EXHIBIT 99.4(a)
Form of Individual Flexible Premium Variable
Annuity Contract (draft)
Pacific Mutual
Life Insurance Company
000 Xxxxxxx Xxxxxx Xxxxx
XXXXXXX XXX Xxxxxxx Xxxxx, XX 00000
================================================================================
Individual Flexible Premium Variable Annuity Contract
. Investment Experience Reflected in Benefits
. Variable and Fixed Accumulation Before Annuity Date; Variable and Fixed
Annuity Payments Thereafter
. Death Benefit Proceeds Payable Before Annuity Date
. Participating
Please read your contract carefully. This is a legal contract between you, the
Owner, and us, Pacific Mutual Life Insurance Company, a mutual company.
We agree to pay the benefits of this Contract according to its provisions.
The consideration for this Contract is the application for it, (copy or
confirmation is attached) and our receipt of the purchase payment(s).
Contract Loan Amount is less than 100% of Contract Value.
Benefits and values under this Contract may be on a variable basis. Amounts
directed into one or more of the Variable Investment Options will reflect the
investment experience of those Investment Options. These amounts may increase
or decrease, and are not guaranteed as to a dollar amount.
Free Look Right -- You may return this Contract within 10 days after you
receive it. To do so, mail it to us at our Service Center or to the agent who
sold it to you. This Contract will then be deemed void from the beginning. No
withdrawal fee will be imposed, and we will refund:
. any Purchase Payments allocated to the Fixed Option; and
. any Variable Account Value as of the Business Day we receive the Contract;
plus
. any Contract fees and charges for premium taxes and or other taxes we deduct
from your Contract Value allocated to the Variable Accounts.
Signed at our Home Office, 000 Xxxxxxx Xxxxxx Xxxxx, Xxxxxxx Xxxxx, Xxxxxxxxxx
00000.
Chairman and Chief Executive Officer Secretary
Form 95-01
CONTRACT SPECIFICATIONS
SERVICE CENTER: Send Forms and written requests to: Send Payments to:
Pacific Mutual Life Pacific Mutual Life
Insurance Company Insurance Company
X.X. Xxx 0000 X.X. Xxx 000000
Xxxxxxxx, Xxxxxxxxxx Xxxxxxxx, Xxxxxxxxxx
00000-0000 91189-0060
Toll-free number: 1-800-722-2333 (between 6:00 a.m. and 5:00 p.m., Pacific
Time)
Please use our toll-free number to present inquiries or obtain information
about your coverage and for us to provide assistance in resolving complaints.
BASIC CONTRACT - NON-QUALIFIED PLAN
INVESTMENT OPTIONS:
FIXED OPTION
VARIABLE INVESTMENT OPTIONS:
MONEY MARKET MULTI-STRATEGY
HIGH YIELD BOND EQUITY
MANAGED BOND BOND AND INCOME
GOVERNMENT SECURITIES EQUITY INDEX
GROWTH LT INTERNATIONAL
EQUITY INCOME ---------------
ADMINISTRATIVE CHARGE: 0.15%
MORTALITY AND EXPENSE RISKS CHARGE: 1.25%
ANNUAL FEE: $40 IF CONTRACT IS LESS THAN $100,000
CONTRACT NUMBER: 001234567-0
CONTRACT DATE: JAN 01, 1995
OWNER(S): XXXXXX XXXXXXXX XXX
ANNUITANT(S): XXXXXX XXXXXXXX DOE
ANNUITANT'S ISSUE AGE AND SEX: 35, MALE
INITIAL PURCHASE PAYMENT: $25,000
ANNUITY START DATE: JAN 01, 2045
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DEFINITIONS
PM, we, our and us -- Pacific Mutual Life Insurance Company.
You and your -- The person or persons named as Owner(s) in the Contract
Specifications. If there are Joint Owners, you and your means both Joint
Owners.
Account Value -- The amount of your Contract Value allocated to a Subaccount(s)
or to the Fixed Option.
Age -- The Owner's or Annuitant's attained age, as applicable, at his or her
last birthday.
Annuitant -- The person you name on whose life annuity payments may be
determined. The Annuitant's life may also be used to determine certain minimum
death benefits, and the Annuity Date. If you designate Joint Annuitants or a
Contingent Annuitant, unless otherwise stated, "Annuitant" means the sole
surviving Annuitant. You cannot change the Annuitant or change or add a Joint
Annuitant except that if your Contract is a Qualified Contract, you may add a
Joint Annuitant on the Annuity Date.
Annuity Date ("Annuity Start Date") -- The date shown in the Contract
Specifications, or the date you later elect, if any, for the start of annuity
payments if the Annuitant is still living and the Contract is in force.
Annuity Options -- A set of features of a series of payments after your Annuity
Date.
Beneficiary -- The person you name who may receive any death benefit proceeds
payable on the death of the Annuitant or an Owner prior to the Annuity Date; or
any remaining annuity benefits payable on the death of the Annuitant after the
Annuity Date. If no Beneficiary is named or the Beneficiary does not survive
the Annuitant, and the Annuitant dies, then the Annuitant's estate will have the
rights of the Beneficiary. If you are not the Annuitant and you die before the
Annuitant, and before the Annuity Date, any death benefit proceeds will be
payable to the surviving Joint Owner, if any; otherwise to the surviving
Contingent Owner, if any; otherwise, to the Beneficiary, if living; otherwise,
to the Annuitant or the Annuitant's estate.
Business Day -- Any day on which the value of the amount invested in a
Subaccount is determined. In this Contract, "day" or "date" means Business Day
unless otherwise stated. If any transaction or event under this Contract is
scheduled to occur on a "corresponding date" that does not exist in a given
calendar period, or on a day that is not a Business Day, such transaction or
event will be deemed to occur on the next following Business Day, unless
otherwise stated.
Code -- The Internal Revenue Code of 1986, as amended.
Contingent Annuitant -- The person, if any, you select who may become the
Annuitant if the Annuitant dies before your Annuity Date. You may add or change
your Contingent Annuitant prior to the Annuity Date provided the existing
Contingent Annuitant is not the sole surviving Annuitant. Any Contingent
Annuitant you name must not have attained age 86 as of your Contract Date.
Contingent Owner -- The person, if any, you select who may succeed to your
rights as Owner of this Contract if you die before your Annuity Date.
Contract Anniversary -- The same date in each subsequent year as your Contract
Date.
Contract Date -- The date we issue your Contract, as shown in the Contract
Specifications. Contract Years, Contract Semi-Annual Periods, Contract Quarters
and Contract Months are measured from this date.
Contract Debt -- As of the end of any Business Day, the principal amount you
have outstanding on any loan under this Contract, plus any accrued and unpaid
interest.
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Contract Value -- As of the end of any Business Day, your Variable Account
Value, plus your Fixed Option Value, plus the amount held in the Loan Account to
secure your Contract Debt, if any, including any interest.
Fixed Option -- Amounts allocated under your Contract to the Fixed Option are
held in our General Account and receive interest at rates declared periodically
("the Guaranteed Interest Rate"), but not less than 3% on an annual basis.
General Account -- Our General Account consists of all assets of PM, other than
those assets allocated to Separate Account A or to any of our other separate
accounts.
