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EXHIBIT 4(a)
XXXXXX INVESTORS LIFE INSURANCE COMPANY
An Illinois stock corporation, herein called the "Company"
Home Office: 0 Xxxxxx Xxxxx, Xxxx Xxxxx, XX 00000-0000
Annuitant XXXX XXX Age 35
Contract Date OCT 01 1991 Contract No. 0001600
This contract is issued in consideration of the attached application by the
contractholder and payment of the purchase payment. The provisions on this
cover and the pages that follow are part of this contract.
The Company agrees to pay an annuity to the annuitant provided the annuitant is
living and this contract is in force on the annuity date. The Company further
agrees to pay the death benefit prior to the annuity date upon the death of the
owner or the annuitant when a death benefit is payable. Payment shall be made
upon the Company's receipt of due proof of death and the return of the owner's
certificate.
Signed for the Company at its home office in Long Grove, Illinois
[sig] [sig]
Secretary President
GROUP SINGLE PREMIUM MODIFIED GUARANTEED AND
VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
BENEFITS AND PAYMENTS PROVIDED BY THIS CONTRACT, WHEN BASED ON GUARANTEE PERIOD
VALUES, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE MARKET VALUE ADJUSTMENT
FORMULA STATED IN THE CONTRACT SCHEDULE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED UPON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD PROVISIONS
FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the contractholder and the Company
READ THIS CONTRACT CAREFULLY
Form L-1600 (9/91) 113960
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CONTRACT SCHEDULE
DESCRIPTION OF PLAN: GROUP SINGLE PREMIUM MODIFIED GUARANTEED AND
VARIABLE DEFERRED ANNUITY
GROUP CONTRACT NUMBER: (0000) CONTRACT DATE: (OCTOBER 1, 1991)
CONTRACTHOLDER: ( XYZ GROUP ) TYPE OF PLAN: (QUALIFIED OR
NONQUALIFIED)
STATE OF DELIVERY: THIS CONTRACT IS DELIVERED IN THE STATE WHERE
THE APPLICATION WAS COMPLETED BY THE CONTRACTHOLDER AND IS
SUBJECT TO THE LAWS OF THAT STATE
INITIAL ALLOCATION OPTIONS:
GUARANTEE PERIOD OPTIONS:
( 1 YEAR GUARANTEE PERIOD ) ( 6 YEAR GUARANTEE PERIOD )
( 2 YEAR GUARANTEE PERIOD ) ( 7 YEAR GUARANTEE PERIOD )
( 3 YEAR GUARANTEE PERIOD ) ( 8 YEAR GUARANTEE PERIOD )
( 4 YEAR GUARANTEE PERIOD ) ( 9 YEAR GUARANTEE PERIOD )
( 5 YEAR GUARANTEE PERIOD ) (10 YEAR GUARANTEE PERIOD )
SUBACCOUNT OPTIONS:
MONEY MARKET SUBACCOUNT I
MONEY MARKET SUBACCOUNT II
TOTAL RETURN SUBACCOUNT
HIGH YIELD SUBACCOUNT
EQUITY SUBACCOUNT
GOVERNMENT SECURITIES SUBACCOUNT
INTERNATIONAL SUBACCOUNT
RECORDS MAINTENANCE FEE: [ $30 per owner each contract year. ]
MORTALITY AND EXPENSE RISKS AND ADMINISTRATIVE COSTS CHARGE:
[ 1.25% annually to be assessed daily on the owner's separate
account value. ]
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CONTRACT SCHEDULE
MARKET VALUE ADJUSTMENT FORMULA
The market value adjustment is determined by the application of the following
formula:
_ _ t/365
| ( 1 + I ) |
Market Value Adjustment = Guarantee Period Value x | -------------- | - 1
| ( 1 + J + .005 ) |
|_ _|
Where, I is the guaranteed interest rate being credited to the guarantee
period value subject to the market value adjustment.
J is the current interest rate declared by the Company, as of the
effective date of the application of the market value adjustment, for current
allocations to a guarantee period, the length of which is equal to the balance
of the guarantee period for the guarantee period value subject to the market
value adjustment, rounded to the next higher number of complete years, and
t is the number of days remaining in the guarantee period.
WITHDRAWAL/EARLY ANNUITIZATION CHARGE TABLE
CONTRACT YEAR CHARGE
------------- ------
1 - 2 6%
3 - 4 5%
5 - 6 4%
7+ 0%
A maximum of 10% of the owner's market adjusted value plus separate account
value may be withdrawn each contract year without incurring a withdrawal/early
annuitization charge.
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XXXXXX INVESTORS LIFE INSURANCE COMPANY [XXXXXX LOGO]
X.X. XXX 0000, XXXXXXX, XX 00000-0000
GROUP MASTER APPLICATION
Group Single Premium Modified Guaranteed and Variable Deferred Annuity
------------------------------------------------------------------------
Application For Name of Product
XYZ Group
------------------------------------------------------------------------
Name of Group
0 Xxxxx Xxxxx Xxxxxx
------------------------------------------------------------------------
Principal Xxxxxx Xxxxxxx
Xxxxxxx XX 00000
------------------------------------------------------------------------
City State Zip
BENEFITS AND PAYMENTS PROVIDED BY THIS CONTRACT, WHEN BASED ON GUARANTEE PERIOD
VALUES, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE MARKET VALUE ADJUSTMENT
FORMULA STATED IN THE CONTRACT SCHEDULE.
BENEFITS, PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED UPON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED
AS TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD
PROVISIONS FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
/s/ Xxxx Xxxxx
------------------------------------------------------------------------
Signature of Authorized Representative
Xxxx Xxxxx
------------------------------------------------------------------------
Typed Name
President
------------------------------------------------------------------------
Title
Xxxxxxx XX 00000
------------------------------------------------------------------------
Signed at City State
October 1, 1991
------------------------------------------------------------------------
Date
Xxx Xxxxx
------------------------------------------------------------------------
Witnessed
Xxxxxxx Xxx
------------------------------------------------------------------------
Licensed Agent
Form L-1605 (9/91) 113980
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DEFINITIONS
AGE - Attained age.
ACCUMULATED GUARANTEE PERIOD VALUE - On any valuation date, the accumulated
guarantee period value is the sum of the owner's guarantee period values.
ACCUMULATION PERIOD - The period of time between the certificate's issue date
and annuity date.
ACCUMULATION UNIT - An accounting unit of measure used to calculate the value
of each subaccount.
ANNUITANT - The person named in the enrollment application during whose
lifetime an annuity is to be paid. Under a nonqualified plan when two people
are named as joint annuitants, the term "annuitant" means the joint annuitants
or the survivor of them. The person(s) named as an annuitant may not be
changed.
ANNUITY - A series of payments starting on the annuity date.
ANNUITY DATE - The date stated in the enrollment application on which the
certificate matures and annuity payments are scheduled to begin. Unless
otherwise directed, the annuity date is the twentieth anniversary of the
certificate's issue date. The annuity date may be changed by the owner.
ANNUITY OPTION - One of several forms in which annuity payments may be made.
ANNUITY PERIOD - The period starting on the annuity date.
ANNUITY PURCHASE VALUE - The annuity purchase value is the sum of the owner's:
(1) market adjusted value; plus the separate account value; minus (2) any
applicable charges.
ANNUITY UNIT - An accounting unit of measure used to calculate the amount of
variable annuity payments after the first annuity payment. The value of an
annuity unit is determined separately for each subaccount.
CERTIFICATE - An individual certificate of participation issued by the Company
to each owner as evidence of the rights and benefits under this contract.
CERTIFICATE OWNER OR OWNER - The owner is the annuitant unless a different
owner is named in the enrollment application. The owner possesses all ownership
rights granted under the terms of this contract. Under a non-qualified plan,
when more than one person is named as owner, the term "owner" means joint
owners. The owner may be changed during the lifetime of the owner and the
annuitant.
CERTIFICATE VALUE - On any valuation date, the certificate value is the sum of
the owner's (1). accumulated guarantee period value; plus (2) separate account
value.
CERTIFICATE YEAR - The annual anniversary of the issue date of the certificate.
CONTRACT DATE, CONTRACT YEAR - The contract date is stated in the contract
schedule. Subsequent contract years will begin on anniversaries of the
contract date.
CONTRACTHOLDER - The contractholder is stated in the contract schedule. It is
the entity to which this contract is issued.
FIXED ANNUITY - An annuity payment plan under which the amount of each annuity
payment does not vary with the investment experience of a subaccount.
FUND - The Xxxxxx Investors Fund, an open-end diversified investment company in
which the Separate Account invests.
GENERAL ACCOUNT - The general account includes all the assets of the Company,
other than those allocated to the Separate Account or any other legally
segregated separate account, including that portion of the annuity purchase
value applied to purchase a fixed annuity.
GUARANTEED INTEREST RATE - The rate of interest established by the Company for
a given guarantee period.
GUARANTEE PERIOD - A period of time during which an amount is to be credited
with a guaranteed interest rate. Guarantee period options may have durations of
from one (1) to ten (10) years. The guarantee periods initially offered under
this contract are stated in the contract schedule.
GUARANTEE PERIOD VALUE - On any valuation date, the guarantee period value is
the owner's: (1) net purchase payment allocated or amount transferred to a
guarantee period; plus (2) interest credited; minus (3) withdrawals, previously
assessed withdrawal charges and transfers; and (4) as adjusted for any
applicable market value adjustment previously made.
ISSUE DATE - The issue date is stated in the certificate schedule. It is the
date the owner's purchase payment, received by the Company, is available for
use and begins to be credited with interest. If the normal issue date is the
29th, 30th or 31st of the month, the issue date is the 28th day of that month.
MARKET ADJUSTED VALUE - A guarantee period value adjusted by the market value
adjustment formula prior to the end of a guarantee period.
MARKET VALUE ADJUSTMENT - An adjustment of values under a guarantee period in
accordance with the market value adjustment formula prior to the end of that
guarantee period. The adjustment reflects the change in the value of the
guarantee period value due to changes in interest rates since the date the
guarantee period commenced. The adjustment is computed using the market value
adjustment formula stated in the contract schedule.
MORTALITY AND EXPENSE RISKS AND ADMINISTRATIVE COSTS CHARGE - A charge deducted
in the calculation of the accumulation unit value and the annuity unit value
for the Company's assumption of mortality risks and expense guarantees and
administrative costs.
NET PURCHASE PAYMENT - The gross amount of the purchase payment less any
applicable premium taxes.
