DRAFT
EX-4a
DRAFT
DRAFT 2 11/09/09
|
[0000
Xxxxxxxxxxx Xxxxxx
Purchase,
New York 10577
xxx.xxxxxxx.xxx]
Thank you
for choosing Xxxxxxx National Life Insurance Company of New York, hereinafter
also referred to as "the Company." If You have any questions, please contact the
Company at the Service Center address and telephone number shown on the Contract
Data Page.
THIS
ANNUITY CONTRACT IS ISSUED BY THE COMPANY AND IS A LEGAL AGREEMENT BETWEEN THE
OWNER ("YOU") AND XXXXXXX NATIONAL LIFE INSURANCE COMPANY OF NEW
YORK.
READ
YOUR CONTRACT CAREFULLY.
THE
VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION AND
ANNUITY PERIODS IS NOT GUARANTEED AND MAY INCREASE OR DECREASE BASED UPON THE
INVESTMENT EXPERIENCE OF THE FUND UNDERLYING THE SEPARATE ACCOUNT.
IF
THE ACTUAL INVESTMENT RATES EXPERIENCED BY THE SEPARATE ACCOUNT ASSETS ARE LESS
THAN 4.30%, VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME.
AMOUNTS
ALLOCATED TO THE FIXED ACCOUNT(S) WILL EARN INTEREST AT THE CURRENT INTEREST
RATE FOR THE DURATION OF THE FIXED ACCOUNT OPTION PERIOD. THE INTEREST RATE
CREDITED FOR SUBSEQUENT PERIODS IS SUBJECT TO CHANGE AS DECLARED BY THE
COMPANY.
FEES
AND EXPENSES GENERALLY ARE HIGHER AND THE WITHDRAWAL CHARGE PERIOD GENERALLY IS
LONGER THAN FOR VARIABLE ANNUITY CONTRACTS THAT DO NOT HAVE A CONTRACT
ENHANCEMENT FEATURE.
NOTICE
OF RIGHT TO EXAMINE
YOU MAY
RETURN THIS CONTRACT TO THE SELLING PRODUCER OR XXXXXXX NATIONAL LIFE INSURANCE
COMPANY OF NEW YORK WITHIN 20 DAYS AFTER YOU RECEIVE IT. UPON RECEIPT OF THIS
CONTRACT, THE COMPANY WILL REFUND THE FULL PREMIUM ALLOCATED TO THE FIXED
ACCOUNTS LESS ANY WITHDRAWALS FROM THE FIXED ACCOUNT, PLUS THE SEPARATE ACCOUNT
CONTRACT VALUE, LESS ANY CONTRACT ENHANCEMENT. UPON SUCH REFUND, THIS CONTRACT
SHALL BE VOID. THE EFFECTIVE DATE OF THE SURRENDER, AND THE DATE THE FUNDS IN
THE SEPARATE ACCOUNT WILL BE VALUED, WILL BE THE DATE THE CONTRACT WAS MAILED TO
THE COMPANY, OR RETURNED TO YOUR SELLING PRODUCER.
ONE
OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE
DATE. PLEASE CHECK THE CONTRACT DATA PAGE TO DETERMINE WHICH DCA+ FIXED ACCOUNT
OPTIONS ARE CURRENTLY AVAILABLE.
INDIVIDUAL
DEFERRED VARIABLE AND FIXED ANNUITY CONTRACT (FLEXIBLE PREMIUM).
DEATH
BENEFIT AVAILABLE.
INCOME
OPTIONS AVAILABLE.
NONPARTICIPATING.
This
Contract is signed by the Company
President
and Chief Executive Officer
Secretary
VA340NY
TABLE
OF CONTENTS
Provision Page
Number
CONTRACT
DATA PAGE 3a
DEFINITIONS 4
GENERAL
PROVISIONS 7
ACCUMULATION
PROVISIONS 11
WITHDRAWAL
PROVISIONS 13
DEATH
BENEFIT PROVISIONS 17
INCOME
PROVISIONS 20
TERMINATION
PROVISION 23
TABLE OF
INCOME OPTIONS 24
VA340NY 2
CONTRACT
DATA PAGE
Contract
Number:
|
1234567890
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Owner:
|
Xxxx
Xxx
|
Owner
Issue Age:
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35
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Joint
Owner:
|
Xxxx
Xxx
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Joint
Owner Issue Age:
|
35
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Annuitant:
|
Xxxx
Xxx
|
Annuitant
Issue Age:
|
35
|
Joint
or Contingent Annuitant:
|
Xxxx
Xxx
|
Joint
or Contingent Annuitant Issue Age:
|
30
|
Initial
Premium:
|
$50,000.00
|
Issue
Date:
|
11/01/2009
|
Issue
State:
|
New
York
|
Income
Date:
|
11/01/2039
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Fixed
Account Minimum Interest Rate:
|
[2.00%]
|
Initial
Current Interest Rate:
|
[3.00%]
for the 1-Year Fixed Option Period
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Initial
Current DCA+ Interest Rate:
|
6-month
[X.XX%] [NOT
AVAILABLE]
12-month
[X.XX%] [NOT
AVAILABLE]
ONE
OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE
ISSUE DATE. AVAILABILITY IS INDICATED ABOVE.
|
Contract
Enhancement Percentage:
|
6%
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Beneficiary(ies):
|
Xxxxx
Xxx
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VA340NY 3a
CONTRACT DATA PAGE (CONT'D)
Mortality and
Expense On
an annual basis, this charge equals [1.65%] of the daily
Charge: net
asset value of the Investment Divisions.
Administration
Charge:
|
On
an annual basis, this charge equals 0.15% of the daily net asset value of
the Investment Divisions.
|
|
Total
Asset Based Charges:On an annual basis, the total of all asset based
charges is equal to [1.80%] of the daily net asset value of the Investment
Divisions.
|
|
Asset
based charges are deducted daily as part of the Accumulation Unit Value
calculation. Total asset based charges include the Mortality and Expense
Charge, the Administration Charge and asset based charges for optional
benefits.
|
Optional
Benefits Elected at Issue:
BENEFIT
|
CHARGE
|
VA340NY 3b
CONTRACT DATA PAGE (CONT'D)
Annual
Contract An
annual charge of no more than [$30.00] will be deducted Maintenance Charge: by the Company
from those Contracts where the Contract
Value
is less than $50,000 at the time such charge is
assessed.
Withdrawal
Charge Completed
Years
Since Withdrawal
Charge
Schedule: Receipt
of
Premium Percentage
0 4.00%
1 3.50%
2 3.50%
3 3.00%
4 2.50%
5 2.00%
6 2.00%
7 2.00%
8 1.50%
9+ 0.00%
Recapture
Charge Completed
Years
Since Recapture
Charge
Schedule: Receipt
of
Premium Percentage
0 6.00%
1 5.50%
2 4.50%
3 4.00%
4 3.50%
5 3.00%
6 2.00%
7 1.00%
7
|
0.50%
|
9+ 0.00%
Transfer/Transfer
Charge:
|
A
fee of $25.00 is charged for each transfer in excess of [15] in any
Contract Year. Any Transfer Charge is deducted from the amount transferred
prior to the allocation to the new Contract Option. Transfer Charges will
not be applied to Company required transfers from the Fixed Account Option
or to transfers due to dollar cost averaging, or other systematic
investment programs provided by the Company, nor will these transfers
count against the [15] free transfers allowed in a Contract
Year.
|
Asset
allocation service providers must comply with the Company's administrative
systems, rules, and procedures.
A
transfer will be effective as of the end of the Business Day when the Company
receives a transfer request prior to market close in Good Order, otherwise the
transfer will be effective as of the end of the next Business Day.
The
Company will not be liable for a transfer made in accordance with the Owner's
instructions.
VA340NY 3c
CONTRACT DATA PAGE (CONT'D)
(Continued): Prior
to and after the Income Date, You may transfer all or a
portion
of Your Contract Value in one Investment Division to any
available
Investment Division(s).
FROM INVESTMENT DIVISION TO A FIXED
ACCOUNT OPTION. Prior to the Income Date, You may transfer all or a
portion of Your Contract Value in an Investment Division to a Fixed Account
Option. The Company may restrict or prohibit this type of transfer from time to
time on a nondiscriminatory basis.
