Exhibit 99.4(a)
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
Home Office: Dallas, Texas 75201
Administrative Office: 0000 Xxxxxxxxx Xxxxxx Xxxxx,
Xxxxx 0000, Xxxxxxxxxx, Xxxxxxxx 00000
Telephone: 0-000-000-0000
A Stock Company
Jefferson National Life Insurance Company (the "Company") agrees with the Owner
to provide benefits to the Owner, subject to the provisions set forth in this
Contract and in consideration of Purchase Payments received from the Owner.
RIGHT TO EXAMINE CONTRACT: WITHIN 10 DAYS OF THE DATE OF RECEIPT OF THIS
CONTRACT BY THE OWNER, IT MAY BE RETURNED BY DELIVERING OR MAILING IT TO THE
COMPANY AT ITS ADMINISTRATIVE OFFICE. WHEN THE CONTRACT IS RECEIVED BY THE
COMPANY, IT WILL BE VOIDED AS IF IT HAD NEVER BEEN IN FORCE. THE COMPANY WILL
REFUND ANY PREMIUMS PAID.
THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY
READ YOUR CONTRACT CAREFULLY
/s/ Xxxxx X. Xxxxxx /s/ Xxxxx Xxxxxxx
Secretary President
INDIVIDUAL FIXED AND VARIABLE
ANNUITY CONTRACT
NON-PARTICIPATING
WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED
ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE VALUES MAY INCREASE OR DECREASE
BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED IN THIS CONTRACT.
TABLE OF CONTENTS
CONTRACT SCHEDULE 4
DEFINITIONS 8
PURCHASE PAYMENT PROVISIONS 9
PURCHASE PAYMENTS 9
ALLOCATION OF PURCHASE PAYMENTS 9
SEPARATE ACCOUNT PROVISIONS 10
THE SEPARATE ACCOUNTS 10
VARIABLE ACCOUNT 10
VALUATION OF ASSETS 10
ACCUMULATION UNITS 10
ACCUMULATION UNIT VALUE 10
MORTALITY AND EXPENSE RISK CHARGE 10
ADMINISTRATIVE CHARGE 10
DISTRIBUTION EXPENSE CHARGE 11
MVA ACCOUNT PROVISIONS 11
MVA ACCOUNT 11
INTEREST TO BE CREDITED 11
GUARANTEE PERIOD 11
MULTIPLE GUARANTEE PERIODS 11
CHANGE IN GUARANTEE PERIOD 11
MARKET VALUE ADJUSTMENT 11
MVA ACCOUNT VALUES 11
FIXED ACCOUNT PROVISIONS 12
FIXED ACCOUNT VALUES 12
INTEREST TO BE CREDITED 12
CONTRACT VALUE 12
CONTRACT MAINTENANCE CHARGE 12
DEDUCTION FOR CONTRACT MAINTENANCE CHARGE 12
TRANSFERS 12
TRANSFERS DURING THE ACCUMULATION PERIOD 12
TRANSFERS DURING THE ANNUITY PERIOD 13
WITHDRAWAL PROVISIONS 13
WITHDRAWALS 13
CONTINGENT DEFERRED SALES CHARGE 13
WITHDRAWAL CHARGE 13
PROCEEDS PAYABLE ON DEATH 14
DEATH OF OWNER DURING THE ACCUMULATION PERIOD 14
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 14
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 14
DEATH OF OWNER DURING THE ANNUITY PERIOD 14
DEATH OF ANNUITANT 14
PAYMENT OF DEATH BENEFIT 14
BENEFICIARY 15
CHANGE OF BENEFICIARY 15
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15
2
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 15
OWNER 15
JOINT OWNER 15
ANNUITANT 15
ASSIGNMENT OF A CONTRACT 15
ANNUITY PROVISIONS 16
GENERAL 16
ANNUITY DATE 16
SELECTION OF AN ANNUITY OPTION 16
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 16
ANNUITY OPTIONS 16
OPTION 1. LIFETIME ONLY ANNUITY: 16
OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 16
OPTION 3. INSTALLMENT REFUND LIFE ANNUITY 16
OPTION 4. PAYMENT FOR A FIXED PERIOD: 16
OPTION 5. JOINT AND SURVIVOR ANNUITY 16
ANNUITY 16
FIXED ANNUITY 17
VARIABLE ANNUITY 17
ANNUITY UNIT 17
MORTALITY TABLES 17
GENERAL PROVISIONS 17
THE CONTRACT 17
MISSTATEMENT OF AGE 17
INCONTESTABILITY 17
MODIFICATION 17
NON-PARTICIPATING 17
EVIDENCE OF SURVIVAL 17
PROOF OF AGE 18
PROTECTION OF PROCEEDS 18
REPORTS 18
TAXES 18
REGULATORY REQUIREMENTS 18
ANNUITY OPTION TABLES 19
3
CONTRACT SCHEDULE
OWNER: ((FIRSTNAM))((LASTNAME))
CONTRACT ISSUE DATE: ((COVISS))
JOINT OWNER: ((JFIRSTNM))((JLASTNAM))
ANNUITY DATE: ((COVEFF))
CONTRACT NUMBER: ((POLNUM))
PURCHASE PAYMENTS:
INITIAL PURCHASE PAYMENT: ((INITPREM))
MINIMUM SUBSEQUENT PURCHASE PAYMENT: $1,000; or if the automatic premium
check option is elected: $250 monthly
MAXIMUM TOTAL PURCHASE PAYMENT: $1,000,000, without prior Company
approval
ALLOCATION GUIDELINES:
1. Currently, the Owner can select all investment options, including
Sub-Accounts of the Variable Account, MVA Account. The Company
reserves the right to change this in the future.
2. If the Purchase Payments and forms required to issue a Contract are in
good order, the initial Net Purchase Payment will be credited to the
Contract within two (2) business days after receipt at the
Administrative Office. Additional Purchase Payments will be credited
to the Contract as of the Valuation Period when they are received.
3. Allocation percentages must be in whole numbers. Each allocation must
be at least 1%.
4 Currently, the minimum amount which must be allocated for any
Guarantee Period in the MVA Account is $2,000. The Company reserves
the right to change this minimum in the future.
BENEFICIARY:
As designated by the Owner at the Contract Issue Date, unless subsequently
changed.
CONTRACT MAINTENANCE CHARGE:
The Contract Maintenance Charge is currently $30.00 each Contract Year. The
Company reserves the right to change the Contract Maintenance Charge but it
will not exceed $60 per Contract Year. However, during the Accumulation
Period, if the Contract Value on the Contract Anniversary is at least
$25,000, then no Contract Maintenance Charge will be deducted. If a total
withdrawal is made on other than a Contract Anniversary and the Contract
Value for the Valuation Period during which the total withdrawal is made is
less than $25,000, the full Contract Maintenance Charge will be deducted at
the time of the total withdrawal. If the Annuity Date is not the Contract
Anniversary and the Contract Value on the Annuity Date is less than
$25,000, then the full Contract Maintenance Charge will be deducted on the
Annuity Date. During the Annuity Period, no Contract Maintenance Charge
will be deducted.
