Deferred Annuity Contract
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[GRAPHIC OMITTED] American Centurion
(logo) Life Assurance Company
AMERICAN 00 Xxxxxxx Xxx. Ext.
EXPRESS P.O. Box 5555
(R) Albany, New York 12205
[GRAPHIC OMITTED]
(logo)
American
Centurion
Life
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This is a deferred annuity contract. It is a legal contract between you, as the
owner, and us, American Centurion Life Assurance Company, a Stock Company.
PLEASE READ YOUR CONTRACT CAREFULLY.
If the annuitant is living on the Retirement Date, upon your request, we will
begin to pay you monthly annuity payments. Any payments made by us are subject
to the terms of this contract. The owner and beneficiary are as named in the
application unless they are changed as provided for in this contract.
We issue this contract in consideration of your application and the payment of
the initial purchase payment.
Signed for and issued by American Centurion Life Assurance Company of Albany,
New York, as of the contract date.
ACCUMULATION VALUES AND ANNUITY PAYMENTS, WHEN BASED ON THE INVESTMENT RESULTS
OF THE VARIABLE SUBACCOUNTS, ARE VARIABLE AND NOT GUARANTEED AS TO FIXED DOLLAR
AMOUNT. See the Fixed and Variable Accounts section for variable provisions.
The Mortality & Expense Risk and Variable Account Administrative Charges are
shown under Contract Data.
In order for the dollar amount of variable annuity payments not to decrease,
the assets of the variable accounts must have an annual net rate of investment
return of 3.5%. This is equal to the gross investment return minus the
mortality and expense risk charge and administrative charge shown under
Contract Data.
The Fixed Account may not be available on the contract date. Please check the
Contract Data to determine whether the Fixed Account is currently available.
NOTICE OF YOUR RIGHT TO EXAMINE THIS CONTRACT FOR 10 DAYS. If for any reason you
are not satisfied with this contract, return it to us or our agent within 10
days after you receive it. We will then cancel this contract. Upon such
cancellation we will refund an amount equal to the sum of: (1) the contract
value, less any purchase payment credits, if applicable, at the end of the
Valuation Period during which we receive the contract; and (2) any fees paid or
any premium tax charges paid. This contract will then be considered void from
its start.
/s/ Xxxx X. Xxxxxxx /s/ Xxxxxxx X. Xxxxxxxx
Secretary President
|X| Flexible Purchase Payments
|X| Investment Experience Reflected in Benefits
|X| Optional Fixed Dollar or Variable Accumulation Values and Annuity Payments
|X| Annuity Payments to Begin on the Retirement Date
|X| This Contract is Nonparticipating - Dividends Are Not Payable
[INN]
272877-NY [A(6/04)]
Guide To Contract Provisions
Definitions Important words and meanings..................................................Page 3
General Provisions Entire contract; Annuity tax qualification; Incontestable;
Modification of the contract; Benefits based on incorrect data;
State laws; Federal laws; Reports to owner; Evidence of survival;
Protection of proceeds; Payments by us; Voting rights.........................Page 4
Ownership and Beneficiary Owner's rights; Change of ownership; Beneficiary; Change of
beneficiary; Assignment.......................................................Page 5
Payments to Beneficiary Describes options and amounts payable upon death..............................Page 6
Purchase Payments Purchase payments; Amount and intervals; Payment limits;
Allocations of purchase payments; Additional "credits" for
purchase payments.............................................................Page 7
Contract Value Describes the fixed and variable account contract values;
Interest to be credited, Contract administrative charge; Premium
tax charges, Transfers of contract values; Dollar Cost Averaging
Program.......................................................................Page 8
Fixed and Variable Describes the Fixed Account; Describes the variable
Accounts subaccounts, accumulation units and values; Net investment
factor; Mortality and expense risk charge; Variable account
administrative charge; Annuity unit value....................................Page 10
Withdrawal Provisions Withdrawal of the contract for its withdrawal value; Rules for
withdrawal; Withdrawal value; Withdrawal charges; Withdrawal
Order; Waiver of withdrawal charges; Suspension or delay in
payment of withdrawal........................................................Page 12
Annuity Provisions When annuity payments begin; Different ways to receive annuity
payments; Determination of payment amounts...................................Page 16
Tables of Annuity Rates Tables showing amount of the first variable annuity payment and
the guaranteed fixed annuity payments for the various payment
plans........................................................................Page 18
[INN]
272877-NY [A(6/04)]
Definitions
The following words are often used in this contract. When we use these words,
this is what we mean:
Accumulation Unit
An accumulation unit is an accounting unit of measure. It is used to calculate
the contract value prior to annuitization.
Annuitant
The person or persons on whose life monthly annuity payments depend. The term
"annuitant" as used in this contract includes joint annuitants and therefore is
replaced in all instances with the term "annuitants." The annuitants are those
persons named under Contract Data or elected at annuitization. All terms,
conditions, rights and requirements that apply to an "annuitant" under this
contract shall apply jointly and severally to each joint annuitant named. Any
contract provisions based on the age of the annuitant will be based on the age
of the oldest annuitant, except that annuity income plan rates will be based on
the specific annuitant(s)' age(s).
Annuitization
The application of the contract value of this contract to provide annuity
payments under an annuity payment plan.
Annuity Unit
An annuity unit is an accounting unit of measure. It is used to calculate the
value of annuity payments from the variable subaccounts on and after
annuitization.
Code
The Internal Revenue Code of 1986, as amended, its regulations thereunder and/or
promulgations of the Internal Revenue Service, as applicable.
Contract Anniversary
The same day and month as the contract date each year that the contract remains
in force.
Contract Date
It is the date from which contract anniversaries, contract years, and contract
months are determined. Your contract date is shown under Contract Data.
Contract Value
The sum of the (1) fixed account contract value (which receives a declared
interest rate); and (2) the variable account contract value (which varies with
the investment performance of the elected subaccounts) for this contract.
Fixed Account
The Fixed Account is made up of all our assets other than those in any separate
account.
Xxxxx Xxxxxxx
A fixed annuity is an annuity with payments which are guaranteed by us as to
dollar amount during the annuity payment period.
Retirement Date
The date shown under Contract Data on which annuity payments are scheduled to
begin. This date may be changed as provided in this contract. You will be
notified prior to the retirement date in order to select an appropriate annuity
payment plan.
Valuation Date
A valuation date is each day the New York Stock Exchange is open for trading.
Valuation Period
A valuation period is the interval of time commencing at the close of business
on each valuation date and ending at the close of business on the next valuation
date.
