----------------------------------------
Aetna Life Insurance and Annuity Company
Home Office: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000
(000) 000-0000
Aetna Life Insurance and Annuity Company (We or Us) agrees to pay benefits
according to the terms and conditions set forth in this Contract.
--------------------------------------------------------------------------------
Certificate of Group Annuity Coverage
Aetna certifies that an account is established for you under the Group Annuity
Contract and Certificate numbers shown below.
This certificate describes Group Annuity Contract provisions. It replaces any
and all prior certificates or endorsements issued to you under the stated
Contract and Certificate numbers. This Certificate is for information only and
is not a part of the Contract.
THE VARIABLE FEATURES OF THE GROUP CONTRACT ARE DESCRIBED IN SECTIONS 6 AND 12.
--------------------------------------------------------------------------------
Right to Cancel
The Certificate Holder may cancel the Certificate within ten (10) days of
receiving it by returning it to Us at the address above or the person from whom
it was purchased. Within seven (7) days of the cancellation request, We will
return the Certificate Holder's Purchase Payment(s) made plus any increase, or
minus any decrease on the amount allocated to the Separate Account.
Signed at the Home Office on the Effective Date.
/s/ Xxx Xxxxxxx /s/ Xxxxx X. Xxxxxxxxx
President Secretary
--------------------------------------------------------------------------------
Contract Holder Group Annuity Contract Number
--------------------------------------------------------------------------------
Certificate Holder Certificate Number
--------------------------------------------------------------------------------
Annuitant Name Type of Plan
ALL PAYMENTS AND VALUES PROVIDED BY THE GROUP CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. THIS CERTIFICATE CONTAINS A MARKET VALUE ADJUSTMENT
FORMULA. APPLICATION OF A MARKET VALUE ADJUSTMENT MAY RESULT IN EITHER AN
INCREASE OR DECREASE IN THE CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA
DOES NOT APPLY TO A GUARANTEED TERM AT THE TIME OF ITS MATURITY.
Page
Table of Contents
Right to Cancel................................................................1
Contract Schedule..............................................................4
Separate Account......................................................4
ALIAC Guaranteed Account (AG Account).................................4
Separate Account and AG Account.......................................4
Fixed Annuity.........................................................6
Section 1. Definitions....................................................7
Section 2. General Provisions.............................................9
The Contract..........................................................9
Certificates..........................................................9
Nonparticipating Contract.............................................9
Misstatements and Adjustments.........................................9
Reports...............................................................9
Premium Taxes.........................................................9
Protection of Proceeds................................................9
Evidence of Survival..................................................9
Proof of Age..........................................................9
Change of Contract....................................................9
Section 3. Ownership.....................................................10
Group Contract Holder................................................10
Certificate Holder Rights............................................10
Transfer of Ownership................................................11
Section 4. Beneficiary Provisions........................................11
Beneficiary..........................................................11
Change of Beneficiary................................................11
Death of Beneficiary.................................................11
Section 5. Purchase Payments.............................................11
Purchase Payments....................................................11
Allocation of Purchase Payments......................................11
Section 6. Separate Account..............................................12
General..............................................................12
Investment Allocations to the Separate Account.......................12
Valuation of Assets..................................................12
Accumulation Unit....................................................12
Net Return Factor for Each Valuation Period..........................12
Administrative Charge................................................13
Mortality Risk Charge................................................13
Expense Risk Charge..................................................13
Mortality and Expense Guarantee......................................13
2
Section 7. AG Account....................................................13
AG Account Guaranteed Interest Rate..................................13
Deposit Period.......................................................13
Guaranteed Term......................................................14
Guaranteed Term(s) Groups............................................14
Maturity Date........................................................14
Allocation of Net Purchase Payments to the AG Account................14
AG Account Guaranteed Term Maturity Date and Maturity Value..........14
Transfers from the AG Account........................................14
Withdrawals from the AG Account......................................15
Reinvestment.........................................................15
AG Account Market Value Adjustment (Factor)..........................15
Section 8. Certificate Holder's Account Value; Transfers and
Withdrawals During the Accumulation Period ...................16
Certificate Holder's Account Value...................................16
Transfers During the Accumulation Period.............................16
Withdrawals During the Accumulation Period...........................17
Deferred Sales Charge................................................17
Waiver of Deferred Sales Charge......................................17
Payment of Adjusted Certificate Holder Account Value.................17
Systematic Withdrawal Option (SWO)...................................18
Section 9. Maintenance Charge............................................18
Maintenance Charge...................................................18
Section 10. Proceeds Payable on Death.....................................19
Death of the Certificate Holder Prior to the Annuity Date............19
Death Benefit Amount Prior to the Annuity Date.......................19
Death Benefit Payment Methods........................................20
Death of Certificate Holder On or After the Annuity Date.............21
Death of the Annuitant...............................................21
Section 11. Delay of Payments.............................................21
Delay of Payments....................................................21
Section 12. Annuity Provisions............................................21
Designation of Annuitant.............................................21
Terms of Annuity Options.............................................22
Annuity Unit.........................................................23
Annuity Unit Value...................................................23
Annuity Net Return Factor............................................23
Annuity Options......................................................24
3
Contract Schedule
Separate Account
--------------------------------------------------------------------------------
Separate Account: Variable Account B
Charges to the Separate A daily charge is deducted from the assets of
Account: the Separate Account. The deduction is the daily
equivalent of the annual effective percentage
shown below:
(a) During the Accumulation Period:
Administrative Charge 0.15%
Mortality Risk Charge 0.35%
Expense Risk Charge 0.90%
TOTAL Separate Account Charges
During Accumulation Period 1.40%
(b) During the Annuity Period
Administrative Charge Not To Exceed 0.25%
Mortality Risk Charge 0.35%
Expense Risk Charge 0.90%
TOTAL Maximum Separate Account
Charges During Annuity Period 1.50%
ALIAC Guaranteed Account (AG Account)
--------------------------------------------------------------------------------
Minimum Guaranteed Interest 3.0%
Rate (effective annual rate
of return):
Separate Account and AG Account
--------------------------------------------------------------------------------
Minimum Initial Purchase $1,500
Payment:
Minimum Subsequent $500 or $50 per month if paid by an automatic
Purchase Payment: check plan
Maximum Subsequent $500,000 without Home Office approval
Purchase Payment:
Transfers: We allow an unlimited number of transfers during
the Accumulation Period. Twelve (12) transfers
in any calendar year are free. Thereafter, We
reserve the right to charge a transfer charge up
to $10 for each subsequent transfer.
4
Maintenance Charge: The annual maintenance charge is $30. If the
Certificate Holder's Account is $50,000 or more
on the date the maintenance charge is to be
deducted, the maintenance charge is $0.
Deferred Sales Charge: For each withdrawal from a Certificate Holder's
Account, a deferred sales charge for each Net
Purchase Payment will be determined as follows:
Years from Receipt of Deferred
Net Purchase Payment Sales Charge
0-1 7%
1-2 6%
2-3 5%
3-4 4%
4-5 3%
5-6 2%
6-7 1%
7+ 0%
Waiver of Deferred Section 8.05 provides for the following:
Sales Charge:
(c) At least 12 months after the date of the
first Purchase Payment in an amount
equal to or less than 15% of the
Certificate Holder's Account Value.
(d) For a full withdrawal where the
Certificate Holder's Account Value does
not exceed $2,500 and no withdrawals
have been taken from the Certificate
Holder's Account within the prior 12
months.
Systematic Withdrawal Option: (a) Specified Payment - Maximum Percentage: 10%
(b) Specified Period - Minimum Period: 10 years
(c) Specified Percentage - Maximum Percentage: 10%
Death Benefit Factor: 4%
Death Benefit There is no maximum death benefit amount.
Maximum Amount:
Death Benefit 85 years
Maximum Age:
Fund for Allocation of Excess Federated Prime Money Fund II
Guaranteed Death Benefit
Value:
Latest Annuity Date: The Certificate Holder's 90th birthday.
5
Fixed Annuity
--------------------------------------------------------------------------------
Minimum Guaranteed 3.0%
Interest Rate
(effective annual rate
of return):
6
Section 1. Definitions
--------------------------------------------------------------------------------
1.01 Accumulation Period - The period during which one or more Net
Purchase Payments applied to a Certificate Holder's Account
accumulate to provide future Annuity payments.
1.02 Accumulation Unit - A measure of the net investment results for
each variable investment option during the Accumulation Period. The
Accumulation Units for the applicable Funds are used to calculate
the portion of a Certificate Holder's Account Value attributable to
a Separate Account during the Accumulation Period.
1.03 Adjusted Certificate Holder Account Value - The Certificate
Holder's Account Value, plus or minus any aggregate AG Account
Market Value Adjustment.
1.04 Annuitant - The natural person on whose life an Annuity payment is
based.
1.05 Annuity - A series of payments We make for life, a definite period
or a combination of the two.
1.06 Annuity Date - The date on which Annuity payments commence.
1.07 Annuity Options - Annuity payment methods available during the
Annuity Period.
1.08 Annuity Period - The period of time during which Annuity payments
are made.