NON-QUALIFIED PLAN - A contract issued other than as a qualified plan.
L-1600 (9/91) Page 1
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L-1600 (9/91) Page 2
PAYEE - A recipient of periodic payments under this contract. The term includes
an annuitant or a beneficiary who becomes entitled to a death benefit payment.
PURCHASE PAYMENTS - A dollar amount received by the Company in U.S. currency as
consideration for the benefits to be provided under this contract.
QUALIFIED PLAN - A contract issued under a retirement plan which qualified for
favorable tax treatment under Section 401, 403(b), 408 or 457 of the Internal
Revenue Code of 1986 as amended.
RECEIVED BY THE COMPANY - The receipt by the Company at its home office.
SEPARATE ACCOUNT - A unit investment trust registered with the Securities and
Exchange Commission under the Investment Company Act of 1940 known as the
KILICO Variable Annuity Separate Account.
SEPARATE ACCOUNT VALUE - On any valuation date the Separate Account value is
the sum of the owner's subaccount values.
SIXTH CERTIFICATE ANNIVERSARY - The sixth certificate anniversary date is the
sixth anniversary of the certificate issue date and each subsequent sixth
anniversary of that date.
SUBACCOUNTS - The Separate Account has several subaccounts. The subaccounts
available under this contract are stated in the contract schedule.
SUBACCOUNT VALUE - On any valuation date, the owner's subaccount value is
computed using the formula stated in this contract. Each subaccount is valued
separately.
TERMINATION VALUE - The termination value is the sum of the owner's: (1)
market adjusted value; plus (2) separate account value; minus (3) any
applicable charges.
VALUATION DATE - Each business day on which valuation of the assets of the
Separate Account is required by applicable law, which currently is each day
that the New York Stock Exchange is open for trading.
VALUATION PERIOD - The period that starts at the close of a valuation date and
ends at the close of the next succeeding valuation date.
VARIABLE ANNUITY - An annuity payment plan which varies as to dollar amount in
relation to subaccount investment experience.
WITHDRAWAL/EARLY ANNUITIZATION CHARGE - An amount which may be deducted from
the certificate value after application of any applicable market value
adjustment, upon a partial or total withdrawal, or upon the election of an
annuity option.
GENERAL PROVISIONS
THE CONTRACT - This contract, the attached application and any endorsements is
the entire contract
between the parties. All statements made in the group application and an
enrollment application, in the absence of fraud, are deemed representations and
not warranties. No such statement shall void this contract or be used as a
defense of a claim unless it is contained in the group or enrollment
application.
MODIFICATION OF CONTRACT - Only the Company's president, secretary and
assistant secretaries have the power to approve a change or waive any
provisions of this contract or any certificate issued under this contract. Any
modification must be in writing. No agent or person, other than such officers
named, has authority to change or waive the provisions of this contract.
CERTIFICATES - The Company shall issue an individual certificate to each owner
as evidence of his or her rights and benefits under this contract. The
certificate is not a part of this contract.
SUCCESSOR CONTRACTHOLDER - The contractholder, with the consent of the Company,
may at any time appoint a successor contractholder. Any successor
contractholder will have all rights, duties and obligations of the original
contractholder.
DISCONTINUANCE OF NEW PARTICIPANTS - The Company, by giving thirty days prior
written notice to the contractholder, may limit or discontinue the acceptance
of new applications and the issuance of new certificates under this contract.
Such limitation or discontinuance will have no effect on the rights or benefits
of any owner's certificate issued prior to the effective date of such
limitation or discontinuation.
INCONTESTABILITY - This contract cannot be contested after it has been in force
for two years.
CHANGE OF ANNUITY DATE - The owner may elect in writing prior to the annuity
date and during the lifetime of the annuitant, to change the annuity date.
ASSIGNMENT - No assignment under this contract is binding unless received by
the Company in writing. The Company assumes no responsibility for the validity
of any assignment. Once filed, the rights of an owner, annuitant and
beneficiary are subject to the assignment. Any claim is subject to proof of
interest of the assignee.
REPORTS - At least once each certificate year, the owner will receive a
statement showing the certificate value, interest credited, investment
experience and changes made since the last report as well as any other
information required by statute.
NON-PARTICIPATING - This contract does not pay dividends nor does it
participate in any of the Company's surplus or earnings.
RESERVES, VALUES AND DEATH BENEFITS - All reserves are greater than or equal
to those required by
statute. Any values and death benefit that may be
available are not less than the minimum values and
benefits required by any statute of the state in which this contract is
delivered.
PREMIUM TAXES - The Company shall deduct state premium taxes when paid by the
Company.
RECORDS MAINTENANCE CHARGE - The owner is assessed an annual records
maintenance charge as shown in the contract schedule on each certificate
anniversary and upon certificate termination. The charge shall be allocated
equally among the subaccounts in which the owner participates. A number of
accumulation units
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sufficient to equal the proper portion of the charge shall be redeemed from
each subaccount. If the owner is not participating in the Separate Account at
the time the records maintenance charge is assessed, in order to meet the
assessment, the records maintenance charge shall be deducted from the guarantee
period closest to maturity of the shortest original duration. The records
maintenance charge is not assessed during the annuity period.
OWNERSHIP PROVISIONS
OWNER - Unless otherwise provided in the enrollment application, the annuitant
shall be the original owner. The owner, prior to the annuity date and prior to
the annuitant's death, has the exclusive right to exercise every option and
right conferred by this contract. If more than one owner is named, the joint
owners must agree to any change.
CHANGE OF OWNERSHIP - Certificate ownership may be changed at any time during
the lifetime of the owner and annuitant. A change must be made by written
notice from the owner with information sufficient to clearly identify the new
owner to the Company. Upon receipt by the Company, the change shall take effect
as of the date it was signed except for action taken by the Company before the
change was received. The Company reserve the right to require the certificate
for endorsement of a change.
BENEFICIARY DESIGNATION AND CHANGE OF BENEFICIARY - The owner may change the
beneficiary by filing a written change form subject to the following:
(1) The change must be filed while during the annuitant's lifetime and prior to
the annuity date;
(2) The certificate must be in force at the time of filing a change;
(3) Such change must not be prohibited by the terms of an existing: (a)
assignment; (b) beneficiary designation; or (c) other restriction;
(4) No such change shall take effect unless received by the Company;
(5) After receipt, the change shall take effect on the date the change form was
signed. However, action taken by the Company before the change form was
received shall remain effective; and
(6) The change form provides information sufficient to identify the new
beneficiary.
The Company reserves the right to require the certificate for endorsement of a
change.
DEATH OF BENEFICIARY - The interest of any beneficiary who dies prior to the
death benefit distribution shall pass to the other beneficiaries, if any,
share and share alike, unless otherwise provided in the beneficiary
designation.
If no beneficiary survives or is named, the distribution shall be made to the
owner's estate upon the death of the owner or to the annuitant's estate upon
the death of the annuitant who is not the owner.
If a beneficiary dies within ten days of the owner's death, the death benefit
shall be paid as if the owner survived the beneficiary. If a beneficiary dies
within ten days of the annuitant's death and the annuitant is not the owner,
the death benefit shall be paid as if the annuitant survived the beneficiary.
In the event that the owner, annuitant and beneficiary die simultaneously, the
death benefit shall be paid as if the owner survived the annuitant and the
beneficiary.
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENT - The minimum purchase payment accepted by the Company on
behalf of the owner is $5,000. The maximum purchase payment accepted by the
Company on behalf of the owner without prior Compzny approval is $1,000,000 or
the maximum permitted by the Code for the qualified plan.
The minimum allocation to a guarantee period or to a subaccount is $1,000.
The Company reserves the right to waive or modify the above limits.
PLACE OF PAYMENT - All purchase payments under this contract are payable to the
Company at its home office or such other location within the United States as
may be designated by the Company in writing to the owner or other interested
parties. A purchase payment received by an agent shall begin earning interest
after its receipt by the Company.
APPLICATION OF PURCHASE PAYMENT - The net purchase payment is credited and
begins earning interest no later than two business days after its receipt by
the Company at its home office. A guarantee period begins on the day the
purchase payment and interest is credited.
GUARANTEE PERIOD PROVISIONS
GUARANTEE PERIOD - All amounts allocated to a guarantee period are held by the
Company in a non-unitized separate account. The initial guarantee period
options available under this contract are shown in the certificate schedule.
GUARANTEE PERIOD VALUE - On any valuation date, the guarantee period value is
the sum of the owner's: (1) net purchase payment allocated or amount
transferred to a guarantee period; plus (2) interest credited; minus (3)
withdrawals, previously assessed withdrawal charges and transfers; and (4) as
adjusted for any applicable market value adjustment previously made.
ACCUMULATED GUARANTEE PERIOD VALUE - On any valuation date, the accumulated
guarantee period value is the sum of the owner's guarantee period values. At
any time during the accumulation period, the accumulated guarantee period value
may be allocated to a maximum of forty guarantee periods.
CURRENT GUARANTEED INTEREST RATE - The guaranteed period(s) initially elected
and the guaranteed interest rate(s) initially credited to the owner's net
purchase payment are stated in the certificate schedule.
A current guaranteed interest rate shall be declared by the Company with
respect to each amount transferred to a guarantee period. This rate shall be
binding upon the Company for the guarantee period elected at the time an
amount is transferred.
L-1600 (9/91) Page 3
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L-1600 (9/91) Page 4
At the end of a guaranteed period, the Company shall declare a guaranteed
interest rate applicable for the next subsequent guarantee period of the same
duration.
COMPOUNDING OF VALUES - Interest credited under this contract is calculated by
compounding daily at the daily equivalent interest rate which would produce at
the end of the year a result identical to the one produced by applying the
interest rate declared as an annual rate.
MARKET VALUE ADJUSTMENT PROVISION
MARKET VALUE ADJUSTMENT - The market value adjustment formula is stated in the
contract schedule. This formula is applicable for both an upward or downward
adjustment to a guarantee period value when, prior to the end of a guarantee
period value such value is: (1) taken as a total or partial withdrawal; (2)
applied to purchase an annuity option; (3) transferred to another guarantee
period or subaccount; or (4) applied to the death benefit payment. However, a
market value adjustment shall not be applied to any guarantee period value
transaction effected within 15 days before or after the end of the applicable
guarantee period.