Variable Account
Consists of separate subaccounts to which you may allocate purchase payments and
contract values; each invests in shares of one fund. The value of your
investment in each subaccount changes with the performance of the particular
fund. The subaccounts available on the contract date are named under Contract
Data.
Variable Annuity
A variable annuity is an annuity with payments which are not predetermined or
guaranteed as to dollar amounts and vary in amount with the investment
experience of one or more of the variable subaccounts.
We, Our, Us
American Centurion Life Assurance Company.
Written Request
A request in writing signed by you and delivered to us at our home office.
You, Your
The owner of this contract. The owner may be someone other than the annuitant.
The owner is shown in the application unless the owner has been changed as
provided in this contract.
272877-NY Page 2
General Provisions
Entire Contract
This contract form and any endorsements or riders attached to it are the entire
contract between you and us.
No one except one of our corporate officers (President, Vice President,
Secretary or Assistant Secretary) can change or waive any of our rights or
requirements under this contract. That person must do so in writing. None of our
other representatives or other persons has the authority to change or waive any
of our rights or requirements under this contract.
Annuity Tax Qualification
This contract is intended to qualify as an annuity contract under Section 72 of
the Code for federal income tax purposes. To that end, the provisions of this
contract are to be interpreted to ensure or maintain such tax-qualification,
notwithstanding any other provisions to the contrary.
Contract Modification
This contract may be modified at any time by written agreement between the
contract owner and us. The modification must be signed by one of our corporate
officers (President, Vice President, Secretary or Assistant Secretary).
We reserve the right to modify this contract to the extent necessary to qualify
this contract as an annuity contract under Section 72 of the Code and all
related laws and regulations which are in effect during the term of this
contract.
We will obtain any necessary approval of any regulatory authority for the
modifications and will provide you with notice and copy of any such
modification.
Incontestable
This contract is incontestable from its date of issue.
Benefits Based on Incorrect Data
Payments under the contract will be based on the annuitant's birthdate and sex.
If the annuitant's birthdate or sex or your birthdate has been misstated,
payments under this contract will be adjusted. They will be based on what would
have been provided at the correct birthdate and sex. Any underpayments made by
us will promptly be paid in a single sum with an interest credit of 6% per
annum. Any overpayments made by us will be subtracted from the future payments
together with an interest charge of 6% per annum.
State Laws
This contract is governed by the laws of the state in which it is delivered. The
values and benefits of this contract are at least equal to those required by
such state. Any paid up annuity, cash withdrawal or death benefits available
under the contract are not less than the minimum benefits required by any
statute of the state in which the contract is delivered.
Reports to Owner
At least once a year we will send you a statement showing the contract value,
the cash withdrawal value and death benefit of this contract as of a date not
more than two months prior to the statement. This statement will be based on any
laws or regulations that apply to contracts of this type. It will be mailed to
your last known post office address.
Evidence of Survival
Where any payments under this contract depend on the recipient or annuitant
being alive on a given date, proof that such condition has been met may be
required by us. Such proof may be required prior to making the payments.
Protection of Proceeds
Payments under this contract are not assignable by any beneficiary prior to the
time they are due. To the extent allowed by law, payments are not subject to the
claims of creditors or to legal process.
Payments by Us
All sums payable by us are payable from our home office. Any payment or
withdrawal from a variable subaccount is based on the variable subaccount value.
Voting Rights
So long as federal law requires, we will give certain voting rights to contract
owners. As contractowner, if you have voting rights we will send a notice to you
telling you the time and place of the shareholder meeting. The notice will also
explain matters to be voted upon and how many votes you get.
272877-NY Page 3
Ownership And Beneficiary
Owner's Rights
As long as the annuitant is living and unless otherwise provided in this
contract, you may exercise all rights and privileges provided in this contract
or allowed by us.
Change of Ownership
You may change the ownership. Any change of ownership must be made by written
request on a form approved by us. The change must be made while the annuitant is
living. Once the change is received by us, it will take effect as of the date of
your request, subject to any action taken or payment made by us before the
receipt.
Beneficiary
Beneficiaries are those you have named in the application or later changed as
provided below, to receive benefits of this contract if you or the annuitant die
while this contract is in force.
Only those beneficiaries who are living when death benefits become payable may
share in the benefits, if any. Benefits will be paid to all primary
beneficiaries surviving you or the annuitant, in accordance with your last
beneficiary designation on file. If none survive, proceeds will be paid to all
surviving contingent beneficiaries. If no beneficiary survives you or the
annuitant, we will pay the benefits to you, if living, otherwise to your estate.
Change of Beneficiary
You may change the beneficiary anytime while the annuitant is living by
satisfactory written request to us. Once the change is received by us, it will
take effect as of the date of your request, subject to any action taken or
payment made by us before the receipt.
Assignment
You can assign this contract or any interest in it while the annuitant is
living. Your interest and the interest of any beneficiary is subject to the
interest of the assignee. An assignment is not a change of ownership and an
assignee is not an owner as these terms are used in this contract. Any amounts
payable to the assignee will be paid in a single sum.
A copy of any assignment must be submitted to us at our home office. Any
assignment is subject to any action taken or payment made by us before the
assignment was received at our home office. We are not responsible for the
validity of any assignment.
272877-NY Page 4
Payments To Beneficiary
Death Benefits Before Annuitization
A death benefit is payable to the beneficiary upon the earlier death of you or
the annuitant while this contract is in force and prior to annuitization.
As of the date we receive due proof of death, w e will pay the beneficiary the
greater of the following amounts, less any applicable purchase payment credits
that have not vested:
1. the contract value; or
2. the "Return of Payment Value".
Return of Payment Value (ROP) Definition
The ROP is the total purchase payments and any applicable purchase payment
credits made to the contract, minus "adjustments for partial withdrawals".
Adjustments for Partial Withdrawals Definition
"Adjustments for partial withdrawals" are for each partial withdrawal using the
following formula:
a X b where:
-------
c
a = the partial withdrawal including any
applicable withdrawal charge
b = the ROP on the date of (but prior to) the partial
withdrawal
c = the contract value on the date of (but
prior to) the partial withdrawal.
Any amounts payable or applied by us as described in the sections below will be
based on the contract values as of the valuation date on or next following the
date on which due proof of death is received at our administrative office. Due
proof of death includes all documents needed to complete the beneficiary's
claim.
Payment of Death Benefit Before Annuitization
The above death benefit will be payable in a lump sum upon the receipt of due
proof of death of you or the annuitant, whichever first occurs. The beneficiary
may elect to receive payment any time within five years after the date of death.
The above death benefit will also be made upon the first to die if ownership is
in a joint tenancy except where spouses are joint owners with right of
survivorship and the surviving joint spouse elects to continue the contract.