Investment Option -- A Variable Account or a Fixed Option offered under the
Contract.
Loan Amount -- As of the end of any Business Day, the Loan Amount equals the
amount that is eligible as a loan under the Contract if your Contract is issued
under a Qualified Plan under Code Section 401(a), 401(k), 403(a), or 403(b) and
your Qualified Plan permits loans.
Non-qualified Contract -- A Contract other than a Qualified Contract.
Owner -- The person(s) who has (have) all rights under this Contract before the
Annuity Date. If your Contract names Joint Owners, Owner means both Joint
Owners.
Purchase Payment (Premium Payment) -- An amount paid to us by or on behalf of an
Owner as consideration for the benefits provided under this Contract.
Qualified Contract -- A Contract that qualifies under the Code as an individual
retirement annuity ("XXX"), or a Contract purchased by a Qualified Plan that
qualifies for special tax treatment under the Code.
Qualified Plan -- A retirement plan that receives favorable tax treatment under
Section 401, 403(a) and (b), 408, or 457 of the Code.
SEC -- Securities and Exchange Commission.
Separate Account / The Separate Account A -- A separate account of PM that
consists of Subaccounts.
Service Center -- PM's mailing address shown in the Contract Specifications. We
will notify you of any change in our mailing address.
Subaccount -- An investment division of the Separate Account. Each Subaccount,
(a "Variable Investment Option" or "Variable Account"), invests its assets in a
separate series or class of shares of a designated investment company.
Subaccount Annuity Unit (Annuity Units) -- Annuity Units are used to measure
variation in variable annuity payments. The amount of each variable annuity
payment (after the first payment) will vary with the value and number of your
Annuity Units in each Subaccount.
Subaccount Unit -- Subaccount units are used to measure your Contract Value in
that Subaccount.
Variable Account (A "Variable Investment Option") -- A Subaccount of a PM
Separate Account or a separate account of PM, which is available under your
Contract, in which assets of PM are segregated from assets in its General
Account and other separate accounts.
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PURCHASE PAYMENTS
Purchase Payments -- This Contract will not be in force until we receive the
initial purchase payment. Your initial purchase payment is shown in the
Contract Specifications. You may make additional purchase payments at any time
before the Annuity Date, while the Annuitant is living and this Contract is in
force. Each additional purchase payment must be at least $1,000. We may limit
the amount of any single purchase payment. You must obtain our consent before
making a purchase payment that will bring your aggregate purchase payments over
$500,000.
Purchase payments are payable in U.S. dollars either at our Service Center or
through our agent. Checks should be made payable to Pacific Mutual Life
Insurance Company. If you make purchase payments by check other than a
cashier's check, your withdrawal requests and any refund under the "free look"
period may be delayed until your check has cleared. On written request a
receipt for the purchase payment signed by an officer of PM will be provided
after payment.
Purchase Payment Allocation -- You may allocate all or a part of a purchase
payment to one or more of the Investment Options prior to the Annuity Date. We
will allocate your purchase payments that we receive during the Free Look Period
as shown in your application, or most recent allocation instructions received by
us, if any.
You may change your allocation by sending us proper instructions. See GENERAL
PROVISIONS: Instructions and Requests. We will allocate any purchase payment
according to your most recent allocation instructions. We may reject any
instruction or purchase payment that does not comply with our requirements.
Minimum Investment Option Amount -- We reserve the right to require that, as a
result of any allocation to an Investment Option, any transfer, or any partial
withdrawal, your remaining Account Value in any Investment Option must meet a
minimum Account Value amount. We also reserve the right to transfer any
remaining Account Value that does not meet such minimum amount to your other
Investment Options on a prorata basis relative to your most recent allocation
instructions.
THE FIXED OPTION
Under the Fixed Option, we credit interest at the Guaranteed Interest Rate(s)
during each Guarantee Term on the amount of purchase payments and or Contract
Value that you allocate or transfer to, or roll over in, the Fixed Option, as
described below.
Purchase payments and or Contract Value you allocate or transfer to, or roll
over in, the Fixed Option are held in our General Account. Subject to
applicable law, we have sole discretion over the investment of our General
Account assets.
Guarantee Term -- We credit your Contract with a "Guaranteed Interest Rate(s)"
for a specified period of time (a "Guarantee Term") of up to one year on that
portion of your purchase payment and or Contract Value allocated to the Fixed
Option, while the Annuitant is living and this Contract is in force, and prior
to the Annuity Date. We credit the Guaranteed Interest Rate in effect on the
Business Day that the allocation and or transfer is effective for an initial
Guarantee Term that ends on your next Contract Anniversary.
At the end of each initial Guarantee Term and each succeeding Guarantee Term, we
roll over your Fixed Option Value attributed to that Guarantee Term to a new
Guarantee Term of at least one year, unless you instruct us otherwise. We
credit the Guaranteed Interest Rate(s) in effect at the time of the rollover on
the amount of the Fixed Option Value rolled over until the end of such Guarantee
Term. We reserve the right to offer Guarantee Terms for durations other than
one year.
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We stop crediting interest on that portion of your Fixed Option Value you
withdraw, transfer, (including transfers to the Loan Account), or convert to an
Annuity Option, including: any fees for withdrawals or transfers; any annual
fee; and any charges for premium taxes and or other taxes. We do so as of the
end of the Business Day any such transaction is effective.
Guaranteed Interest Rate -- Guaranteed Interest Rates may be reset periodically,
but will never be less than the Minimum Guaranteed Interest Rate of 3% annually.
All Guaranteed Interest Rates are expressed as annual rates, and interest is
accrued daily.
VARIABLE INVESTMENT OPTIONS
The Variable Investment Options consist of Subaccounts of the Separate Account.
The available Subaccounts as of the Contract Date are shown in the Contract
Specifications.
Separate Account -- We established and maintain the Separate Account under the
laws of California. Any income, gains or losses (whether or not realized) from
the assets of each Variable Account are credited or charged against such
Variable Account without regard to our other income, gains, or losses. Assets
may be put in our Separate Account to support this Contract and other variable
annuity contracts. Assets may be put in our Separate Account for other
purposes, but not to support contracts other than variable annuity contracts.
The assets of our Separate Account are our property. The portion of the
Separate Account assets equal to the reserves and other Contract liabilities
with respect to each Variable Account will not be chargeable with liabilities
arising out of any other business we conduct. We may transfer assets of a
Separate Account in excess of the reserves and other liabilities with respect to
that Variable Account to another separate account or to our General Account.
All obligations arising under the Contract are our general corporate
obligations. We do not hold ourselves out to be trustees of the Separate Account
assets.
We reserve the right, subject to compliance with the law then in effect, and
after any required regulatory approval, to:
. add or change designated investment companies or their portfolios, or other
investment vehicles;
. add, delete or make substitutions for the securities and other assets that
are held or purchased by the Separate Account or any Variable Account;
. permit conversion or exchanges between portfolios and or classes of
contracts on the basis of Owners' requests;
. add, remove or combine Variable Accounts;
. combine the assets of any Variable Account with any other separate account
of PM or of any of its affiliates;
. register or deregister Separate Account A or any Variable Account under the
Investment Company Act of 1940 ("1940 Act");
. operate any Variable Account as a managed investment company under the 1940
Act;
. run any Variable Account under the direction of a committee, board, or
other group;
. restrict or eliminate any voting rights of Owners with respect to any
Variable Account or other persons who have voting rights as to any Variable
Account;
. make any changes required by the 1940 Act or other federal securities laws;
. make any changes necessary to maintain the status of the Contracts as
annuities under the Code;
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. make other changes required under federal or state law relating to
annuities;
. suspend or discontinue sale of the Contracts, and;
. comply with law.