VARIABLE ACCOUNT PROVISIONS
SEPARATE ACCOUNT - The variable benefits under this contract are provided
through the KILICO Variable Annuity Separate Account which is referred to in
this contract as the Separate Account. The Separate Account is registered with
the Securities and Exchange Commission as a unit investment trust under the
Investment Company Act of 1940. It is a separate investment account maintained
by the Company into which a portion of the Company's assets have been allocated
for this contract and may be allocated for certain other contracts.
LIABILITIES OF SEPARATE ACCOUNT - The assets equal to the reserves and other
liabilities of the Separate Account shall not be charged with liabilities
arising out of any other business the Company may conduct. The assets of the
Separate Account shall be valued on each valuation date.
SEPARATE ACCOUNT VALUE - On any valuation day the Separate Account value is the
sum of the owner's subaccount values. At any time during the accumulation
period, the separate account value may be allocated to a maximum of seven
subaccounts.
SUBACCOUNTS - The Separate Account consists of several subaccounts as shown in
the contract schedule. The Company may, from time to time combine or remove
subaccounts in the Separate Account and establish additional subaccounts of the
Separate Account. In such event the owner may be permitted to select other
subaccounts under this contract. However, the right to make any such selection
is limited by the terms and conditions the Company may impose on such
transactions.
FUND - Each subaccount of the Separate Account shall buy shares of a separate
series of the Xxxxxx Investors Fund. The Xxxxxx Investors Fund is registered
under the Investment Company Act of 1940 as an open-end diversified management
investment company. Each series of the Xxxxxx Investors Fund represents a
separate investment portfolio which corresponds to a subaccount of the Separate
Account.
If the Company establishs additional subaccounts, each new subaccount shall
invest in a series of the Xxxxxx Investors Fund or in shares of another
investment company. The Company may also substitute other investment companies.
RIGHTS RESERVED BY US - The Company reserves the right, subject to compliance
with the law as currently applicable or subsequently changed:
(1) To operate the Separate Account in any form permitted under the Investment
Company Act of 1940 or in any other form permitted by law;
(2) To take any action necessary to comply with or obtain and continue any
exemptions from the Investment Company Act of 1940 or to comply with any other
applicable law;
(3) To transfer any assets in any subaccount to another subaccount or to one or
more separate accounts, or to the Company's general account, or to add, combine
or remove subaccounts in the Separate Account; and
(4) To delete the shares of any of the portfolios of the fund or any other
open-end investment company and to substitute, for the fund shares held in any
subaccount, the shares of another portfolio of the fund or the shares of
another investment company or any other investment permitted by law.
When required by law, the Company shall obtain the owner's approval of such
changes and the approval of any regulatory authority.
ACCUMULATION UNIT VALUE - Each subaccount has an accumulation unit value. When
the net purchase payment or other amounts are allocated to a subaccount, a
number of units are purchased based on the subaccount's accumulation unit value
at the end of the valuation period during which the allocation is made. When
amounts are transferred out of or deducted from a subaccount, units are
redeemed in a similar manner.
The accumulation unit value for each subsequent valuation period is the
investment experience factor for that period multiplied by the accumulation
unit value for the immediately preceding period. Each valuation period has a
single accumulation unit value which is applied to each day in the period. The
number of accumulation units shall not change as a result of investment
experience.
INVESTMENT EXPERIENCE FACTOR - Each subaccount has its own investment
experience factor. The investment experience of the Separate Account is
calculated by applying the investment experience factor to the owner's
certificate value in each subaccount during a valuation period.
The investment experience factor of a subaccount for a valuation period is
determined by dividing (1) by (2) and subtracting (3) from the result, where:
(1) is the net result of:
(a) the net asset value per share of the investment held in the subaccount
determined at the end of the current valuation period; plus
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(b) the per share amount of any dividend or capital gain distributions made by
the investments held in the subaccount, if the "ex-dividend" date occurs during
the current valuation period; plus or minus
(c) a charge or credit for any taxes reserved for the current valuation period
which the Company determines to have resulted from the investment operations of
the subaccount;
(2) is the net asset value per share of the investment held in the subaccount,
determined at the end of the last prior valuation period;
(3) is the factor representing the mortality and expense risks and
administrative costs charge stated in the contract schedule for the number of
days in the valuation period.
TRANSFERS AND WITHDRAWAL PROVISIONS
TRANSFERS DURING THE ACCUMULATION PERIOD - Beginning fifteen days after the
issue date and each fifteen days thereafter, the owner may direct the following
transfers:
(1) All or part of a guarantee period value may be transferred to another
guarantee period or to the Separate Account.
(2) All or part of a subaccount value may be transferred to a guarantee period
or to another subaccount.
One transfer is permitted under (1) or (2) during each fifteen day period. At
any time the owner may participate in a maximum of seven subaccounts.
Transfers shall also be subject to the following conditions:
(3) The minimum value which may be transferred from a guarantee period or
subaccount is $1,000 or if smaller, the remaining value in the guarantee period
or the subaccount from which the transfer is being made.
(4) No partial transfer shall be made if the remaining value in the guarantee
period or subaccount is less than $1,000 after such transfer unless such
guarantee period or subaccount is eliminated by means of such transfer.
An amount transferred from a guarantee period is subject to the market value
adjustment formula stated in the contract schedule unless the transfer is
effective within 15 days before or after the end of the applicable guarantee
period. If a transfer election to be effected at the end of a guarantee period
is not received by us within 15 days before or after the end of the applicable
guarantee period, the subsequent guarantee period shall be of the same duration
as the then current guarantee period.
Any transfer request must clearly specify: (1) the amount which is to be
transferred: and (2) the guarantee period(s) or subaccount(s) which are to be
affected. A telephone transfer direction shall be honored by the Company only
when a properly executed telephone transfer authorization is on file with the
Company and such transfer direction complies with the owner's authorization
conditions.
(5) No transfer shall be made within seven calendar days of the date on which
the first annuity payment is due.
(6) During the thirty day period prior to the date on which the first annuity
payment is due, an additional transfer of all or part of the accumulated
guarantee period value may be made to one or more subaccounts. Such transfer
must be effective no later than the seventh calendar day prior to such due
date.
The Company reserves the right at any time and without prior notice to any
party to terminate, suspend or modify the transfer privileges.
TOTAL WITHDRAWAL - At any time prior to the annuity date, the owner may
terminate participation in this contract. Payment of the termination value to
the owner discharges us from all our obligations under this contract.
The termination value shall be determined as of the date a completed written
request for termination is received by the Company and the certificate is
returned. The market value adjustment formula shall be applied to the
applicable portion of the total value withdrawn unless such withdrawal is
effected within 15 days before or after the end of the applicable guarantee
period.
PARTIAL WITHDRAWALS - At any time prior to the annuity date, the owner may
withdraw part of the certificate value.
A partial withdrawal is subject to the following conditions:
(1) The remaining certificate value shall not be less than $2,500.
(2) The minimum partial withdrawal from a guarantee period prior to any market
value adjustment, or from a subaccount is $1,000.
(3) The remaining guarantee period value or subaccount value after a withdrawal
may not be less than $1,000.
Unless the Company is directed otherwise by the owner a partial withdrawal
shall be taken from the guarantee periods and subaccounts in proportion to the
values that each guarantee period and subaccount bears to the owner's
certificate value.
WITHDRAWAL CHARGE - A withdrawal charge shall be applied against a total or
partial withdrawal as shown in the Withdrawal Charge Table stated in the
contract schedule after application of any applicable market value adjustment.
A maximum of 10% of the owner's market adjusted value plus separate account
value may be withdrawn each certificate year without incurring a withdrawal
charge. Any amount withdrawn which is not subject to a withdrawal charge will
be considered a "partial free withdrawal."
TRANSFER AND WITHDRAWAL PROCEDURES - A withdrawal or transfer of guarantee
period value will be effective on the valuation date following receipt by the
Company at its home office of a written request for a withdrawal or a telephone
transfer direction containing all required information.
Accumulation units will be redeemed to the extent necessary to achieve the
dollar amount when the withdrawal or transfer is made from a subaccount. The
accumulation units credited in each subaccount shall be reduced by the number
of accumulation units redeemed.
The reduction in the number of accumulation units shall be determined on the
basis of the accumulation unit value at
L-1600 (9/91) Page 5
10
L-1600 (9/91) Page 6
the end of the valuation period during which the request containing all
required information is received by the Company. An amount shall be paid within
seven calendar days after the date proper election is received by the Company,
except as provided below.
DEFERMENT OF WITHDRAWAL OR TRANSFER - If the withdrawal or transfer is to be
made from a subaccount, the Company may suspend the right of withdrawal or
transfer or delay payment more than seven calendar days: (1) during any period
when the New York Stock Exchange is closed other than customary weekend and
holiday closings; (2) when trading in the markets normally utilized is
restricted: or any emergency exists as determined by the Securities and
Exchange Commission, so that disposal or investments or determination of the
accumulation unit value is not reasonably practicable; or (3) for such other
periods as the Securities and Exchange Commission by order may permit for
protection of owners.
If the withdrawal or transfer is to be made of a guarantee period value, the
Company may defer the payment for the period permitted by law but not more than
six months after written election or direction is received by the Company.
During the period of deferral, interest at the then current interest rate(s)
for the same guarantee period(s) will continue to be credited to the guarantee
period value.
DEATH BENEFIT PROVISION
DEATH BENEFIT AGE - Under a qualified plan where the owner and the annuitant
are the same person, the age on the certificate issue date shall be used to
calculate the death benefit. Under a nonqualified plan where the owner and the
annuitant may be different individuals, the age of the older of the owner or
annuitant, on the certificate issue date, is used to calculate the death
benefit.
AMOUNT OF DEATH BENEFIT - When the age used to calculate the death benefit is
less than 66, during the first six certificate years the death benefit shall be
the greater of: (1) the market adjusted value plus separate account value; or
(2) the sum of the net purchase payment received, minus withdrawals and
withdrawal charges, accumulated at 5% per year.
On the first sixth certificate anniversary, the "current minimum death benefit"
shall be the greater of: (1) the market adjusted value plus separate account
value; or (2) the sum of the net purchase payment received minus withdrawals
and withdrawal charges, accumulated at 5% annually for the first six
certificate years.
From the seventh to the twelfth certificate year, the death benefit shall be
the greater of (1) the market adjusted value plus separate account value; or
(2) the "current minimum death benefit value" minus withdrawals from the first
sixth certificate anniversary to the date the Company receives due proof of
death.