1.09 Annuity Unit - A measure of the net investment results for each
variable investment option during the Annuity Period. Annuity Units
are used to calculate the amount of each variable Annuity payment.
1.10 Beneficiary - The person(s) entitled to receive any death benefit
under the Certificate Holder's Account. Upon the death of a joint
Certificate Holder, the surviving joint Certificate Holder, if any,
is treated as the Beneficiary. Any other Beneficiary designation on
record with Us at the time of death is treated as a contingent
Beneficiary.
1.11 Certificate - The document issued to a Certificate Holder to
evidence a Certificate Holder's Account established under the group
Contract.
1.12 Certificate Holder - A person who has established a Certificate
Holder's Account under a group Contract. We reserve the right to
limit ownership to natural persons. If more than one Certificate
Holder owns an Account, each Certificate Holder shall be a joint
Certificate Holder. Any joint Certificate Holder must be the spouse
of the other joint Certificate Holder. Joint Certificate Holders
have joint ownership rights and both must authorize any exercising
of those ownership rights unless otherwise allowed by Us.
1.13 Certificate Holder's Account - A record We establish for each
Certificate Holder to maintain values under a group Contract.
7
1.14 Certificate Holder's Account Value - The dollar value as of any
Valuation Period of all amounts accumulated in a Certificate
Holder's Account.
1.15 Contract - This agreement between the Group Contract Holder and Us.
1.16 Effective Date - The date a Certificate is issued to a Certificate
Holder.
1.17 Fund - One of the variable investment options which may be selected
by a Certificate Holder.
1.18 General Account - The General Account is made up of all of our
general assets other than those allocated to the separate accounts.
1.19 ALIAC Guaranteed Account (AG Account) - An investment option where
We guarantee specified rate(s) of interest for specified periods of
time. The AG Account is a separate account established by Us in
accordance with the provisions of the Connecticut General Statutes
Section 38a-433. Certificate Holders do not participate in the
investment gain or loss from the assets held in the AG Account.
Assets in the AG Account may be charged with liabilities arising
out of any other business We may conduct.
1.20 Group Contract Holder - The entity to which a group Contract is
issued.
1.21 Home Office - Our headquarters, located at 000 Xxxxxxxxxx Xxxxxx,
Xxxxxxxx, XX 00000.
1.22 Market Value Adjustment - An adjustment to any withdrawal made from
the AG Account before the end of a guaranteed term as stated in
Section 7.11.
1.23 Net Purchase Payment - The Purchase Payment less premium taxes, if
applicable.
1.24 Purchase Payment - The gross payment accepted by Us and allocated
to the Certificate Holder's Account. We reserve the right to refuse
to accept any Purchase Payment at any time for any reason.
1.25 Separate Account - A separate account that buys and holds shares of
the Fund(s). Income, gains or losses, realized or unrealized, are
credited or charged to the Separate Account without regard to Our
other income, gains or losses. We own the assets held in the
Separate Account and are not a trustee as to such amounts. The
Separate Account generally is not guaranteed and is held at market
value. The name of the Separate Account is shown on the Contract
Schedule. The assets of the Separate Account, to the extent of
reserves and other Contract liabilities of the Separate Account,
will not be charged with Our other liabilities.
1.26 Valuation Period - The period of time for which a Fund determines
its net asset value, usually from 4:15 p.m. Eastern time each day
the New York Stock Exchange is open until 4:15 p.m. the next such
business day, or such other day that one or more of the Funds
determines its net asset value. The assets of the Separate Account
are not chargeable with the liabilities arising out of any other
business We may conduct.
8
1.27 Variable Annuity Contract - An Annuity Contract providing for the
accumulation of value and/or for Annuity payments which vary in
amount based on investment results.
Section 2. General Provisions
--------------------------------------------------------------------------------
2.01 The Contract - The entire Contract consists of this Contract and
any attached applications or endorsements.
2.02 Certificates - A Certificate is issued to each Certificate Holder
whose Purchase Payment(s) is accepted by Us. The Certificate
evidences a Certificate Holder's Account established under the
Contract. Certificates are not part of the Contract.
2.03 Nonparticipating Contract - Neither the Group Contract Holder,
Certificate Holder nor any Beneficiary have a right to share in our
earnings.
2.04 Misstatements and Adjustments - If We learn that the age of any
Annuitant or second Annuitant is misstated, the correct age will be
used to adjust payments. We reserve the right to request
reimbursement or adjust future payments for any amount overpaid. We
will pay the amount of any underpayment.
2.05 Reports - We furnish each Certificate Holder with a report showing
the Certificate Holder's Account Value at least once each calendar
year. We also furnish an annual report of the Separate Account.
2.06 Premium Taxes - Any premium taxes paid to any governmental entity
are charged against Purchase Payments or a Certificate Holder's
Account. We may, at our sole discretion, pay premium taxes when due
and deduct that amount from the Certificate Holder's Account at a
later date. Payment at an earlier date does not waive any right We
may have to deduct amounts at a later date.
2.07 Protection of Proceeds - To the extent permitted by law, all
payments under this Contract to a Certificate Holder or Beneficiary
shall be free from legal process and the claim of any creditor.
2.08 Evidence of Survival - The Company may require satisfactory
evidence of the continued survival of any person(s) on whose life
Annuity payments are based.
2.09 Proof of Age - The Company may require evidence of age of any
Annuitant under Annuity Options 2 and 3 and of the designated
second Annuitant under Annuity Option 3.
2.10 Change of Contract - Only our authorized officers may change the
terms of this Contract. We will notify the Group Contract Holder in
writing at least 30 days before the effective date of any change.
Any change will not affect the amount or terms of any Annuity which
begins before the change.
9
We may make any change that affects the AG Account Market Value
Adjustment with at least thirty (30) days' advance written notice
to the Group Contract Holder and the Certificate Holder. Any such
change shall become effective for any new guaranteed term and will
apply to all present and future Certificate Holders' Accounts.
We reserve the right to change the terms of the Systematic
Withdrawal Option for future elections and discontinue the
availability of this option.
Any change to any of the following provisions under this Contract
will not apply to Certificate Holder's Accounts in existence before
the effective date of the change:
(a) Net Purchase Payment (1.23)
(b) AG Account Guaranteed Interest Rate (7.01)
(c) Net Return Factor (6.05)
(d) Certificate Holder's Account Value (1.14)
(e) Deferred Sales Charge (8.04)
(f) Annuity Unit Value (12.04)
(g) Annuity Options (12.06)
(h) Fixed Annuity Interest Rates (12.01)
(i) Transfers (8.02).
Any change that affects the Annuity Option and the tables for the
Annuity Options may be made:
(a) No earlier than twelve (12) months after the Effective
Date; and
(b) No earlier than twelve (12) months after the effective date
of any prior change.
Any Certificate Holder's Account established on or after the
effective date of any change will be subject to the change. If the
Group Contract Holder does not agree to any change under this
provision, We reserve the right to not allow any new Certificate
Holder's Accounts to be established under this Contract. This
Contract may also be changed as deemed necessary by Us to comply
with federal or state law.
Section 3. Ownership
--------------------------------------------------------------------------------
3.01 Group Contract Holder - The Group Contract Holder has title to the
Contract. The Contract and any amounts accumulated thereunder are
not subject to the claims of the Group Contract Holder nor any of
its creditors.
3.02 Certificate Holder Rights - The Certificate Holder has all interest
and right to amounts held in his or her Certificate Holder's
Account. The Certificate Holder and any joint Certificate Holder
are named on the Specifications page. The Certificate Holder and
any joint Certificate Holder may exercise all the rights under the
Certificate Holder's Account, subject to the rights of:
(a) Any assignee under an assignment filed at our Home Office;
and
(b) Any irrevocably named Beneficiary.
10
Upon the death of a Certificate Holder prior to the Annuity Date, a
spousal Beneficiary may elect to continue the Certificate Holder's
Account in his or her own name and retain all ownership rights and
privileges or take distribution of the death benefit as defined in
Section 10.
3.03 Transfer of Ownership - The Group Contract Holder may transfer
ownership of this Contract. A written request, dated and signed,
must be filed at our Home Office.
Any transfer of ownership terminates the interest of any existing
Group Contract Holder. It does not change the rights of any
Certificate Holder.
A Certificate Holder may transfer all of his or her rights under
the Contract. A written request, dated and signed by the
Certificate Holder and any joint Certificate Holder, must be filed
at our Home Office. After the transfer is recorded, it will take
effect as of the date the request was signed. Any such transfer
terminates the interest of any existing Certificate Holder. It does
not change the Beneficiary, nor transfer the Beneficiary's
interest. A transfer will not affect any payments We may make or
actions We may take before such transfer has been recorded at our
Home Office.
Section 4. Beneficiary Provisions
--------------------------------------------------------------------------------
4.01 Beneficiary - The Certificate Holder may name a Beneficiary and a
contingent Beneficiary. At the death of the Certificate Holder
prior to the Annuity Date, the Beneficiary(ies) named in our
records will receive a death benefit as stated in Section 10. Upon
the death of either joint Certificate Holder prior to the Annuity
Date, the surviving joint Certificate Holder, if any, will be
treated as the designated Beneficiary and any other Beneficiary
designation on record with Us at the time of death is treated as a
contingent Beneficiary.