In lieu of a lump sum, payments may be made under:
1. an Annuity Payment Plan, provided:
1. the beneficiary elects the plan within 60 days after we receive due proof
of death; and
2. not exceed the life or life expectancy of the beneficiary; and
3. payments must begin no later than one year after the date of death; or
2. under other distribution options that we may offer and that satisfy
requirements of Code Section72(s)(2) and related regulations, rulings or
promulgations of the Internal Revenue Service or Department of the
Treasury.
For Annuity Payment Plans, the reference to "annuitant" in the Annuity
Provisions shall apply to the beneficiary.
Spouse's Option to Continue Contract Upon Owner's Death
If you die prior to annuitization and your spouse is the as sole beneficiary or
joint tenant with right of survivorship, your spouse may keep the contract in
force as owner and may make additional purchase payments to the contract. If you
were also the annuitant, then your spouse becomes the annuitant as well.
The election by the spouse to continue the contract must be made by written
request within 60 days after we receive due proof of death. Upon such
continuation the contract value shall be equal to the death benefit that would
otherwise have been paid. Withdrawal charges, if any, under the continued
contract shall only apply to additional purchase payments.
Death After Annuitization
If you or the annuitant die after annuitization, the amount payable to the
beneficiary, if any, will be as provided in the Annuity Payment Plan then in
effect.
272877-NY Page 5
Purchase Payments
Purchase Payments
Purchase payments are the payments you make for this contract and the benefits
it provides. Purchase payments must be paid or mailed to us at our home office
or to an authorized agent. If requested, we'll give you a receipt for your
purchase payments.
Net purchase payments are that part of your purchase payments applied to the
contract value. A net purchase payment is equal to the purchase payment less any
applicable premium tax charge.
Additional Purchase Payments
Additional purchase payments may be made until the earlier of:
1. the date this contract terminates by withdrawal or otherwise; or
2. the date on which annuity payments begin.
Additional purchase payments are subject to the "Payment Limits Provision"
below.
Payment Limits Provision
Maximum Purchase Payments - The maximum purchase payments in the first or later
contract years may not exceed the amounts shown under Contract Data.
Additional Purchase Payments -- You may make additional purchase payments of at
least the amount shown under Contract Data.
Allocation of Purchase Payments
In most cases, you request, in whole percentages from 0% to 100%, how you want
your purchase payments allocated among the Fixed Account and variable
subaccounts. The amount of your purchase payments you may allocate to the Fixed
Account is limited as shown under Contract Data. We reserve the right to
decrease the allowable Fixed Account Purchase Payment percentage limits from
those shown under Contract Data. We will provide 30 days advance written
notification if we do so, and will notify you in writing when the restrictions
are lifted.
Allocations to certain accounts or subaccounts may be limited or required under
the terms of certain optional benefit riders, if any, attached to this contract.
Your allocations as of the contract date are shown under Contract Data.
Unless any restrictions apply, you may, by written request, or other method
agreed to by us, change your choice of accounts or percentages. The first net
purchase payment will be allocated as of the end of the valuation period during
which we make an affirmative decision to issue this contract. Net purchase
payments after the first will be allocated as of the end of the valuation period
during which we receive the payment at our home office.
Additional "Credits" for Purchase Payments
We may apply an additional purchase payment credit to your contract value for
applicable net purchase payments you make to this contract as indicated under
Contract Data. The purchase payment credit is a percentage of such net purchase
payment which is the purchase payment less the amount of partial withdrawals
that exceed all prior purchase payments. The percentage depends on the amount of
cumulative purchase payments under the contract less partial withdrawals as
shown under Contract Data.
If an additional purchase payment causes the contract as a whole to be eligible
for a greater percentage credit, an additional credit on prior purchase
payments, less any partial withdrawals, will be allocated on the date of the
additional purchase payment. Such additional credit is calculated to bring the
credit percentage on all prior net purchase payments to the current level.
Purchase payment credits will be allocated to the contract value according to
your then-existing purchase payment allocation instructions.
Any partial withdrawal reduces the cumulative net purchase payments used as the
basis of the credits on a last-in, first-out basis. Purchase payment credits are
vested as shown under Contract Data.
Credits shall be reversed from the contract value for any purchase payment that
is not honored.
The amount returned to you under the Right to Examine Contract (Free-look)
provision shall not include any Credits applied to your contract.
272877-NY Page 6
Contract Value
Contract Value
The contract value at any time is the sum of:
1. the Fixed Account contract value; and
2. the variable account contract value.
If:
1. part or all of the contract value is withdrawn; or
2. charges described herein are made against the contract value;
then a number of accumulation units from the variable subaccounts and an amount
from the Fixed Account will be deducted to equal such amount.
For withdrawals, deductions will be made from the Fixed Account or variable
subaccounts that you specify. Otherwise, the number of units from the variable
subaccounts and the amount from the Fixed Account will be deducted in the same
proportion that your interest in each bears to the total contract value.
Fixed Account Contract Value
The Fixed Account contract value at any time will be:
1. the sum of all purchase payments and any applicable purchase payment
credits allocated to the Fixed Account, plus interest credited; plus
2. any amounts transferred to the Fixed Account from any variable subaccount,
plus interest credited; less
3. any amounts transferred from the Fixed Account to any variable subaccount;
less
4. any amounts deducted for charges or withdrawals.
Variable Account Contract Value
The variable account contract value at any time will be
the sum of the value of the units in any variable subaccount resulting from:
1. purchase payments and any purchase payment credit allocated to a
subaccount; plus
2. any amounts transferred to a subaccount from another subaccount or from the
Fixed Account; less
3. any amounts transferred from a subaccount to another subaccount or to the
Fixed Account; less
4. any amounts deducted from a subaccount for charges or withdrawals.
Contract Administrative Charge
We charge a fee for establishing and maintaining our records for this contract.
The charge per year is shown under Contract Data and is deducted from the
contract value at the end of each contract year or, if earlier, when the
contract is fully withdrawn.
The charge deducted will be prorated among the variable subaccounts and the
Fixed Account in the same proportion your interest in each bears to the total
contract value. However, any amount deducted from the Fixed Account contract
value will be limited to: (1) the amount of interest credited in excess of the
guaranteed minimum interest rate shown under Contract Data; plus (2) any amounts
allocated or transferred to the Fixed Account contract in that year. In no
instance will the charge from the Fixed Account contract exceed $30 in any
contract year.
We waive the annual contract administrative charge for any contract year if your
contract value, immediately prior to the deduction of the charge, equals or
exceeds $50,000.
