EXHIBIT 99.(4)(j)
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
Home Office: Dallas, Texas 75201
Administrative Office: 0000 Xxxxxxxxx Xxxxxx Xxxxx,
Xxxxx 0000, Xxxxxxxxxx, Xxxxxxxx 00000
Telephone: 0-000-000-0000
A Stock Company
Jefferson National Life Insurance Company (the "Company") agrees with the Owner
to provide benefits to the Owner, subject to the provisions set forth in this
Contract and in consideration of Purchase Payments received from the Owner.
RIGHT TO EXAMINE CONTRACT: WITHIN [[FREEDAYS]] DAYS OF THE DATE OF RECEIPT OF
THIS CONTRACT BY THE OWNER, IT MAY BE RETURNED BY DELIVERING OR MAILING IT TO
THE COMPANY AT ITS ADMINISTRATIVE OFFICE OR TO THE AGENT THROUGH WHOM IT WAS
PURCHASED. WHEN THE CONTRACT IS RECEIVED BY THE COMPANY, IT WILL BE VOIDED AS IF
IT HAD NEVER BEEN IN FORCE. THE COMPANY WILL REFUND THE CONTRACT VALUE COMPUTED
AS OF THE BUSINESS DAY THE COMPANY RECEIVES THE RETURNED CONTRACT AT ITS
ADMINISTRATIVE OFFICE.
THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY
READ YOUR CONTRACT CAREFULLY
/s/ /s/
Secretary President
INDIVIDUAL FLEXIBLE PREMIUM
DEFERRED VARIABLE ANNUITY CONTRACT
NON-PARTICIPATING
WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED
ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
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TABLE OF CONTENTS
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CONTRACT SCHEDULE..............................................................4
DEFINITIONS....................................................................6
PURCHASE PAYMENT PROVISIONS....................................................8
PURCHASE PAYMENTS.....................................................8
ALLOCATION OF PURCHASE PAYMENTS.......................................8
SEPARATE ACCOUNT PROVISIONS....................................................8
THE SEPARATE ACCOUNTS.................................................8
VARIABLE ACCOUNT......................................................8
VALUATION OF ASSETS...................................................8
ACCUMULATION UNITS....................................................8
ACCUMULATION UNIT VALUE...............................................8
CONTRACT VALUE.................................................................9
SUBSCRIPTION FEE...............................................................9
DEDUCTION FOR SUBSCRIPTION FEE........................................9
TRANSFERS......................................................................9
TRANSFERS DURING THE ACCUMULATION PERIOD..............................9
TRANSFERS DURING THE ANNUITY PERIOD..................................10
WITHDRAWAL PROVISIONS.........................................................11
WITHDRAWALS..........................................................11
PROCEEDS PAYABLE ON DEATH.....................................................11
DEATH OF OWNER DURING THE ACCUMULATION PERIOD........................11
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD..................11
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD.................11
DEATH OF OWNER DURING THE ANNUITY PERIOD.............................12
DEATH OF ANNUITANT...................................................12
PAYMENT OF DEATH BENEFIT.............................................12
BENEFICIARY..........................................................12
CHANGE OF BENEFICIARY................................................12
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION..................................13
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS............................13
OWNER ...............................................................13
JOINT OWNER..........................................................13
ANNUITANT............................................................13
ASSIGNMENT OF A CONTRACT.............................................13
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TABLE OF CONTENTS
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ANNUITY PROVISIONS............................................................14
GENERAL..............................................................14
ANNUITY DATE.........................................................14
SELECTION OF AN ANNUITY OPTION.......................................14
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS.............................14
ANNUITY OPTIONS......................................................14
OPTION 1. LIFETIME ONLY ANNUITY:............................14
OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS..........14
OPTION 3. PAYMENT FOR A FIXED PERIOD:.......................14
OPTION 4. JOINT AND SURVIVOR ANNUITY........................14
ANNUITY .............................................................15
FIXED ANNUITY........................................................15
VARIABLE ANNUITY.....................................................15
ANNUITY UNIT.........................................................15
MORTALITY TABLES.....................................................15
GENERAL PROVISIONS............................................................16
THE CONTRACT.........................................................16
MISSTATEMENT OF AGE..................................................16
INCONTESTABILITY.....................................................16
MODIFICATION.........................................................16
NON-PARTICIPATING....................................................16
EVIDENCE OF SURVIVAL.................................................16
PROOF OF AGE.........................................................16
PROTECTION OF PROCEEDS...............................................16
REPORTS..............................................................16
TAXES ............................................................16
REGULATORY REQUIREMENTS..............................................16
PAYMENTS TO THIRD PARTIES............................................16
PAYMENTS FROM THIRD PARTIES..........................................16
ANNUITY OPTION TABLES.........................................................17
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CONTRACT SCHEDULE
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OWNER: [[FIRSTNAM]] [[LASTNAME]]
CONTRACT ISSUE DATE: [[COVISS]]
JOINT OWNER: [[JFIRSTNM]] [[JLASTNAM]]
ANNUITY DATE: [[EXPDAT]]
CONTRACT NUMBER: [[POLNUM]]
PURCHASE PAYMENTS:
INITIAL PURCHASE PAYMENT: [[INITPREM]]
MAXIMUM TOTAL PURCHASE PAYMENT: $10,000,000.00 without
prior Company approval
ALLOCATION GUIDELINES:
1. The Owner, Registered Representative or Financial Advisor can select
from all available investment options. The Company reserves the right
to change this in the future.
