Exhibit 1.A.(13)(a)
RIDER FOR TERM INSURANCE BENEFIT ON LIFE OF SECOND INSURED TO DIE
This benefit is part of this contract only if it is included in the list of
other benefits on the contract data pages. As part of the contract, it is
subject to all the provisions of the contract.
Benefit
We will pay an amount under this rider if we receive due
proof that the death of the second Insured to die occurred in the term period
for the rider and while this contract is in force. We will pay this amount to
the beneficiary for insurance payable upon the death of the second Insured to
die. But our payment is subject to all the provisions of the rider and of the
rest of this contract.
We show the amount of term insurance under this benefit and the term period on a
contract data page. The term period starts on the contract date. The anniversary
at the end of the term period is part of that period.
Rider Charges
The maximum charge for this rider is shown under Adjustments to the Contract
Fund. In determining this charge we will periodically consider factors such as
mortality, persistency, expenses, taxes and/or investment experience.
Termination
This rider will end on the earliest of:
the end of its term period;
the end of the grace period if the contract is in default and the premium
required to bring it out of default has not been paid; and
the date the contract ends for any other reason.
Further, if you ask us in a form that meets our needs, we will cancel the
benefit as of the first monthly date on or after we receive your request.
Monthly charges due then and later will be reduced accordingly.
This rider is subject to the terms and conditions of the Incontestability and
Suicide provisions of this contract.
Rider attached to and made part of this contract on the Contract Date.
PROCESSING DATE: XXX XX, XXXX
CONTRACT DATA
Insured(s) Information
(1) [XXXX XXX] [Male], [Issue Age 55]
(2) [XXXX XXX] [Female], [Issue Age 52]
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Rating Class
Insured (1) [Non-smoker]
Insured (2) [Non-smoker]
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Basic Contract Information
Policy Number [xx xxx xx]
Contract Date [January 1, 2000]
Premium Period While either Insured is living
Beneficiary [See Beneficiary Provision attached]
Loan Interest Rate 5.00%
Preferred Loan Interest Rate 4.25%
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Type of Death Benefit (see Death Benefit Provisions)
Type [A]
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Survivorship Insurance
Basic Insurance Amount [$250,000.00]
Additional amount(s) provided by rider(s). Refer to the appropriate form for
details.
Xxxxx XX 194 C
Rider for Term Insurance Benefit on Life of Second Insured to Die
(Term Period is 4 years starting on the Contract Date)
Amount [$100,000.00]
Total Survivorship Insurance on the Contract Date [$350,000.00]
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CONTRACT DATA CONTINUED ON THE NEXT PAGE
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PROCESSING DATE: XXX XX, XXXX
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
Minimum Initial Premium
The minimum initial premium due on the Contract Date is [$622.11].
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Contract Limitations
The minimum premium we will accept is $25.00.
The minimum Basic Insurance Amount is $250,000.00.
The minimum decrease in Basic Insurance Amount is $10,000.00.
The minimum amount you may withdraw is $500.00.
The minimum amount you may borrow is $500.00.
The surrender charge threshold is [$250,000.00].
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Adjustments to Premium Payments
From each premium paid we will:
subtract a charge of up to 7.5% for any taxes attributable to premiums. For
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purposes of this charge, the term "taxes attributable to premiums" shall
include: (a) any federal, state or local income tax, (b) any premium, excise,
or business tax, and (c) any other type of tax (or component thereof) measured
by or based upon the amount of premium received by us.
subtract a charge for sales expenses from premiums paid in the first five
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contract years at a rate of up to 12%.
subtract a charge for sales expenses from premiums paid after the fifth
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contract year at a rate of up to 4%.
The remainder of the premium is the invested premium amount.
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Adjustments to the Contract Fund
On the Contract Date the contract fund is equal to the invested premium amount
credited on that date, minus
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a charge for administrative expenses of up to $0.10 per $1,000 of the basic
insurance amount effective on the Contract Date plus $10.00.
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POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
a charge for the cost of insurance of up to the maximum monthly rate (see
Table of Maximum Monthly Insurance Rates) multiplied by the coverage amount
divided by $1000. The coverage amount is equal to the death benefit (see Death
Benefit) minus the contract fund.
On each day after the contract date, we will adjust the contract fund by:
adding any invested premium amounts.
------
adding any increase due to investment results of the variable investment
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options.
adding guaranteed interest at an effective annual rate of 4% (0.01074598% a
------
day) on that portion of the contract fund that is not in a variable investment
option (see Fixed Investments and Loans).
adding any excess interest on that portion of the contract fund that is not in
------
a variable investment option.
subtracting any decrease due to investment results of the variable investment
-----------
options.
subtracting a charge against the variable investment options at an effective
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annual rate of not more than 0.90% a year (.00245475% a day) for mortality and
expense risks that we assume.
subtracting any withdrawals.
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subtracting an administrative charge of up to $25.00 for any withdrawals.
