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Exhibit 4
ANCHOR NATIONAL LIFE INSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
CERTIFICATE NUMBER P9999999999
PARTICIPANT XXXX XXX
STATUTORY HOME OFFICE EXECUTIVE OFFICE ANNUITY SERVICE CENTER
0000 XXXXX 00XX XX., XXXXX 000 0 SUNAMERICA CENTER P.O. BOX 54299
PHOENIX, AZ 85018 LOS ANGELES, CA 90067-6022 LOS ANGELES, CA 90054-0299
ANCHOR NATIONAL LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "Anchor
National") agrees to provide benefits to the Participant under the Group
Contract, in accordance with the provisions set forth in this Certificate and in
consideration of the Participant's Enrollment Form and Purchase Payments We
received.
THIS CERTIFICATE IS EVIDENCE OF COVERAGE UNDER THE GROUP CONTRACT IF A
PARTICIPANT ENROLLMENT FORM IS ATTACHED. THE COVERAGE WILL BEGIN AS OF THE
CERTIFICATE DATE, SHOWN ON THE CERTIFICATE DATA PAGE.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED, AND WILL INCREASE OR DECREASE BASED UPON
THE INVESTMENT EXPERIENCE OF THE SUBACCOUNTS YOU CHOOSE.
RIGHT TO EXAMINE - YOU MAY RETURN THIS CERTIFICATE TO OUR ANNUITY SERVICE CENTER
OR TO THE AGENT THROUGH WHOM THE CERTIFICATE WAS PURCHASED WITHIN 10 DAYS AFTER
YOU RECEIVE IT, IF YOU ARE NOT SATISFIED WITH IT. THE COMPANY WILL REFUND THE
CERTIFICATE VALUE ON THE BUSINESS DAY DURING WHICH THE CERTIFICATE IS RECEIVED.
UPON SUCH REFUND, THE CERTIFICATE SHALL BE VOID.
For Individual Retirement Annuities, a refund of the Purchase Payment(s) may be
required. Therefore, We reserve the right to allocate your Purchase Payment(s)
to the Cash Management Subaccount until the end of the Right To Examine period.
Thereafter, allocations will be made as shown on the Certificate Data Page.
THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY.
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Xxxxx X. Xxxxxx Xxx Xxxxx
Secretary President
ALLOCATED FIXED AND
VARIABLE GROUP ANNUITY CERTIFICATE
Nonparticipating
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TABLE OF CONTENTS
CERTIFICATE DATA PAGE...................................................................PAGE 3
PURCHASE PAYMENT ALLOCATION.............................................................PAGE 4
DEFINITIONS.............................................................................PAGE 5
PURCHASE PAYMENT PROVISIONS.............................................................PAGE 8
Purchase Payments; Deferment of Payments; Suspension of Payments; Substitution of Portfolio
ACCUMULATION PROVISIONS.................................................................PAGE 8
Separate Account Accumulation Value; Number of Accumulation Units; Accumulation Unit Value
(AUV); Fixed Account Accumulation Value; Fixed Account Guarantee Period Options And Interest
Crediting
CHARGES AND DEDUCTIONS.................................................................PAGE 10
Expense Risk Charge; Distribution Expense Charge; Mortality Risk Charge; Guaranteed Death
Benefit Risk Charge
TRANSFER PROVISIONS....................................................................PAGE 10
Transfers of Accumulation Units and Annuity Units Between Subaccounts; Transfers of
Accumulation Units To and From the Fixed Account
WITHDRAWAL PROVISIONS..................................................................PAGE 11
GENERAL PROVISIONS.....................................................................PAGE 11
Entire Contract; Change of Annuitant; Death of Annuitant; Misstatement of Age or Sex; Proof
of Age, Sex or Survival; Conformity With State Laws; Changes in Law; Assignment; Claims of
Creditors; Premium Taxes or Other Taxes; Written Notice; Periodic Reports; Incontestability;
Nonparticipating
DEATH PROVISIONS.......................................................................PAGE 13
Death of Participant Before the Annuity Date; Due Proof of Death; Amount of Death Benefit;
Death of Participant or Annuitant on or After the Annuity Date; Beneficiary
ANNUITY PROVISIONS.....................................................................PAGE 16
Annuity Date; Payments to Participant; Fixed Annuity Payments; Amount of Fixed Annuity
Payments; Amount of Variable Annuity Payments
ANNUITY PAYMENT OPTIONS................................................................PAGE 18
FIXED ANNUITY PAYMENT OPTIONS TABLE....................................................PAGE 19
VARIABLE ANNUITY PAYMENT OPTIONS TABLE.................................................PAGE 21
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CERTIFICATE DATA PAGE
CERTIFICATE NUMBER: ANNUITY SERVICE CENTER:
P9999999999 P.O. BOX 54299
LOS ANGELES, CA 90054-0299
PARTICIPANT: AGE AT ISSUE:
XXXX XXX 35
ANNUITANT: FIRST PURCHASE PAYMENT:
XXXX XXX $20,000.00
ANNUITY DATE: CERTIFICATE DATE:
June 1, 2026 June 1, 1996
LATEST ANNUITY DATE: FIXED ACCOUNT OPTIONS -
June 1, 2051 Minimum Guarantee Rate:
3.0%
DEATH BENEFIT OPTION:
Purchase Payment Accumulation
BENEFICIARY:
As Stated On Participant Enrollment Form
SEPARATE ACCOUNT:
VARIABLE ANNUITY ACCOUNT FOUR
FOR INQUIRIES
CALL 1-800-445-SUN2
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PURCHASE PAYMENT ALLOCATION
Subaccounts
50.00% Cash Management 25.00% Government & Quality Bond
0.00% Corporate Bond 0.00% Growth
0.00% Global Bond 0.00% Natural Resources
0.00% High-Yield Bond 0.00% Capital Appreciation
0.00% Worldwide High Income
0.00% Utility
0.00% SunAmerica Balanced
0.00% Asset Allocation
0.00% Growth-Income
0.00% Alliance Growth
0.00% Federated Value
0.00% Venture Value
0.00% Aggressive Growth
0.00% Global Equities
0.00% Intl Diversified Equities
Fixed Account Options
Guarantee Initial
Period Interest Rate
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25.00% 1 Year Fixed 3.00%
0.00% 1 Year DCA Fixed
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DEFINITIONS
Defined in this section are some of the words and phrases used in this
Certificate. These terms are capitalized when used in the Certificate. Other
capitalized terms in the Certificate refer to the captioned paragraph explaining
that particular concept in the Certificate.