MORTALITY AND EXPENSE RISK CHARGE:
Equal, on an annual basis, to 1.25% of the average daily net asset value of
the Variable Account.
ADMINISTRATIVE CHARGE:
Equal, on an annual basis, to .15% of the average daily net asset value of
the Variable Account. The Company may increase this charge; however, the
maximum Administrative Charge will not exceed .25% of the average daily net
asset value of the Variable Account. In the event of an increase, the
Company will give Owners 90 days prior notice of the increase.]
DISTRIBUTION EXPENSE CHARGE:
NONE
4
TRANSFERS:
NUMBER OF TRANSFERS PERMITTED: There are currently no limits on the number
of transfers that can be made during the Accumulation Period. Owners are
permitted four transfers per Contract Year during the Annuity Period.
TRANSFER FEE: For each transfer, the Transfer Fee is the lesser of $25.00
or 2% of the amount transferred. The Company does not assess a Transfer Fee
on one transfer in a 30-day period during the Accumulation Period or the
four transfers permitted during the Annuity Period. All reallocations made
on a given date count as one transfer. Transfers made at the end of the
Right to Examine Contract period by the Company and any transfers made
pursuant to a pre-approved Dollar Cost Averaging Program or pursuant to a
pre-approved Rebalancing Program will not be counted in determining the
application of the Transfer Fee.
MINIMUM AMOUNT TO BE TRANSFERRED: $500 (from any Sub-Account or any
Guarantee Period of the MVA Account), or the Owner's entire interest in the
Sub-Account or the Guarantee Period, if less. This requirement is waived if
the transfer is pursuant to a pre-approved Dollar Cost Averaging Program or
Rebalancing Program.
MINIMUM AMOUNT WHICH MUST REMAIN IN EACH ACCOUNT AFTER A TRANSFER: $500 per
Sub-Account or a Guarantee Period in the MVA Account; or $0 if the entire
amount in any Sub-Account of the Variable Account or a Guarantee Period in
the MVA Account is transferred.]
MAXIMUM AMOUNT WHICH CAN BE TRANSFERRED FROM THE FIXED ACCOUNT OR MVA
ACCOUNT TO THE VARIABLE ACCOUNT: NONE
WITHDRAWALS:
CONTINGENT DEFERRED SALES CHARGE: NONE
WITHDRAWAL CHARGE: NONE
MINIMUM PARTIAL WITHDRAWAL: $500 from each Sub-Account of the Variable
Account each Guarantee Period of the MVA Account and the Fixed Account.
This requirement is waived if the partial withdrawal is pursuant to the
Systematic Withdrawal Program.
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN CONTRACT AFTER A PARTIAL
WITHDRAWAL: $500. The Company reserves the right to increase this amount.
MINIMUM CONTRACT VALUE WHICH MUST REMAIN IN ANY SUB-ACCOUNT OF THE VARIABLE
ACCOUNT AFTER A PARTIAL WITHDRAWAL: $500
MAXIMUM AMOUNT WHICH CAN BE WITHDRAWN FROM THE FIXED AND MVA ACCOUNTS: The
Fixed Account is currently not available. There is currently no limitation
on the maximum amount which can be withdrawn from the Fixed Account or the
MVA Account.
SEPARATE ACCOUNTS:
Variable Account: Conseco Variable Variable Annuity Account F for the
Variable Annuity portion of the Contract.
And
MVA Account: Conseco Variable Market Value Adjustment Account for the
portion of the Contract that may be subject to a Market
Value Adjustment.
ELIGIBLE FUNDS:
CONSECO SERIES TRUST: 20 Focus Portfolio, Balanced Portfolio, Equity
Portfolio, Fixed Income Portfolio, Government Securities Portfolio, High
Yield Portfolio, Money Market Portfolio
THE XXXXX AMERICAN FUND: Xxxxx American Growth Portfolio, Xxxxx American
Leveraged AllCap Portfolio, Xxxxx American Midcap Growth Portfolio, Xxxxx
American Small Capitalization Portfolio
XXXXXXXXX XXXXXX ADVISORS MANAGEMENT TRUST: Limited Maturity Bond
Portfolio, Midcap Growth Portfolio, Partners Portfolio, Regency
Portfolio, Xxxxxxxx Portfolio
PIONEER INVESTMENTS: Pioneer Equity Income VCT Portfolio, Pioneer Europe
VCT Portfolio, Pioneer Fund VCT Portfolio
XXXXXX INSTITUTIONAL PRODUCTS TRUST: Xxxxxx IPT Growth Portfolio, Xxxxxx
IPT International Portfolio, Xxxxxx IPT Large Cap Growth Portfolio,
Xxxxxx IPT Small Company Growth Portfolio
5
FEDERATED INSURANCE SERIES: Federated International Equity Fund II,
Federated High Income Bond Fund II, Federated Utility Fund II
LAZARD RETIREMENT SERIES, INC.: Lazard Retirement Equity Portfolio, Lazard
Retirement Small Cap Portfolio
LORD XXXXXX SERIES FUND, INC.: Growth and Income Portfolio, America's Value
Portfolio
XXX XXX WORLDWIDE INSURANCE TRUST: Worldwide Bond Fund, LEVCO Equity Value
Fund, Worldwide Hard Assets Fund, Worldwide Emerging Markets Fund, Xxxxx
Mid Cap Value Fund, Real Estate Fund, Worldwide Absolute Return Fund,
Worldwide Ultra Short-Term Income Fund
JANUS ASPEN SERIES: Aggressive Growth Portfolio, Growth Portfolio,
Worldwide Growth Portfolio, International Growth Portfolio, Growth and
Income Portfolio
STRONG VARIABLE INSURANCE FUNDS, INC.: Strong Mid Cap Growth Fund II
STRONG OPPORTUNITY FUND II, INC.: Opportunity Fund II
XXXXXXXX PORTFOLIOS, INC.: Xxxxxxxx Communications and Information
Portfolio, Xxxxxxxx Global Technology
INVESCO VARIABLE INVESTMENT FUNDS, INC: INVESCO VIF - Core Equity Fund,
INVESCO VIF -Financial Services Fund, INVESCO VIF - Health Sciences Fund,
INVESCO VIF - High Yield Fund, INVESCO VIF - Real Estate Opportunity
Fund, INVESCO VIF -Technology Fund, INVESCO VIF -Telecommunications Fund
AMERICAN CENTURY VARIABLE PORTFOLIOS, INC.: VP Income and Growth Fund, VP
International Fund, VP Value Fund
DREYFUS FUNDS: Disciplined Stock Portfolio, Dreyfus Socially Responsible
Growth Portfolio, International Value Portfolio, Dreyfus Stock Index Fund
RYDEX VARIABLE TRUST: U.S. Government Money Market Fund, Nova Fund, OTC
Fund, Ursa Fund, Mekros small Cap Fund, Medius Mid Cap Fund, U.S.