On each sixth certificate anniversary thereafter, the "current minimum death
benefit value" is compared to the market adjusted value plus the separate
account value, and whichever is greater becomes the new "current minimum death
benefit value" for the next six certificate years. And, the death benefit for
each subsequent six certificate years shall be the greater of: (1) the market
adjusted value plus the separate account value; or (2) the "current minimum
death benefit value" minus withdrawals from the sixth certificate anniversary
to the date the Company receives due proof of death.
When the age used to calculate the death benefit is age 66 or over, during the
first six certificate years the death benefit shall be the greater of: (1) the
market adjusted value plus the separate account value; or (2) the sum of the
net purchase payment received minus withdrawals and withdrawal charges. On the
first sixth certificate anniversary, the "current minimum death benefit value"
shall be set for the remainder of the accumulation period at the greater of:
(1) the market adjusted value plus the separate account value on the first
sixth certificate anniversary; or (2) the net purchase payment received minus
withdrawals. Thereafter, the death benefit shall be the greater of: (1) the
market adjusted value plus the separate account value; or (2) the "current
minimum death benefit value" minus withdrawals from the sixth certificate
anniversary to the date the Company receives due proof of death.
DEATH BENEFIT PAYMENT - The death benefit shall be computed at the end of the
valuation period next following receipt by the Company of due proof of death
and the return of the certificate. Payment of the death benefit to the
beneficiary shall discharge the Company from further obligations to the owner.
Due proof of death in the form of a certified copy of the death certificate; a
certified copy of a decree of a court of competent jurisdiction as to the
finding of death or written notice in a form satisfactory to the Company is
required within sixty days of such death or as soon thereafter as is reasonably
possible and prior to any death benefit payment.
A death benefit shall be paid prior to the annuity date in the event of: (1)
the death of the owner who is also the annuitant; (2) the death of either the
annuitant or owner when the annuitant is not the owner; (3) the death of a
joint owner; or (4) the death of the surviving joint annuitant when joint
annuitants are named and they are not the owners.
Upon the death of the owner, the death benefit shall be paid in a lump sum. In
lieu of a lump sum payment, the beneficiary may elect within sixty days
following the Company's receipt of due proof of death of the owner to have the
death benefit distributed in accordance with Option 2; or Options 1, 3 or 6
over a period not extending beyond the life expectancy of the beneficiary (or
if the beneficiary is not an individual, five years after the owner's death).
The death benefit distribution must begin no later than one year from the
owner's death.
If the primary beneficiary is the surviving spouse at the owner's death, the
surviving spouse may elect to be treated as the successor owner of the
certificate with no requirement to begin death benefit distribution.
If the death benefit becomes payable by reason of the death of the annuitant,
who is not the owner, the death benefit shall be paid in the manner elected by
the named beneficiary, including a lump sum payment or under an annuity option.
PROVISIONS FOR CERTAIN QUALIFIED PLAN CONTRACTS
11
The following provisions apply and shall take precedence over contrary contract
provisions if the enrollment application indicates issuance as an individual
retirement annuity ("XXX") described in Internal Revenue Code ("Code") Section
408(b), or as a terminal funding annuity distributed by a plan described in
Code Section 401(a), or as a tax sheltered annuity described in Code Section
403(b).
(1) The annuitant is the owner.
(2) The annuitant's entire interest in the contract is nonforfeitable.
(3) Transferability is not permitted except to the Company on surrender or
settlement.
(4) Distributions shall be in accordance with Code Section 401(a)(9).
(5) If a tax sheltered annuity, distributions after 1988 shall be restricted in
accordance with Code Section 403(b)(11).
(6) If a terminal funding annuity or tax sheltered annuity, the contract and
the benefits under it shall not be sold, assigned, discounted or pledged as
collateral for a loan or as a security for the performance of an
obligation or for any other purpose to any person other
than the Company.
(7) If an XXX, total annual purchase payments shall not exceed $2,000 except in
the case of a rollover contribution or a Simplified Employee Pension Plan.
(8) If an XXX, the contract and the benefits under it shall not be sold,
assigned or pledged as collateral for a loan or as security for the performance
of an obligation, or for any other purpose to any person.
(9) If an XXX,
(a) within seven days of the date of the application, the owner may revoke such
application and receive a full refund of the purchase payment; and
(b) notice of revocation by the owner must be made by wire or telephone to the
Company at its home office.
(10) If an XXX or tax sheltered annuity, the Company shall not be responsible
under any circumstance for the timing, purpose or propriety of any
distribution, nor shall the Company incur any liability or responsibility for
any tax imposed on account of any such distribution. Without limiting the
foregoing, the Company is not obligated to make any distribution absent a
specific written direction in accordance with the provisions of the contract
from the owner or the beneficiary.
All of the foregoing provisions are irrevocable unless amended from time to
time to reflect any required change in the Internal Revenue Code or regulation
thereunder.
ANNUITY PERIOD PROVISIONS
ELECTION OF ANNUITY OPTION -The annuity purchase value may be applied under one
of the annuity options. Election of an annuity option must be in writing to
the Company. An election may be made: (1) by the owner prior to the annuity
date and during the lifetime of the annuitant; (2) by the annuitant on the
annuity date unless the owner has restricted the right to make such an
election; or (3) by the beneficiary upon payment of the death benefit.
An election shall be revoked by a subsequent change of beneficiary or an
assignment of benefits, unless the assignment provides otherwise.
In the absence of an election of an annuity option, under a nonqualified plan,
an annuity shall be paid under Option 3 for a guaranteed period of ten years
and for as long thereafter as the annuitant shall alive. In the absence of an
election of an annuity option under a qualified plan, an annuity shall be paid
under Option 4 with a monthly income at two-thirds of the full amount payable
during the lifetime of the surviving payee.
If the total annuity purchase value is applied under one of the following
options, this certificate must be surrendered to the Company.
Any option in effect for the first annuity payment shall not be changed
thereafter.
Subject to the terms of the death benefit provision, the beneficiary may elect
that the death benefit be left with the Company and applied under one of the
annuity options.
If the annuity purchase value to be applied is less than $4,000, the Company
has the right to make payment in one lump sum. If the amount of any payment is
less than $50, the Company may increase the interval between payments to a
quarterly, semi-annual or annual payment to make the payment at least $50.
Payments must be made to a natural person referred to as the payee, in the
payee's own right. The age to be used in applying Annuity Options 2, 3, 4 and 5
is the payee's adjusted age on the first annuity payment due date.
If the total certificate value on the seventh calendar day before the first
annuity payment due date is allocated to the guarantee period(s), the annuity
shall be paid as a fixed annuity. If the total certificate value on such date
is allocated to the Separate Account, the annuity shall be paid as a variable
annuity. If the certificate value on such date is allocated to both guarantee
period(s) and subaccount(s), then the annuity shall be paid as a combination of
a fixed and variable annuity. A fixed and variable annuity payment shall
reflect the investment performance of the subaccounts in accordance with the
allocation of the certificate value existing on such date. Allocations shall
not be changed thereafter, except as provided in the Transfers During The
Annuity Period provision of the contract.
ADJUSTED AGE: ANNUITY OPTIONS 2, 3, 4 AND 5 - The tables below shall be applied
to the attained age of each payee to establish the adjusted age used in the
calculation of benefits for these annuity options.
CALENDAR YEAR OF BIRTH ADJUSTED AGE
1909 - and earlier Age increased by 1
1910 - 1919 Age
1920 - 1929 Age decreased by 1
1930 - 1939 Age decreased by 2
1940 - 1949 Age decreased by 3
1950 & later Age decreased by 4
L-1600 (9/91) Page 7
12
L-1600 (9/91) Page 8
OPTION 1
INCOME FOR SPECIFIED PERIOD - The Company shall pay income for the period and
payment mode elected but not less than 3 years nor more than 30 years.
A payee by written notice to the Company may cancel all or part of any
remaining Option 1 variable annuity payments due and receive the value of any
remaining unpaid instalments less any applicable early annuitization charge.
OPTION 2
LIFE INCOME- The Company shall pay a monthly income to the payee during the
payee's lifetime.
OPTION 3
LIFE INCOME WITH INSTALLMENTS GUARANTEED -
The Company shall pay a monthly income for the period elected and thereafter
for the remaining lifetime of the payee. The period elected may be 5, 10, 15 or
20 years.
OPTION 4
JOINT AND SURVIVOR ANNUITY - The Company shall pay the full monthly income
while both payees are living. Upon the death of either payee, the income shall
continue during the lifetime of the surviving payee. The surviving payee's
income shall be the percentage of such full amount chosen at the time of
election of Option 4.
OPTION 5
PENSION AND SURVIVOR ANNUITY - The Company shall pay the full monthly income
during the lifetime of the primary payee. Such payments shall continue whether
or not the secondary payee is living. If the primary payee dies before the
secondary payee dies, the benefits shall continue during the lifetime of the
secondary payee. However, such benefits shall be for the percentage chosen for
such continuation at the time Option 5 is elected.
OPTION 6
INCOME OF SPECIFIED AMOUNT - The Company shall pay a monthly income elected
for as long as the amount applied and interest shall last. The minimum income
which may be elected is $10 per month for each $1,000 applied. The total
certificate value must be allocated to a fixed annuity when Option 6 is
elected.
OTHER SETTLEMENT ARRANGEMENTS - May be available with Company consent.
EARLY ANNUITIZATION CHARGE - Should the owner elect that annuity payments are
to begin within six years of the certificate issue date, an early annuitization
charge shall be applied as shown in the certificate schedule after application
of any applicable market value adjustment.
Any applicable early annuitization charge is waived when the owner elects an
annuity option which provides either an income benefit period of 5 years or
more or a benefit under which payment is contingent upon the life of the
payee(s).
FIXED ANNUITY - The owner's accumulated guarantee period value as adjusted for
any applicable market value adjustment on the day immediately preceding the
date on which the first annuity payment is due is reduced by any early
annuitization charge, records maintenance charge and any premium taxes. The
remaining value shall be used to determine the fixed annuity monthly payment in
accordance with the annuity option elected. That portion of the annuity
purchase value allocated to a fixed annuity is held in the Company's general
account.
VARIABLE ANNUITY - The Separate Account value, at the end of the valuation
period immediately preceding the valuation period that includes the date on
which the first annuity payment is due, is first reduced by early annuitization
charge, records maintenance charge and applicable premium taxes. The remaining
value shall be used to determine the first monthly variable annuity payment.
