[Xxxxxxx Xxxxxxx]
[XX-0123456]
Lincoln Life & Annuity Company of New York
(A Stock Company)
Home Office: 000 Xxxxxxx Xxxxxx, Xxxxx 0000, Xxxxxxxx, Xxx Xxxx 00000
Servicing Office: 0000 Xxxxx Xxxxxxx Xxxxxx, Xxxx Xxxxx, Xxxxxxx 00000-0000
ANNUITY CONTRACT
Individual Flexible Purchase Payment Deferred Variable Annuity Contract
With Annuity Payment Options
Nonparticipating
Lincoln Life & Annuity Company of New York (LNY) agrees to provide the benefits
and other rights described in this Contract in accordance with the terms of this
Contract.
READ THIS CONTRACT CAREFULLY. This is a legal contract between the Owner and
LNY. We want to be sure you understand the features and benefits contained in
this Contract. IT IS THEREFORE IMPORTANT THAT YOU READ YOUR CONTRACT CAREFULLY.
If you have any questions after reading the Contract, we hope you will contact
your representative or the Servicing Office of LNY.
NOTICE OF RIGHT TO EXAMINE CONTRACT. Within 10 days after this Contract is first
received, it may be cancelled for any reason without penalty (e.g., no
Contingent Deferred Sales Charge will be deducted) by delivering or mailing it
to the representative through whom it was purchased or to the Servicing Office
of LNY. When the Contract is received at the Servicing Office, LNY will return
the Contract Value plus an amount to reflect any deducted daily charges (daily
charges are described in Section 4.04) as of the date of cancellation where
permitted by law.
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE. THE AMOUNTS MAY INCREASE OR
DECREASE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT (SEE ARTICLE 4 AND
ARTICLE 8). PRIOR TO THE ANNUITY COMMENCEMENT DATE, THE MAXIMUM MORTALITY AND
EXPENSE RISK AND ADMINISTRATIVE CHARGE IS 1.40% AND THEREAFTER IS 1.40%. THE
SMALLEST RATE OF INVESTMENT RETURN REQUIRED TO ENSURE THAT THE DOLLAR AMOUNT OF
VARIABLE ANNUITY PAYMENTS DOES NOT DECREASE IS: 4.40% IF THE ASSUMED INTEREST
RATE (AIR) IS 3.0%, 5.40% IF THE AIR IS 4.0%, OR 6.40% IF THE AIR IS 5.0%.
Signed for Lincoln Life & Annuity Company of New York at its Home Office in
Syracuse, New York.
/s/ Xxxx X. Gotta
Xxxx X. Gotta
President
Form 30070BNY 5/03
Table of Contents
Article Page
1 Definitions 4
2 Purchase Payments 6
3 Contract Value 7
4 Variable Account 8
5 DCA Fixed Account 10
6 Transfers, Withdrawals and Surrenders 11
7 Death Benefits 13
8 Annuity Payment Options 15
9 Beneficiary 19
10 Suspension or Deferral of Payments 20
11 General Provisions 21
12 Annuity Purchase Rates Under A Variable Annuity Payment 24
13 Annuity Purchase Rates Under A Fixed Annuity Payment 27
14 Additional Services 28
ARTICLE 1
DEFINITIONS
ACCUMULATION UNIT -- A unit of measure used in the calculation of the value of a
Variable Subaccount prior to the Annuity Commencement Date.
ANNUITANT OR JOINT ANNUITANT -- The person or persons upon whose life or lives
the annuity payments made after the Annuity Commencement Date will be based.
ANNUITY COMMENCEMENT DATE -- The Valuation Date on which the Contract Value is
withdrawn for payment of annuity benefits under the annuity payment option
selected.
ANNUITY PAYMENT DATE -- The date on which the Owner is entitled to the first
annuity payment. Subsequent annuity payments will be due on the same day of the
month as the first annuity payment, at the applicable frequency. Annuity
payments cannot commence within 12 months of the Contract Date.
ANNUITY UNIT -- A unit of measure used after the Annuity Commencement Date to
calculate the amount of a Variable Annuity Payment.
BENEFICIARY -- The person or persons or entity designated by the Owner to
receive the Death Benefit, if any.
CODE -- The Internal Revenue Code of 1986, as amended.
CONTINGENT ANNUITANT -- Prior to the Annuity Commencement Date, the individual
who will become the Annuitant upon the death of the Annuitant.
CONTINGENT DEFERRED SALES CHARGE (CDSC) -- Charges assessed on a surrender of
the Contract or a partial withdrawal from the Contract, calculated according to
the Contract provisions.
CONTRACT -- The agreement between LNY and the Owner, in which LNY provides an
annuity as described on the front page of this Contract.
CONTRACT DATE -- The date this Contract became effective. The Contract Date is
shown on the Contract Specifications.
CONTRACT VALUE -- Prior to the Annuity Commencement Date, the sum of the values
of the Variable Account and the DCA Fixed Account attributable to this Contract
on a given Valuation Date.
CONTRACT YEAR -- Each twelve-month period starting with the Contract Date on the
Contract Specifications and starting with each Contract Date anniversary
thereafter.
DCA FIXED ACCOUNT - A portion of this Contract established by LNY to accept
Purchase Payments that may only be used for the Dollar Cost Averaging program.
Funds in the DCA Fixed Account are invested in the General Account of LNY.
DEATH BENEFIT -- The amount payable upon death of an Owner or an Annuitant.
DOLLAR COST AVERAGING (DCA) -- An option that allows the automatic transfer of a
portion of the Contract Value in periodic installments from a designated DCA
holding account to one or more of the Variable Subaccounts available under the
Contract. The periodic installments will be over any DCA period made available
by LNY and selected by the Owner. A designated DCA holding account may be a
designated Variable Subaccount and/or the DCA Fixed Account, if available.
EARNINGS -- The excess of the Contract Value over the Purchase Payments which
have not yet been withdrawn from this Contract.
FIXED ANNUITY PAYMENTS -- Periodic payments made to the Owner or the Owner's
designee by LNY on or after the Annuity Commencement Date which LNY guarantees
as to the dollar amount. Fixed annuity payments are made out of the General
Account.
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FUND -- Any of the underlying investment options available in the Variable
Account.
GUARANTEED INTEREST RATE -- The effective annual rate of interest LNY guarantees
to credit on assets in the DCA Fixed Account.
GENERAL ACCOUNT -- An account consisting of all assets owned by LNY other than
those assets in segregated investment accounts.
HOME OFFICE -- The principal office of LNY located at 000 Xxxxxxx Xxxxxx, Xxxxx
0000, Xxxxxxxx, Xxx Xxxx 00000, or an institution designated by LNY.
LNY -- Lincoln Life & Annuity Company of New York.
MATURITY DATE - The date by which an election to receive payments under an
Annuity Payment Option must be made. The Maturity Date is the later of the
Annuitant's 90/th/ birthday or 10 years from the Contract Date. The Maturity
Date is shown on the Contract Specifications.
NET ASSET VALUE PER SHARE -- The market value of a Fund share calculated each
day.
NOTICE -- Any form of communication providing information as required by LNY,
either in signed writing or another manner, that LNY approves in advance. All
Notices must be received by LNY in the Servicing Office and must include all
required information necessary to process the request. To be effective for any
Valuation Date, a Notice must be received in good order prior to the end of that
Valuation Date.
OWNER -- The one person, two persons or entity who exercises rights of ownership
under this Contract. If two persons are named as Owner, all references to Owner
means joint Owner.
PURCHASE PAYMENTS -- Amounts paid into this Contract by the Owner.
QUALIFIED CONTRACT -- A contract that is used as a funding vehicle for a
retirement plan qualified for special tax treatment under the Code, including
Sections 401, 403, 408, 408A and 457. All other contracts are considered
Non-qualified contracts.
SERVICING OFFICE - - The office where servicing of this Contract takes place,
located at 0000 Xxxxx Xxxxxxx Xxxxxx, Xxxx Xxxxx, Xxxxxxx, 00000-0000, or an
institution designated by LNY.
VALUATION DATE -- Close of the market of each day that the New York Stock
Exchange is open for business.
VALUATION PERIOD -- The period commencing at the close of business on a
particular Valuation Date and ending at the close of business on the next
succeeding Valuation Date.
