHER CHARGES DEDUCTED FROM THE PREMIUMS OR IMPOSED UNDER THE
CONTRACT. UPON SUCH REFUND, THIS CONTRACT SHALL BE VOID.
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
and will allocate the Separate Account Contract Value to the Investment Divisions specified by the
Contract Owner when the "Notice of Right to Examine Contract" period has expired.
INDIVIDUAL DEFERRED
VARIABLE ANNUITY CONTRACT
(FLEXIBLE PREMIUM).
DEATH BENEFIT AVAILABLE.
INCOME OPTIONS AVAILABLE.
NONPARTICIPATING.
This Contract is signed by the Company
President
Secretary
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]
FINAL 2
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VA780NY 2
TABLE OF CONTENTS
Provision Page Number
Contract Data Pages [3a
Definitions 4
General Provisions 7
Accumulation Provisions 11
Withdrawal Provisions 12
Death Benefit Provisions 14
Income Provisions 17
Termination Provision 21]
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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VA780NY-FB1 3a
CONTRACT DATA PAGES
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 Annuitant: [Xxxx Xxx]
Joint Annuitant Issue Age: [35]
Initial Premium: [$25,000]
Issue Date: [January 1, 2017]
Issue State: New York
Income Date: [January 1, 2077]
Beneficiary(ies): [Xxxxx Xxx]
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VA780NY-FB1 3b
CONTRACT DATA PAGES (CONT'D)
Monthly Contract A monthly charge of [$10.00] will be deducted on a pro-rata basis
Charge: from the Investment Division(s) on each Contract Monthly
Anniversary. The Monthly Contract Charge will increase by [$2.50]
on the Contract Anniversary every [5] years following the Issue
Date. The Company reserves the right to waive the increase to the
Monthly Contract Charge on a nondiscriminatory basis.
Withdrawal Charge Completed Years Since Withdrawal Charge
Schedule: Receipt of Premium Percentage
0 2.00%
1 2.00%
2 1.00%
3+ 0.00%
Withdrawals: Minimum partial withdrawal amount: [$500]
Minimum amount remaining in an Investment Division after
withdrawal: [$100]
Minimum partial withdrawal made in connection with a systematic
withdrawal program: [$50]
Additional Free Withdrawal Percentage: [10%]
Transfer/Transfer Charge: Prior to and after the Income Date, You may transfer all or a portion
of Your Separate Account Contract Value in one (1) Investment
Division to any available Investment Divisions.
A fee of [$25.00] is charged for each transfer in excess of [15] in
any Contract Year. Any Transfer Charge is deducted from the
amount transferred prior to the allocation to the new Investment
Division. Transfer Charges will not be applied to transfers due to
dollar cost averaging or other systematic investment programs
provided by the Company, nor will these transfers count against the
[15] free transfers allowed in a Contract Year. Transfers not
exercised during a given Contract Year are not accumulated and
used in subsequent Contract Years.
A transfer will be effective as of the end of the Business Day when
the Company receives a transfer request in Good Order. If a
transfer request is received but is not in Good Order, the transfer
will be effective as of the end of the Business Day on which the
request is put in Good Order.
Asset allocation service providers must comply with the Company's
administrative systems, rules, and procedures.
The Company will not be liable for a transfer made in accordance
with the Owner's instructions.
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VA780NY-FB1 3c
CONTRACT DATA PAGES (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 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 [$2,500,000].
The Owner may allocate Premiums among the Investment
Divisions. Allocations may be made in any percent from 0% to
100%. The minimum that may be allocated to an Investment
Division is [$100]. Any subsequent Premium will be allocated
according to the most recent instructions on file with the Company,
provided that each allocation meets the minimums, regardless of
such instructions.
Investment Divisions: Availability is indicated in the Contract application, current
prospectus and any supplements. The Company may periodically
add or delete Investment Divisions.
Maximum Investment The number of allocations to the Investment Divisions may not
Division(s) Allocations exceed [99] at any one time.
Allowed:
Separate Account: [JNLNY Separate Account I]
The Investment Division(s) 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 this
Contract.
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VA780NY-FB1 3d
CONTRACT DATA PAGES (CONT'D)
TABLE OF INCOME OPTIONS
The following table is for a Contract whose net proceeds are $1,000, and will apply pro rata to the
amount payable under this Contract.