FROM A FIXED ACCOUNT OPTION TO AN
INVESTMENT DIVISION. Prior to the Income Date, You may transfer all or a
portion of Your Contract Value in a Fixed Account Option to any available
Investment Division(s).The Company may restrict transfers to a Fixed Account
Option(s) from time to time on a nondiscriminatory basis.
Premium(s):
|
Premiums
are flexible with the exception that Premiums will not be accepted on or
after the first Contract Anniversary following the Owner's 85th birthday.
This means that the Owner may change the amounts, frequency or timing of
Premiums. The initial Premium must be at least $5,000 for Nonqualified
Plan Contracts and $2,000 for Qualified Plan Contracts. Subsequent
Premiums must be at least $500 ($50 if made in connection with an
automatic payment plan). Total Premiums under a Contract may not exceed
$1,000,000, unless approved by the Company. However, the Company may waive
the minimums and maximums at any
time.
|
The Owner
may allocate Premiums among the Fixed Account Option and Investment Divisions,
subject to the approval of the Company, which will be granted in advance on a
nondiscriminatory basis. Allocations may be made in any percent from 0% to 100%
in whole percentages. The minimum that may be allocated to a Fixed Account
Option or to an Investment Division is $100. The Company reserves the right to
restrict any Premium allocation to a Fixed Account Option at any time on a
nondiscriminatory basis. Any subsequent Premium will be allocated according to
Your most recent instructions on file with the Company, provided that such
allocation meets the minimums and restrictions described above, regardless of
such instructions.
VA340NY 3d
CONTRACT DATA PAGE (CONT'D)
Premium(s)
(Continued):
|
The
Company reserves the right to require, in advance, the automatic transfer
of amounts allocated to the 1-year Fixed Account Option to the Investment
Division(s) of Your choice in regular installments over a specified period
from the date of allocation on a nondiscriminatory basis. A pre-determined
amount will be transferred from the source Fixed Account Option to the
Owner selected Investment Division(s) such that at the end of the
specified period all amounts in the 1-year Fixed Account Option will have
been transferred. The Company reserves the right to specify in advance the
transfer amount, the length of the period, and the transfer frequency over
which the transfers will be completed. The funds being transferred will be
allocated to the Investment Division(s) elected by You. You may change
Your selected Investment Division(s) at any time. These automatic
transfers will not count against the [15] free transfers in a Contract
Year.
|
CONTRACT OPTIONS:
Investment
Division(s):
|
Availability
is indicated in the Contract application, current prospectus and any
supplements. The Company may periodically add or delete Investment
Divisions.
|
The
Contract Options You have selected will be detailed in a confirmation sent to
You by the Company on or after the Issue Date and are stated in the Contract
application attached to this Contract.
Xxxxxxx
National Life Insurance Company of New York
[0000
Xxxxxxxxxxx Xxxxxx
Purchase,
New York 10577
888/965-6569
xxx.xxxxxxx.xxx]
If You
have questions about this Contract including requests for information about
coverage or complaint resolutions, You may contact our Service Center at the
following address or telephone number.
Xxxxxxx
of New York Service Center
[P.O.
Box 30900
Lansing,
MI 48909-8400
Customer
Care: 800/599-5651
(8:00
a.m. - 8:00 p.m. ET)
E-Mail:
xxxxxxxxx@xxxxxxx.xxx]
|
Express
Mail:
Xxxxxxx
of New York Service Center
[0
Xxxxxxxxx Xxx
Xxxxxxx,
XX 00000
(8:00
a.m. - 8:00 p.m. ET)
E-Mail:
xxxxxxxxx@xxxxxxx.xxx]
|
VA340NY 3e
DEFINITIONS
ACCUMULATION UNIT. A unit of
measure used to calculate the value in an Investment Division prior to the
Income Date.
ANNUITANT. The natural person
on whose life annuity payments for this Contract are based. Any reference to the
Annuitant includes any Joint Annuitant.
ANNUITY UNIT. A unit of
measure used to calculate the amount of a variable annuity payment.
ANTICIPATED INITIAL PREMIUM.
Premium received by the Company for this Contract either with the
Contract application or from a transfer(s) or rollover(s) from a Qualified
Plan(s) or a transfer(s) that qualifies for favorable tax treatment under
Section 1035 of the Internal Revenue Code (as amended) that is (are) known to
the Company at the time of application for this Contract.
BASE INTEREST RATE. The rate
of interest established by the Company, at its sole discretion, for a specified
Fixed Account Option period. In no event will the Base Interest Rate be less
than the Fixed Account Minimum Interest Rate shown on the Contract Data
Page.
BENEFICIARY(IES). The
person(s) or entity(ies) designated to receive any Contract benefits upon the
death of the Owner.
BUSINESS DAY. Each day that
the New York Stock Exchange is open for business. All requests for transactions
that are received at the Company's Service Center in Good Order on any Business
Day prior to market close, generally 4 P.M. Eastern Time, will be processed
effective the end of that Business Day.
CONTINGENT ANNUITANT. The
natural person that is designated as a subject life for purposes of electing an
optional endorsement on a Qualified Plan custodial account contract only. Any
reference to the Annuitant does not include any Contingent
Annuitant.
CONTRACT. The Individual
Deferred Variable and Fixed Annuity Contract between You and the
Company.
CONTRACT ANNIVERSARY. Each one
year anniversary of the Issue Date.
CONTRACT ENHANCEMENT. The
amount credited to the Separate Account Contract Value and/or the Fixed Account
Contract Value for each Premium received in accordance with the Contract
Enhancement Provision.
CONTRACT MONTH. The one-month
period beginning on the Issue Date or any Contract Monthly
Anniversary.
CONTRACT OPTION. One of the
allocation options offered by the Company under this Contract. Each Contract
Option is more fully explained in the Accumulation Provisions.
CONTRACT VALUE. The Contract
Value equals the sum of the Separate Account Contract Value and the Fixed
Account Contract Value.
VA340NY 4
DEFINITIONS
(CONT'D)
CONTRACT YEAR. The
twelve-month period beginning on the Issue Date or any Contract
Anniversary.
CURRENT INTEREST RATE. The
Base Interest Rate plus any additional interest rate credited by the Company,
less any charges due under any optional endorsements to the Contract. In no
event will the Current Interest Rate be less than the Fixed Account Minimum
Interest Rate shown on the Contract Data Page.
DESIGNATED OPTION(S). The
Investment Division(s) and/or Fixed Account Option made available by the Company
and selected by the Owner to which amounts will be transferred from a Source
Option pursuant to one of the Company's systematic investment
programs.
FIXED ACCOUNT. Contract Values
allocated to the Fixed Account Option. Allocations made to the Fixed Account
Option are part of the general account of the Company. The general account is
made up of all general assets of the Company, other than those in the Separate
Account and other segregated asset accounts.
FIXED ACCOUNT CONTRACT VALUE.
The sum of all amounts allocated and credited to the Fixed Account Option
under the Contract, less any amounts canceled or withdrawn for charges,
deductions, withdrawals or transfers.
FIXED ACCOUNT MINIMUM VALUE.
Premiums, net of any applicable premium tax, Contract Enhancements, and
transfers allocated to the Fixed Account Option, less transfers, withdrawals,
and charges from the Fixed Account Option, accumulated at the Fixed Account
Minimum Interest Rate shown on the Contract Data Page, less any Withdrawal
Charge, Recapture Charge or tax due.
FIXED ACCOUNT OPTION. A
Contract Option within the Fixed Account for a specific period under which the
Current Interest Rate will be credited.
GOOD ORDER. The receipt by the
Company of any and all information, documentation, instructions and/or Premium
deemed necessary by the Company, in its sole discretion, to issue the Contract
or execute any transaction pursuant to the terms of the Contract.
INCOME DATE. The date on which
annuity payments are to begin under an income option.
INVESTMENT DIVISIONS. Separate
and distinct divisions of the Separate Account to which specific Underlying
Mutual Fund shares are allocated, and for which Accumulation Units and Annuity
Units are separately maintained. The Contract Value in the Investment Divisions
will go up or down depending on the performance of the Underlying Mutual
Funds.
ISSUE DATE. The date the
Contract was issued by the Company, as shown on the Contract Data
Page.
JOINT OWNER. If there is more
than one Owner, each Owner shall be a Joint Owner of the Contract. Joint Owners
have equal ownership rights and must each authorize any exercising of those
ownership rights under the Contract.