VARIABLE ACCOUNT -- The segregated investment account into which LNY sets aside
and invests the assets allocated to the Variable Subaccount(s) made available by
LNY and selected by the Owner. The Variable Account for this Contract is shown
on the Contract Data page.
VARIABLE ANNUITY PAYMENTS -- Periodic payments made to the Owner or the Owner's
designee by LNY on or after the Annuity Commencement Date which vary in amount
with the investment experience of each applicable Variable Subaccount.
VARIABLE SUBACCOUNT -- That portion of the Variable Account which invests in
shares of a particular Fund. There is a separate Variable Subaccount for each
particular Fund.
Page 5
ARTICLE 2
PURCHASE PAYMENTS
2.01 WHERE PAYABLE
All Purchase Payments must be made to LNY at its Servicing Office.
2.02 AMOUNT AND FREQUENCY
LNY reserves the right to limit future Purchase Payments into this Contract. The
minimum subsequent Purchase Payments are shown on the Contract Specifications.
Purchase Payments may be made until the earliest of: the Annuity Commencement
Date, death of the Owner, or surrender of the Contract. In the event that
Purchase Payments are discontinued by the Owner, this Contract will continue and
Purchase Payments may be resumed at any time prior to the earlier of: the
Annuity Commencement Date, death of the Owner, or surrender of this Contract.
2.03 DOLLAR COST AVERAGING
All or part of a Purchase Payment may be allocated to the DCA Fixed Account or
any other subaccount made available for the purpose of Dollar Cost Averaging.
Any amount so allocated will be transferred from the subaccount used for Dollar
Cost Averaging to the designated Variable Subaccount in regular installments
over a period chosen by the Owner. Transfers will occur at the same interval
until the end of the chosen period or, if sooner, until the account value in the
subaccount used for Dollar Cost Averaging has been exhausted.
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ARTICLE 3
CONTRACT VALUE
3.01 CONTRACT VALUE
The Contract Value, at any time prior to the Annuity Commencement Date, is equal
to the sum of the values of the Variable Account and the DCA Fixed Account
attributable to this Contract on a given Valuation Date.
3.02 ACCOUNT FEE
LNY will deduct an Account Fee from the Contract Value as shown on the Contract
Specifications.
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ARTICLE 4
VARIABLE ACCOUNT
4.01 THE VARIABLE ACCOUNT
Purchase Payments under the Contract may be allocated to the Variable Account of
the Contract. The Variable Account, which is designated on the Contract
Specifications, is for the exclusive benefit of persons entitled to receive
benefits under variable annuity contracts. Income, gains and losses (whether or
not realized) from the assets allocated to the Variable Account shall be
credited to or charged against the Variable Account without regard to other
income, gains or losses of LNY. The Variable Account will not be charged with
the liabilities arising from any other part of LNY's business.
Subject to any required regulatory approvals, LNY reserves the right to
eliminate the shares of any Fund and substitute the securities of a different
Fund or investment company or mutual fund. Such elimination and substitution may
occur if the shares of a Fund are no longer available for investment or, if in
the judgment of LNY, further investment in any Fund should become inappropriate
in view of the purposes of the Contract. LNY may close any Variable Subaccount
to new Purchase Payments, transfers of Contract Value or both. LNY may add new
Variable Subaccounts in which the assets of the Variable Account may be
invested. LNY will give the Owner written notice of the elimination and
substitution of any Fund as required by law after such substitution occurs.
4.02 ALLOCATION OF PURCHASE PAYMENTS TO A VARIABLE SUBACCOUNT
The Owner may allocate Purchase Payments to any of the available Variable
Subaccounts in accordance with the restrictions on the Contract Specifications.
A Notice must be given to LNY if the Owner elects to allocate any Purchase
Payment to a new Variable Subaccount not previously selected.
Purchase Payments allocated to each Variable Subaccount will be invested at Net
Asset Value Per Share of one of the Funds. Following receipt of a Purchase
Payment, LNY will use each Purchase Payment to buy Accumulation Units in the
Variable Subaccount(s) selected by the Owner.
4.03 VALUATION OF THE VARIABLE ACCOUNT
The value of the Variable Account, at any time prior to the Annuity Commencement
Date, is equal to the sum of the values allocated to the Variable Subaccounts.
The value of a Variable Subaccount, at any time prior to the Annuity
Commencement Date, is equal to the Accumulation Units credited to a Variable
Subaccount multiplied by the value of the Accumulation Unit for the respective
Variable Subaccount.
Accumulation Units are used to value all amounts allocated to or withdrawn from
a Variable Subaccount as a result of Purchase Payments, transfers, withdrawals,
or fees and charges. Accumulation Units for each Variable Subaccount are valued
separately. The value of an Accumulation Unit may increase or decrease from
Valuation Period to Valuation Period. The number of Accumulation Units is
determined by dividing the amount allocated to or withdrawn from a Variable
Subaccount by the dollar value of one Accumulation Unit of the Variable
Subaccount as of the Valuation Date the transaction becomes effective. The
number of Accumulation Units held for an Owner in a Variable Subaccount will not
be changed by any change in the dollar value of Accumulation Units in the
Variable Subaccount.
The value of an Accumulation Unit was arbitrarily established at the inception
of the Variable Subaccount. The Accumulation Unit value for a Variable
Subaccount for any later Valuation Period is determined as follows:
a. the total value of Fund shares held in the Variable Subaccount is
calculated by multiplying the number of Fund shares owned by the
Variable Subaccount at the beginning of the Valuation Period by the
Net Asset Value Per Share of the Fund at the end of the Valuation
Period, and adding any dividend or other distribution of the Fund if
an ex-dividend date occurs during the Valuation Period; minus
b. the liabilities of the Variable Subaccount at the end of the Valuation
Period (such liabilities include daily charges imposed on the Variable
Subaccount (see Section 4.04) and may include a charge or credit with
Page 8
respect to any taxes paid or reserved for by LNY that LNY determines
is a result of the operation of the Variable Account); the result
divided by
c. the outstanding number of Accumulation Units in the Variable
Subaccount at the beginning of the Valuation Period.
The Accumulation Unit value may increase or decrease the dollar value of
benefits under the Contract. Expenses incurred by LNY will not adversely affect
the dollar value of benefits.
4.04 MORTALITY AND EXPENSE RISK AND ADMINISTRATIVE CHARGE
LNY will deduct a Mortality and Expense Risk and Administrative charge (daily
charge) from the Variable Account as shown on the Contract Specifications.
4.05 CHANGE IN OPERATION
LNY reserves the right to transfer assets of the Variable Account to another
account, and to modify the structure or operation of the Variable Account,
subject to obtaining any necessary regulatory approvals. LNY guarantees that
such modification will not affect the Contract Value.
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ARTICLE 5
DCA FIXED ACCOUNT
5.01 ALLOCATION OF PURCHASE PAYMENTS INTO THE DCA FIXED ACCOUNT
Any Purchase Payment paid into this Contract may be allocated to the DCA Fixed
Account. LNY reserves the right to discontinue accepting new Purchase Payments
to this account at any time. In this event, LNY will provide 30-day advance
written notice to the Owner that Purchase Payments may no longer be allocated to
the DCA Fixed Account.
The Owner may allocate Purchase Payments to the DCA Fixed Account, if available,
subject to the following limitations:
a. If LNY is accepting new Purchase Payments to the DCA Fixed Account.
b. The minimum amount that may be allocated to the DCA Fixed Account is
shown on the Contract Specifications.
c. If the Owner elects to allocate any Purchase Payment to the DCA Fixed
Account and the DCA Fixed Account was not previously selected, the
Owner must first provide LNY with Notice of allocation.
Any Purchase Payment so allocated will be transferred from the DCA Fixed Account
to the designated Variable Subaccount available in the Contract in regular
installments over a period chosen by the Owner. Transfers will occur at the same
interval until the end of the chosen period or, if sooner, until the account
value in the DCA Fixed Account has been exhausted.
