ANCHOR NATIONAL LIFE INSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
CONTRACT NUMBER P9999999999
OWNER XXXX XXX
STATUTORY HOME OFFICE
0000 XXXXX 00XX XX., XXX 000
XXXXXXX, XX 00000
EXECUTIVE OFFICE
0 XXXXXXXXXX XXXXXX
XXX XXXXXXX, XX 00000-6022
ANNUITY SERVICE CENTER
P.O. BOX 54299
LOS ANGELES, CA 90054-0299
ANCHOR NATIONAL LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "Anchor
National") agrees to provide benefits to the Owner in accordance with the
provisions set forth in this Contract and in consideration of the Owner's
application and Purchase Payments We received.
THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED. THE VALUE WILL INCREASE OR DECREASE BASED
UPON THE INVESTMENT EXPERIENCE OF THE INVESTMENTS UNDERLYING THE SUBACCOUNTS YOU
CHOOSE.
THE CASH SURRENDER BENEFIT OF AMOUNTS ALLOCATED TO ANY FIXED-MVA ACCOUNT OPTION
INCREASES OR DECREASES BASED ON THE APPLICATION OF THE MARKET VALUE ADJUSTMENT.
THE UNADJUSTED CASH SURRENDER BENEFIT IS AVAILABLE FOR 30 DAYS AFTER THE END OF
THE GUARANTEED PERIOD. THERE IS NO MARKET VALUE ADJUSTMENT FOR ANY CASH
SURRENDER BENEFIT OF AMOUNTS ALLOCATED TO NON-MVA FIXED ACCOUNT OPTIONS.
TEN DAY RIGHT TO EXAMINE CONTRACT - YOU MAY RETURN THIS CONTRACT TO OUR ANNUITY
SERVICE CENTER OR TO THE AGENT THROUGH WHOM THE CONTRACT WAS PURCHASED WITHIN 10
DAYS AFTER YOU RECEIVE IT, IF YOU ARE NOT SATISFIED WITH IT. THE COMPANY WILL
REFUND THE CONTRACT VALUE ON THE BUSINESS DAY DURING WHICH THE CONTRACT IS
RECEIVED. UPON SUCH REFUND, THE CONTRACT SHALL BE VOID.
THIS IS A LEGAL CONTRACT. READ IT CAREFULLY.
/s/ XXXXX X. XXXXXX /s/ XXX XXXXX
____________________ ________________
XXXXX X. XXXXXX XXX XXXXX
Secretary President
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
Nonparticipating
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TABLE OF CONTENTS
CONTRACT DATA PAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . .PAGE 3
PURCHASE PAYMENT ALLOCATION. . . . . . . . . . . . . . . . . . . . . . . .PAGE 4
DEFINITIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PAGE 5
PURCHASE PAYMENT PROVISIONS. . . . . . . . . . . . . . . . . . . . . . . .PAGE 7
Purchase Payments; Deferment of Payments; Suspension of Payments; Substitution
of Investment Portfolios
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 ; Market Value Adjustment
CHARGES AND DEDUCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . PAGE 10
Contract Administration Charge; Withdrawal Charge; Expense Risk Charge;
Distribution Expense Charge; Mortality Risk Charge
TRANSFER PROVISION . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE 11
Transfers of Accumulation Units and Annuity Units Between Subaccounts; Transfers
of Accumulation Units To and From the Fixed Account
WITHDRAWAL PROVISION . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE 12
Withdrawal Charge
GENERAL PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE 13
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 and Other Taxes; Written Notice;
Periodic Reports; Incontestability; Non-Participating
DEATH PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE 14
Death of Owner Before the Annuity Date; Due Proof of Death; Amount of Death
Benefit; Death of Owner or Annuitant on or After the Annuity Date; Beneficiary
ANNUITY PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE 16
Annuity Date; Payments to Owner; 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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CONTRACT DATA PAGE
CONTRACT NUMBER: ANNUITY SERVICE CENTER:
P9999999999 P.O. BOX 54299
LOS ANGELES, CA 90054-0299
OWNER: AGE AT ISSUE:
XXXX XXX 35
ANNUITANT: FIRST PURCHASE PAYMENT:
XXXX XXX $10,000.00
ANNUITY DATE: CONTRACT DATE:
JULY 1, 2026 JULY 1, 1996
LATEST ANNUITY DATE: FIXED ACCOUNT -
JULY 1, 2051 Minimum Guarantee Rate: (3.0%)
BENEFICIARY:
As stated in the application
ANNUAL CONTRACT ADMINISTRATION CHARGE:
$35.00
SEPARATE ACCOUNT:
VARIABLE ANNUITY ACCOUNT FIVE