ACCUMULATION UNIT
A unit of measurement used to compute the Certificate Value in a Subaccount
prior to the Annuity Date.
AGE
Age as of last birthday.
ANNUITANT
The natural person on whose life the annuity benefits under the Certificate are
based. The Annuitant is as named on the Certificate Data Page. If the
Certificate is in force and the Annuitant is alive on the Annuity Date, We will
begin payments to the Payee.
ANNUITY DATE
The date on which annuity payments to the Payee are to start. The Participant
must specify the Annuity Date, which must be at least two years after the
Certificate Date.
ANNUITY SERVICE CENTER
As specified on the Certificate Data Page.
ANNUITY UNIT
A unit of measurement used to compute annuity payments from the Subaccounts.
AUTOMATIC DOLLAR COST AVERAGING (DCA)
You may authorize the automatic transfer of amounts at regular intervals from a
source account to one or more Subaccounts (other than the source account). The
source account may be either the One Year DCA Fixed Account Option or any of the
Subaccounts. The unit values are determined on the dates of transfers. You may
terminate DCA at any time. However, upon termination or annuitization, any
amounts remaining in the One Year DCA Fixed Account Option will be transferred
to the One Year Fixed Account Option. We reserve the right to change the terms
and conditions of the DCA program at any time.
BENEFICIARY
The Beneficiary is as designated on the Participant Enrollment Form unless later
changed by the Participant.
CERTIFICATE
This Certificate describes Your interest as a Participant under the group
annuity contract.
CERTIFICATE DATE
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The date Your Certificate is issued, as shown on the Certificate Data Page. It
is the date from which Certificate Years and anniversaries are measured.
CERTIFICATE VALUE
The sum of: (1) Your share of the Subaccounts' Accumulation Unit values and (2)
the value of amounts allocated to the Fixed Account Options.
CERTIFICATE YEAR
A year starting from the Certificate Date in one calendar year and ending on the
day preceding the anniversary of such date in the succeeding calendar year.
CURRENT INTEREST RATE
The rate of interest declared by Us applicable to allocations of Subsequent
Purchase Payments to the Fixed Account Options. The Current Interest Rate will
not be less than the Minimum Guarantee Rate as shown on the Certificate Data
Page.
DEATH BENEFIT OPTION
As specified on the Certificate Data Page.
FIXED ACCOUNT OPTIONS
The investment options under this Certificate that are credited with a fixed
rate of interest declared by the Company. All Purchase Payments allocated to the
Fixed Account Options become part of the Company's general asset account. The
general asset account contains all the assets of the Company except for the
Separate Account and other segregated asset accounts. The Fixed Account Options
for this Certificate are shown on page 4.
FIXED ANNUITY
A series of periodic annuity payments of predetermined amounts that do not vary
with investment experience. Such payments are made from the Company's general
asset account.
GUARANTEE PERIOD
The one-year period for which either the Initial Interest Rate, the Current
Interest Rate or the Renewal Interest Rate is credited to amounts allocated to
the Fixed Account Options.
INITIAL INTEREST RATE
The rate of interest credited to the first Purchase Payment as described in the
Accumulation Provisions section. The Initial Interest Rate for this
Certificate's first Purchase Payment is listed on page 4. The Initial Interest
Rate may not be less than the Minimum Guarantee Rate as shown on the Certificate
Data Page.
IRC
The Internal Revenue Code of 1986, as amended, or as it may be amended or
superseded.
NYSE
New York Stock Exchange.
PARTICIPANT
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The person or entity named in the Certificate who is entitled to exercise all
rights and privileges of ownership under the Certificate.
PAYEE
The person receiving payment of annuity benefits under this Certificate.
PORTFOLIO
The variable investment options available under the Certificate in which the
corresponding Subaccount(s) invest.
PURCHASE PAYMENTS
Payments in U.S. currency made by or on behalf of the Participant to the Company
for the Certificate.
RENEWAL INTEREST RATE
The rate(s) of interest declared by Us applicable to transfers from the
Subaccounts into the Fixed Account Options and to amounts previously allocated
to a Fixed Account Option wherein the Guarantee Period has expired. The Renewal
Interest Rate may not be less than the Minimum Guarantee Rate as shown on the
Certificate Data Page.
SEPARATE ACCOUNT
A segregated asset account named on the Certificate Data Page. The Separate
Account consists of the Subaccounts, each investing in the shares of the
corresponding Portfolio. The assets of the Separate Account are not commingled
with the general assets and liabilities of the Company. Each Subaccount is not
chargeable with liabilities arising out of any other Subaccount. The value of
amounts allocated to the Subaccounts of the Separate Account is not guaranteed.