UNDER OPTION 4 MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3
No. of
Monthly
Install-
ments
Monthly
Install-
ments
Age of
Annui-
tant
No. of Mos.
Certain
Age of
Annui-
tant
No. of Mos.
Certain
Age of
Annui-
tant
No. of Mos.
Certain
Age of
Annui-
tant
No. of Mos.
Certain
Male Life 120 240 Male Life 120 240 Female Life 120 240 Female Life 120 240
60 17.09 40 2.33 2.32 2.31 68 4.72 4.57 4.02 40 2.22 2.22 2.21 68 4.36 4.26 3.86
72 14.31 41 2.37 2.36 2.35 69 4.90 4.72 4.09 41 2.26 2.26 2.25 69 4.52 4.40 3.94
84 12.33 42 2.41 2.41 2.39 70 5.09 4.89 4.16 42 2.30 2.30 2.29 70 4.69 4.55 4.02
96 10.84 43 2.45 2.45 2.43 71 5.31 5.06 4.23 43 2.34 2.34 2.32 71 4.87 4.70 4.09
108 9.68 44 2.50 2.50 2.47 72 5.54 5.24 4.29 44 2.38 2.38 2.36 72 5.06 4.87 4.16
120 8.76 45 2.55 2.54 2.52 73 5.79 5.43 4.34 45 2.42 2.42 2.40 73 5.28 5.04 4.22
132 8.00 46 2.60 2.59 2.56 74 6.06 5.63 4.39 46 2.47 2.47 2.45 74 5.51 5.23 4.28
144 7.37 47 2.65 2.64 2.61 75 6.35 5.83 4.43 47 2.52 2.51 2.49 75 5.76 5.42 4.34
156 6.84 48 2.71 2.70 2.66 76 6.67 6.04 4.47 48 2.57 2.56 2.54 76 6.03 5.62 4.38
168 6.38 49 2.77 2.76 2.71 77 7.02 6.26 4.50 49 2.62 2.61 2.59 77 6.33 5.83 4.43
180 5.98 50 2.83 2.82 2.76 78 7.40 6.48 4.52 50 2.67 2.67 2.64 78 6.65 6.04 4.46
192 5.64 51 2.89 2.88 2.82 79 7.81 6.70 4.54 51 2.73 2.72 2.69 79 7.01 6.26 4.49
204 5.33 52 2.96 2.94 2.88 80 8.27 6.92 4.56 52 2.79 2.78 2.74 80 7.40 6.48 4.52
216 5.06 53 3.03 3.01 2.94 81 8.76 7.13 4.57 53 2.85 2.84 2.80 81 7.83 6.70 4.54
228 4.82 54 3.10 3.08 3.00 82 9.30 7.34 4.58 54 2.92 2.91 2.85 82 8.29 6.92 4.56
240 4.60 55 3.18 3.16 3.06 83 9.89 7.53 4.58 55 2.99 2.98 2.91 83 8.80 7.13 4.57
252 4.40 56 3.26 3.23 3.13 84 10.54 7.72 4.59 56 3.07 3.05 2.98 84 9.35 7.33 4.58
264 4.22 57 3.35 3.32 3.19 85 11.26 7.88 4.59 57 3.14 3.12 3.04 85 9.95 7.52 4.58
276 4.06 58 3.44 3.40 3.26 86 12.05 8.03 4.59 58 3.23 3.20 3.11 86 10.59 7.70 4.59
288 3.90 59 3.54 3.49 3.34 87 12.91 8.17 4.59 59 3.31 3.29 3.18 87 11.28 7.87 4.59
300 3.77 60 3.64 3.59 3.41 88 13.86 8.28 4.60 60 3.40 3.37 3.25 88 12.03 8.02 4.59
312 3.64 61 3.74 3.69 3.48 89 14.88 8.38 4.60 61 3.50 3.46 3.32 89 12.84 8.15 4.59
324 3.52 62 3.86 3.79 3.56 90 15.99 8.46 4.60 62 3.60 3.56 3.40 90 13.71 8.27 4.60
336 3.41 63 3.98 3.91 3.64 91 17.17 8.53 4.60 63 3.71 3.66 3.47 91 14.66 8.37 4.60
348 3.31 64 4.11 4.02 3.71 92 18.43 8.58 4.60 64 3.82 3.77 3.55 92 15.70 8.45 4.60
360 3.21 65 4.24 4.15 3.79 93 19.78 8.63 4.60 65 3.95 3.88 3.63 93 16.86 8.53 4.60
66 4.39 4.28 3.87 94 21.20 8.66 4.60 66 4.07 4.00 3.71 94 18.13 8.58 4.60
67 4.55 4.42 3.95 95 22.67 8.68 4.60 67 4.21 4.12 3.79 95 19.53 8.63 4.60
Note: Due to the length of the information, factors for Option 2 are available from the Service
Center upon Your request. You may contact our Service Center as specified on the cover page
of the Contract.