If any of these changes result in a material change in the underlying
investments of a Variable Account, we will notify you of such change.
We will not change the investment policy of the Separate Account without: (1)
the approval of the Insurance Commissioner in the State of California; and (2)
following the filing and other procedures established by insurance regulators of
the state of issue, with whom the approval process is on file. Unless required
by law or regulation, an investment policy may not be changed without our
consent.
From time to time we may make other Variable Accounts available to you. Any new
Variable Accounts may invest in portfolios of the designated investment company,
other designated investment companies or their portfolios, or in other
investment vehicles. New Variable Accounts will be made available to existing
Owners at our discretion. We will provide you with written notice of all
material details, including investment objectives and charges. We will comply
with the filing or other procedures established by applicable state insurance
regulators, to the extent required by applicable law.
CONTRACT VALUE
Your Contract Value on any Business Day is the sum of: your Fixed Option Value
on that day; plus your Variable Account Value on that day; plus your Loan
Account Value to secure any Contract Debt on that day. We generally determine
values at or about 4:00 p.m., Eastern time, on each day that the New York Stock
Exchange is open, provided our offices are also open on that day.
Fixed Option Value -- Your Fixed Option Value on any Business Day is: your
Fixed Option Value on the prior Business Day increased by interest; plus the
amount of any purchase payments received by us and allocated to the Fixed Option
on that day; plus the amount of any transfers to the Fixed Option on that day,
including transfers from the Loan Account; minus any deductions from the Fixed
Option on that day caused by: transfers, including transfers to the Loan
Account; withdrawals; amounts converted to an Annuity Option; any charges for
premium taxes and or other taxes; any fees for withdrawals and or transfers; and
any annual fee. See THE FIXED OPTION.
Variable Account Value -- Your Variable Account Value on any Business Day is the
sum of your Subaccount Values on that day.
Subaccount Value -- Your Subaccount Value for each Subaccount on any Business
Day is the number of Subaccount Units in the Subaccount that are credited to
your Contract on that day multiplied by the Unit Value of the Subaccount on that
day.
We credit your Contract with Subaccount Units for a Subaccount as a result of:
any portion of your purchase payments received by us and allocated to the
Subaccount; and any transfers of your Contract Value to the Subaccount,
including transfers from the Loan Account.
We debit your Contract with Subaccount Units for a Subaccount as a result of any
deductions from the Subaccount, including those caused by: withdrawals;
transfers, (including transfers to the Loan Account); amounts converted to an
Annuity Option; any fees for transfers and or withdrawals; any charges for
premium taxes and or other taxes; and any annual fee.
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The number of Subaccount Units we debit or credit to your Contract in connection
with a transaction is equal to the amount of the transaction applicable to that
Subaccount divided by that Subaccount's Unit Value on that day. The number of
your Subaccount Units in a Subaccount will change only if we debit or credit
Subaccount Units for the transactions above. The number of Subaccount Units
will not change because of subsequent changes in the Subaccount Unit Value.
Subaccount Unit Value -- The initial Unit Value of each Subaccount was $10 on
the Business Day the Subaccount began operations. At the end of each subsequent
Business Day, the Unit Value for each Subaccount is equal to Y x Z where:
(Y) is the Unit Value for that Subaccount as of the end of the prior Business
Day; and
(Z) is the Net Investment Factor for that Subaccount for the period (a
"valuation period") between the prior Business Day and that Business Day.
Net Investment Factor -- Each Subaccount's Net Investment Factor for any
valuation period is equal to (A/B)-C where:
(A) is the net result of:
(a) the net asset value per share of the portfolio shares held by the
Subaccount as of the end of that valuation period;
(b) plus the per share amount of any dividend or capital gain
distributions made during that valuation period on the portfolio
shares held by the Subaccount;
(c) minus or plus any per share charge or credit for any income taxes,
other taxes, or amount(s) set aside during that valuation period as a
reserve for any income and or any other taxes for which we determine
to have resulted from the operations of the Subaccount or Contract,
and or any taxes attributable, directly or indirectly, to purchase
payments;
(B) is the net asset value per share of the portfolio shares held by the
Subaccount as of the end of the prior valuation period; and
(C) is a factor that we assess against the net assets held by each Subaccount
for the mortality and expense risk charge and the administrative fee
during that valuation period.
Loan Account Value -- Your Loan Account Value as of the end of any Business Day
is: your Loan Account Value on the prior Business Day, increased by interest;
plus any Contract Debt loaned on that day; minus any Contract Debt repaid on
that day, including any withdrawal from the Loan Account to repay Contract Debt;
and minus any earned interest transferred from the Loan Account on that day.
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CHARGES, FEES AND DEDUCTIONS
Administrative Fee -- We charge an administrative fee against assets held in
each Subaccount. This fee is assessed daily at the annual rate of .15%. This
fee is guaranteed not to increase.
Annual Fee -- We charge an annual fee of $40 on each Contract Anniversary
against your Contract Value, and at the time you make a full withdrawal, if your
Contract Value is less than $100,000 on that date. This fee is guaranteed not
to increase.
We will deduct the annual fee, if any, from each Investment Option on a prorata
basis relative to your Account Value in each Investment Option. Any annual fee
we deduct from a Subaccount will reduce the number of Subaccount Units credited
to your Contract.
No annual fee is charged on amounts you annuitize or on payment of any death
benefit proceeds.
Mortality and Expense Risk Charge -- We impose a mortality and expense risk
charge against assets held in each Subaccount. This charge is assessed daily at
the annual rate of 1.25%. The mortality and expense risk charge is to
compensate us for the risks we assume that mortality and expenses will vary from
those we assumed. This charge is guaranteed not to increase.
Premium Taxes -- From your Contract Value, we will deduct a charge for any taxes
we pay that are attributable to purchase payments, ("premium taxes"). Such
taxes will include, but not be limited to: any federal, state or local premium
taxes; and any federal, state or local income, excise, business or any other
type of tax, (or component thereof), measured by or based upon, directly or
indirectly, the amount of purchase payments we receive from you. We will
normally deduct this charge when you annuitize. We may impose this charge on a
full withdrawal, a partial withdrawal at the time any death benefit is paid, or
when we pay the taxes. We will base this charge on the Contract Value, the
amount of the transaction, the aggregate amount of purchase payments we receive
under your Contract or any other amount, at our sole discretion, we deem
appropriate.
Other Taxes -- We reserve the right to charge the Separate Account and or deduct
from your Contract Value a charge for any federal, state or local taxes we pay
that are or become attributable to the Separate Account or Contract, including,
but not limited to, income taxes attributable to our operation of the Separate
Account or to our operations with respect to the Contract, or taxes
attributable, directly or indirectly, to purchase payments.