Government Bond Fund, Sector Rotation Fund, Juno Fund
FIRST AMERICAN INSURANCE PORTFOLIO: First American Large Cap Growth
Portfolio, First American Mid Cap Growth Portfolio
AIM FUNDS: AIM V.I. Basic Value Fund Series II, AIM V.I. Mid-Cap Core
Equity Fund Series II
CHOICE CAPITAL MANAGEMENT: Xxxxx Market Neutral Fund PIMCO FUNDS:
PIMCO PVIT Total Return Portfolio, PIMCO PVIT Real Return Portfolio
ROYCE & ASSOCIATES: Royce Capital Fund - Small Cap Portfolio, Royce Capital
Fund - Micro-Cap Portfolio
THIRD AVENUE MANAGEMENT: Third Avenue Variable Series Trust Value Portfolio
MVA ACCOUNT:
Minimum Guaranteed Interest Rate: 3%
Current MVA Account Guarantee Period Options And
Credited Interest Rates:
((YEAR1)) ((IRATE1))
((YEAR2)) ((IRATE2))
((YEAR3)) ((IRATE3))
MARKET VALUE ADJUSTMENT FACTOR:
The Market Value Adjustment Factor is equal to:
(1 + A)
------- (TO THE POWER OF N/365) - 1
(1 + B)
where: A = the U.S. Treasury rate in effect at the beginning of the
Guarantee Period for the length of the guarantee period
selected.
B = the current U.S. Treasury rate as of the transaction date plus
.005. Treasury rate period is
6
determined by N/365 rounded to the next highest year.
N = Number of days remaining in the MVA Guarantee Period.
If the Treasury rate is not available for the period, the rate will be
arrived at by interpolation. If no Treasury Rates are available, an Index
will be selected by the Company and approved by the State Insurance
Commissioner.
MVA Waiver: For withdrawals from MVA Account Guarantee Period Option, after
the first year in such Guarantee Period option, the Owner can make one
withdrawal each Contract Year of up to a total of 10% of each such
Guarantee Period of the MVA option without the Market Value Adjustment.
FIXED ACCOUNT:
Not Available
RIDERS:
((RIDER1))
((RIDER2))
((RIDER3))
((RIDER4))
((RIDER5))
((RIDER6))
((RIDER7))
ADMINISTRATIVE OFFICE:
Jefferson National Life Insurance Company
Administrative Office
0000 Xxxxxxxxx Xxxxxx Xxxxx, Xxxxx 0000
Xxxxxxxxxx, XX 00000
(000) 000-0000
7
DEFINITIONS
ACCOUNT(S): The Fixed Account, the MVA Account and the General Account and/or
one or more of the Sub-Accounts of the Variable Account.
ACCUMULATION PERIOD: The period prior to the Annuity Date during which Purchase
Payments may be made by an Owner.
ACCUMULATION UNIT: A unit of measure used to determine the value of an Owner's
interest in a Sub-Account of the Variable Account during the Accumulation
Period.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax, and
Contract Maintenance Charge and plus the applicable Market Value Adjustment
which may be positive or negative. This amount is applied to the applicable
Annuity Tables to determine Annuity Payments.
AGE: The age of any Owner or Annuitant on his/her last birthday. For Joint
Owners, all provisions which are based on age are based on the Age of the older
of the Joint Owners.
ADMINISTRATIVE OFFICE: The office indicated on the Contract Schedule of this
Contract to which notices, requests and Purchase Payments must be sent. All sums
payable to the Company under this Contract are payable at the Administrative
Office or an address designated by the Company.
ANNUITANT: The natural person on whose life Annuity Payments are based. On or
after the Annuity Date, the Annuitant shall also include any Joint Annuitant.
ANNUITY DATE: The date on which Annuity Payments begin. The Annuity Date is
shown on the Contract Schedule.
ANNUITY OPTIONS: Options available for Annuity Payments.
ANNUITY PAYMENTS: The series of payments made to the Owner or any named payee
after the Annuity Date under the Annuity Option selected.
ANNUITY PERIOD: The period of time beginning with the Annuity Date during which
Annuity Payments are made.
ANNUITY UNIT: An accounting unit of measure used to calculate the amount of
Annuity Payments.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Administrative Office.
BENEFICIARY: The person(s) or entity(ies) who will receive the death benefit
payable under this Contract.
COMPANY: Conseco Variable Insurance Company.
CONTRACT ANNIVERSARY: An Anniversary of the Contract Issue Date.
CONTRACT ISSUE DATE: The later of the date on the cover of the Contract or the
date Purchase Payments are received. The Contract Issue Date is shown on the
Contract Schedule.
CONTRACT VALUE: The dollar value as of any Valuation Period of all amounts in
the Contract.
CONTRACT WITHDRAWAL VALUE: The Contract Value less any applicable Premium Tax,
less any Contingent Deferred Sales Charge, less any applicable Contract
Maintenance Charge and plus any Market Value Adjustment which may be positive or
negative.
CONTRACT YEAR: The first Contract Year is the annual period which begins on the
Contract Issue Date. Subsequent Contract Years begin on each anniversary of the
Contract Issue Date.
4
CREDITED INTEREST RATE: The interest rate credited to the Contract by the
Company for any given Guarantee Period in the MVA Account or the Fixed Account.
The Credited Interest Rates for the available Guarantee Periods for the Fixed
Account and the MVA Account are shown on the Contract Schedule.
EFFECTIVE DATE: The Effective Date of a Guarantee Period with a Credited
Interest Rate.
ELIGIBLE FUND: An investment entity shown on the Contract Schedule.
FIXED ACCOUNT: An investment option within the General Account.
FIXED ANNUITY: A series of payments made during the Annuity Period which are
guaranteed as to dollar amount by the Company.
GENERAL ACCOUNT: The Company's general investment account which contains all the
assets of the Company with the exception of the Variable Account and other
segregated asset accounts.
GUARANTEE PERIOD: The period for which the Credited Interest Rate is credited in
either the MVA Account or the Fixed Account. Each deposit or transfer to the MVA
Account creates one or more new Guarantee Period(s). The Guarantee Periods
selected by the Owner are shown on the Contract Schedule.
MARKET VALUE ADJUSTMENT: An adjustment to the amount withdrawn or transferred
from an MVA Account prior to the end of the applicable Guarantee Period. The
adjustment reflects the change in the value of the funds withdrawn or
transferred due to the change in the interest rates since the beginning of the
Guarantee Period.
MVA ACCOUNT: A separate account which provides investment options where the
Company guarantees the rate of interest for a specified Guarantee Period and
where withdrawals or transfers may be subject to a Market Value Adjustment.
NET PURCHASE PAYMENT: A Purchase Payment less any applicable Premium Tax.
OWNER: The person(s) who owns the Contract.
PORTFOLIO: A segment of an Eligible Fund which constitutes a separate and
distinct class of shares. Portfolios which are available for investment by the
Sub-Accounts of the Variable Account under this Contract are shown on the
Contract Schedule.
PREMIUM TAX: Any premium taxes incurred to any governmental entity and assessed
against Purchase Payments or Contract Value.
PURCHASE PAYMENT: A payment made by or for an Owner with respect to this
Contract.
SUB-ACCOUNT: Variable Account assets are divided into Sub-Accounts which are
listed on the Contract Schedule. Assets of each Sub-Account will be invested in
shares of an Eligible Fund or a Portfolio of an Eligible Fund.
