Exhibit 24(b)(4)(a)(i)
(XXXX XXXXXXX(R) LOGO) XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: [000 Xxxxxx Xxxx Xxxxx, 0xx Xxxxx
Xxxxxxxx, XX 00000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
This Contract is issued in consideration of the Payments. Xxxx Xxxxxxx Life
Insurance Company of New York, a stock company, agrees to pay the benefits of
this Contract in accordance with its terms.
VARIABLE ACCOUNT PROVISIONS
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE, MAY INCREASE OR
DECREASE IN ACCORDANCE WITH THE FLUCTUATIONS IN THE INVESTMENT RESULTS, AS
APPLICABLE AND NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE
ACCOUNT PROVISIONS BEGIN ON PAGE 6.
The smallest annual rate of investment return which is required to be earned on
the assets of the separate account so that the dollar amount of variable annuity
payments will not decrease is [2.17%]. Explicit annual charges against the
assets of the separate account are as follows:
Contract Asset Fee Charge: Not greater than [1.25%]
RIGHT TO REVIEW
You may cancel the Contract by returning it to our Annuities Service Center or
the registered representative who sold it to you at any time within [10] days
after receipt of the Contract. Within 7 days of receipt of the Contract by us,
we will pay the Contract Value computed at the end of the Business Day on which
the Contract is delivered to us plus the sum of all fees and charges deducted
from the gross Payments to the Owner.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this [10] day period, we will return the greater of (i) Contract
Value computed at the end of the Business Day on which the Contract is delivered
to us plus the sum of all fees and charges deducted from the gross Payments or
(ii) sum of all Payments less any Withdrawals. If you return the Contract to us
after the first 7 days and before the [10]-day period has elapsed, we will
refund an amount determined as described in the paragraph above.
SIGNED FOR THE COMPANY at its Main Administration Office in Boston,
Massachusetts, on the Contract Date.
-s- Xxxxx X. Xxxxxxxxx -s- Xxxxxxx Xxxxx
Xxxxx X. Xxxxxxxxx, President Xxxxxxx Xxxxx, Secretary
INDIVIDUAL FLEXIBLE PAYMENT DEFERRED VARIABLE ANNUITY
Variable Accumulation prior to Annuity Commencement Date
Variable and Fixed Annuity Options
Death Benefit Proceeds Payable prior to Annuity Commencement Date
Withdrawal Charge Waiver Benefit
Non-Participating
DOLLAR COST AVERAGING (DCA) ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE
DATE.
REFER TO THE AVAILABLE INVESTMENT OPTIONS ON THE SPECIFICATIONS PAGES FOR
DETAILS.
ANNUITIES SERVICE CENTER:
[P.O. Box 9506 Portsmouth, NH 03802-9506] [0-000-000-0000] [www.jhannuitiesnew
xxxx.xxx]
OVERNIGHT MAILING ADDRESS:
[000 Xxxxxxxxx Xxxxx Xxxxxxxxxx, XX 00000-0000]
VENTUREW-B.11-NY SAMPLE
Table of Contents
Specifications Pages S.1
Part 1 - Definitions 1
Part 2 - Parties to the Contract 4
Part 3 - Payments 5
Part 4 - Fees And Deductions 6
Part 5 - Variable Account Provisions 6
Part 6 - Transfers 8
Part 7 - Withdrawal Provisions 9
Part 8 - Death Benefits 11
Part 9 - Contract Maturity 13
Part 10 - Annuity Payments 13
Part 11- Annuity Options 15
Part 12 - General Provisions 15
Part 13 - Contract Termination 17
INTRODUCTION
This is an individual flexible payment deferred variable annuity contract. This
Contract provides that, prior to the Annuity Commencement Date, the Contract
Value will accumulate on a variable basis. You allocate Payments among one or
more Investment Options. The initial Investment Options are identified on the
Specifications Pages. The Contract Value will vary with the investment
performance of your Investment Account. Subject to the provisions of the
Contract, you may take withdrawals and transfer amounts among the Investment
Options.
After the Annuity Commencement Date, Annuity Payments may be either fixed or
variable, or a combination of fixed and variable. If you select Annuity Payments
on a variable basis, the payment amount will vary with the investment
performance of the Variable Account.
If the Owner (Annuitant if the Owner is not an individual) dies while this
Contract is in effect prior to the Annuity Commencement Date, we will pay a
Death Benefit to the Beneficiary upon receipt of all required claim forms and
proof of death of the Owner at the Annuities Service Center.
VENTUREW-B.11-NY SAMPLE
Specifications Page
TYPE OF CONTRACT: [Qualified] CONTRACT DATE: [06/15/2011]
CONTRACT NUMBER: [000000005] ISSUE STATE: NY
OWNER: [Xxxx X. Xxx] OWNER'S AGE & SEX: [55] [Male]
ANNUITANT: [Xxxx X. Xxx] ANNUITANT'S AGE & SEX: [55] [Male]
[CO-OWNER:] [ ] [CO-OWNER'S AGE & SEX:] [ ] [ ]
[CO-ANNUITANT:] [ ] [CO-ANNUITANT'S AGE & SEX:] [ ] [ ]
PLAN [Venture Frontier]
FEES AND CHARGES
CONTRACT ASSET FEE [1.25% years 1-7]
[1.15% years 8+]
Electronic-Delivery
of Financial
Transaction
Owner Elects Electronic Delivery of Confirmations is Not
ANNUAL CONTRACT FEE Financial Transaction Confirmations Elected by Owner
----------------------------------- --------------------
[$0] [$50]
[RIDER FEE(S) See Optional Riders section on page S.[4]]
PAYMENT LIMITS
PAYMENT LIMITS - Minimum Additional Payment Amount: [$30]
- Total Additional Payments: [$100,000]
- Maximum Amount: [$1,000,000]
S.1
VENTUREW-B.11-NY SAMPLE
LIMITS-TRANSFERS AND AMOUNT OF PARTIAL WITHDRAWALS
TRANSFER CHARGES AND LIMITATIONS- - Minimum Transfer Amount: $300
BEFORE ANNUITY COMMENCEMENT - Minimum Investment Account Value: $100
DATE - Number of Transfers Per Contract Year: two per month
- Transfer Charge: the lesser of $25 or 2% of the amount
of each transfer in excess of 12 per Contract Year
TRANSFER LIMITATIONS - ON OR AFTER ANNUITY COMMENCEMENT DATE - Number of Transfers Per Contract Year: 4
LIMITATIONS ON AMOUNT OF - Minimum Amount of Partial Withdrawal: [$300]
PARTIAL WITHDRAWALS - Minimum Investment Account Balance: $100
- Minimum Remaining Contract Value: $1,000
WITHDRAWALS CHARGES
TABLE OF WITHDRAWAL CHARGES Number of Complete Years Withdrawal Charge
Payment has been in Contract Percentage
---------------------------- -----------------
0 8%
1 7%
2 6%
3 5%
4 4%
5 3%
6 2%
7+ 0%
[Withdrawal Charges will be waived for any contract
issued to an employee of the Company.]