If you make a full withdrawal of this contract, we deduct the full contract
administrative charge at the time of full withdrawal regardless of contract
value.
The charge does not apply at or after annuitization of this contract or at the
time a death benefit is paid.
Premium Tax Charges
We reserve the right to deduct an amount from the value of this contract at the
time that any applicable premium taxes assessed against us or otherwise not
previously deducted are payable.
If a tax is payable at the time of your purchase payment and we choose to not
deduct it at that time, we further reserve the right to deduct it at a later
date.
Transfers of Contract Values
While this contract is in force prior to annuitization, transfers of contract
values may be made as outlined below unless contract values are required to be
allocated to certain accounts or subaccounts under the terms of certain optional
benefit riders, if any, attached to this contract.
1. You may transfer all or a part of the values held in one or more of the
variable subaccounts to another one or more of the variable subaccounts.
Subject to
272877-NY Page 7
Items 2 and the Fixed Account transfer limit shown under Contract Data, you
may also transfer values held in one or more of the variable subaccounts to
the Fixed Account or Guarantee Period Accounts.
2. On or within the 30 days before or after a contract anniversary you may
transfer values from the Fixed Account to one or more of the variable
subaccounts or Guarantee Period Accounts. This amount shall not exceed the
Fixed Account transfer limit shown under Contract Data. If such a transfer
is made, no transfers from any variable subaccount or Guarantee Period
Account to the Fixed Account may be made for six months after such a
transfer.
We reserve the right to decrease the allowable Fixed Account Transfer percentage
limits from those in the Fixed Account transfer limit shown under Contract Data.
We will provide 30 days advance written notification if we do so, and will
notify you in writing when the restrictions are lifted.
We also reserve the right to:
1. limit the number of transfers to 12 per contract year; and
2. require up to a maximum of 10 valuation dates between each transfer; and
3. limit the amount to be transferred on any one valuation date to no more
than $2,000,000; and
4. upon 30 days prior written notice, to only accept transfer instructions
from you (the contract owner), and not from your representative, agent or
person acting under a power of attorney for you.
You may make a transfer by written request. Transfers may also be made according
to automated transfer procedures that are then currently in effect, if any.
There is no fee or charge for these transfers. However, the minimum transfer is
$500. If you request a transfer of $500 or less, we will transfer the entire
value in the subaccount or in the Fixed Account from which the transfer is being
made. The minimum automated transfer is $100.
Dollar Cost Averaging Program
You may elect to participate in any DCA Program we offer by written request on a
form approved by us. Under the program you may allocate purchase payments to the
Special DCA fixed account(s), if the Special DCA program is offered, and
authorize the automatic transfer of amounts on a monthly basis from the Special
DCA fixed account to any of the variable subaccount(s) or the Fixed Account. All
amounts allocated to the Special DCA fixed account will be transferred out
within the specified Special DCA fixed account time period you elect from the
time periods we make available.
You may also authorize the automatic transfer of amounts, on an annual,
semiannual, quarterly or monthly basis, for specified amounts from the One Year
Ffixed Account or any of the variable subaccounts to any other variable
subaccounts other than the source account.
The unit values credited and applied to your contract are determined on each
date of transfer. You may terminate the DCA Program at any time. However, upon
termination or annuitization, any amounts remaining in the Special DCA fixed
account will be transferred to the One Year Fixed Account.
Fixed and Variable Accounts
The Fixed Account
The Fixed Account is made up of all our assets other than those in
1. The Variable Account; and in
2. Any other segregated asset accounts.
The Fixed Account includes the One Year Fixed Account.
We will credit interest to the Fixed Account. Interest will begin to accrue
daily on the date the purchase payments which are received in our home office
become available for us to use.
We will pay interest on the portion of your initial purchase payment allocated
to the Fixed Account at a guaranteed rate shown under Contract Data.
After the first year, interest will accrue on the Fixed Account value at rates
determined by us and at our discretion. Theses rates will be based on various
factors including, but not limited to, the interest rate environment, returns
earned on investments backing these annuities, the rates currently in effect for
new and existing company annuities, product design, competition, and the
company's revenues and expenses. However, we guarantee that the rate will not be
less than the minimum effective annual interest rate shown under Contract Data.
We back the principal and interest guarantees relating to the Fixed Account.
Purchase payments and transfers to the Fixed Account become part of our general
account.
The Variable Account
The variable account is a separate investment account of ours. It consists of
several subaccounts which are named under Contract Data. We have allocated a
part of
272877-NY Page 8
our assets for this and certain other contracts to the variable account. Such
assets remain our property. However, they may not be charged with the
liabilities from any other business in which we may take part.
Investments of the Variable Account
Purchase payments applied to the variable subaccounts will be allocated as
specified by the owner. Each variable subaccount will buy, at net asset value,
shares of the fund shown for that subaccount under Contract Data or as later
added or changed.
We may change the funds the variable subaccounts buy shares from if laws or
regulations change, the existing funds become unavailable or, in our
judgment, the funds are no longer suitable for the subaccounts. We have the
right to substitute any funds for those shown under Contract Data, including
funds other than those shown under Contract Data.
We may also:
|X| add new subaccounts investing in other funds,
|X| combine any two or more subaccounts,
|X| make additional subaccounts investing in additional funds,
|X| transfer assets to and from the subaccounts or the variable account, and
|X| eliminate or close any subaccounts.
We would first seek approval of the Securities and Exchange Commission if
necessary, and, where required, the insurance regulator of the state where this
contract is delivered.
Valuation of Assets
Fund shares in the variable subaccounts will be valued at their net asset value.
Variable Account Accumulation Units
The number of accumulation units for each of the variable subaccounts is found
by adding the number of accumulation units resulting from:
1. purchase payments and any applicable purchase payment credits allocated to
the subaccount; and
2. transfers to the subaccount;
and subtracting the number of accumulation units resulting from:
1. transfers from the subaccount; and
2. withdrawals (including withdrawal charges) from the subaccount; and
3. contract administrative charge or any rider charge deductions from the
subaccount.
The number of accumulation units added or subtracted for each of the above
transactions is found by dividing (1) by (2) where:
1. is the amount allocated to or deducted from the subaccount; and
2. is the accumulation unit value for the subaccount for the respective
valuation period during which we received the purchase payment or transfer
value, or during which we deducted transfers, withdrawals, withdrawal
charges, rider charges or contract administrative charges.