5.02 CREDITING OF INTEREST ON DCA FIXED ACCOUNT
Prior to the earlier of:
a. the Annuity Commencement Date;
b. termination of this Contract upon payment of any Death Benefit; or
c. surrender of this Contract;
LNY guarantees that at the end of each Valuation Period an effective annual
interest rate, adjusted for the number of days in the Valuation Period, will be
credited to the portion of Contract Value, if any, in the DCA Fixed Account at
that time. LNY guarantees that it will credit an effective annual Minimum
Guaranteed Interest Rate during all years as shown on the Contract
Specifications. LNY may credit interest at effective annual rates in excess of
the Minimum Guaranteed Interest Rate at any time.
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ARTICLE 6
TRANSFERS, WITHDRAWALS AND SURRENDERS
6.01 TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE
Prior to the earlier of: the Annuity Commencement Date, termination of this
Contract upon payment of any Death Benefit, or surrender of this Contract, the
Owner may provide Notice to direct a transfer of a portion of the Contract Value
between any available Variable Subaccount(s) or from the DCA Fixed Account
subject to any restrictions described in this Contract.
Transfers will be subject to the following:
a. The Transfer Requirements outlined on the Contract Specifications.
b. LNY reserves, in its sole opinion, the right to limit or modify
transfers that may have an adverse effect on other contract owners.
Restrictions may be applied in any manner reasonably designed to
prevent any use of the transfer right that is considered by LNY to
disadvantage other contract owners.
LNY has the right to waive or modify any of these restrictions.
Upon receipt of Notice to transfer, LNY will process the transfer within the
time period required by the Securities and Exchange Commission, unless the
Suspension or Deferral of Payments or Transfers provision (Article 10) is in
effect.
Transfers from a Variable Subaccount will be accomplished at Accumulation Unit
values as of the Valuation Date the Notice to transfer is received.
If the DCA program is discontinued by the Owner prior to the end of the selected
DCA period, any remaining portion of the Contract Value held in a designated DCA
holding account within the DCA Fixed Account will be transferred automatically
to the Variable Subaccount(s) the Owner selected under the DCA program.
6.02 WITHDRAWALS
The Owner may, upon Notice to LNY, withdraw a part of the surrender value of
this Contract at any time prior to the earlier of: the Annuity Commencement
Date, termination of this Contract upon payment of any Death Benefit, or
surrender of this Contract.
Withdrawals will be subject to the withdrawal and surrender requirements as
shown on the Contract Specifications.
A withdrawal will be effective on the Valuation Date that LNY receives Notice to
withdraw. The Notice must specify from which Variable Subaccount and/or the DCA
Fixed Account the withdrawal will be made. If no allocation is specified, LNY
will withdraw the amount requested on a pro-rata basis from each Variable
Subaccount and/or the DCA Fixed Account.
Upon receipt of Notice of withdrawal, LNY will pay the amount of any withdrawal
within the time period as required by the Securities and Exchange Commission
unless the Suspension or Deferral of Payments or Transfers provision (Article
10) is in effect.
Xxxxxxxxxxx will be accomplished at Accumulation Unit values as of the Valuation
Date the Notice for withdrawal is received.
A partial withdrawal will result in a proportional reduction in any Death
Benefit payable under the Contract.
6.03 SURRENDERS
The Owner may, upon Notice to LNY, surrender this Contract for its surrender
value at any time prior to the earlier of: the Annuity Commencement Date, or
termination of this Contract upon payment of any Death Benefit.
Page 11
This Contract will terminate upon surrender. The surrender will be effective on
the Valuation Date on which LNY receives Notice of surrender.
Surrenders will be subject to the withdrawal and surrender requirements as shown
on the Contract Specifications.
The surrender value on the Valuation Date of surrender will be the sum of "a."
and "b." minus the CDSC, where:
"a." is the Contract Value in the DCA Fixed Account and;
"b." is the portion of the Contract Value in the Variable Account.
LNY reserves the right to surrender this Contract if any withdrawal reduces the
total Contract Value to less than $2,000, and Purchase Payments have stopped for
a period of three full years. By payment of the Contract Value, LNY shall be
relieved of any further obligation under this Contract.
Upon receipt of Notice to surrender, LNY will pay the amount of any surrender
within the time period required by the Securities and Exchange Commission,
unless the Suspension or Deferral of Payments or Transfers provision (Article
10) is in effect.
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ARTICLE 7
DEATH BENEFITS
7.01 DEATH BEFORE THE ANNUITY COMMENCEMENT DATE
Entitlement.
If there is a single Owner, then upon the death of the Owner LNY will pay a
Death Benefit to the designated Beneficiary(s). If the designated Beneficiary of
the Death Benefit is the surviving spouse of the deceased Owner, the spouse may
elect to continue the Contract as the new Owner. The Death Benefit in effect at
the time of death of the original Owner will continue, unless subsequently
terminated by the surviving spouse. If there are no designated Beneficiaries,
LNY will pay a Death Benefit to the Owner's estate. Upon the death of the spouse
who continues the Contract as the new Owner, LNY will pay a Death Benefit to the
designated Beneficiary(s).
If there are two Owners, upon the death of the first Owner, LNY will pay a Death
Benefit to the surviving Owner. If the surviving Owner is the spouse of the
deceased Owner, then the spouse may elect to continue the Contract as sole
Owner. The Death Benefit in effect at the time of death of the original Owner
will continue, unless subsequently terminated by the surviving spouse. Upon the
death of the Owner who continues the Contract, LNY will pay a Death Benefit to
the designated Beneficiary(s).
If the Annuitant is also an Owner, then the Death Benefit paid upon the death of
the Annuitant will be subject to the Contract provisions regarding death of an
Owner. If the surviving spouse of the deceased Annuitant assumes the Contract,
the Contingent Annuitant, if any, will become the Annuitant. If there is no
named Contingent Annuitant, the surviving spouse will become the Annuitant.
If an Annuitant who is not an Owner dies, then the Contingent Annuitant, if
named, becomes the Annuitant and no Death Benefit is payable on the death of the
Annuitant.
If an Annuitant who is not an Owner dies and no Contingent Annuitant is named,
the youngest Owner immediately becomes the Annuitant and the Contract continues.
In lieu of continuing the Contract, the Owner may elect to receive a Death
Benefit (in equal shares, if applicable). Written notification of the election
to receive the Death Benefit must be received by LNY within 75 days of the death
of the Annuitant. This Contract will terminate when any Death Benefit is paid
due to the death of the Annuitant.
If the Owner is a corporation or other non-individual (non-natural person), the
death of the Annuitant will be treated as the death of the Owner.
The Death Benefit will be paid upon approval by LNY and after LNY is in receipt
of:
a. proof, satisfactory to LNY, of the death;
b. written authorization for payment; and
c. all claim forms, fully completed.
Due proof of death may be a certified copy of a death certificate, a certified
copy of a decree of a court of competent jurisdiction as to the findings of
death, or any other proof of death acceptable to LNY.
All Death Benefit payments will be subject to the laws and regulations governing
death benefits.
Notwithstanding any provision of this Contract to the contrary, the payment of
Death Benefits provided under the Contract must be made in compliance with Code
Section 72(s) or 401(a)(9) as applicable, as amended from time to time.
Determination of Amounts
The Death Benefit is equal to the greater of:
a. the Contract Value on the Valuation Date the Death Benefit is approved
by the LNY Servicing Office for payment; or
Page 13
b. the sum of all Purchase Payments decreased proportionally by all
withdrawals, including any applicable charges and any premium tax
incurred; or
Upon the death of an Owner or Annuitant of this Contract, if a surviving spouse
continues the Contract, the excess, if any, of the Death Benefit over the
current Contract Value as of the date on which the death claim is approved by
LNY for payment will be credited into the Contract. The excess will only be
credited one time for each Contract.
If the Owner is a corporation or other non-individual (non-natural person) and
there are Joint Annuitants, upon the death of the first Joint Annuitant to die,
if the Contract is continued, the excess, if any, of the Death Benefit over the
current Contract Value as of the date on which the death claim is approved by
LNY for payment will be credited into the Contract. This excess will only be
credited one time for each Contract.
If at any time the Owner or Annuitant named on this Contract is changed, except
on the death of the prior Owner or Annuitant, the Death Benefit for the new
Owner or Annuitant will be the Contract Value as of the Valuation Date the death
claim for the new Owner or Annuitant is approved by the LNY Servicing Office for
payment.
Other Death Benefit requirements may apply as shown on the Contract
Specifications.