INITIAL ALLOCATION OF NET PAYMENT (SEE FOLLOWING PAGE FOR ALL AVAILABLE
INVESTMENT OPTIONS)
INITIAL PAYMENT [$100,000.00]
[DCA ACCOUNT OPTIONS:] [INITIAL INTEREST RATE] [INITIAL GUARANTEE PERIOD EXPIRES]
[6 Month DCA Account] [25.00%] [1.00%] [12/15/2011]
[THE INTEREST RATE FOR THE DCA ACCOUNT OPTION ABOVE MAY CONTAIN AN ENHANCEMENT
THAT MAY NOT BE PROVIDED IN SUBSEQUENT GUARANTEE PERIODS.]
VARIABLE INVESTMENT OPTIONS:
[Lifestyle Balanced PS] [75.00%]
TOTAL [100.00%]
S.2
VENTUREW-B.11-NY SAMPLE
AVAILABLE INVESTMENT OPTIONS
VARIABLE ACCOUNT: XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK SEPARATE
ACCOUNT A
VARIABLE INVESTMENT OPTIONS:
[Lifestyle Balanced]
[Lifestyle Balanced PS]
[Lifestyle Conservative]
[Lifestyle Conservative PS]
[Lifestyle Growth]
[Lifestyle Growth PS]
[Lifestyle Moderate]
[Lifestyle Moderate PS]
[Ultra Short Term Bond]
DOLLAR COST AVERAGING (DCA) ACCOUNT INVESTMENT OPTIONS:
6 Month DCA Account
[6 Month DCA Not Currently Available]
12 Month DCA Account
[12 Month DCA Not Currently Available]
S.3
VENTUREW-B.11-NY SAMPLE
OPTIONAL RIDERS
[ENHANCED DEATH BENEFIT RIDER: MARKETING NAME]
- [Rider Date:] [06/15/2011]
- [Rider Fee Percentage:] [0.30%]
- [Total Asset Fee Percentage [1.55% years 1-7]
(Contract Asset Fee from Pg S.1 + [1.45% years 8+]
Rider Fee Percentage):]
[GUARANTEED MINIMUM WITHDRAWAL BENEFIT RIDER: MARKETING NAME]
- [Rider Date:] [06/15/2011]
- [Maximum Rider Fee Percentage:] [1.50%]
ANNUITY BENEFITS
MATURITY DATE: [10/25/2046]
ANNUITY OPTION: Life 10-Year Certain
ANNUITY PAYMENTS - GENERAL INFORMATION The rates for Annuity Payments are determined based on:
- Mortality Table: Annuity 2000 Table projected from 2002 to
date of annuitization at Scale G, 100% female blend
- Fixed Annuity Payment Interest Rate: 1.00% interest per year
- Variable Annuity Payment Assumed Interest Rate: 1.00%
The amount of each Annuity Payment will depend upon the age of the Annuitant,
the Co-Annuitant, if any, or other payee.
S.4
VENTUREW-B.11-NY SAMPLE
AMOUNT OF FIRST MONTHLY PAYMENT
PER $1000 OF CONTRACT VALUE
FOR AN ANNUITANT BORN IN 1952
OPTION 1: LIFE ANNUITY
Option 1(A): Non-Refund Option 1(B): 10 Year Certain
----------------------- ----------------------------
Age of Age of
Xxxxxxxxx Xxxxxxxxx
----------------------- ----------------------------
55 N/A 55 N/A
60 3.08 60 3.06
65 3.50 65 3.47
70 4.07 70 3.99
75 4.85 75 4.66
80 5.91 80 5.46
85 7.40 85 6.35
OPTION 2: JOINT AND SURVIVOR LIFE ANNUITY
Option 2(A): Non-Refund
Age of Co-Annuitant
------------------------------------------
Age of 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
--------- -------- ------- ---- ------ --------
55 N/A N/A N/A N/A N/A
60 2.29 2.46 2.62 2.77 2.88
65 2.51 2.72 2.93 3.11 3.26
70 2.78 3.05 3.33 3.57 3.77
75 3.13 3.49 3.86 4.19 4.45
80 3.59 4.08 4.58 5.03 5.38
85 4.22 4.88 5.57 6.17 6.62
Option 2(B): 10 Year Certain
Age of Co-Annuitant
-----------------------------------------
Age of 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
--------- -------- ------- ---- ------- -------
55 N/A N/A N/A N/A N/A
60 2.29 2.46 2.62 2.77 2.88
65 2.51 2.72 2.93 3.11 3.26
70 2.78 3.05 3.32 3.57 3.75
75 3.13 3.49 3.85 4.16 4.40
80 3.58 4.06 4.53 4.93 5.20
85 4.18 4.80 5.38 5.83 6.12
Monthly installments for ages not shown and other years of birth will be
furnished on request.
S.5
VENTUREW-B.11-NY SAMPLE
BENEFICIARY INFORMATION
[Xxxx Xxx]
DISCLOSURES
PURSUANT TO SECTION 3 OF THE FEDERAL DEFENSE OF MARRIAGE ACT ("DOMA"), SAME
SEX-MARRIAGES, DOMESTIC PARTNERSHIPS AND CIVIL UNIONS CURRENTLY ARE NOT
RECOGNIZED FOR PURPOSES OF FEDERAL LAW. THEREFORE, THE FAVORABLE INCOME-DEFERRAL
OPTIONS AFFORDED BY FEDERAL TAX LAW TO AN OPPOSITE-SEX SPOUSE UNDER INTERNAL
REVENUE CODE SECTIONS 72(S) AND 401(A)(9) ARE CURRENTLY NOT AVAILABLE TO A
SAME-SEX SPOUSE, DOMESTIC PARTNER OR CIVIL UNION PARTNER. SAME-SEX SPOUSES,
DOMESTIC PARTNERS OR CIVIL UNION PARTNERS WHO OWN OR ARE CONSIDERING THE
PURCHASE OF ANNUITY PRODUCTS THAT PROVIDE BENEFITS BASED UPON STATUS AS A SPOUSE
SHOULD CONSULT A TAX ADVISOR. TO THE EXTENT THAT AN ANNUITY CONTRACT ACCORDS TO
SPOUSES OTHER RIGHTS OR BENEFITS THAT ARE NOT AFFECTED BY DOMA, SAME-SEX
SPOUSES, DOMESTIC PARTNERS AND CIVIL UNION PARTNERS RECOGNIZED BY THE ISSUE
STATE REMAIN ENTITLED TO SUCH RIGHTS OR BENEFITS TO THE SAME EXTENT AS ANY
ANNUITY HOLDER'S SPOUSE.