FOR INQUIRIES
CALL 1-800-445-SUN2
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PURCHASE PAYMENT ALLOCATION
SUBACCOUNTS
80.00% Growth Strategy
0.00% Moderate Growth Strategy
0.00% Balanced Growth Strategy
0.00% Conservative Growth Strategy
FIXED ACCOUNT OPTIONS
Guarantee Initial
Period Interest Rate
--------- -------------
20.00% 1 Year Fixed Non-MVA 3.0%
0.00% 1 Year DCA Fixed Non-MVA
0.00% 3 Year Fixed MVA
0.00% 5 Year Fixed MVA
0.00% 7 Year Fixed MVA
0.00% 10 Year Fixed MVA
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DEFINITIONS
Defined in this section are some of the words and phrases used in this Contract.
These terms are capitalized when used in the Contract. Other capitalized terms
in the Contract refer to the captioned paragraph explaining that particular
concept in the Contract.
ACCUMULATION UNIT
A unit of measurement used to compute the Contract 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 Contract are
based. The Annuitant is as named on the Contract Data Page. If the Contract 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 Owner must
specify the Annuity Date, which must be at least two years after the Contract
Date.
ANNUITY SERVICE CENTER
As specified on the Contract Data Page.
ANNUITY UNIT
A unit of measurement used to compute annuity payments from the Subaccount.
AUTOMATIC DOLLAR COST AVERAGING PROGRAM (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, 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 application unless later changed by the
Owner.
CONTRACT DATE
The date Your Contract is issued, as shown on the Contract Data Page. It is the
date from which Contract Years and anniversaries are measured.
CONTRACT 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.
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CONTRACT YEAR
A year starting from the Contract Date in one calendar year and ending on the
day preceding the anniversary of such date in the succeeding calendar years.
CONTRIBUTION YEAR
A year starting from the date of the Purchase Payment in one calendar year and
ending on the day preceding the anniversary of such date in the succeeding
calendar years.
CURRENT INTEREST RATE
The rates 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 Contract Data Page.
FIXED ACCOUNT OPTIONS
The investment options under this Contract 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 Contract 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 period for which either the Initial Interest Rate, the Current Interest Rate
or the Renewal Interest Rate is credited to the amounts allocated to the Fixed
Account Options.
INITIAL INTEREST RATE
The rates of interest credited to the first Purchase Payment as described in the
Accumulation Provisions section. The Initial Interest Rate for this Contract'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 Contract Data Page.
IRC
The Internal Revenue Code of 1986, as amended, as the same may be amended or
superseded.
NYSE
New York Stock Exchange
OWNER
The person or entity named in the Contract who is entitled to exercise all
rights and privileges of ownership under the Contract.
PAYEE
The person receiving payment of annuity benefits under this Contract.
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PURCHASE PAYMENTS
Payments in U.S. currency made by or on behalf of the Owner to the Company for
the Contract.
RENEWAL INTEREST RATE
The rate(s) of interest declared by Us applicable to transfers from the
Subaccounts into any of 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 Contract Data Page.
SEPARATE ACCOUNT
The segregated asset account named on the Contract Data Page. The Separate
Account consists of several Subaccounts. The assets of the Separate Account are
not comingled 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
A variable investment option available under the Contract, comprising a division
of the Separate Account. 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 Owner.
