Federal Xxxxxx Life Assurance Company [LOGO OF ZURICH LIFE]
A Stock Life Insurance Company
0000 XxXxxxxx Xxxxxxx
Xxxxxxxxxx, Xxxxxxxx 00000-0000
RIGHT TO CANCEL - FREE LOOK PROVISION - At any time within 10 days of receiving
this contract you may return it to us or to the agent through whom it was
purchased. Immediately upon our receipt, this contract will be voided as if it
had never been in force. All purchase payments allocated to the fixed account
plus the separate account contract value computed at the end of the valuation
period following our receipt of this contract will then be refunded within ten
days.
We agree to pay an annuity to the owner provided this contract is in force on
the annuity date.
We further agree to pay the death benefit prior to the annuity date upon the
death of an owner when a death benefit is payable. Payment will be made upon our
receipt of due proof of death and the return of this contract.
This contract is issued in consideration of the initial purchase payment. The
provisions on this cover and the pages that follow are part of this contract.
Signed for Federal Xxxxxx Life Assurance Company at its home office in
Schaumburg, Illinois.
/s/ [ILLEGIBLE] /s/ [ILLEGIBLE]
Secretary President
FIXED AND VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
ALL BENEFITS, PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED UPON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD PROVISIONS
FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the owner and Federal Xxxxxx Life Assurance
Company.
READ YOUR CONTRACT CAREFULLY.
INDEX
PAGE
ANNUITY OPTION TABLE 16
ANNUITY PERIOD PROVISIONS 12 - 15
Election of Annuity Option 12
Annuity Options 12 - 13
Transfers During the Annuity Period 14 - 15
APPLICATION Follows Endorsements, if any
CONTRACT SCHEDULE Follows Index
DEATH BENEFIT PROVISIONS 10 - 11
Amount Payable Upon Death 10
Payment of Death Benefits 11
Spousal Continuation 11
DEFINITIONS 1 - 2
ENDORSEMENTS, if any Follows Annuity Option Table
FIXED ACCOUNT PROVISIONS 5 - 6
Fixed Account 5
Fixed Account Contract Value 5 - 6
GENERAL PROVISIONS 2 - 3
The Contract 2
Incontestability 2
Assignment 3
Reports 3
Premium Taxes 3
LOAN PROVISIONS 10
Loans 10
Loan Interest Rate 10
Loan Repayment 10
OWNERSHIP PROVISIONS 3 - 4
Owner of Contract 3
Change of Ownership 3
Beneficiary 4
PURCHASE PAYMENT PROVISIONS 4 - 5
Initial Purchase Payment 4
Purchase Payment Limitations 4 - 5
TRANSFER AND WITHDRAWAL PROVISIONS 7 - 9
Transfers During the Accumulation Period 7 - 8
Withdrawals During the Accumulation Period 8 - 9
Withdrawal Charges 9
Transfer and Withdrawal Procedures 9
VARIABLE ACCOUNT PROVISIONS 6 - 7
Separate Account 6
Liabilities of Separate Account 6
Subaccounts 6
Rights Reserved by the Company 6 - 7
Accumulation Unit Value 7
CONTRACT SCHEDULE
Contract number: [ 0003251] Issue Date: [May 1, 2003]
Initial Purchase Payment: [$2,500 ] Type of contract: [Nonqualified]
Owner: [Xxxx Xxx]
Owner date of birth
or trust inception date: [March 04, 1968]
Annuitant: [Xxxx Xxx]
Annuitant gender: [Male]
Annuitant date of birth: [March 04, 1968]
Joint Owner: [None]
Joint Owner date of birth: [N/A]
Joint Annuitant: [None]
Joint Annuitant gender: [N/A]
Joint Annuitant date of birth: [N/A]
Annuity Date: [May 1, 2033]
Maximum Annuity Date [Later of the oldest owner's or annuitant's 90th birthdate]
Date of Continuance: N/A
Optional Enhanced
Death Benefit Rider: [Annual Step Up Enhanced Death Benefit Rider] Not Selected
[Annual Step Up with 5% Roll Up Enhanced Death Benefit Rider] Selected
Guaranteed Roll-Up Interest Rate Applicable to [Annual Step Up with [5%] Roll Up Enhanced Death Benefit Rider]:
Class 1 Accumulation Options [0.00%]
Class 2 Accumulation Options [5.00%]
Agent: [Xxxx Xxxxx]
Page A
CONTRACT SCHEDULE
BENEFICIARY INFORMATION
Primary beneficiary(ies):
[Xxxx Xxx]
Contingent beneficiary(ies):
[Xxxxx Xxx]
We declare a fixed account interest rate for each allocation to the fixed
account for an initial period when the allocation is made and at the start of
each subsequent interest period. This interest rate will never be less than the
minimum guaranteed fixed account interest rate.
The minimum guaranteed fixed account interest rate is:
Contract Years [1 - 10] [2.00%]
[11+] 3.00%
The initial period is: [Through the contract year in which the allocation is
made.]
Subsequent periods are: [Each next contract year.]
Maximum Total Purchase Payments: [$1,000,000]
Maximum Fixed Account Purchase Payments Per
Contract Year [$100,000]
Minimum Initial Account Allocation: [Subaccount $500
Fixed Account see limits in
Contract]
Minimum Subsequent Account Allocation: [Subaccount $50
Fixed Account see limits in
Contract]
Page B
CONTRACT SCHEDULE
Withdrawal Charge:
A withdrawal charge applies to each purchase payment. Year one is the
contract year in which the purchase payment is made. Each later year is
measured from the start of the contract year in which the purchase
payment was made.
During Year The Withdrawal
Charge is:
One 6.00%
Two 5.00%
Three 4.00%
Four 3.00%
Five 2.00%
Six 1.00%
Seven and later 0.00%
Up to 10% of the contract value less debt may be withdrawn as a partial
free withdrawal each contract year. Charges are applied to purchase
payments and all related accumulations for any withdrawal in excess of
the 10% partial free withdrawal.
A daily equivalent of the following annual charges will be assessed each day on
the subaccounts:
Mortality and expense risk charge: [1.30%]
[Optional Enhanced Death Benefit rider charge:] [Annual Step Up Enhanced Death Benefit Rider][0.20%]
[Annual Step Up with 5% Roll Up Enhanced Death Benefit Rider] [0.35%]
The Optional Enhanced Death Benefit rider charge applies to the Class 2
accumulation options. This charge does not apply to the Class 1
accumulation options.