VALUATION DATE: Each day on which the New York Stock Exchange ("NYSE") is open
for business.
VALUATION PERIOD: The period of time beginning at the close of business of the
NYSE on each Valuation Date and ending at the close of business for the next
succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account designated on the Contract Schedule which
provides investment options where the benefits are variable and are not
guaranteed as to dollar amount.
WRITTEN REQUEST: A request in writing, in a form satisfactory to the Company,
which is received by the Administrative Office.
5
PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS: The initial Purchase Payment for an Owner is due on the
Contract Issue Date. Subject to the maximum and minimum amounts shown on the
Contract Schedule, the Owner may make subsequent Purchase Payments and may
increase or decrease or change the frequency of such payments. The Company
reserves the right to reject any Application or Purchase Payment.
ALLOCATION OF PURCHASE PAYMENTS: Net Purchase Payments are allocated to one or
more of the Fixed Account and/or the MVA Account Guarantee Period options and/or
to one or more Sub-Accounts of the Variable Account in accordance with the
selections made by the Owner. The allocation of the initial Net Purchase Payment
for an Owner is made in accordance with the selection made by the Owner at the
Contract Issue Date. Unless otherwise changed by the Owner, subsequent Net
Purchase Payments are allocated in the same manner as the initial Net Purchase
Payment. Allocation of the Net Purchase Payments is subject to the Allocation
Guidelines shown on the Contract Schedule. The Company has reserved the right to
allocate initial Net Purchase Payments to the Money Market Sub-Account (except
for any amounts allocated to the Fixed Account and/or MVA Account) until the
expiration of the Right to Examine period.
SEPARATE ACCOUNT PROVISIONS
THE SEPARATE ACCOUNTS: The Separate Accounts are designated on the Contract
Schedule and consists of assets set aside by the Company, which are kept
separate from that of the general assets and all other separate account assets
of the Company.
VARIABLE ACCOUNT: The assets of the Variable Account equal to reserves and other
liabilities will not be charged with liabilities arising out of any other
business the Company may conduct.
The Variable Account assets are divided into Sub-Accounts. The Sub-Accounts
which are available under this Contract are listed on the Contract Schedule. The
assets of the Sub-Accounts are allocated to the Eligible Fund(s) and the
Portfolio(s), if any, within an Eligible Fund, shown on the Contract Schedule.
The Company may, from time to time, add additional Eligible Fund(s) or
Portfolio(s) to those shown on the Contract Schedule. The Owner may be permitted
to transfer Contract Values or allocate Net Purchase Payments to the additional
Sub-Account(s) within the Variable Account. However, the right to make such
transfers or allocations will be limited by the terms and conditions imposed by
the Company.
Should the shares of any such Eligible Fund(s) or any Portfolio(s) within an
Eligible Fund become unavailable for investment by the Variable Account, or the
Company's Board of Directors deems further investment in these shares
inappropriate, the Company may limit further purchase of such shares or
substitute shares of another Eligible Fund or Portfolio for shares already
purchased under a Contract.
VALUATION OF ASSETS: The assets of the Accounts are valued at their fair market
value in accordance with procedures of the Company.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Sub-Accounts of the Variable Account as a
result of Net Purchase Payments, withdrawals, transfers, or fees and charges.
The Company will determine the number of Accumulation Units of a Sub-Account
purchased or canceled. This will be done by dividing the amount allocated to (or
the amount withdrawn from) the Sub-Account by the dollar value of one
Accumulation Unit of the Sub-Account as of the end of the Valuation Period
during which the request for the transaction is received at the Administrative
Office.
ACCUMULATION UNIT VALUE: The Accumulation Unit Value for each Sub-Account was
arbitrarily set initially at $10. Subsequent Accumulation Unit Values for each
Sub-Account are determined by multiplying the Accumulation Unit Value for the
immediately preceding Valuation Period by the Net Investment Factor for the
Sub-Account for the current period.
6
The Net Investment Factor for each Sub-Account is determined by dividing A by B
and subtracting C where:
A is (i) the net asset value per share of the Eligible Fund or
Portfolio of an Eligible Fund held by the Sub-Account at the
end of the current Valuation Period; plus
(ii) any dividend or capital gains per share declared on
behalf of such Eligible Fund or Portfolio that has an
ex-dividend date within the current Valuation Period; plus
(iii) a charge factor, if any, for any taxes or any tax
reserve established by the Company as a result of the
operation or maintenance of the Sub-Account.
B is the net asset value per share of the Eligible Fund or
Portfolio held by the Sub-Account for the immediately
preceding Valuation Period.
C is the Valuation Period equivalent of the per month Mortality
and Expense Risk Charge, for the Administrative Charge and
for the Distribution Charge, if any, which are shown on the
Contract Schedule.
The Accumulation Unit Value may increase or decrease from Valuation Period to
Valuation Period.
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, the Company deducts a
Mortality and Expense Risk Charge from the Variable Account which is equal, on
an annual basis, to the amount shown on the Contract Schedule. The Mortality and
Expense Risk Charge compensates the Company for assuming the mortality and
expense risks under this Contract.
ADMINISTRATIVE CHARGE: Each Valuation Period, the Company deducts an
Administrative Charge from the Variable Account which is equal, on an annual
basis, to the amount shown on the Contract Schedule. The Administrative Charge
compensates the Company for the costs associated with the administration of this
Contract and the Variable Account.
DISTRIBUTION EXPENSE CHARGE: Each Valuation Period, the Company deducts a
Distribution Expense Charge from the Variable Account which is equal, on an
annual basis, to the amount shown on the Contract Schedule. The Distribution
Charge compensates the Company for the costs associated with the distribution of
the Contracts.
MVA ACCOUNT PROVISIONS
MVA ACCOUNT: The assets of the MVA Account equal to reserves and other
liabilities will not be charged with liabilities arising out of any other
business the Company may conduct.
Net Purchase Payments may be allocated to one or more of the MVA Account
Guarantee Period options which are available at the time the Purchase Payment is
made. The initial MVA Account Guarantee Period options are shown on the Contract
Schedule. In addition, during the Accumulation Period, Contract Values can be
transferred from the Variable Account and/or the Fixed Account to one or more of
the MVA Account Guarantee Period options.
INTEREST TO BE CREDITED: The Credited Interest Rate for the Guarantee Period(s)
of the MVA Account is shown on the Contract Schedule. After the initial
Guarantee Period, the Credited Interest Rate for any subsequent Guarantee Period
of the MVA Account may change. All interest payable under a Contract is
compounded daily at the stated effective annual interest rate. In no event will
the Credited Interest Rate be less than the Minimum Guaranteed Interest Rate,
prior to the application of the Market Value Adjustment, specified on the
Contract Schedule.
GUARANTEE PERIOD: The Current MVA Account Guarantee Period is shown on the
Contract Schedule. During the thirty (30) days prior to the end of a current
Guarantee Period, the Owner may renew for the same or any other Guarantee Period
then available at the then Credited Interest Rate or may elect to transfer all
or a portion of the amount to a Fixed Account option, if available, or to the
Variable Account. Any transfer elected during the thirty (30) days prior to the
end of a current Guarantee Period will be made as of the date the request is
received by the Company and will not be subject to the Market Value Adjustment.