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 may 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 Contract.
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.
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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
or determine the value of the assets held in a Subaccount, or
(d) the Securities and Exchange Commission, by order, so permits for the
protection of Owners.
Conditions in (b) and (c) will be decided by or in accordance with rules of the
Securities and Exchange Commission.
SUBSTITUTION OF INVESTMENT PORTFOLIOS
If: (a) the shares of the underlying investment portfolios in which the
Subaccounts invest should no longer be available for investment by the Separate
Account; or (b) if further investment in the shares of an investment portfolio
is no longer appropriate in view of the purpose of the Contract, then We may
substitute shares of another underlying investment series, for shares already
purchased, or to be purchased in the future by Purchase Payments under the
Contract. 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
The Separate Account Accumulation Value under the Contract shall be the sum of
the values of the Accumulation Units held in the Subaccounts for the Owner.
NUMBER OF ACCUMULATION UNITS
For each Subaccount, the number of Accumulation Units is the sum of each
Purchase Payment and transfer 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, transfers, Contract Administration Charge and Withdrawal
Charge. Adjustments will be made as of the end of the NYSE business day in
which We receive all requirements for the transaction, as appropriate.
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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 and Mortality 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 Contract, 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 Contract has been in effect. This amount
shall be adjusted for withdrawals, annuitizations, transfers, Contract
Administration Charge and Withdrawal Charge. The Fixed Account Accumulation
Value shall not be less than the minimum values required by law in the state
where this Contract is issued.
FIXED ACCOUNT GUARANTEE PERIOD OPTIONS AND INTEREST CREDITING
Any amounts allocated to the Fixed Account Options from the first Purchase
Payment will earn interest at the Initial Interest Rate for the Fixed Account
Option(s) selected for the duration of the Guarantee Period.
Subsequent Purchase Payments allocated to the Fixed Account Options will earn
interest at the Current Interest Rate for the Fixed Account Option(s) selected
for the duration of the Guarantee Period.
Transfers to the Fixed Account Options from the Subaccounts and amounts renewed
into the Fixed Account Options will earn interest at the Renewal Interest Rate
for the Fixed Account Option(s) selected for the duration of the Guarantee
Period.
For thirty (30) days following the date of expiration of a Guarantee Period, You
may renew for the same or any other Guarantee Period at the Renewal Interest
Rate or You may transfer all or a portion of the amount to the Subaccounts. If
the Owner does not specify a Guarantee Period at the time of renewal, We will
select the same Guarantee Period as has just expired, crediting the Contract
with the Renewal Interest Rate in effect on the date of expiration of the
Guarantee Period, so long as such Guarantee Period does not extend beyond the
Annuity Date. If a renewal occurs within one year of the latest Annuity Date,
We will credit interest up to the Annuity Date at the Renewal Interest Rate for
the One Year Fixed Account Option.
If You are participating in the DCA program, Purchase Payments 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 the One Year Fixed Account Option.
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MARKET VALUE ADJUSTMENT (MVA)
Any payments and values based on a multi-year Fixed Account Option may be
subject to a MVA, the operation of which may result in upward or downward
adjustments in the Contract Value, if withdrawn, transferred or annuitized prior
to the end of the respective Guarantee Period. The MVA will be calculated by
multiplying the amount withdrawn, transferred or annuitized by the formula
described below:
N/12
{(1 + I)/(1+J+0.0050)} -1
I = The interest rate currently in effect for that Guarantee Period.
J = The Initial Interest Rate available for the Guarantee Period equal to the
number of years (rounded up to an integer) remaining in the current Guarantee
Period at the time of withdrawal, transfer or annuitization. In the
determination of J, if the Company currently does not offer the applicable
Guarantee Period, then the rate will be determined by linear interpolation of
the Initial Interest Rate for the nearest two Guarantee Periods that are
available.
N = The number of full months remaining in the current Guarantee Period at the
time the withdrawal or annuitization request is processed.