SUBACCOUNT
One or more divisions of the Separate Account which invests in shares of the
corresponding Portfolios. The available Subaccounts are shown on page 4.
SUBSEQUENT PURCHASE PAYMENTS
Purchase Payments made subsequent to the first Purchase Payment.
VARIABLE ANNUITY
A series of periodic annuity payments which vary in amount according to the
investment experience of one or more Subaccounts, as selected by You.
WE, OUR, US, THE COMPANY
Anchor National Life Insurance Company.
YOU, YOUR
The Participant.
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PURCHASE PAYMENT PROVISIONS
PURCHASE PAYMENTS
Purchase Payments are flexible. This means that, subject to Company declared
minimums and maximums, You may change the amounts, frequency or timing of
Purchase Payments. Purchase Payments will be allocated to the Fixed Account
Options and one or more Subaccounts in accordance with instructions from You. We
reserve the right to specify the minimum Purchase Payment that may be allocated
to a Subaccount under the Certificate.
DEFERMENT OF PAYMENTS
We may defer making payments from the Fixed Account Options for up to six (6)
months. Interest, subject to state requirements, will be credited during the
deferral period.
SUSPENSION OF PAYMENTS
We may suspend or postpone any payments from the Subaccounts if any of the
following occur:
(a) the NYSE is closed;
(b) trading on the NYSE is restricted;
(c) an emergency exists such that it is not reasonably practical to dispose
of securities in the Portfolios or to determine the value of its assets;
or
(d) the Securities and Exchange Commission, by order, so permits for the
protection of Participants.
Conditions in (b) and (c) will be decided by or in accordance with rules of the
Securities and Exchange Commission.
SUBSTITUTION OF PORTFOLIO
If: (a) the shares of the Portfolios should no longer be available for
investment by the Separate Account; or (b) in the judgment of the Fund's Board
of Trustees, further investment in the shares of a Portfolio is no longer
appropriate in view of the purpose of the Certificate, then We may substitute
shares of another underlying investment series or portfolio, for shares already
purchased, or to be purchased in the future by Purchase Payments under the
Certificate. No substitution of securities may take place without prior approval
of the Securities and Exchange Commission and under such requirements as it may
impose.
ACCUMULATION PROVISIONS
SEPARATE ACCOUNT ACCUMULATION VALUE
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The Separate Account Accumulation value under the Certificate shall be the sum
of the values of the Accumulation Units held in the Subaccounts for the
Participant.
NUMBER OF ACCUMULATION UNITS
For each Subaccount, the number of Accumulation Units is the sum of each
Purchase Payment and transfer amount allocated to the Subaccount, reduced by
premium taxes, if any:
Divided by
The Accumulation Unit value for that Subaccount as of the NYSE business day in
which the Purchase Payment or transfer amount is received.
The number of Accumulation Units will be similarly adjusted for withdrawals,
annuitizations and transfers. Adjustments will be made as of the end of the NYSE
business day in which We receive all requirements for the transaction, as
appropriate.
ACCUMULATION UNIT VALUE (AUV)
The AUV of a Subaccount for any NYSE business day is calculated by subtracting
(2) from (1) and dividing the result by (3) where:
(1) is the total value at the end of the given NYSE business day of the
assets attributable to the Accumulation Units of the Subaccount minus
the total liabilities;
(2) is the cumulative unpaid charge for assumption of Expense Risk,
Distribution Expense, Mortality Risk and Guaranteed Death Benefit Risk
charges (See CHARGES AND DEDUCTIONS);
(3) is the number of Accumulation Units outstanding at the end of the given
NYSE business day.
FIXED ACCOUNT ACCUMULATION VALUE
Under the Certificate, the Fixed Account Accumulation Value shall be the sum of
all monies allocated or transferred to the Fixed Account Option(s), reduced by
any applicable premium taxes, plus all interest credited on the Fixed Account
Option(s) during the period that the Certificate has been in effect. This amount
shall be adjusted for withdrawals, annuitizations and transfers. The Fixed
Account Accumulation Value shall not be less than the minimum value required by
law in the state where this Certificate is issued.
FIXED ACCOUNT GUARANTEE PERIOD OPTIONS AND INTEREST CREDITING
Any amounts allocated to the Fixed Account Option(s) from the first Purchase
Payment will earn interest at the Initial Interest Rate for the Fixed Account
Option(s) selected for a one-year Guarantee Period.
Subsequent Purchase Payments allocated to the Fixed Account Option(s) will earn
interest at the Current Interest Rate for the Fixed Account Option(s) selected
for a one-year Guarantee Period.
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Transfers to the Fixed Account Option(s) from the Subaccounts and amounts
renewed into the Fixed Account Option(s) will earn interest at the Renewal
Interest Rate for the Fixed Account Option(s) selected for a one-year Guarantee
Period.
If You are participating in the DCA program, Purchase Payments designated for
DCA will be allocated to the One Year DCA Fixed Account Option. Upon termination
of the DCA program, any amounts remaining in the One Year DCA Fixed Account
Option will be transferred to the One Year Fixed Account Option. Such amounts
will earn interest at the Renewal Interest Rate for a one-year Guarantee Period.
CHARGES AND DEDUCTIONS
We will deduct the following charges from Your Certificate:
EXPENSE RISK CHARGE
On an annual basis this charge equals 0.35% of the average daily total net asset
value of the Subaccounts to which Your Purchase Payments are allocated. This
charge is to compensate Us for assuming the expense risks under the Certificate.