For annuity Options 1 through 5, the first monthly variable annuity payment
shall be based upon the annuity option elected in accordance with the Annuity
Option Table.
Subsequent variable annuity payments are determined as follows. The number of
annuity units for each subaccount is calculated by dividing the amount of the
first monthly annuity payment attributable to the value in that subaccount by
the annuity unit value for that subaccount at the end of the valuation period
immediately preceding the valuation period which includes the date on which the
first annuity payment is to start. The number of annuity units per payment for
each subaccount shall remain fixed unless a transfer is made. Upon transfer,
the number of annuity units per payment shall change and the dollar amount of
subsequent annuity payments may decrease or increase from month to month
depending upon the investment experience of each applicable subaccount. The
actual amount of any subsequent annuity payment is determined by multiplying
the number of annuity units per payment in each subaccount by the annuity unit
value for such subaccount at the end of the valuation period immediately
preceding the valuation period which includes the date on which the payment is
to be made, and then adding the resultant values.
The Company guarantees that the dollar amount of each annuity payment after the
first shall not be adversely affected by actual expenses or by variations in
mortality experience from the expense and mortality assumptions on which the
first payment is based.
ANNUITY UNIT VALUE - The value of an annuity unit is determined separately for
each of the subaccounts.
For each subaccount, the annuity unit value for any valuation period is
determined by multiplying the annuity unit value for the immediately preceding
valuation period by the net investment factor for the valuation period for
which the annuity unit value is being calculated, and multiplying the result by
an interest factor which offsets the effect of the assumed investment earnings
rate of 4% per annum which is assumed in the annuity tables contained in the
contract, which are based upon the 1983 Annuity Mortality Tables.
The net investment factor for each subaccount for any valuation period is
determined by dividing (1) by (2) and subtracting (3) from the result, where:
(1) is the net result of:
(a) the net assets value per share of the investments held in the subaccount
determined at the end of the current valuation period; plus
(b) the per share amount of any dividend or capital gain distributions made by
the investments held in the
13
subaccount, if the "ex-dividend" date occurs during the current valuation
period; plus or minus
(c) a charge or credit for any taxes reserved for the current valuation period
which KILICO determines to have resulted from the investment operations of the
subaccount;
(2) is the net asset value per share of the investment held in the subaccount,
determined at the end of the last prior valuation period;
(3) is the factor representing the mortality and expense risks and
administrative costs charge stated in this contract for the number of days in
the valuation period.
TRANSFERS DURING THE ANNUITY PERIOD - During the annuity period, the payee(s)
by written notice in a form satisfactory to the Company may convert variable
annuity payments to fixed annuity payments or have variable annuity payments
reflect the investment experience of other subaccounts. The payees may not
convert fixed annuity payments to variable annuity payments. A transfer may be
made subject to the following:
(1) Transfers from a variable annuity subaccount to a fixed annuity may be made
effective only on an anniversary of the first annuity payment date. Notice for
such transfer must be received by the Company not less than thirty days prior
to the effective date of the transfer;
(2) Transfers from one subaccount to another subaccount shall be effective
during the valuation period next succeeding the date the notice is received by
the Company. However, if the notice for the transfer is received within the
seven days immediately preceding an annuity payment date, the transfer shall be
effective during the valuation period next succeeding that annuity payment
date. No transfer to a subaccount may be made during the first year of the
annuity period. All transfers in subsequent years between subaccounts shall be
made on the same day in a given year and are limited to one transfer each year;
(3) No transfer may result in a payee having more than three subaccounts; and
(4) The payee's entire interest in a subaccount must be transferred.
The number of annuity units per payment attributable to a subaccount to which
transfer is made is equal to in the case of a transfer between subaccounts, the
number of annuity units per payment in the subaccount from which transfer is
being made multiplied by the annuity unit value for that subaccount, such
amount being divided by the annuity unit value for the subaccount to which
transfer is being made.
The amount of money allocated to a fixed annuity in the event of a transfer
from a subaccount equals the annuity reserve for the payee's interest in such
subaccount. The annuity reserve is the product of (1) multiplied by (2)
multiplied by (3) where: (1) is the number of annuity units representing the
payee's interest in such subaccount per annuity payment; (2) is the annuity
unit value for such subaccount; and (3) is the present value of $1.00 per
payment period as of the adjusted age(s) of the payee(s) attained at the time
of the transfer, based upon 1983 Annuity Mortality Tables with 4% interest per
annum. Money allocated to a fixed account upon such transfer shall be applied
under the same annuity option as originally elected, except that adjustment
shall be made for the time period elapsed since the beginning of annuity
payments.
All amounts and annuity unit values are determined as of the end of the
valuation period preceding the effective date of the transfer.
The Company reserves the right at any time and without prior notice to any
party to terminate, suspend or modify the transfer privileges.
SUPPLEMENTARY AGREEMENT - A supplementary agreement shall be issued to reflect
payments to be made under an annuity option. If payment is made as a death
benefit payment, its effective date shall be the date of the Company's receipt
of due proof of death and the return of the certificate. Otherwise, its
effective date will be the date chosen by the owner.
DATE OF FIRST PAYMENT - Interest under an option shall begin to accrue on the
effective date of the supplementary agreement.
EVIDENCE OF AGE, SEX AND SURVIVAL - The Company may require satisfactory
evidence of the age, sex and the continued survival of any person on whose
life the income is based.
MISSTATEMENT OF AGE OR SEX - If a payee's age or sex has been misstated, the
amount payable under this contract shall be such as the stipulated payments to
the Company would have purchased at the correct age or sex. Interest not to
exceed six per cent per annum shall be charged to any overpayment or credited
to any underpayment against future payments made by the Company under this
contract.
INTEREST AND MORTALITY - Interest on funds held by the Company under Options 1
and 6 is at 4.00% interest per year. The sums payable under Options 2, 3, 4 and
5 are based on the 1983 Annuity Mortality Tables at 4.00% interest per annum.
Interest shall be compounded annually. Additional interest earnings, if any,
shall be paid as determined by the Company.
DISBURSEMENT OF FUNDS UPON DEATH OF PAYEE: UNDER OPTIONS 1, 3 OR 6 - Upon the
death of the payee, the value of any remaining unpaid instalments shall
continued to be paid to the payee's beneficiary unless otherwise provided in
the supplementary agreement.
PROTECTION OF BENEFITS - Unless otherwise provided in the supplementary
agreement, the payee may not commute, anticipate, assign, alienate or otherwise
encumber any payment to be received.
CREDITORS - The proceeds under this contract and any payment under an annuity
option will be exempt from the claim of creditors and from legal process to the
extent permitted by law.
L-1600 (9/91) Page 9
14
ANNUITY OPTION TABLES
OPTION 1 - INCOME FOR SPECIFIED PERIOD*
AMOUNT OF INSTALLMENT FOR PERIOD AND PAYMENT MODE ELECTED
(FOR EACH $1000 APPLIED)
SPECIFIED
PERIOD
(YEARS) ANNUAL SEMI-ANNUAL QUARTERLY MONTHLY
3 346.49 174.94 87.90 29.40
4 264.89 133.75 67.20 22.47
5 215.99 109.05 54.79 18.32
6 183.42 92.61 46.53 15.56
7 160.20 80.89 40.64 13.59
8 142.82 72.11 36.23 12.12
9 129.32 65.29 32.81 10.97
10 118.55 59.86 30.07 10.06
15 86.48 43.66 21.94 7.34
20 70.75 35.72 17.95 6.00
25 61.55 31.08 15.61 5.22
30 55.61 28.08 14.11 4.72
OPTION 2 - LIFE INCOME*
MONTHLY INSTALLMENT FOR EACH $1000 APPLIED
ADJUSTED MONTHLY INCOME ADJUSTED MONTHLY INCOME
AGE MALE FEMALE AGE MALE FEMALE
35 4.06 3.89 60 5.86 5.29
36 4.10 3.91 61 6.00 5.40
37 4.14 3.94 62 6.16 5.52
38 4.18 3.97 63 6.32 5.65
39 4.22 4.01 64 6.49 5.78
40 4.27 4.04 65 6.68 5.92
41 4.31 4.07 66 6.88 6.08
42 4.36 4.11 67 7.09 6.24
43 4.42 4.15 68 7.31 6.42
44 4.47 4.19 69 7.56 6.61
45 4.53 4.24 70 7.82 6.81
46 4.59 4.28 71 8.09 7.04
47 4.65 4.33 72 8.39 7.28
48 4.72 4.38 73 8.71 7.54
49 4.79 4.44 74 9.05 7.83
50 4.86 4.50 75 9.41 8.14
51 4.84 4.56 76 9.81 8.47
52 5.02 4.62 77 10.23 8.83
53 5.10 4.69 78 10.68 9.23
54 5.19 4.76 79 11.16 9.65
55 5.29 4.84 80 11.68 10.12
56 5.39 4.92 81 12.23 10.62
57 5.49 5.00 82 12.81 11.16
58 5.61 5.09 83 13.44 11.76
59 5.73 5.19 84 14.09 12.39
85 14.79 13.08
*Values for ages not shown will be furnished by the Company upon request.