4.02 Change of Beneficiary - The Certificate Holder may change the
Beneficiary. A written request, dated and signed by the Certificate
Holder, must be filed at our Home Office. If there are joint
Certificate Holders, both must sign the request. After the change
is recorded, it will take effect as of the date the request was
signed. If the request reaches our Home Office and is recorded
after the Certificate Holder dies, but before any payment is made,
the change is valid.
4.03 Death of Beneficiary - If all of the Beneficiaries and contingent
Beneficiaries die prior to the Certificate Holder's death, We pay
the death benefit in one sum to the Certificate Holder's estate.
Section 5. Purchase Payments
--------------------------------------------------------------------------------
5.01 Purchase Payments - Subject to the maximum and minimum shown on the
Contract Schedule, the Certificate Holder may determine the amount
and frequency of Purchase Payments. We reserve the right not to
accept any Purchase Payment. We will declare from time to time the
acceptability of additional Purchase Payments.
5.02 Allocation of Purchase Payments - The Certificate Holder may elect
to have each Net Purchase Payment accumulate:
11
(a) On a variable basis invested in shares of one or more Funds
in which the Separate Account invests;
(b) For guaranteed terms offered in the current deposit
period(s) under the AG Account; or
(c) In a combination of any of the available investment
options.
Net Purchase Payments must be allocated in whole percentages. For
subsequent Purchase Payments, if no allocation instructions are
received with the Purchase Payment, the allocation will be as
indicated in the most recent directive from the Certificate Holder.
If the same guaranteed term(s) are not available, the next shortest
will be used. If no shorter guaranteed term is available, the next
longer guaranteed term will be used.
Section 6. Separate Account
--------------------------------------------------------------------------------
6.01 General - The assets of the Separate Account, equal to the reserves
and other Contract liabilities that depend on the investment
performance of the Separate Account are not chargeable with
liabilities arising out of any other business We may conduct.
Income, gains or losses of the Separate Account, realized or
unrealized, are credited to or charged against the assets of the
Separate Account without regard to Our other income, gains or
losses.
6.02 Investment Allocations to the Separate Account - The assets of the
Separate Account are segregated by Fund. If the shares of any Fund
are no longer available for investment by the Separate Account or
if in our judgment, further investment in such shares should become
inappropriate in view of the purpose of the Contract, We may cease
to make such Fund shares available for investment under the
Contract prospectively, or We may substitute shares of another Fund
for shares already acquired. We may also, from time to time, add
additional Funds. Any elimination, substitution or addition of
Funds will be done in accordance with applicable state and federal
securities laws. We reserve the right to substitute shares of
another Fund for shares already acquired without a proxy vote.
6.03 Valuation of Assets - The shares of the Funds will be valued at
their net asset value at the end of each Valuation Period.
6.04 Accumulation Unit - A Net Purchase Payment that is allocated to one
or more Funds is credited to the Certificate Holder's Account as
Accumulation Units. The number of Accumulation Units credited is
determined by dividing the applicable portion of the Net Purchase
Payment by the Accumulation Unit value for the appropriate Fund.
The Accumulation Unit value used is that which is computed for the
next Valuation Period after which the Purchase Payment is received
at our Home Office. Accumulation Units attributable to the initial
Purchase Payments will be credited within two business days of
acceptance.
Accumulation Unit values may increase or decrease from Valuation
Period to Valuation Period.
6.05 Net Return Factor for Each Valuation Period - The value of an
Accumulation Unit for any Valuation Period is calculated by
multiplying the Accumulation Unit value for the immediately
preceding Valuation Period by the net return factor of the
appropriate Fund for the current period.
The net return factor for each Fund is equal to 1.0000000 plus the
net return rate.
12
The net return rate equals:
(a) The value of the shares of the Fund held by the Separate
Account at the end of a Valuation Period; minus
(b) The value of the shares of the Fund held by the Separate
Account at the start of the Valuation Period; plus or minus
(c) Taxes (or reserves for taxes) on the Separate Account (if
any); divided by
(d) The total value of the Funds(s) Accumulation Units and
Fund(s) Annuity Units of the Separate Account at the start
of the Valuation Period; minus
(e) A daily actuarial charge as shown on the Contract Schedule
for Annuity mortality and expense risks and profit and a
daily administrative charge.
The net return rate may be more or less than zero (0) percent.
The value of a share of the Fund is equal to the net assets of the
Fund divided by the number of shares outstanding.
6.06 Administrative Charge - We deduct an administrative charge equal,
on an annual basis, to the amount shown on the Contract Schedule.
6.07 Mortality Risk Charge - We deduct a mortality risk charge equal, on
an annual basis, to the amount shown on the Contract Schedule.
6.08 Expense Risk Charge - We deduct an expense risk charge equal, on an
annual basis, to the amount shown on the Contract Schedule.
6.09 Mortality and Expense Guarantee - We guarantee that the dollar
amount of each Annuity payment after the first will not be affected
by variations in mortality or expense experience.
Section 7. AG Account
--------------------------------------------------------------------------------
7.01 AG Account Guaranteed Interest Rate - All amounts allocated to the
AG Account earn a rate of interest that is guaranteed for a
specified period of time. The rate will be credited daily and will
never be less than the minimum guaranteed interest rate shown on
the Contract Schedule. We determine the rate and it is not based on
investment experience.
For guaranteed terms of one year or less, one guaranteed interest
rate is credited for the full guaranteed term. For longer
guaranteed terms, an initial guaranteed interest rate is credited
from the date of deposit to the end of a specified period within
the guaranteed term. There may be different guaranteed interest
rate(s) declared for subsequent specified time intervals throughout
the guaranteed term.
7.02 Deposit Period - A calendar week, a calendar month, a calendar
quarter, or any other period of time We specify during which Net
Purchase Payment(s), transfers and reinvestments are accepted into
the AG Account for one or more guaranteed terms. We reserve the
right to extend the deposit period.
13
7.03 Guaranteed Term - The period of time for which AG Account
guaranteed interest rates are guaranteed on Net Purchase Payments.
Transfers and reinvestments are made into a current deposit period
for the AG Account. Such period begins on the day following the
close of the deposit period and ends on the designated Maturity
Date. Guaranteed terms, if any, are offered at our discretion for
various lengths of time ranging up to and including ten years.
During a deposit period, We may make available any number of
guaranteed terms. The Certificate Holder may allocate Net Purchase
Payments and transfers into any or all of the available guaranteed
terms.
7.04 Guaranteed Term(s) Groups - All AG Account guaranteed term(s) with
the same length of time from the close of the deposit period until
the designated Maturity Date.
7.05 Maturity Date - The last day of a guaranteed term.
7.06 Allocation of Net Purchase Payments to the AG Account - When the
Certificate Holder wishes to allocate all or any portion of a Net
Purchase Payment to the AG Account, he or she must tell Us the
percentage to apply to one or more of the AG Account guaranteed
term(s) available during the current deposit period. If no
allocation instructions are received, a Net Purchase Payment is
allocated as indicated in the most recent directive from the
Certificate Holder. If the same guaranteed term is not available
for any amount allocated to the AG Account, We will allocate the
amount to the next shortest guaranteed term available. If no
shorter guaranteed term is available, We will allocate it to the
next longest guaranteed term.
7.07 AG Account Guaranteed Term Maturity Date and Maturity Value - On
the maturity date, the value of the total of all amounts allocated
to that guaranteed term is called the maturity value.
When Certificate Holders have assets in the AG Account, at least
eighteen (18) days before a maturity date, We notify them of the:
(a) Projected maturity value; and
(b) Guaranteed terms and the applicable guaranteed interest
rates available during the current deposit period.
When no allocation instructions are received and the assets in a
guaranteed term have been reinvested by Us in another guaranteed
term on the maturity date, the Certificate Holder may transfer or
withdraw, during the month following the maturity date, the
reinvested amount with interest earned (as of the date the request
is received at our Home Office) without incurring a Market Value
Adjustment. This transaction is allowed only once for each maturity
date, regardless of whether the transfer or withdrawal is partial
or full.
7.08 Transfers from the AG Account - A Certificate Holder may transfer
any portion, or all, of an amount in the AG Account to one or more
of the Funds or to another available guaranteed term. The amount
withdrawn for any reason before the maturity date is subject to a
Market Value Adjustment.
14
7.09 Withdrawals from the AG Account - When the Certificate Holder
requests a withdrawal from the AG Account, if instructions are not
provided by the Certificate Holder, amounts are withdrawn on a pro
rata basis from the guaranteed term(s) groups in which the
Certificate Holder's Account is currently invested. Within a
guaranteed term group, the amount to be withdrawn will be withdrawn
first from the oldest deposit period. Except on the maturity date,
withdrawals from the AG Account will be subject to a Market Value
Adjustment.