DISTRIBUTION EXPENSE CHARGE
On an annual basis this charge equals 0.15% of the average daily total net asset
value of the Subaccounts to which Your Purchase Payments are allocated. This
charge is to compensate Us for all distribution expenses associated with the
Certificate.
MORTALITY RISK CHARGE
On an annual basis this charge equals 0.90% of the average daily total net asset
value of the Subaccounts to which Your Purchase Payments are allocated. This
charge is to compensate Us for assuming the mortality risks under the
Certificate.
GUARANTEED DEATH BENEFIT RISK CHARGE
On an annual basis this charge equals 0.12% of the average daily total net asset
value of the Subaccounts to which Your Purchase Payments are allocated. This
charge is to compensate Us for the risk assumed as a result of contractual
obligations to provide an enhanced minimum guaranteed Death Benefit prior to the
Annuity Date.
TRANSFER PROVISIONS
Prior to the Annuity Date, You may transfer all or part of Your Certificate
Value to any of the Subaccounts or Fixed Account Options subject to certain
restrictions. We reserve the right to charge a fee for transfers if the number
of transfers exceeds the limit specified by Us. The minimum amount that can be
transferred and the amount that can remain in a Subaccount or Fixed Account
Option are subject to Company limits.
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TRANSFERS OF ACCUMULATION AND ANNUITY UNITS BETWEEN SUBACCOUNTS
Prior to the Annuity Date, You may transfer all or a portion of Your Certificate
Value from one Subaccount to another Subaccount. A transfer will result in the
purchase of Accumulation Units in a Subaccount and the redemption of
Accumulation Units in the other Subaccount. Transfers will be effected at the
end of the NYSE business day in which We receive Your request for the transfer.
After the Annuity Date, You may transfer all or a portion of Your Certificate
Value from one Subaccount to another Subaccount. A transfer will result in the
purchase of Annuity Units in a Subaccount and the redemption of Annuity Units in
the other Subaccount. Transfers will be effected at the end of last NYSE
business day of the month in which We receive Your request for the transfer.
TRANSFERS OF ACCUMULATION UNITS TO AND FROM THE FIXED ACCOUNT
Prior to the Annuity Date, You may transfer all or any part of Your Certificate
Value from the Subaccount(s) to the Fixed Account Option(s) or from the Fixed
Account Option(s) to the Subaccount(s) of the Certificate. However, You may only
transfer to the One Year DCA Fixed Account Option if You are participating in
the DCA program.
After the Annuity Date, transfers into or out of the Fixed Account Option(s) are
not allowed.
WITHDRAWAL PROVISIONS
On or before the Annuity Date and while You are living, You may withdraw all or
part of Your Certificate Value under this Certificate by informing Us at Our
Annuity Service Center. For a full withdrawal, this Certificate must be returned
to Our Annuity Service Center. The minimum amount that can be withdrawn and the
amount remaining after a withdrawal are subject to Company limits.
Without written notice to the contrary, withdrawals will be deducted from the
Certificate Value in proportion to their allocation among the Fixed Account
Options and the Subaccounts. Withdrawals will be based on values at the end of
the NYSE business day in which the request for withdrawal and the Certificate
(in the case of a full withdrawal), are received at the Executive Office. Unless
the SUSPENSION OF PAYMENTS or DEFERMENT OF PAYMENTS sections are in effect,
payment of withdrawals will be made within seven calendar days.
GENERAL PROVISIONS
ENTIRE CONTRACT
The entire contract between You and Us consists of the group annuity contract,
the application, the Participant Enrollment Form as completed by You at the time
of purchase, this Certificate and any attached endorsement(s). An agent cannot
change the terms or conditions of this
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contract. Any change must be in writing and approved by Us. Only Our President,
Secretary, or one of Our Vice-Presidents can give Our approval.
CHANGE OF ANNUITANT
If the Participant is an individual, the Participant may change the Annuitant at
any time prior to the Annuity Date. To make a change, the Participant must send
a written notice to Us at least 30 days before the Annuity Date. If the
Participant is not an individual, the Participant may not change the Annuitant.
DEATH OF ANNUITANT
If the Participant and Annuitant are different and the Annuitant dies before the
Annuity Date, the Participant becomes the Annuitant until such time as the
Participant elects a new Annuitant. The preceding sentence shall not apply if
the Participant is not an individual.
MISSTATEMENT OF AGE OR SEX
If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment from the One
Year Fixed Account Option, plus interest at the rate of 4% per year, will be
deducted from the next payment(s) due. Any underpayment from the One Year Fixed
Account Option, plus interest at the rate of 4% per year, will be paid in full
with the next payment due. Any overpayment from the Subaccounts will be deducted
from the next payment(s) due. Any underpayment from the Subaccounts will be paid
in full with the next payment due.
PROOF OF AGE, SEX, OR SURVIVAL
The Company may require satisfactory proof of correct Age or sex at any time. If
any payment under this Certificate depends on the Annuitant being alive, the
Company may require satisfactory proof of survival.
CONFORMITY WITH STATE LAWS
The provisions of this Certificate will be interpreted by the laws of the state
in which the enrollment form was signed or such other state as is required by
law. Any provision which, on the Certificate Date, is in conflict with the law
of such state is amended to conform to the minimum requirements of such law.
CHANGES IN LAW
If the laws governing this Certificate or the taxation of benefits under the
Certificate change, We reserve the right to amend this Certificate to comply
with these changes.