OPTION 3 - LIFE INCOME WITH INSTALLMENTS
GUARANTEED*
MONTHLY INSTALLMENTS FOR EACH $1000 APPLIED
GUARANTEED PERIOD (M = MALE F = FEMALE)
ADJUSTED 5YR 5YR 10YR 10YR 15YR 15YR 20YR 20 YR
AGE M F M F M F M F
35 4.06 3.88 4.06 3.88 4.04 3.88 4.02 3.87
36 4.10 3.91 4.09 3.91 4.08 3.90 4.06 3.89
37 4.14 3.94 4.13 3.94 4.11 3.93 4.09 3.92
38 4.18 3.97 4.17 3.97 4.15 3.96 4.12 3.95
39 4.22 4.00 4.21 4.00 4.19 3.99 4.16 3.98
40 4.26 4.04 4.25 4.03 4.23 4.02 4.20 4.01
41 4.31 4.07 4.30 4.07 4.27 4.06 4.24 4.04
42 4.36 4.11 4.34 4.10 4.32 4.09 4.28 4.07
43 4.41 4.15 4.39 4.14 4.36 4.13 4.32 4.11
44 4.46 4.19 4.44 4.18 4.41 4.17 4.36 4.15
45 4.52 4.23 4.50 4.23 4.46 4.21 4.40 4.18
46 4.58 4.28 4.55 4.27 4.51 4.25 4.45 4.22
47 4.64 4.33 4.61 4.32 4.56 4.30 4.50 4.27
48 4.71 4.38 4.67 4.37 4.62 4.34 4.55 4.31
49 4.77 4.43 4.74 4.42 4.68 4.39 4.60 4.36
50 4.85 4.49 4.81 4.47 4.74 4.45 4.65 4.40
51 4.92 4.55 4.88 4.53 4.80 4.50 4.71 4.45
52 5.00 4.61 4.95 4.59 4.87 4.56 4.76 4.50
53 5.08 4.68 5.03 4.66 4.94 4.62 4.82 4.56
54 5.17 4.75 5.11 4.72 5.01 4.68 4.88 4.61
55 5.26 4.83 5.20 4.80 5.09 4.74 4.94 4.67
56 5.36 4.91 5.29 4.87 5.17 4.81 5.00 4.73
57 5.47 4.99 5.38 4.95 5.25 4.88 5.06 4.79
58 5.58 5.08 5.48 5.03 5.33 4.96 5.12 4.85
59 5.70 5.17 5.59 5.12 5.42 5.04 5.18 4.91
60 5.82 5.27 5.70 5.22 5.51 5.12 5.24 4.98
61 5.96 5.38 5.82 5.32 5.60 5.21 5.31 5.05
62 6.10 5.50 5.95 5.42 5.69 5.30 5.37 5.11
63 6.26 5.62 6.08 5.53 5.79 5.39 5.43 5.18
64 6.42 5.75 6.21 5.65 5.89 5.49 5.48 5.25
65 6.60 5.89 6.35 5.77 5.98 5.58 5.54 5.32
66 6.78 6.03 6.50 5.90 6.08 5.69 5.59 5.39
67 6.98 6.19 6.65 6.04 6.18 5.79 5.64 5.45
68 7.18 6.36 6.81 6.19 6.28 5.90 5.69 5.51
69 7.40 6.54 6.97 6.34 6.37 6.01 5.73 5.58
70 7.64 6.74 7.14 6.50 6.47 6.12 5.77 5.63
71 7.88 6.95 7.31 6.67 6.55 6.22 5.81 5.69
72 8.14 7.17 7.48 6.84 6.64 6.33 5.84 5.73
73 8.41 7.41 7.65 7.02 6.72 6.44 5.87 5.78
74 8.70 7.67 7.83 7.21 6.80 6.54 5.89 5.82
75 9.00 7.95 8.00 7.40 6.87 6.64 5.91 5.85
76 9.32 8.24 8.17 7.60 6.93 6.73 5.93 5.88
77 9.65 8.56 8.34 7.80 6.99 6.82 5.95 5.91
78 9.99 8.89 8.50 7.99 7.05 6.90 5.96 5.93
79 10.35 9.24 8.66 8.19 7.10 6.97 5.97 5.94
80 10.72 9.61 8.81 8.36 7.14 7.03 5.98 5.96
81 11.09 10.01 8.95 8.57 7.18 7.09 5.99 5.97
82 11.47 10.41 9.09 8.74 7.21 7.13 5.99 5.98
83 11.86 10.84 9.21 8.91 7.23 7.17 5.99 5.99
84 12.25 11.28 9.32 9.06 7.26 7.21 6.00 5.99
85 12.64 11.72 9.43 9.21 7.28 7.24 6.00 6.00
*Values for ages not shown will be furnished by the Company upon request.
Form L-1606 (9/91) Page 1
15
OPTION 4 - JOINT AND SURVIVOR ANNUITY
(66-2/3% CONTINUING SURVIVOR BENEFIT)
MONTHLY INSTALLMENT FOR EACH $1000 APPLIED*
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 55 56 57 58 59 60 61
55 4.83 4.87 4.91 4.96 5.00 5.05 5.09
56 4.87 4.91 4.95 5.00 5.04 5.09 5.14
57 4.91 4.95 4.99 5.04 5.09 5.14 5.19
58 4.94 4.99 5.04 5.08 5.13 5.18 5.23
59 4.98 5.03 5.08 5.13 5.18 5.23 5.28
60 5.03 5.07 5.12 5.17 5.23 5.28 5.34
61 5.07 5.12 5.17 5.22 5.27 5.33 5.39
62 5.11 5.16 5.21 5.27 5.32 5.38 5.44
63 5.15 5.21 5.26 5.32 5.37 5.43 5.50
64 5.20 5.25 5.31 5.37 5.43 5.49 5.55
65 5.24 5.30 5.36 5.42 5.48 5.54 5.61
66 5.29 5.35 5.41 5.47 5.53 5.60 5.67
67 5.34 5.40 5.46 5.52 5.59 5.66 5.73
68 5.39 5.45 5.51 5.57 5.64 5.71 5.79
69 5.43 5.50 5.56 5.63 5.70 5.77 5.85
70 5.48 5.55 5.61 5.68 5.75 5.83 5.91
71 5.53 5.60 5.67 5.74 5.81 5.89 5.97
72 5.58 5.65 5.72 5.79 5.87 5.95 6.03
73 5.63 5.70 5.77 5.85 5.92 6.01 6.09
74 5.68 5.75 5.83 5.90 5.98 6.07 6.16
75 5.73 5.80 5.88 5.96 6.04 6.13 6.22
ADJUSTED
AGE 62 63 64 65 66 67 68
55 5.14 5.19 5.24 5.29 5.35 5.40 5.46
56 5.19 5.24 5.29 5.35 5.40 5.46 5.52
57 5.24 5.29 5.35 5.40 5.46 5.52 5.58
58 5.29 5.34 5.40 5.46 5.52 5.58 5.64
59 5.34 5.40 5.46 5.52 5.58 5.64 5.71
60 5.39 5.45 5.51 5.58 5.64 5.71 5.77
61 5.45 5.51 5.57 5.64 5.70 5.77 5.84
62 5.50 5.57 5.63 5.70 5.77 5.84 5.92
63 5.56 5.63 5.70 5.77 5.84 5.91 5.99
64 5.62 5.69 5.76 5.83 5.91 5.99 6.07
65 5.68 5.75 5.82 5.90 5.98 6.06 6.14
66 5.74 5.81 5.89 5.97 6.05 6.14 6.22
67 5.80 5.88 5.96 6.04 6.12 6.21 6.30
68 5.86 5.94 6.02 6.11 6.20 6.29 6.39
69 5.93 6.01 6.09 6.18 6.27 6.37 6.47
70 5.99 6.07 6.16 6.26 6.35 6.45 6.55
71 6.05 6.14 6.23 6.33 6.43 6.53 6.64
72 6.12 6.21 6.30 6.40 6.51 6.61 6.72
73 6.18 6.28 6.37 6.48 6.58 6.69 6.81
74 6.25 6.34 6.45 6.55 6.66 6.78 6.90
75 6.31 6.41 6.52 6.63 6.74 6.86 6.98
ADJUSTED
AGE 69 70 71 72 73 74 75
55 5.51 5.57 5.63 5.69 5.76 5.82 5.89
56 5.58 5.64 5.70 5.76 5.83 5.89 5.96
57 5.64 5.70 5.77 5.83 5.90 5.97 6.04
58 5.70 5.77 5.84 5.91 5.98 6.05 6.12
59 5.77 5.84 5.91 5.98 6.06 6.13 6.21
60 5.84 5.91 5.99 6.06 6.14 6.22 6.30
61 5.92 5.99 6.07 6.14 6.22 6.31 6.39
62 5.99 6.07 6.15 6.23 6.31 6.40 6.49
63 6.07 6.15 6.23 6.32 6.41 6.50 6.59
64 6.15 6.23 6.32 6.41 6.50 6.59 6.69
65 6.23 6.32 6.41 6.50 6.60 6.70 6.80
66 6.31 6.40 6.50 6.60 6.70 6.80 6.91
67 6.40 6.49 6.59 6.70 6.80 6.91 7.02
68 6.48 6.58 6.69 6.80 6.91 7.02 7.14
69 6.57 6.68 6.79 6.90 7.02 7.14 7.26
70 6.66 6.77 6.88 7.00 7.13 7.25 7.38
71 6.75 6.86 6.98 7.11 7.24 7.37 7.50
72 6.84 6.96 7.09 7.22 7.35 7.49 7.63
73 6.93 7.06 7.19 7.32 7.46 7.61 7.76
74 7.02 7.15 7.29 7.43 7.58 7.73 7.89
75 7.11 7.25 7.39 7.54 7.70 7.86 8.02
OPTION 5 - PENSION AND SURVIVOR ANNUITY
PRIMARY PAYEE - MONTHLY INSTALLMENT FOR EACH $1000 APPLIED