If a Withdrawal Charge is applied to a withdrawal, then the MVA will be applied
to the withdrawal amount net of the Withdrawal Charge.
There will be no MVA on withdrawals from the Fixed Account Options in the
following situations: (1) to pay a Death Benefit paid upon death of the Owner;
(2) on amounts withdrawn to pay fees or charges; (3) on amounts withdrawn
from the Fixed Account Option within thirty (30) days after the end of the
Guarantee Period; (4) on annuitizations on the Latest Annuity Date; (5) on
amounts withdrawn from the One Year Fixed Account Option or the One Year DCA
Fixed Account Option .
CHARGES AND DEDUCTIONS
We will deduct the following charges from the Contract:
CONTRACT ADMINISTRATION CHARGE
The charge specified on the Contract Data Page will be deducted on each Contract
anniversary that occurs on or prior to the Annuity Date. It will also be
deducted when the Contract Value is withdrawn in full if withdrawal is not on
the Contract anniversary. We reserve the right to assess a charge on a class
basis which is less than the charge specified on the Contract Data Page.
WITHDRAWAL CHARGE
This charge may be deducted upon withdrawal of the Contract Value, in whole or
in part. See WITHDRAWAL PROVISIONS.
EXPENSE RISK CHARGE
On an annual basis this charge equals 0.35% of the average daily total net asset
value of Your Purchase Payments allocated to the Subaccounts. This charge is to
compensate Us for assuming the expense risks under the Contract.
10
DISTRIBUTION EXPENSE CHARGE
On an annual basis this charge equals 0.15% of the average daily total net asset
value of Your Purchase Payments allocated to the Subaccounts. This charge is to
compensate Us for all distribution expenses associated with the Contract.
MORTALITY RISK CHARGE
On an annual basis this charge equals 0.90% of the average daily total net asset
value of Your Purchase Payments allocated to the Subaccounts. This charge is to
compensate Us for assuming the mortality risks under the Contract.
TRANSFER PROVISION
Prior to the Annuity Date, You may transfer all or part of Your Contract Value
to any of the Subaccounts or the 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.
TRANSFERS OF ACCUMULATION AND ANNUITY UNITS BETWEEN SUBACCOUNTS
Prior to the Annuity Date, You may transfer all or a portion of Your Contract
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 completed request for the
transfer.
After the Annuity Date, You may transfer all or a portion of Your Contract 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 the NYSE
business day in which We receive Your completed request for the transfer.
The minimum amount that can be transferred between Subaccounts and the amount
that can remain in the Subaccount are subject to Company limits.
TRANSFERS OF ACCUMULATION UNITS TO AND FROM THE FIXED ACCOUNT
Prior to the Annuity Date, You may transfer all or any part of Your Contract
Value from the Subaccount(s) to the Fixed Account Options or from the Fixed
Account Options to the Subaccount(s) of the Contract. 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 Options are
not allowed.
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WITHDRAWAL PROVISION
On or before the Annuity Date and while the Owner is living, You may withdraw
all or part of Your Contract Value under this Contract by informing Us at Our
Annuity Service Center. For a full withdrawal, this Contract must be returned
to Our Annuity Service Center.
Without a written notice to the contrary, withdrawals will be deducted from the
Contract 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 Contract (in the case
of a full withdrawal), are received at the Annuity Service Center. Unless the
SUSPENSION OF PAYMENTS or DEFERMENT OF PAYMENTS sections are in effect, payment
of withdrawals will be made within seven calendar days.
WITHDRAWAL CHARGE
Each Contract Year, the Owner may withdraw, free of a Withdrawal Charge, 10% of
all Purchase Payments which are still subject to a Withdrawal Charge. Amounts
withdrawn as a free withdrawal do not reduce Purchase Payments for purposes of
calculating future free withdrawals. The Owner will not receive the benefit of a
free withdrawal in a full surrender.