[THIS PLAN IS INTENDED TO QUALIFY UNDER THE INTERNAL REVENUE CODE FOR
TAX-FAVORED STATUS. LANGUAGE CONTAINED IN THIS CONTRACT REFERRING TO FEDERAL TAX
STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. PLEASE SEEK THE ADVICE OF
YOUR OWN TAX ADVISOR REGARDING YOUR INDIVIDUAL TAX TREATMENT.]
S.6
VENTUREW-B.11-NY SAMPLE
PART 1 DEFINITIONS
------------------------ ------------------------------------------------------
WE AND YOU "We", "us" and "our" means the Company. "You" or
"your" means the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the value
of the Variable Account of this Contract before the
Annuity Commencement Date.
ANNUITANT Any individual person or persons whose life is used to
determine the duration of Xxxxxxx Payments involving
life contingencies. The Annuitant is as designated on
the Specifications Pages, unless changed.
ANNUITIES SERVICE CENTER Any office designated by us for the receipt of
Payments and processing of Owner requests.
ANNUITY COMMENCEMENT DATE The date Annuity Payments begin. This date may not be
earlier than six months following the Contract Date or
later than the Maturity Date. Annuity Payments may not
be scheduled under the Contract to begin earlier than
12 months from the Contract Date.
ANNUITY OPTION The method selected by you for Annuity Payments made
by us.
ANNUITY PAYMENT(S) Payment(s) by us to you, in accordance with the
Annuity Option elected under the terms of this
Contract.
ANNUITY UNIT A unit of measure that is used after the Annuity
Commencement Date to calculate Variable Annuity
payments.
BENEFICIARY The person, persons or entity to whom certain benefits
are payable following the death of an Owner, or in
certain circumstances, an Annuitant. For purposes of
section 72(s) of the Internal Revenue code, the
"designated beneficiary" under the Contract shall be
the individual who is entitled to receive the amounts
payable on death of an Owner, or if any Owner is not
an individual, on any change in, or death of, of an
Annuitant
BUSINESS DAY Any date on which the New York Stock Exchange is open
for business and the net asset value of a Portfolio is
determined.
COMPANY The insurance company named on the first page of this
Contract (or any successor insurance company named by
endorsement to this Contract) that will pay benefits
in accordance with this Contract.
CONTRACT ANNIVERSARY The annual anniversary of the Contract beginning
twelve months from the Contract Date and each year
thereafter.
CONTRACT DATE The date of issue of this Contract as designated on
the Specifications Pages.
CONTRACT VALUE The total of your Investment Account Values.
CONTRACT YEAR The period of time measured twelve consecutive months
from the Contract Date or any Contract Anniversary
thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled to
receive the Contract proceeds if all Beneficiaries
die before the Owner dies.
1
VENTUREW-B.11-NY SAMPLE
ENDORSEMENT An Endorsement modifies the contract to which it is
attached. Endorsements must be signed by an officer
of the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are
predetermined and guaranteed as to dollar amount.
GOOD ORDER The standard we apply when we determine whether an
instruction is satisfactory. An instruction will be
considered in Good Order if it is received at our
Annuities Service Center: (a) in a manner that is
satisfactory to us such that it is sufficiently
complete and clear that we do not need to exercise
any discretion to follow such instruction and
complies with all relevant laws and regulations and
Company requirements; (b) on specific forms, or by
other means we then permit (such as via telephone or
electronic submission); and/or (c) with any
signatures and dates we may require. We will notify
you if an instruction is not in Good Order.
INTERNAL REVENUE CODE (IRC) The Internal Revenue Code of 1986, as amended from
time to time, and any successor statute of similar
purpose.
INVESTMENT ACCOUNT An account established by us which represents your
interest in an Investment Option prior to the
Annuity Commencement Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment
Account.
INVESTMENT OPTIONS The Subaccount(s) of the Variable Account. The
Investment Options available under this Contract at
issue are shown on the Specifications Pages.
MATURITY DATE The latest date on which annuity benefits may
commence. It is the date listed on the
Specifications Pages, unless changed. Any extension
of the maximum Maturity Date beyond age 90 of the
oldest Annuitant or the 10th Conract Year will be
subject to the laws and regulations then in effect
and our prior approval.
NET PAYMENT The Payment less the amount of premium tax, if any,
deducted from the Payment.
NET SURRENDER VALUE The Surrender Value less any amount withheld by us
for income taxes.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified
Plans.
OWNER The person, persons or entity entitled to the
ownership rights under this Contract. The Owner is
as designated on the Specifications Pages, unless
changed.
PORTFOLIO The investment choices available to the Variable
Account.
PAYMENT An amount paid to us by you as consideration for the
benefits provided by this Contract.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax
treatment under sections 401, 403, 408 or 457, of
the Internal Revenue Code of 1986, as amended.
RIDER A rider provides an optional benefit, which may
result in an additional charge to the Contract. A
rider supplements the contract to which it is
attached. Riders must be signed by an officer of the
Company in order to be effective.
2
VENTUREW-B.11-NY SAMPLE
SEPARATE ACCOUNT A segregated account of the Company that is not
commingled with our general assets and obligations.
SUBACCOUNT(S) A division of the Variable Account. Each Subaccount
is invested in shares of a different Portfolio.
SURRENDER VALUE The Contract Value on any Valuation Date, less, if
applicable, any contract fees, any rider charges,
any deduction for premium taxes or similar taxes,
and any Withdrawal Charge.
VALUATION PERIOD Any period from one Business Day to the next,
measured from the time on each such day that the net
asset value of each Portfolio is determined.
VARIABLE ACCOUNT The Company's Separate Account as shown on the
Specifications Pages.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount; and
(2) vary in relation to the investment experience of
one or more specified variable Subaccounts.
WITHDRAWAL AMOUNT The amount deducted from the Contract Value when you
take a withdrawal. This amount is the total of the
amount paid to you plus the following, if
applicable: any contract fees, any rider charges,
any deduction for premium taxes or similar taxes,
any amount for income taxes resulting from the
withdrawal, and any Withdrawal Charges. The
Withdrawal Amount may not exceed the Contract Value.