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subtracting an administrative charge of up to $25.00 for any decrease in Basic
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Insurance Amount.
subtracting an administrative charge of up to $25.00 for each transfer
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exceeding twelve in any contract year.
subtracting any surrender charge that may result from a withdrawal, surrender,
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or reduction in the Basic Insurance Amount.
And on each monthly date, we will adjust the contract fund by:
subtracting a monthly charge for administrative expenses during the first five
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Contract Years of up to $0.10 per $1000 of the Basic Insurance Amount plus
$10.00.
subtracting a monthly charge for administrative expenses after the first five
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Contract Years of up to $0.05 per $1000 of the Basic Insurance Amount plus
$10.00.
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POLICY NO. XX XXX XXX
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subtracting a monthly charge for the cost of insurance of up to the maximum
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monthly rate (see Table of Maximum Monthly Insurance Rates) multiplied by the
coverage amount divided by $1000. The coverage amount is equal to the death
benefit (see Death Benefit) minus the contract fund.
subtracting a maximum monthly charge for the following benefits:
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the maximum monthly charge for Xxxxx XX 194 C during the first four contract
years is the rate shown under the Table of Maximum Monthly Insurance Rates,
plus $0.05 multiplied by the rider amount (shown under Survivorship
Insurance) divided by $1,000.
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Schedule of Maximum Surrender Charges
For a full surrender at the beginning of the contract year indicated, the
maximum charge we will deduct from the contract fund is shown below. For a
full surrender at other times, the surrender charge will reflect the completed
contract months that have passed since the last anniversary.
For a Surrender Occurring
At the Start of The Maximum Surrender
Contract Year Charge is
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1 [$2,000.00]
2 [$2,000.00]
3 [$2,000.00]
4 [$2,000.00]
5 [$2,000.00]
6 [$2,000.00]
7 [$1,600.00]
8 [$1,200.00]
9 [$800.00]
10 [$400.00]
11 and later [$0.00]
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We may also deduct a surrender charge when you decrease the Basic
Insurance Amount or change the type of death benefit, and when you make a
withdrawal. (See Decrease in Basic Insurance Amount, Changing the Type of
Death Benefit, and Withdrawals.)
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CONTRACT DATA CONTINUED ON NEXT PAGE
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PROCESSING DATE: XXX XX, XXXX
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
Variable Investment Options
The Pruco Life of New Jersey Variable Appreciable Account
Each variable investment option of this account invests in a specific
portfolio of The Prudential Series Fund, Inc. and such other funds as we may
specify from time to time. We show the available variable investment options
of the account below. Unless we say otherwise, the variable investment
options invest in funds or fund portfolios with the same names. This account
is registered with the SEC under the Investment Company Act of 1940.
The Prudential Series Fund, Inc.
Money Market Portfolio
Diversified Bond Portfolio
Conservative Balanced Portfolio
Flexible Managed Portfolio
High Yield Bond Portfolio
Stock Index Portfolio
Equity Income Portfolio
Equity Portfolio
Prudential Xxxxxxxx Portfolio
Global Portfolio
AIM Variable Insurance Funds, Inc.
AIM V.I. Value Fund
Janus Aspen Series
Janus Aspen Growth Portfolio
MFS Variable Insurance Trust
MFS Emerging Growth Series
X. Xxxx Price International Series, Inc.
X. Xxxx Price International Stock Portfolio
CONTRACT DATA CONTINUED ON NEXT PAGE
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PROCESSING DATE: XXX XX, XXXX
POLICY NO. XX XXX XXX
CONTRACT DATA CONTINUED
American Century Variable Portfolio, Inc.
American Century VP Value Fund
Xxxxxxxxx Variable Products Series Fund
Franklin Small Cap Investments Fund-Class 2
Fixed Interest Rate Investment Option
The fixed interest rate investment option is funded by the general account of
the Company. It is described in the Fixed Investments provision of this
contract.
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Initial Allocation of Invested Premium Amounts
[Fixed Interest Rate Investment Option] [40%]
[Flexible Managed Portfolio] [60%]
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END OF CONTRACT DATA
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PROCESSING DATE: XXX XX, XXXX
POLICY NO. XX XXX XXX
TABLE(S)
Table of Death Benefit Guarantee Values
These values are used to determine the death benefit guarantee as described
under Death Benefit Guarantee. The values on contract anniversaries are shown
below. On a date that falls between two anniversaries, the value will fall
between the values for those anniversaries considering the time that has passed
since the last anniversary.
The Limited Death Benefit Guarantee period is the first [23] contract years.