Transfer Fee -- We reserve the right to impose a transfer fee of $15 on each
transfer made in excess of fifteen transfers in any Contract Year. We will
treat each transfer request as a single transfer, regardless of the number of
Investment Options or Guarantee Terms from which or to which Account Values are
to be transferred. We will deduct any transfer fee we impose from your Contract
Value on a prorata basis relative to your Account Value in each Investment
Option immediately after the transfer.
Withdrawal Fee -- We reserve the right to impose a withdrawal fee of $15 on each
partial withdrawal made in excess of fifteen withdrawals in any Contract Year.
We will deduct from your Contract Value, on a prorata basis relative to your
Account Value in each Investment Option immediately after the withdrawal, any
such fee we impose on a partial withdrawal. We will treat each withdrawal
request as a single withdrawal, regardless of the number of Investment Options
or Guarantee Terms from which Account Values are to be withdrawn.
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TRANSFERS
You may make transfers under this Contract subject to certain restrictions and
any transfer fees.
You may request transfer of part or all of your Contract Value among Investment
Options as often as you wish, while your Annuitant is living and prior to the
Annuity Date.
If your transfer causes your Account Value remaining in any Investment Option
immediately after such transfer to be less than any minimum amount we may
establish, we may transfer such remaining Account Value to your other Investment
Options on a prorata basis relative to your most recent allocation instructions.
We may reject any transfer request. We also reserve the right to limit the size
of transfers, to limit the number and frequency of transfers, to restrict
transfers, and to suspend the right to transfer.
WITHDRAWALS
You may, prior to your Annuity Date, withdraw all or a portion of the amount
available under your Contract, while the Annuitant is living and your Contract
is in force. If you make a full withdrawal, we require return of your Contract
with your written request, or a signed lost Contract affidavit. You may choose
to withdraw from any specific Investment Option(s), or from all Investment
Options proportionately. If you do not specify, we will make the withdrawal
from your Investment Options on a prorata basis relative to your Account Value
in each. Each partial withdrawal must be for $1,000 or more.
If your partial withdrawal causes your Contract Value to be less than $1000
immediately after the withdrawal, we may terminate your Contract and send you
the withdrawal proceeds. If your partial withdrawal causes your Account Value
remaining in any Investment Option to be less than any minimum amount we may
establish, we reserve the right to transfer such remaining Account Value to your
other Investment Options on a prorata basis relative to your most recent
allocation instructions.
Amount Available for Withdrawal -- The amount available for withdrawal is your
Contract Value as of the end of the Business Day on which we receive your proper
withdrawal request, less:
. any annual fee;
. any withdrawal fee;
. any charges for premium taxes and or other taxes; and
. any existing Contract Debt.
The amount we send to you (your "withdrawal proceeds") will also reflect any
required or requested federal and or state income tax withholding.
If you make a full withdrawal, this Contract will end; we will have no further
obligations under this Contract.
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CONTRACT LOANS
If your Contract is issued under a Qualified Plan under Code Section 401(a),
401(k), 403(a), or 403(b) and your Qualified Plan permits, you may request a
loan of all or part of the Loan Amount, subject to the provisions of the
Qualified Plan Loan Endorsement attached to this Contract. If your Contract is
a Non-Qualified Contract, or if your Qualified Plan does not permit loans, loans
under this Contract will not be available to you.
DEATH BENEFIT
A death benefit may be payable on proof of the death of the Annuitant or an
Owner before the Annuity Date, while this Contract is in force.
Death of Annuitant -- The Death Benefit Amount as of any Business Day (before
your Annuity Date) is equal to the greater of:
. your aggregate purchase payments, less: any withdrawals, any fees for
withdrawals or transfers, and any annual fees, since your Contract Date; or
. your Contract Value as of that day.
The Guaranteed Minimum Death Benefit Amount is determined as follows: First, we
calculate what the Death Benefit Amount would have been as of your fifth
Contract Anniversary and each subsequent fifth Contract Anniversary that occurs
while the Annuitant is living and before the Annuitant reaches his or her 76th
birthday, (each of these Contract Anniversaries is a "Milestone Date"). We then
adjust the Death Benefit Amount for each Milestone Date as follows: (1) we add
the aggregate amount of any purchase payments received by us since that
Milestone Date; and (2) we subtract any withdrawals, any fees for withdrawals or
transfers, any annual fees, and any previous charges for premium taxes and or
other taxes, since that Milestone Date. The highest of these adjusted Death
Benefit Amounts as of the Notice Date is your Guaranteed Minimum Death Benefit
Amount.
If the Annuitant dies on or before your fifth Contract Anniversary (your first
Milestone Date), or dies after your first Milestone Date and had reached his or
her 76th birthday on or prior to your first Milestone Date, the death benefit
will be equal to your Death Benefit Amount as of the Notice Date. The "Notice
Date" is the day on which we receive proof (in good form) of death and
instructions satisfactory to us regarding payment of death benefit proceeds.
If the Annuitant dies after your first Milestone Date and had not yet reached
his or her 76th birthday as of your first Milestone Date, the death benefit will
be equal to the greater of:
. your Death Benefit Amount as of the Notice Date; or
. your Guaranteed Minimum Death Benefit Amount as of the Notice Date.
The proceeds of any death benefit payable will be the amount of the death
benefit reduced by any charges for premium taxes and or other taxes and any
Contract Debt. These proceeds will be payable in a lump sum or, if the
recipient chooses, may be applied towards an Annuity Option under this Contract
or towards the purchase of any annuity option we then offer. Any such annuity
option is subject to the same restrictions and requirements as are Annuity
Options under this Contract.
If an Annuitant dies before the Annuity Date, unless there is a surviving Joint
or Contingent Annuitant, we will pay the death benefit proceeds to the
Beneficiary, if living; otherwise to the Annuitant's estate. If an Annuitant
dies and there is a surviving Joint Annuitant, the surviving Joint Annuitant
becomes the Annuitant. If there is no surviving Joint Annuitant and there is a
Contingent Annuitant, the Contingent Annuitant becomes the
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Annuitant. Death benefit proceeds are payable only on the death of the sole
surviving Annuitant prior to the Annuity Date. If you are the Annuitant and
you die, we will determine the amount of any death benefit and the Beneficiary
under the Death of Annuitant provisions; we will distribute any death benefit
proceeds under the Death of Owner Distribution Rules below.
Death of Owner -- If you are not the Annuitant, and you die before the
Annuitant, the death benefit will be equal to your Contract Value as of the
Notice Date.
The proceeds of any death benefit payable will be the amount of the death
benefit reduced by any charges for premium taxes and or other taxes and any
Contract Debt. These proceeds will be payable in a lump sum or, if the
recipient chooses, may be applied towards an Annuity Option under this Contract
or towards the purchase of any annuity option we then offer. Any such annuity
option is subject to the same restrictions and requirements as are Annuity
Options under this Contract.
If you die while the Annuitant is living and prior to the Annuity Date, we will
pay the death benefit proceeds to the surviving Joint Owner, if any. If there
is no surviving Joint Owner and there is a Contingent Owner, we will pay the
death benefit proceeds to the surviving Contingent Owner, if any. If there is
no surviving Contingent Owner, the death benefit proceeds will be paid to the
Beneficiary, if living; otherwise to the Annuitant or the Annuitant's estate.