2. If the Purchase Payments and forms required to issue a Contract are in
good order, the initial Purchase Payment will be credited to the
Contract within two (2) business days after receipt at the
Administrative Office. Additional Purchase Payments will be credited
to the Contract as of the Valuation Period when they are received.
3. Allocation percentages must be in whole numbers. Each allocation must
be at least 1%.
BENEFICIARY:
As designated by the Owner at the Contract Issue Date, unless subsequently
changed.
SUBSCRIPTION FEE:
The Subscription Fee is $20.00 monthly. The Subscription Fee will be
deducted on a pro-rata basis first from the balance of any money market
account(s), and then pro-rata from the balance of any other account(s). The
Subscription Fee is deducted at Annuitization, Death and upon full
surrender of the Contract. During the Annuity Period, no Subscription Fee
will be deducted.
MORTALITY AND EXPENSE RISK CHARGE:
NONE
ADMINISTRATIVE CHARGE:
NONE
DISTRIBUTION EXPENSE CHARGE:
NONE
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CONTRACT SCHEDULE (CONTINUED)
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TRANSFERS:
NUMBER OF TRANSFERS PERMITTED: Subject to the Company's administrative
rules regarding active trading, there are no limits on the number of
transfers that can be made during the Accumulation Period or during the
Annuity Period; however, the Company reserves the right to impose a fee for
excessive transfers after properly notifying the customer.
TRANSFER FEE: There are no Transfer Fee restrictions; however, the Company
reserves the right to impose a fee at a later date for excessive transfers
after properly notifying the customer. The Company reserves the right to
impose any fees charged by the underlying subaccount portfolio.
MINIMUM AMOUNT TO BE TRANSFERRED: There is no minimum amount for transfers;
however, the Company reserves the right to change the minimum amount
required for transfers in the future.
MINIMUM AMOUNT WHICH MUST REMAIN IN EACH ACCOUNT AFTER A TRANSFER: There is
no minimum amount; however, the Company reserves the right to change the
minimum amount required to remain in each account after a transfer.
WITHDRAWALS:
CONTINGENT DEFERRED SALES CHARGE: NONE
WITHDRAWAL CHARGE: NONE
MINIMUM PARTIAL WITHDRAWAL: $500 from each Sub-Account. This requirement is
waived if the partial withdrawal is pursuant to the Systematic Withdrawal
Program.
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN CONTRACT AFTER A PARTIAL
WITHDRAWAL:
There is no minimum amount; however, the Company reserves the right to
change the minimum amount required to remain in the contract after a
partial withdrawal.
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN ANY SUB-ACCOUNT AFTER A PARTIAL
WITHDRAWAL: There is no minimum amount; however, the Company reserves the
right to change the minimum amount required to remain in any Sub-Account
after a partial withdrawal.
SEPARATE ACCOUNTS:
Variable Account:Jefferson National Life Annuity Account G.
RIDERS: [None]
ADMINISTRATIVE OFFICE:
Jefferson National Life Insurance Company
Administrative Office
0000 Xxxxxxxxx Xxxxxx Xxxxx, Xxxxx 0000
Xxxxxxxxxx, XX 00000
(000) 000-0000
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DEFINITIONS
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ACCOUNT(S): One or more of the Sub-Accounts of the Variable Account.
ACCUMULATION PERIOD: The period prior to the Annuity Date during which Purchase
Payments may be made by an Owner.
ACCUMULATION UNIT: A unit of measure used to determine the value of an Owner's
interest in a Sub-Account of the Variable Account during the Accumulation
Period.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax and
Subscription Fee. This amount is applied to the applicable Annuity Tables to
determine Annuity Payments.
AGE: The age of any Owner or Annuitant on his/her last birthday. For Joint
Owners, all provisions which are based on age are based on the Age of the older
of the Joint Owners.
ADMINISTRATIVE OFFICE: The office indicated on the Contract Schedule of this
Contract to which notices, requests and Purchase Payments must be sent. All sums
payable to the Company under this Contract are payable at the Administrative
Office or an address designated by the Company.
ANNUITANT: The natural person on whose life Annuity Payments are based. On or
after the Annuity Date, the Annuitant shall also include any Joint Annuitant. In
the event of Joint Annuitant's, both Xxxxxxxxx's lives are used to determine
Annuity Payments.
ANNUITY DATE: The date on which Annuity Payments begin. The Annuity Date is
shown on the Contract Schedule.
ANNUITY OPTIONS: Options available for Annuity Payments.
ANNUITY PAYMENTS: The series of payments made to the Owner or any named payee
after the Annuity Date under the Annuity Option selected.
ANNUITY PERIOD: The period of time beginning with the Annuity Date during which
Annuity Payments are made.
ANNUITY UNIT: An accounting unit of measure used to calculate the amount of
Annuity Payments.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Administrative Office.