Payment of Amounts
The Death Benefit payable on the death of the Owner, or after the death of the
first Owner, or upon the death of the spouse who continues the Contract, will be
distributed to the designated Beneficiary(s) as follows:
a. the Death Benefit must be completely distributed within five years of
the Owner's date of death; or
b. an election may be made within the one year period after the Owner's
date of death for the designated Beneficiary, to receive the Death
Benefit in substantially equal installments over the life of such
designated Beneficiary or over a period not extending beyond the life
expectancy of such designated Beneficiary; provided that such
distributions begin not later than one year after the Owner's date of
death.
The Death Benefit payable upon the death of the Annuitant, must be elected by
the Owner within 75 days of the death of the Annuitant, and will be distributed
to the Owner in either form of a lump sum or under an Annuity Payment Option. An
Annuity Payment Option must be selected within 60 days after LNY approves the
death claim.
If a lump sum settlement is elected, the proceeds will be mailed within the time
period required by the Securities and Exchange Commission following LNY's
approval of the death claim, unless the Suspension or Deferral of Payments or
Transfers provision (Article 10) is in effect. If any Death Benefit payable is
deferred, interest will be paid as required by New York Insurance Law using an
interest rate no less than the interest rate currently paid under the interest
settlement option.
The Death Benefit in effect will terminate on the Annuity Commencement Date.
7.02 DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
Upon receipt of due proof of death of the Annuitant, any remaining annuity
benefits payable will continue to be distributed under the Annuity Payment
Option then in effect.
Upon the death of the Owner, any remaining annuity payments will be made at
least as rapidly as the Annuity Payment Option then in effect. Upon the death of
the Owner, the rights of ownership granted by the Contract will pass to the
surviving Owner, if any, otherwise to the Beneficiary. If there is no named
Beneficiary at the time of a sole Owner's death, then the rights of ownership
will pass to the Annuitant, if still living; otherwise to the Joint Annuitant,
if applicable. If no named Beneficiary, Annuitant or Joint Annuitant survives
the Owner, any remaining payments payable will continue to the Owner's estate.
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ARTICLE 8
ANNUITY PAYMENT OPTIONS
8.01 ANNUITY PAYMENTS
Annuity Payments will commence on the Annuity Payment Date. Payments are made
under the Annuity Payment Option selected (see Section 8.02).
8.02 CHOICE OF ANNUITY PAYMENT OPTION
An election to receive payments under an Annuity Payment Option must be made by
the Maturity Date. However, the Owner may elect to receive payments under an
Annuity Payment Option any time after the 12 month anniversary of the Contract
Date but prior to the Maturity Date upon written request. The Maturity Date is
set forth on the Contract Specifications. If an Annuity Payment Option is not
chosen prior to the Maturity Date, payments will commence to the Owner on the
Maturity Date under the Annuity Payment Option providing a Life Annuity with
annuity payments guaranteed for 10 years.
Upon written request by the Owner and any Beneficiary who cannot be changed, the
Maturity Date may be deferred.
By Owner
Prior to the Annuity Commencement Date, the Owner may choose or change any
Annuity Payment Option. In addition, the Owner may select an Annuity Payment
Option that meets the requirements of Code Section 72(s) or 401(a)(9) as set
forth in Section 7.01, Payment of Amounts, for payment of the Death Benefit to a
Beneficiary. A Notice of such selection of a distribution method must be made
and approved by LNY. Upon Notice, the Owner may change or revoke, in writing to
the LNY Servicing Office, any such selection, unless such selection was made
irrevocable.
By Beneficiary
If an Annuity Payment Option has not been previously selected by the Owner as
the distribution option for the payment of the Death Benefit to a Beneficiary,
then at the time proceeds are payable to a Beneficiary, a Beneficiary may choose
any Annuity Payment Option that meets the requirements of Code Section 72(s) or
401(a)(9) as set forth in Section 7.01, Payment of Amounts. The Beneficiary then
becomes the Annuitant.
A Notice is required to choose an Annuity Payment Option.
8.03 ANNUITY PAYMENT OPTIONS
a. Life Annuity / Life Annuity with Certain Period -- Fixed and/or Variable
Annuity Payments will be made for the lifetime of the Annuitant with no
Certain Period, or life and a 10 year Certain Period, or life and a 20 year
Certain Period.
b. Unit Refund Life Annuity - Variable Annuity Payments will be made for the
lifetime of the Annuitant with the guarantee that upon death, if:
1) the number of Annuity Units initially purchased (determined by
dividing the total dollar amount applied to purchase this option by
the Annuity Unit value on the Annuity Commencement Date) is greater
than;
2) the number of Annuity Units paid as part of each Variable Annuity
Payment multiplied by the number of annuity payments paid prior to
death;
then a refund payment equal to the number of Annuity Units determined
by (1) minus (2) will be made.
The refund payment value will be determined using the Annuity Unit value on
the Valuation Date on which the refund payment is approved by LNY, after
LNY is in receipt of:
Page 15
(a) due proof of death acceptable to LNY;
(b) written authorization for payment; and
(c) all claim forms, fully completed.
c. Cash Refund Life Annuity -- Fixed Annuity Payments will be made for the
lifetime of the Annuitant with the guarantee that upon death, if:
1) the total dollar amount applied to purchase this option is greater
than;
2) the Fixed Annuity Payment multiplied by the number of annuity benefit
payments paid prior to death;
then a refund payment equal to the dollar amount of (1) minus (2) will
be made.
The refund payment will be paid upon approval by LNY, after LNY is in
receipt of:
(a) due proof of death acceptable to LNY;
(b) written authorization for payment; and
(c) all claim forms, fully completed.
This option is only available to Annuitants under age 91.
d. Joint Life Annuity / Joint Life Annuity with Certain Period -- Fixed and/or
Variable Annuity Payments will be made during the joint life of the
Annuitant and a Joint Annuitant. Payments will be made for joint life with
no Certain Period, or joint life and a 10-year Certain Period, or joint
life and a 20-year Certain Period. Upon the death of either Xxxxxxxxx,
annuity payments continue at the same amount for the life of the surviving
Annuitant.
e. Joint Life and Two-Thirds to Survivor Annuity / Joint Life and Two-Thirds
to Survivor Annuity with Certain Period -- Fixed and/or Variable Annuity
Payments will be made during the joint life of the Annuitant and a Joint
Annuitant. Upon the death of either Xxxxxxxxx, two thirds of the annuity
payment due while both Annuitants were alive will continue for the life of
the surviving Annuitant. Payments will be made for joint life with no
Certain Period, or joint life and a 10-year Certain Period, or joint life
and a 20-year Certain Period.
f. Other options may be available as agreed upon in writing by LNY.
At the time an Annuity Payment Option is selected under the provisions of this
Contract, the Owner may elect to have the Contract Value applied to provide a
Variable Annuity Payment, a Fixed Annuity Payment, or a combination Fixed and
Variable Annuity Payment. If no election is made, the Contract Value will be
used to provide a Variable Annuity Payment.
At the time Fixed and/or Variable Annuity Payments commence, they will not be
less than those that would be provided by a specific amount for any single
premium immediate annuity contract offered by LNY at the time to the same class
of annuitants. The specific amount is the greater of the surrender value or 95%
of the accumulation value.
8.04 DETERMINATION OF THE AMOUNT OF THE FIRST ANNUITY PAYMENT
The amount of annuity payment will depend on the age and sex (except in cases
where unisex rates are required) of the Annuitant as of the Annuity Commencement
Date. A choice may be made to receive payments once each month, four times each
year, twice each year, or once each year. If no choice is made, payments will
automatically be made monthly.
Article 12 of this Contract illustrates the minimum payment amounts and the age
adjustments which will be used to determine the first monthly payment for a
Variable Annuity Payment based upon the assumed interest rate selected by the
Owner. The tables show the dollar amount of the first monthly payment which can
be purchased with each $1,000 of Contract Value, after deduction of any
applicable premium taxes. Amounts shown use an Individual Mortality Table on
file with the New York Superintendent of Insurance, with an assumed interest
rate of
Page 16
3.0%, 4.0% and 5.0% per year. This table is based on a modification of the 1983
'a' Individual Annuity Mortality Table, projected 21 years to the year 2004
using projection Scale G. The Owner must select one of the assumed interest
rates, as shown on the Contract Specifications, for the Variable Annuity Payment
prior to the Annuity Commencement Date. The assumed interest rate may not be
changed after the Annuity Commencement Date.