WRITTEN REQUEST A notice provided in a form acceptable to Us based
on the type of request and received in Good Order at
our Annuities Service Center.
3
VENTUREW-B.11-NY SAMPLE
PART 2 PARTIES TO THE CONTRACT
-------------------------- ----------------------------------------------------
OWNER Before the Annuity Commencement Date, the Owner of
this Contract shall be the person, persons or entity
designated on the Specifications Pages or the latest
change filed with us. A co-Owner is not permitted
under this Contract if any Owner is an entity. On
the Annuity Commencement Date the Annuitant will
become the Owner of this Contract, unless the Owner
is a trust or custodian. If amounts become payable
to the Beneficiary under this Contract, the
Beneficiary becomes the Owner of this Contract.
Unless indicated otherwise, references to the Owner
will also include the co-Owner.
ANNUITANT The Annuitant is the person designated as such on
the Specifications Pages or the latest change filed
with us. If you name more than one Xxxxxxxxx, the
second Annuitant is referred to as the co-Annuitant.
Unless indicated otherwise, references to the
Annuitant will also include the co-Annuitant.
BENEFICIARY The Beneficiary is as designated on the
Specifications Pages, unless changed. However, if
there is a surviving Owner, that person will be
treated as the Beneficiary. If no such Beneficiary
is living, the Beneficiary is the Contingent
Beneficiary. If no Beneficiary or Contingent
Beneficiary is living, the Beneficiary is the estate
of the deceased Owner.
CHANGE OF OWNER, ANNUITANT, Subject to the rights of an irrevocable Beneficiary,
BENEFICIARY you may change the Owner, Annuitant, or Beneficiary
by Written Request. Any change will take effect on
the date the request is signed. Any change of Owner
or Annuitant is subject to our issue age limitations
based on age at the date of the change. The
Annuitant may not be changed after the Annuity
Commencement Date. You need not send us the Contract
unless we request it. We will not be liable for any
payments or actions we take before the Written
Request is received.
The addition of any Owner may result in the
resetting of the Guaranteed Minimum Death Benefit to
an amount equal to the Contract Value as of the date
of such change. For purposes of subsequent
calculations of the Guaranteed Minimum Death
Benefit, we will treat the Contract Value on the
date of the change as a Payment made on that date.
In addition, all anniversary values, all Payments
made and all amounts deducted in connection with
partial withdrawals prior to the date of the
addition of the Owner will not be considered in the
determination of the Guaranteed Minimum Death
Benefit.
If any Annuitant is changed and any Owner
is not an individual, the entire interest in the
Contract must be distributed to the Owner within
five years of the change.
ASSIGNMENT You may assign this Contract, except as otherwise
provided, at any time prior to the Annuity
Commencement Date. No assignment will be binding
on us unless it is in the form of a Written Request.
We will not be liable for any payments made or
actions we take before the assignment is received by
us. An absolute assignment will revoke the interest
of any revocable Beneficiary. We will not be
responsible for the validity of any assignment.
If this Contract is issued in a Qualified Plan, this
Contract is subject to assignment restrictions for
Federal Income Tax purposes. In such event, this
Contract shall not be sold, assigned, discounted, or
pledged as collateral for a loan or as security for
the performance of an obligation or for any other
purpose, to any person other than us.
4
VENTUREW-B.11-NY SAMPLE
PART 3 PAYMENTS
-------------------------- ----------------------------------------------------
GENERAL The Contract is not effective until the Initial
Payment is received by us at our Annuities Service
Center or such other place designated by us. All
Payments under this Contract are payable at our
Annuities Service Center or such other place as we
may designate.
PAYMENT LIMITS The Initial Payment is shown on the Specifications
Pages. Each additional Payment must be at least
equal to the Minimum Additional Payment Amount shown
on the Specifications Pages. No additional payment
will be accepted, without our prior approval, after
the first Contract Year that causes the total of all
additional Payments received after the first
Contract Year to exceed the Total Additional
Payments amount shown on the Specifications Pages.
If a Payment would cause the Contract Value on the
date of such Payment to exceed the Maximum Amount
shown on the Specifications Pages, or the Contract
Value on the date of such Payment already exceeds
the Maximum Amount, no additional Payments will be
accepted without our prior approval.
ALLOCATION OF NET PAYMENTS When we receive Payments, the Net Payments will be
allocated among Investment Options in accordance
with the allocation percentages shown on the
Specifications Pages. You may change the allocation
of subsequent Net Payments at any time, without
charge, by Written Request.
5
VENTUREW-B.11-NY SAMPLE
PART 4 FEES AND DEDUCTIONS
-------------------------- ----------------------------------------------------
CONTRACT ASSET FEE To compensate us for assuming mortality and expense
risks, and administration expenses, we deduct from
each variable Investment Option a fee each Valuation
Period at an annual rate set forth on the
Specifications Pages. A portion of this Asset Fee
may also be used to reimburse us for distribution
expenses. This fee is reflected in the Net
Investment Factor used to determine the value of
Accumulation Units and Annuity Units of the
Contract.
ANNUAL CONTRACT FEE To compensate us for assuming administration
expenses, we charge an Annual Contract Fee as set
forth on the Specifications Pages. Prior to the
Annuity Commencement Date, the Annual Contract Fee
is deducted on each Contract Anniversary. We
withdraw the Annual Contract Fee from each
Investment Option in the same proportion that the
value of the Investment Accounts of each Investment
Option bears to the Contract Value. If the Contract
Value is totally withdrawn on any date other than
the Contract Anniversary, we will deduct the total
amount of the Annual Contract Fee from the amount
paid. After the Annuity Commencement Date, we
deduct the Annual Contract Fee on a pro rata basis
from each Annuity Payment.
TAXES We reserve the right to charge certain taxes against
your Payments (either at the time of payment or
liquidation due to withdrawals, annuitization or
death benefit), or against the Contract Value,
Death Benefit proceeds, or Annuity Payments, as
appropriate. Such taxes may include premium taxes or
other taxes levied by any government entity which
we, in our sole discretion, determine have resulted
from the establishment or maintenance of the
Variable Account, or from the receipt by us of
Payments, or from the issuance of this Contract, or
from the commencement or continuance of Annuity
Payments under this Contract.
RIDER FEE(S) We charge an additional fee to compensate us for the
additional benefits provided by any optional benefit
riders elected by you. The Rider Fee for each rider
you elect is shown on the Specifications Pages or in
the Rider. Rider Fees are deducted as described in
the applicable benefit Rider issued by us.