BENEFICIARY: The person(s) or entity(ies) who will receive the death benefit
payable under this Contract.
COMPANY: Jefferson National Life Insurance Company.
CONTRACT ANNIVERSARY: An Anniversary of the Contract Issue Date.
CONTRACT ISSUE DATE: The later of the date on the cover of the Contract or the
date Purchase Payments are received. The
Contract Issue Date is shown on the Contract Schedule.
CONTRACT VALUE: The dollar value as of any Valuation Period of all amounts in
the Contract.
CONTRACT WITHDRAWAL VALUE: The Contract Value less any applicable Premium Tax,
less any applicable Subscription Fee.
CONTRACT YEAR: The first Contract Year is the annual period which begins on the
Contract Issue Date. Subsequent Contract Years begin on each anniversary of the
Contract Issue Date.
ELIGIBLE FUND: An investment entity that is made available for this Contract.
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DEFINITIONS (CONTINUED)
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FINANCIAL ADVISOR: An investment adviser selected by a Contract Owner to provide
a Contract Owner's asset allocation and investment advisory services.
FIXED ANNUITY: A series of payments made during the Annuity Period which are
guaranteed as to dollar amount by the Company.
NET PURCHASE PAYMENT: A Purchase Payment less any applicable Premium Tax.
OWNER: The person(s) who own(s) the Contract.
PORTFOLIO: A segment of an eligible fund which constitutes a separate and
distinct class of shares.
PREMIUM TAX: Any premium taxes incurred to any governmental entity and assessed
against Purchase Payments or Contract Value.
PURCHASE PAYMENT: A payment made by or for an Owner with respect to this
Contract.
REGISTERED REPRESENTATIVE: A person who is licensed by the National Association
of Securities Dealers, Inc. ("NASD") to sell variable products and is sponsored
by an NASD member broker/dealer that is party to a selling group agreement with
the Company.
SUB-ACCOUNT: Separate Account assets are divided into Sub-Accounts. Each
Sub-Account will invest its assets in shares of a single Eligible Fund or a
single Portfolio of an Eligible Fund.
VALUATION DATE: Each day on which the New York Stock Exchange ("NYSE") or
applicable bond market is open for business.
VALUATION PERIOD: The period of time beginning at the close of business of the
NYSE (or applicable bond market) on each Valuation Date and ending at the close
of business for the next succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account designated on the Contract Schedule which
provides investment options where the benefits are variable and are not
guaranteed as to dollar amount.
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PURCHASE PAYMENT PROVISIONS
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PURCHASE PAYMENTS: The initial Purchase Payment for an Owner is due on the
Contract Issue Date. Subject to the maximum and minimum amounts shown on the
Contract Schedule, the Owner may make subsequent Purchase Payments and may
increase or decrease or change the frequency of such payments. The Company
reserves the right to reject any Application or Purchase Payment.
ALLOCATION OF PURCHASE PAYMENTS: Net Purchase Payments are allocated to one or
more of the Sub-Accounts of the Variable Account in accordance with the
selections made by the Owner, Registered Representative or Financial Advisor.
The allocation of the initial Net Purchase Payment for an Owner is made in
accordance with the selection made by the Owner, Registered Representative or
Financial Advisor at the Contract Issue Date. Unless otherwise changed by the
Owner, Registered Representative or Financial Advisor, subsequent Net Purchase
Payments are allocated in the same manner as the initial Net Purchase Payment.
Allocation of the Net Purchase Payments is subject to the Allocation Guidelines
shown on the Contract Schedule. The Company reserves the right to allocate
initial Net Purchase Payments to the Money Market Sub-Account until the
expiration of the Right to Examine period.
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SEPARATE ACCOUNT PROVISIONS
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THE SEPARATE ACCOUNTS: The Separate Account is designated on the Contract
Schedule and consists of assets set aside by the Company, which are kept
separate from that of the general assets and all other separate account assets
of the Company.
VARIABLE ACCOUNT: The assets of the Variable Account equal to reserves and other
liabilities will not be charged with liabilities arising out of any other
business the Company may conduct.
The Variable Account assets are divided into Sub-Accounts. The assets of the
Sub-Accounts are allocated to the Eligible Fund(s) and the Portfolio(s), if any,
within an Eligible Fund. The Company may, from time to time, add additional
Eligible Fund(s) or Portfolio(s). The Owner, Registered Representative or
Financial Advisor may be permitted to transfer Contract Values or allocate Net
Purchase Payments to the additional Sub-Account(s) within the Variable Account.
However, the right to make such transfers or allocations will be limited by the
terms and conditions imposed by the Company.
Should the shares of any such Eligible Fund(s) or any Portfolio(s) within an
Eligible Fund become unavailable for investment by the Variable Account, or the
Company's Board of Directors deems further investment in these shares
inappropriate, the Company may limit further purchase of such shares or
substitute shares of another Eligible Fund or Portfolio for shares already
purchased under a Contract.
VALUATION OF ASSETS: The assets of the Accounts are valued at their fair market
value in accordance with procedures of the Company.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Sub-Accounts of the Variable Account as a
result of Net Purchase Payments, withdrawals, transfers, or fees and charges.