If you are not also the Annuitant, then, in the event the deaths of the Owner
and Annuitant are under circumstances where it cannot be determined who died
first, payment will be made in accordance with the Death of Owner provisions of
this Contract.
Death of Owner Distribution Rules -- The following rules will control the
determination of whether a distribution must be made under this Contract, even
if they are inconsistent with any other provisions contained in this Contract.
The rules do not effect the determination of the amount of benefit payable or
distribution proceeds. Where there is more than one Owner, these rules apply
upon the date on which the first of these joint Owners dies.
If the Owner dies before the Annuity Date, then any death benefit proceeds under
this Contract must be distributed either: (1) within five years after the
Owner's death; or (2) over a period that does not exceed the life or life
expectancy of the Designated Beneficiary with payments that start within one
year after the Owner's death. The Designated Beneficiary is the individual
selected by the Owner to succeed to the Owner's interest in the Contract after
the death of an Owner of this Contract which includes a Joint or Contingent
Owner, if any, a Beneficiary, or the Annuitant or the Annuitant's estate.
If the spouse of the deceased Owner is the sole surviving Beneficiary, or is the
sole surviving Joint or Contingent Owner, and has an unrestricted right to
receive the death benefit proceeds in one lump sum, the spouse may continue this
Contract in force as Owner rather than receive the death benefit proceeds. In
this case, if the spouse's death occurs before the Annuity Date, then any death
benefit proceeds must be distributed within 5 years of the spouse's death.
If the Owner dies after the Annuity Date, but payments have not yet been
completed, then distributions of the remaining amounts payable under this
Contract must be made at least as rapidly as the rate that was being used at the
date of death.
If the Owner is a Non-individual Owner, the rules set forth in these Death of
Owner Distribution Rules apply in the event of the death of the Primary
Annuitant. A Non-individual Owner means a corporation or other entity which is
a non-natural person, unless the entity demonstrates to our satisfaction, or we
otherwise determine at our sole option, that the Contract should be treated, for
purposes of Section 72(s) of the Code, as owned by an individual (natural)
person. Primary Annuitant means the individual, the events in the life of whom
are of primary importance in affecting the timing or amount of the payout under
the Contract. The rules set forth in these Distribution Rules are intended to
satisfy the distributions-at-death timing requirements of Section
Page 13
72(s) of the Code. This Contract is deemed to incorporate any provision of
Section 72(s) of the Code, or any successor provision, as interpreted by us and
deemed necessary to qualify this Contract as an annuity. We reserve the right
to amend this Contract without a signed request and to provide a form of
amendment (rider) to the Contract to satisfy any changes in these requirements.
These Distribution Rules do not apply to Qualified Contracts issued under
Qualified Plans as defined in Section 401(a), 401(k), 403(a) or 403(b) of the
Code.
Interest on Death Benefit Proceeds -- If proceeds are not paid in one sum or
applied under an Annuity Option within 30 days after we receive due proof of the
death of the Annuitant or an Owner before the Annuity Date, we will pay interest
on the proceeds. Interest will be paid at the rate of 3% a year from the date
we receive due proof of death until the proceeds are paid or applied under an
Annuity Option. If the law in the state in which you live on the Contract Date
requires payment of a greater amount, we will pay that amount.
BENEFICIARY
Your Beneficiary is the person you name who may receive any death benefit
proceeds, or any remaining annuity payments after the Annuity Date, under your
Contract if the Annuitant or Owner dies. If you leave no surviving Beneficiary,
the Annuitant's estate, (in the event of an Owner's death, the Annuitant or
Annuitant's estate), may receive the death benefit proceeds under your Contract.
If the Beneficiary is a trustee, we will neither be responsible for verifying a
trustee's right to receive any death benefit proceeds payable, nor for how the
trustee disposes of any death benefit proceeds. If before payment of any death
benefit proceeds, we receive written notice that the trust has been revoked or
is not in effect, then any death benefit proceeds payable will be paid to the
Annuitant or the Annuitant's estate.
Adding or Changing Your Beneficiary -- You may add, change, or remove any
Beneficiary, other than an irrevocable Beneficiary, subject to the terms of any
assignment, at any time prior to the Annuity Date by sending us a written
request in a form satisfactory to us. However, if you have named an irrevocable
Beneficiary, you may not add any new Beneficiary, or remove or change the
irrevocable Beneficiary, without obtaining his or her written consent in a form
acceptable to us. You may remove any non-irrevocable Beneficiary without
obtaining the consent of the irrevocable Beneficiary. Qualified Contracts may
have additional restrictions on naming and changing Beneficiaries. The change
or addition will take effect only when we receive all necessary documents and
record the change or addition.
ANNUITY BENEFITS
On the Annuity Date, your Contract Value will convert into the Annuity Option(s)
you have chosen. We will send the first annuity payment under this Contract on
the day following the Annuity Date.
Choice of Annuity Date -- Your Annuity Date is shown in the Contract
Specifications. If you did not select an Annuity Date in your application for
this Contract, we assigned an Annuity Date based on the type of this Contract
and the Annuitant's age. See Default Annuity Date and Options.
You may change your Annuity Date by notifying us in writing at least 10 Business
Days prior to your current Annuity Date or new Annuity Date, whichever is
earlier. Your Annuity Date may not be earlier than your first Contract
Anniversary, and must occur on or before the day your younger Annuitant reaches
his or her 100th birthday. If your Contract is a Qualified Contract, your
Annuity Date cannot be earlier than your first Contract Anniversary, and must
occur on or before April 15 of the calendar year following the year in which
your Annuitant (who is the Qualified Plan participant) reaches his or her 70
1/2th birthday. You may be subject to additional restrictions under your
Qualified Plan. You should consult with your Qualified Plan administrator
before you elect your Annuity Date.
Page 14
Application of Contract Value -- Prior to the Annuity Date, you may elect to
convert all or part of your Contract Value less any Contract Debt, any transfer
fee, and any charges for premium taxes and or other taxes, to an Annuity Option
we then offer on the Annuity Date. You may also elect a full withdrawal in lieu
of annuity payments under an Annuity Option. Before we make any full withdrawal,
we require return of this Contract, (or a signed lost Contract affidavit), to
us. The aggregate net amount you apply must be at least $5,000; otherwise, we
will pay a single amount equal to your withdrawal proceeds. See WITHDRAWALS.
If you convert only a portion of your Contract Value on your Annuity Date, you
may, at that time, have the option to elect to continue your Contract with
that remaining Contract Value. If this option is available, you would choose a
second Annuity Date for such Contract Value; all references in this Contract to
your Annuity Start Date (or Annuity Date) would, with regard to such Contract
Value, be deemed to refer to that second Annuity Date. This option may or may
not be available, or may be available only for certain types of Contracts. You
should call PM for more information if you desire this option.
Your Selections -- Prior to the Annuity Date, you may make three selections
about the annuity payments. First, you may choose whether you want those
payments to be a fixed-dollar amount or a variable-dollar amount, or both.
Second, you may choose the form of annuity payments (Annuity Option). Third,
you may choose to have annuity payments made monthly, quarterly, semi-annually,
or annually.