PART 5 VARIABLE ACCOUNT PROVISIONS
-------------------------- ----------------------------------------------------
INVESTMENT ACCOUNT We will establish a separate Investment Account for
you for each variable Investment Option to which you
allocate amounts. The Investment Account represents
the number of your Accumulation Units in an
Investment Option.
INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment
Account is determined by (a) times (b) where:
(a) equals the number of Accumulation Units
credited to the Investment Account; and;
(b) equals the value of the appropriate
Accumulation Unit.
ACCUMULATION UNITS We will credit Net Payments to your Investment
Accounts in the form of Accumulation Units. The
number of Accumulation Units we will credit to each
Investment Account of the Contract will be
determined by dividing the Net Payment allocated to
that Investment Account by the Accumulation Unit
value for that Investment Account.
6
VENTUREW-B.11-NY SAMPLE
Accumulation Units will be adjusted for any
transfers and will be canceled on payment of a death
benefit, withdrawal, maturity or assessment of
certain charges based on their value for the
Business Day on which such transaction occurs.
VALUE OF ACCUMULATION UNIT We will determine the Accumulation Unit value for a
particular Investment Account for any Business Day
by multiplying the Accumulation Unit value for the
immediately preceding Business Day by the net
investment factor for the Valuation Period for which
the value is being determined. The value of an
Accumulation Unit may increase, decrease or remain
the same from one Business Day to the next.
NET INVESTMENT FACTOR The net investment factor is an index that measures
the investment performance of a Subaccount from one
Business Day to the next ("the Valuation Period").
The net investment factor for any Valuation Period
is determined by dividing (a) by (b) and subtracting
(c) from the result where:
(a) is the net result of:
(i) the net asset value per share of a
Portfolio share held in the Subaccount
determined as of the end of the current
Valuation Period, plus
(ii) the per share amount of any dividend or
capital gain distributions made by the
Portfolio on shares held in the
Subaccount and received during the
current Valuation Period; and
(b) is the net asset value per share of a
Portfolio share held in the Subaccount
determined as of the end of the immediately
preceding Valuation Period; and
(c) is the Contract Asset Fee shown on the
Specifications Pages divided by 365 and
multiplied by the number of calendar days in the
Valuation Period.
The net investment factor may be greater or less
than, or equal to, one.
ADDITION, DELETION, We reserve the right, subject to prior approval of
SUBSTITUTION OR the New York Superintendent of Insurance and in
RESTRICTION OF compliance with applicable law, to make additions
INVESTMENT OPTIONS to, deletions from, or substitutions for the
Portfolio shares that are held by the Variable
Account or that the Variable Account may purchase.
We reserve the right to eliminate the shares of any
of the eligible Portfolios and to substitute shares
of another Portfolio. We will not substitute any
shares attributable to your interest in a Subaccount
without notice to you and prior approval of the
Securities and Exchange Commission to the extent
required by the Investment Company Act of 1940.
Nothing contained herein shall prevent the Variable
Account from purchasing other securities for other
series or classes of contracts, or from effecting a
conversion between shares of another open-end
investment company.
We reserve the right, subject to prior approval of
the New York Superintendent of Insurance and in
compliance with applicable law, to establish
additional Subaccounts which would invest in shares
of a new Portfolio. We also reserve the right to
eliminate existing Subaccounts, to restrict or
prohibit additional allocations to a Subaccount, to
combine Subaccounts or to transfer assets in a
Subaccount to another Separate Account established
by us or an affiliated company. In the event of any
such substitution or change, we may, by appropriate
endorsement, make such changes in this and other
Contracts as may be necessary or appropriate to
reflect such substitutions or change. If deemed by
us to be in the best interests of persons having
voting rights under the Contracts, the Variable
Account may be operated as a management company
under the Investment Company Act of 1940 or it may
be de-registered under such Act in the event such
registration is no longer required.
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VENTUREW-B.11-NY SAMPLE
INSULATION The portion of the assets of the Variable Account
equal to the reserves and other contract liabilities
with respect to such account shall not be charged
with liabilities arising out of any other business
we may conduct. Moreover, the income, gains and
losses, realized or unrealized, from assets
allocated to the Variable Account shall be credited
to or charged against such account without regard to
our other income, gains or losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets
with a value at least equal to the amounts
accumulated in accordance with the terms of the
applicable agreements with respect to the Separate
Account and the reserves for annuities, in the
course of payment that vary with the investment
experience of the Separate Account.
PART 6 TRANSFERS
------------------------- -----------------------------------------------------
TRANSFERS BEFORE ANNUITY While this Contract is in effect prior to the
COMMENCEMENT DATE Annuity Commencement Date, you may transfer amounts
among the Investment Accounts of the Contract,
subject to the limitations below. Amounts will be
canceled from the Investment Accounts from which
amounts are transferred and credited to the
Investment Account to which amounts are transferred.
We will effect such transfers so that the Contract
Value on the date of transfer will not be affected
by the transfer.
You must transfer at least the Minimum Transfer
Amount shown on the Specifications Pages or, if
less, the entire amount in the Investment Account
each time you make a transfer. If, after the
transfer, the amount remaining in the Investment
Account from which the transfer is made is less than
Minimum Investment Account Value shown on the
Specifications Pages, then we will transfer the
entire amount instead of the requested amount.
We limit the number of transfers you may make each
Contract Year among each Variable Investment Option
as shown in the Transfers Before Annuity
Commencement Date section on the Specifications
Pages.
We do not impose a charge for the first 12 transfers
in a Contract Year. For each additional transfer
during a Contract Year, the Transfer Charge is shown
on the Specifications Pages.
TRANSFERS ON OR AFTER Once variable Annuity Payments have begun, you
ANNUITY COMMENCEMENT may transfer all or part of the investment upon
DATE which your variable Annuity Payments are based from
one Subaccount to another. To do this, we will
convert the number of variable Annuity Units you
hold in the Subaccount from which you are
transferring to a number of variable Annuity Units
of the Subaccount to which you are transferring 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. After the transfer,
the variable Annuity Payments will reflect changes
in the values of your new variable Annuity Units.
You must give us notice at least 30 days before the
due date of the first variable Annuity Payment to
which the transfer will apply.
We reserve the right, upon notice, to limit the
number of transfers that can be made after variable
annuity payments have begun. If such a limit is
imposed, the number of transfers per Contract Year
will be no less than the Minimum Number of Transfers
Per Contract Year shown in the Transfers On Or After
Annuity Commencement Date section on the
Specifications Pages.