We will assess a records maintenance charge at the end of each calendar quarter
in which you participate in the separate account, upon a full withdrawal, and on
the annuity date. This charge will not be assessed after the annuity date. This
charge will be deducted on a proportional basis from amounts allocated to the
subaccounts. The amount of this charge will depend on the amount of the contract
value on the date the charge is made:
Amount Of Records Maintenance
Contract Value Charge
less than $25,000 $ 7.50
$25,000 to $49,999.99 $ 3.75
$50,000 and greater none
Page C
CONTRACT SCHEDULE
Initial Initial Annual Effective Allocation
Allocations Interest Rate(s) Percentage(s)
Janus Aspen Worldwide Growth N/A 80%
Fixed Account 3.0% 20%
Page D
CONTRACT SCHEDULE
Class 1 Accumulation Options:
Fixed Account
[Xxxxxxx Money Market subaccount]
Class 2 Accumulation Options:
[All subaccounts except the Xxxxxxx Money Market subaccount.]
[Separate Account: FKLA Variable Annuity Separate Account.]
FKLA Variable Annuity Separate Account Subaccounts available on the Issue Date:
Xxxxxxx Money Market
Xxxxxxx Government Securities
Xxxxxxx High Yield
Xxxxxxx Total Return
Xxxxxxx Growth
Xxxxxxx International Research
Xxxxxxx Small Cap Growth
Xxxxxxx Investment Grade Bond
Xxxxxxx Small Cap Value
Xxxxxxx Contrarian Value
SVS Focus Value + Growth
Xxxxxxx Technology Growth
Xxxxxxx Bond
Xxxxxxx Capital Growth
Xxxxxxx International
Credit Suisse Warburg Pincus Trust - Emerging Markets
Janus Aspen Balanced
Janus Aspen Growth
Janus Aspen Aggressive Growth
Janus Aspen Worldwide Growth
Pilgrim Emerging Markets Fund, Inc.
Pilgrim Natural Resources Trust
Fidelity VIP II Asset Manager
Fidelity VIP II Index 500
Fidelity VIP II Contrafund (R)
Fidelity VIP Equity-Income
Fidelity VIP Growth
Xxxxx American Growth
Xxxxx American Small Capitalization
Xxxxx American MidCap Growth
American Century VP Income & Growth
American Century VP Value
The Dreyfus Socially Responsible Growth Fund, Inc.
X.X. Xxxxxx Small Company
Page E
DEFINITIONS
Accumulation Period - The period between the
issue date and the annuity date.
Accumulation Unit - An accounting unit of
measure used to calculate the value of each
subaccount.
Age - The attained age.
Annuitant - The person during whose lifetime the
annuity is to be paid. Under a nonqualified plan
when two people are named as joint annuitants,
the term "annuitant" means the joint annuitants
or the survivor.
Annuity - A series of payments paid in
accordance with this contract which begins on
the annuity date.
Annuity Date - The date on which annuity
payments begin. The original annuity date is
stated in the contract schedule.
Annuity Period - This is the period that starts
on the annuity date.
Annuity Unit - An accounting unit of measure
used to calculate the amount of variable annuity
payments after the first annuity payment.
Annuity Unit Value - The value of an annuity
unit of a subaccount determined for a valuation
period according to the formula stated in this
contract.
Contract Value - The sum of the fixed account
contract value plus the separate account
contract value.
Contract Year - A one year period of time
starting on the issue date and successive
contract anniversaries.
Debt - The principal of any outstanding loan
plus any loan interest due or accrued.
Fixed Account - Our assets other than those
allocated to the separate account or any other
separate account. We guarantee a minimum rate of
interest on purchase payments allocated to the
fixed account.
Fixed Account Contract Value - The fixed account
contract value is the value of the fixed account
of this contract on any valuation date.
Fixed Annuity - An annuity payment plan that
does not vary as to dollar amount with
investment experience.
Fund - An investment company or separate series
thereof, in which subaccounts of the separate
account invest.
Issue Date - The issue date is stated in the
contract schedule.
Mortality and Expense Risk Charge - This is a
charge deducted in the calculation of the
accumulation unit value and the annuity unit
value. It is for our assumption of mortality
risks and expense guarantees.
Nonqualified - This contract issued other than
as a qualified plan.
Owner - See "You, You, Yours" below.
Purchase Payments - This is the dollar amount we
receive in U.S. currency to buy the benefits
this contract provides.
Qualified Plan - This contract issued under a
retirement plan which qualifies for favorable
income tax treatment under Section 401, 403, 408
or 457 of the Internal Revenue Code as amended.
Records Maintenance Charge - This is a charge
assessed against your contract as specified in
the contract schedule.
Page 1
Page 2
DEFINITIONS (Continued)
Received By The Company - This means received by
Federal Xxxxxx Life Assurance Company at its
home office in Schaumburg, Illinois.
Separate Account - A unit investment trust
registered with the Securities and Exchange
Commission under the Investment Company Act of
1940 and identified in the contract schedule.
Separate Account Contract Value - This is the
sum of the subaccount values of this contract on
the valuation date.
Subaccounts - The separate account has multiple
subaccounts. The subaccounts available on the
issue date are stated in the contract schedule.
Subaccount Value - We will value each subaccount
separately according to the formula stated in
this contract.
Valuation Date - Each business day that
applicable law requires that we value the assets
of the separate account. Currently this is each
day that the New York Stock Exchange is open for
trading.
Valuation Period - The period that starts at the
close of a valuation date and ends at the close
of the next succeeding valuation date.
Variable Annuity - An annuity payment plan which
varies as to dollar amount because of subaccount
investment experience.
We, Our, Us - Federal Xxxxxx Life Assurance
Company.
You, Your, Yours - The party(ies) named as owner
in the contract schedule unless later changed as
provided in this contract. Under a nonqualified
plan when more than one person is named as
owner, the terms "you," "your," "yours," means
joint owners. The owner may be changed during
the lifetime of the owner. The owner, prior to
the death of an owner, has the exclusive right
to exercise every option and right conferred by
this contract.
GENERAL PROVISIONS
The Contract This contract and any attached application,
endorsement(s) and rider(s) constitute the
entire contract between the parties. All
statements made in the application are deemed
representations and not warranties. No statement
will void this contract or be used as a defense
of a claim unless it is contained in the
application.