The Company will determine the number of Accumulation Units of a Sub-Account
purchased or canceled. This will be done by dividing the amount allocated to (or
the amount withdrawn from) the Sub-Account by the dollar value of one
Accumulation Unit of the Sub-Account as of the end of the Valuation Period
during which the request for the transaction is received at the Administrative
Office.
ACCUMULATION UNIT VALUE: The Accumulation Unit Value for each Sub-Account was
arbitrarily set initially at $10. Subsequent Accumulation Unit Values for each
Sub-Account are determined by multiplying the Accumulation Unit Value for the
immediately preceding Valuation Period by the Net Investment Factor for the
Sub-Account for the current period.
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SEPARATE ACCOUNT PROVISIONS (CONTINUED)
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The Net Investment Factor for each Sub-Account is determined by dividing A by B
where:
A is (i) the net asset value per share of the Eligible
Fund or Portfolio of an Eligible Fund held by the
Sub-Account at the end of the current Valuation Period;
plus
(ii) any dividend or capital gains per share declared on
behalf of such Eligible Fund or Portfolio that has an
ex-dividend date within the current Valuation Period;
plus
(iii) a charge factor, if any, for any taxes or any tax
reserve established by the Company as a result of the
operation or maintenance of the Sub-Account.
B is the net asset value per share of the Eligible Fund or
Portfolio held by the Sub-Account for the immediately
preceding Valuation Period.
The Accumulation Unit Value may increase or decrease from Valuation Period to
Valuation Period.
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CONTRACT VALUE
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The Contract Value for any Valuation Period is the sum of the Contract Value in
each of the Sub-Accounts of the Variable Account.
The Contract Value in a Sub-Account of the Variable Account is determined by
multiplying the number of Accumulation Units allocated to the Owner's Account
for the Sub-Account by the Accumulation Unit Value.
Withdrawals will result in the cancellation of Accumulation Units in a
Sub-Account.
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SUBSCRIPTION FEE
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DEDUCTION FOR SUBSCRIPTION FEE: During the Accumulation Period, each month the
Company deducts a Subscription Fee from the Contract Value for reimbursement of
expenses relating to maintenance and administration of the Contract. The
Subscription Fee amount is shown on the Contract Schedule Page. The Subscription
Fee will be deducted on a pro-rata basis first from the balance of any money
market account(s), and then pro-rata from the balance of any other account(s).
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TRANSFERS
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TRANSFERS DURING THE ACCUMULATION PERIOD: Subject to any limitation imposed by
the Company on the number of transfers during the Accumulation Period shown on
the Contract Schedule, an Owner, Registered Representative or Financial Advisor
may transfer all or part of the Contract Value in a Sub-Account without the
imposition of any Transfer Fee if there have been no more than the number of
free transfers shown on the Contract Schedule for the Contract Year.
All transfers are subject to the following:
1. The minimum amount which can be transferred from a Sub-Account is
shown on the Contract Schedule.
2. The Company reserves the right, at any time and without prior notice
to any party, to terminate, suspend or modify the transfer privilege
described above or to block one or more trades pursuant to company
administrative rules.
If an Owner, Registered Representative or Financial Advisor, or other authorized
person elects to use this transfer privilege, the Company will not be liable for
transfers made in accordance with instructions received from such person. All
amounts and Annuity Units will be determined as of the end of the Valuation
Period during which the request for transfer is received at the Administrative
Office.
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TRANSFERS (CONTINUED)
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The Contract is not designed for professional market timing organizations. The
Company reserves the right to modify (including terminating) the transfer
privileges described above.
TRANSFERS DURING THE ANNUITY PERIOD: Subject to any limitations imposed by the
Company on the number of transfers during the Annuity Period shown on the
Contract Schedule, the Owner, Registered Representative or Financial Advisor may
transfer Annuity Units in accordance with the following:
1. Transfers may be made upon an Authorized Request to the Company at
least thirty (30) days before the due date of the first Annuity
Payment for which the change will apply. Transfers will be made by
converting the number of Annuity Units being transferred to the number
of Annuity Units of the Sub-Account to which the transfer is made, so
that the next Annuity Payment, if it were made at that time would be
the same amount that it would have been without the transfer.
Thereafter, Annuity Payments will reflect changes in the value of the
new Annuity Units.
2. The minimum amount which can be transferred from a Sub-Account is
shown on the Contract Schedule.
3. The Company reserves the right, at any time and without prior notice
to any party, to terminate, suspend or modify the transfer privilege
described above or to block one or more trades pursuant to company
administrative rules.
If an Owner, Registered Representative or Financial Advisor, or other authorized
person elects to use this transfer privilege, the Company will not be liable for
transfers made in accordance with instructions received from such person. All
amounts and Annuity Units will be determined as of the end of the Valuation
Period during which the request for transfer is received at the Administrative
Office.
The Contract is not designed for professional market timing organizations. The
Company reserves the right to modify (including terminating) the transfer
privileges described above.
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WITHDRAWAL PROVISIONS
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WITHDRAWALS: During the Accumulation Period, the Owner may, upon an Authorized
Request, make a total or partial withdrawal of the Contract Withdrawal Value.