ASSIGNMENT
You may assign this Certificate before the Annuity Date, but We will not be
bound by an assignment unless it is received by Us in writing. Your rights and
those of any other person referred to in this Certificate will be subject to the
assignment. Certain assignments may be
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taxable. We do not assume any responsibility for the validity or tax
consequences of any assignment.
CLAIMS OF CREDITORS
To the extent permitted by law, no right or proceeds payable under this
Certificate will be subject to claims of creditors or legal process.
PREMIUM TAXES OR OTHER TAXES
The Company may deduct from Your Certificate Value any premium tax or other
taxes payable to a state or other government entity, if applicable. Should We
advance any amount so due, We are not waiving any right to collect such amount
at a later date. The Company will deduct any withholding taxes required by
applicable law.
WRITTEN NOTICE
Any notice We send to You will be sent to Your address shown in the Participant
Enrollment Form unless You request otherwise. Any written request or notice to
Us must be sent to Our Annuity Service Center, as specified on the Certificate
Data Page.
PERIODIC REPORTS
At least once during each Certificate Year, We will send You a statement of the
account activity of the Certificate. The statement will include all transactions
which have occurred during the accounting period shown on the statement.
Statements of Your Certificate Value will cease to be provided to You after the
Annuity Date.
INCONTESTABILITY
This Certificate will be incontestable from the Certificate Date.
NONPARTICIPATING
This Certificate does not share in Our surplus.
DEATH PROVISIONS
Notwithstanding any provision of this Certificate to the contrary, all payments
of benefits under this Certificate will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time. If the
Certificate is owned by a trust or other non-natural person, We will treat the
death of any Annuitant as the death of the "Primary Annuitant" and as the death
of any Participant.
DEATH OF PARTICIPANT BEFORE THE ANNUITY DATE. We will pay a death benefit to the
Beneficiary upon Our receiving all required documentation including: (a) due
proof that any Participant died before the Annuity Date; and (b) an election
form selecting the death benefit option. If no election is received within 60
days of our receipt of due proof of death, the death benefit will be paid in
accordance with option 1 below. The Beneficiary must select one of the following
options:
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1. Immediately collect the death benefit in a lump sum
payment. If a lump sum payment is elected, payment will be
in accordance with any applicable laws and regulations
governing payments and death; or
2. Collect the death benefit in the form of one of the
Annuity Payment Options. The payments must be over the
life of the Beneficiary or over a period not extending
beyond the life expectancy of the Beneficiary. Payments
under this death benefit option must commence within one
year after the Participant's death, otherwise, the death
benefit will be paid in accordance with option 1 above; or
3. If the Beneficiary is the Participant's spouse, the
Beneficiary may elect to become the Participant and
continue the Certificate in force. If this option is
elected, no death benefit is paid. Upon the new
Participant's subsequent death, the entire interest must
be distributed immediately under option 1 or 2 above.
In any event, the entire interest in the Certificate will be distributed within
five years from the date of death of the Participant.
DUE PROOF OF DEATH
Due Proof of Death means:
1. a certified copy of a death certificate; or
2. a certified copy of a decree of a court of competent
jurisdiction as to the finding of death; or
3. a written statement by a medical doctor who attended the
deceased Participant at the time of death; or
4. any other proof satisfactory to Us.
AMOUNT OF DEATH BENEFIT
The amount of the death benefit will be determined based upon your selection on
the Participant Enrollment Form. Once selected, the death benefit option cannot
be changed. The death benefit options are as described below.
A. PURCHASE PAYMENT ACCUMULATION DEATH BENEFIT OPTION
Prior to the Annuity Date and upon death of the Participant, the
Beneficiary will receive the greatest of:
1. the Certificate Value at the end of the NYSE business day during
which We receive at Our Annuity Service Center all required
documentation including due proof of death of the Participant
and an election of the type of payment to be made; or
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2. Purchase Payments less any partial withdrawals, compounded until
the date of death at 4% interest, plus any Purchase Payments and
less any withdrawals recorded after the date of death; or
3. the Certificate Value at the seventh Certificate anniversary,
plus any subsequent Purchase Payments and less any subsequent
partial withdrawals compounded until the date of death at 4%
interest, plus any Purchase Payments and less any partial
withdrawals recorded after the date of death.
If the Participant was age 70 or older on the Certificate Date, both (2) and (3)
above will be compounded at 3%, rather than 4%. If the death benefit is paid on
the death of a Participant who was not originally named in the application and
was age 70 or older on the Certificate Date, both (2) and (3) above will be
compounded at 3%, rather than 4%.
B. MAXIMUM ANNIVERSARY VALUE DEATH BENEFIT OPTION
If, upon the death of the Participant and prior to the Annuity Date, the
Participant had not attained his or her 90th birthday, the Beneficiary
will receive the greatest of:
1. the Certificate Value at the end of the NYSE business day during
which We receive at Our Annuity Service Center all required
documentation including due proof of death of the Participant
and an election of the type of payment to be made; or
2. Purchase Payments less any partial withdrawals; or
3. the maximum anniversary value preceding the date of death. The
maximum anniversary value is equal to the greatest anniversary
value attained from the following:
As of the date of receipt of due proof of death and an election
of the type of payment to be made, at our Annuity Service
Center, We will calculate an anniversary value for each
Certificate anniversary prior to the Participant's 81st
birthday. The anniversary value is equal to the Certificate
Value on a Certificate anniversary, increased by the dollar
amount of any Purchase Payments made since that anniversary and
reduced by the dollar amount of any partial withdrawals since
that anniversary.