Modification of Contract Only our president, secretary and assistant
secretaries have the power to approve a change
or waive any provisions of this contract. Any
such modifications must be in writing. No agent
or person other than the officers named has the
authority to change or waive the provisions of
this contract.
Upon notice to you, this contract may be
modified by us as is necessary to comply with
any law or regulation issued by a governmental
agency to which we or the separate account is
subject or as is necessary to assure continued
qualification of this contract under the
Internal Revenue Code or other laws relating to
retirement plans or annuities or as otherwise
may be in your best interest. In the event of a
modification, we may make appropriate
endorsement to this contract and we will obtain
all required regulatory approvals.
Incontestability We cannot contest this contract after it has
been in force for two years from the issue date.
GENERAL PROVISIONS (Continued)
Change of Annuity Date You may write to us prior to distribution of a
death benefit or the first annuity payment date
and request a change of the annuity date. The
new annuity date must not be later than the
maximum annuity date stated in the contract
schedule.
Assignment No assignment of this contract is binding unless
we receive it in writing. We assume no
responsibility for the validity or sufficiency
of any assignment. Once filed, the rights of the
owner, annuitant and beneficiary are subject to
the assignment. Any claim is subject to proof of
interest of the assignee.
Due Proof of Death We must receive written proof of the death of
the owner when a death benefit is payable. The
proof may be a certified death certificate or
any other proof satisfactory to us.
Reserves, Contract Values, All reserves are equal to or greater than those
Annuity and Death Benefits required by statute. Any available contract
value, paid-up annuity benefit and death benefit
are not less than the minimum benefits required
by the statutes of the state in which this
contract is delivered.
Non-Participating This contract does not pay dividends. It will
not share in our surplus or earnings.
Reports At least once each contract year we will send
you a statement showing purchase payments
received, interest credited, investment
experience and charges made since the last
report, as well as any other information
required by statute.
Premium Taxes We will make a deduction for state premium taxes
in certain situations. On any contract subject
to premium tax, as provided under applicable
law, the tax will be deducted from: a. the
purchase payments when we receive them; b. the
contract value upon total withdrawal; or c. from
the total contract value applied to an annuity
option at the time annuity payments start.
Qualified Plans If this contract is issued under a qualified
plan additional provisions may apply. The rider
or amendment to this contract used to qualify it
under the applicable section of the Internal
Revenue Code will indicate the extent of change
in the provisions.
OWNERSHIP PROVISIONS
Owner Before the annuity date and prior to the death
of an owner, you have the right to cancel or
amend this contract if we agree. You may
exercise every option and right conferred by
this contract including the right of assignment.
The joint owners must agree to any change if
more than one owner is named.
Change of Ownership You may change the owner by written request
before the annuity date and prior to the death
of an owner. You must furnish information
sufficient to clearly identify the new owner to
us. The change is subject to any existing
assignment of this contract. When we record the
effective date of the change, it will be the
date the notice was signed except for action
taken by us prior to receiving the request. Any
change is subject to the payment of any
proceeds. We may require you to return this
contract to us for endorsement of a change.
Page 3
Page 4
OWNERSHIP PROVISIONS (Continued)
Annuitant Prior to the annuity date, an annuitant may be
replaced or added unless the owner is a
non-natural person. At all times there must be
at least one annuitant. If the annuitant dies,
the youngest owner will become the new annuitant
unless a new annuitant is otherwise named. Upon
the death of an annuitant prior to the annuity
date, a death benefit is not paid unless the
owner is a non-natural person.
Beneficiary Designation and The beneficiary is stated in the contract
Change of Beneficiary schedule. In the case of joint owners, the
surviving joint owner is automatically the
primary beneficiary of any death benefit
resulting from the death of a joint owner. You
may change the beneficiary if you send us a
written change form. Changes are subject to the
following:
1. The change must be filed while you are alive
and prior to the annuity date;
2. This contract must be in force at the time
you file a change;
3. Such change must not be prohibited by the
terms of an existing assignment, beneficiary
designation or other restriction;
4. Such change will take effect when we receive
it;
5. After we receive the change, it will take
effect on the date the change form was
signed. However, action taken by us before
the change form was received will remain in
effect; and
6. The request for change must provide
information sufficient to identify the new
beneficiary.
7. In the case of joint owners, the designation
of a beneficiary other than the joint
surviving owner will be deemed to be a
contingent beneficiary(ies).
We may require you to return this contract for
endorsement of a change.
Death of Beneficiary The interest of a beneficiary who dies before
the distribution of the death benefit will pass
to the other beneficiaries, if any, share and
share alike, unless otherwise provided in the
beneficiary designation. If no beneficiary
survives or is named, the distribution will be
made to your estate when you die. If a
beneficiary dies within ten days of the date of
your death, the death benefit will be paid as if
you had survived the beneficiary. If you and the
beneficiary die simultaneously, we will pay the
death benefit as if you had survived the
beneficiary.
PURCHASE PAYMENT PROVISIONS
Initial Purchase Payment The minimum initial purchase payment is $2,500
for a nonqualified plan and $50 for a qualified
plan.
Purchase Payment Limitations The minimum subsequent purchase payment is $500
for a nonqualified plan and $50 for a qualified
plan. We will accept a subsequent qualified plan
purchase payment of less than $50 when annual
contributions from a payroll deduction or salary
reduction plan equal or exceed $600.
The sum of all purchase payments allocated to
the fixed account in any contract year may not
exceed the maximum fixed account purchase
payment shown on the contract schedule. Purchase
payments made under a systematic investment
program that has been approved by us are not
subject to the above limitation, but we reserve
the right to modify or terminate this provision
and to apply the contract year allocation
limitation to such purchase payments.
The sum of all purchase payments allocated to
the contract may not exceed the maximum total
purchase payments shown on the contract
schedule.
We will not accept purchase payments more
frequently than once every other week.
PURCHASE PAYMENT PROVISIONS (Continued)
Initial purchase payments of less than $500 may
be allocated to: 1. the fixed account; or 2. a
subaccount; or 3. to the fixed account and one
subaccount.
Subsequent nonqualified purchase payments must
first be applied to the fixed account or any
subaccount whose value is less than $500. After
each initial account has been allocated to at
least $500, purchase payments may be allocated
to a new account.