7.10 Reinvestment - We will mail a notice to the Certificate Holder
before a guaranteed term's maturity date. This notice will contain
the guaranteed terms available during the current deposit periods
with their guaranteed interest rate(s) and projected maturity
value. If no specific direction is given by the Certificate Holder
prior to the maturity date, each maturity value will be reinvested
in the current deposit period for a guaranteed term of the same
duration. If a guaranteed term of the same duration is unavailable,
each matured term value will automatically be reinvested in the
current deposit period for the next shortest guaranteed term
available. If no shorter guaranteed term is available, the next
longer guaranteed term will be used. We will mail a confirmation
statement to the Certificate Holder after the maturity date. This
notice will state the guaranteed term and guaranteed interest
rate(s) which will apply to the reinvested matured term value.
7.11 AG Account Market Value Adjustment (Factor) - The Market Value
Adjustment factor (MVA factor) reflects any change in interest
rates from the time assets are allocated to the AG Account to the
time they are transferred or withdrawn. An MVA factor is applied to
any amount withdrawn or transferred from the AG Account before the
end of a guaranteed term, including amounts paid in a lump sum
death benefit or applied to an Annuity Option.
The amount withdrawn from the AG Account is multiplied by the MVA
factor which is calculated as follows:
x
---
365
(1 + i)
-----------
x
---
365
(1 + j)
-----------
Where:
i is the Deposit Period Yield
j is the Current Yield
x is the number of days remaining, (computed
from Wednesday of the week of withdrawal) in
the guaranteed Term.
Determination of MVA factor parameters:
A yield is computed at the close of the last business day of each
week of the deposit period. The yield will equal the average of the
yields on U.S. Treasury Notes which matured during the last three
months of the applicable guaranteed term.
15
The deposit period yield is the average of those yields for the
deposit period. If withdrawal is made prior to the close of the
deposit period, it is the average of those yields on each week
preceding withdrawal.
The current yield is the average of the yields on the last business
day of the week preceding withdrawal on the same U.S. Treasury
Notes included in the deposit period yield.
If no U.S. Treasury Notes matured during the last three months of
the guaranteed term, We reserve the right to use the average of the
yields on U.S. Treasury Notes that mature during a following
quarter.
Section 8. Certificate Holder's Account Value; Transfers and Withdrawals
During the Accumulation Period
--------------------------------------------------------------------------------
8.01 Certificate Holder's Account Value - The value of a Certificate
Holder's Account is determined by adding the value of the total of
Accumulation Units attributed to the selected Fund(s) to the value
of any amounts attributed to the AG Account.
8.02 Transfers During the Accumulation Period - Before the Annuity Date,
the Certificate Holder may transfer from any Fund or guaranteed
term of the AG Account to:
(a) Any other Fund; or
(b) Any guaranteed term of the AG Account available in the
current deposit period.
Transfer requests can be submitted as a percentage or as a dollar
amount. We may establish a minimum transfer amount. Within a
guaranteed term group, the amount transferred is withdrawn first
from the oldest deposit period, then from the next oldest, and so
on until the amount requested is satisfied.
The Certificate Holder may make an unlimited number of transfers
during the Accumulation Period. The number of free transfers
allowed is shown on the Contract Schedule. Transfers in excess of
that number may be subject to the transfer charge shown on the
Contract Schedule. Transfers of a matured term value from the AG
Account on or within one calendar month after a guaranteed term's
maturity date do not count against the annual transfer limit.
Amounts applied to guaranteed terms of the AG Account may not be
transferred to the Funds or to another guaranteed term during the
deposit period or for 90 days after the close of the deposit period
except for matured term value(s) during the calendar month
following the guaranteed term's maturity date.
Transfers from guaranteed terms of the AG Account are subject to a
Market Value Adjustment.
16
8.03 Withdrawals During the Accumulation Period - The Certificate Holder
may withdraw all or a portion of the Certificate Holder's Account
Value during the Accumulation Period by properly completing a
withdrawal request form. Withdrawal requests can be submitted as a
percentage or as a specific dollar amount. Net Purchase Payment
amounts are withdrawn first, and then the excess value, if any. For
any partial withdrawal, if instructions are not provided by the
Certificate Holder, amounts are withdrawn on a pro rata basis from
the Fund(s), and/or the guaranteed term(s) groups in which the
Certificate Holder's Account is currently invested. Within a
guaranteed term group, the amount to be withdrawn will be withdrawn
first from the oldest deposit period, then from the next oldest,
and so on until the amount requested is satisfied.
After deduction of the maintenance charge, if applicable, the
withdrawn amount shall be reduced by the applicable deferred sales
charge and any applicable premium taxes.
8.04 Deferred Sales Charge - The deferred sales charge only applies to
the portion of the amount withdrawn attributable to Net Purchase
Payment(s) and varies according to the elapsed time since receipt
of the Purchase Payment. The deferred sales charge is shown on the
Contract Schedule.
8.05 Waiver of Deferred Sales Charge - No deferred sales charge is
deducted when a Certificate Holder's Account Value is paid:
(a) To a Beneficiary as a death benefit, except for Purchase
Payments made by a surviving joint Certificate Holder as
described in Section 10.02(b);
(b) As a premium for an Annuity Option;
(c) At least the number of months, as shown on the Contract
Schedule, after the date of the first Purchase Payment and
in an amount equal to or less than the percentage of the
Certificate Holder's Account Value as shown on the Contract
Schedule. This applies to the first withdrawal request,
partial or full, in a calendar year. The Certificate
Holder's Account Value is calculated as of the date the
withdrawal request is received in good order at our Home
Office. This waiver is not available to the Certificate
Holder while a SWO is in effect;
(d) For a full withdrawal where the Certificate Holder's
Account Value does not exceed the amount shown on the
Contract Schedule and no withdrawals have been taken from
the Certificate Holder's Account within the prior 12
months;
(e) For a distribution made by Us under Section 8.06; or
(f) For a distribution which is part of a SWO under Section
8.07.
We reserve the right to allow the proceeds of a total withdrawal to
be reinstated under the terms and conditions as established by Us
from time to time.
8.06 Payment of Adjusted Certificate Holder Account Value - Upon 90
day's written notice to the Certificate Holder, We will terminate
any Certificate Holder's Account if the Certificate Holder's
Account Value becomes less than $1,500 immediately following any
partial withdrawal. We do not intend to exercise this right in
cases where the Certificate Holder's Account Value is reduced to
$1,500 or less solely due to investment performance. When We make a
distribution pursuant to this provision, the deferred sales charge
will not be deducted.
17
8.07 Systematic Withdrawal Option (SWO) - We will allow the Certificate
Holder to establish a schedule of withdrawals to be made
automatically from the Certificate Holder's Account Value. All
distributed amounts will be withdrawn on a pro rata basis from the
Fund(s) and/or the guaranteed term(s) groups of the AG Account in
which the Certificate Holder's Account is invested.
The Certificate Holder must elect one of the following SWO methods:
(a) Specified Payment: Payments of a designated dollar amount.
The annual amount may not be greater than the percentage of
the Certificate Holder's Account Value at time of the
election as shown on the Contract Schedule. This annual
dollar amount will remain constant. At our discretion, We
may require a minimum payment amount; or
(b) Specified Period: Payments which are made over a period of
time which must be at least the minimum period as shown on
the Contract Schedule. The annual amount paid each year is
calculated by dividing the Certificate Holder's Account
Value as of December 31 of the prior year by the number of
payment years remaining; or
(c) Specified Percentage: Payment of a designated percentage
which cannot be greater than the percentage of the
Certificate Holder's Account Value at the time of election
as shown on the Contract Schedule. The percentage may be
changed by written request. We reserve the right to limit
the number of times the percentage may be changed. The
annual amount is calculated by multiplying the Certificate
Holder's Account Value as of December 31 of the year prior
to the payment by the designated percentage.
In our discretion, We may require a minimum initial Certificate
Holder's Account Value for election of this option. SWO may be
elected by submitting a completed and signed election form to Us.
Once elected, this option may be revoked by submitting a written
request to Us. SWO may be elected only once by the Certificate
Holder or by a spousal Beneficiary.
Certificate Holders should consult their tax adviser prior to
requesting this distribution option. We are not responsible for any
adverse tax consequences due to a Certificate Holder's receiving
SWO payments. A ten (10) percent penalty tax may apply to
distributions to a Certificate Holder who has not reached age
59-1/2. Upon death of the Certificate Holder, any payments will be
made under the terms of Section 10.
Section 9. Maintenance Charge
--------------------------------------------------------------------------------
9.01 Maintenance Charge - We will deduct an annual maintenance charge as
shown in the Contract Schedule from the Certificate Holder's
Account during the Accumulation Period. We will deduct the
maintenance charge on the anniversary of the Effective Date of the
Certificate for the Certificate Holder's Account. This maintenance
charge is also deducted upon withdrawal of the entire Adjusted
Certificate Holder's Account. The maintenance charge is deducted
proportionately from each investment option used.
18
Section 10. Proceeds Payable on Death
--------------------------------------------------------------------------------
10.01 Death of the Certificate Holder Prior to the Annuity Date - In the
event of the death of the Certificate Holder or a joint Certificate
Holder prior to the Annuity Date, a death benefit is payable to the
Beneficiary(ies) designated by the Certificate Holder. Upon the
death of a joint Certificate Holder, the surviving joint
Certificate Holder, if any, will be treated as the designated
Beneficiary. Any other Beneficiary designation on record with Us at
the time of death will be treated as a contingent Beneficiary.