272877-NY Page 9
Variable Account Accumulation Unit Value
The value of an accumulation unit for each of the variable subaccounts was set
at $1 when the first fund shares were bought. The value for any later valuation
period is found as follows:
The accumulation unit value for each variable subaccount for the last prior
valuation period is multiplied by the net investment factor for the same
subaccount for the next following valuation period. The result is the
accumulation unit value. The value of an accumulation unit may increase or
decrease from one valuation period to the next.
Net Investment Factor
The net investment factor is an index applied to measure the investment
performance of a variable subaccount from one valuation period to the next. The
net investment factor may be greater or less than one; therefore, the value of
an accumulation or annuity unit may increase or decrease.
The net investment factor for any such subaccount for any valuation period is
determined by dividing (1) by (2), and subtracting (3) and (4) from the result.
This is done where:
1. is the sum of:
a. the net asset value per share of the fund held in the variable
subaccount determined at the end of the current valuation period; plus
b. the per share amount of any dividend or capital gain distribution made
by the fund held in the variable subaccount, if the "ex-dividend" date
occurs during the current valuation period; and
2. is the net asset value per share of the fund held in the variable
subaccount, determined at the end of the last prior valuation period; and
3. is a factor representing the mortality and expense risk charge; and
4. is a factor representing the variable account administrative charge.
Mortality and Expense Risk Charge
In calculating unit values we will deduct a mortality and expense risk charge
from the variable subaccounts equal, on an annual basis, to the percentage shown
under Contract Data of the daily net asset value. This deduction is made to
compensate us for assuming the mortality and expense risks under contracts of
this type. We estimate that approximately 2/3 of this charge is for assumption
of mortality risk and 1/3 is for assumption of expense risk. The deduction will
be:
1. made from each variable subaccount; and
2. computed on a daily basis.
Variable Account Administrative Charge
In calculating unit values, we will deduct a variable account administrative
charge shown under Contract Data from the variable subaccounts. This deduction
is made to compensate us for certain administrative and operating expenses for
contracts of this type. The deduction will be:
1. made from each variable subaccount; and
2. computed on a daily basis.
Annuity Unit Value
The value of an annuity unit for each variable subaccount was arbitrarily set at
$1 when the first fund shares were bought. The value for any later valuation
period is found as follows:
1. the annuity unit value for each variable subaccount for the last prior
valuation period is multiplied by the net investment factor for the
subaccount for the valuation period for which the annuity unit value is
being calculated.
2. the result is multiplied by an interest factor, which on an annualized
basis is equal to .966184. This is done to neutralize the assumed
investment rate which is built into Table A under the Tables of Annuity
Rates section.
272877-NY Page 10
Withdrawal Provisions
Withdrawal
By written request and subject to the rules below you may:
1. fully withdraw this contract for the total withdrawal value; or
2. partially withdraw this contract for a part of the withdrawal value.
Rules for Withdrawal
All withdrawals will have the following conditions.
1. You must apply by written request or other method agreed to by us:
a. while this contract is in force; and
b. prior to the earlier of beginning an annuity payment plan or the death
of the annuitant or owner.
2. Unless we agree otherwise, you must withdraw an amount equal to at least
$500. Each variable subaccount value Fixed Account value after a partial
withdrawal must be either $0 or at least $50.
3. The amount withdrawn, less any charges, will normally be mailed to you
within seven days of the receipt of your written request and this contract,
if required. For withdrawals from the Fixed Account, we have the right to
defer payment to you for up to six months from the date we receive your
request. If we defer payment more than 10 days, we will pay annual interest
at a rate required by law on the amount deferred.
4. For partial withdrawals, if you do not specify from which account the
withdrawal is to be made, the withdrawal will be made from the variable
subaccounts and the Fixed Account in the same proportion as your interest
in each bears to the contract value.
5. Any amounts withdrawn and charges which may apply cannot be repaid.
Upon withdrawal for the full withdrawal value this contract will terminate. We
may require that you return the contract to us before we pay the full withdrawal
value.
Withdrawal Value
The withdrawal value at any time will be:
1. the contract value;
2. minus the full contract administrative charge;
3. minus any withdrawal charge;
4. minus any rider charges on a prorata basis;
5. minus any purchase payment credits that have not vested as shown under
Contract Data.
Withdrawal Charge
A withdrawal charge may apply in the event you withdraw some or all of your
contract value. The withdrawal charge schedule for your contract is shown under
Contract Data.
A withdrawal charge applies if you withdraw purchase payments received that are
still in the withdrawal charge period as shown under Contract Data. The
withdrawal charge percentage depends upon the number of years since you made the
payment(s) withdrawn as shown under Contract Data. Refer to Waiver of Withdrawal
Charges for situations when withdrawal charges are not deducted.
The withdrawal charge applies regardless of the contract value at time of
withdrawal. Therefore, the purchase payment amount applied to the withdrawal
charge percentage may be greater or less than the contract value.
For full withdrawals, we determine your withdrawal charge by multiplying each of
your purchase payments not previously withdrawn and not subject to a waiver of
withdrawal charge by the applicable withdrawal charge percentage, and then
totaling the charges.
For a partial withdrawal that is subject to a withdrawal charge, the amount we
actually withdraw from your contract value will be the amount you request plus
any applicable withdrawal charge as of the date of withdrawal. The withdrawal
charge is applied to this total amount. We pay you the amount you requested.
For partial withdrawals, the withdrawal charge is prorated based on the
percentage of your contract value being withdrawn. For example, if you withdraw
half of your contract value, approximately half of the withdrawal charge
applicable for a full withdrawal would be charged. (However, any waivers of
withdrawal charge will not be prorated, so the withdrawal charge in the above
example would be reduced further to account for applicable waivers.)
For partial withdrawals, we determine the amount that represents purchase
payments which could be subject to a withdrawal charge by the following formula:
PW - FA X (PP - PE)
-------
CV - FA
PW = Amount of partial withdrawal
FA = Free amount (amounts that are subject to a waiver of withdrawal charge)
CV = Contract value prior to the withdrawal
272877-NY Page 11
PP = Purchase payments not previously withdrawn
PE = Amounts withdrawn totaling up to 10% of the prior contract
anniversary value to the extent it is larger than amounts withdrawn
that represent contract earnings (See item 1 under Waiver of
Withdrawal Charges.)
After calculating the amount of purchase payments that might be subject to a
withdrawal charge, we use the Withdrawal Order described below to determine the
withdrawal charge.
Waiver of Withdrawal Charges
Withdrawal charges are waived for all of the following.