Article 13 of this Contract illustrates the minimum payment amounts and the age
adjustments that will be used to determine the monthly payments for a Fixed
Annuity Payment. The tables show the dollar amount of the guaranteed monthly
payments which can be purchased with each $1,000 of Contract Value, after
deduction of any applicable premium taxes. Amounts shown use an Individual
Mortality Table on file with the New York Superintendent of Insurance, with an
interest rate of 1.50% per year. This table is based on a modification of the
1983 'a' Individual Annuity Mortality Table, projected 21 years to the year 2004
using projection Scale G.
Minimum payment amounts for ages not shown in Articles 12 and 13 can be obtained
from LNY's Servicing Office. The minimum payment amounts shown for Joint and
Survivor Annuities are for joint ages; that is, for a male and a female both of
the same age. Minimum payment amounts for other age and sex combinations on
Joint and Survivor Annuities are not illustrated in Articles 12 and 13, but are
available from LNY's Servicing Office.
Determination of the first Annuity Payment Date is shown on the Contract
Specifications.
The Annuity Unit Value, if applicable, and Contract Value used to effect annuity
benefit payments will be determined as of the Annuity Commencement Date.
8.05 DETERMINATION OF THE AMOUNT OF VARIABLE ANNUITY PAYMENTS AFTER THE FIRST
PAYMENT
The first Variable Annuity Payment is sub-divided into components, each of which
represents the product of:
a. the percentage elected by the Owner of a specific Variable Subaccount,
the performance of which will determine future Variable Annuity
Payments, and
b. the entire first Variable Annuity Payment.
Each Variable Annuity Payment after the first payment attributable to a specific
Variable Subaccount will be determined by multiplying the Annuity Unit value for
the Variable Subaccount for the Valuation Date no more than 14 days before each
payment is due by a constant number of Annuity Units. This constant number of
each specific Variable Subaccount is determined by dividing the component of the
first payment attributable to such Variable Subaccount as described above by the
Annuity Unit value for that Variable Subaccount on the Annuity Commencement
Date. The total Variable Annuity Payment will be the sum of the payments
attributable to each Variable Subaccount. In the absence of transfers between
Variable Subaccounts, the number of Annuity Units attributable to each Variable
Subaccount remains constant, although the Annuity Unit values will vary with the
investment performance of the Funds. The Annuity Unit value may increase or
decrease the dollar value of benefits under the Contract.
The Annuity Unit value for any Valuation Period for any Variable Subaccount is
determined by multiplying the Annuity Unit value for the immediately preceding
Valuation Period by the product of (a) the daily factor raised to a power equal
to the number of days in the current Valuation Period and (b) the Accumulation
Unit value of the same Variable Subaccount for this Valuation Period divided by
the Accumulation Unit value of the same Variable Subaccount for the immediately
preceding Valuation Period. The daily factor is equal to 0.999919020 for a 3.0%
assumed interest rate, 0.999892552 for a 4.0% assumed interest rate, and
0.999866337 for a 5.0% assumed interest rate.
The valuation of all assets in the Variable Subaccount will be determined in
accordance with the provisions of applicable laws, rules, and regulations. The
method of determination by LNY of the value of an Accumulation Unit and of any
Annuity Unit will be conclusive upon the Owner, Annuitant and any Beneficiary.
LNY guarantees that the dollar amount of each payment after the first will not
be affected by variations in mortality experience from mortality assumptions on
which the first payment is based.
Page 17
8.06 TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE
After the Annuity Commencement Date, if any portion of the annuity payment is a
Variable Annuity Payment, the Owner may direct a transfer of assets from one
Variable Subaccount to another Variable Subaccount or to a Fixed Annuity Payment
by providing Notice to transfer. Such transfers will be limited to three (3)
times per Contract Year. Assets may not be transferred from a Fixed Annuity
Payment to a Variable Annuity Payment.
A transfer from one Variable Subaccount to another Variable Subaccount will
result in the purchase of Annuity Units in one Variable Subaccount and the
redemption of Annuity Units in the other Variable Subaccount. Such a transfer
will be accomplished at relative Annuity Unit values as of the Valuation Date
the Notice to transfer is received. The valuation of Annuity Units is described
above. A transfer from a Variable Subaccount to a Fixed Annuity Payment will
result in the redemption of Annuity Units in that Variable Subaccount and the
purchase of a minimum Fixed Annuity Payment based on the tables in Article 13.
8.07 PROOF OF AGE
Payment will be subject to proof of age that LNY will accept, such as a
certified copy of a birth certificate.
8.08 MINIMUM ANNUITY PAYMENT REQUIREMENTS
LNY reserves the right to reduce the frequency of payments to an interval which
will result in each payment exceeding the minimum annuity payment amount shown
on the Contract Specifications. LNY will pay the Contract Value in a lump sum if
the frequency interval is annual and the resulting annuity payment is less than
the minimum annuity payment amount shown on the Contract Specifications.
8.09 EVIDENCE OF SURVIVAL
LNY has the right to ask for proof that the Annuitant(s) on whose life (or
lives) the payment is based is alive when each payment is due.
8.10 CHANGE IN ANNUITY PAYMENT OPTION
The Annuity Payment Option may not be changed after the Annuity Commencement
Date.
Page 18
ARTICLE 9
BENEFICIARY
9.01 DESIGNATION OF BENEFICIARY
The Owner may designate a Beneficiary and a contingent Beneficiary.
Prior to the Annuity Commencement Date, if there is a single Owner, the
designated Beneficiary will receive the Death Benefit proceeds upon the death of
the Owner unless the Beneficiary as the surviving spouse elects to continue the
Contract.
Prior to the Annuity Commencement Date, if there are two Owners, upon the death
of the first Owner, the surviving Owner will receive the Death Benefit proceeds.
The surviving Owner will be treated as the primary designated Beneficiary. Any
other Beneficiary designation on record at the time of death will be treated as
a contingent Beneficiary.
Prior to the Annuity Commencement Date, if the surviving spouse of a deceased
Owner continues the Contract as the sole Owner, then the designated
Beneficiaries move up, in the order of their original designation, to replace
the spouse as original Beneficiary, unless the Beneficiary designation is
subsequently changed by the surviving spouse as the new Owner.
Prior to the Annuity Commencement Date, if the Annuitant dies and a Death
Benefit is paid, the Owner will be treated as the primary designated
Beneficiary. Any other primary Beneficiary on record at the time of death will
be treated as a contingent Beneficiary.
Unless otherwise stated in the Beneficiary designation, multiple Beneficiaries
are presumed to share equally.
9.02 CHANGE OF BENEFICIARY
The Owner may change any Beneficiary unless otherwise provided in the previous
designation by providing a Notice to change Beneficiary. A change of Beneficiary
will revoke any previous designation. When a change of Beneficiary is received
by LNY, whether or not the Owner is then alive, it will take effect as of the
date the request was sent. For purposes of determining on which date a written
change of Beneficiary is sent, the postmark date will be used. Any payment made
or action taken or allowed before the change of Beneficiary is received will be
without prejudice to LNY.
LNY reserves the right to request the Contract for endorsement of the change.
9.03 DEATH OF BENEFICIARY
Unless otherwise provided in the Beneficiary designation, if any Beneficiary
dies before the Owner, that Beneficiary's interest will go to any other primary
Beneficiaries named, according to their respective interests. If there are no
primary Beneficiaries, the Beneficiaries' interest will pass to a contingent
Beneficiary, if any. Prior to the Annuity Commencement Date, if no Beneficiary
or contingent Beneficiary survives the Owner, the Death Benefits will be paid to
the Owner's estate.
Unless otherwise provided in the Beneficiary designation, once a Beneficiary is
receiving Death Benefits or annuity payments under an Annuity Payment Option,
the Beneficiary may name his or her own Beneficiary to receive any remaining
benefits due under the Contract, should the original Beneficiary die prior to
receipt of all benefits. If no Beneficiary is named or the named Beneficiary
predeceases the original Beneficiary, any remaining benefits will continue to
the original Beneficiary's estate. A Beneficiary designation must be made by
Notice to LNY.