A Beneficiary may request We pay the death benefit under one of the
options described in Section 10.03. If the Beneficiary is the
spouse of the Certificate Holder, he or she may elect to continue
the Certificate Holder's Account in his or her own name and
exercise all the Certificate Holder's rights under the Contract.
10.02 Death Benefit Amount Prior to the Annuity Date
(a) Except as set forth in Section 10.02(b), the amount of the
guaranteed death benefit value is equal to the greater of:
(i) The Certificate Holder's Account Value at the end of
the Valuation Period during which We receive at our
Home Office due proof of death and election of the
type of payment to be made; or
(ii) The death benefit determined as of the Valuation
Period corresponding to the date of death.
Until the first Effective Date anniversary, the
death benefit is equal to the Purchase Payments made
by the Certificate Holder prior to the Effective
Date anniversary less any withdrawals and any
amounts applied to an Annuity Option.
For each Certificate year thereafter, the death
benefit during the Certificate year equals the death
benefit at the beginning of the Certificate year
plus Purchase Payments made during the year less any
withdrawals and any amounts applied to an Annuity
Option.
On each Effective Date anniversary, the death
benefit is determined as follows:
(A) The death benefit on the previous Effective
Date anniversary increased by the death
benefit factor shown on the Contract
Schedule; plus
(B) Purchase Payments made by the Certificate
Holder during the Certificate year increased
by the death benefit factor shown on the
Contract Schedule for the portion of the
year since the Purchase Payment was made;
less
(C) Any withdrawals or amounts applied to an
Annuity Option during the Certificate year
increased by the death benefit factor shown
on the Contract Schedule for the portion of
the Certificate year since the withdrawal or
election of Annuity option; or
19
(iii) The Certificate Holder's Account Value on the most
recent seventh year anniversary of the Effective
Date plus any Purchase Payments made after such
Effective Date anniversary less any withdrawals and
any amounts applied to an Annuity Option.
Notwithstanding the foregoing, the death benefit under (ii)
or (iii) will not exceed the death benefit maximum amount
shown on the Contract Schedule.
The death benefit calculation described in (ii) and (iii)
above, applies until the Certificate Holder reaches the
death benefit maximum age shown on the Contract Schedule.
Thereafter, the death benefit is only adjusted for Purchase
Payments, withdrawals and amounts applied to Annuity
Options. If the Certificate Holder reaches the death
benefit maximum age shown on the Contract Schedule prior to
the seventh anniversary of the Effective Date, the death
benefit will be the greater of (i) or (ii) above.
The excess, if any, of the guaranteed death benefit value
over the Certificate Holder's Account Value is determined
when we receive at our Home Office due proof of death and
allocated to the Fund shown on the Contract Schedule. The
Certificate Holder's Account Value plus any excess amount
deposited becomes the Certificate Holder's Account Value.
(b) In the case of a Beneficiary of a surviving joint
Certificate Holder who continued the Certificate Holder's
Account in his or her own name, the death benefit shall be
equal to (a)(i) above less any applicable deferred sales
charge on any Purchase Payment made after We have received
at our Home Office due proof of death of the first joint
Certificate Holder.
10.03 Death Benefit Payment Methods - A non-spousal Beneficiary must
elect the death benefit to be paid under one of the following
methods in the event of the death of the Certificate Holder prior
to the Annuity Date:
Method 1 - Lump sum payment of the death benefit; or
Method 2 - The payment of the entire death benefit within (5) years
of the date of the Certificate Holder's death; or
Method 3 - Payment of the death benefit over the lifetime of the
designated Beneficiary or over a period not extending beyond the
life expectancy of the designated Beneficiary with distribution
beginning within one year of the date of death of the Certificate
Holder.
Any portion of the death benefit not applied under Option 3 within
one year of the date of Certificate Holder's death, must be
distributed within five (5) years of the date of death. A Market
Value Adjustment will apply at the time the death benefit is paid.
A spousal Beneficiary may elect to continue the Certificate
Holder's Account in his or her name, elect a lump sum payment of
the death benefit or apply the Adjusted Certificate Holder's
Account Value to an Annuity Option.
20
10.04 Death of Certificate Holder On or After the Annuity Date - If the
Certificate Holder who is not the Annuitant, dies on or after the
Annuity Date, the remaining payments under the Annuity Option
elected will be made to the Beneficiary at least as rapidly as
under the method of distribution in effect at the Certificate
Holder's death.
10.05 Death of the Annuitant - If the Annuitant, who is not a Certificate
Holder, dies on or before the Annuity Date, a new Annuitant may be
named. If no Annuitant is named, the Certificate Holder will be the
Annuitant. If the Annuitant dies after the Annuity Date, the death
benefit, if any, will be payable to the Beneficiary as specified in
the Annuity Option elected. We will require proof of the
Annuitant's death. Death benefits will be paid at least as rapidly
as under the method of distribution in effect at the Annuitant's
death.
Section 11. Delay of Payments
--------------------------------------------------------------------------------
11.01 Delay of Payments - We will make any payments under this Contract
within seven days after a request is received in good order. We
reserve the right to suspend or postpone any type of payment from
the Separate Account for any period when:
(a) The New York Stock Exchange is closed for other than
customary weekend and holiday closings;
(b) Trading on the Exchange is restricted;
(c) An emergency exists as a result of which it is not
reasonably practicable to dispose of securities held in the
Separate Account or determine their value; or
(d) The Securities and Exchange Commission so permits delay for
the protection of security holders.
The applicable rules of the Securities and Exchange Commission will
govern as to whether the conditions in (b) or (c) exist.
We also reserve the right to delay any type of payment from the AG
Account for up to six (6) months.
Section 12. Annuity Provisions
--------------------------------------------------------------------------------
12.01 Designation of Annuitant - The Certificate Holder and the Annuitant
need not be the same person. The Certificate Holder names the
Annuitant and during the Accumulation Period, may change the
designated Annuitant. We change the Annuitant when We receive a
written request in good order at our Home Office. We will not
change the Annuitant when Annuity payments have commenced.
The Certificate Holder elects an Annuity Option by telling Us to
use all or any portion of the Certificate Holder's Adjusted Account
Value (minus any applicable premium taxes if not previously
deducted) to purchase Annuity payments under an Annuity Option.
21
When an Annuity Option is chosen the Certificate Holder must
designate a:
(a) Fixed Annuity using the General Account;
(b) Variable Annuity using any of the Funds available during
the Annuity Period; or
(c) Combination of (a) and (b).
If a fixed Annuity is chosen, We will calculate the amount using an
interest assumption no less than the percentage specified on the
Contract Schedule. We may calculate the amount using a higher
interest rate.
If a variable Annuity is chosen, an Assumed Annual Net Return Rate
of 5% may be chosen. If not chosen, We will use an Assumed Annual
Net Return Rate of 3.5%
Payments are made on a monthly basis to the Certificate Holder
unless the Certificate Holder requests a different mode of payment.
Once elected, an Annuity Option may not be revoked, except for
Option 1 when elected on a variable basis.
12.02 Terms of Annuity Options - The minimum first payment amount must be
at least $50 per month and at least $250 per year.
If the Certificate Holder elects a fixed Annuity and We determine
that the Certificate Holder would receive larger payments by
applying the Certificate Holder's Account Value, reduced by the
deferred sales charge, to a single premium immediate Annuity
currently offered by Us, We will make the larger payments.
We determine the first payment of a variable Annuity, or the
payment amount of a fixed Annuity, using the Annuitant's (and
second Annuitant's if applicable) adjusted age which We calculate
as follows:
(a) If Annuity payments begin any time between July 1, 1992 and
December 31, 1999, the adjusted age is the Annuitant's age
as of the birthday closest in time to the Annuity Date
reduced by one (1) year.
(b) If the Annuity begins any time between January 1, 2000 and
December 31, 2009, the adjusted age is the Annuitant's age
as of the birthday closest in time to the Annuity Date
reduced by two (2) years.
(c) For each succeeding decade, the adjusted age is the
Annuitant's age as determined in (b), reduced by one
additional year.
The Annuity rates for Options 2 and 3 are based on mortality from
1983 Table A.
Assumed Annual Net Return Rate is the interest rate used to
determine the amount of the first Annuity payment under a variable
Annuity. The Separate Account must earn this rate plus enough to
cover the mortality and expense risks charges (which may include
profit) and administrative charges if future variable Annuity
payments are to remain level.
22
The Certificate Holder must give written notice to Us at least 30
days before the Annuity payments begin, electing or changing:
(a) The date on which Annuity payments are to begin;
(b) The Annuity Option;
(c) Whether the payments are to be made monthly, quarterly,
semiannually or annually;
(d) The investment options used to provide Annuity payments.
The first Annuity payment may not be earlier than one (1) calendar
year after the initial Purchase Payment, nor later than the later
of the:
(a) First day of the month following the Annuitant's birthday
shown on the Contract Schedule; or
(b) Tenth anniversary of the last Purchase Payment. In lieu of
the election of an Annuity, the Certificate Holder may
request a lump sum payment.