The first annuity payment on any Annuity Date must be at least $250. We will
reduce your payment frequency if the first annuity payment is less than $250.
If you elect annuity payments for a Period Certain Only, we reserve the right to
also reduce the Period Certain to meet the $250 minimum first payment. After
the Annuity Date, you may not change the Annuity Option, or surrender the
Contract for payment of amounts converted into a variable annuity and or fixed
annuity.
Fixed and Variable Annuities -- You may choose a fixed annuity (with fixed-
dollar payments), a variable annuity (with variable-dollar payments), or you may
choose both. You may convert one portion of your Contract Value, less any
Contract Debt, any transfer fee, and any charges for premium taxes and or other
taxes, into a fixed annuity and another portion into a variable annuity. If you
select a variable annuity, you may choose any Subaccounts for your annuity. On
your Annuity Date, we will transfer that portion of your Contract Value, less
Contract Debt, you indicate to the Subaccount(s) you choose, if you select a
variable annuity. We will transfer the portion of your Contract Value, less
Contract Debt, you indicate, to the Fixed Option, if you choose a fixed annuity.
We will apply the net amount you convert to a fixed annuity and or a variable
annuity, (and in this instance, to each Subaccount), based on your relative
Account Value in each Investment Option on the Annuity Date. Any net amount you
convert to a fixed annuity will be held in our General Account (but not under
the Fixed Option).
Each periodic payment for the fixed annuity will be equal to the amount of your
first fixed annuity payment (unless you elect a joint and survivor life annuity
with reduced survivor payments). The amount of each variable annuity periodic
payment will vary with the investment results of the Subaccount(s) you select.
After the Annuity Date, the Annuitant may exchange the Annuity Units in any
Subaccount(s) for Annuity Units in any other Subaccount(s) up to four times in
any twelve month period. We reserve the right to limit the Subaccounts
available, to change the number and frequency of exchanges, and to change the
number of Subaccounts you may choose.
In choosing an Annuity Option, you must submit your Option request to us in
writing on a form provided by us or in another form satisfactory to us.
Annuity Options -- The following forms of annuity payments are available under
this Contract, although additional options may become available in the future:
Page 15
Option 1: Life Only. Periodic payments are made to the Annuitant during his or
her lifetime. Payments stop when the Annuitant dies.
Option 2: Life with Period Certain. Periodic payments are made to the Annuitant
during his or her lifetime, with payments guaranteed for a specified
period. You may choose to have payments guaranteed from 5 through 30
years (in full years only). If the Annuitant dies before the
guaranteed payments are completed, we pay the Beneficiary the
remainder of the guaranteed payments.
Option 3: Joint and Survivor Life. Periodic payments are made during the
lifetime of the Primary Annuitant. After the death of the Primary
Annuitant, periodic payments are made to the secondary Annuitant named
in the election if and so long as such secondary Annuitant lives.
Payments made to the secondary Annuitant may be in installments equal
to 50%, 66 2/3% or 100% (as specified in the election) of the original
payment amount payable during the lifetime of the Primary Annuitant.
If you elect a reduced payment to the secondary Annuitant, fixed
annuity payments will be equal to 50% or 66 2/3% of the original fixed
payment payable during the lifetime of the Primary Annuitant; variable
annuity payments will be determined using 50% or 66 2/3%, as
applicable, of the number of Annuity Units for each Subaccount
credited to the Contract. Payments stop when both Annuitants die.
Option 4: Period Certain Only. Periodic payments are made to the Annuitant over
a specified period. You may choose to have payments continue from 5
through 30 years (in full years only). If the Annuitant dies before
the guaranteed payments are completed, we pay the Beneficiary the
remainder of the guaranteed payments.
Default Annuity Date and Options -- If this is a Non-Qualified Contract and you
did not choose an Annuity Date when you submitted your application for this
Contract, your Annuity Date is the Annuitant's 100th birthday. If there are
Joint Annuitants, the Annuity Date will be based on the younger Annuitant's
birthday, unless otherwise required by law. If this is a Qualified Contract and
you did not choose an Annuity Date, your Annuity Date is April 1 of the calendar
year following your Annuitant's 70 1/2th birthday; if there are Joint
Annuitants, the Annuity Date will be based on the birthday of the Annuitant who
is the Qualified Plan participant. If the Annuitant has reached his or her 70
1/2th birthday when the Contract is issued, the Annuity Date is April 1 of the
calendar year following the first Contract Anniversary.
If you do not elect an Annuity Option, your Contract Value, less any Contract
Debt, and any charges for premium taxes and or other taxes, when converted, will
be converted as follows, subject to our minimum requirements: (1) the net
amount from your Fixed Option Value will be applied to a fixed annuity and held
in our General Account; and (2) the net amount from your Variable Account Value
will be applied to a variable annuity and applied to the Subaccounts in
proportion to your Account Value in each Subaccount on the Annuity Date. If
this is a Non-Qualified Contract, or a Qualified Contract and the Annuitant is
not married, your Annuity Option will be Period Certain Only for five years. If
this is a Qualified Contract and the Annuitant is married, your Annuity Option
will be Joint and Survivor Life, with survivor payments of 50%, and the
Annuitant's spouse will be named as the secondary Annuitant. If you do not
elect your frequency of payments, we will make payments based on our most
frequent schedule that results in an initial annuity payment of at least $250.
Amount of Payments -- We use the Annuity Option Tables at the end of the
Contract to determine the amount of the first annuity payment, based on your net
amount from your Contract Value applied to the Annuity Option on the Annuity
Date and your selections. The first annuity payment amount depends on the form
of annuity, the payment frequency you select, and whether you select a fixed
annuity and or a variable annuity. If you do not choose the Period Certain Only
Option, this amount also depends on the age of the Annuitant(s) on the Annuity
Date and the sex of the Annuitant(s), unless unisex rates apply.
Page 16
Fixed Annuity Payments -- The minimum guaranteed income purchased per $1000 of
the net amount applied to a fixed annuity is based on an annual interest rate of
3% and the 1983a Mortality Table. The fixed annuity payments made will be based
on the greater of: (1) our current annuity purchase rates in effect for this
Contract on your Annuity Date; and (2) our guaranteed purchase rates. The
dollar amount of any payments after the first annuity payment are specified
during the annuity payment period according to the provisions of the Annuity
Option you elect.
Variable Annuity Payments -- Your Subaccount Annuity Units. For each
Subaccount, we divide the amount of the initial variable annuity payment from
each Subaccount by the Annuity Unit Value for that Subaccount, (the "Annuity
Unit Value"), on the Annuity Date, to obtain the number of Annuity Units for
that Subaccount. The number of your Annuity Units in each Subaccount will not
change unless exchanges of Annuity Units are made, but the Annuity Unit Value of
those Annuity Units will vary.
Your Subsequent Variable Payments. The amount of each subsequent variable
annuity payment will be the sum of the amounts payable based on your Annuity
Units in each Subaccount. To determine the amount payable for each Subaccount,
we multiply the number of your Annuity Units in that Subaccount by their Annuity
Unit Value on the day in each payment period that corresponds to the Annuity
Date.