WHEN THE PRIMARY PAYEE IS MALE AND THE SECONDARY PAYEE IS FEMALE*
(100% MALE CONTINUING SURVIVOR BENEFIT)
(50% FEMALE CONTINUING SURVIVOR BENEFIT)
MALE
ADJUSTED SECONDARY PAYEE - FEMALE ADJUSTED AGE
AGE 55 56 57 58 59 60 61
55 4.83 4.85 4.87 4.89 4.91 4.93 4.95
56 4.88 4.91 4.93 4.95 4.97 5.00 5.02
57 4.94 4.97 4.99 5.01 5.04 5.06 5.09
58 5.00 5.03 5.05 5.08 5.10 5.13 5.16
59 5.06 5.09 5.12 5.14 5.17 5.20 5.23
60 5.13 5.15 5.18 5.21 5.24 5.27 5.30
61 5.19 5.22 5.25 5.29 5.32 5.35 5.38
62 5.26 5.29 5.33 5.36 5.39 5.43 5.46
63 5.33 5.36 5.40 5.44 5.47 5.51 5.54
64 5.40 5.44 5.48 5.51 5.55 5.59 5.63
65 5.48 5.51 5.55 5.59 5.64 5.68 5.72
66 5.55 5.59 5.64 5.68 5.72 5.77 5.81
67 5.63 5.67 5.72 5.76 5.81 5.86 5.90
68 5.71 5.76 5.80 5.85 5.90 5.95 6.00
69 5.79 5.84 5.89 5.94 5.99 6.04 6.10
70 5.88 5.93 5.98 6.03 6.08 6.14 6.20
71 5.96 6.01 6.07 6.12 6.18 6.24 6.30
72 6.05 6.10 6.16 6.22 6.28 6.34 6.40
73 6.14 6.19 6.25 6.31 6.38 6.44 6.51
74 6.23 6.29 6.35 6.41 6.48 6.55 6.62
75 6.32 6.38 6.44 6.51 6.58 6.65 6.73
ADJUSTED
AGE 62 63 64 65 66 67 68
55 4.97 4.99 5.01 5.03 5.04 5.06 5.08
56 5.04 5.06 5.08 5.10 5.12 5.14 5.15
57 5.11 5.13 5.15 5.17 5.20 5.22 5.24
58 5.18 5.20 5.23 5.25 5.28 5.30 5.32
59 5.25 5.28 5.31 5.33 5.36 5.38 5.41
60 5.33 5.36 5.39 5.42 5.45 5.47 5.50
61 5.41 5.44 5.47 5.51 5.54 5.56 5.59
62 5.50 5.53 5.56 5.60 5.63 5.66 5.69
63 5.58 5.62 5.65 5.69 5.73 5.76 5.80
64 5.67 5.71 5.75 5.79 5.83 5.87 5.90
65 5.76 5.80 5.85 5.89 5.93 5.97 6.01
66 5.86 5.90 5.95 5.99 6.04 6.08 6.13
67 5.95 6.00 6.05 6.10 6.15 6.20 6.25
68 6.05 6.10 6.16 6.21 6.26 6.32 6.37
69 6.15 6.21 6.26 6.32 6.38 6.44 6.49
70 6.26 6.31 6.38 6.44 6.50 6.56 6.62
71 6.36 6.42 6.49 6.55 6.62 6.69 6.75
72 6.47 6.54 6.60 6.67 6.74 6.82 6.89
73 6.58 6.65 6.72 6.79 6.87 6.95 7.03
74 6.69 6.76 6.84 6.92 7.00 7.08 7.17
75 6.80 6.88 6.96 7.05 7.13 7.22 7.31
ADJUSTED
AGE 69 70 71 72 73 74 75
55 5.09 5.11 5.12 5.14 5.15 5.16 5.17
56 5.17 5.19 5.20 5.22 5.23 5.25 5.26
57 5.25 5.27 5.29 5.31 5.32 5.34 5.35
58 5.34 5.36 5.38 5.40 5.41 5.43 5.45
59 5.43 5.45 5.47 5.49 5.51 5.53 5.55
60 5.52 5.55 5.57 5.59 5.62 5.64 5.66
61 5.62 5.65 5.67 5.70 5.72 5.75 5.77
62 5.72 5.75 5.78 5.81 5.84 5.86 5.89
63 5.83 5.86 5.90 5.93 5.96 5.99 6.01
64 5.94 5.98 6.01 6.05 6.08 6.11 6.14
65 6.06 6.10 6.14 6.17 6.21 6.25 6.28
66 6.17 6.22 6.26 6.30 6.35 6.39 6.42
67 6.30 6.35 6.39 6.44 6.49 6.53 6.57
68 6.42 6.48 6.53 6.58 6.63 6.68 6.73
69 6.55 6.61 6.67 6.72 6.78 6.83 6.89
70 6.69 6.75 6.81 6.87 6.93 6.99 7.05
71 6.82 6.89 6.96 7.03 7.09 7.16 7.22
72 6.96 7.04 7.11 7.18 7.26 7.33 7.40
73 7.10 7.18 7.26 7.35 7.43 7.51 7.58
74 7.25 7.34 7.42 7.51 7.60 7.69 7.77
75 7.40 7.49 7.58 7.68 7.77 7.87 7.96
*Values for other age, sex and percent combinations will be furnished by the
Company upon request.
Page 2
16
ANNUITY OPTION TABLES
OPTION 1 - INCOME FOR SPECIFIED PERIOD*
AMOUNT OF INSTALLMENT FOR PERIOD AND PAYMENT MODE ELECTED
(FOR EACH $1000 APPLIED)
SPECIFIED
PERIOD
(YEARS) ANNUAL SEMI-ANNUAL QUARTERLY MONTHLY
3 346.49 174.94 87.90 29.40
4 264.89 133.75 67.20 22.47
5 215.99 109.05 54.79 18.32
6 183.42 92.61 46.53 15.56
7 160.20 80.89 40.64 13.59
8 142.82 72.11 36.23 12.12
9 129.32 65.29 32.81 10.97
10 118.55 59.86 30.07 10.06
15 86.48 43.66 21.94 7.34
20 70.75 35.72 17.95 6.00
25 61.55 31.08 15.61 5.22
30 55.61 28.08 14.11 4.72
OPTION 2 - LIFE INCOME*
MONTHLY INSTALLMENT FOR EACH $1000 APPLIED
ADJUSTED MONTHLY-INCOME ADJUSTED MONTHLY-INCOME
AGE AGE
35 3.98 60 5.58
36 4.01 61 5.71
37 4.04 62 5.84
38 4.08 63 5.98
39 4.12 64 6.14
40 4.16 65 6.30
41 4.20 66 6.48
42 4.24 67 6.66
43 4.29 68 6.86
44 4.34 69 7.08
45 4.39 70 7.31
46 4.44 71 7.56
47 4.50 72 7.83
48 4.55 73 8.12
49 4.62 74 8.43
50 4.68 75 8.77
51 4.75 76 9.13
52 4.82 77 9.52
53 4.90 78 9.94
54 4.98 79 10.40
55 5.06 80 10.88
56 5.15 81 11.41
57 5.25 82 11.97
58 5.35 83 12.58
59 5.46 84 13.23
*Values for ages not shown will be furnished by the Company upon request.
OPTION 3 - LIFE INCOME WITH INSTALLMENTS
GUARANTEED*
MONTHLY INSTALLMENTS FOR EACH $1000 APPLIED
GUARANTEE PERIOD
ADJUSTED 5 YR 10 YR 15 YR 20 YR
AGE
35 3.98 3.97 3.96 3.95
36 4.01 4.00 3.99 3.98
37 4.04 4.04 4.02 4.01
38 4.08 4.07 4.06 4.04
39 4.11 4.11 4.09 4.07
40 4.15 4.15 4.13 4.11
41 4.19 4.19 4.17 4.14
42 4.24 4.23 4.21 4.18
43 4.28 4.27 4.25 4.22
44 4.33 4.32 4.29 4.26
45 4.38 4.37 4.34 4.30
46 4.43 4.42 4.39 4.34
47 4.49 4.47 4.44 4.39
48 4.55 4.52 4.49 4.43
49 4.61 4.58 4.54 4.48
50 4.67 4.64 4.60 4.53
51 4.74 4.71 4.66 4.58
52 4.81 4.78 4.72 4.64
53 4.89 4.85 4.78 4.69
54 4.96 4.92 4.85 4.75
55 5.05 5.00 4.92 4.81
56 5.14 5.08 5.00 4.87
57 5.23 5.17 5.07 4.93
58 5.33 5.27 5.15 4.99
59 5.44 5.36 5.24 5.06
60 5.55 5.47 5.32 5.12
61 5.67 5.58 5.41 5.19
62 5.80 5.69 5.50 5.25
63 5.94 5.81 5.60 5.31
64 6.09 5.94 5.70 5.38
65 6.24 6.07 5.79 5.44
66 6.41 6.21 5.90 5.50
67 6.59 6.36 6.00 5.56
68 6.77 6.51 6.10 5.61
69 6.98 6.67 6.20 5.66
70 7.19 6.83 6.30 5.71
71 7.42 7.00 6.40 5.75
72 7.66 7.17 6.50 5.79
73 7.92 7.35 6.59 5.83
74 8.19 7.53 6.68 5.86
75 8.48 7.72 6.76 5.89
76 8.78 7.90 6.84 5.91
77 9.11 8.08 6.91 5.93
78 9.45 8.26 6.98 5.95
79 9.80 8.44 7.04 5.96
80 10.17 8.61 7.09 5.97
81 10.56 8.77 7.13 5.98
82 10.95 8.93 7.17 5.99
83 11.36 9.07 7.21 5.99
84 11.77 9.20 7.24 5.99
85 12.19 9.33 7.26 6.00
*Values for ages not shown will be furnished by the Company upon request.