12.03 Annuity Unit - The number of Annuity Units per Fund is based on the
amount of the first variable Annuity payment which is equal to:
(a) The portion of the Certificate Holder's Account Value
(minus any premium taxes) applied to pay a variable
Annuity; divided by,
(b) 1000; multiplied by,
(c) The payment rate for the Annuity Option chosen.
Such amount, or portion, of the variable Annuity payment will be
divided by the Annuity Unit value for the appropriate Fund on the
tenth Valuation Period before the due date of the first payment to
determine the number of each Fund's Annuity Units. The number of
each Fund's Annuity Unit remains fixed. Each future payment is
equal to the sum of the products of each Fund's Annuity Unit value
multiplied by the appropriate number of units. The Fund's Annuity
Unit value on the tenth Valuation Period prior to the due date of
the payment is used.
12.04 Annuity Unit Value - For any Valuation Period, a Fund's Annuity
Unit value is equal to:
(a) The value for the previous Valuation Period; multiplied by,
(b) The Annuity Net Return Factor for the Valuation Period;
multiplied by,
(c) A daily factor to reflect the Assumed Annual Net Return
Rate (the factor for 3.5% per year is .9999058; for 5% per
year it is .9998663).
The dollar value of a Fund(s) Annuity Unit values and payments may
go up or down due to investment gain or loss.
12.05 Annuity Net Return Factor - The Annuity net return factor is used
to compute all Separate Account Annuity payments for any Fund.
The Annuity net return factor(s) for each Fund is equal to
1.0000000 plus the net return rate. The net return rate is equal
to:
23
(a) The value of the shares of the Fund held by the Separate
Account at the end of a Valuation Period; minus,
(b) The value of the shares of the Fund held by the Separate
Account at the start of the Valuation Period; plus or
minus,
(c) Taxes (or reserves for taxes) on the Separate Account (if
any); divided by
(d) The total value of the Fund(s) Accumulation Units and
Fund(s) Annuity Units of the Separate Account at the start
of the Valuation Period; minus,
(e) A daily actuarial charge as shown of the Contract Schedule
for Annuity mortality and expense risks and profit and a
daily administrative charge which will not exceed the
administrative charge as shown on the Contract Schedule.
The net return rate may be more or less than zero (o) percent.
The value of a share of the Fund is equal to the net assets of the
Fund divided by the number of shares outstanding.
12.06 Annuity Options
Option 1 - Payments for a Stated Period of Time - An Annuity will
be paid for the number of years chosen. The number of years must be
at least 5 and not more than 30.
If payments for this Annuity Option are made under a variable
Annuity, the present value of any remaining payments may be
withdrawn at any time.
Option 2 - Life Income - An Annuity will be paid for the life of
the Annuitant. If also chosen, We will guarantee payments for 60,
120, 180, or 240 months.
Option 3 - Life Income Based upon the Lives of Two Annuitants - An
Annuity will be paid during the lives of the Annuitant and a second
Annuitant. Payments will continue until both Annuitants have died.
When this Annuity Option is chosen, a choice must be made of:
(a) 100% of the payment to continue after the first death;
(b) 66-2/3% of the payment to continue after the first death:
(c) 50% of the payment to continue after the first death;
(d) Payments for a minimum of 120 months with 100% of the
payment to continue after the first death; or
(e) 100% of the payment to continue at the death of the second
Annuitant and 50% of the payment to continue at the death
of the Annuitant.
We may make other options available as allowed by law.
24
OPTION 1
Payments for a Stated Period of Time
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
------------------------------------------------------------------------------
Guaranteed Monthly Quarterly Semi-Annual Annual
Years Rate Payment Payment Payment Payment
------------------------------------------------------------------------------
5 3.00% 17.91 53.59 106.78 211.99
6 3.00% 15.14 45.30 90.27 179.22
7 3.00% 13.16 39.39 78.49 155.83
8 3.00% 11.68 34.96 69.66 138.31
9 3.00% 10.53 31.52 62.81 124.69
10 3.00% 9.61 28.77 57.33 113.82
11 3.00% 8.86 26.52 52.85 104.93
12 3.00% 8.24 24.65 49.13 97.54
13 3.00% 7.71 23.08 45.98 91.29
14 3.00% 7.26 21.73 43.29 85.95
15 3.00% 6.87 20.56 40.96 81.33
16 3.00% 6.53 19.54 38.93 77.29
17 3.00% 6.23 18.64 37.14 73.74
18 3.00% 5.96 17.84 35.56 70.59
19 3.00% 5.73 17.13 34.14 67.78
20 3.00% 5.51 16.50 32.87 65.26
21 3.00% 5.32 15.92 31.72 62.98
22 3.00% 5.15 15.40 30.68 60.92
23 3.00% 4.99 14.92 29.74 59.04
24 3.00% 4.84 14.49 28.88 57.33
25 3.00% 4.71 14.09 28.08 55.76
26 3.00% 4.59 13.73 27.36 54.31
27 3.00% 4.47 13.39 26.68 52.97
28 3.00% 4.37 13.08 26.06 51.74
29 3.00% 4.27 12.79 25.49 50.60
30 3.00% 4.18 12.52 24.95 49.53
------------------------------------------------------------------------------
25
OPTION 2
Life Income
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
Payments Guaranteed for a Stated Period of Months
---------------------------------------------------------------------------------------------------------------------------------
None 60 120 180 240
Adjusted -----------------------------------------------------------------------------------------------------------------
Age of
Annuitant Male Female Male Female Male Female Male Female Male Female
---------------------------------------------------------------------------------------------------------------------------------
50 $ 4.27 $ 3.90 $ 4.26 $ 3.90 $ 4.22 $ 3.89 $ 4.17 $ 3.86 $ 4.08 $ 3.82
51 4.34 3.97 4.33 3.96 4.30 3.95 4.23 3.92 4.14 3.88
52 4.43 4.03 4.41 4.03 4.37 4.01 4.30 3.98 4.20 3.93
53 4.51 4.10 4.50 4.10 4.45 4.08 4.37 4.04 4.26 3.99
54 4.60 4.18 4.59 4.17 4.54 4.15 4.45 4.11 4.32 4.04
55 4.70 4.25 4.68 4.25 4.62 4.22 4.53 4.18 4.39 4.11
56 4.80 4.34 4.78 4.33 4.72 4.30 4.61 4.25 4.45 4.17
57 4.91 4.42 4.89 4.41 4.82 4.38 4.69 4.32 4.51 4.23
58 5.03 4.52 5.00 4.51 4.92 4.47 4.78 4.40 4.58 4.30
59 5.15 4.61 5.12 4.60 5.03 4.56 4.87 4.48 4.65 4.37
60 5.28 4.72 5.25 4.70 5.14 4.66 4.96 4.57 4.71 4.44
61 5.43 4.83 5.39 4.81 5.27 4.76 5.06 4.66 4.78 4.51
62 5.58 4.95 5.53 4.93 5.39 4.87 5.16 4.75 4.84 4.58
63 5.74 5.08 5.69 5.05 5.53 4.99 5.26 4.85 4.90 4.65
64 5.91 5.21 5.85 5.18 5.66 5.10 5.36 4.95 4.96 4.72
65 6.10 5.36 6.03 5.32 5.81 5.22 5.46 5.05 5.02 4.79
66 6.30 5.51 6.21 5.47 5.96 5.36 5.56 5.16 5.08 4.86
67 6.51 5.67 6.41 5.63 6.12 5.50 5.66 5.26 5.13 4.93
68 6.73 5.85 6.62 5.80 6.28 5.65 5.77 5.37 5.18 5.00
69 6.97 6.04 6.84 5.98 6.44 5.80 5.86 5.49 5.23 5.06
70 7.23 6.25 7.07 6.18 6.61 5.97 5.96 5.60 5.27 5.12
71 7.51 6.47 7.32 6.39 6.79 6.14 6.05 5.71 5.31 5.18
72 7.80 6.71 7.58 6.62 6.96 6.32 6.14 5.83 5.34 5.23
73 8.12 6.98 7.85 6.86 7.14 6.50 6.23 5.94 5.37 5.28
74 8.46 7.26 8.14 7.12 7.32 6.69 6.31 6.04 5.40 5.32
75 8.82 7.57 8.45 7.40 7.50 6.89 6.38 6.14 5.42 5.35
---------------------------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
26
OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
(Annuitant is Male and Second Annuitant is Female)
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
--------------------------------------------------------------------------------------------------------------
Adjusted Ages
-------------------------------
Second
Annuitant Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------------------------------------------------------------------------------------------------------------
55 50 $ 3.69 $ 4.05 $ 4.27 $ 3.69 $ 4.13
55 55 3.88 4.25 4.47 3.87 4.25
55 60 3.06 4.47 4.71 4.06 4.36
60 55 3.99 4.44 4.71 3.98 4.55
60 60 4.24 4.71 4.99 4.23 4.70
60 65 4.49 5.01 5.32 4.48 4.85
65 60 4.38 4.97 5.32 4.38 5.10
65 65 4.72 5.33 5.70 4.71 5.32
65 70 5.07 5.75 6.17 5.05 5.54
70 65 4.93 5.68 6.15 4.91 5.86
70 70 5.40 6.21 6.70 5.36 6.18
70 75 5.89 6.82 7.40 5.81 6.49
75 70 5.69 6.68 7.32 5.62 6.92
75 75 6.37 7.45 8.15 6.23 7.40
75 80 7.07 8.34 9.16 6.78 7.85
--------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
The rates assume the Annuitant is Male and
the Second Annuitant is Female.