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VENTUREW-B.11-NY SAMPLE
After the Annuity Commencement Date, transfers will
not be allowed from a fixed to a variable Annuity
Option, or from a variable to a fixed Annuity
Option.
DEFERRAL, MODIFICATION OR We reserve the right to defer, modify or terminate
TERMINATION OF TRANSFER the transfer privilege at any time that we are
PRIVILEGE unable to purchase or redeem shares of the
Portfolios. Transfer charges and limitations are
identified above and in the Suspension of Payments
provision in the Withdrawals Provisions section.
PART 7 WITHDRAWAL PROVISIONS
------------------------- -----------------------------------------------------
PAYMENTS OF WITHDRAWALS You may withdraw part or all of the Surrender Value,
at any time before the earlier of the death of an
Owner, the Annuity Commencement Date or the Maturity
Date, by sending us a Written Request. We will pay
all withdrawals within seven days of receipt at the
Annuities Service Center subject to postponement in
certain circumstances, as specified below.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the entire
Contract Value, we will terminate the Contract and
pay you the Net Surrender Value.
PARTIAL WITHDRAWAL If you request to withdraw an amount less than the
Surrender Value, we will pay you the amount
requested and deduct the Withdrawal Amount from the
Contract Value. Unless you specify the amount to be
withdrawn from each Investment Option, the
Withdrawal Amount will be withdrawn from each
Investment Option on a pro rata basis.
Partial withdrawals will reduce the Death Benefit,
as described in the Death Benefit section.
FREQUENCY AND AMOUNT OF You may make as many partial withdrawals as you
PARTIAL WITHDRAWALS wish. Limitations on the amount of partial
withdrawals are as follows.
(a) Any withdrawal from an Investment Account
must be at least equal to the Minimum Amount
of Partial Withdrawal shown on the
Specifications Pages or the entire balance in
the Investment Account, if less.
(b) If after the withdrawal, the amount
remaining in the Investment Account is less
than the Minimum Investment Account Balance
shown on the Specifications Pages, then we
will consider the withdrawal request to be a
request for withdrawal of the entire amount
held in the Investment Account.
(c) If a partial withdrawal reduces the Contract
Value to less than the Minimum Remaining
Contract Value shown on the Specifications
Pages, or if the amount requested is greater
than or equal to the amount available as a
total withdrawal, then we will treat the
partial withdrawal as a total withdrawal of
the Contract Value.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from, or
postpone the date of payments from, the variable
Investment Accounts 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) the Securities and
Exchange Commission, by order, so permits for the
protection of security holders; provided that
applicable rules and regulations of the Securities
and Exchange Commission
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VENTUREW-B.11-NY SAMPLE
shall govern as to whether the conditions described
in (2) and (3) exist.
WITHDRAWAL CHARGE If a withdrawal is made from the Contract we may
assess a Withdrawal Charge against Payments. The
amount of the Withdrawal Charge and when it is
assessed is discussed below.
(a) A Free Withdrawal Amount may be withdrawn free
of a Withdrawal Charge.
The Free Withdrawal Amount is the greater of:
(i) Earnings, which for purposes of these
Withdrawal Charge provisions, means the
excess of the Contract Value on the date
of withdrawal over the unliquidated
Payments; or
(ii) the excess of a. over b. where
a. equals 10% times the total Payments;
and
b. equals 100% of all prior partial
withdrawals in that Contract Year.
(b) Amounts will be withdrawn from the Contract in
the following order for purposes of calculating
the Withdrawal Charge:
(i) Earnings; then
(ii) any Free Withdrawal Amount in excess of
Earnings; then
(iii) Payments not previously liquidated, in
the order such Payments were received.
(c) Payments are liquidated when the Withdrawal
Amount exceeds Earnings.
The amount of Payments liquidated equals
(i) the lesser of the Withdrawal Amount or
the total unliquidated Payments; minus
(ii) Earnings.
(d) A total withdrawal will liquidate all
unliquidated Payments. Any Payments liquidated
may be subject to a Withdrawal Charge based on
the length of time the Payment has been in the
Contract. The Withdrawal Charge is determined
by multiplying the amount of the Payment being
liquidated by the applicable Withdrawal Charge
percentage obtained from the table shown on the
Specifications Pages.
(e) The total Withdrawal Charge will be the sum
of the Withdrawal Charges for the Payments
being liquidated.
WAIVER OF WITHDRAWAL A Withdrawal Charge is not applied if the withdrawal
CHARGE is:
(a) payment of the Death Benefit; or
(b) due to the application of the Contract Value
to an Annuity Option; or
(c) taken at the Maturity Date of the Contract;
or
(d) a distribution required to satisfy Federal
Income Tax minimum distribution requirements
that apply to this Contract; or
(e) a withdrawal guaranteed under certain riders
attached to the Contract, as specified in the
rider.
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VENTUREW-B.11-NY SAMPLE
PART 8 DEATH BENEFITS
------------------------- -----------------------------------------------------
DEATH BENEFIT BEFORE Prior to the Maturity Date or Annuity Commencement
ANNUITY COMMENCEMENT Date, if earlier, we will determine the Death
DATE Benefit as of the date on which written notice and
proof of death and all required claim forms are
received in Good Order at the Company's Annuities
Service Center as follows:
The Death Benefit will be determined as the greater
of the Contract Value or the Guaranteed Minimum
Death Benefit.
The Guaranteed Minimum Death Benefit is the sum of
all Payments made, less any amount deducted in
connection with partial withdrawals. For purposes
of calculating the Guaranteed Minimum Death Benefit,
the amount deducted in connection with partial
withdrawals will be equal to (i) times (ii), where
(i) is equal to the Guaranteed Minimum Death Benefit
prior to the withdrawal, and (ii) is equal to the
amount of the partial withdrawal divided by the
Contract Value prior to the partial withdrawal.
We will permit the Owner to limit the Death Benefit
option(s) to be offered any named Beneficiary, if
the Owner provides written notice to the Company
prior to death and the desired option(s) is one
provided for in this Contract.
Death benefit distributions prior to the Annuity
Commencement Date are governed by Internal Revenue
Code Section 72(s). Pursuant to Section 72(s) any
reference in this provision to "spouse" means a
spouse as defined in federal law.
DEATH OF ANNUITANT: On the death of the last
surviving Annuitant, the Owner becomes the new
Annuitant, if the Owner is an individual. If the
Owner is not an individual the death of any
Annuitant is treated as the death of an Owner and
the Death Benefit will be determined by substituting
the Annuitant for the Owner as described below.