Subsequent qualified plan contributions from a
payroll deduction or salary reduction program of
$50 or more may be made to the fixed account or
to an additional subaccount.
We will deduct any applicable state premium
taxes from the purchase payments we apply to the
contract.
We reserve the right: (a) not to allow
allocation of any purchase payment to the fixed
account if the fixed account interest rate
applicable to that purchase payment would be
less than or equal to 3%; and, (b) to except
purchase payments that are part of a systematic
investment program that has been approved by us
from such allocation limitation.
We reserve the right to waive or modify these
limits. We also reserve the right not to accept
any purchase payment.
Place of Payment All purchase payments under this contract must
be paid to us at our home office or such other
location as we may select. We will notify you
and any other interested parties in writing of
such other locations. Purchase payments received
by an agent will begin earning interest after we
receive it.
FIXED ACCOUNT PROVISIONS
Fixed Account The guaranteed benefits under this contract are
provided through the fixed account.
Fixed Account Contract Value The fixed account contract value includes: 1.
your purchase payments allocated to the fixed
account; 2. amounts transferred from a
subaccount to the fixed account at your request;
and 3. the interest credited to amounts so
allocated or transferred. Transfers and
withdrawals from the fixed account reduce the
fixed account contract value.
The initial fixed account interest rate credited
to the initial purchase payment is in effect
through the end of the guarantee period and is
shown in the contract schedule. At the beginning
of each subsequent guarantee period shown in the
contract schedule, we will declare the fixed
account interest rate applicable to the initial
purchase payment for each such subsequent
guarantee period. We will declare the fixed
account interest rate with respect to each
subsequent purchase payment received. Any such
purchase payment we receive will be credited
that rate through the end of the guarantee
period shown in the contract schedule. At the
beginning of each subsequent guarantee period,
we will declare the fixed account interest rate
applicable to each subsequent purchase payment
for such guarantee period.
We reserve the right to declare the fixed
account current interest rate(s) based upon: the
issue date; the date we receive a purchase
payment; or the date of account transfer.
We calculate the interest credited to the fixed
account by compounding daily, at daily interest
rates, rates which would produce at the end of a
contract year a result identical to the one
produced by applying an annual interest rate.
Page 5
Page 6
FIXED ACCOUNT PROVISIONS (Continued)
The minimum guaranteed fixed account interest
rate is shown in the contract schedule.
VARIABLE ACCOUNT PROVISIONS
Separate Account The variable benefits under this contract are
provided through the separate account identified
in the contract schedule. The separate account
is registered with the Securities and Exchange
Commission as a unit investment trust under the
Investment Company Act of 1940. It is a separate
investment account maintained by us into which a
portion of the company's assets have been
allocated for this contract and may be allocated
for certain other contracts.
Liabilities of Separate Account The assets equal to the reserves and other
liabilities of the separate account will not be
charged with liabilities arising out of any
other business we may conduct. We will value the
assets of the separate account on each valuation
date.
Separate Account Contract Value On any valuation day the separate account
contract value is the sum of its subaccount
values.
Subaccounts The separate account consists of multiple
subaccounts as shown in the contract schedule.
We may, from time to time, combine or remove
subaccounts in the separate account and
establish additional subaccounts of the separate
account. In such event we may permit you to
select other subaccounts under this contract.
However, the right to select any other
subaccount is limited by the terms and
conditions we may impose on such transactions.
Fund Each subaccount of the separate account will buy
shares of a fund or a separate series of a fund.
Each fund is registered under the Investment
Company Act of 1940 as an open-end diversified
management investment company. Each series of a
fund represents a separate investment portfolio
which corresponds to one of the subaccounts of
the Separate Account.
If we establish additional subaccounts each new
subaccount will invest in a new series of a fund
or in shares of another investment company. We
may also substitute other investment companies.
Rights Reserved by the Company We reserve the right, subject to compliance with
the current law or as it may be changed in the
future:
1. To operate the separate account in any form
permitted under the Investment Company Act
of 1940 or in any other form permitted by
law;
2. To take any action necessary to comply
with or obtain and continue any exemptions
from the Investment Company Act of 1940 or
to comply with any other applicable law;
3. To transfer any assets in any subaccount
to another subaccount or to add, combine or
remove subaccounts in the separate account;
4. To delete the shares of any of the
portfolios of a fund or any other open-end
investment company and to substitute, for
the fund shares held in any subaccount, the
shares of another portfolio of a fund or the
shares of another investment company or any
other investment permitted by law; and
5. To change the way we assess charges, but
not to increase the aggregate amount above
that currently charged to the separate
account and the funds in connection with the
contracts.
VARIABLE ACCOUNT PROVISIONS (Continued)
When required by law, we will obtain your
approval of such changes and the approval of any
regulatory authority.
Accumulation Unit Value Each subaccount has an accumulation unit value.
When purchase payments or other amounts are
allocated to a subaccount, a number of units are
purchased based on the accumulation unit value
of the subaccount at the end of the valuation
period during which the allocation is made. When
amounts are transferred out of or deducted from
a subaccount, units are redeemed in a similar
manner.
The accumulation unit value for each subsequent
valuation period is the investment experience
factor for that period multiplied by the
accumulation unit value for the period
immediately preceding. Each valuation period has
a single accumulation unit value that is applied
to each day in the period. The number of
accumulation units will not change as a result
of investment experience.
Investment Experience Factor Each subaccount has its own investment
experience factor. The investment experience of
the separate account is calculated by applying
the investment experience factor to the cash
value in each subaccount during a valuation
period.
The investment experience factor of a subaccount
for a valuation period is determined by dividing
1. by 2. and subtracting 3. from the result,
where:
1. is the net result of:
a. the net asset value per share of the
investment held in the subaccount determined
at the end of the current valuation period;
plus
b. the per share amount of any dividend or
capital gain distributions made by the
investments held in the subaccount, if the
"ex-dividend" date occurs during the current
valuation period; plus or minus
c. a charge or credit for any taxes reserved
for the current valuation period which we
determine resulted from the investment
operations of the subaccount;
2. is the net asset value per share of the
investment held in the subaccount,
determined at the end of the last valuation
period;
3. is the factor representing the mortality and
expense risk charge stated in the contract
schedule and any applicable charges for any
optional death benefits for the number of
days in the valuation period.