Withdrawals in excess of this free withdrawal amount may be subject to a
Withdrawal Charge. The withdrawal charge applied to any withdrawal will depend
on the age of the Purchase Payment to which the withdrawal is attributed. See
chart below.
For the purpose of determining the Withdrawal Charge, a withdrawal will be
attributed to amounts in the following order: (1) free withdrawal amount
(partial withdrawals only); (2) Purchase Payments which are both no longer
subject to the Withdrawal Charge and are not yet withdrawn; (3) Purchase
Payments subject to a Withdrawal Charge; and (4) other Contract Value. Purchase
Payments, when withdrawn, are assumed to be withdrawn on a first-in-first-out
(FIFO) basis.
Number of Contribution Years Elapsed Withdrawal Charge as a
Between Contribution Year of Purchase Payment Percentage of Withdrawn
and Contribution Year of Withdrawal Purchase Payment
--------------------------------------------------------------------------------
1 7%
2 6%
3 6%
4 5%
5 4%
6 3%
7 2%
8+ 0%
The Withdrawal Charge will be assessed against the Subaccounts and the Fixed
Account Options in the same proportion as the remaining Contract Value is
allocated unless You request that the withdrawal come from a particular Fixed
Account Option or Subaccount. If the remaining Contract Value is insufficient
to cover the Withdrawal Charge, any remaining balance will be deducted from the
withdrawal amount requested.
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GENERAL PROVISIONS
ENTIRE CONTRACT
The entire contract between You and Us consists of the application as completed
by You at the time of purchase, this Contract and any attached endorsement(s).
An agent cannot change the terms or conditions of this 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 Owner is an individual, the Owner may change the Annuitant at any time
prior to the Annuity Date. To make a change, the Owner must send a written
notice to Us at least 30 days before the Annuity Date. If the Owner is not an
individual, the Owner may not change the Annuitant.
DEATH OF ANNUITANT
If the Owner and Annuitant are different and the Annuitant dies before the
Annuity Date, the Owner becomes the Annuitant until such time as the Owner
elects a new Annuitant. The preceding sentence shall not apply if the Owner 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
Fixed Account Options, plus interest at the rate of 4% per year, will be
deducted from the next payment(s) due. Any underpayment from the Fixed Account
Options, 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 Contract depends on the Annuitant being alive, the
Company may require satisfactory proof of survival.
CONFORMITY WITH STATE LAWS
The provisions of this Contract will be interpreted by the laws of the state in
which the application was signed or such state as is required by law. Any
provision which, on the Contract 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 Contract or the taxation of benefits under the
Contract change, We reserve the right to amend this Contract to comply with
these changes.
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ASSIGNMENT
You may assign this Contract 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 Contract will be subject to the
assignment. Certain assignments may be 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 Contract
will be subject to claims of creditors or legal process.
PREMIUM TAXES AND OTHER TAXES
The Company may deduct from Your Contract 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 application
unless You request otherwise. Any written request or notice to Us must be sent
to Our Annuity Service Center, as specified on the Contract Data Page.
PERIODIC REPORTS
At least once during each Contract Year, We will send You a statement of the
account activity of the Contract. The statement will include all transactions
which have occurred during the accounting period shown on the statement.
Statements of Your Contract Value will cease to be provided to You after the
Annuity Date.
INCONTESTABILITY
This Contract will be incontestable from the Contract Date.
NONPARTICIPATING
This Contract does not share in Our surplus.
DEATH PROVISIONS
Notwithstanding any provision of this Contract to the contrary, all payments of
benefits under this Contract will be made in a manner that satisfies IRC Section
72(s), as amended from time to time. If the Contract is owned by a trust or
other non-individual, We will treat the death of the Annuitant as the death of
the "Primary Annuitant", as defined in IRC Section 72(s)(6), and as the death of
any Owner.
DEATH OF OWNER BEFORE THE ANNUITY DATE. We will pay a death benefit to the
Beneficiary upon Our receiving: (a) due proof that a Owner died before the
Annuity Date; and (b) an election form selecting the death benefit option. If no
election form is received within 60 days of our receipt of due proof of death,
the death benefit will be paid in accordance with death benefit option 1 below.