DEATH OF OWNER: We will pay the Death Benefit to the
Beneficiary if any Owner dies prior to the Maturity
Date or Annuity Commencement Date, if earlier. The
Death Benefit may be taken in one sum immediately,
in which case the Contract will terminate. If the
Death Benefit is not taken in one sum immediately,
the Contract will continue subject to the following
provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit over
the Contract Value will be allocated to and
among the Investment Accounts in proportion to
their values as of the date on which the Death
Benefit is determined.
(c) No additional Payments may be applied to the
Contract.
(d) If the Beneficiary is not the deceased Owner's
spouse, the entire interest in the Contract
must be distributed under one of the following
options:
(i) The entire interest in the Contract must
be distributed over the life of the
Beneficiary, or over a period not
extending beyond the life expectancy of
the Beneficiary, with distributions
beginning within one year of the Owner's
death; or
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VENTUREW-B.11-NY SAMPLE
(ii) the entire interest in the Contract must
be distributed within 5 years of the
Owner's Death, or
(iii) as Annuity Payments under one of the
options described in the Annuity Options
section.
If the Beneficiary dies before the
distributions required by (i) or (ii) are
complete, the entire remaining Contract Value
must be distributed in a lump sum immediately.
(e) If the Beneficiary is the deceased Owner's
spouse, the Contract will continue with the
surviving spouse as the new Owner, subject to
the provisions of Internal Revenue Code Section
72(s). The surviving spouse may name a new
Beneficiary (and, if no Beneficiary is so
named, the surviving spouse's estate will be
the Beneficiary).
The spouse may also elect distributions under
one of the following options:
(i) the entire interest in the Contract may
be distributed over the life of the
Beneficiary, or over a period not
extending beyond the life expectancy of
the Beneficiary, with distributions
beginning within one year of the Owner's
death; or
(ii) as Annuity Payments under one of the
options described in the Annuity Options
section.
(f) We will waive Withdrawal Charges on any
withdrawals.
If there is more than one Beneficiary, the
foregoing provisions will independently apply to
each Beneficiary, to the extent of that
Beneficiary's share.
DEATH BENEFIT ON OR AFTER If Annuity Payments have been selected
ANNUITY COMMENCEMENT based on an Annuity Option providing for payments
DATE for a guaranteed period, and the Annuitant dies on
or after the Annuity Commencement Date, we will make
the remaining guaranteed payments to the
Beneficiary. Any remaining payments will be made at
least as rapidly as under the method of distribution
being used as of the date of the Annuitant's death.
If no Beneficiary is living, we will commute any
unpaid guaranteed payments to a single sum (on the
basis of the interest rate used in determining the
payments) and pay that single sum to the estate of
the last to die of the Annuitant and the
Beneficiary.
PROOF OF DEATH We will require Proof of death upon the death of
the Annuitant or the Owner. Proof of death is one of
the following received at the Annuities Service
Center:
(a) A certified copy of a death certificate;
(b) A certified copy of a decree of a court of
competent jurisdiction as to the finding of
death; or
(c) Any other proof satisfactory to us.
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VENTUREW-B.11-NY SAMPLE
PART 9 CONTRACT MATURITY
CHANGE IN MATURITY DATE Prior to the Maturity Date, an Owner may make a
Written Request to change the Maturity Date. Any
extension of the Maturity Date will be subject to
our prior approval and any applicable law or
regulation then in effect.
OPTIONS AT MATURITY DATE We will send You information about Your available
options prior to the Maturity Date. If by the
Maturity Date, you do not choose an Annuity
Option, make a total withdrawal of the Surrender
Value, or ask us to change the Maturity Date, we
will automatically pay you Annuity Payments under
the Annuity Option shown on the Specifications
Pages and the Annuity Commencement Date is
considered to be the Maturity Date.
We will provide variable Annuity Payments unless
otherwise elected. You can change the Annuity
Option at any time before the Annuity
Commencement Date.
PART 10 ANNUITY PAYMENTS
GENERAL The entire Contract Value or the entire amount of
the Beneficiary's portion of the Death Benefit
may be applied in accordance with one or more of
the Annuity Options described below, subject to
any restrictions of Internal Revenue Code section
72(s). Once Annuity Payments commence, the
Annuity Option may not be changed. The "Life
10-Year Certain" Annuity Option described under
Part 11, Option 1 is the default Annuity Option
unless you request another option on or prior to
the Maturity Date or unless otherwise required by
the Internal Revenue Code.
You may select a Fixed or Variable Annuity. We
will provide variable Annuity Payments unless
otherwise elected. Once Annuity Payments
commence, the Annuity Option may not be changed.
The method used to calculate the amount of the
initial and subsequent Annuity Payments is
described below.
We may pay the Contract Value or Death Benefit,
on the Annuity Commencement Date in one lump sum
if the corresponding monthly income is less than
$20.
VARIABLE ANNUITY PAYMENTS We will determine the amount of the first
Variable Annuity Payment by applying the portion
of the Contract Value used to effect a Variable
Annuity (minus any applicable premium taxes) to
the Annuity Option elected based on the mortality
table and assumed interest rate shown in the
Specifications Pages. We will provide a table of
the annuity factors upon Written Request. If the
current rates in use by us on the Annuity
Commencement Date are more favorable to you, we
will use the current rates. The portion of the
Contract Value used to effect a Variable Annuity
will be measured as of a date not more than 10
business days prior to the Annuity Commencement
Date.
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VENTUREW-B.11-NY SAMPLE
Subsequent payments will be based on the
investment performance of one or more Subaccounts
as you select. The amount of such payments is
determined by the number of Annuity Units
credited for each Subaccount. Such number is
determined by dividing the portion of the first
payment allocated to that Subaccount by the
Annuity Unit value for that Subaccount determined
as of the same date that the Contract Value used
to effect Annuity Payments was determined. We
then multiply this number of Annuity Units for
each Subaccount by the appropriate Annuity Unit
value for each subsequent determination date,
which is a uniformly applied date not more than
10 business days before the payment is due.
Variable Annuity payments, at the time of their
commencement, will not be less than those that
would be provided by the application of the
amount described below to purchase a single
premium immediate annuity then offered to the
same class of annuitants by us or a company
affiliated with us. Since no such annuity
currently exists, we will apply rates that are
reasonable in relation to the market single
premium immediate annuity rates. The amount
applied would be equal to the greater of;
(a) the Contract Value less applicable Withdrawal
Charges; or
(b) 95% of the Contract Value.