Limited Lifetime
Contract Death Benefit Death Benefit
Anniversary Guarantee Value Guarantee Value
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Contract Date [$0.00] [$0.00]
1st [$1,674.97] [$5,631.90]
2nd [$3,416.94] [$11,489.08]
3rd [$5,228.59] [$17,580.54]
4th [$7,112.71] [$23,915.66]
5th [$8,968.51] [$30,400.51]
6th [$25,550.39] [$37,144.75]
7th [$30,352.64] [$44,158.76]
8th [$35,346.98] [$51,453.33]
9th [$40,541.09] [$59,039.69]
10th [$45,942.97] [$66,929.50]
11th [$51,560.92] [$75,134.90]
12th [$57,403.59] [$83,668.52]
13th [$63,479.97] [$92,543.48]
14th [$69,799.40] [$101,773.44]
15th [$76,371.61] [$111,372.60]
16th [$83,206.71] [$121,355.73]
17th [$90,315.21] [$131,738.18]
18th [$97,708.05] [$142,535.93]
19th [$105,396.61] [$153,765.59]
20th [$113,392.71] [$165,444.44]
21st [$121,708.65] [$177,590.44]
22nd [$130,357.23] [$190,222.28]
23rd [$139,351.75] [$203,359.40]
24th [$217,022.00]
25th [$231,231.10]
TABLE(S) CONTINUED ON NEXT PAGE
Page 4 (2000)
PROCESSING DATE: XXX XX, XXXX
POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
Limited Lifetime
Contract Death Benefit Death Benefit
Anniversary Guarantee Value Guarantee Value
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26th [$246,008.57]
27th [$261,377.14]
28th [$277,360.45]
29th [$293,983.09]
30th [$311,270.64]
31st [$329,249.69]
32rd [$347,947.90]
33rd [$367,394.04]
34th [$387,618.03]
35th [$408,650.98]
36th [$430,525.24]
37th [$453,274.47]
38th [$476,933.67]
39th [$501,539.24]
40th [$527,129.03]
41st [$553,742.42]
42nd [$581,420.34]
43rd [$610,205.38]
44th [$640,141.82]
45th [$671,275.72]
46th [$703,654.97]
47th [$737,329.39]
48th [$772,350.79]
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On the [23rd] Contract Anniversary, if your accumulated net payments (premium
payments accumulated at 4% annual interest less any withdrawals accumulated at
4% annual interest) are equal to the Limited Death Benefit Guarantee Value shown
above for that anniversary, a monthly net premium payment (premium less any
withdrawal) of no more than [$6,472.52]. would be needed to bring the
accumulated net payments up to the Lifetime Death Benefit Guarantee Value shown
above for the next anniversary.
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TABLE(S) CONTINUED ON NEXT PAGE
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POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
Table of Maximum Monthly Insurance Rates per $1,000
Contract Maximum Contract Maximum
Year Monthly Rate Year Monthly Rate
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1 [0.00346] 26 [3.59752]
2 [0.01159] 27 [4.16392]
3 [0.02168] 28 [4.80287]
4 [0.03412] 29 [5.52620]
5 [0.04921] 30 [6.34146]
6 [0.06728] 31 [7.25393]
7 [0.08873] 32 [8.25881]
8 [0.11463] 33 [9.34439]
9 [0.14605] 34 [10.49932]
10 [0.18443] 35 [11.71790]
11 [0.23149] 36 [12.99841]
12 [0.28919] 37 [14.34320]
13 [0.35833] 38 [15.76527]
14 [0.44016] 39 [17.29274]
15 [0.53580] 40 [18.99353]
16 [0.64692] 41 [20.97260]
17 [0.77599] 42 [23.40832]
18 [0.92855] 43 [26.56868]
19 [1.11005] 44 [30.68652]
20 [1.32664] 45 [35.84659]
21 [1.58423] 46 [44.77000]
22 [1.88796] 47 [61.99667]
23 [2.23965] 48 [83.33333]
24 [2.64066]
25 [3.09213]
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We may charge less than the maximum monthly rates. From time to time, we
will consider the need to change the rates we charge. We describe the
factors we use to determine such changes under General Provisions.
See the Basis of Computation for a description of the basis we use to
compute these rates.
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POLICY NO. XX XXX XXX
TABLE(S) CONTINUED
Table of Attained Age Factors
These factors are used to determine your death benefit as described under Death
Benefit Provisions.
These factors apply during each contract year starting on the contract
anniversary when the younger insured's attained age is as shown.
Attained Age of Attained Age of
Younger Insured Factors Younger Insured Factors
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52 [3.70] 76 [1.65]
53 [3.60] 77 [1.61]
54 [3.40] 78 [1.60]
55 [3.30] 79 [1.52]
56 [3.20] 80 [1.50]
57 [3.10] 81 [1.45]
58 [3.00] 82 [1.42]
59 [2.90] 83 [1.40]
60 [2.80] 84 [1.36]
61 [2.70] 85 [1.33]
62 [2.60] 86 [1.31]
63 [2.50] 87 [1.30]
64 [2.40] 88 [1.26]
65 [2.32] 89 [1.24]
66 [2.30] 90 [1.22]
67 [2.20] 91 [1.20]
68 [2.10] 92 [1.19]
69 [2.03] 93 [1.17]
70 [2.00] 94 [1.15]
71 [1.91] 95 [1.13]
72 [1.90] 96 [1.10]
73 [1.80] 97 [1.07]
74 [1.74] 98 [1.06]
75 [1.70] 99 [1.04]
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END OF TABLE(S)
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