VA340NY 5
DEFINITIONS
(CONT'D)
LATEST INCOME DATE. The
Contract Anniversary on or next following the Owner's 95th birthday under a
Nonqualified Plan Contract, or such earlier date required by the applicable
qualified plan, law or regulation.
NONQUALIFIED PLAN. A
retirement plan which does not qualify for favorable tax treatment under Section
401, 403, 408, 408A or 457 of the Internal Revenue Code, as
amended.
OWNER ("YOU," "YOUR"). The
person or entity shown on the Contract Data Page who is entitled to exercise all
rights and privileges under this Contract. Usually, but not always, the Owner is
the Annuitant. If Joint Owners are named, all references to Owner shall mean
Joint Owner.
PREMIUM(S). Considerations
paid into this Contract by or on behalf of the Owner.
QUALIFIED PLAN. A retirement
plan which qualifies for favorable tax treatment under Sections 401, 403, 408,
408A or 457 of the Internal Revenue Code, as amended.
RECAPTURE CHARGE. The charge
assessed against certain withdrawals from the Contract Value, which reflects
that portion of the Contract Enhancement(s) still subject to
recapture.
REMAINING PREMIUM. The total
Premium reduced by withdrawals that incur Withdrawal Charges and Recapture
Charges, and withdrawals of Premiums that are no longer subject to Withdrawal
Charges and Recapture Charges.
SEPARATE ACCOUNT. A segregated
asset account established and maintained by the Company in accordance with
applicable law in which a portion of the Company's assets have been allocated
for this and certain other contracts.
SEPARATE ACCOUNT CONTRACT VALUE.
The current value of the amounts allocated to the Investment Divisions of
this Contract.
SERVICE CENTER. The Company's
address and telephone number as specified on the Contract Data Page or as may be
designated by the Company from time to time.
SOURCE OPTION (THE SOURCE).
The Investment Division or Fixed Account Option made available by the
Company and selected by the Owner from which amounts will be transferred to a
Designated Option(s) pursuant to one of the Company's systematic investment
programs.
UNDERLYING MUTUAL FUNDS. The
registered management investment companies in which assets of the Investment
Division(s) of the Separate Account will be invested.
WITHDRAWAL CHARGE. The charge
assessed against certain withdrawals from the Contract Value.
WITHDRAWAL VALUE. The Contract
Value, less any tax payable, minus any applicable Withdrawal Charges, Recapture
Charges, Annual Contract Maintenance Charges, and charges due under any optional
endorsement to the Contract.
VA340NY 6
ANNUITANT. The Owner may
change the Annuitant at any time prior to the Income Date, unless the Owner is
not a natural person. If the Owner is not a
natural person, the age of the Annuitant will be used in lieu of the Owner's age
for all purposes under this Contract, unless otherwise specified in the
Contract. Also, if the Owner is not a natural person, the Waiver of Withdrawal
Charge and Recapture Charge for Extended Care will apply to the
Annuitant.
ASSIGNMENT. The Owner may
assign this Contract before the Income Date. An assignment will take effect when
signed by the Owner, subject to action taken by Us prior to receipt in writing.
The Owner may exercise these rights subject to the interest of any assignee or
irrevocable beneficiary. The
Company assumes no responsibility for the validity or tax consequences of any
assignment. If You make an assignment, You may have to pay income tax. You are
encouraged to seek competent legal and/or tax advice.
BENEFICIARY. The individual(s)
or entity(ies) designated by the Owner to receive any amount payable under this
Contract upon the Owner's death or upon the death of the Annuitant on or after
the Income Date pursuant to the terms of this Contract. (See Income Provision
section for details.) The original Beneficiary(ies) will be shown on the
Contract Data Page. If two or more persons are named, those surviving the Owner
will share equally unless otherwise stated. If there are no surviving
Beneficiaries at the death of the Owner, the death benefit will be paid to the
Owner's estate. Upon the death of a Joint Owner, the surviving Joint Owner, if
any, will be treated as the primary Beneficiary and all other Beneficiaries will
be treated as contingent Beneficiaries. The Owner may change the
Beneficiary(ies) by submitting a written request to the Service Center, unless
an irrevocable beneficiary designation was previously filed with the Company.
Any change will take effect on the date the notice is signed by the Owner
subject to any actions taken by the Company prior to the receipt of the request
in writing.
CHARGES AND FEES. The Company
may assess charges or fees under the Contract. Please see the Contract Data Page
for more information as to charges or fees.
The
Annual Contract Maintenance Charge specified on the Contract Data Page will be
deducted on each Contract Anniversary that occurs on or prior to the Income
Date. It will also be deducted when the Contract Value is withdrawn in full if
the full withdrawal is not on a Contract Anniversary.
CONFORMITY WITH LAWS. This
Contract will be interpreted under the law of the State of New York when it is
issued. Any provision which, on the Issue Date, is in conflict with New York
law, is amended to conform to the minimum requirements of such law.
CONTESTABILITY. The Company
will not contest this Contract from its Issue Date, as shown on the Contract
Data Page.
CONTRACT ENHANCEMENT. At the
time each Premium payment is received, the Company will credit an amount equal
to the 6% Contract Enhancement Percentage, multiplied by the Premium. The
Contract Enhancement will be allocated to the Investment Divisions and/or Fixed
Account Option in the same proportion as the Premium.
Your
Contract Value will reflect any gains or losses attributable to a Contract
Enhancement. A Contract Enhancement, and any gains or losses attributable to a
Contract Enhancement distributed under Your Contract will be considered earnings
under the Contract for tax purposes.
VA340NY 7
GENERAL
PROVISIONS (CONT'D)
DEFERMENT OF PAYMENTS. The
Company may defer payment from a Fixed Account Option for a period not exceeding
six (6) months. Deferral for the six (6) month period will be made only if We
make a written request and receive written approval from the regulatory official
of the State of New York. Interest pursuant to New York law will be credited
during such deferred period.
ENTIRE CONTRACT. The Contract,
and any attached Company forms, applications, endorsements and amendments
together make up the entire Contract.
INCORRECT AGE OR SEX. If the
age or sex of the Owner or Annuitant is incorrect, the payments will be those
that the Premiums paid would have purchased at the correct age and sex. Any
underpayments or overpayments will be adjusted immediately by the Company using
an interest rate of 6.00% either as a credit to or charge against the next
succeeding payment by the Company.
MINIMUM BENEFITS. For any paid
up annuity option, cash value or death benefit, the amount available under this
Contract will not be less than the minimum requirements of the state where this
Contract was delivered.
MODIFICATION OF CONTRACT. Any
change or waiver of the provisions of this Contract must be in writing and
signed by the President, a Vice President, the Secretary or Assistant Secretary
of the Company and filed with the New York Insurance Department prior to use.
Written consent of the Owner will be obtained prior to changing any terms and
conditions of the Contract in a manner that diminishes the Owner's rights and/or
benefits under the Contract. No financial representative or producer has
authority to change or waive any provision of this Contract.
NONPARTICIPATING. This
Contract does not share in the Company's surplus or earnings.
NOTICE. Information or
instructions given to the Company by You must be in a form satisfactory to the
Company, referred to as Good Order. A notice relating to Owner, Beneficiary
designation or assignment changes shall take effect on the date signed by You
once it is received and recorded at the Company's Service Center subject to
action taken by the Company prior to receipt in writing. Otherwise, any other
notice takes effect when the Company accepts it and it is recorded at the
Service Center.
Any
notice the Company sends to the Owner will be sent to the Owner's last known
address unless the Owner requests otherwise in writing. Any request or notice
must be sent to the Service Center, unless the Company advises You otherwise.
You are responsible for promptly notifying the Company of any address
change.
PROOF OF AGE, SEX OR SURVIVAL.
The Company may require satisfactory proof of correct age or sex at any time. If
any payment under this Contract depends on the Annuitant, Owner or Beneficiary
being alive, the Company may require satisfactory proof of
survival.
PROTECTION OF PROCEEDS.
Proceeds under this Contract are not assignable by any Beneficiary prior
to the time such proceeds become payable. To the extent permitted by New York
law, proceeds are not subject to the claims of creditors or to legal
process.