1. In each contract year, amounts withdrawn totaling up to 10% of the contract
value as of the beginning of that contract year (your initial purchase
payment and any purchase payment credit applied is considered the beginning
of contract year contract value during the first contract year), or, if
larger, amounts withdrawn that represent contract earnings (Contract
earnings are defined as the contract value less purchase payments not
previously withdrawn); and
2. Withdrawals made if both you and the annuitant were under age 76 on the
contract date, and you provide proof satisfactory to us that, as of the
date you request the withdrawal, you or the annuitant are confined to a
hospital or nursing home, and have been for the prior 60 days.
To qualify, the nursing home must:
a. be licensed by an appropriate licensing agency to provide nursing
services; and
b. provide 24-hour-a-day nursing services; and
c. have a doctor available for emergency situations; and
d. have a nurse on duty or call at all times; and
e. maintain clinical records; and
f. have appropriate methods for administering drugs
3. Withdrawal charges are waived if you or the annuitant are diagnosed in the
second or later contract years as disabled with a medical condition that
with reasonable medical certainty will result in death within 12 months or
less from the date of the licensed physician's statement. You must provide
us with a licensed physician's statement containing the terminal illness
diagnosis and the date the terminal illness was initially diagnosed.
4. If an IRA endorsement is attached to this contract: IRA required minimum
distributions, for those amounts required to be distributed from this
contract only.
5. Annuity payment plan payments.
6. Payments made in the event of the death of the owner or annuitant.
Withdrawal Order
We use this order to determine withdrawal charges.
o First, withdrawals up to 10% of your prior contract anniversary contract
value not previously withdrawn during this contract year. (No withdrawal
charge.)
o Next, withdrawals are from amounts representing contract earnings - if any
- in excess of the annual 10% free withdrawal amount. (No withdrawal
charge.)
o Next, withdrawals are from purchase payments not previously withdrawn and
which had been paid more than the number of years in the withdrawal charge
period shown under Contract Data prior to withdrawal. (No withdrawal
charge.)
o Last, withdrawals are from purchase payments received that are still within
the withdrawal charge period shown in the schedule under Contract Data. We
withdraw these payments on a "first-in, first-out" (FIFO) basis. There is a
withdrawal charge on these payments.
Suspension or Delay in Payment of Withdrawal
We have the right to suspend or delay the date of any withdrawal payment from
the variable subaccounts for any period:
1. when the New York Stock Exchange is closed; or
2. when trading on the New York Stock Exchange is restricted; or
3. when an emergency exists as a result of which:
a) disposal of securities held in the variable subaccounts is not
reasonably practical; or
b) it is not reasonably practical to fairly determine the value of the
net assets of the variable subaccounts; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of security holders.
5. if and to the extent permitted or required under the Federal Investment
Company Act of 1940, as amended, and any other applicable federal or state
law.
Rules and regulations of the Securities and Exchange Commission will govern as
to whether the conditions set forth in 2 and 3 exist.
272877-NY Page 12
Annuity Provisions
Annuitization
When annuitization occurs, the contract value will be applied to make annuity
payments. The first payment will be made as of the retirement date. This date is
shown under Contract Data. Before payments begin we will require satisfactory
proof that the annuitant is alive. We may also require that you exchange this
contract for a supplemental contract which provides the annuity payments.
Change of Retirement Date
You may change the retirement date shown for this contract. Tell us the new date
by written request. The retirement date may not be earlier than 13 months from
the contract date, and may not be later than the later of the annuitant's 85th
birthday or the 10th contract anniversary. If you select a new date, it must be
at least 30 days after we receive your written request at our home office.
Pre-election of an Annuity Income Plan
If this is a nonqualified contract, you may elect how the death benefit is to be
paid under the contract in the event of death before annuitization. You must
make any such election on a form satisfactory to us. We must receive the form in
our home office prior to the date of death. The death benefit will then be
payable as elected by you, rather than as requested by the beneficiary.
If for any reason such election does not satisfy Section 72 of the Code or
related distribution requirements, the election will be void. The beneficiary
will then be permitted to elect payment as otherwise allowed by this contract.
Annuity Payment Plans
Annuity payments may be made on a fixed dollar basis, a variable basis or a
combination of both. You can schedule receipt of annuity payments according to
one of the Plans A through E below or another plan agreed to by us.
Plan A -- This provides monthly annuity payments during the lifetime of the
annuitant. No payments will be made after the annuitant dies.
Plan B -- This provides monthly annuity payments during the lifetime of the
annuitant with a guarantee by us that payments will be made for a period of at
least five, 10 or 15 years. You must select the guaranteed period.
Plan C --This provides monthly annuity payments during the lifetime of the
annuitant with a guarantee by us that payments will be made for a certain number
of months. We determine the number of months by dividing the amount applied
under this plan by the amount of the first monthly annuity payment.
Plan D -- Monthly annuity payments will be paid during the lifetime of the
annuitant and joint annuitant. When either the annuitant or the joint annuitant
dies we will continue to make monthly payments during the lifetime of the
survivor. No payments will be made after the death of both the annuitant and
joint annuitant.
Plan E -- This provides monthly annuity payments for a period of years. The
period of years may be no less than 10 nor more than 30.
You may select the plan by written request to us at least 30 days before the
retirement date. If at least 30 days before the retirement date we have not
received at our home office your written request to select a plan, we will make
payments according to Plan B with payments guaranteed for 10 years.
If the Plan selected has a payment amount that is the same as another Plan
having a longer guarantee period, then the Plan with the longer guarantee period
will be deemed to have been chosen.
If the amount to be applied to a plan is not at least $2,000 and produces a
monthly payment of less than $20, or if payments are to be made to other than a
natural person, we have the right to make a lump sum payment of the contract
value.
272877-NY Page 13
Allocation of Contract Values at Annuitization
At the time of annuitization under an Annuity Payment Plan, you may reallocate
your contract value to the Fixed Account to provide fixed dollar payments and/or
among the variable subaccounts, to provide variable annuity payments. Unless we
agree otherwise, you may use a maximum of five variable subaccounts at any one
time during annuitization.
Fixed Annuity
A fixed annuity is an annuity with payments that are guaranteed by us as to
dollar amount. Fixed annuity payments remain the same - second and later
payments will never be less than the amount of the first payment. At
annuitization contract value amounts you allocate to provide fixed dollar
payments will be applied to the applicable Annuity Table. This will be done in
accordance with the payment plan chosen. The minimum amount payable for each
$1,000 so applied is shown in Table B under the Tables of Annuity Rates section.
Variable Annuity
A variable annuity is an annuity with payments which:
1. are not predetermined or guaranteed as to dollar amount; and
2. vary in amount with the investment experience of the variable subaccounts.