If the deceased Participant had attained age 90, then the death benefit will be
the Certificate Value as defined in (1) above.
DEATH OF PARTICIPANT OR ANNUITANT ON OR AFTER THE ANNUITY DATE.
If any Participant or Annuitant dies on or after the Annuity Date and before the
entire interest in the Certificate has been distributed, We will pay the
remaining portion of the interest of the
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Certificate as under the annuity payment option being used on the date of death.
For further information pertaining to death of the Annuitant, see ANNUITY
PAYMENT OPTIONS.
BENEFICIARY
The Beneficiary is as designated on the Participant Enrollment Form unless later
changed by the Participant. While: (a) the Participant is living; and (b) before
the Annuity Date, the Participant may change the Beneficiary by written notice
in a form satisfactory to Us. The change will take effect on the date We record
the proper notice subject to any payments We have made. If two or more persons
are named: (a) those surviving the Participant will share equally unless
otherwise stated; and (b) the Beneficiaries must elect to receive their
respective portions of the death benefit according to the death benefit options.
If the Annuitant survives the Participant, and there are no surviving
Beneficiaries, the Annuitant will be deemed the Beneficiary. If the Participant
is also the Annuitant and there are no surviving Beneficiaries at the death of
the Participant, the death benefit will be paid to the estate of the Participant
in accordance with option 1, under DEATH OF PARTICIPANT BEFORE THE ANNUITY DATE.
ANNUITY PROVISIONS
ANNUITY DATE
The Participant selects an Annuity Date (the date on which annuity payments are
to begin) at the time of application. The Participant may change the Annuity
Date at any time, at least seven days prior to the Annuity Date, by written
notice to the Company at its Annuity Service Center. The Annuity Date must
always be the first day of the calendar month and must be at least two years
after the Certificate Date, but not beyond the later of the Participant's 90th
birthday or ten years after the Certificate Date. If the Participant is a
non-natural person, the latest Annuity Date is the later of the Annuitant's 90th
birthday or ten years after the Certificate Date. If no Annuity Date is
selected, the Annuity Date will be the latest Annuity Date, as set by the
Company.
PAYMENTS TO PARTICIPANT
Unless You request otherwise, We will make annuity payments to You. If You want
the annuity payments to be made to some other Payee, We will make such payments
subject to receipt of a written request filed at the Annuity Service Center no
later than thirty (30) days before the due date of the first annuity payment.
Any such request is subject to the rights of any assignee. No payments available
to or being paid to the Payee while the Annuitant is alive can be transferred,
commuted, anticipated or encumbered.
FIXED ANNUITY PAYMENTS
If a Fixed Annuity payment option has been elected, the proceeds payable under
this Certificate less any applicable premium taxes, shall be applied to the
payment of the Fixed Annuity payment option elected at rates which are at least
equal to the annuity rates based upon the applicable
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tables in the Certificate. In no event will the Fixed Annuity payments be
changed once they begin.
AMOUNT OF FIXED ANNUITY PAYMENTS
The amount of each Fixed Annuity payment will be determined by applying the
portion of the Certificate Value allocated to Fixed Annuity payments less any
applicable premium taxes to the annuity table applicable to the Fixed Annuity
payment option chosen.
AMOUNT OF VARIABLE ANNUITY PAYMENTS
(a) FIRST VARIABLE ANNUITY PAYMENT: The dollar amount of the first Variable
Annuity payment will be determined by applying the portion of the
Certificate Value allocated to the Subaccount, less any applicable
premium taxes, to the annuity table applicable to the Variable Annuity
payment option chosen. If the Certificate Value is allocated to more
than one Subaccount, the value of Your interest in each Subaccount is
applied separately to the Variable Annuity payment option table to
determine the amount of the first annuity payment attributable to each
Subaccount.
(b) NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
applicable Subaccount is the amount of the first annuity payment
attributable to that Subaccount divided by the value of the applicable
Annuity Unit for that Subaccount as of the Annuity Date. The number will
not change as a result of investment experience.
(c) VALUE OF EACH VARIABLE ANNUITY UNIT: The initial value of an Annuity
Unit of each Subaccount was arbitrarily set at $10 when the Subaccounts
were established. The value may increase or decrease from one month to
the next. For any month, the value of an Annuity Unit of a particular
Subaccount is the value of that Annuity Unit as of the last NYSE
business day of the preceding month, multiplied by the Net Investment
Factor for that Subaccount for the last NYSE business day of the current
month.
The Net Investment Factor for any Subaccount for a certain month is determined
by dividing (1) by (2) where:
(1) is the Accumulation Unit Value of the Subaccount
determined as of the last business day at the end of
that month, and
(2) is the Accumulation Unit Value of the Subaccount
determined as of the last business day at the end of the
preceding month.
The result is then multiplied by a factor that neutralizes the assumed
investment rate of 3.5%.
(d) SUBSEQUENT VARIABLE ANNUITY PAYMENTS: After the first Variable Annuity
payment, payments will vary in amount according to the investment
performance of the applicable Subaccount(s) to which Your Purchase
Payments are allocated. The amount may change from month to month. The
amount of each subsequent payment for each Subaccount is :
The number of Annuity Units for each Subaccount as determined for the first
annuity payment
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Multiplied by
The value of an Annuity Unit for that Subaccount at the end of the month
immediately preceding the month in which payment is due.