Page 19
ARTICLE 10
SUSPENSION OR DEFERRAL OF PAYMENTS OR TRANSFERS
10.01 SUSPENSION OR DEFERRAL OF PAYMENTS OR TRANSFERS FROM OR WITHIN THE
VARIABLE ACCOUNT
LNY reserves the right to suspend or postpone payments for a transfer,
withdrawal or surrender for any period when:
1. the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held in the
Variable Account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Variable Account's net assets; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of the Owner.
The applicable rules and regulations of the Securities and Exchange Commission
will govern as to whether the conditions described in (2) and (3) exist.
10.02 SUSPENSION OR DEFERRAL OF PAYMENTS OR TRANSFERS FROM THE DCA FIXED ACCOUNT
LNY reserves the right to defer payment for a withdrawal, surrender or transfer
from the DCA Fixed Account for the period permitted by law but for not more than
six (6) months after Notice is received by LNY.
If any payment is deferred by more than 10 working days, interest will be paid
as required by New York Insurance Law using an interest rate no less than the
interest rate currently paid under the interest settlement option.
Page 20
ARTICLE 11
GENERAL PROVISIONS
11.01 THE CONTRACT
The Contract and any riders attached, together with the application therefore if
a copy of such application is attached to the Contract when issued, constitute
the entire Contract. Only the President, a Vice President, the Secretary or an
Assistant Secretary of LNY has the power, on behalf of LNY, to change, modify,
or waive any provisions of this Contract.
All statements made by or under the authority of the Owner for the issuance of
the Contract are deemed to be representations and not warranties.
LNY reserves the right to unilaterally change the Contract for the purpose of
keeping the Contract in compliance with federal or state law, subject to the
prior approval of the New York Superintendent of Insurance.
Any changes, modifications, or waivers must be in writing. No representative or
person other than the above named officers has authority to change or modify
this Contract or waive any of its provisions. All terms used in this Contract
will have their usual and customary meaning except when specifically defined.
11.02 OWNERSHIP
All Owners will be treated as having equal, undivided interests in the Contract,
including rights of survivorship. Either Owner, independently of the other, may
exercise any ownership rights in the Contract. The existence of a Joint Owner
will not operate to continue the Contract upon the death of the first Owner,
unless the Joint Owner is the spouse of the deceased Owner (see Section 7.01,
Entitlement).
The Owner may transfer all rights and privileges of ownership. On the effective
date of transfer, the transferee will become the Owner and will have all the
rights and privileges of the Owner. The Owner may revoke any transfer prior to
its effective date. Unless provided otherwise, a transfer will not affect the
interest of any Beneficiary designated prior to the effective date of the
transfer.
A transfer of ownership, or a revocation of transfer, must be in writing to the
Company at its Servicing Office. When a transfer or revocation has been
received, it will take effect as of the effective date specified by the Owner.
Any payments made or any action taken or allowed by LNY before the transfer or
the revocation is received will be without prejudice to LNY.
11.03 ANNUITANTS
Prior to the Annuity Commencement Date.
The Owner may name only one Annuitant. If the Owner is a tax-exempt entity, the
Owner may name one Annuitant or two Joint Annuitants.
If the Owner is a natural person, the Owner has the right to change the
Annuitant at any time by sending Notice of change to LNY at its Servicing
Office; once received by LNY, the change will be effective as of the date the
request was sent. For purposes of determining on which date a written change of
Annuitant is sent, the postmark date will be used. If the Owner is a non-natural
person, the Annuitant may not be changed. The new Annuitant must be under the
age of 90 as of the effective date of the change. Change of Annuitant may affect
the Death Benefit (refer to Article 7, Death Benefits).
A Contingent Annuitant may be named, or changed upon receipt of Notice by LNY.
On or After the Annuity Commencement Date.
The Annuitant or Joint Annuitants may not be changed. Any Contingent Annuitant
designation is no longer applicable and is terminated.
Page 21
11.04 ASSIGNMENTS
This Contract may be assigned. LNY will not be bound by any assignment unless it
is received in writing at LNY's Servicing Office in a form acceptable to LNY.
The effective date of the assignment will be the date it is received by LNY. LNY
will not be responsible for the validity of any assignment.
If this Contract is used with a Qualified Plan, the Contract will not be
transferable unless allowed under applicable law.
11.05 INCONTESTABILITY
This Contract will not be contested by LNY.
11.06 MISSTATEMENT OF AGE AND/OR SEX
If the age and/or sex of the Annuitant has been misstated, the amount payable
under the Contract will be adjusted to be the amount of income which the actual
premium paid would have purchased for the correct age and/or sex according to
LNY's rates in effect on the Contract Date. Any overpayment by LNY, with
interest at the rate of 6% per year, compounded annually, will be charged
against the payments to be made next succeeding the adjustment. Any underpayment
by LNY will be paid in a lump sum, with interest at the rate of 6% per year,
compounded annually.
11.07 NONPARTICIPATING
The Contract is nonparticipating and will not share in the surplus earnings of
LNY.
11.08 OWNERSHIP OF THE ASSETS
LNY will have exclusive and absolute ownership and control of its assets,
including all assets in the Variable Account.
11.09 REPORTS
Prior to the Annuity Commencement Date, at least once each Calendar Year, LNY
will mail a report to the Owner. The report will be mailed to the last address
known to LNY. The report will include a statement of the number of Accumulation
Units credited to the Variable Account and the dollar value of such units as
well as a statement of the value of any Fixed Account. The report will also
include the total account value, the cash surrender value, and Death Benefit.
Such other information as may be required by law or regulation will also be
included. The information in the report will be as of a date not more than two
months prior to the date of mailing the report. The Owner will have 60 days from
the date the report or confirmation is received to notify LNY of any errors in
the report or confirmation, otherwise the report or confirmation will be deemed
to be final and correct.
11.10 PREMIUM TAX
State and local government premium tax, if applicable, will be deducted from
Purchase Payments or Contract Value when incurred by LNY or at another time of
LNY's choosing.
11.11 MAXIMUM ISSUE AGE
The Owner and the Annuitant (or both Joint Annuitants, if applicable), when
named, must be under the age of 90.
11.12 LOANS
Loans are not permitted under this Contract.
Page 22
11.13 MINIMUM BENEFITS PAYABLE
Any benefits paid under this Contract will not be less than those required by
the New York Insurance Law.