The Owner must specify by an Authorized Request which Sub-Account is the source
of the partial withdrawal.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of an Authorized Request unless the Suspension
or Deferral of Payments Provision is in effect.
Each partial withdrawal must be for an amount which is not less than the amount
shown on the Contract Schedule. The minimum Contract Value which must remain in
the Contract after a partial withdrawal is shown on the Contract Schedule.
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PROCEEDS PAYABLE ON DEATH
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DEATH OF OWNER DURING THE ACCUMULATION PERIOD: Upon the death of the Owner, or
any Joint Owner, during the Accumulation Period, the death benefit will be paid
to the Beneficiary(ies) designated by the Owner. If there are multiple
Beneficiaries, the first Beneficiary will be paid his share of any proceeds once
his Authorized Request is received. The remaining proceeds to be paid to other
Beneficiaries will be placed into a money market account until the Company
receives Authorized Requests from each remaining Beneficiary.
Upon the death of any Joint Owner, the surviving Joint Owner, if any, will be
treated as the Primary Beneficiary. Any other Beneficiary designation on record
at the time of death will be treated as a contingent Beneficiary.
A Beneficiary may request that the death benefit be paid under one of the Death
Benefit Options below. If the Beneficiary is the spouse of the Owner, he or she
may elect to continue the Contract at the then current Contract Value in his or
her own name and exercise all the Owner's rights under the Contract.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: The death benefit will be
the Contract Value determined as of the end of the Valuation Period during which
the Company receives both due proof of death and an election for the payment
method, reduced by the applicable portion of the Subscription Fee.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: A non-spousal Beneficiary
must elect the death benefit to be paid under one of the following options in
the event of the death of the Owner or any Joint Owner during the Accumulation
Period:
OPTION 1 - lump sum payment of the death benefit; or
OPTION 2 - the payment of the entire death benefit within 5 years of
the date of the death of the Owner or any Joint Owner; or
OPTION 3 - payment of the death benefit under an Annuity Option over
the lifetime of the Beneficiary or over a period not extending
beyond the life expectancy of the Beneficiary with
distribution beginning within one year of the date of death of
the Owner or any Joint Owner.
Any portion of the death benefit not applied under Option 3 within one year of
the date of the Owner's death, must be distributed within five years of the date
of death.
A spousal Beneficiary may elect to continue the Contract in his or her own name
at the then current Contract Value, elect a lump sum payment of the death
benefit or apply the death benefit to an Annuity Option.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and an Authorized Request, unless the
Suspension or Deferral of Payments Provision is in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period beginning with the date of receipt of proof of death.
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PROCEEDS PAYABLE ON DEATH (CONTINUED)
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DEATH OF OWNER DURING THE ANNUITY PERIOD: If the Owner, or any Joint Owner, who
is not the Annuitant, dies during the Annuity Period, any remaining payments
under the Annuity Option elected will continue at least as rapidly as under the
method of distribution in effect at such Owner's or Joint Owner's death. Upon
the death of any Owner during the Annuity Period, the Beneficiary becomes the
Owner. Upon the death of any Joint Owner during the Annuity Period, the
surviving Joint Owner, if any, will be treated as the Primary Beneficiary. Any
other Beneficiary designation on record at the time of death will be treated as
a Contingent Beneficiary.
DEATH OF ANNUITANT: Upon the death of an Xxxxxxxxx, who is not the Owner, during
the Accumulation Period, the Owner will automatically become the Annuitant. The
Owner may designate a new Annuitant, subject to the Company's underwriting rules
then in effect. If the Owner is a non-natural person, the death of an Annuitant
will be treated as the death of the Owner and proceeds will be paid to the
Beneficiary of record.
Upon the death of the Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death and an
Authorized Request before any death benefit is paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the
finding of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments, and in accordance with Company administrative
procedures.
BENEFICIARY: The Beneficiary designation in effect on the Contract Issue Date
will remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the death of the Owner. Unless the Owner provides
otherwise, the death benefit will be paid in equal shares to the survivor(s) as
follows:
1. to the Primary Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if there are none
2. to the Contingent Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if there are none
3. to the estate of the Owner.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), the Owner may change the Primary Beneficiary(ies) or
Contingent Beneficiary(ies). A change may be made by an Authorized Request. The
change will take effect as of the date the Authorized Request is received. The
Company will not be liable for any payment made or action taken before it
records the change.
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SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
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The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange (or applicable bond market) is closed
(other than customary weekend and holiday closings);
2. trading on the New York Stock Exchange (or applicable bond market) 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 Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
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OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
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OWNER: The Owner has all interest and right to amounts held in his or her
Contract. The Owner is the person designated as such on the Contract Issue Date,
unless changed.
The Owner may change owners of the Contract at any time by Authorized Request. A
change of Owner will automatically revoke any prior designation of Owner. The
change will become effective as of the date the Authorized Request is received.
The Company will not be liable for any payment made or action taken before it
records the change.