BASIS OF COMPUTATION. The actuarial basis for the Table of Income Options is the 2012
Individual Annuity Mortality Period Table, with an assumed net investment rate of 1.00% and a
0% expense load. The interest rate used in the present value calculation referred to in Options 3
and 4 will be determined by the Company, but in no instance will it be greater than the rate used
to calculate the initial payment. The Table of Income Options does not include any applicable tax.
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VA780NY 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.
BENEFICIARY(IES). The natural person(s) or entity(ies) designated by the Owner to receive any
death benefit payable under the 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.
CONTRACT. The Individual Deferred Variable Annuity Contract described herein.
CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.
CONTRACT MONTHLY ANNIVERSARY. Each one-month anniversary of the Issue Date.
CONTRACT YEAR. The twelve-month period beginning on the Issue Date or on any Contract
Anniversary thereafter while the Contract remains in force.
DESIGNATED OPTION(S). The Investment Division(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 required by the
Company.
GOOD ORDER. The receipt by the Company of any and all information, documentation,
instructions and/or Premium required 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. The Income Date must be at least thirteen (13) months after the Contract Issue Date.
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 Separate Account Contract Value will go up or down
depending on the performance of the Underlying Mutual Funds.
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VA780NY 6
DEFINITIONS (CONT'D)
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 Separate
Account Contract Value. The Withdrawal Charge Schedule is shown on the Contract Data Page.
WITHDRAWAL VALUE. The Separate Account Contract Value, less any tax payable, applicable
Withdrawal Charges and Monthly Contract Charge.
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VA780NY 10
GENERAL PROVISIONS (CONT'D)
TRANSFER. The conditions for transfer between Investment Divisions are explained on the
Contract Data Page. The Company reserves the right to restrict the number, means and
frequency of transfers per year that may be requested by the Owner.
Your ability to make transfers is also subject to modification if the Company determines, at the
Company's discretion, that the exercise by one or more Owners is, or would be, to the
disadvantage of other Owners. Restrictions may be applied in any manner reasonably designed
to prevent any use of the transfer provision which is considered by the Company to be to the
disadvantage of other Owners. A modification regarding Your ability to make transfers to or from
one or more of the Investment Divisions could include, but not be limited to:
1. The requirement of a minimum time period between each transfer.
2. Limiting transfer requests of an agent acting on behalf of one or more Owners or under a
power of attorney on behalf of one or more Owners.
3. Limiting the dollar amount that may be transferred at any one time.
The Company may from time to time offer systematic investment programs that allow You to
transfer funds among the Investment Divisions. These programs may include, but are not limited
to, dollar cost averaging, portfolio rebalancing, and the automatic monthly transfer of earnings
from the money market Investment Division to the Designated Option(s). After issue of Your
Contract, You may elect one of these programs by contacting the Company's Service Center, and
the Company will furnish all necessary forms to request these programs. The Company makes
no guarantee that these programs will result in a profit or protect against loss in a declining market.
For the optional dollar cost averaging program, You may authorize the automatic transfer of a
fixed dollar amount or selected percentage of the value of a Source Option, periodically to one or
more Designated Option(s). The intervals between transfers may be monthly, quarterly,
semiannually or annually.
WRITTEN NOTICE. Written information or instructions given to the Company by You must be in
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 the request is signed by the
Owner, subject to any payments made or actions taken by the Company prior to receipt in writing
at the Company's Service Center in Good Order. Otherwise, any other Written Notice takes effect
on the date it was received 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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VA780NY 11
ACCUMULATION PROVISIONS
An Owner may not allocate Separate Account Contract Values to more than the maximum number
of Investment Divisions, specified on the Contract Data Page, at any one time.