TRANSFER AND WITHDRAWAL PROVISIONS
Transfers During the Once each fifteen days all or part of the
Accumulation Period separate account contract value may be
transferred to another subaccount. Transfers may
also be made at that time to the fixed account
subject to the conditions stated in paragraph 7
below. We will allow the first transfer fifteen
days after the issue date.
Transfers will be subject to the following
conditions:
1. The minimum amount which may be transferred,
subject to paragraph 6 below, is $500 or, if
smaller, the remaining value in the fixed
account or a subaccount;
2. No partial transfer will be made if the
remaining contract value of the fixed
account or any subaccount will be less than
$500 unless the transfer will eliminate your
interest in such account;
Page 7
Page 8
TRANSFERS AND WITHDRAWAL PROVISIONS (Continued)
3. No transfer may be made within seven
calendar days of the date on which the first
annuity payment is due;
4. You may request an additional transfer from
the fixed account, subject to paragraph 6
below, to one or more subaccounts during the
thirty day period before the date on which
the first annuity payment is due. Such
transfer must become effective no later than
the seventh calendar day before such due
date;
5. When you request a transfer from the fixed
account contract value to a subaccount, we
will limit the amount that can be
transferred, subject to paragraph 6 below,
to the amount which exceeds debt and the
withdrawal charge, if any, applicable to the
total fixed account contract value for the
contract year during which the total
transfer is made.
6. Total transfers out of the fixed account in
any contract year may not exceed 25% of the
value of the fixed account as of: (a) the
prior contract anniversary; or (b) the issue
date for transfers made prior to the first
contract anniversary. Transfers made under a
systematic investment program that has been
approved by us are not subject to the above
limitation, but we reserve the right to
modify or terminate this provision and to
apply the above limitation to such
transfers.
7. Total transfers into the fixed account in
any contract year, that would be credited a
current interest rate of 3% or less, may not
exceed 25% of the contract value as of: (a)
the prior contract anniversary; or (b) the
issue date for transfers made prior to the
first contract anniversary. Transfers made
under a systematic investment program that
has been approved by us are not subject to
the above limitation, but we reserve the
right to modify or terminate this provision
and to apply the above limitation to such
transfers.
8. We reserve the right: (a) not to allow any
transfer into the fixed account if the fixed
account interest rate with respect to that
transfer would be less than or equal to 3%;
and, (b) to except from such transfer
limitation transfers made under an approved
systematic investment program.
We will transfer amounts bought by purchase
payments and all related accumulations received
in a given contract year, in the chronological
order we received them.
Any transfer request must clearly specify: 1.
the amount which is to be transferred; and 2.
the names of the accounts which are affected. We
will only honor a telephone transfer request if
a properly executed telephone transfer
authorization is on file with us. Such request
for a transfer must comply with the conditions
of the authorization.
We reserve the right at any time and without
notice to any party, to terminate, suspend, or
modify these transfer rights.
Withdrawals During the During the accumulation period, you may withdraw
Accumulation Period all or part of the contract value that remains
after we subtract any withdrawal charge, debt
and applicable premium taxes. We must receive a
written request that indicates the amount of the
withdrawal from the fixed account and each
subaccount. You must return the contract to us
if you elect a total withdrawal.
TRANSFER AND WITHDRAWAL PROVISIONS (Continued)
Withdrawals are subject to the conditions that
follow.
1. Each withdrawal must be at least $500 or the
value that remains in the fixed account or a
subaccount if smaller;
2. A minimum of $500 must remain in the account
after you make a withdrawal unless the
account is eliminated by such withdrawal;
3. The maximum you may withdraw from any
account is the value of the fixed account or
a subaccount less the amount of any
withdrawal charge;
4. Any withdrawal amount you request will be
increased by the withdrawal charge;
5. We will limit a withdrawal from the fixed
account to an amount which equals the fixed
account contract value less debt and
interest on any such loan to the end of the
contract year.
Withdrawal Charges 1. All purchase payments in a given contract
year and all related accumulations are
totaled by account and each total is used
separately in computing the withdrawal
charge as stated in the withdrawal charge
table shown in the contract schedule.
2. All amounts to be withdrawn and any
applicable withdrawal charges will be
charged first against purchase payments and
all related accumulations in the
chronological order we received such
purchase payments by contract year.
3. Any amount withdrawn which is not subject to
a withdrawal charge will be considered a
"partial free withdrawal."
4. In the event of a partial withdrawal, a
"partial free withdrawal" is applied against
purchase payments and all related
accumulations in the chronological order we
received such purchase payments by contract
year even though the purchase payments and
related accumulations are no longer subject
to a withdrawal charge.
Transfer and Withdrawal We will withdraw or transfer from the fixed
Procedures account as of the valuation date that follows
the date we receive your written or telephone
transfer request. To process a withdrawal, the
request must contain all required information.
We will redeem the necessary number of
accumulation units to achieve the dollar amount
when the withdrawal or transfer is made from a
subaccount. We will reduce the number of
accumulation units credited in each subaccount
by the number of accumulation units redeemed.
The reduction in the number of accumulation
units is determined on the basis of the
accumulation unit value at the end of the
valuation period when we receive the request,
provided the request contains all required
information. We will pay the amount within seven
calendar days after the date we receive the
request, except as provided below.
Deferment of Withdrawal If the withdrawal or transfer is to be made from
or Transfer a subaccount, we may suspend the right of
withdrawal or transfer or delay payment more
than seven calendar days: 1. during any period
when the New York Stock Exchange is closed other
than customary weekend and holiday closings; 2.
when trading in the markets normally utilized is
restricted, or an emergency exists as determined
by the Securities and Exchange Commission, so
that disposal of investments or determination of
the accumulation unit value is not practical; or
3. for such other periods as the Securities and
Exchange Commission by order may permit for
protection of owners.
We may defer the payment of a withdrawal or
transfer from the fixed account, for the period
permitted by law. This can never be more than
six months after you send us a written request.
During the period of deferral, we will continue
to credit interest, at the then current interest
rate(s), to the fixed account contract value.
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LOAN PROVISIONS
Loans You may request a loan any time before the
annuity date. You must assign this contract to
us as security for a loan.
The maximum loan available is the fixed account
contract value minus: 1. any withdrawal charge
that applies to the total fixed account contract
value in the year in which you make the loan;
and 2. interest on the loan paid to the end of
the contract year in which you make the loan.