JOINT OWNER: A Contract may be owned by Joint Owners. If Joint Owners are named,
any Joint Owner must be the spouse of the other Owner. Upon the death of either
Owner, the surviving spouse will be the Primary Beneficiary. Any other
Beneficiary designation will be treated as a Contingent Beneficiary unless
otherwise indicated in an Authorized Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by the Owner at the Contract Issue Date,
unless changed prior to the Annuity Date. The Owner may not change the Annuitant
except in the event that the Annuitant dies prior to the Annuity Date. The
Annuitant may not be changed in a Contract which is owned by a non-natural
person. Any change of Annuitant is subject to the Company's underwriting rules
then in effect.
ASSIGNMENT OF A CONTRACT: An Authorized Request specifying the terms of an
assignment of a Contract must be provided to the Administrative Office. The
Company will not be liable for any payment made or action taken before it
records the assignment.
The Company will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with Company consent.
If the Contract is assigned, the Owner's rights may only be exercised with the
consent of the assignee of record.
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ANNUITY PROVISIONS
--------------------------------------------------------------------------------
GENERAL: On the Annuity Date, the Adjusted Contract Value will be applied under
the Annuity Option selected by the Owner. The Owner may elect to have the
Adjusted Contract Value applied to provide a Fixed Annuity, a Variable Annuity
or a combination Fixed and Variable Annuity. If a combination is elected, the
Owner must specify what part of the Contract Value is to be applied to the Fixed
and Variable Options.
ANNUITY DATE: The Annuity Date must be at least two (2) years after the Contract
Issue Date. The Annuity Date may not be later than the maximum date permitted
under state law. Prior to the Annuity Date, the Owner subject to the above, may
change the Annuity Date by an Authorized Request. Any change must be requested
at least thirty (30) days prior to the new Annuity Date.
SELECTION OF AN ANNUITY OPTION: An Annuity Option may be selected by an
Authorized Request of the Owner. If no Annuity Option is selected, Option 2 with
120 monthly payments guaranteed will automatically be applied. Prior to the
Annuity Date, the Owner can change the Annuity Option selected by an Authorized
Request. Any change must be requested at least thirty (30) days prior to the
Annuity Date.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS: Annuity Payments are paid in monthly
installments. The Adjusted Contract Value is applied to the Annuity Table for
the Annuity Option selected. If the Adjusted Contract Value to be applied under
an Annuity Option is less than $5,000, the Company reserves the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment would be or
become less than $50, the Company reserves the right to reduce the frequency of
payments to an interval which will result in each payment being at least $50.
ANNUITY OPTIONS: The following Annuity Options or any other annuity option
acceptable to the Company may be selected:
OPTION 1. LIFETIME ONLY ANNUITY: The Company will make monthly payments
during the life of the Annuitant. If this option is elected, it is
understood and agreed that payments shall cease immediately upon the death
of the Annuitant and the annuity will terminate without further value.
OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS: The Company will make
monthly payments for the guaranteed period selected and thereafter for the
life of the Annuitant. If this option is elected, it is understood and
agreed that upon the death of the Annuitant, any amounts remaining under
the guaranteed period selected will be distributed to the Beneficiary at
least as rapidly as under the method of distribution being used as of the
date of the Annuitant's death. The guaranteed period may be five (5) years,
ten (10) years or twenty (20) years.
OPTION 3. PAYMENT FOR A FIXED PERIOD: The Company will make monthly
payments for a fixed period of 3 to 20 years.
OPTION 4. JOINT AND SURVIVOR ANNUITY: The Company will make monthly
payments during the joint life time of the Annuitant and a Joint Annuitant.
Payments will continue during the lifetime of the surviving Annuitant and
will be computed on the basis of 100%, 50% or 66 2/3% of the Annuity
Payment (or limits) in effect during the joint life time.
14
ANNUITY: If the Owner selects a Fixed Annuity, the Adjusted Contract Value is
allocated to the General Account and the Annuity is paid as a Fixed Annuity. If
the Owner selects a Variable Annuity, the Adjusted Contract Value will be
allocated to the Sub-Accounts of the Variable Account in accordance with the
selection made by the Owner, and the Annuity will be paid as a Variable Annuity.
If no selection is made, the Adjusted Contract Value will be applied in the same
proportions to the same Sub-Accounts as the allocations are at the time of
election. Unless the Owner specifies otherwise, the payee of the Annuity
Payments shall be the Owner. The Adjusted Contract Value will be applied to the
applicable Annuity Table contained in the Contract based upon the Annuity Option
selected by the Owner. The amount of the first payment for each $1,000 of
Adjusted Contract Value is shown in the Annuity Tables.
FIXED ANNUITY: The Owner may elect to have the Adjusted Contract Value applied
to provide a Fixed Annuity.
The dollar amount of each Fixed Annuity Payment shall be determined in
accordance with Annuity Tables contained in this Contract which are based on the
minimum guaranteed interest rate of 3% per year.
VARIABLE ANNUITY: The Owner may elect to have the Adjusted Contract Value
applied to provide a Variable Annuity. Variable Annuity Payments reflect the
investment performance of the Variable Account in accordance with the allocation
of the Adjusted Contract Value to the Sub-Accounts during the Annuity Period.
Variable Annuity Payments are not guaranteed as to dollar amount.