Determination of the First Variable Annuity Payment
At annuitization, the contract value amounts you allocate to provide variable
annuity payments will be applied to the applicable Annuity Table. This will be
done:
1. on the valuation date on or next preceding the seventh calendar day before
the retirement date; and
2. in accordance with the payment plan chosen.
The amount payable for the first payment for each $1,000 so applied is shown in
Table A under the Tables of Annuity Rates section.
Variable Annuity Payments After the First Payment
Variable annuity payments after the first payment vary in amount. The amount
changes with the investment performance of the variable subaccounts. The dollar
amount of variable annuity payments after the first is not fixed. It may change
from month to month. The dollar amount of such payments is determined as
follows.
1. The dollar amount of the first annuity payment is divided by the value of
an annuity unit as of the valuation date on or next preceding the seventh
calendar day before the retirement date. This result establishes the fixed
number of annuity units for each monthly annuity payment after the first
payment. This number of annuity units remains fixed during the annuity
payment period.
2. The fixed number of annuity units is multiplied by the annuity unit value
as of the valuation date on or next preceding the seventh calendar day
before the date the payment is due. The result establishes the dollar
amount of the payment.
We guarantee that the dollar amount of each payment after the first will not be
affected by variations in expenses or mortality experience.
Exchange of Annuity Units
After annuity payments begin, annuity units of any variable subaccount may be
exchanged for units of any of the other variable subaccounts. This may be done
no more than once a year. Unless we agree otherwise you may use a maximum of
five variable subaccounts at any one time. Once annuity payments start no
exchanges may be made to or from any fixed annuity.
272877-NY Page 14
Tables Of Annuity Rates
Table A below shows the amount of the first monthly variable annuity payment,
based on a 3.5% assumed investment return, for each $1,000 of value applied
under any payment plan. The amount of the first and all subsequent monthly fixed
dollar annuity payments for each $1,000 of value applied under any payment plan
will be based on our fixed dollar Table of Annuity Rates in effect at
annuitization. Such rates are guaranteed to be not less than those shown in
Table B. The amount of such annuity payments under Plans A, B and C will depend
upon the sex and age of the annuitant at annuitization. The amount of such
annuity payments under Plan D will depend upon the sex and the age of the
annuitant and the joint annuitant at annuitization.
Table A - Dollar Amount of First Monthly Variable Annuity Payment Per $1,000 Applied
------------ -------- ----------------- --- ----------- ----------------- --- ------------- --------------- ------------------
Plan A Plan B Plan C Plan D
------------ -------- ----------------- --- ----------- ----------------- --- ------------- --------------- ------------------
Age Life Income Life Income Joint & Survivor
at Beginning Life Income Five Years with Ten Years Fifteen Years Installment Non-Refund
Annuit- In Non-Refund Certain Certain Certain Refund Male & Female
ization Year Male Female Male Female Male Female Male Female Male Female Same Age
------------ -------- -------- -------- -------- ------ -------- -------- -------- -------- ------ -------- ------------------
Age 65 2005 5.61 4.98 5.57 4.96 5.44 4.91 5.23 4.82 5.17 4.75 4.49
2010 5.52 4.91 5.48 4.89 5.36 4.85 5.17 4.76 5.11 4.70 4.44
2015 5.43 4.84 5.40 4.83 5.29 4.79 5.11 4.71 5.05 4.65 4.39
2020 5.35 4.78 5.32 4.77 5.22 4.73 5.06 4.66 4.99 4.60 4.35
2025 5.27 4.72 5.24 4.71 5.15 4.68 5.00 4.62 4.93 4.56 4.31
2030 5.19 4.67 5.17 4.66 5.09 4.63 4.95 4.57 4.88 4.52 4.27
------------ -------- -------- -------- -------- ------ -------- -------- -------- -------- ------ -------- ------------------
Age 70 2005 6.53 5.69 6.43 5.65 6.16 5.53 5.75 5.33 5.81 5.30 5.02
2010 6.40 5.59 6.32 5.56 6.06 5.45 5.69 5.27 5.72 5.23 4.95
2015 6.28 5.50 6.20 5.47 5.97 5.37 5.62 5.21 5.64 5.16 4.89
2020 6.17 5.41 6.09 5.38 5.88 5.30 5.56 5.15 5.57 5.10 4.83
2025 6.06 5.33 5.99 5.31 5.80 5.23 5.50 5.09 5.49 5.04 4.77
2030 5.95 5.25 5.90 5.23 5.72 5.17 5.45 5.04 5.42 4.99 4.72
------------ -------- -------- -------- -------- ------ -------- -------- -------- -------- ------ -------- ------------------
Age 75 2005 7.80 6.73 7.58 6.64 7.00 6.36 6.26 5.92 6.63 6.03 5.79
2010 7.62 6.59 7.42 6.51 6.89 6.25 6.20 5.85 6.52 5.94 5.69
2015 7.45 6.46 7.27 6.38 6.79 6.15 6.15 5.79 6.41 5.85 5.59
2020 7.29 6.33 7.13 6.27 6.69 6.06 6.09 5.73 6.31 5.77 5.51
2025 7.14 6.22 6.99 6.16 6.59 5.97 6.03 5.67 6.22 5.69 5.43
2030 6.99 6.11 6.86 6.05 6.49 5.89 5.98 5.61 6.13 5.62 5.35
------------ -------- -------- -------- -------- ------ -------- -------- -------- -------- ------ -------- ------------------
Age 85 2005 12.15 10.61 10.95 9.92 8.76 8.38 6.97 6.88 9.13 8.41 8.54
2010 11.79 10.29 10.72 9.68 8.68 8.28 6.95 6.85 8.95 8.24 8.33
2015 11.46 10.00 10.49 9.46 8.59 8.18 6.93 6.83 8.79 8.09 8.14
2020 11.14 9.72 10.27 9.25 8.51 8.08 6.92 6.81 8.64 7.95 7.96
2025 10.85 9.47 10.06 9.05 8.43 7.98 6.90 6.78 8.49 7.82 7.79
2030 10.57 9.24 9.87 8.86 8.35 7.89 6.88 6.75 8.36 7.70 7.64
------------ -------- -------- -------- -------- ------ -------- -------- -------- -------- ------ -------- ------------------
Table A above is based on the "1983 Individual Annuitant Mortality Table A" with
100% Projection Scale G and a 3.5% assumed investment return. Annuity rates for
any year, age, or any combination of year, age and sex not shown above, will be
calculated on the same basis as those rates shown in the Table above. Such rates
will be furnished by us upon request. Amounts shown in the Table below are based
on a 3.5% assumed investment return.