VA340NY 8
GENERAL
PROVISIONS (CONT'D)
REPORTS. The Company will send
You a report at least once a year. The Company will also send You reports as
required by law. They shall be addressed to the last address of the Owner known
to the Company.
SUBSTITUTION OF INVESTMENT
DIVISION(S). The Company may substitute
any Underlying Mutual Fund(s) with another Underlying Mutual Fund without Your
consent. Substitution would occur if the Company determines that the use of
certain Underlying Mutual Fund(s) is no longer possible or if the Company
determines it is no longer appropriate for the purposes of the Contract. No
substitution will be made without notice to You and without prior approval of
the New York Insurance Department. Changes of Underlying Mutual Fund(s) are
subject to the federal securities laws and the laws of the state of New York.
Should a substitution, addition, or deletion occur, You will be allowed to
select from the then current Investment Divisions and substitution may be made
with respect to both existing Contract Value in that Investment Division(s) and
the allocation of future Premiums.
SUSPENSION OF PAYMENTS. The
Company may suspend or postpone any transfers or payments to or from the
Investment Divisions if any of the following occur:
1.
|
The
New York Stock Exchange is closed;
|
2.
|
Trading
on the New York Stock Exchange is
restricted;
|
3.
|
An
emergency exists such that it is not reasonably practical to dispose of
securities in the Separate Account or to determine the value of its
assets; or
|
4.
|
The
Securities and Exchange Commission, by order, so permits for the
protection of Contract Owners.
|
The
applicable rules and regulations of the Securities and Exchange Commission will
govern whether conditions described in 2. and/or 3. exist.
TAXES. The Company may deduct
from the Contract Value any premium taxes or other taxes payable to a state or
other government entity because of this Contract. Should the Company advance any
amount so due, the Company is not waiving any right to collect such amount at a
later date. The Company will deduct any withholding taxes required by applicable
law as a result of any withdrawals or amounts payable from this
Contract.
TRANSFER. The conditions for
transfer between Contract Options are explained in the Contract Data Page. The
Company reserves the right to restrict the number, means and frequency of
transfers per year that may be requested by the Owner.
Your
ability to make transfers is subject to modification if the Company determines
that the exercise by one or more owners is, or would be, to the disadvantage of
other owners. Restrictions may be applied in any manner reasonably designed to
prevent any use of the transfer provision which is considered by the Company to
be to the disadvantage of other owners. A modification regarding Your ability to
make transfers to or from one or more of the Investment Divisions could include,
but not be limited to:
1.
|
The
requirement of a minimum time period between each
transfer;
|
2.
|
Limiting
transfer requests of an agent acting on behalf of one or more owners or
under a power of attorney on behalf of one or more owners;
or
|
3.
|
Limiting
the dollar amount that may be transferred at any one
time.
|
VA340NY 9
GENERAL
PROVISIONS (CONT'D)
The
Company may provide systematic investment programs that allow You to transfer
funds among the Investment Divisions and the Fixed Account Option. These
programs may include dollar cost averaging, portfolio rebalancing, and the
automatic monthly transfer of earnings from the Fixed Account Option and/or
money market Investment Division to other Investment Divisions. You may contact
the Company's Service Center, and the Company will furnish all necessary forms
to request these programs. The Company makes no guarantee that these programs
will result in a profit or protect against loss in a declining
market.
In order
to participate in a dollar cost averaging program or automatic transfer of
earnings program, the Separate Account Contract Value plus the Fixed Account
Contract Value must be at least $15,000. The Company may waive this requirement
at its discretion. For a dollar cost averaging program, You may authorize the
automatic transfer of a fixed dollar amount or selected percentage of the value
of a Source Option, periodically to one or more Designated Option(s). The
intervals between transfers may be monthly, quarterly, semi-annually or
annually.
VA340NY 10
An Owner
may not allocate Contract Values to more than eighteen Contract Options at any
one time. The Company may waive this restriction at its discretion.
SEPARATE ACCOUNT. The Separate
Account consists of assets the Company has set aside and has kept separate from
the rest of the Company's general account assets and those of its other
segregated asset accounts. These assets are not chargeable with liabilities
arising out of any other business the Company may conduct. All the income,
gains, and losses resulting from these assets are credited to or charged against
the contracts supported by the Separate Account, and not against any other
contracts the Company may issue. The assets of the Separate Account will be
available to cover the liabilities of the Company's general account only to the
extent that the assets of the Separate Account exceed the liabilities of the
Separate Account arising under the Contracts supported by the Separate Account.
The Separate Account consists of several Investment Divisions. The assets of the
Separate Account shall be valued at least as often as any benefits of this
Contract, but in no event will such valuation be less frequently than
monthly.
Accumulation Units. The
Separate Account Contract Value will go up or down depending on the performance
of the Investment Divisions. In order to monitor the Separate Account Contract
Value during the accumulation phase, the Company uses a unit of measure called
an Accumulation Unit. The value of an Accumulation Unit may go up or down from
Business Day to Business Day. Adjustments to the Contract Value, such as
withdrawals, transfers, and charges, result in the redemption of Accumulation
Units. However, these adjustments do not affect the value of the Accumulation
Units.
When You
make an allocation to the Investment Divisions, the Company credits Your
Contract with Accumulation Units. The number of Accumulation Units credited is
determined by dividing the amount allocated to any Investment Division by the
Accumulation Unit Value for that Investment Division at the close of the
Business Day when the allocation is made.
Accumulation Unit Value. The
Company determines the value of an Accumulation Unit for each of the Investment
Divisions. This is done by:
1.
|
Determining
the total amount of money invested in the particular Investment
Division;
|
2.
|
Subtracting
from that amount any Mortality and Expense Charge, Administration Charge,
and any other charge for optional benefits and
taxes;
|
3.
|
Dividing
the remainder by the number of outstanding Accumulation
Units.
|
FIXED ACCOUNT. Amounts
allocated to the Fixed Account will earn interest at the Current Interest Rate,
compounded annually during the Fixed Account Option period. Subsequent Base
Interest Rates may be higher or lower than the Base Interest Rates previously
declared by the Company.
You may
allocate Premiums, or make transfers from the Investment Divisions, to the Fixed
Account Option at any time prior to the Income Date, subject to the provisions
of this Contract.
VA340NY 11
ACCUMULATION
PROVISIONS (CONT'D)
The
Company may restrict the availability of the Fixed Account Option at any time.
Written notice will be sent to You 30 days in advance of any restriction placed
on the Fixed Account Option after Your Contract is in force. Written notice will
also be provided to You when restrictions are lifted.
If the
Owner does not specify a Fixed Account Option at the time of renewal, the
Company will select the same Fixed Account Option period as has just expired.
Within at least 15 days, but not more than 45 days, prior to the end of any
Fixed Account Option, We will notify You of your ability to:
a)
|
withdraw
amounts allocated to the Fixed Account
Option;
|
b)
|
elect
a transfer to Investment Division(s) within 30 days following the end of
such Fixed Account Option; or
|
c)
|
elect
a Fixed Account Option with the same duration, within 30 days following
the end of such Fixed Account
Option.
|
If a
renewal occurs within one year of the Income Date, the Company will credit
interest up to the Income Date at the then Current Interest Rate for the Fixed
Account Option.
Fixed Account Contract Value.
The Fixed Account Contract Value under the Contract shall be the sum of
all monies allocated or transferred to the Fixed Account Option, reduced by any
applicable taxes, plus all interest credited to the Fixed Account Option,
adjusted for withdrawals, transfers, and charges.
VA340NY 12
At or
before the Income Date, the Owner may withdraw all or part of the amounts under
this Contract by informing the Company at the Service Center. For full
withdrawal, this Contract, or a completed Lost Contract Affidavit, must be
returned to the Service Center.
Premiums
withdrawn from the Contract Value may be subject to a Withdrawal Charge and
Recapture Charge as explained in more detail below.
Premiums
that are no longer subject to the Withdrawal Charge and Recapture Charge (and
not previously withdrawn), plus earnings may be withdrawn free of Withdrawal
Charges and Recapture Charges at any time.
Upon full
withdrawal, the Owner will receive the Withdrawal Value. The Withdrawal Value
will be based on values at the end of the Business Day in which the request for
withdrawal is received at the Service Center in Good Order. In no event shall the amount
withdrawn, whether a full withdrawal or partial withdrawal, exceed the
Withdrawal Value.