We guarantee that the amount of each Variable Annuity payment will not be
affected by variations in expenses or mortality experience.
ANNUITY PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Certificate to the Company at its Annuity Service Center, the Certificate Value
may be applied to provide one of the following options or any annuity payment
option that is mutually agreeable. After two years from the Certificate Date,
and prior to the Annuity Date, You can choose one of the options described
below. If no option has been selected by the Annuity Date, You will
automatically receive option 4, below, with 120 monthly payments guaranteed.
OPTIONS 1 & 1V - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED
Payments payable to a Payee during the lifetime of the Annuitant. No further
payments are payable after the death of the Annuitant.
OPTIONS 2 & 2V - JOINT AND SURVIVOR LIFE ANNUITY
Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. No further payments are payable
after the deaths of both the Annuitant and the designated second person.
OPTIONS 3 & 3V - JOINT AND SURVIVOR LIFE ANNUITY - 120 MONTHLY PAYMENTS
GUARANTEED
Payments are payable to the Payee during the lifetime of the
Annuitant and during the lifetime of a designated second person. If, at the
death of the survivor, payments have been made for less than 120 monthly
periods, the remaining guaranteed annuity payments will be continued to the
Beneficiary.
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OPTIONS 4 & 4V - LIFE ANNUITY WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED
Payments payable to the Payee during the lifetime of the Annuitant. If, at the
death of the Annuitant, payments have been made for less than the 120 or 240
monthly periods, as selected at the time of annuitization, the remaining
guaranteed annuity payments will be continued to the Beneficiary.
OPTIONS 5 & 5V - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
Payments payable to the Payee for any specified period of time for five (5)
years or more, but not exceeding thirty (30) years, as selected at the time of
annuitization. The selection must be made for full twelve month periods. In the
event of death of the Annuitant, any remaining annuity payments will be
continued to the Beneficiary.
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FIXED ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Fixed Annuity Payment Options Table is the 1983a
Annuitant Mortality Table, without projection with a guaranteed interest rate of
3%. The Fixed Annuity Payment Options Table does not include any applicable
premium tax.
OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(Monthly installments for ages not shown will be furnished upon request.)
OPTION 4 OPTION 4
AGE OF OPTION 1 LIFE ANNUITY LIFE ANNUITY
ANNUITANT LIFE ANNUITY (W/120 PAYMENTS GUARANTEED) (W/240 PAYMENTS GUARANTEED)
MALE FEMALE MALE FEMALE MALE FEMALE
55 4.70 4.25 4.62 4.22 4.39 4.11
56 4.80 4.34 4.72 4.30 4.45 4.17
57 4.91 4.42 4.82 4.38 4.51 4.23
58 5.03 4.52 4.92 4.47 4.58 4.30
59 5.15 4.61 5.03 4.56 4.64 4.37
60 5.28 4.72 5.14 4.66 4.71 4.44
61 5.42 4.83 5.26 4.76 4.78 4.51
62 5.57 4.95 5.39 4.86 4.84 4.58
63 5.74 5.07 5.52 4.98 4.90 4.65
64 5.91 5.21 5.66 5.10 4.96 4.72
65 6.10 5.35 5.81 5.22 5.02 4.79
66 6.29 5.51 5.96 5.36 5.08 4.86
67 6.50 5.67 6.11 5.50 5.13 4.93
68 6.73 5.85 6.28 5.65 5.18 5.00
69 6.97 6.04 6.44 5.80 5.23 5.06
70 7.23 6.25 6.61 5.96 5.27 5.12
71 7.51 6.47 6.78 6.14 5.31 5.18
72 7.80 6.71 6.96 6.31 5.34 5.23
73 8.12 6.97 7.14 6.50 5.37 5.28
74 8.45 7.26 7.32 6.69 5.40 5.32
75 8.82 7.56 7.49 6.89 5.42 5.35
76 9.21 7.90 7.67 7.09 5.44 5.39
77 9.62 8.26 7.84 7.29 5.45 5.41
78 10.07 8.65 8.01 7.49 5.47 5.43
79 10.55 9.07 8.17 7.69 5.48 5.45
80 11.06 9.53 8.33 7.89 5.49 5.47
81 11.61 10.03 8.48 8.08 5.49 5.48
82 12.19 10.57 8.61 8.26 5.50 5.49
83 12.81 11.16 8.74 8.43 5.50 5.49
84 13.46 11.79 8.86 8.59 5.51 5.50
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85 14.16 12.48 8.97 8.74 5.51 5.50
OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------
55 60 65 70 75 80 85
55 3.88 4.06 4.23 4.38 4.50 4.58 4.63
60 3.99 4.24 4.49 4.72 4.91 5.06 5.16
65 4.07 4.38 4.72 5.07 5.39 5.65 5.84
70 4.14 4.50 4.93 5.40 5.89 6.34 6.68
75 4.18 4.58 5.08 5.68 6.37 7.07 7.68
80 4.21 4.64 5.19 5.90 6.78 7.77 8.76
85 4.23 4.67 5.26 6.04 7.07 8.36 9.78
OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------
55 60 65 70 75 80 85
55 3.87 4.06 4.23 4.37 4.48 4.56 4.60
60 3.98 4.23 4.48 4.71 4.89 5.02 5.09
65 4.07 4.38 4.71 5.05 5.35 5.57 5.71
70 4.13 4.49 4.91 5.36 5.81 6.18 6.42
75 4.17 4.57 5.05 5.62 6.23 6.78 7.17
80 4.20 4.61 5.14 5.79 6.54 7.27 7.82
85 4.21 4.64 5.19 5.89 6.73 7.60 8.30
OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
FIXED PAYMENT FOR SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 9.61 17 6.23 24 4.84
11 8.86 18 5.96 25 4.71
5 17.91 12 8.24 19 5.73 26 4.59
6 15.14 13 7.71 20 5.51 27 4.47
7 13.16 14 7.26 21 5.32 28 4.37
8 11.68 15 6.87 22 5.15 29 4.27
9 10.53 16 6.53 23 4.99 30 4.18
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VARIABLE ANNUITY PAYMENT OPTIONS TABLE
BASIS OF COMPUTATION
The actuarial basis for the Variable Annuity Payment Options Table is the 1983a
Annuitant Mortality Table, without projection with an effective annual Assumed
Investment Rate of 3.5%. Variable Annuity Payment Options Table does not include
any applicable premium tax.