7
If the Owner does not specify a Guarantee Period at the time of renewal, the
Company will select and transfer to the same Guarantee Period as has just
expired, so long as such Guarantee Period does not extend beyond the latest
Annuity Date that can be selected by an Owner. If such Guarantee Period does
extend beyond the latest Annuity Date, the Company will choose the one year
period. If there is no Guarantee Period for the same period available, the one
year period will be selected. If the one year period is no longer available, the
next longest period available will be selected.
MULTIPLE GUARANTEE PERIODS: The Owner may elect one or more Guarantee Periods
subject to the Company's underwriting rules. Multiple Guarantee Periods are
treated separately for purposes of applying the Market Value Adjustment. The
Company reserves the right to credit different Credited Interest Rates to the
Contract Value attributable:
1. to different Guarantee Periods; and
2. to Guarantee Periods of the same duration with different Effective Dates.
CHANGE IN GUARANTEE PERIOD: The Owner may upon Written Request change to any
Guarantee Period then being offered by the Company with respect to contracts of
this type and class. The Market Value Adjustment will apply to a change made at
any time other than at the end of a Guarantee Period. The Market Value
Adjustment will not apply to a change made at the end of a Guarantee Period if
Written Request is received by the Company within thirty (30) days prior to the
end of the Guarantee Period.
MARKET VALUE ADJUSTMENT: Any amount withdrawn, transferred or annuitized prior
to the end of that Guarantee Period may be subject to a Market Value Adjustment.
The Market Value Adjustment will be calculated by multiplying the amount
withdrawn, transferred or annuitized by the formula shown on the Contract
Schedule.
There will be no Market Value Adjustment on withdrawals from the MVA Account in
the following situations: (1) death benefit paid under a Contract; (2) amounts
withdrawn to pay fees or charges; (3) amounts withdrawn or transferred from the
MVA Account during the 30 days prior to the end of the Guarantee Period; (4) an
Owner annuitizes his/her Contract under an Annuity Option providing for at least
60 monthly Annuity Payments; and (5) any withdrawal subject to the MVA Waiver
shown on the Contract Schedule.
MVA ACCOUNT VALUES: The MVA Account portion of a Contract at any time is equal
to:
1. the Net Purchase Payments allocated to the MVA Account on behalf of an
Owner; plus
2. the Contract Value transferred to the MVA Account; plus
3. interest credited to the Contract Value in the MVA Account; less
4. any prior withdrawals of Contract Value in the MVA Account and any
Contingent Deferred Sales Charge; less
5. any Contract Value transferred from the MVA Account; less
6. Contract Maintenance Charges or Transfer Fees deducted from the Contract
Value allocated to the MVA Account.
Any subsequent Purchase Payments and transfers to the MVA Account will be
allocated to a new Guarantee Period with a new Effective Date.
FIXED ACCOUNT PROVISIONS
FIXED ACCOUNT VALUES: The Fixed Account portion of a Contract at any time is
equal to:
1. the Net Purchase Payments allocated to the Fixed Account on behalf of an
Owner; plus
2. the Contract Value transferred to the Fixed Account; plus
8
3. interest credited to the Contract Value in the Fixed Account; less
4. any prior withdrawals of Contract Value in the Fixed Account and any
Contingent Deferred Sales Charge; less
5. any Contract Value transferred from the Fixed Account; less
6. Contract Maintenance Charges or Transfer Fees deducted from the Contract
Value allocated to the Fixed Account.
INTEREST TO BE CREDITED: The Company guarantees that the interest to be credited
to the Fixed Account will not be less than the Minimum Guaranteed Interest Rate
shown on the Contract Schedule. The Company may credit additional interest at
its sole discretion for any Fixed Account option. The Fixed Account Option and
the Initial Current Interest Rate are shown on the Contract Schedule.
CONTRACT VALUE
The Contract Value for any Valuation Period is the sum of the Contract Value in
each of the Sub-Accounts of the Variable Account, the Contract Value in the MVA
Account and the Contract Value in the Fixed Account.
The Contract Value in a Sub-Account of the Variable Account is determined by
multiplying the number of Accumulation Units allocated to the Owner's Account
for the Sub-Account by the Accumulation Unit Value.
Withdrawals will result in the cancellation of Accumulation Units in a
Sub-Account or a reduction in the Contract Value in the Fixed Account or the MVA
Account, as applicable.
CONTRACT MAINTENANCE CHARGE
DEDUCTION FOR CONTRACT MAINTENANCE CHARGE: During the Accumulation Period, on
each Contract Anniversary the Company deducts a Contract Maintenance Charge from
the Contract Value by reducing the Contract Value in the Fixed Account and/or
the MVA Account and by canceling Accumulation Units from each applicable
Sub-Account to reimburse it for expenses relating to maintenance of the
Contract. The Contract Maintenance Charge will be deducted first from the Fixed
Account and if there is insufficient value in the Fixed Account, then the
Contract Maintenance Charge will be deducted from the MVA Account or the
Sub-Account of the Variable Account with the largest balance. The Contract
Maintenance Charge is shown on the Contract Schedule.
TRANSFERS
TRANSFERS DURING THE ACCUMULATION PERIOD: Subject to any limitation imposed by
the Company on the number of transfers during the Accumulation Period shown on
the Contract Schedule, an Owner may transfer all or part of his or her Contract
Value in the Fixed Account, the MVA Account or a Sub-Account by Authorized
Request without the imposition of any Transfer Fee if there have been no more
than the number of free transfers shown on the Contract Schedule for the
Contract Year. All transfers are subject to the following:
1. If more than the number of free transfers, shown on the Contract Schedule,
have been made in a Contract Year, the Company will deduct a Transfer Fee,
shown on the Contract Schedule, for each subsequent transfer permitted.
The Transfer Fee is deducted from the Account which is the source of the
transfer. However, if the Owner's entire interest in an Account is being
transferred, the Transfer Fee will be deducted from the amount which is
transferred. If there are multiple source Accounts, the Transfer Fee will
be allocated first to the Fixed Account and then to the Sub-Account or the
MVA Account with the largest balance involved in a transfer transaction.
2. The minimum amount which can be transferred from a Sub-Account is shown on
the Contract Schedule. The minimum amount which must remain in a
Sub-Account, the Fixed and the MVA Account is shown on the Contract
Schedule. The maximum amount which can be transferred from the Fixed
Account or the MVA Account to the Variable Account is shown on the
Contract Schedule.
3. The Company reserves the right, at any time and without prior notice to
any party, to terminate, suspend or modify the transfer privilege
described above.
9
If an Owner elects to use this transfer privilege, the Company will not be
liable for transfers made in accordance with the instructions received from the
Owner or other authorized persons. All amounts and Accumulation Units will be
determined as of the end of the Valuation Period during which the request for
transfer is received at the Administrative Office.