We may defer granting a loan for six months from
the date we receive the written loan request.
Loan Interest The loan interest is 5.50% per year compounded
daily at the daily equivalent of a 5.50% annual
rate. Interest is due at the end of each
contract year. If you do not pay interest when
it is due, we will add it to the loan and it
will bear interest at the same rate as the loan.
We will charge interest on a daily basis.
Loan Payment You may repay a debt in full or in part at any
time prior to the annuity date. If the debt
equals or exceeds the fixed account contract
value, less any withdrawal charge that applies
to the total withdrawal of the fixed account,
your interest in the fixed account will
terminate. The termination occurs thirty-one
days after we mail notice of termination to your
last known address and that of any assignee of
record.
We will apply any repayment of debt: first to
reduce that part of the debt that can be
attributed to interest; and second to that part
of the debt that can be attributed to purchase
payments.
Effects of Loans on Interest While there is a loan, the portion of the fixed
Rates account contract value that equals the debt will
earn interest at 3.00% per year, compounded
daily at the daily equivalent of a 3.00% annual
rate, instead of the current interest rate.
DEATH BENEFIT PROVISIONS
Amount Payable Upon Death We compute the death benefit at the end of the
valuation period following: our receipt of due
proof of death; such other information we may
require to process the death benefit, and the
return of this contract.
If death occurs prior to the oldest owner
attaining age 75, we will pay the greater of: a.
the contract value less debt; or b. the total
amount of purchase payments, less debt and the
aggregate dollar amount of all adjustments for
withdrawals. We will pay the contract value less
debt if death occurs on or after the oldest
owner's 75th birthday.
Adjustments for Withdrawals The adjustment for withdrawals described above
is a dollar amount determined for each
withdrawal which is equal to (1) divided by (2),
with the result multiplied by (3), where:
1. is the withdrawal and withdrawal charge
amount;
2. is the contract value immediately prior to
the withdrawal; and
3. is the value of the death benefit immediatly
prior to the withdrawal.
DEATH BENEFIT PROVISIONS (Continued)
Payment of Death Benefits We will pay a death benefit before the annuity
date if the owner or a joint owner dies. If the
owner is a non-natural person, a death benefit
will be paid upon the death of an annuitant
before the annuity date.
When we pay the death benefit we will then have
no further obligation under this contract.
When you die, we will pay the death benefit in a
lump sum. This sum may be deferred for up to
five years from the date of your death.
Instead of a lump sum payment the beneficiary
may elect to have the death benefit distributed
as stated in Option 1 for a period not to exceed
the beneficiary's life expectancy; or Options 2,
or 3 based upon the life expectancy of the
beneficiary as prescribed by federal
regulations. The beneficiary must make this
choice within sixty days of the time we receive
due proof of death.
If the beneficiary is not a natural person, the
beneficiary must elect that the entire death
benefit be distributed within five years of your
death. Distribution of the death benefit must
start within one year after your death. It may
start later if prescribed by federal
regulations.
Spousal Continuation If this contract was issued as a nonqualified
plan or an Individual Retirement Annuity ("IRA")
and your spouse is the primary beneficiary when
you die, the surviving spouse may elect to be
the successor owner of this contract. This is
known as a spousal continuation. In such case,
no death benefit will be payable upon your
death.
Upon your death, your surviving spouse may
continue this contract thereby waiving claim to
the death benefit otherwise payable. Electing to
continue this contract under the spousal
continuation provision of this contract will
affect how the charges and benefits under this
contract and applicable endorsements and riders
are calculated or determined.
If a spousal continuation is elected, the
contract value will be adjusted to equal the
amount otherwise payable as a death benefit
under this contract subject to the following:
1. The contract value will be adjusted to equal
the amount of the death benefit. If the
death benefit otherwise payable exceeds the
contract value one day prior to the date of
continuance, such excess will be credited to
the money market subaccount listed in the
contract schedule. This amount may
subsequently be transferred from the money
market subaccount to other options under
this contract.
2. Upon the death of your surviving spouse
before the annuity date, the amount of the
death benefit payable will be determined as
if: (a) the contract was issued on the date
of continuance; and (b) the contract value
applied on the date of continuance resulted
from our receipt of an initial purchase
payment.
3. Withdrawal charges will not apply to
withdrawals made from contract value
credited on the date of continuance.
Withdrawal charges will apply to purchase
payments made after the date of continuance.
4. This contract may not be continued under a
subsequent spousal continuation.
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ANNUITY PERIOD PROVISIONS
Election of Annuity Option We must receive an election of an annuity option
in writing. You may make an election before the
annuity date. The beneficiary may make an
election when we pay the death benefit.
An election will be revoked by: 1. a subsequent
change of beneficiary; or 2. an assignment of
this contract unless the assignment provides
otherwise.
Subject to the terms of the death benefit
provision, the beneficiary may elect to have the
death benefit remain with us under one of the
annuity options.
If an annuity option is not elected by the
annuity date, an annuity will be paid under
Option 3 if there is one annuitant on the
annuity date or under Option 5 if there are
joint annuitants on the annuity date.
If the total contract value is applied under one
of the annuity options, this contract must be
surrendered to us.
An option can not be changed after the first
annuity payment is made.
If, on the seventh calendar day before the first
annuity payment due date, all the contract value
is allocated to the fixed account, the annuity
will be paid as a fixed annuity. If all of the
contract value on such date is allocated to the
separate account, the annuity will be paid as a
variable annuity. If the contract value on such
date is allocated to both the fixed account and
a subaccount, then the annuity will be paid as a
combination of a fixed and variable annuity. A
fixed and variable annuity payment will reflect
the investment performance of the subaccounts in
accordance with the allocation of the contract
values existing on such date. Allocations will
not be changed thereafter, except as provided in
the Transfers During The Annuity Period
provision of this contract.
Payments for all options are derived from the
applicable tables. Current annuity rates will be
used if they produce greater payments than those
quoted in the contract. The age in the tables is
the age of the annuitant on the last birthday
before the first payment is due.
The option selected must result in a payment
that is at least equal to our minimum payment,
according to our rules, at the time the annuity
option is chosen. If at any time the payments
are less than the minimum payment, we have the
right to increase the period between payments to
quarterly, semi-annual or annual so that the
payment is at least equal to the minimum payment
or to make payment in one lump sum.