The dollar amount of the first Variable Annuity Payment is determined in
accordance with the description above. The dollar amount of the Variable Annuity
Payments for each applicable Sub-Account after the first Variable Annuity
Payment is determined as follows:
1. The dollar amount of the first Variable Annuity Payment is divided by
the value of an Annuity Unit for each applicable Sub-Account as of the
Annuity Date. This sets the number of Annuity Units for each monthly
payment for the applicable Sub-Account.
2. The fixed number of Annuity Units per payment in each Sub-Account is
multiplied by the Annuity Unit Value for that Sub-Account for the last
Valuation Period of the month preceding the month for which the
payment is due. This result is the dollar amount of the payment for
each applicable Sub-Account.
The total dollar amount of each Variable Annuity Payment is the sum of all
Sub-Account Variable Annuity Payments.
ANNUITY UNIT: The value of any Annuity Unit for each Sub-Account of the Variable
Account was arbitrarily set initially at $10.
The Sub-Account Annuity Unit Value at the end of any subsequent Valuation Period
is determined as follows:
1. The Net Investment Factor for the current Valuation Period is
multiplied by the value of the Annuity Unit for the Sub-Account for
the immediately preceding Valuation Period.
2. The result in (1) is then divided by the Assumed Investment Rate
Factor which equals 1.00 plus the Assumed Investment Rate for the
number of days since the preceding Valuation Date. The Owner can
choose either a 5% or a 3% Assumed Investment Rate.
MORTALITY TABLES: 80% of the Annuity 2000 Mortality Table with Male-Female sex
distinction and a 3% interest rate is used in establishing the annuity table.
The dollar amount of an Annuity Payment for any Age or combination of ages not
shown in the tables, or for any other form of Annuity Option agreed to by the
Company, will be provided by the Company upon Formal Request.
15
--------------------------------------------------------------------------------
GENERAL PROVISIONS
--------------------------------------------------------------------------------
THE CONTRACT: The entire Contract consists of this Contract, the Application, if
any, and any riders or endorsements attached to this Contract.
This Contract may be changed or altered only by the President or Vice President
and the Secretary of the Company. A change or alteration must be made in
writing.
The Company reserves the right to deduct from Your Contract Value amounts paid
to You in excess of amounts owed to You as a result of Company's administrative
error.
MISSTATEMENT OF AGE: If the Age of any Annuitant has been misstated, any Annuity
benefits payable will be the Annuity benefits provided by the correct Age. After
Annuity Payments have begun, any underpayments will be made up in one sum with
the next Annuity Payment. Any overpayments will be deducted from future Annuity
Payments until the total is repaid.
INCONTESTABILITY: This Contract will not be contestable from the date of issue.
MODIFICATION: This Contract may be modified in order to maintain compliance with
applicable state and federal law.
NON-PARTICIPATING: This Contract will not share in any distribution of
dividends.
EVIDENCE OF SURVIVAL: The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments are based.
PROOF OF AGE: The Company may require evidence of Age of any Annuitant and any
Owner.
PROTECTION OF PROCEEDS: To the extent permitted by law, death benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
other than the person entitled to them under any Contract. No payment and no
amount under this Contract can be taken or assigned in advance of its payment
date unless the Company receives the Owner's consent.
REPORTS: At least once each calendar year, the Company will furnish each Owner
with a report showing the Contract Value and any other information as may be
required by law. The Company will also furnish an annual report of the Variable
Account.
TAXES: Any taxes paid to any governmental entity relating to any Contract will
be deducted from the Purchase Payment or Contract Value when incurred. The
Company will, in its sole discretion, determine when taxes have resulted from:
the investment experience of the Variable Account; receipt by the Company of the
Purchase Payments; or commencement of Annuity Payments. The Company may, in its
sole discretion, pay taxes when due and deduct that amount from the Contract
Value at a later date. Payment at an earlier date does not waive any right the
Company may have to deduct amounts at a later date. The Company reserves the
right to establish a provision for federal income taxes if it determines, in its
sole discretion, that it will incur a tax as a result of the operation of the
Variable Account. The Company will deduct for any income taxes incurred by it as
a result of the operation of the Variable Account whether or not there was a
provision for taxes and whether or not it was sufficient. The Company will
deduct any withholding taxes required by applicable law.
REGULATORY REQUIREMENTS: All values payable under any Contract will not be less
than the minimum benefits required by the laws and regulations of the states in
which the Contract is delivered.
PAYMENTS TO THIRD PARTIES: The Company may sponsor conferences or otherwise
remunerate broker/dealers, registered representatives or other third parties for
marketing or other services.
PAYMENTS FROM THIRD PARTIES: The Company may enter into certain agreements under
which it is reimbursed by a Portfolio's advisors, distributors and/or affiliates
for the administrative or distribution services the Company provides to the
Portfolio.
16
The following Tables show the monthly income payable for each $1,000 applied
under Option 1, 2, 3, or 4. Values shown are based on 3% interest for all
options.