Rates for ages not shown will be provided on request and will be computed on a
basis consistent with the rates in the above tables.
27
OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
(Annuitant is Female and Second Annuitant is Male)
Rates for a Fixed Annuity with Guaranteed Interest Rate of 3.0%
--------------------------------------------------------------------------------------------------------------
Adjusted Ages
-------------------------------
Second
Annuitant Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------------------------------------------------------------------------------------------------------------
55 50 $ 3.75 $ 4.07 $ 4.26 $ 3.75 $ 3.98
55 55 3.88 4.25 4.47 3.87 4.06
55 60 3.99 4.44 4.71 3.98 4.12
60 55 4.06 4.47 4.71 4.06 4.37
60 60 4.24 4.71 4.99 4.23 4.47
60 65 4.38 4.97 5.32 4.38 4.54
65 60 4.49 5.01 5.32 4.48 4.89
65 65 4.72 5.33 5.70 4.71 5.02
65 70 4.93 5.68 6.15 4.91 5.14
70 65 5.07 5.75 6.17 5.05 5.60
70 70 5.40 6.21 6.70 5.36 5.79
70 75 5.69 6.68 7.32 5.62 5.96
75 70 5.89 6.83 7.40 5.81 6.63
75 75 6.37 7.45 8.15 6.23 6.92
75 80 6.78 8.11 8.99 6.54 7.15
--------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
The rates assume the Annuitant is Female and the Second Annuitant is Male.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
28
OPTION 1
Payments for a Stated Period of Time
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Variable Annuity with Assumed Net Return Rate of 3.5%
------------------------------------------------------------------------------
Guaranteed Monthly Quarterly Semi-Annual Annual
Years Rate Payment Payment Payment Payment
------------------------------------------------------------------------------
5 3.50% 18.12 54.19 107.92 213.99
6 3.50% 15.35 45.92 91.44 181.32
7 3.50% 13.38 40.01 79.69 158.01
8 3.50% 11.90 35.59 70.88 140.56
9 3.50% 10.75 32.16 64.05 127.00
10 3.50% 9.83 29.42 58.59 116.18
11 3.50% 9.09 27.18 54.13 107.34
12 3.50% 8.46 25.32 50.42 99.98
13 3.50% 7.94 23.75 47.29 93.78
14 3.50% 7.49 22.40 44.62 88.47
15 3.50% 7.10 21.24 42.31 83.89
16 3.50% 6.76 20.23 40.29 79.89
17 3.50% 6.47 19.34 38.51 76.37
18 3.50% 6.20 18.55 36.94 73.25
19 3.50% 5.97 17.85 35.54 70.47
20 3.50% 5.75 17.22 34.28 67.98
21 3.50% 5.56 16.65 33.15 65.74
22 3.50% 5.39 16.13 32.13 63.70
23 3.50% 5.24 15.66 31.19 61.85
24 3.50% 5.09 15.24 30.34 60.17
25 3.50% 4.96 14.85 29.56 58.62
26 3.50% 4.84 14.49 28.85 57.20
27 3.50% 4.73 14.15 28.19 55.90
28 3.50% 4.63 13.85 27.58 54.69
29 3.50% 4.53 13.57 27.02 53.57
30 3.50% 4.45 13.30 26.49 52.53
------------------------------------------------------------------------------
29
OPTION 1
Payments for a Stated Period of Time
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Variable Annuity with Assumed Net Return Rate of 5.0%
------------------------------------------------------------------------------
Guaranteed Monthly Quarterly Semi-Annual Annual
Years Rate Payment Payment Payment Payment
------------------------------------------------------------------------------
5 5.00% 18.74 56.00 111.33 219.98
6 5.00% 15.99 47.77 94.96 187.64
7 5.00% 14.02 41.90 83.30 164.59
8 5.00% 12.56 37.52 74.58 147.35
9 5.00% 11.42 34.11 67.81 133.99
10 5.00% 10.51 31.40 62.42 123.34
11 5.00% 9.77 29.19 58.03 114.66
12 5.00% 9.16 27.36 54.38 107.45
13 5.00% 8.64 25.81 51.31 101.39
14 5.00% 8.20 24.50 48.69 96.21
15 5.00% 7.82 23.36 46.44 91.75
16 5.00% 7.49 22.37 44.47 87.88
17 5.00% 7.20 21.51 42.75 84.48
18 5.00% 6.94 20.74 41.23 81.47
19 5.00% 6.71 20.06 39.88 78.80
20 5.00% 6.51 19.46 38.68 76.42
21 5.00% 6.33 18.91 37.59 74.28
22 5.00% 6.17 18.42 36.62 72.35
23 5.00% 6.02 17.98 35.73 70.61
24 5.00% 5.88 17.57 34.93 69.02
25 5.00% 5.76 17.20 34.20 67.57
26 5.00% 5.65 16.87 33.53 66.25
27 5.00% 5.54 16.56 32.92 65.04
28 5.00% 5.45 16.28 32.35 63.93
29 5.00% 5.36 16.01 31.83 62.90
30 5.00% 5.28 15.77 31.35 61.95
------------------------------------------------------------------------------
30
OPTION 2
Life Income
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Variable Annuity with Assumed Net Return Rate of 3.5%
Payments Guaranteed for a Stated Period of Months
---------------------------------------------------------------------------------------------------------------------------------
None 60 120 180 240
Adjusted -----------------------------------------------------------------------------------------------------------------
Age of
Annuitant Male Female Male Female Male Female Male Female Male Female
---------------------------------------------------------------------------------------------------------------------------------
50 $ 4.56 $ 4.20 $ 4.55 $ 4.19 $ 4.51 $ 4.18 $ 4.45 $ 4.15 $ 4.36 $ 4.11
51 4.64 4.26 4.62 4.25 4.58 4.24 4.51 4.21 4.42 4.16
52 4.72 4.32 4.70 4.32 4.66 4.30 4.58 4.26 4.48 4.21
53 4.80 4.39 4.79 4.38 4.74 4.36 4.65 4.32 4.53 4.27
54 4.89 4.46 4.87 4.46 4.82 4.43 4.73 4.39 4.59 4.32
55 4.99 4.54 4.97 4.53 4.91 4.50 4.80 4.46 4.65 4.38
56 5.09 4.62 5.07 4.61 5.00 4.58 4.88 4.53 4.72 4.44
57 5.20 4.71 5.17 4.70 5.10 4.66 4.96 4.60 4.78 4.50
58 5.32 4.80 5.29 4.79 5.20 4.75 5.05 4.68 4.84 4.57
59 5.44 4.90 5.41 4.88 5.31 4.84 5.14 4.76 4.91 4.63
60 5.57 5.00 5.53 4.99 5.42 4.93 5.23 4.84 4.97 4.70
61 5.71 5.11 5.67 5.09 5.54 5.03 5.32 4.93 5.03 4.77
62 5.86 5.23 5.81 5.21 5.66 5.14 5.42 5.02 5.09 4.84
63 6.02 5.36 5.97 5.33 5.79 5.25 5.51 5.11 5.16 4.91
64 6.20 5.49 6.13 5.46 5.93 5.37 5.61 5.21 5.21 4.98
65 6.38 5.64 6.31 5.60 6.07 5.49 5.71 5.31 5.27 5.05
66 6.58 5.79 6.49 5.75 6.22 5.63 5.81 5.41 5.32 5.12
67 6.79 5.95 6.69 5.91 6.38 5.76 5.91 5.52 5.38 5.18
68 7.02 6.13 6.89 6.08 6.53 5.91 6.01 5.63 5.42 5.25
69 7.26 6.32 7.11 6.26 6.70 6.06 6.11 5.74 5.47 5.31
70 7.52 6.53 7.35 6.45 6.86 6.23 6.20 5.85 5.51 5.37
71 7.80 6.75 7.59 6.66 7.03 6.39 6.29 5.96 5.54 5.42
72 8.09 6.99 7.85 6.89 7.21 6.57 6.38 6.07 5.57 5.47
73 8.41 7.26 8.12 7.13 7.38 6.75 6.46 6.17 5.60 5.51
74 8.75 7.54 8.41 7.39 7.55 6.94 6.53 6.28 5.63 5.55
75 9.12 7.85 8.71 7.66 7.73 7.13 6.61 6.38 5.65 5.59
---------------------------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
31
OPTION 2
Life Income
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
Rates for a Variable Annuity with Assumed Net Return Rate of 5.0%
Payments Guaranteed for a Stated Period of Months
---------------------------------------------------------------------------------------------------------------------------------
None 60 120 180 240
Adjusted -----------------------------------------------------------------------------------------------------------------
Age of
Annuitant Male Female Male Female Male Female Male Female Male Female
---------------------------------------------------------------------------------------------------------------------------------
50 $ 5.48 $ 5.12 $ 5.46 $ 5.11 $ 5.41 $ 5.09 $ 5.34 $ 5.06 $ 5.24 $ 5.01
51 5.55 5.17 5.53 5.17 5.48 5.14 5.40 5.11 5.29 5.05
52 5.63 5.23 5.61 5.23 5.55 5.20 5.46 5.16 5.34 5.10