Annuity Unit Value -- The initial Annuity Unit Value for each Subaccount was
arbitrarily set at $10 on the Business Day the Subaccount began operations. At
the end of each subsequent Business Day, the Annuity Unit Value for each
Subaccount is equal to (A x B) x C where:
(A) is the Subaccount's Annuity Unit Value for that Subaccount as of the end
of the prior Business Day;
(B) is the Net Investment Factor for that Subaccount for that valuation
period; and
(C) is an interest factor to offset the effect of the assumed interest rate of
5% per year, which is built into the Annuity Option Tables.
We generally calculate the Annuity Unit Value of each Subaccount at or about
4:00 p.m., Eastern Time, on each day the New York Stock Exchange is open,
provided our offices are also open that day.
We guarantee that the amount of each subsequent annuity payment will not be
affected by variations in our expenses or in mortality experience.
Periodic Payments -- The first payment under these Options will be determined on
the Annuity Date and will be made on the day following the Annuity Date. For a
Designated Beneficiary entitled to a death benefit on account of the Annuitant's
death, the first payment will be made on the first day of the calendar month on
or next following the day we receive due proof of the Annuitant's death and
instructions regarding payment, and such other documentation as we may require
(called the "Annuity Date"). Subsequent payments will be determined on the day
in each payment period that corresponds to the Annuity Date and will be made on
the following day.
Misstatement of Age or Sex -- We may require proof of the Annuitant's age and
sex before commencing annuity payments. If the age or sex (or both) of the
Annuitant are incorrectly stated in this Contract, we will correct the amount
payable to equal the amount that the Account Value, less any charges for premium
taxes and or other taxes, under this Contract would have purchased for the
Annuitant's correct age and sex, if applicable. If we make the correction after
annuity payments have commenced, and we have made overpayments, we will deduct
the amount of the overpayment, with interest at 3% per year, from any payments
due then or later. If we have made underpayments, we will add the amount, with
interest at 3% a year, of the underpayments to the next payment we make after we
receive proof of the correct sex and/or date of birth.
Page 17
GENERAL PROVISIONS
Reports to Owners -- We will send you those reports required by applicable law.
Payments, Instructions and Requests -- Unless this Contract provides otherwise,
all payments, loan repayments, instructions and requests must be received in
writing at our Service Center at its mailing address. (See DEFINITIONS: Service
Center). Any subsequent purchase payments, loans, loan repayments, requests for
transfer, or withdrawal and instructions we receive in proper form before the
close of the New York Stock Exchange on any Business Day usually will be
processed the same Business Day unless the transaction or event is scheduled to
occur on another day. Generally, all other instructions and requests normally
will be effective as of the end of the day next following the Business Day we
receive them in proper form, unless the event is scheduled to occur on another
day. We may require that you provide signature guarantees or other safeguards
for any instruction, request or other document you may send to our Service
Center. You acknowledge and agree that we will not be liable for any loss,
liability, cost or expense of any kind or character for acting on instructions
or requests submitted to us that we reasonably believe to be genuine, provided
we follow our procedures.
Entire Contract -- This document, the attached application or confirmation
thereof, any subsequent applications to change this Contract or confirmation
thereof, and any riders and endorsements, constitute the entire Contract, and
supersede any and all prior agreements, whether oral or written, about the
subject matter of this Contract and the application. All statements made in the
application are representations and not warranties.
Contract Modifications -- Modifications to this Contract or any waivers of our
rights or requirements under this Contract can only be made if in writing by an
authorized officer of PM.
Basis of Values -- A detailed statement showing how values are determined has
been filed with the state insurance departments. All values and reserves are at
least equal to those required by the laws of the state in which this Contract is
delivered.
Claims of Creditors -- Your Contract Value and other benefits under this
Contract are exempt from the claims of creditors to the extent permitted by law.
Removal of Beneficiary or Contingent Annuitant -- You may remove a Beneficiary,
(other than an irrevocable Beneficiary), or a Contingent Annuitant from this
Contract by providing proper instructions to our Service Center.
Ownership -- This Contract belongs to the Owner. The Owner is entitled to
exercise all rights available to the Owner under this Contract. If this
Contract is jointly owned, both Owners must join in any request to exercise
these rights. The Owner may exercise these rights under this Contract without
the consent of the Beneficiary, (other than any irrevocable Beneficiary), or any
other person, except as otherwise required by law.
Assignment -- You may assign all rights and benefits under this Contract before
the Annuity Date. We are not bound by any assignment until we have received
written notice satisfactory to us and we record the assignment. We are not
responsible for the validity of any assignment. If the Contract has been
absolutely assigned, the assignee becomes the Owner. A person who receives the
Contract as collateral security does not become the Owner, unless the Contract
is absolutely assigned. You should consult with your tax adviser before taking
any action.
Delay of Payments -- Generally, payments, transfers, or exchanges will be made
within seven days from receipt of the payment and or request in a form
satisfactory to us. Payment of your withdrawal proceeds or
Page 18
transfers or exchanges to or from a Variable Account may be delayed after
receipt of your withdrawal, transfer, or exchange request under certain
circumstances. These include: a closing of the New York Stock Exchange other
than on a regular holiday or weekend; a trading restriction by the SEC; or an
emergency declared by the SEC. We may delay payments or transfers from our
General Account (which would include payment of your withdrawal proceeds and
transfers from the Fixed Option, loans, repayments of Contract Debt from the
Loan Account, repayments from the Fixed Option of due and unpaid interest on
Contract Debt, fixed annuity payments, and lump sum death benefit payments
unless state law requires otherwise) for up to six months after the requested
effective date of the transaction. Any amount delayed will, so long as it is
held under the Fixed Option, continue to earn interest at the Guaranteed
Interest Rate(s) then in effect until the Guaranteed Term in effect has ended,
and 3% on an annual basis thereafter. If you make purchase payments by check,
we may delay making payments to you until your check has cleared.
Incontestability -- We will not contest this Contract.
Proof of Life or Death -- Before we make a payment, we have the right to require
proof of the life or death of any person whose life or death determines whether,
to whom, or how much we must pay any benefits under this Contract.
Dividends -- We do not expect dividends to become payable. At the end of each
Contract Year, we will determine your dividend, if any. You may choose to have
it paid in cash or added to your Contract Value. If you do not make a choice, we
will add it to your Contract Value. We will allocate any dividend added to your
Contract Value in accordance with your most recent allocation instructions,
unless you instruct otherwise. You should consult with your tax adviser before
making any election.
Withholding Taxes -- We will withhold any taxes required to be withheld by law
or requested to be withheld.
ANNUITY OPTION TABLES
For the fixed annuity option, the Tables below illustrate the minimum guaranteed
monthly income purchased per $1000 of the net amount applied. The actuarial
basis for the fixed annuity option Tables is the 1983 Annuity Mortality Table
with interest at 3%. The Tables also illustrate the rates for the first monthly
variable annuity payment per $1000 of the net amount applied to the variable
annuity payment option. The rates for variable annuity payments are based on
interest at the annual rate of 5%. Subsequent payments may be higher or lower
than the first payment, based on the investment performance of the Subaccount(s)
you elect and whether you exchange Subaccount Annuity Units.