Except in
connection with a systematic withdrawal program, the minimum partial withdrawal
amount is $500, or if less, the Owner's entire interest in the Investment
Division or Fixed Account Option from which a withdrawal is
requested.
The
Owner's interest in the Investment Division or Fixed Account Option from which
the withdrawal is requested must be at least [$100] after the withdrawal is
completed or the Owner's entire interest in the Investment Division or Fixed
Account Option will be withdrawn.
Unless
otherwise specified, the withdrawal will be made from each Investment Division
and each Fixed Account Option in proportion to their current value. Withdrawals
will be based on values at the end of the Business Day on which the request for
withdrawal is received in Good Order at the Service Center.
The
Company will waive the Withdrawal Charge and Recapture Charge on any withdrawal
necessary to satisfy the minimum distribution requirements of the Internal
Revenue Code. Any withdrawal in excess of the required minimum distribution will
cause the entire amount to be subject to any applicable Withdrawal Charge and
Recapture Charge.
You may
elect to take a systematic withdrawal by surrendering a specific sum or a
certain percentage on a monthly, quarterly, semiannual or annual basis, subject
to a $50 minimum withdrawal. Such withdrawals will be counted in determining the
portion of the Contract Value taken as an Additional Free Withdrawal. Systematic
withdrawals in excess of the Additional Free Withdrawal amount may be subject to
a Withdrawal Charge and Recapture Charge.
WITHDRAWAL CHARGE. A
Withdrawal Charge may be imposed upon certain withdrawals. Withdrawal Charges
will be calculated in accordance with the Withdrawal Charge schedule on the
Contract Data Page. The Withdrawal Charge is equal to the Withdrawal Charge
percentage applied to the portion of Remaining Premium withdrawn. The Withdrawal
Charge will be taken from the Investment Divisions and the Fixed Account Option
in the same proportion as the requested withdrawal.
VA340NY 13
WITHDRAWAL
PROVISIONS (CONT'D)
The
Withdrawal Charge will be deducted from the remaining Contract Value such that
the actual reduction in Contract Value as a result of the withdrawal will be
greater than the withdrawal amount requested and paid.
For
purposes of determining the Withdrawal Charge, earnings are defined as the
excess of the Contract Value over he sum of remaining Contract Enhancements and
Remaining Premiums. Withdrawals will be allocated first to earnings, if any
(which may be withdrawn free of Withdrawal Charge), second to Remaining Premium
on a first-in, first-out basis so that all withdrawals will be allocated to
Remaining Premium to which the lowest (if any) Withdrawal Charges apply, and
third to Contract Enhancements (which may be withdrawal free of any Withdrawal
Charge.)
RECAPTURE CHARGE. The Contract
Enhancement may be recaptured upon certain withdrawals. Recapture Charges will
be calculated in accordance with the Recapture Charge schedule set forth on the
Contract Data Page. The Recapture Charge is equal to the Recapture Charge
percentage applied to the portion of Remaining Premium withdrawn. The Recapture
Charge will be taken from the Investment Divisions and the Fixed Account Option
in the same proportion as the requested withdrawal.
The
Recapture Charge will be deducted from the remaining Contract Value such that
the actual reduction in Contract Value as a result of the withdrawal may be
greater than the withdrawal amount requested and paid.
For
purposes of determining the Recapture Charge, earnings are defined as the excess
of the Contract Value over the sum of remaining Contract Enhancements and
Remaining Premiums. Withdrawals will be allocated first to earnings, if any
(which may be withdrawn free of any Recapture Charge), second to Remaining
Premium on a first-in, first-out basis so that all withdrawals will be allocated
to Remaining Premium to which the lowest (if any) Recapture Charges apply, and
third to Contract Enhancements (which may be withdrawn free of any Recapture
Charge.)
ADDITIONAL FREE WITHDRAWAL.
During a Contract Year, You may make partial withdrawals from the
Contract without the Withdrawal Charge and Recapture Charge being applied. This
Additional Free Withdrawal is equal to:
1.
|
10%
of Premium that remains subject to Withdrawal Charges and/or Recapture
Charges and that has not been previously withdrawn (this can be utilized
once or in segments throughout the Contract Year);
less,
|
2.
|
all
remaining earnings, as defined in the Withdrawal Charge and Recapture
Charge provisions.
|
In
no event shall the Additional Free Withdrawal exceed the Withdrawal
Value.
Both
Withdrawal Charges and Recapture Charges are waived on amounts withdrawn that
are less than or equal to the Additional Free Withdrawal. Although Additional
Free Withdrawals reduce principal in either the Investment Division and/or the
Fixed Account Option, they do not reduce Remaining Premium. As a result, You
will not receive the benefit of an Additional Free Withdrawal if you take a full
withdrawal. Withdrawals during the Contract Year in excess of the Additional
Free Withdrawal may be subject to a Withdrawal Charge and Recapture
Charge.
VA340NY 14
WITHDRAWAL
PROVISIONS (CONT'D)
This
Additional Free Withdrawal is non-cumulative; that is, Additional Free
Withdrawals not taken during any given Contract Year cannot be taken as
Additional Free Withdrawals in a subsequent Contract Year.
WAIVER OF WITHDRAWAL CHARGE AND
RECAPTURE CHARGE FOR EXTENDED CARE. If You are confined as an inpatient
to a Nursing Home or Hospital for ninety (90) consecutive days, a period during
which the Withdrawal Charge and/or Recapture Charge otherwise would normally
apply, the Company will waive the Withdrawal Charge and Recapture Charge on any
amounts You request withdrawn from the Contract under this
provision.
You can
withdraw an amount without a Withdrawal Charge and Recapture Charge pursuant to
this benefit only once, regardless of the subsequent occurrence of the same
condition or the occurrence of a different condition. You are not eligible for
this waiver if:
1.
|
You
are confined to a Nursing Home or Hospital during the thirty-day (30)
period following the Issue Date, unless such confinement is not related to
a subsequent confinement for which You request the waiver;
or,
|
2.
|
You
are no longer confined to a Nursing Home or
Hospital.
|
Confinement
to the Nursing Home or Hospital must be prescribed by a Physician and be
medically necessary, meaning the confinement is appropriate and consistent with
the diagnosis in accordance with accepted standards of practice, and which could
not have been omitted without adversely affecting the confined Owner's
condition.
Withdrawals
made pursuant to this provision shall not exceed [$250,000]. If your Contract
Value is below this amount, you may withdraw 100% of the Contract Value.
Withdrawals will be taken from the Separate Account Contract Value and the Fixed
Account Contract Value as stated in the Withdrawal Provisions of the
Contract.
Definitions. For the purpose
of this provision, the following definitions apply:
Hospital. A facility located
within the United States or its territories which is operated pursuant to law;
operates primarily for the care and treatment of sick and injured persons as
inpatients; provides continuous 24-hour nursing service by or under the
supervision of a registered professional nurse (R.N.); is supervised by a staff
of licensed physicians; and, has medical, diagnostic and major surgical
facilities on a prearranged basis.
Immediate Family. A spouse,
child, brother, sister, parent or grandparent.
Nursing Home. A facility
located in the United States or its territories; operates pursuant to law in the
jurisdiction in which it is located; provides custodial care under the
supervision of a registered nurse (R.N.) or a Physician; and, does not
include any place owned or operated by a member of the Beneficiary's,
Annuitant's or Joint Annuitant's, Owner's or Joint Owner's Immediate
Family.
VA340NY 15
WITHDRAWAL
PROVISIONS (CONT'D)
Physician. An individual who
is licensed to practice medicine and treat illness or injury in the United
States or its territories where treatment is received and who is acting within
the scope of his or her license. The term Physician only refers to a Physician
licensed and currently practicing in the United States or its territories.
Physician does not include:
1. an
Annuitant or Joint Annuitant;
2. an Owner
or Joint Owner
3. Beneficiary(ies);
or
|
4.
|
a
person who is part of the Beneficiary's, Annuitant's or Joint Annuitant's,
Owner's or Joint Owner's Immediate
Family.
|
Claim Requirements. Written
notice and proof of claim of the Owner's confinement must be submitted to the
Company 90 days after the date the Owner becomes confined to a Nursing Home or
Hospital before a waiver will be considered pursuant to this Endorsement. Written proof includes:
(1) a properly completed Company claim form; (2) Your signed medical records
release; and (3) a Physician's statement of condition satisfactory to the
Company. The Company reserves the right to request additional medical
information from any Physician, Hospital, or Nursing Home. The Company may
require, at its expense, an additional examination by a Physician of its choice.