Page 23
ARTICLE 12
ANNUITY PURCHASE RATES UNDER A VARIABLE PAYMENT OPTION
WITH A 3.0% ASSUMED INTEREST RATE
(on file with the New York Superintendent of Insurance)
----------------------------------------------------------------------------------------
DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS
PURCHASED WITH EACH $1,000 APPLIED
----------------------------------------------------------------------------------------
SINGLE LIFE ANNUITIES
----------------------------------------------------------------------------------------
Age No Period Certain 120 Months Certain 240 Months Certain Unit Refund
Male Female Male Female Male Female Male Female
----------------------------------------------------------------------------------------
60 $ 4.91 $ 4.42 $ 4.83 $ 4.38 $ 4.52 $ 4.24 $ 4.53 $ 4.21
61 5.03 4.51 4.93 4.47 4.59 4.31 4.62 4.29
62 5.16 4.61 5.04 4.56 4.66 4.38 4.71 4.36
63 5.30 4.72 5.16 4.66 4.72 4.45 4.80 4.45
64 5.45 4.83 5.29 4.77 4.79 4.52 4.89 4.53
65 5.60 4.95 5.42 4.88 4.85 4.59 5.00 4.62
66 5.77 5.08 5.55 4.99 4.91 4.66 5.10 4.72
67 5.95 5.22 5.69 5.11 4.97 4.74 5.21 4.82
68 6.14 5.37 5.84 5.24 5.03 4.81 5.33 4.92
69 6.34 5.53 5.99 5.38 5.09 4.88 5.45 5.03
70 6.56 5.70 6.15 5.53 5.14 4.95 5.57 5.15
71 6.79 5.88 6.31 5.68 5.19 5.02 5.71 5.27
72 7.03 6.08 6.48 5.84 5.24 5.08 5.85 5.40
73 7.29 6.30 6.64 6.01 5.28 5.14 5.99 5.54
74 7.57 6.53 6.82 6.18 5.31 5.19 6.15 5.68
75 7.86 6.78 6.99 6.37 5.35 5.24 6.31 5.83
----------------------------------------------------------------------------------------
------------------------------------------------------------------------------
JOINT AND SURVIVOR ANNUITIES
------------------------------------------------------------------------------
Joint and Full to Survivor Joint and Two-Thirds to Survivor
------------------------------------------------------------------------------
Certain Period Certain Period
------------------------------------------------------------------------------
Joint
None 120 240 Age None 120 240
------------------------------------------------------------------------------
$ 4.02 $ 4.01 $ 3.99 60 $ 4.42 $ 4.38 $ 4.24
4.09 4.09 4.06 61 4.51 4.47 4.31
4.17 4.16 4.12 62 4.61 4.56 4.37
4.25 4.24 4.20 63 4.72 4.66 4.44
4.34 4.33 4.27 64 4.83 4.76 4.52
4.43 4.42 4.35 65 4.95 4.87 4.59
4.53 4.52 4.43 66 5.08 4.99 4.66
4.63 4.62 4.51 67 5.21 5.11 4.73
4.75 4.73 4.59 68 5.36 5.23 4.80
4.87 4.85 4.67 69 5.51 5.37 4.87
5.00 4.98 4.75 70 5.68 5.51 4.94
5.14 5.11 4.83 71 5.86 5.66 5.01
5.28 5.25 4.91 72 6.05 5.81 5.07
5.44 5.40 4.99 73 6.25 5.97 5.13
5.61 5.56 5.06 74 6.47 6.14 5.19
5.80 5.72 5.13 75 6.71 6.32 5.24
------------------------------------------------------------------------------
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
------------- ----------------- ------------- -----------------
Before 1920 +2 1970-1979 -4
1920-1929 +1 1980-1989 -5
1930-1939 0 1990-1999 -6
1940-1949 -1 2000-2009 -7
1950-1959 -2 2010-2019 -8
1960-1969 -3
Page 24
A VARIABLE ANNUITY PAYMENT WITH A 4.0% ASSUMED INTEREST RATE
(on file with the New York Superintendent of Insurance)
----------------------------------------------------------------------------------------
DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS
PURCHASED WITH EACH $1,000 APPLIED
----------------------------------------------------------------------------------------
SINGLE LIFE ANNUITIES
----------------------------------------------------------------------------------------
Age No Period Certain 120 Months Certain 240 Months Certain Unit Refund
Male Female Male Female Male Female Male Female
----------------------------------------------------------------------------------------
60 $ 5.49 $ 5.00 $ 5.39 $ 4.95 $ 5.07 $ 4.79 $ 5.16 $ 4.82
61 5.61 5.09 5.50 5.03 5.13 4.86 5.25 4.89
62 5.74 5.19 5.61 5.13 5.19 4.92 5.34 4.97
63 5.88 5.29 5.72 5.22 5.25 4.99 5.44 5.05
64 6.02 5.40 5.84 5.32 5.32 5.06 5.54 5.14
65 6.18 5.52 5.97 5.43 5.38 5.13 5.64 5.23
66 6.35 5.65 6.10 5.55 5.44 5.20 5.75 5.33
67 6.53 5.79 6.24 5.67 5.49 5.27 5.87 5.43
68 6.72 5.93 6.39 5.79 5.55 5.33 5.99 5.54
69 6.92 6.09 6.53 5.93 5.60 5.40 6.12 5.66
70 7.14 6.26 6.69 6.07 5.65 5.47 6.25 5.78
71 7.37 6.45 6.85 6.22 5.70 5.53 6.39 5.91
72 7.62 6.65 7.01 6.38 5.74 5.59 6.54 6.04
73 7.88 6.86 7.17 6.54 5.78 5.65 6.69 6.19
74 8.16 7.10 7.34 6.71 5.81 5.70 6.85 6.34
75 8.45 7.35 7.51 6.89 5.85 5.75 7.02 6.50
----------------------------------------------------------------------------------------
------------------------------------------------------------------------------
JOINT AND SURVIVOR ANNUITIES
------------------------------------------------------------------------------
Joint and Full to Survivor Joint and Two-Thirds to Survivor
------------------------------------------------------------------------------
Certain Period Certain Period
------------------------------------------------------------------------------
Joint
None 120 240 Age None 120 240
------------------------------------------------------------------------------
$ 4.58 $ 4.58 $ 4.55 60 $ 4.99 $ 4.95 $ 4.79
4.65 4.65 4.61 61 5.09 5.04 4.86
4.72 4.72 4.68 62 5.18 5.13 4.92
4.80 4.80 4.75 63 5.29 5.22 4.99
4.89 4.88 4.82 64 5.40 5.32 5.06
4.98 4.97 4.89 65 5.52 5.43 5.12
5.07 5.07 4.97 66 5.64 5.54 5.19
5.18 5.17 5.04 67 5.78 5.66 5.26
5.29 5.28 5.12 68 5.92 5.78 5.33
5.41 5.39 5.20 69 6.08 5.91 5.39
5.54 5.51 5.28 70 6.25 6.05 5.46
5.67 5.64 5.35 71 6.42 6.20 5.52
5.82 5.78 5.43 72 6.61 6.35 5.58
5.98 5.93 5.50 73 6.82 6.51 5.64
6.15 6.08 5.57 74 7.04 6.67 5.69
6.33 6.25 5.63 75 7.28 6.84 5.74
------------------------------------------------------------------------------
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
------------- ----------------- ------------- -----------------
Before 1920 +2 1970-1979 -4
1920-1929 +1 1980-1989 -5
1930-1939 0 1990-1999 -6
1940-1949 -1 2000-2009 -7
1950-1959 -2 2010-2019 -8
1960-1969 -3
Page 25
A VARIABLE ANNUITY PAYMENT WITH A 5.0% ASSUMED INTEREST RATE
(on file with the New York Superintendent of Insurance)
----------------------------------------------------------------------------------------
DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS
PURCHASED WITH EACH $1,000 APPLIED
----------------------------------------------------------------------------------------
SINGLE LIFE ANNUITIES
----------------------------------------------------------------------------------------
Age No Period Certain 120 Months Certain 240 Months Certain Unit Refund
Male Female Male Female Male Female Male Female
----------------------------------------------------------------------------------------
60 $ 6.10 $ 5.59 $ 5.98 $ 5.54 $ 5.63 $ 5.37 $ 5.79 $ 5.44
61 6.21 5.68 6.08 5.62 5.69 5.43 5.88 5.51
62 6.34 5.78 6.19 5.71 5.75 5.49 5.98 5.59
63 6.48 5.88 6.30 5.80 5.81 5.56 6.07 5.67
64 6.62 5.99 6.42 5.90 5.87 5.62 6.18 5.76
65 6.78 6.11 6.54 6.01 5.92 5.69 6.28 5.85
66 6.94 6.24 6.67 6.12 5.98 5.75 6.40 5.95
67 7.12 6.37 6.80 6.23 6.03 5.82 6.52 6.05
68 7.31 6.52 6.94 6.36 6.08 5.88 6.64 6.16
69 7.52 6.67 7.09 6.49 6.13 5.94 6.77 6.28
70 7.74 6.84 7.24 6.63 6.18 6.01 6.91 6.41
71 7.97 7.03 7.39 6.77 6.22 6.07 7.06 6.54
72 8.21 7.23 7.55 6.93 6.26 6.12 7.21 6.68
73 8.47 7.44 7.71 7.09 6.30 6.17 7.37 6.82
74 8.75 7.68 7.87 7.26 6.33 6.22 7.54 6.98
75 9.05 7.93 8.04 7.43 6.36 6.27 7.72 7.15
----------------------------------------------------------------------------------------
------------------------------------------------------------------------------
JOINT AND SURVIVOR ANNUITIES