Option 1 We will make monthly payments for 10 years.
Fixed Installment Annuity
Option 2 We will make monthly payments while the
Life Annuity annuitant is alive.
Option 3 We will make monthly payments for a 10 year
Life Annuity With certain period and thereafter while the
Installments Guaranteed annuitant is alive.
ANNUITY PERIOD PROVISIONS (Continued)
Option 4 We will pay the full monthly income while both
Joint and Survivor Annuity annuitants are alive. Upon the death of either
annuitant, we will continue to pay the a
percentage of the original monthly payment. The
percentage payable during the life of the
surviving annuitant must be selected at the time
the annuity option is chosen. The percentages
available are 50%, 66 2/3%, 75% and 100%.
Option 5 We will make monthly payments for a 10 year
Joint and Survivor Annuity certain period and thereafter while the
with Installments Guaranteed annuitants are alive.
Other Options We may make other annuity options available.
Payments are also available on a quarterly,
semi-annual or annual basis.
Fixed Annuity The fixed account contract value on the first
day preceding the date on which the first
annuity payment is due, is first reduced by any
debt and premium taxes that apply. The value
that remains will be used to determine the fixed
annuity monthly payment in accordance with the
annuity option selected.
Variable Annuity The separate account contract value, at the end
of the valuation period preceding the valuation
period that includes the date on which the first
annuity payment is due, is first reduced by any
premium taxes that may apply. The value that
remains is used to determine the first monthly
annuity payment. The first monthly annuity
payment is based upon the guaranteed annuity
option shown in the Annuity Option Table. You
may elect any option available.
The dollar amount of subsequent payments may
increase or decrease depending on the investment
experience of each subaccount. The number of
annuity units per payment will remain fixed for
each subaccount unless a transfer is made. If a
transfer is made, the number of annuity units
per payment will change.
The number of annuity units for each subaccount
is calculated by dividing a. by b. where:
a. is the amount of the monthly payment that
can be attributed to that subaccount; and
b. is the annuity unit value for that
subaccount at the end of the valuation
period. The valuation period includes the
date on which the payment is made.
Monthly annuity payments, after the first
payment, are calculated by summing up, for each
subaccount, the product of a. times b. where:
a. is the number of annuity units per payment
in each subaccount; and
b. is the annuity unit value for that
subaccount at the end of the valuation
period. The valuation period includes the
date on which the payment is made.
After the first payment, we guarantee that the
dollar amount of each annuity payment, will not
be affected adversely by actual expenses or
changes in mortality experience from the expense
and mortality assumptions on which we based the
first payment.
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ANNUITY PERIOD PROVISIONS (Continued)
Annuity Unit Value The value of an annuity unit, for each
subaccount, at the end of any subsequent
valuation period is determined by multiplying
the result of a. times b. by c. where:
a. is the annuity unit value for the
immediately preceding valuation period; and
b. is the net investment factor for the
valuation period for which the annuity unit
value is being calculated; and
c. is the interest factor of .99993235 per
calendar day of such subsequent valuation
period to offset the effect of the assumed
rate of 2.50% per year used in the Annuity
Option Table.
The net investment factor for each subaccount
for any valuation period is determined by
dividing a. by b. where:
a. is the value of an accumulation unit of the
applicable subaccount as of the end of the
current valuation period plus or minus the
per share charge or credit for taxes
reserved; and
b. is the value of an accumulation unit of the
applicable subaccount as of the end of the
immediately preceding valuation period, plus
or minus the per share charge or credit for
taxes reserved.
Transfer During the Annuity You may not convert fixed annuity payments to
Period variable annuity payments. However, during the
annuity period, you, by sending us a written
notice in a form satisfactory to us, may:
convert variable annuity payments to fixed
annuity payments; or have variable annuity
payments reflect the investment experience of
other subaccounts. A transfer may be made
subject to the following:
1. Transfer from a subaccount to the fixed
account can be effective only on an
anniversary of the first annuity payment
date. We must receive notice of such
transfer at least thirty days prior to the
effective date of the transfer;
2. Transfers from one subaccount to another
subaccount will be effective during the
valuation period next succeeding the date
the notice is received by us. However, no
transfers may be made during the seven days
immediately preceding an annuity payment
date. No transfer to a subaccount may be
made during the first year of the annuity
period. In subsequent years all transfers
between subaccounts will be made on the same
day in a given year and are limited to one
transfer each year;
3. You may not have more than three subaccounts
after any transfer; and
4. Your entire interest in a subaccount must be
transferred.
The number of annuity units per payment
attributable to a subaccount to which transfer
is made is equal to, in the case of a transfer
between subaccounts, the number of annuity units
per payment in the subaccount from which
transfer is being made multiplied by the annuity
unit value for that subaccount, such amount
being divided by the annuity unit value for the
subaccount to which transfer is being made.
The amount of money allocated to the fixed
account in the event of a transfer from
subaccount equals the annuity reserve for the
owner's interest in such subaccount. The annuity
reserve is the product of a. multiplied by b.
multiplied by c. where: a. is the number of
annuity units representing the owner's interest
in such subaccount per annuity payment; b. is
the annuity unit value for such subaccount; and
c. is the present value of $1.00 per payment
period using the attained age(s) of the
annuitant(s) and any remaining guaranteed
payments that may be due at the time of the
transfer. The guaranteed monthly payments are
based on an interest rate of 2.50% per year and,
where mortality is involved, the "Annuity 2000
Table" developed by the Society of Actuaries
projected using Scale G to the year 2015. Money
allocated to the fixed account upon such
transfer will be applied under the same annuity
option as originally elected. Any guaranteed
period payments will be adjusted to reflect the
number of guaranteed payments already made. If
all guaranteed payments have already been made,
no further payments will be guaranteed.
>
ANNUITY PERIOD PROVISIONS (Continued)
All amounts and annuity unit values are
determined as of the end of the annuity
valuation period which precedes the effective
date of the transfer.
We reserve the right at any time and without
notice to any party to terminate, suspend or
modify the transfer privileges.
Supplementary Agreement A supplementary agreement will be issued to
reflect payments that will be made under a
settlement option. If payment is made as a death
benefit distribution, the effective date will be
the date of death. Otherwise the effective date
will be the date chosen by the owner.