53 5.71 5.30 5.69 5.29 5.62 5.26 5.53 5.22 5.40 5.15
54 5.80 5.37 5.77 5.36 5.70 5.33 5.60 5.27 5.45 5.20
55 5.89 5.44 5.86 5.43 5.79 5.39 5.67 5.34 5.51 5.25
56 5.99 5.52 5.96 5.51 5.87 5.47 5.74 5.40 5.56 5.31
57 6.10 5.60 6.06 5.59 5.97 5.54 5.82 5.47 5.62 5.37
58 6.21 5.69 6.17 5.67 6.06 5.62 5.90 5.54 5.68 5.42
59 6.33 5.79 6.29 5.77 6.17 5.71 5.98 5.61 5.74 5.48
60 6.46 5.89 6.41 5.87 6.28 5.80 6.06 5.69 5.79 5.55
61 6.60 6.00 6.55 6.97 6.39 5.90 6.15 5.77 5.85 5.61
62 6.75 6.11 6.69 6.08 6.51 6.00 6.24 5.86 5.91 5.67
63 6.91 6.23 6.84 6.20 6.64 6.10 6.33 5.95 5.96 5.73
64 7.09 6.37 7.00 6.33 6.77 6.22 6.42 6.04 6.02 5.80
65 7.27 6.51 7.18 6.46 6.91 6.34 6.52 6.13 6.07 5.86
66 7.47 6.66 7.36 6.61 7.05 6.46 6.61 6.23 6.12 5.92
67 7.68 6.82 7.55 6.76 7.20 6.60 6.70 6.33 6.16 5.99
68 7.91 7.00 7.76 6.93 7.35 6.74 6.80 6.43 6.21 6.04
69 8.15 7.19 7.98 7.11 7.51 6.89 6.89 6.54 6.25 6.10
70 8.41 7.39 8.21 7.30 7.67 7.04 6.97 6.64 6.28 6.15
71 8.69 7.62 8.45 7.51 7.83 7.21 7.06 6.74 6.32 6.20
72 8.99 7.86 8.70 7.73 8.00 7.38 7.14 6.85 6.35 6.25
73 9.31 8.12 8.97 7.97 8.16 7.55 7.21 6.95 6.37 6.29
74 9.65 8.41 9.26 8.23 8.33 7.73 7.29 7.04 6.39 6.33
75 10.02 8.72 9.55 8.50 8.50 7.92 7.35 7.14 6.41 6.36
---------------------------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
32
OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
(Annuitant is Male and Second Annuitant is Female)
Rates for a Variable Annuity with Assumed Net Return Rate of 3.5%
--------------------------------------------------------------------------------------------------------------
Adjusted Ages
-------------------------------
Second
Annuitant Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------------------------------------------------------------------------------------------------------------
55 50 $ 3.97 $ 4.35 $ 4.56 $ 3.97 $ 4.42
55 55 4.16 4.54 4.76 4.15 4.54
55 60 4.34 4.76 5.00 4.34 4.64
60 55 4.27 4.73 5.00 4.26 4.83
60 60 4.51 4.99 5.27 4.50 4.98
60 65 4.76 5.29 5.60 4.75 5.13
65 60 4.66 5.25 5.61 4.65 5.39
65 65 4.99 5.61 5.99 4.98 5.60
65 70 5.34 6.03 6.46 5.31 5.81
70 65 5.19 5.97 6.44 5.17 6.14
70 70 5.67 6.49 6.99 5.62 6.47
70 75 6.16 7.10 7.68 6.07 6.77
75 70 5.95 6.96 7.61 5.87 7.20
75 75 6.64 7.73 8.43 6.48 7.68
75 80 7.33 8.62 9.45 7.02 8.13
--------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
The rates assume the Annuitant is Male and the Second Annuitant is Female.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
33
OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
(Annuitant is Female and Second Annuitant is Male)
Rates for a Variable Annuity with Assumed Net Return Rate of 3.5%
--------------------------------------------------------------------------------------------------------------
Adjusted Ages
-------------------------------
Second
Annuitant Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------------------------------------------------------------------------------------------------------------
55 50 $ 4.03 $ 4.36 $ 4.55 $ 4.03 $ 4.41
55 55 4.16 4.54 4.76 4.15 4.54
55 60 4.27 4.73 5.00 4.26 4.83
60 55 4.34 4.76 5.00 4.34 4.64
60 60 4.51 4.99 5.27 4.50 4.98
60 65 4.66 5.25 5.61 4.65 5.39
65 60 4.76 5.29 5.60 4.75 5.13
65 65 4.99 5.61 5.99 4.98 5.60
65 70 5.19 5.97 6.44 5.17 6.14
70 65 5.34 6.03 6.46 5.31 5.81
70 70 5.67 6.49 6.99 5.62 6.47
70 75 5.95 6.96 7.61 5.87 7.20
75 70 6.16 7.10 7.68 6.07 6.77
75 75 6.64 7.73 8.43 6.48 7.68
75 80 7.04 8.39 9.29 6.79 8.70
--------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
The rates assume the Annuitant is Female and the Second Annuitant is Male.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
34
OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
(Annuitant is Male and Second Annuitant is Female)
Rates for a Variable Annuity with Assumed Net Return Rate of 5.0%
--------------------------------------------------------------------------------------------------------------
Adjusted Ages
-------------------------------
Second
Annuitant Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------------------------------------------------------------------------------------------------------------
55 50 $ 4.88 $ 5.26 $ 5.48 $ 4.88 $ 5.34
55 55 5.04 5.44 5.66 5.04 5.43
55 60 5.21 5.65 5.89 5.21 5.53
60 55 5.15 5.63 5.91 5.14 5.73
60 60 5.37 5.87 6.16 5.37 5.86
60 65 5.61 6.16 6.49 5.60 6.01
65 60 5.52 6.14 6.51 5.51 6.28
65 65 5.83 6.49 6.87 5.82 6.47
65 70 6.17 6.90 7.33 6.13 6.67
70 65 6.04 6.84 7.34 6.00 7.03
70 70 6.49 7.35 7.87 6.44 7.33
70 75 6.97 7.96 8.56 6.87 7.62
75 70 6.77 7.84 8.51 6.68 8.08
75 75 7.45 8.60 9.33 7.27 8.55
75 80 8.14 9.49 10.35 7.80 8.98
--------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
The rates assume the Annuitant is Male and the Second Annuitant is Female.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
35
OPTION 3
Life Income for Two Payees
Amount of First Monthly Payment for Each $1,000
After Deduction of any Charge for Premium Taxes
(Annuitant is Female and the Second Annuitant is Male)
Rates for a Variable Annuity with Assumed Net Return Rate of 5.0%
--------------------------------------------------------------------------------------------------------------
Adjusted Ages
-------------------------------
Second
Annuitant Annuitant Option 3a Option 3b Option 3c Option 3d Option 3e
--------------------------------------------------------------------------------------------------------------
55 50 $ 4.93 $ 5.27 $ 5.46 $ 4.93 $ 5.19
55 55 5.04 5.44 5.66 5.04 5.43
55 60 5.15 5.63 5.91 5.14 5.73
60 55 5.21 5.65 5.89 5.21 5.53
60 60 5.37 5.87 6.16 5.37 5.86
60 65 5.52 6.14 6.51 5.51 6.28
65 60 5.61 6.16 6.49 5.60 6.01
65 65 5.83 6.49 6.87 5.82 6.47
65 70 6.04 6.84 7.34 6.00 7.03
70 65 6.17 6.90 7.33 6.13 6.67
70 70 6.49 7.35 7.87 6.44 7.33
70 75 6.77 7.84 8.51 6.68 8.08
75 70 6.97 7.96 8.56 6.87 7.62
75 75 7.45 8.60 9.33 7.27 8.55
75 80 7.86 9.28 10.20 7.57 9.59
--------------------------------------------------------------------------------------------------------------
Rates are based on mortality from 1983 Table a.
The rates assume the Annuitant is Male and the Second Annuitant is Female.
Rates for ages not shown will be provided on request and will be computed
on a basis consistent with the rates in the above tables.
36
--------------------------------------------------------------------------------
Aetna Life Insurance and Annuity Company
Home Office: 000 Xxxxxxxxxx Xxxxxx
Xxxxxxxx, Xxxxxxxxxxx 00000
(000) 000-0000
Certificate of Group Annuity Coverage
--------------------------------------------------------------------------------
ALL PAYMENTS AND VALUES PROVIDED BY THE GROUP CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT. THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA.
APPLICATION OF A MARKET VALUE ADJUSTMENT MAY RESULT IN EITHER AN INCREASE OR
DECREASE IN THE CURRENT VALUE. THE MARKET VALUE ADJUSTMENT FORMULA DOES NOT
APPLY TO A GUARANTEED TERM AT THE TIME OF ITS MATURITY.
GPlCERT(4/94)