Form L-1607 (9/91) Page 1
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OPTION 4 - JOINT AND SURVIVOR ANNUITY
(66-2/3% CONTINUING SURVIVOR BENEFIT)
MONTHLY INSTALLMENT FOR EACH $1000 APPLIED*
ADJUSTED
AGE OF
PRIMARY SECONDARY PAYEE - ADJUSTED AGE
PAYEE 55 56 57 58 59 60 61
55 4.85 4.89 4.93 4.97 5.01 5.05 5.10
56 4.89 4.93 4.97 5.01 5.06 5.10 5.15
57 4.93 4.97 5.01 5.06 5.10 5.15 5.20
58 4.97 5.01 5.06 5.10 5.15 5.20 5.25
59 5.01 5.06 5.10 5.15 5.20 5.25 5.30
60 5.05 5.10 5.15 5.20 5.25 5.30 5.35
61 5.10 5.15 5.20 5.25 5.30 5.35 5.41
62 5.15 5.19 5.25 5.30 5.35 5.41 5.47
63 5.19 5.24 5.30 5.35 5.41 5.47 5.53
64 5.24 5.29 5.35 5.41 5.46 5.52 5.59
65 5.29 5.34 5.40 5.46 5.52 5.58 5.65
66 5.34 5.40 5.45 5.52 5.58 5.64 5.71
67 5.39 5.45 5.51 5.57 5.64 5.71 5.78
68 5.44 5.50 5.57 5.63 5.70 5.77 5.84
69 5.49 5.56 5.62 5.69 5.76 5.83 5.91
70 5.55 5.61 5.68 5.75 5.82 5.90 5.98
71 5.60 5.67 5.74 5.81 5.89 5.96 6.04
72 5.66 5.73 5.80 5.87 5.95 6.03 6.11
73 5.71 5.79 5.86 5.93 6.01 6.10 6.19
74 5.77 5.84 5.92 6.00 6.08 6.17 6.26
75 5.83 5.90 5.98 6.06 6.15 6.24 6.33
ADJUSTED
AGE 62 63 64 65 66 67 68
55 5.15 5.19 5.24 5.29 5.34 5.39 5.44
56 5.19 5.24 5.29 5.34 5.40 5.45 5.50
57 5.25 5.30 5.35 5.40 5.45 5.51 5.57
58 5.30 5.35 5.41 5.46 5.52 5.57 5.63
59 5.35 5.41 5.46 5.52 5.58 5.64 5.70
60 5.41 5.47 5.52 5.58 5.64 5.71 5.77
61 5.47 5.53 5.59 5.65 5.71 5.78 5.84
62 5.53 5.59 5.65 5.72 5.78 5.85 5.92
63 5.59 5.65 5.72 5.78 5.85 5.92 5.99
64 5.65 5.72 5.79 5.86 5.93 6.00 6.07
65 5.72 5.78 5.86 5.93 6.00 6.08 6.16
66 5.78 5.85 5.93 6.00 6.08 6.16 6.24
67 5.85 5.92 6.00 6.08 6.16 6.24 6.33
68 5.92 5.99 6.07 6.16 6.24 6.33 6.42
69 5.99 6.07 6.15 6.24 6.33 6.42 6.51
70 6.06 6.14 6.23 6.32 6.41 6.51 6.60
71 6.13 6.22 6.31 6.40 6.50 6.60 6.70
72 6.20 6.29 6.39 6.49 6.59 6.69 6.80
73 6.28 6.37 6.47 6.57 6.68 6.78 6.90
74 6.35 6.45 6.55 6.66 6.77 6.88 7.00
75 6.43 6.53 6.63 6.74 6.86 6.98 7.10
ADJUSTED
AGE 69 70 71 72 73 74 75
55 5.49 5.55 5.60 5.66 5.71 5.77 5.83
56 5.56 5.61 5.67 5.73 5.79 5.84 5.90
57 5.62 5.68 5.74 5.80 5.86 5.92 5.98
58 5.69 5.75 5.81 5.87 5.93 6.00 6.06
59 5.76 5.82 5.89 5.95 6.01 6.08 6.15
60 5.83 5.90 5.96 6.03 6.10 6.17 6.24
61 5.91 5.98 6.04 6.11 6.19 6.26 6.33
62 5.99 6.06 6.13 6.20 6.28 6.35 6.43
63 6.07 6.14 6.22 6.29 6.37 6.45 6.53
64 6.15 6.23 6.31 6.39 6.47 6.55 6.63
65 6.24 6.32 6.40 6.49 6.57 6.66 6.74
66 6.33 6.41 6.50 6.59 6.68 6.77 6.86
67 6.42 6.51 6.60 6.69 6.78 6.88 6.98
68 6.51 6.60 6.70 6.80 6.90 7.00 7.10
69 6.61 6.70 6.81 6.91 7.01 7.12 7.22
70 6.70 6.81 6.91 7.02 7.13 7.24 7.36
71 6.81 6.91 7.02 7.14 7.25 7.37 7.49
72 6.91 7.02 7.14 7.26 7.38 7.50 7.63
73 7.01 7.13 7.25 7.38 7.51 7.64 7.77
74 7.12 7.24 7.37 7.50 7.64 7.78 7.92
75 7.22 7.36 7.49 7.63 7.77 7.92 8.07
OPTION 5 - PENSION AND SURVIVOR ANNUITY
MONTHLY INSTALLMENT FOR EACH $1000 APPLIED*
PRIMARY PAYEE - 100% CONTINUING SURVIVIOR BENEFIT
SECONDARY PAYEE - 50% CONTINUING SURVIVOR BENEFIT
ADJUSTED
AGE OF
PRIMARY SECONDARY PAYEE - ADJUSTED AGE
PAYEE 55 56 57 58 59 60 61
55 4.75 4.76 4.78 4.80 4.81 4.83 4.84
56 4.80 4.82 4.84 4.86 4.87 4.89 4.91
57 4.86 4.88 4.90 4.92 4.94 4.96 4.97
58 4.92 4.94 4.96 4.99 5.01 5.03 5.05
59 4.98 5.01 5.03 5.05 5.08 5.10 5.12
60 5.05 5.07 5.10 5.12 5.15 5.17 5.19
61 5.12 5.14 5.17 5.20 5.22 5.25 5.27
62 5.19 5.22 5.24 5.27 5.30 5.33 5.36
63 5.26 5.29 5.32 5.35 5.38 5.41 5.44
64 5.33 5.37 5.40 5.43 5.46 5.50 5.53
65 5.41 5.44 5.48 5.51 5.55 5.59 5.62
66 5.49 5.53 5.56 5.60 5.64 5.68 5.71
67 5.57 5.61 5.65 5.69 5.73 5.77 5.81
68 5.65 5.69 5.74 5.78 5.82 5.87 5.91
69 5.74 5.78 5.83 5.87 5.92 5.97 6.01
70 5.83 5.87 5.92 5.97 6.02 6.07 6.12
71 5.92 5.97 6.02 6.07 6.12 6.18 6.23
72 6.01 6.06 6.12 6.17 6.23 6.28 6.34
73 6.11 6.16 6.22 6.28 6.33 6.39 6.46
74 6.21 6.26 6.32 6.38 6.44 6.51 6.57
75 6.31 6.37 6.43 6.49 6.56 6.63 6.70
ADJUSTED
AGE 62 63 64 65 66 67 68
55 4.86 4.87 4.88 4.90 4.91 4.92 4.93
56 4.92 4.94 4.95 4.97 4.88 4.99 5.01
57 4.99 5.01 5.03 5.04 5.06 5.07 5.08
58 5.06 5.08 5.10 5.12 5.13 5.15 5.17
59 5.14 5.16 5.18 5.20 5.22 5.23 5.25
60 5.22 5.24 5.26 5.28 5.30 5.32 5.34
61 5.30 5.32 5.35 5.37 5.39 5.42 5.44
62 5.38 5.41 5.44 5.46 5.49 5.51 5.53
63 5.47 5.50 5.53 5.56 5.58 5.61 5.64
64 5.56 5.59 5.63 5.66 5.69 5.72 5.74
65 5.66 5.69 5.72 5.76 5.79 5.82 5.86
66 5.75 5.79 5.83 5.87 5.90 5.94 5.97
67 5.85 5.89 5.93 5.97 6.01 6.05 6.09
68 5.96 6.00 6.04 6.09 6.13 6.18 6.22
69 6.06 6.11 6.16 6.21 6.25 6.30 6.35
70 6.17 6.22 6.28 6.33 6.38 6.43 6.48
71 6.28 6.34 6.40 6.45 6.51 6.56 6.62
72 6.40 6.46 6.52 6.58 6.64 6.70 6.76
73 6.52 6.58 6.65 6.71 6.78 6.85 6.91
74 6.64 6.71 6.78 6.85 6.92 6.99 7.06
75 6.77 6.84 6.91 6.99 7.07 7.14 7.22
ADJUSTED
AGE 69 70 71 72 73 74 75
55 4.94 4.95 4.96 4.97 4.98 4.99 4.99
56 5.02 5.03 5.04 5.05 5.06 5.07 5.07
57 5.10 5.11 5.12 5.13 5.14 5.15 5.16
58 5.18 5.19 5.21 5.22 5.23 5.24 5.25
59 5.27 5.28 5.30 5.31 5.32 5.34 5.35
60 5.36 5.38 5.39 5.41 5.42 5.44 5.45
61 5.46 5.48 5.49 5.51 5.53 5.54 5.56
62 5.56 5.58 5.60 5.62 5.64 5.65 5.67
63 5.66 5.69 5.71 5.73 5.75 5.77 5.79
64 5.77 5.80 5.82 5.85 5.87 5.89 5.91
65 5.89 5.92 5.94 5.97 6.00 6.02 6.05
66 6.01 6.04 6.07 6.10 6.13 6.16 6.18
67 6.13 6.17 6.20 6.24 6.27 6.30 6.33
68 6.26 6.30 6.34 6.38 6.41 6.45 6.48
69 6.39 6.44 6.48 6.52 6.56 6.60 6.64
70 6.53 6.58 6.63 6.68 6.72 6.76 6.81
71 6.68 6.73 6.78 6.83 6.89 6.93 6.98
72 6.82 6.88 6.94 7.00 7.06 7.11 7.16
73 6.98 7.04 7.11 7.17 7.23 7.29 7.35
74 7.14 7.21 7.28 7.35 7.42 7.48 7.55
75 7.30 7.38 7.45 7.53 7.61 7.68 7.76
*Values for other age and percent combinations will be furnished by the
Company upon request.
Page 2
18
XXXXXX INVESTORS LIFE INSURANCE COMPANY
0 Xxxxxx Xxxxx, Xxxx Xxxxx, XX 00000-0000
ENDORSEMENT
This Endorsement forms a part of the attached contract. The effective date of
this Endorsement is the effective date of this contract.
All references throughout this contract to the sex of a person used in the
calculation of benefits are deleted from this contract.
Except as modified herein, all terms and conditions of the contract remain
unchanged.
IN WITNESS WHEREOF, Xxxxxx Investors Life Insurance Company has caused this
Endorsement to be signed by its President and Secretary.
[sig] [sig]
Secretary President
Form L-9006 (9/88)
19
INDEX
CONTRACT SCHEDULE PAGE
DEFINITIONS.......................................... 1-2
GENERAL PROVISIONS................................... 2-3
The Contract................................... 2
Modification Of Contract....................... 2
Incontestability............................... 2
Reserves, Values, and Death Benefits........... 2
OWNERSHIP PROVISIONS................................. 3
Owner.......................................... 3
Change of Ownership............................ 3
Beneficiary.................................... 3
PURCHASE PAYMENT PROVISIONS.......................... 3
Purchase Payment............................... 3
Purchase Payment Limitations................... 3
GUARANTEE PERIOD PROVISIONS.......................... 3-4
MARKET VALUE ADJUSTMENT PROVISION.................... 4
VARIABLE ACCOUNT PROVISIONS.......................... 4-5
TRANSFER AND WITHDRAWAL PROVISIONS................... 5-6
DEATH BENEFIT PROVISION.............................. 6-7
Amount of Death Benefit........................ 6
Payment of Death Benefit....................... 6-7
PROVISIONS FOR CERTAIN QUALIFIED PLAN CONTRACT....... 7
ANNUITY PERIOD PROVISIONS............................ 7-10
ANNUITY OPTION TABLES
ENDORSEMENTS, if any
L-1600 (9/91)
20
GROUP SINGLE PREMIUM MODIFIED GUARANTEED AND
VARIABLE DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
XXXXXX INVESTORS LIFE INSURANCE COMPANY
An Illinois stock corporation
0 Xxxxxx Xxxxx, Xxxx Xxxxx, XX 00000-0000
This is a legal contract between the contractholder and Xxxxxx Investors Life
Insurance Company
READ YOUR CONTRACT CAREFULLY
Form L-1600 (9/91)