If there is a discrepancy between medical opinions, the opinion of the Company's
Physician will govern.
A
PAYMENT UNDER THIS PROVISION MAY BE TAXABLE. AS WITH ALL TAX MATTERS, YOU ARE
ENCOURAGED TO SEEK LEGAL AND/OR TAX ADVICE.
VA340NY 16
DEATH OF OWNER BEFORE THE INCOME
DATE. Upon the Owner's death, or the death of any Joint Owner, before the
Income Date, the death benefit will be paid to the Beneficiary(ies) designated
by the Owner. Upon the death of a Joint Owner, the surviving Joint Owner, if
any, will be treated as the primary Beneficiary. Any other beneficiary
designation on record at the Service Center at the time of death will be treated
as a contingent Beneficiary.
Β·
|
DEATH BENEFIT AMOUNT BEFORE THE
INCOME DATE. The death benefit is equal to the greater
of:
|
1.
|
The
current Contract Value; or
|
2.
|
All
Premiums (net of any applicable premium tax) paid into the Contract less
any withdrawals and any applicable charges and adjustments for such
withdrawals incurred since the issuance of the
Contract.
|
All
adjustments will occur at the time of the withdrawal or Premium payment. All
adjustments for amounts withdrawn will reduce the death benefit in the same
proportion that the Contract Value was reduced on the date of such
withdrawal.
The death
benefit amount will be determined as of the end of the Business Day when due
proof of the Owner's death satisfactory to the Company and an election as to the
type of death benefit option is received by the Company at its Service Center in
Good Order.
From the
time of death of the Owner until the death benefit amount is determined, any
amount allocated to an Investment Division will be subject to investment risk.
This investment risk is borne by the Beneficiary(ies).
Β·
|
DEATH BENEFIT OPTIONS BEFORE
INCOME DATE. In the event of the Owner's death or the death of a
Joint Owner before the Income Date, a Beneficiary must request that the
death benefit be paid under one of the death benefit options below unless
the Owner did so previously. The following are the available death benefit
options:
|
1.
|
Option
1 - single lump-sum payment of the death benefit;
or
|
2.
|
Option
2 - payment of the entire death benefit within five years of the date of
the death of the Owner or any Joint Owner;
or
|
3.
|
Option
3 - payment of the death benefit under an income 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 the death of the Owner or 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
the Owner's death.
VA340NY 17
DEATH
BENEFIT PROVISIONS (CONT'D)
If a
single lump-sum payment is requested, the amount will be paid within seven days
of receipt of proof of death and the election in Good Order at the Service
Center, unless either the Suspension of Payments or Deferment of Payments under
the General Provisions is in effect.
Payment
to the Beneficiary, other than in a single lump-sum, may only be elected during
the 60-day period beginning with the date of receipt of proof of death in Good
Order by the Service Center.
The
settlement of the death proceeds will be made upon receipt of proof of death and
will include any required interest from the date of death until
settlement.
Spousal Continuation Option.
If the Joint Owner, if any, or the Beneficiary is the spouse of the
deceased Owner, he or she may elect to continue the Contract in his or her own
name, at the current Contract Value, and exercise all the Owner's rights under
the Contract in lieu of taking the death benefit as a lump-sum
payment.
Special Spousal Continuation Option.
In lieu of taking the death benefit as a lump-sum payment or continuing
the Contract at the then current Contract Value, if the Beneficiary is the
spouse of the Contract Owner, he or she may elect to continue the Contract at an
adjusted Contract Value as described below. The spouse will then exercise all
the Contract Owner's rights under the Contract. The date that the Company
receives the spouse's written request to continue the Contract, under this
Special Spousal Continuation Option, and proof of the death of the Contract
Owner in Good Order will be referred to as the Continuation Date.
The
Contract Value for the continuing Contract will be adjusted so that it will
equal the amount of the death benefit that would have been payable as a lump sum
payment at Your death. If the Contract Value on the Continuation Date is less
than the death benefit, an amount will be added to the Contract Value to make up
the difference. This amount is referred to as the Continuation Adjustment. The
Continuation Adjustment will be allocated among the Contract Options in
accordance with the current instructions for the Contract, subject to any
minimum allocation restrictions unless the Company receives other allocation
instructions with the Special Spousal Continuation Option election. No Contract
Enhancement will be credited for the Continuation Adjustment. Withdrawal Charges
and Recapture Charges will continue at the same schedule as prior to the initial
Owner's death. However, no Withdrawal Charge or Recapture Charge schedule will
apply to the Continuation Adjustment.
For
purposes of determining future death benefits under the continuing Contract, the
Contract Value following the application of any Continuation Adjustment will be
considered as the initial Premium of the continuing Contract. Any future death
benefit, including an enhanced death benefit, if any, will be determined on that
basis and will use the age of the surviving spouse on the Continuation
Date.
This
Special Spousal Continuation Option can only be exercised one time under this
Contract, but may not be available if the Owner elected to pre-select the death
benefit option. Any benefit available under this Special Spousal Continuation
Option will end upon the change of ownership or assignment of the
Contract.
VA340NY 18
DEATH
BENEFIT PROVISIONS (CONT'D)
Pre-Selected Death Benefit Option
Election. Prior to the Income Date the Owner may designate the option
under which the death benefit will be paid. This designation of the death
benefit option must be given in a form acceptable to the Company, and will take
effect only after being recorded by the Company.
The Owner
may elect any death benefit option described in this Contract, or other death
benefit option, as agreed upon by the Company at the time of election. Once
elected, the designation can only be revoked or changed by the Owner in a form
acceptable to the Company. Upon the death of the Owner, the Beneficiary may not
revoke or modify the death benefit option elected, subject to the requirements
of the Internal Revenue Code. However, at the time of the Owner's death, the
Company reserves the right to change or modify the death benefit option if the
death benefit option previously elected exceeds the life expectancy of the
Beneficiary. If a Pre-selected Death Benefit Option Election is not made by the
Owner prior to the Owner's death, the Beneficiary may request that the death
benefit be paid under any of the death benefit options described in this
Contract, or other death benefit option, as agreed upon by the Company at the
time of request.
If this
Pre-selected Death Benefit Option Election is in force at the time of the
Owner's death, the payment of the death benefit may not be postponed, nor can
the Contract be continued under any provisions of this Contract. These
restrictions apply even if the Beneficiary is the spouse of the Owner, unless
such restriction is prohibited by law.
DEATH OF OWNER AFTER THE INCOME DATE.
If the Owner or any Joint Owner, who is not an Annuitant, dies after the
Income Date, any remaining payments under the income option elected will
continue at least as rapidly as under the method of distribution in effect at
the Owner's death. Upon the Owner's death after the Income Date, the Beneficiary
becomes the Owner.
DEATH OF ANNUITANT BEFORE INCOME
DATE. Upon the death of an Annuitant who is not an Owner before the
Income Date, the Contract remains in force and the Owner will become the
Annuitant. The Owner may designate a new Annuitant. However, if the Owner is not
a natural person, the death of the primary Annuitant will be treated as the
death of the Owner and a new Annuitant may not be designated.
DEATH OF ANNUITANT AFTER INCOME DATE.
Upon the death of the Annuitant after the Income Date, the death benefit,
if any, will be as specified in the income option elected. Death benefits will
be paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
VA340NY 19
INCOME DATE. The date on which
annuity payments are to begin. The Income Date may not be sooner than 13 months
from the Issue Date of the Contract. If no Income Date is selected, the Income
Date will be the Latest Income Date. At any time at least seven days prior to
the Income Date then indicated on the Company's records, the Owner may change
the Income Date by written notice to the Service Center, subject to the Latest
Income Date.
INCOME OPTIONS. The Owner, or
any Beneficiary who is so entitled, may elect to receive a single lump-sum.
However, a single lump-sum distribution will be deemed to be a withdrawal.
Alternatively, an income option may be elected. The Owner may, upon prior
written notice to the Company at its Service Center, elect an income option at
any time prior to the Income Date or change an income option up to seven days
before the Income Date. Unless otherwise designated, the Owner will be the
payee.