OPTIONS 1V & 4V - TABLE OF MONTHLY INSTALLMENTS PER $1,000
(Monthly installments for ages not shown will be furnished upon request.)
OPTION 4V OPTION 4V
AGE OF OPTION 1V LIFE ANNUITY LIFE ANNUITY
ANNUITANT LIFE ANNUITY (W/120 PAYMENTS GUARANTEED) (W/240 PAYMENTS GUARANTEED)
MALE FEMALE MALE FEMALE MALE FEMALE
55 4.99 4.54 4.91 4.51 4.66 4.38
56 5.09 4.62 5.00 4.58 4.72 4.44
57 5.20 4.71 5.10 4.66 4.78 4.51
58 5.32 4.80 5.20 4.75 4.85 4.57
59 5.44 4.90 5.31 4.84 4.91 4.64
60 5.57 5.00 5.42 4.93 4.97 4.70
61 5.71 5.11 5.54 5.03 5.04 4.77
62 5.86 5.23 5.67 5.14 5.10 4.84
63 6.02 5.36 5.80 5.25 5.16 4.91
64 6.20 5.49 5.94 5.37 5.22 4.98
65 6.38 5.64 6.08 5.50 5.28 5.05
66 6.58 5.79 6.23 5.63 5.33 5.12
67 6.79 5.95 6.38 5.77 5.38 5.19
68 7.02 6.13 6.54 5.91 5.43 5.25
69 7.26 6.32 6.71 6.07 5.48 5.32
70 7.52 6.53 6.87 6.23 5.52 5.37
71 7.80 6.75 7.05 6.40 5.55 5.43
72 8.09 6.99 7.22 6.58 5.59 5.48
73 8.41 7.26 7.40 6.76 5.62 5.52
74 8.75 7.54 7.57 6.95 5.64 5.57
75 9.12 7.85 7.75 7.14 5.66 5.60
76 9.51 8.18 7.92 7.34 5.68 5.63
77 9.92 8.54 8.09 7.54 5.70 5.66
78 10.37 8.94 8.26 7.74 5.71 5.68
79 10.85 9.36 8.42 7.94 5.72 5.70
80 11.37 9.82 8.57 8.13 5.73 5.71
81 11.92 10.32 8.71 8.32 5.74 5.72
82 12.50 10.87 8.85 8.50 5.74 5.73
83 13.12 11.46 8.97 8.67 5.75 5.74
84 13.78 12.09 9.09 8.83 5.75 5.74
85 14.47 12.78 9.20 8.97 5.75 5.75
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OPTION 2V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
JOINT & 100% SURVIVOR LIFE ANNUITY
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
--------- -----------------------
55 60 65 70 75 80 85
55 4.16 4.34 4.51 4.66 4.78 4.86 4.92
60 4.27 4.51 4.76 4.99 5.19 5.33 5.44
65 4.35 4.66 4.99 5.34 5.66 5.92 6.11
70 4.42 4.78 5.20 5.67 6.16 6.60 6.96
75 4.47 4.86 5.35 5.95 6.63 7.33 7.95
80 4.50 4.92 5.46 6.17 7.04 8.04 9.02
85 4.52 4.95 5.53 6.31 7.34 8.63 10.05
OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
(MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)
AGE OF
MALE
ANNUITANT AGE OF FEMALE ANNUITANT
55 60 65 70 75 80 85
55 4.16 4.34 4.51 4.65 4.76 4.84 4.88
60 4.26 4.51 4.75 4.98 5.16 5.29 5.37
65 4.35 4.65 4.98 5.31 5.61 5.84 5.98
70 4.41 4.76 5.17 5.62 6.07 6.44 6.68
75 4.46 4.84 5.32 5.88 6.48 7.03 7.42
80 4.48 4.89 5.41 6.05 6.79 7.52 8.07
85 4.50 4.92 5.46 6.15 6.99 7.85 8.53
OPTION 5V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
PAYMENTS FOR A SPECIFIED PERIOD
NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY NUMBER MONTHLY
OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT OF YEARS PAYMENT
-------- ------- -------- ------- -------- ------- -------- -------
10 9.83 17 6.47 24 5.09
11 9.09 18 6.20 25 4.96
5 18.12 12 8.46 19 5.97 26 4.84
6 15.35 13 7.94 20 5.75 27 4.73
7 13.38 14 7.49 21 5.56 28 4.63
8 11.90 15 7.10 22 5.39 29 4.53
9 10.75 16 6.76 23 5.24 30 4.45
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ANCHOR NATIONAL LIFE INSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
ALLOCATED FIXED AND
VARIABLE GROUP ANNUITY CERTIFICATE
Nonparticipating
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