MORTALITY AND EXPENSE We guarantee that the dollar amount of each
GUARANTEE Variable Annuity payment will not be affected by
changes in mortality and expense experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each Subaccount
for any Business Day is determined as follows:
(a) The net investment factor for the Subaccount
for the Valuation Period ending on the
Business Day for which the Annuity Unit value
is being calculated is multiplied by the
value of the Annuity Unit for the preceding
Business Day; and
(b) The result is adjusted to compensate for the
interest rate used to determine the first
Variable Annuity payment.
The dollar value of Annuity Units may increase,
decrease or remain the same from one Valuation
Period to the next.
FIXED ANNUITY PAYMENTS We will determine the amount of each Fixed
Annuity payment by applying the portion of the
Contract Value used to effect a Fixed Annuity
measured as of a date not more than 10 business
days prior to the Annuity Commencement Date
(minus any applicable premium taxes) to the
Annuity Option elected based on the mortality
table and interest rate shown on the
Specifications Pages. The Fixed Annuity payment
will not be less than that available by applying
the amount described below to purchase a single
premium immediate annuity then offered to the
same class of annuitants by us or a company
affiliated with us. Such an amount would be equal
to the greater of:
(c) the Contract Value less applicable
Withdrawal Charges; or
(d) 95% of the Contract Value.
We guarantee the dollar amount of Fixed Annuity
payments.
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VENTUREW-B.11-NY SAMPLE
PART 11 ANNUITY OPTIONS
DESCRIPTION OF ANNUITY Option 1: Life Annuity
OPTIONS
a) Life Non-Refund. We will make Annuity
Payments during the lifetime of the
Annuitant. No payments are due after the
death of the Annuitant.
b) Life with 10-Year Certain. We will make
Annuity Payments for 10 years and after that
during the lifetime of the Annuitant. No
payments are due after the death of the
Annuitant or, if later, the end of the
10-year period.
Option 2: Joint and Survivor Life Annuity
The second Annuitant named shall be referred to
as the Co-Annuitant.
a) Joint and Survivor Non-Refund. We will make
Annuity Payments during the joint lifetime of
the Annuitant and Co-Annuitant. Payments will
then continue during the remaining lifetime
of the survivor. No payments are due after
the death of the last survivor of the
Annuitant and Co-Annuitant.
b) Joint and Survivor with 10-Year Certain. We
will make Annuity Payments for 10 years and
after that during the joint lifetime of the
Annuitant and Co-Annuitant. Payments will
then continue during the remaining lifetime
of the survivor. No payments are due after
the death of the survivor of the Annuitant
and Co-Annuitant or, if later, the end of the
10-year period.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the
Annuity Options described above, you may choose
an alternate form of settlement acceptable to us.
Once Annuity Payments commence, the form of
settlement may not be changed.
PART 12 GENERAL PROVISIONS
ENTIRE CONTRACT The entire Contract consists of this Contract,
Endorsements and Riders, if any, and the
application, if one is attached to this Contract.
BENEFITS AND VALUES The benefits and values available under this
Contract are not less than the minimum required
by any statute of the state in which this
Contract is delivered. We have filed a detailed
statement of the method used to calculate the
benefits and values with the Department of
Insurance in the state in which this Contract is
delivered, if required by law.
MODIFICATION Only the President, a Vice President, or the
Secretary of the Company has authority to agree
on our behalf to any alteration of the Contract
or to any waiver of our rights or requirements.
The change or waiver must be in writing. We will
not change or modify this Contract without prior
approval of the New York Superintendent of
Insurance. No change that reduces benefits will
be made without your written consent.
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VENTUREW-B.11-NY SAMPLE
CLAIMS OF CREDITORS All benefits and payments under this Contract
shall be exempt from the claims of creditors to
the extent permitted by law.
MISSTATEMENT AND PROOF OF We may require proof of age or survival of any
AGE OR SURVIVAL person upon whose age or survival any Annuity
Payments or other benefits provided by this
Contract or any Rider attached thereof depend. If
the age of the Annuitant has been misstated, the
benefits will be those which would have been
provided for the correct age. If we have made
incorrect benefit payments, we will immediately
pay the amount of any underpayment adjusted with
interest at 3% per annum. We will deduct the
amount of any overpayment from future benefit
payments without adjustment for interest.
INCONTESTABILITY This Contract is not contestable.
NON-PARTICIPATING Your Contract is non-participating and will not
share in our profits or surplus earnings. We will
pay no dividends on your Contract.
REPORTS We provide periodic reports no less frequently
than annually without charge, containing the
Investment Account Value, the Contract Value and
Death Benefit. The report will include the number
of Accumulation Units credited to the Variable
Account, the Accumulation Unit value and the
dollar value of the Accumulation Unit of the
Variable Account no more than 4 months prior to
the date of the delivery of the report. We will
provide annual calendar year reports concerning
the status of the Contract and such information
concerning required minimum distributions as is
prescribed by the Commissioner of Internal
Revenue. We will provide additional status
reports upon request for a charge not to exceed
$25 per request.
CURRENCY AND PLACE OF All payments made to or by us shall be made in
PAYMENTS the lawful currency of the United States of
America at the Annuities Service Center or
elsewhere if we consent.
NOTICES AND ELECTIONS To be effective, all notices and elections you
make under this Contract must be in the form of a
Written Request. All notices, requests and
elections will be effective when signed. We will
not be liable for any payments made or actions
taken before the Written Request is received by
us.
GOVERNING LAW This Contract will be governed by the laws of the
jurisdiction indicated on the Specifications
Pages.
SECTION 72(S) The provisions of this Contract shall be
interpreted so as to comply with the requirements
of Section 72(s) of the Internal Revenue Code.
16
VENTUREW-B.11-NY SAMPLE
PART 13 CONTRACT TERMINATION
CANCELLATION FOR NONPAYMENT If, prior to the Annuity Commencement Date, no
& MINIMUM ACCOUNT VALUE Payments have been made for Two consecutive
Contract Years, and if both:
(a) the total Payments made, less any partial
withdrawals, are less then $2,000; and
(b) the Contract Value at the end of such two
year period is less than $2,000;
we may cancel this Contract and pay you the
Contract Value (measured as of the Valuation
Period during which the cancellation occurs),
less the Annual Contract Fee.
OTHER This Contract will terminate on the earliest of :
(a) receipt of your request to withdraw the
entire Contract Value;
(b) the date a Death Benefit is payable and the
Beneficiary takes the Death Benefit as a lump
sum; or
(c) the date the Contract Value reduces to zero,
subject to the provisions of any benefit
rider attached to this Contract.
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VENTUREW-B.11-NY SAMPLE
XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: Valhalla, New York (XXXX XXXXXXX (R) LOGO)
VENTUREW-B.11-NY SAMPLE