If no
other income option is elected, monthly annuity payments will be made in
accordance with Option 3 below, a life annuity with 120-month period certain.
Payments will be made in monthly, quarterly, semiannual or annual installments
as selected by the Owner. However, if the amount available to apply under an
income option is less than $5,000, and New York law permits, the Company has the
right to make payments in one single lump-sum. The single lump-sum payment will
not be less than would have been applied under an income option. In addition, if
the first payment provided would be less than $50, and New York law permits, the
Company may require the frequency of payments be at quarterly, semiannual or
annual intervals so as to result in an initial payment of at least
$50.
NO
WITHDRAWALS OF CONTRACT VALUE ARE PERMITTED DURING THE ANNUITY PERIOD FOR ANY
INCOME OPTION UNDER WHICH PAYMENTS ARE BEING MADE PURSUANT TO LIFE
CONTINGENCIES.
Upon
written election filed with the Company at its Service Center, all of the
Contract Value will be applied to provide one of the following income options.
The amount at annuitization will not be less than the greater of the Withdrawal
Value or 95% of the Contract Value.
OPTION 1 - LIFE INCOME. An
annuity payable monthly during the lifetime of the Annuitant. Under this income
option, no further annuity payments are payable after the death of the
Annuitant, and there is no provision for a death benefit payable to the Owner.
Therefore, it is possible under Option 1 for the Owner to receive only one
monthly annuity payment under this income option if the Annuitant has an early
death. If the Annuitant dies after the Income Date but prior to the first
annuity payment being paid, the amount applied to this income option will be
paid to the Owner or the Owner's Beneficiary(ies).
OPTION 2 - JOINT AND SURVIVOR.
An annuity payable monthly while both the Annuitant and a designated
second person are living. Upon the death of either person, the monthly annuity
payments will continue during the lifetime of the survivor at either the full
amount previously payable or as a percentage (either one-half or two-thirds) of
the full amount, as chosen at the time of election of the income option. If a
reduced annuity payment to the survivor is desired, variable annuity payments
will be determined using either one-half or two-thirds of the number of each
type of Annuity Unit credited. Fixed annuity payments will be equal to either
one-half or two-thirds of the fixed annuity payment payable during the joint
life of the Annuitant and the designated second person.
VA340NY 20
INCOME
PROVISIONS (CONT'D)
Annuity
payments terminate automatically and immediately upon the death of the surviving
person without regard to the number or total amount of payments received. There
is no minimum number of fixed annuity payments, and it is possible to have only
one monthly annuity payment if both the Annuitant and the designated second
person die before the due date of the second payment. If both Annuitants die
after the Income Date but prior to the first annuity payment being paid, the
amount applied to this income option will be paid to the Owner or the Owner's
Beneficiary(ies).
OPTION 3 - LIFE ANNUITY WITH 120 OR
240 MONTHLY PERIODS GUARANTEED. An annuity payable monthly during the
lifetime of the Annuitant with the guarantee that if, at the death of the
Annuitant, payments have been made for fewer than the guaranteed 120 or 240
monthly periods, as elected, the balance of the guaranteed number of payments
will continue to be made to the Owner as scheduled. In the event the Owner dies
before the specified number of guaranteed payments has been made, the
Beneficiary(ies) may elect to continue receiving the fixed and variable payments
according to the terms of this Contract or may alternatively elect to receive
the present value of any remaining guaranteed payments in a single lump-sum, the
amount of which is calculated by the Company. The present value of any remaining
guaranteed payments will be based on the total annuity payment as of the date of
the calculation.
OPTION 4 - INCOME FOR A SPECIFIED
PERIOD. Under this income option, the Owner can elect monthly payments
for any number of years from 5 to 30. This election must be made for full
12-month periods. In the event the Owner dies before the specified number of
payments has been made, the Beneficiary(ies) may elect to continue receiving the
fixed and variable payments according to the terms of this Contract or may
alternatively elect to receive the present value of any remaining guaranteed
payments in a single lump-sum, the amount of which is calculated by the Company.
The present value of any remaining guaranteed payments will be based on the
total annuity payment as of the date of the calculation.
ADDITIONAL OPTIONS. The
Company may make other income options available including income options for
longer periods.
The Owner
may elect either fixed or variable annuity payments as described
below.
FIXED ANNUITY PAYMENTS. To the
extent a fixed income option has been elected, the Contract Value allocated to
the fixed annuity payment option, less any applicable taxes and Contract
charges, shall be applied to the payment of the income option elected at
whichever of the following is more favorable to the Owner:
1.
|
the
annuity rates based upon the Table of Income Options specified in the
Contract; or
|
2.
|
the
then current rates provided by the Company on contracts of this type on
the Income Date.
|
In no
event will the fixed payments be changed once they begin.
VARIABLE ANNUITY PAYMENT. The
initial variable annuity payment is determined by taking the Contract Value
allocated to that Investment Division, less any tax and any applicable Contract
charges, and then applying it to the Table of Income Options specified in the
Contract.
VA340NY 21
INCOME
PROVISIONS (CONT'D)
The first
variable annuity payment is divided by the value of an Annuity Unit as of the
Income Date to establish the number of Annuity Units representing each variable
annuity payment. The number of Annuity Units determined for the first variable
annuity payment remains constant for the second and subsequent variable annuity
payments, assuming that no reallocation of Contract Values is made.
The
amount of the second and each subsequent variable annuity payment is determined
by multiplying the number of Annuity Units by the Annuity Unit Value as of the
Business Day next preceding the date on which each payment is due.
ANNUITY UNIT VALUE. The
initial value of an Annuity Unit of each Investment Division was set when the
Investment Divisions were established. The value may increase or decrease from
one Business Day to the next. The Table of Income Options contained in the
Contract is based on the assumed net investment rates described in the Basis of
Computation provision. If the actual net investment rate experienced by an
Investment Division exceeds the assumed net investment rate, variable annuity
payments will increase over time. Conversely, if the actual net investment rate
is less than the assumed net investment rate, variable annuity payments will
decrease over time. If the actual net investment rate equals the assumed net
investment rate, the variable annuity payments will remain
constant.
The value
of a fixed number of Annuity Units will reflect the investment performance of
the Investment Divisions, and the amount of each payment will vary
accordingly.
For each
Investment Division, the value of an Annuity Unit for any Business Day is
determined by multiplying the Annuity Unit Value for the immediately preceding
Business Day by the net investment factor for the Business Day for which the
Annuity Unit Value is being calculated. The result is then multiplied by a
second factor which offsets the effect of the assumed net investment rate. The
net investment factor, which reflects changes in the net asset value of
Investment Divisions, is determined by dividing 1. by 2., and then subtracting
3. from the result, where:
1.
|
Is
the net result of:
|
a.
|
the
net asset value of an Investment Division determined as of the end of the
Business Day, plus
|
b.
|
the
per share amount of any dividend or other distribution declared by the
Investment Division if the "ex-dividend" date occurs on the Business Day,
plus or minus
|
c.
|
a
per share credit or charge with respect to any taxes paid or reserved for
by the Company which are determined by the Company to be attributable to
the operation of the Investment Division (no federal income taxes are
applicable under present law);
|
2.
|
Is
the net asset value of the Investment Division determined as of the end of
the preceding Business Day; and
|
3.
|
Is
the asset charge factor determined by the Company for the Business Day to
reflect the applicable Mortality and Expense Charge and the Administration
Charge.
|
Neither
expenses actually incurred, other than taxes on the investment return, nor
mortality actually experienced, shall adversely affect the dollar amount of
variable annuity payments after such payments have been
commenced.
VA340NY 22
This
Contract will terminate and all benefits under this Contract will cease on the
earlier of:
1.
|
the
date of a full surrender;
|
2.
|
the
date the Contract Value falls to zero for any reason;
or
|
3.
|
the
date upon which due proof of death of the Owner (or any Joint Owner) and
an election of the type of payment to the Beneficiary(ies) is received at
Our Service Center in Good Order.
|
VA340NY 23
The
following table is for this Contract whose net proceeds are $1,000, and will
apply pro rata to the amount payable under this Contract.
UNDER
OPTION 4
|
MONTHLY
INSTALLMENT UNDER OPTIONS 1 OR 3
|
||||||||||||||||
No.
of Monthly Install-ments
|
Monthly
Install-ments
|
Age
of Annui-tant
|
No.
of Mos.