=================================================================================================================
OPTION 3 TABLE OPTION 1 AND 2 TABLES
-----------------------------------------------------------------------------------------------------------------
MALE
---------------------------------------------------------------------
Monthly Installments for Life
with Guaranteed Period
---------------------------------------------------------------------
(2)
(1) ------------------------------------------- Age of
Payee
No of 5 Years 10 Years 20 Years When First
Years Monthly Lifetime Certain Certain Certain Installment
Payable Installments Only and Life and Life and Life is Payable
-----------------------------------------------------------------------------------------------------------------
3 $28.99
4 22.06
5 17.90 $3.92 $3.91 $3.90 $3.82 50
-----------------------------------------------------------------------------------------------------------------
6 15.13 3.98 3.98 3.96 3.87 51
7 13.16 4.05 4.04 4.02 3.92 52
8 11.68 4.11 4.11 4.08 3.98 53
9 10.53 4.19 4.18 4.15 4.03 54
10 9.61 4.26 4.25 4.22 4.09 55
-----------------------------------------------------------------------------------------------------------------
11 8.86 4.34 4.33 4.30 4.15 56
12 8.24 4.43 4.41 4.38 4.21 57
13 7.71 4.52 4.50 4.46 4.27 58
14 7.25 4.61 4.60 4.55 4.33 59
15 6.86 4.71 4.70 4.64 4.40 60
-----------------------------------------------------------------------------------------------------------------
16 6.52 4.82 4.80 4.74 4.46 61
17 6.22 4.93 4.91 4.84 4.53 62
18 5.96 5.06 5.03 4.95 4.59 63
19 5.72 5.19 5.16 5.06 4.66 64
20 5.51 5.33 5.29 5.18 4.72 65
=================================================================================================================
17
=================================================================================================================
OPTION 3 TABLE OPTION 1 AND 2 TABLES
-----------------------------------------------------------------------------------------------------------------
FEMALE
---------------------------------------------------------------------
Monthly Installments for Life
with Guaranteed Period
---------------------------------------------------------------------
(2)
(1) ------------------------------------------- Age of
Payee
No of 5 Years 10 Years 20 Years When First
Years Monthly Lifetime Certain Certain Certain Installment
Payable Installments Only and Life and Life and Life is Payable
-----------------------------------------------------------------------------------------------------------------
3 $28.99
4 22.06
5 17.90 $3.71 $3.71 $3.70 $3.66 50
------------------------------------------------------------------------------------------------------------------
6 15.13 3.76 3.76 3.75 3.70 51
7 13.16 3.82 3.81 3.80 3.75 52
8 11.68 3.88 3.87 3.86 3.80 53
9 10.53 3.94 3.93 3.92 3.85 54
10 9.61 4.00 4.00 3.98 3.91 55
------------------------------------------------------------------------------------------------------------------
11 8.86 4.07 4.07 4.05 3.97 56
12 8.23 4.14 4.14 4.12 4.02 57
13 7.71 4.22 4.21 4.19 4.08 58
14 7.25 4.30 4.29 4.27 4.15 59
15 6.86 4.39 4.38 4.35 4.21 60
------------------------------------------------------------------------------------------------------------------
16 6.52 4.48 4.47 4.44 4.28 61
17 6.22 4.58 4.57 4.53 4.35 62
18 5.96 4.68 4.67 4.62 4.42 63
19 5.72 4.79 4.78 4.73 4.49 64
20 5.51 4.91 4.89 4.83 4.56 65
==================================================================================================================
18
================================================================================
OPTION 4
JOINT AND 100% SURVIVOR ANNUITY
MALE AGE
--------------------------------------------------------------------------------
Female Age 55 60 65 70 75
--------------------------------------------------------------------------------
55 3.65 3.75 3.83 3.89 3.93
60 3.79 3.94 4.07 4.17 4.25
65 3.92 4.13 4.33 4.50 4.64
70 4.03 4.29 4.58 4.85 5.09
75 4.11 4.43 4.80 5.20 5.58
================================================================================
================================================================================
OPTION 4
JOINT AND 66 2/3% SURVIVOR ANNUITY
MALE AGE
--------------------------------------------------------------------------------
Female Age 55 60 65 70 75
--------------------------------------------------------------------------------
55 3.96 4.12 4.29 4.48 4.68
60 4.13 4.32 4.54 4.76 5.00
65 4.33 4.56 4.82 5.10 5.39
70 4.54 4.82 5.14 5.49 5.87
75 4.78 5.10 5.49 5.94 6.43
================================================================================
================================================================================
OPTION 4
MALE JOINT AND 50% SURVIVOR ANNUITY
MALE AGE
--------------------------------------------------------------------------------
Female Age 55 60 65 70 75
--------------------------------------------------------------------------------
55 4.13 4.33 4.57 4.85 5.17
60 4.32 4.54 4.81 5.13 5.48
65 4.56 4.81 5.11 5.46 5.87
70 4.85 5.13 5.47 5.88 6.35
75 5.20 5.52 5.92 6.40 6.97
================================================================================
19
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
ADMINISTRATIVE OFFICE: 0000 XXXXXXXXX XXXXXX XX., XXXXX 0000
XXXXXXXXXX, XXXXXXXX 00000
TELEPHONE: 0-000-000-0000
INDIVIDUAL FLEXIBLE PREMIUM
DEFERRED VARIABLE ANNUITY CONTRACT
NON-PARTICIPATING