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 frequent than monthly. The assets of the
Separate Account will be valued at their fair market value on the day the valuation occurs.
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 Separate Account 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 applicable taxes;
3. dividing the remainder by the number of outstanding Accumulation Units.
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VA780NY 12
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 Separate Account 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 Separate Account Contract Value may be subject to a Withdrawal
Charge.
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. If the Separate Account 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 from which the withdrawal is requested must be
at least equal to the minimum amount specified on the Contract Data Page after the withdrawal
is completed or the Owner's entire interest will be withdrawn.
The withdrawal will be made from each Investment Division 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 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.
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 Separate
Account 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.
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VA780NY 17
INCOME PROVISIONS
INCOME DATE. The date on which annuity payments are to begin. The Income Date must be at
least thirteen (13) months after the Contract Issue Date. If no Income Date is selected, the Income
Date will be the Latest Income Date. At any time at least seven (7) days prior to the Income Date
then indicated on the Company's records, the Owner may change the Income Date by submitting
Written Notice to the Company's Service Center, subject to the Latest Income Date.
INCOME OPTIONS. The Owner, or any Beneficiary who is so entitled, may elect to receive a
single lump-sum distribution. However, a single lump-sum distribution will be deemed to be a total
withdrawal and will terminate the Contract.
Alternatively, an income option may be elected. The Owner may, upon prior Written Notice to the
Company at its Service Center, elect an income option at any time prior to the Income Date or
change an income option up to seven (7) days before the Income Date. Unless otherwise
designated, the Owner will be the payee.
If no other income option is elected, monthly annuity payments will be made in accordance with
Option 3 below, a life annuity with 120-month period certain. Payments may be made in monthly,
quarterly, semiannual or annual installments as selected by the Owner. However, if the amount
available to apply under an income option is less than $2,000, the Company has the right to make
payments in one single lump-sum. The single lump-sum payment will not be less than would have
been applied under an income option. If the first payment provided would be less than $20, the
Company may require payments to be made at quarterly, semiannual or annual intervals so as to
result in an initial payment of at least $20, or the Company has the right to make one single lump-
sum payment.
Income payments on the Income Date will not be less than those that would be provided by the
application of the Separate Account Contract Value to purchase a single premium immediate
annuity contract at purchase rates offered by the Company at that time to the same class of
annuitants. The amount at annuitization will not be less than the greater of the Withdrawal Value
or 95% of the Separate Account Contract Value.
NO WITHDRAWALS OF THE SEPARATE ACCOUNT CONTRACT VALUE ARE PERMITTED
DURING THE INCOME PERIOD FOR ANY INCOME OPTION UNDER WHICH PAYMENTS
ARE BEING MADE PURSUANT TO LIFE CONTINGENCIES.
Upon written election filed with the Company at its Service Center, the Separate Account Contract
Value will be applied to provide one of the following income options.
OPTION 1 - LIFE INCOME. An annuity payable monthly during the lifetime of the Annuitant. Under
this income option, no further payments are payable after the death of the Annuitant, and there is
no provision for a death benefit payable to the Owner. Therefore, it is possible under Option 1 for
the Owner to receive only one (1) monthly annuity payment under this income option. 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(ies).
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VA780NY 18
INCOME PROVISIONS (CONT'D)
OPTION 2 - JOINT AND SURVIVOR INCOME. 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 option. 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 annuity payments, and it is possible to have only one (1) monthly 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 and the second designated person after the Income Date
and prior to the first monthly annuity payment, the amount allocated to this income option will be
paid to the Owner or the Owner's Beneficiary(ies).
OPTION 3 - LIFE ANNUITY INCOME 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. The present
value of any remaining payments will be calculated using the interest rate originally used to
determine the benefit payments upon annuitization.
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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VA780NY 20
INCOME PROVISIONS (CONT'D)
The value of a fixed number of Annuity Units will reflect the investment performance of the
Investment Divisions, and the amount of each payment will vary accordingly.
For each Investment Division, the Annuity Unit Value 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., 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); and
2. Is the net asset value of the Investment Division determined as of the end of the preceding
Business Day.