These Tables provide for sex-distinct and unisex payment purchase rates for life
payment options. For some Qualified Plans and in some states the use of sex-
distinct purchase rates are prohibited. For those Qualified Plans and in those
states we use blended unisex purchase rates for life payment options, whether
the Annuitant is male or female.
We will provide rates for any payment frequency, interest rate, age or sex,
combinations thereof, and or payout percentage, if applicable, not shown that we
offer. We will also provide, upon request, rates for any annuity option not
shown that we then offer.
Page 19
OPTIONS 1 AND 2 -- SINGLE LIFE ANNUITIES WITH GUARANTEED PAYMENTS FOR:
Fixed Annuity Rates
Male at 3% Female at 3% Unisex at 3%
Age None 10 Yr. 20 Yr. None 10 Yr. 20 Yr. None 10 Yr. 20 Yr.
30 3.28 3.27 3.26 3.13 3.12 3.12 3.20 3.20 3.19
35 3.44 3.44 3.41 3.26 3.26 3.24 3.35 3.35 3.33
40 3.66 3.64 3.60 3.42 3.42 3.40 3.54 3.54 3.50
45 3.93 3.90 3.82 3.63 3.63 3.59 3.78 3.77 3.71
50 4.27 4.22 4.08 3.90 3.89 3.82 4.09 4.06 3.96
55 4.70 4.62 4.39 4.25 4.22 4.11 4.48 4.43 4.25
60 5.28 5.14 4.71 4.72 4.66 4.44 5.00 4.90 4.58
65 6.10 5.81 5.02 5.35 5.22 4.79 5.73 5.52 4.92
70 7.23 6.61 5.27 6.25 5.96 5.12 6.74 6.30 5.20
75 8.82 7.49 5.42 7.56 6.89 5.35 8.18 7.20 5.39
80 11.06 8.33 5.49 9.53 7.89 5.47 10.28 8.12 5.48
85 14.16 8.97 5.51 12.48 8.74 5.50 13.30 8.86 5.51
Variable Annuity Rates
Male at 5% Female at 5% Unisex at 5%
Age None 10 Yr. 20 Yr. None 10 Yr. 20 Yr. None 10 Yr. 20 Yr.
30 4.57 4.56 4.54 4.44 4.44 4.42 4.51 4.50 4.49
35 4.71 4.70 4.67 4.55 4.54 4.52 4.63 4.62 4.60
40 4.91 4.89 4.82 4.69 4.68 4.65 4.80 4.78 4.74
45 5.16 5.12 5.02 4.87 4.86 4.81 5.02 4.99 4.92
50 5.48 5.41 5.24 5.12 5.09 5.01 5.30 5.26 5.13
55 5.89 5.79 5.51 5.44 5.40 5.26 5.67 5.60 5.39
60 6.46 6.28 5.80 5.89 5.80 5.55 6.18 6.05 5.68
65 7.27 6.91 6.08 6.51 6.34 5.87 6.89 6.64 5.98
70 8.41 7.68 6.29 7.39 7.05 6.16 7.90 7.38 6.23
75 10.02 8.52 6.43 8.72 7.93 6.37 9.36 8.24 6.40
80 12.29 9.30 6.49 10.71 8.88 6.47 11.49 9.10 6.48
85 15.42 9.90 6.51 13.70 9.68 6.50 14.55 9.80 6.51
Page 20
OPTION 3 -- JOINT AND SURVIVOR LIFE
Primary Annuitant
Male Age
60 65 70 75 80 85
3% 5% 3% 5% 3% 5% 3% 5% 3% 5% 3% 5%
Fixed Variable Fixed Variable Fixed Variable Fixed Variable Fixed Variable Fixed Variable
60 4.70 5.87 5.10 6.27 5.55 6.75 6.03 7.29 6.54 7.87 7.03 8.46
65 4.85 6.00 5.32 6.47 5.86 7.03 6.45 7.66 7.07 8.34 7.67 9.04
Female 70 4.98 6.13 5.54 6.67 6.18 7.33 6.91 8.08 7.69 8.92 8.47 9.77
Age 75 5.09 6.24 5.72 6.86 6.49 7.63 7.40 8.54 8.40 9.58 9.43 10.68
80 5.17 6.32 5.86 7.01 6.75 7.89 7.85 8.98 9.13 10.29 10.51 11.71
85 5.22 6.38 5.96 7.11 6.95 8.09 8.21 9.35 9.78 10.93 11.57 12.75
Primary Annuitant
Unisex Age
60 65 70 75 80 85
3% 5% 3% 5% 3% 5% 3% 5% 3% 5% 3% 5%
Fixed Variable Fixed Variable Fixed Variable Fixed Variable Fixed Variable Fixed Variable
60 4.60 5.76 5.02 6.17 5.49 6.66 6.03 7.24 6.60 7.89 7.19 8.57
65 4.72 5.87 5.20 6.34 5.76 6.91 6.41 7.58 7.12 8.35 7.84 9.17
Unisex 70 4.81 5.96 5.36 6.49 6.02 7.15 6.81 7.96 7.70 8.89 8.63 9.89
Age 75 4.88 6.04 5.49 6.62 6.25 7.38 7.20 8.33 8.31 9.46 9.52 10.73
80 4.93 6.09 5.58 6.72 6.43 7.56 7.53 8.65 8.89 10.03 10.45 11.63
85 4.96 6.13 5.64 6.79 6.55 7.69 7.78 8.91 9.37 10.51 11.31 12.47
OPTION 4 -- PERIOD CERTAIN
Period Monthly Period Monthly Period Monthly Period Monthly
Years Income Years Income Years Income Years Income
Fixed Variable Fixed Variable Fixed Variable Fixed Variable
3% 5% 3% 5% 3% 5% 3% 5%
3 28.99 29.80 10 9.61 10.51 17 6.23 7.20 24 4.84 5.88
4 22.06 22.89 11 8.86 9.77 18 5.96 6.94 25 4.71 5.76
5 17.91 18.74 12 8.24 9.16 19 5.73 6.71 26 4.59 5.65
6 15.14 15.99 13 7.71 8.64 20 5.51 6.51 27 4.47 5.54
7 13.16 14.02 14 7.26 8.20 21 5.32 6.33 28 4.37 5.45
8 11.68 12.56 15 6.87 7.82 22 5.15 6.17 29 4.27 5.36
9 10.53 11.42 16 6.53 7.49 23 4.99 6.02 30 4.18 5.28
Page 21
INDEX
Page
CONTRACT SPECIFICATIONS 3
DEFINITIONS 4
PURCHASE PAYMENTS 6
THE FIXED OPTION 6
VARIABLE INVESTMENT OPTIONS 7
CONTRACT VALUE 8
CHARGES, FEES AND DEDUCTIONS 10
TRANSFERS 11
WITHDRAWALS 11
CONTRACT LOANS 12
DEATH BENEFIT 12
BENEFICIARY 14
ANNUITY BENEFITS 14
GENERAL PROVISIONS 18
ANNUITY OPTION TABLES 19
Page 22
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INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT
. Investment Experience Reflected in Benefits
. Variable and Fixed Accumulation Before Annuity Date; Variable and Fixed
Annuity Payments Thereafter
. Death Benefit Proceeds Payable Before Annuity Date
. Participating