Date of First Payment Interest, under an option, will start to accrue
on the effective date of the supplementary
agreement.
Evidence of Age, Sex and We may require satisfactory evidence of the age,
Survival sex and the continued survival of any person on
whose life the income is based.
Misstatement of Age or Sex If the age or sex of the annuitant(s) has been
misstated, the amount payable under this
contract will be such as the purchase payments
sent to us would have purchased at the correct
age or sex. Interest not to exceed 6% compounded
each year will be charged to any overpayment or
credited to any underpayment against future
payments we may make under this contract.
Basis of Annuity Options The guaranteed monthly payments are based on an
interest rate of 2.50% per year and, where
mortality is involved, the "Annuity 2000 Table"
developed by the Society of Actuaries projected
using Scale G to the year 2015.
Disbursement of Funds Upon When the annuitant dies, the value of any unpaid
Death of Annuitant Under installments will be paid, in one sum, to the
Options 1, 3 or 5 owner. The commuted value based upon a minimum
interest rate of not less than 2.50% will be
paid. The commuted value of any variable
installments will be determined by applying the
annuity unit value next determined following our
receipt of due proof of death.
Payment of Death Benefits If an owner, who is not also an annuitant, dies
During the Annuity Period Upon after the annuity date, the following provisions
Death of an Owner apply:
1. If the owner was the sole owner, the
remaining annuity payments will be payable
to the beneficiary in accordance with the
annuity option in effect. The beneficiary
will become the owner.
2. If this contract has joint owners, the
annuity payments will be payable to the
surviving joint owner in accordance with
the terms of the annuity option in effect.
Upon the death of the surviving joint
owner, the beneficiary becomes the owner.
Protection of Benefits Unless otherwise provided in the supplementary
agreement, the owner may not commute,
anticipate, assign, alienate or otherwise hinder
the receipt of any payment.
Creditors The proceeds of this contract and any payment
under an annuity option will be exempt from the
claim of creditors and from legal process to the
extent permitted by law.
Page 15
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Page 16
ANNUITY OPTION TABLE
AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 OF VALUE APPLIED
OPTION ONE - FIXED INSTALLMENT ANNUITY
Number
of years Monthly
selected Payment
10 9.39
OPTIONS TWO AND THREE - LIFE ANNUITY WITH INSTALLMENTS GUARANTEED
AGE OF MONTHLY PAYMENTS GUARANTEED
MALE
ANNUITANT NONE 120
55 4.00 3.96
56 4.08 4.04
57 4.17 4.12
58 4.26 4.21
59 4.36 4.30
60 4.46 4.40
61 4.57 4.50
62 4.69 4.60
63 4.81 4.71
64 4.95 4.83
65 5.09 4.95
66 5.24 5.08
67 5.41 5.22
68 5.58 5.36
69 5.76 5.50
70 5.96 5.65
71 6.17 5.81
72 6.39 5.97
73 6.62 6.13
74 6.88 6.30
75 7.14 6.47
76 7.43 6.65
77 7.73 6.83
78 8.06 7.01
79 8.41 7.18
80 8.79 7.36
81 9.19 7.54
82 9.62 7.71
83 10.08 7.88
84 10.57 8.04
85 11.10 8.20
AGE OF MONTHLY PAYMENTS GUARANTEED
FEMALE
ANNUITANT NONE 120
55 3.71 3.70
56 3.78 3.76
57 3.86 3.83
58 3.93 3.91
59 4.02 3.99
60 4.10 4.07
61 4.20 4.16
62 4.29 4.25
63 4.40 4.35
64 4.51 4.45
65 4.63 4.56
66 4.75 4.68
67 4.89 4.80
68 5.03 4.93
69 5.19 5.06
70 5.36 5.21
71 5.54 5.36
72 5.73 5.52
73 5.94 5.69
74 6.17 5.86
75 6.41 6.04
76 6.68 6.23
77 6.96 6.42
78 7.26 6.62
79 7.59 6.82
80 7.95 7.02
81 8.34 7.23
82 8.76 7.43
83 9.21 7.62
84 9.71 7.81
85 10.24 8.00
OPTION FOUR - JOINT AND 100% SURVIVOR ANNUITY
AGE OF AGE OF FEMALE ANNUITANT
MALE
ANNUITANT 55 60 65 70 75 80 85
55 3.38 3.53 3.67 3.77 3.86 3.91 3.95
60 3.48 3.68 3.88 4.06 4.20 4.30 4.37
65 3.56 3.81 4.08 4.35 4.59 4.77 4.91
70 3.62 3.92 4.26 4.63 4.99 5.32 5.57
75 3.65 3.99 4.39 4.87 5.39 5.90 6.34
80 3.68 4.03 4.49 5.05 5.73 6.46 7.18
85 3.69 4.06 4.55 5.18 5.99 6.96 8.01
OPTION FIVE - JOINT LIFE ANNUITY WITH INSTALLMENTS GUARANTEED
AGE OF AGE OF FEMALE ANNUITANT
MALE
ANNUITANT 55 60 65 70 75 80 85
55 3.38 3.53 3.66 3.77 3.85 3.91 3.94
60 3.48 3.68 3.88 4.05 4.19 4.29 4.35
65 3.56 3.81 4.08 4.34 4.57 4.74 4.86
70 3.61 3.91 4.25 4.61 4.96 5.26 5.46
75 3.65 3.98 4.38 4.84 5.33 5.78 6.13
80 3.67 4.03 4.47 5.01 5.63 6.26 6.78
85 3.69 4.05 4.52 5.12 5.84 6.63 7.34
Rates for ages not shown here will be provided upon request.
>
FIXED AND VARIABLE DEFERRED ANNUITY
NON-PARTICIPATING
ALL BENEFITS, PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED UPON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS, ARE VARIABLE AND ARE NOT GUARANTEED AS
TO DOLLAR AMOUNT. REFER TO THE VARIABLE ACCOUNT AND ANNUITY PERIOD PROVISIONS
FOR A DETERMINATION OF ANY VARIABLE BENEFITS.
This is a legal contract between the owner and Federal Xxxxxx Life Assurance
Company.
READ YOUR CONTRACT CAREFULLY
Federal Xxxxxx Life Assurance Company
0000 XxXxxxxx Xxxxxxx, Xxxxxxxxxx, Xxxxxxxx 00000-0000