Plan E - Dollar Amount of First Monthly Variable Annuity Payment Per $1,000 Applied
--------------------- ------------------ ------------------- ------------------ ------------------- ------------------
Years Payable Monthly Payment Years Payable Monthly Payment Years Payable Monthly Payment
--------------------- ------------------ ------------------- ------------------ ------------------- ------------------
10 9.83 17 6.47 24 5.09
11 9.09 18 6.20 25 4.96
12 8.46 19 5.97 26 4.84
13 7.94 20 5.75 27 4.73
14 7.49 21 5.56 28 4.63
15 7.10 22 5.39 29 4.53
16 6.76 23 5.24 30 4.45
--------------------- ------------------ ------------------- ------------------ ------------------- ------------------
Page 15
Fixed Dollar annuity payments will not be less than those shown in Table B. In
addition, the amount of payments under any annuity payment plan will not be less
than that which would be provided if:
1. a single payment immediate annuity contract were to be offered by us to
annuitants in the same class and
2. the annuity were to be purchased with the greater of: (1) withdrawal value
of the contract; or (2) 95% of the contract value of this contract.
Table B - Dollar Amounts of Each Monthly Fixed Dollar Annuity Payment Per $1,000 Applied
-----------------------------------------------------------------------------------------------------------------------------
Plan A Plan B Plan C
Plan D
Life Income Life Income with Life Income Joint & Survivor
Age at Beginning Non-Refund Five Years Ten Years Fifteen Years Installment Non-Refund
Annui- In Certain Certain Certain Refund Male & Female
tization Year Male Female Male Female Male Female Male Female Male Female Same Age
-----------------------------------------------------------------------------------------------------------------------------
Age 65 2005 4.75 4.14 4.72 4.13 4.62 4.09 4.43 4.01 4.19 3.83 3.68
2010 4.66 4.07 4.63 4.06 4.54 4.03 4.37 3.96 4.13 3.78 3.63
2015 4.57 4.01 4.55 4.00 4.46 3.97 4.31 3.90 4.08 3.74 3.59
2020 4.49 3.95 4.47 3.94 4.39 3.91 4.25 3.85 4.02 3.70 3.54
2025 4.41 3.89 4.39 3.88 4.33 3.86 4.20 3.81 3.97 3.66 3.50
2030 4.34 3.84 4.32 3.83 4.26 3.81 4.15 3.76 3.93 3.62 3.47
----------- ------- -------- ------- --------- ----- -------- ------- ---------- ----- ------- -------- -----------
Age 70 2005 5.66 4.85 5.59 4.82 5.35 4.73 4.98 4.55 4.76 4.34 4.23
2010 5.54 4.76 5.47 4.73 5.26 4.65 4.92 4.49 4.69 4.28 4.16
2015 5.42 4.67 5.36 4.64 5.16 4.57 4.85 4.42 4.62 4.22 4.10
2020 5.31 4.58 5.25 4.56 5.08 4.50 4.79 4.37 4.55 4.17 4.04
2025 5.20 4.50 5.15 4.49 4.99 4.43 4.73 4.31 4.49 4.12 3.98
2030 5.10 4.43 5.05 4.41 4.91 4.36 4.67 4.25 4.43 4.07 3.93
----------- ------- -------- ------- --------- ----- -------- ------- ---------- ----- ------- -------- -----------
Age 75 2005 6.92 5.89 6.74 5.81 6.23 5.57 5.53 5.17 5.50 5.01 5.01
2010 6.74 5.75 6.58 5.68 6.11 5.47 5.47 5.10 5.41 4.93 4.91
2015 6.58 5.62 6.43 5.56 6.01 5.37 5.41 5.04 5.32 4.86 4.82
2020 6.42 5.50 6.29 5.45 5.90 5.27 5.35 4.97 5.24 4.79 4.73
2025 6.27 5.39 6.15 5.34 5.80 5.18 5.29 4.91 5.16 4.72 4.65
2030 6.13 5.28 6.02 5.24 5.71 5.10 5.23 4.85 5.08 4.66 4.58
----------- ------- -------- ------- --------- ----- -------- ------- ---------- ----- ------- -------- -----------
Age 85 2005 11.23 9.72 10.15 9.11 8.06 7.67 6.27 6.18 7.75 7.14 7.76
2010 10.88 9.41 9.91 8.88 7.97 7.56 6.26 6.16 7.61 7.01 7.56
2015 10.55 9.13 9.69 8.66 7.89 7.46 6.24 6.13 7.47 6.88 7.37
2020 10.24 8.86 9.47 8.45 7.80 7.36 6.23 6.11 7.34 6.77 7.19
2025 9.96 8.62 9.26 8.25 7.72 7.26 6.21 6.08 7.22 6.66 7.03
2030 9.69 8.39 9.06 8.06 7.64 7.16 6.19 6.05 7.11 6.56 6.88
Table B above is based on the "1983 Individual Annuitant Mortality Table A" at
2.0% with 100% Projection Scale G. Annuity rates for any year, age, or any
combination of year, age and sex not shown above, will be calculated on the same
basis as those rates shown in the Table above. Such rates will be furnished by
us upon request. Amounts shown in the Table below are based on a 2.0% annual
effective interest rate.
-----------------------------------------------------------------------------------------------------------------------------
Plan E - Dollar Amount of Each Monthly Fixed Dollar Annuity Payment Per $1,000 Applied
-----------------------------------------------------------------------------------------------------------------------------
Years Payable Monthly Payment Years Payable Monthly Payment Years Payable Monthly Payment
---------------------- ------------------- -- -------------- ------------------------- -- ----------- -----------------
10 9.18 17 5.77 24 4.36
11 8.42 18 5.50 25 4.22
12 7.80 19 5.26 26 4.10
13 7.26 20 5.04 27 3.98
14 6.81 21 4.85 28 3.87
15 6.42 22 4.67 29 3.77
16 6.07 23 4.51 30 3.68
---------------------- ------------------- -- -------------- ------------------------- -- ----------- -----------------
272877-NY Page 16
[GRAPHIC OMITTED] American Centurion
(logo) Life Assurance Company
AMERICAN 00 Xxxxxxx Xxx. Ext.
EXPRESS P.O. Box 5555
(R) Albany, New York 12205
[GRAPHIC OMITTED]
(logo)
American
Centurion
Life
Deferred Annuity Contract
|X| Flexible Purchase Payments
|X| Investment Experience Reflected in Benefits
|X| Optional Fixed Dollar or Variable Accumulation Values and Annuity Payments
|X| Annuity Payments to Begin on the Retirement Date
|X| This Contract is Nonparticipating - Dividends Are Not Payable
*recycled paper with a minimum of 10% post-consumer waste