------------------------------------------------------------------------------
Joint and Full to Survivor Joint and Two-Thirds to Survivor
------------------------------------------------------------------------------
Certain Period Certain Period
------------------------------------------------------------------------------
Joint
None 120 240 Age None 120 240
------------------------------------------------------------------------------
$ 5.17 $ 5.17 $ 5.14 60 $ 5.59 $ 5.54 $ 5.37
5.23 5.23 5.20 61 5.68 5.62 5.43
5.31 5.30 5.26 62 5.78 5.71 5.49
5.38 5.38 5.32 63 5.88 5.80 5.56
5.46 5.46 5.39 64 5.99 5.90 5.62
5.55 5.54 5.46 65 6.11 6.00 5.68
5.65 5.64 5.53 66 6.23 6.11 5.75
5.75 5.73 5.60 67 6.36 6.23 5.81
5.85 5.84 5.67 68 6.51 6.35 5.87
5.97 5.95 5.75 69 6.66 6.48 5.94
6.09 6.07 5.82 70 6.83 6.61 6.00
6.23 6.20 5.90 71 7.00 6.75 6.06
6.37 6.33 5.97 72 7.19 6.90 6.11
6.53 6.47 6.03 73 7.40 7.06 6.17
6.69 6.63 6.10 74 7.62 7.22 6.22
6.87 6.79 6.16 75 7.85 7.38 6.26
------------------------------------------------------------------------------
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
------------- ----------------- ------------- -----------------
Before 1920 +2 1970-1979 -4
1920-1929 +1 1980-1989 -5
1930-1939 0 1990-1999 -6
1940-1949 -1 2000-2009 -7
1950-1959 -2 2010-2019 -8
1960-1969 -3
Page 26
ARTICLE 13
ANNUITY PURCHASE RATES UNDER A FIXED ANNUITY PAYMENT OPTION
WITH A 1.50% INTEREST RATE
(on file with the New York Superintendent of Insurance)
----------------------------------------------------------------------------------------
DOLLAR AMOUNT OF FIRST MONTHLY PAYMENT WHICH IS
PURCHASED WITH EACH $1,000 APPLIED
----------------------------------------------------------------------------------------
SINGLE LIFE ANNUITIES
----------------------------------------------------------------------------------------
Age No Period Certain 120 Months Certain 240 Months Certain Cash Refund
Male Female Male Female Male Female Male Female
----------------------------------------------------------------------------------------
60 $ 4.09 $ 3.61 $ 4.02 $ 3.58 $ 3.76 $ 3.46 $ 3.57 $ 3.31
61 4.21 3.70 4.13 3.67 3.83 3.53 3.64 3.38
62 4.33 3.80 4.24 3.77 3.90 3.61 3.72 3.45
63 4.47 3.91 4.36 3.87 3.97 3.68 3.80 3.52
64 4.61 4.02 4.49 3.97 4.04 3.76 3.89 3.60
65 4.77 4.15 4.62 4.08 4.11 3.83 3.98 3.68
66 4.93 4.27 4.76 4.20 4.17 3.91 4.07 3.77
67 5.11 4.41 4.90 4.33 4.24 3.99 4.17 3.86
68 5.30 4.56 5.05 4.46 4.30 4.07 4.27 3.95
69 5.50 4.72 5.21 4.60 4.36 4.14 4.37 4.05
70 5.71 4.89 5.37 4.75 4.42 4.21 4.48 4.15
71 5.94 5.07 5.53 4.90 4.47 4.29 4.60 4.26
72 6.18 5.27 5.70 5.07 4.52 4.35 4.72 4.38
73 6.43 5.48 5.88 5.24 4.56 4.42 4.85 4.49
74 6.71 5.71 6.06 5.42 4.60 4.48 4.98 4.62
75 7.00 5.96 6.42 5.60 4.64 4.53 5.12 4.75
----------------------------------------------------------------------------------------
------------------------------------------------------------------------------
JOINT AND SURVIVOR ANNUITIES
------------------------------------------------------------------------------
Joint and Full to Survivor Joint and Two-Thirds to Survivor
------------------------------------------------------------------------------
Certain Period Certain Period
------------------------------------------------------------------------------
Joint
None 120 240 Age None 120 240
------------------------------------------------------------------------------
$ 3.23 $ 3.23 $ 3.21 60 $ 3.61 $ 3.58 $ 3.46
3.31 3.30 3.28 61 3.70 3.67 3.53
3.39 3.38 3.35 62 3.80 3.77 3.60
3.47 3.47 3.43 63 3.91 3.86 3.68
3.56 3.56 3.50 64 4.02 3.97 3.75
3.66 3.65 3.59 65 4.14 4.08 3.83
3.76 3.75 3.67 66 4.27 4.20 3.91
3.86 3.86 3.75 67 4.40 4.32 3.98
3.98 3.97 3.84 68 4.55 4.45 4.06
4.10 4.09 3.92 69 4.70 4.59 4.13
4.23 4.22 4.01 70 4.87 4.73 4.21
4.37 4.35 4.09 71 5.05 4.88 4.28
4.52 4.49 4.18 72 5.24 5.04 4.35
4.68 4.64 4.26 73 5.44 5.20 4.41
4.85 4.80 4.33 74 5.66 5.38 4.47
5.03 4.97 4.41 75 5.89 5.56 4.52
------------------------------------------------------------------------------
Age Adjustment Table
Year of Birth Adjustment to Age Year of Birth Adjustment to Age
------------- ----------------- ------------- -----------------
Before 1920 +2 1970-1979 -4
1920-1929 +1 1980-1989 -5
1930-1939 0 1990-1999 -6
1940-1949 -1 2000-2009 -7
1950-1959 -2 2010-2019 -8
1960-1969 -3
Page 27
ARTICLE 14
ADDITIONAL SERVICES
There are three additional programs available under this Contract: Automatic
Withdrawal Service (AWS); Cross-Reinvestment; and Portfolio Rebalancing. In
order to take advantage of one of these programs, the appropriate election form
must be completed and sent to LNY at the Servicing Office. These programs are
described below. Only one of these programs may be in effect at a time. None of
these programs can be in effect if a DCA (see Section 2.03) is in effect.
AUTOMATIC WITHDRAWAL SERVICE
The Automatic Withdrawal Service (AWS) provides for an automatic periodic
withdrawal of Contract Value. This service may be elected at any time prior to
the Annuity Commencement Date. The AWS program may be cancelled or changed by
the Owner at any time by sending a written request to the Service Office.
CROSS-REINVESTMENT
Cross-Reinvestment allows the Owner to automatically transfer amounts in a
designated Variable Subaccount that exceed a baseline amount to another specific
Variable Subaccount at specific intervals. This program may be elected at any
time prior to the Annuity Commencement Date.
The Owner designates the holding account, the receiving account(s) and the
baseline amount. Cross-Reinvestment will continue until we receive written
authorization to terminate the program.
A transfer under the Cross-Reinvestment program is not considered a transfer for
purposes of limiting the number of transfers that may be made in a Contract
Year.
PORTFOLIO REBALANCING
Portfolio Rebalancing is an option that restores to a predetermined level the
percentage of Contract Value allocated to each Variable Subaccount. The
rebalancing may take place monthly, quarterly, semi-annually, or annually. The
Portfolio Rebalancing program is available prior to the Annuity Commencement
Date.
The predetermined level will be the allocation initially selected when the
Contract was purchased, unless subsequently changed. The allocation may be
changed at any time by submitting a written request to LNY at its Servicing
Office. If the Portfolio Rebalancing program is selected, all Purchase Payments
allocated to the Variable Subaccounts must be subject to rebalancing.
Once the Portfolio Rebalancing program is activated, any Variable Subaccount
transfer executed outside of the Portfolio Rebalancing program will terminate
the program. Any subsequent Purchase Payment or withdrawal that modifies the
account balance within each Variable Subaccount may also cause termination of
the Portfolio Rebalancing program. Any such termination will be confirmed to the
Owner. The Owner may terminate the Portfolio Rebalancing program, or re-enroll,
at any time by submitting a written request to LNY at the Servicing Office.
Page 28
ANNUITY
CONTRACT
Individual Flexible Purchase Payment Deferred Variable Annuity Contract
With Annuity Payment Options
Nonparticipating
If you have any questions concerning
this Contract, please
contact your LNY representative or
the Servicing Office of LNY.
LINCOLN LIFE & ANNUITY
COMPANY OF NEW YORK
Home Office:
000 Xxxxxxx Xxxxxx
Xxxxx 0000
Xxxxxxxx, Xxx Xxxx 00000
Servicing Office:
0000 Xxxxx Xxxxxxx Xxxxxx
Xxxx Xxxxx, Xxxxxxx 00000-0000