TRANSFERS DURING THE ANNUITY PERIOD: Subject to any limitations imposed by the
Company on the number of transfers during the Annuity Period shown on the
Contract Schedule, the Owner may transfer Annuity Units in accordance with the
following:
1. Transfers may be made upon written notice to the Company at least thirty
(30) days before the due date of the first Annuity Payment for which the
change will apply. Transfers will be made by converting the number of
Annuity Units being transferred to the number of Annuity Units of the
Sub-Account to which the transfer is made, so that the next Annuity
Payment, if it were made at that time would be the same amount that it
would have been without the transfer. Thereafter, Annuity Payments will
reflect changes in the value of the new Annuity Units.
2. If more than the number of free transfers, shown on the Contract Schedule,
have been made in a Contract Year, the Company will deduct a Transfer Fee,
shown on the Contract Schedule, for each subsequent transfer permitted.
The Transfer Fee is deducted from the Account which is the source of the
transfer. However, if the Owner's entire interest in an Account is being
transferred, the Transfer Fee will be deducted from the amount which is
transferred. If there are multiple source Accounts, the Transfer Fee will
be allocated first to the Fixed Account and then the Sub-Account or the
MVA Account with the largest balance involved in a transfer transaction.
3. The minimum amount which can be transferred from a Sub-Account is shown on
the Contract Schedule. The minimum amount which must remain in a
Sub-Account after a transfer is shown on the Contract Schedule.
4. No transfers can be made between the General Account and the Variable
Account.
5. The Company reserves the right, at any time and without prior notice to
any party, to terminate, suspend or modify the transfer privilege
described above.
If an Owner elects to use this transfer privilege, the Company will not be
liable for transfers made in accordance with instructions received from the
Owner or other authorized persons. All amounts and Annuity Units will be
determined as of the end of the Valuation Period during which the request for
transfer is received at the Administrative Office.
WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Period, the Owner may, upon Written
Request, make a total or partial withdrawal of the Contract Withdrawal Value.
The Owner must specify by Written Request which Sub-Account or Guarantee Period
of the MVA Account or Fixed Account, as applicable, is the source of the partial
withdrawal.
A withdrawal from the MVA Account may be subject to a Market Value Adjustment.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
Each partial withdrawal must be for an amount which is not less than the amount
shown on the Contract Schedule. The minimum Contract Value which must remain in
a Sub-Account after a partial withdrawal is shown on the Contract Schedule. The
maximum amounts which can be withdrawn from the Fixed Account and/or the MVA
Account are shown on the Contract Schedule.
CONTINGENT DEFERRED SALES CHARGE: Upon a withdrawal of Contract Value, a
Contingent Deferred Sales Charge as set forth on the Contract Schedule may be
assessed.
10
WITHDRAWAL CHARGE: Upon a withdrawal of Contract Value, a Withdrawal Charge as
set forth on the Contract Schedule may be assessed.
PROCEEDS PAYABLE ON DEATH
DEATH OF OWNER DURING THE ACCUMULATION PERIOD: Upon the death of the Owner, or
any Joint Owner, during the Accumulation Period, the death benefit will be paid
to the Beneficiary(ies) designated by the Owner. Upon the death of any Joint
Owner, the surviving Joint Owner, if any, will be treated as the Primary
Beneficiary. Any other Beneficiary designation on record at the time of death
will be treated as a contingent Beneficiary.
A Beneficiary may request that the death benefit be paid under one of the Death
Benefit Options below. If the Beneficiary is the spouse of the Owner, he or she
may elect to continue the Contract at the then current Contract Value in his or
her own name and exercise all the Owner's rights under the Contract.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: Prior to the Owner
attaining Age 80, the death benefit will be the greater of: (i) the Purchase
Payments, less any withdrawals; or (ii) the Contract Value determined as of the
end of the Valuation Period during which the Company receives both due proof of
death and an election for the payment method. If the death occurs after Age 80,
the death benefit will be the Value determined as of the end of the Valuation
Period during which the Company receives both due proof of death and an election
for the payment method.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: A non-spousal Beneficiary
must elect the death benefit to be paid under one of the following options in
the event of the death of the Owner or any Joint Owner during the Accumulation
Period:
OPTION 1 - lump sum payment of the death benefit; or
OPTION 2 - the payment of the entire death benefit within 5 years of the
date of the death of the Owner or any Joint Owner; or
OPTION 3 - payment of the death benefit under an Annuity Option over the
lifetime of the Beneficiary or over a period not extending beyond the life
expectancy of the Beneficiary with distribution beginning within one year
of the date of death of the Owner or any Joint Owner.
Any portion of the death benefit not applied under Option 3 within one year of
the date of the Owner's death, must be distributed within five years of the date
of death.
A spousal Beneficiary may elect to continue the Contract in his or her own name
at the then current Contract Value, elect a lump sum payment of the death
benefit or apply the death benefit to an Annuity Option.
If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the election, unless the Suspension or
Deferral of Payments Provision is in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period beginning with the date of receipt of proof of death.
DEATH OF OWNER DURING THE ANNUITY PERIOD: If the Owner, or any Joint Owner, who
is not the Annuitant, dies during the Annuity Period, any remaining payments
under the Annuity Option elected will continue at least as rapidly as under the
method of distribution in effect at such Owner's or Joint Owner's death. Upon
the death of any Owner during the Annuity Period, the Beneficiary becomes the
Owner. Upon the death of any Joint Owner during the Annuity Period, the
surviving Joint Owner, if any, will be treated as the Primary Beneficiary. Any
other Beneficiary designation on record at the time of death will be treated as
a Contingent Beneficiary.
DEATH OF ANNUITANT: Upon the death of an Xxxxxxxxx, who is not the Owner, during
the Accumulation Period, the Owner may designate a new Annuitant, subject to the
Company's underwriting rules then in effect. If no designation is made within 30
days of the death of the Annuitant, the Owner will become the Annuitant. If the
Owner is a non-natural person, the death of the Annuitant will be treated as the
death of the Owner and a new Annuitant may not be designated.
11
Upon the death of the Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death before any
death benefit is paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the finding
of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.
BENEFICIARY: The Beneficiary designation in effect on the Contract Issue Date
will remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the death of the Owner.
Unless the Owner provides otherwise, the death benefit will be paid in equal
shares to the survivor(s) as follows:
1. to the Primary Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if there are none
2. to the Contingent Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if there are none
3. to the estate of the Owner.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), the Owner may change the Primary Beneficiary(ies) or
Contingent Beneficiary(ies). A change may be made by Written Request. The change
will take effect as of the date the Written Request is signed. The Company will
not be liable for any payment made or action taken before it records the change.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held in
the Variable Account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Variable Account's net assets;
or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
The Company further reserves the right to postpone payments from the Fixed
Account and the MVA Account for a period of up to six months.
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
OWNER: The Owner has all interest and right to amounts held in his or her
Contract. The Owner is the person designated as such on the Contract Issue Date,
unless changed.
12
The Owner may change owners of the Contract at any time by Written Request. A
change of Owner will automatically revoke any prior designation of Owner. The
change will become effective as of the date the Written Request is signed. The
Company will not be liable for any payment made or action taken before it
records the change.