Certain
|
Age
of Annui-tant
|
No.
of Mos.
Certain
|
Age
of Annui-tant
|
No.
of Mos.
Certain
|
Age
of Annui-tant
|
No.
of Mos.
Certain
|
||||||||
Male
|
Life
|
120
|
240
|
Male
|
Life
|
120
|
240
|
Female
|
Life
|
120
|
240
|
Female
|
Life
|
120
|
240
|
||
60
|
17.73
|
40
|
3.25
|
3.25
|
3.22
|
70
|
6.42
|
5.99
|
4.93
|
40
|
3.09
|
3.09
|
3.07
|
70
|
5.76
|
5.54
|
4.82
|
72
|
14.96
|
41
|
3.30
|
3.29
|
3.26
|
71
|
6.66
|
6.16
|
4.98
|
41
|
3.13
|
3.12
|
3.11
|
71
|
5.97
|
5.71
|
4.88
|
84
|
12.98
|
42
|
3.35
|
3.34
|
3.30
|
72
|
6.91
|
6.33
|
5.02
|
42
|
3.17
|
3.16
|
3.14
|
72
|
6.20
|
5.88
|
4.94
|
96
|
11.49
|
43
|
3.39
|
3.38
|
3.34
|
73
|
7.19
|
6.50
|
5.06
|
43
|
3.21
|
3.20
|
3.18
|
73
|
6.44
|
6.06
|
4.99
|
108
|
10.34
|
44
|
3.45
|
3.43
|
3.38
|
74
|
7.48
|
6.68
|
5.10
|
44
|
3.25
|
3.24
|
3.22
|
74
|
6.70
|
6.25
|
5.04
|
120
|
9.41
|
45
|
3.50
|
3.48
|
3.43
|
75
|
7.79
|
6.86
|
5.13
|
45
|
3.30
|
3.29
|
3.26
|
75
|
6.99
|
6.44
|
5.08
|
132
|
8.66
|
46
|
3.56
|
3.54
|
3.48
|
76
|
8.12
|
7.04
|
5.16
|
46
|
3.34
|
3.33
|
3.30
|
76
|
7.30
|
6.64
|
5.12
|
144
|
8.03
|
47
|
3.61
|
3.59
|
3.53
|
77
|
8.48
|
7.21
|
5.18
|
47
|
3.39
|
3.38
|
3.35
|
77
|
7.63
|
6.84
|
5.15
|
156
|
7.50
|
48
|
3.67
|
3.65
|
3.58
|
78
|
8.86
|
7.39
|
5.20
|
48
|
3.44
|
3.43
|
3.39
|
78
|
7.99
|
7.05
|
5.18
|
168
|
7.05
|
49
|
3.74
|
3.71
|
3.63
|
79
|
9.27
|
7.57
|
5.22
|
49
|
3.50
|
3.49
|
3.44
|
79
|
8.38
|
7.25
|
5.20
|
180
|
6.65
|
50
|
3.81
|
3.78
|
3.68
|
80
|
9.70
|
7.74
|
5.24
|
50
|
3.55
|
3.54
|
3.49
|
80
|
8.80
|
7.45
|
5.22
|
192
|
6.31
|
51
|
3.88
|
3.85
|
3.74
|
81
|
10.17
|
7.90
|
5.25
|
51
|
3.61
|
3.60
|
3.54
|
81
|
9.26
|
7.65
|
5.24
|
204
|
6.01
|
52
|
3.95
|
3.92
|
3.80
|
82
|
10.67
|
8.06
|
5.26
|
52
|
3.68
|
3.66
|
3.60
|
82
|
9.76
|
7.84
|
5.25
|
216
|
5.74
|
53
|
4.03
|
3.99
|
3.86
|
83
|
11.20
|
8.21
|
5.27
|
53
|
3.74
|
3.72
|
3.65
|
83
|
10.31
|
8.02
|
5.26
|
228
|
5.50
|
54
|
4.11
|
4.07
|
3.92
|
84
|
11.77
|
8.36
|
5.27
|
54
|
3.81
|
3.79
|
3.71
|
84
|
10.89
|
8.19
|
5.27
|
240
|
5.29
|
55
|
4.20
|
4.15
|
3.98
|
85
|
12.38
|
8.49
|
5.28
|
55
|
3.89
|
3.86
|
3.77
|
85
|
11.52
|
8.35
|
5.27
|
252
|
5.09
|
56
|
4.29
|
4.23
|
4.04
|
86
|
13.03
|
8.61
|
5.28
|
56
|
3.97
|
3.94
|
3.83
|
86
|
12.21
|
8.50
|
5.28
|
264
|
4.91
|
57
|
4.39
|
4.32
|
4.11
|
87
|
13.72
|
8.73
|
5.28
|
57
|
4.05
|
4.02
|
3.90
|
87
|
12.94
|
8.63
|
5.28
|
276
|
4.75
|
58
|
4.49
|
4.42
|
4.18
|
88
|
14.45
|
8.83
|
5.28
|
58
|
4.14
|
4.10
|
3.96
|
88
|
13.72
|
8.75
|
5.28
|
288
|
4.61
|
59
|
4.60
|
4.52
|
4.24
|
89
|
15.23
|
8.92
|
5.28
|
59
|
4.23
|
4.19
|
4.03
|
89
|
14.54
|
8.86
|
5.28
|
300
|
4.47
|
60
|
4.72
|
4.62
|
4.31
|
90
|
16.06
|
9.01
|
5.28
|
60
|
4.33
|
4.28
|
4.10
|
90
|
15.42
|
8.95
|
5.28
|
312
|
4.35
|
61
|
4.84
|
4.74
|
4.38
|
91
|
16.93
|
9.08
|
5.29
|
61
|
4.43
|
4.38
|
4.17
|
91
|
16.33
|
9.03
|
5.29
|
324
|
4.23
|
62
|
4.97
|
4.85
|
4.45
|
92
|
17.87
|
9.15
|
5.29
|
62
|
4.54
|
4.48
|
4.25
|
92
|
17.28
|
9.11
|
5.29
|
336
|
4.13
|
63
|
5.12
|
4.98
|
4.51
|
93
|
18.85
|
9.21
|
5.29
|
63
|
4.66
|
4.59
|
4.32
|
93
|
18.27
|
9.17
|
5.29
|
348
|
4.03
|
64
|
5.27
|
5.10
|
4.58
|
94
|
19.91
|
9.26
|
5.29
|
64
|
4.79
|
4.70
|
4.39
|
94
|
19.30
|
9.22
|
5.29
|
360
|
3.94
|
65
|
5.43
|
5.24
|
4.64
|
95
|
21.04
|
9.30
|
5.29
|
65
|
4.93
|
4.83
|
4.47
|
95
|
20.38
|
9.27
|
5.29
|
66
|
5.60
|
5.38
|
4.71
|
96
|
22.27
|
9.33
|
5.29
|
66
|
5.07
|
4.95
|
4.54
|
96
|
21.52
|
9.31
|
5.29
|
||
67
|
5.79
|
5.52
|
4.77
|
97
|
23.60
|
9.36
|
5.29
|
67
|
5.22
|
5.09
|
4.61
|
97
|
22.75
|
9.34
|
5.29
|
||
68
|
5.99
|
5.68
|
4.83
|
98
|
25.10
|
9.38
|
5.29
|
68
|
5.39
|
5.23
|
4.69
|
98
|
24.10
|
9.37
|
5.29
|
||
69
|
6.20
|
5.83
|
4.88
|
99
|
26.78
|
9.39
|
5.29
|
69
|
5.57
|
5.38
|
4.75
|
99
|
25.63
|
9.39
|
5.29
|
Note:
|
Due
to the length of the information, the Table for Option 2 is available from
the Service Center upon Your
request.
|
BASIS OF COMPUTATION. The
actuarial basis for the Table of Income Options is the Annuity 2000 Mortality
Table, with an assumed net investment rate of 2.50%. The interest rate used in
the present value calculation referred to in Options 3 and 4 will be determined
by the Company, but in no instance will it be greater than the rate used to
calculate the initial payment. The Table of Income Options does not include any
applicable tax. The benefits of this Contract will not vary due to expense
and/or mortality results.
VA340NY 24