JOINT OWNER: A Contract may be owned by Joint Owners. If Joint Owners are named,
any Joint Owner must be the spouse of the other Owner. Upon the death of either
Owner, the surviving spouse will be the Primary Beneficiary. Any other
Beneficiary designation will be treated as a Contingent Beneficiary unless
otherwise indicated in a Written Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by the Owner at the Contract Issue Date,
unless changed prior to the Annuity Date. The Owner may not change the Annuitant
except in the event that the Annuitant dies prior to the Annuity Date. If no new
Annuitant is designated by the Owner within 30 days of the death of the
Annuitant, the Owner becomes the Annuitant. The Annuitant may not be changed in
a Contract which is owned by a non-natural person. Any change of Annuitant is
subject to the Company's underwriting rules then in effect.
ASSIGNMENT OF A CONTRACT: A Written Request specifying the terms of an
assignment of a Contract must be provided to the Administrative Office. The
Company will not be liable for any payment made or action taken before it
records the assignment.
The Company will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with Company consent.
If the Contract is assigned, the Owner's rights may only be exercised with the
consent of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Annuity Date, the Adjusted Contract Value will be applied under
the Annuity Option selected by the Owner. The Owner may elect to have the
Contract Value applied to provide a Fixed Annuity, a Variable Annuity or a
combination Fixed and Variable Annuity. If a combination is elected, the Owner
must specify what part of the Contract Value is to be applied to the Fixed and
Variable Options.
ANNUITY DATE: The Annuity Date is selected by the Owner at the Contract Issue
Date. The Annuity Date must be the first day of a calendar month and must be at
least 90 days after the Contract Issue Date. The Annuity Date may not be later
than the earlier of when the Annuitant reaches attained age 90 or the maximum
date permitted under state law.
Prior to the Annuity Date, the Owner subject to the above, may change the
Annuity Date by Written Request. Any change must be requested at least thirty
(30) days prior to the new Annuity Date.
SELECTION OF AN ANNUITY OPTION: An Annuity Option may be selected by Written
Request of the Owner. If no Annuity Option is selected, Option B with 120
monthly payments guaranteed will automatically be applied. Unless specified
otherwise, that portion of the Adjusted Contract Value allocated to the Variable
Account shall be used to provide a Variable Annuity and that portion of the
Adjusted Contract Value allocated to the Fixed Account and the MVA Account will
be used to provide a Fixed Annuity. Prior to the Annuity Date, the Owner can
change the Annuity Option selected by Written Request. Any change must be
requested at least thirty (30) days prior to the Annuity Date.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS: Annuity Payments are paid in monthly
installments. The Adjusted Contract Value is applied to the Annuity Table for
the Annuity Option selected. If the Adjusted Contract Value to be applied under
an Annuity Option is less than $5,000, the Company reserves the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment would be or
become less than $50, the Company reserves the right to reduce the frequency of
payments to an interval which will result in each payment being at least $50.
ANNUITY OPTIONS: The following Annuity Options or any other annuity option
acceptable to the Company may be selected:
13
OPTION 1. LIFETIME ONLY ANNUITY: The Company will make monthly payments
during the life of the Annuitant. If this option is elected, it is
understood and agreed that payments shall cease immediately upon the death
of the Annuitant and the annuity will terminate without further value.
OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS: The Company will make
monthly payments for the guaranteed period selected and thereafter for the
life of the Annuitant. If this option is elected, it is understood and
agreed that upon the death of the Annuitant, any amounts remaining under
the guaranteed period selected will be distributed to the Beneficiary at
least as rapidly as under the method of distribution being used as of the
date of the Annuitant's death. The guaranteed period may be five (5) years,
ten (10) years or twenty (20) years.
OPTION 3. INSTALLMENT REFUND LIFE ANNUITY: The Company will make monthly
payments for the installment refund period (the time required for the sum
of the payments to equal the amount applied), and thereafter for the life
of the Annuitant. If this option is elected, it is understood and agreed
that upon the death of the Annuitant, any amounts remaining under the
installment refund period will be distributed to the Beneficiary at least
as rapidly as under the method of distribution being used at the time of
the Annuitant's death.
OPTION 4. PAYMENT FOR A FIXED PERIOD: The Company will make monthly
payments for a fixed period of 3 to 20 years.
OPTION 5. JOINT AND SURVIVOR ANNUITY: The Company will make monthly
payments during the joint life time of the Annuitant and a Joint Annuitant.
Payments will continue during the lifetime of the surviving Annuitant and
will be computed on the basis of 100%, 50% or 66 2/3% of the Annuity
Payment (or limits) in effect during the joint life time.
ANNUITY: If the Owner selects a Fixed Annuity, the Adjusted Contract Value is
allocated to the General Account and the Annuity is paid as a Fixed Annuity. If
the Owner selects a Variable Annuity, the Adjusted Contract Value will be
allocated to the Sub-Accounts of the Variable Account in accordance with the
selection made by the Owner, and the Annuity will be paid as a Variable Annuity.
If no selection is made, the Adjusted Contract Value will be applied in the same
proportions to the same Sub-Accounts as the allocations are at the time of
election. Unless the Owner specifies otherwise, the payee of the Annuity
Payments shall be the Owner. The Adjusted Contract Value will be applied to the
applicable Annuity Table contained in the Contract based upon the Annuity Option
selected by the Owner. The amount of the first payment for each $1,000 of
Adjusted Contract Value is shown in the Annuity Tables.
FIXED ANNUITY: The Owner may elect to have the Adjusted Contract Value applied
to provide a Fixed Annuity.
The dollar amount of each Fixed Annuity Payment shall be determined in
accordance with Annuity Tables contained in this Contract which are based on the
minimum guaranteed interest rate of 3% per year.
VARIABLE ANNUITY: The Owner may elect to have the Adjusted Contract Value
applied to provide a Variable Annuity. Variable Annuity Payments reflect the
investment performance of the Variable Account in accordance with the allocation
of the Adjusted Contract Value to the Sub-Accounts during the Annuity Period.
Variable Annuity Payments are not guaranteed as to dollar amount.
The dollar amount of the first Variable Annuity Payment is determined in
accordance with the description above. The dollar amount of the Variable
Annuity Payments for each applicable Sub-Account after the first Variable
Annuity Payment is determined as follows:
1. The dollar amount of the first Variable Annuity Payment is divided by the
value of an Annuity Unit for each applicable Sub-Account as of the Annuity
Date. This sets the number of Annuity Units for each monthly payment for
the applicable Sub-Account.
2. The fixed number of Annuity Units per payment in each Sub-Account is
multiplied by the Annuity Unit Value for that Sub-Account for the last
Valuation Period of the month preceding the month for which the payment is
due. This result is the dollar amount of the payment for each applicable
Sub-Account.
14
The total dollar amount of each Variable Annuity Payment is the sum of all
Sub-Account Variable Annuity Payments reduced by the applicable portion of the
Contract Maintenance Charge.
ANNUITY UNIT: The value of any Annuity Unit for each Sub-Account of the Variable
Account was arbitrarily set initially at $10.
The Sub-Account Annuity Unit Value at the end of any subsequent Valuation Period
is determined as follows:
1. The Net Investment Factor for the current Valuation Period is multiplied
by the value of the Annuity Unit for the Sub-Account for the immediately
preceding Valuation Period.
2. The result in (1) is then divided by the Assumed Investment Rate Factor
which equals 1.00 plus the Assumed Investment Rate for the number of days
since the preceding Valuation Date. The Owner can choose either a 5% or a
3% Assumed Investment Rate.
MORTALITY TABLES: The mortality table used in establishing the Annuity Table is
the 1983 Individual Annuity Mortality, (IAM) Table, Unisex.
The dollar amount of an Annuity Payment for any Age or combination of Ages not
shown in the Tables or for any other form of Annuity Option agreed to by the
Company will be provided by the Company upon request.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, the Application, if
any, and any riders or endorsements attached to this Contract.
This Contract may be changed or altered only by the President or Vice President
and the Secretary of the Company. A change or alteration must be made in
writing.
MISSTATEMENT OF AGE: If the Age of any Annuitant has been misstated, any Annuity
benefits payable will be the Annuity benefits provided by the correct Age. After
Annuity Payments have begun, any underpayments will be made up in one sum with
the next Annuity Payment. Any overpayments will be deducted from future Annuity
Payments until the total is repaid.
INCONTESTABILITY: This Contract will not be contestable from the date of issue.
MODIFICATION: This Contract may be modified in order to maintain compliance with
applicable state and federal law.
NON-PARTICIPATING: This Contract will not share in any distribution of
dividends.
EVIDENCE OF SURVIVAL: The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments are based.
PROOF OF AGE: The Company may require evidence of Age of any Annuitant and any
Owner.
PROTECTION OF PROCEEDS: To the extent permitted by law, death benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
other than the person entitled to them under any Contract. No payment and no
amount under this Contract can be taken or assigned in advance of its payment
date unless the Company receives the Owner's written consent.
REPORTS: At least once each calendar year, the Company will furnish each Owner
with a report showing the Contract Value and any other information as may be
required by law. The Company will also furnish an annual report of the Variable
Account.
TAXES: Any taxes paid to any governmental entity relating to any Contract will
be deducted from the Purchase Payment or Contract Value when incurred. The
Company will, in its sole discretion, determine when taxes have resulted from:
the investment experience of the Variable Account; receipt by the Company of the
Purchase Payments; or commencement of Annuity Payments. The Company may, in its
sole discretion, pay taxes when
15
due and deduct that amount from the Contract Value at a later date. Payment at
an earlier date does not waive any right the Company may have to deduct amounts
at a later date. The Company reserves the right to establish a provision for
federal income taxes if it determines, in its sole discretion, that it will
incur a tax as a result of the operation of the Variable Account. The Company
will deduct for any income taxes incurred by it as a result of the operation of
the Variable Account whether or not there was a provision for taxes and whether
or not it was sufficient. The Company will deduct any withholding taxes required
by applicable law.
REGULATORY REQUIREMENTS: All values payable under any Contract will not be less
than the minimum benefits required by the laws and regulations of the states in
which the Contract is delivered.
The following Tables show the monthly income payable for each $1,000 applied
under Option 1, 2, 3, 4, or 5.Values shown are based on 3% interest for all
options.
OPTION 4 TABLE OPTION 1,2, AND 3 TABLES
------------------------ ---------------------------------------------------------------------
MALE AND FEMALE
---------------------------------------------------------------------
MONTHLY INSTALLMENTS FOR LIFE
WITH GUARANTEED PERIOD
---------------------------------------------------------------------
(2) AGE OF
(1) (3) ----------------------------------------- PAYEE
NO OF 5 YEARS 10 YEARS 20 YEARS WHEN FIRST
YEARS MONTHLY LIFETIME INSTALLMENT CERTAIN CERTAIN CERTAIN INSTALLMENT
PAYABLE INSTALLMENTS ONLY REFUND AND LIFE AND LIFE AND LIFE IS PAYABLE
--------------------------------------------------------------------------------------------------------------------
3 $ 28.99
4 22.06
5 17.91 $ 4.09 $ 3.97 $ 4.08 $ 4.06 $ 3.96 50
6 15.14 4.16 4.03 4.15 4.12 4.01 51
7 13.16 4.23 4.09 4.22 4.19 4.07 52
8 11.68 4.31 4.16 4.30 4.27 4.13 53
9 10.53 4.39 4.23 4.38 4.35 4.19 54
10 9.61 4.48 4.30 4.47 4.43 4.25 55
11 8.86 4.57 4.38 4.56 4.51 4.32 56
12 8.24 4.67 4.45 4.65 4.60 4.38 57
13 7.71 4.77 4.54 4.76 4.70 4.45 58
14 7.26 4.88 4.63 4.88 4.80 4.51 59
15 6.87 5.00 4.72 4.98 4.90 4.58 60
16 6.53 5.13 4.81 5.10 5.02 4.65 61
17 6.23 5.26 4.92 5.23 5.13 4.72 62
18 5.96 5.41 5.03 5.37 5.28 4.79 63
19 5.73 5.56 5.14 5.52 5.39 4.85 64
20 5.51 5.73 5.26 5.68 5.52 4.92 65
16
OPTION 5
JOINT AND 100% SURVIVOR ANNUITY
AGE OF AGE OF SURVIVING ANNUITANT
ANNUITANT 55 60 65 70 75
-------------------------------------------------------------------------------------------------------------
55 3.93 4.06 4.22 4.32 4.40
60 4.08 4.30 4.51 4.69 4.83
65 4.22 4.51 4.82 5.10 5.34
70 4.32 4.69 5.10 5.53 5.93
75 4.40 4.83 5.34 5.93 6.54
OPTION 5
JOINT AND 66 2/3% SURVIVOR ANNUITY
AGE OF AGE OF SURVIVING ANNUITANT
ANNUITANT 55 60 65 70 75
-------------------------------------------------------------------------------------------------------------
55 4.31 4.52 4.76 5.01 5.28
60 4.52 4.78 5.08 5.39 5.72
65 4.76 5.08 5.44 5.84 6.25
70 5.01 5.39 5.84 6.35 6.91
75 5.28 5.72 6.26 6.91 7.65
OPTION 5
JOINT AND 50% SURVIVOR ANNUITY
AGE OF AGE OF SURVIVING ANNUITANT
ANNUITANT 55 60 65 70 75
-------------------------------------------------------------------------------------------------------------
55 4.53 4.78 5.09 5.45 5.87
60 4.78 5.07 5.41 5.83 6.31
65 5.09 5.41 5.81 6.29 6.85
70 5.45 5.83 6.29 6.86 7.53
75 5.87 6.32 6.85 7.53 8.38
17
JEFFERSON NATIONAL LIFE INSURANCE COMPANY
[ADMINISTRATIVE OFFICE: 0000 XXXXXXXXX XXXXXX XX., XXXXX 0000
XXXXXXXXXX, XXXXXXXX 00000
TELEPHONE: 0-000-000-0000
INDIVIDUAL FIXED AND VARIABLE
ANNUITY CONTRACT
NON-PARTICIPATING