The Beneficiary must select one of the following death benefit options:
14
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
Owner's death, otherwise, the death benefit will be paid in
accordance with death benefit option 1; or
3. If the Beneficiary is the Owner's spouse, the Beneficiary
may elect to become the Owner and continue the Contract in
force, however, no death benefit is paid. Upon the new
Owner's subsequent death, the entire interest must be
distributed immediately.
In any event, the entire interest in the Contract will be distributed within
five years from the date of death of the Owner.
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
Owner at the time of death; Or
4. any other proof satisfactory to Us.
AMOUNT OF DEATH BENEFIT
Before You attain age 75 the amount of the death benefit is equal to the greater
of:
1. the Contract Value at the end of the NYSE business day during which We
receive, at Our Annuity Service Center, due proof of the Owner's death and
an election of the type of payment to be made; Or
2. Purchase Payments less any partial withdrawals, compounded until the date
of death at 3% interest, plus any Purchase Payments and less any
withdrawals recorded after the date of death.
After You attain age 75, the death benefit will be the greater of:
1. the Contract Value at the end of the NYSE business day during which We
receive, at Our Annuity Service Center, due proof of the Owner's death and
an election of the type of payment to be made; Or
2. Purchase Payments less any partial withdrawals, compounded until the
attainment of age 75 at 3% interest, plus any Purchase Payments and less
any partial withdrawals recorded after the attainment of age 75.
15
DEATH OF OWNER OR ANNUITANT ON OR AFTER THE ANNUITY DATE.
If the Owner or Annuitant dies on or after the Annuity Date and before the
entire interest in the Contract has been distributed, We will pay the remaining
portion of the interest of the Contract 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 application unless later changed by the
Owner. While: (a) the Owner is living and (b) before the Annuity Date, the
Owner may change the Beneficiary by written notice in a form satisfactory to Us.
The change will take effect on the date We record the notice subject to any
payments We have made. If two or more persons are named: (a) those surviving
the Owner 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 Owner, and there
are no surviving Beneficiaries, the Annuitant will be deemed the Beneficiary. If
the Owner is also the Annuitant and there are no surviving Beneficiaries at the
death of the Owner, the death benefit will be paid to the estate of the Owner in
accordance with death benefit option 1.
ANNUITY PROVISIONS
ANNUITY DATE
The Owner selects an Annuity Date (the date on which annuity payments are to
begin) at the time of application. The Owner 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
Contract Date, but not beyond the later of the Owner's 90th birthday or ten
years after the Contract Date. If the Owner is a non-natural person, the latest
annuity date is the later of the Annuitant's 90th birthday or ten years after
the Contract Date. If no Annuity Date is selected, the Annuity Date will be the
latest Annuity Date, as set by the Company.
PAYMENTS TO OWNER
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 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 Contract 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 tables in the Contract. In no
event will the Fixed Annuity payments be changed once they begin.
16
AMOUNT OF FIXED ANNUITY PAYMENTS
The amount of each Fixed Annuity payment will be determined by applying the
portion of the Contract 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 Contract
Value allocated to the Subaccount, less any applicable premium taxes, to
the annuity table applicable to the Variable Annuity payment option chosen.
If the Contract 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 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) the Accumulation Unit Value of the Subaccount determined as of
the last business day at the end of that month;
(2) 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
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.
17
ANNUITY PAYMENT OPTIONS
During the Annuitant's life, upon written election and the return of this
Contract to the Company at its Annuity Service Center, the Contract 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 Contract Date, and prior
to the Annuity Date, You can choose one of the options described below. If no
option has been elected by the Annuity Date, You will automatically receive
Option 4 below with 120 monthly payments guaranteed.
OPTIONS 1 & 1V - LIFE ANNUITY, LIFETIME MONTHLY 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.
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 guaranteed annuity payments
will be continued to the Beneficiary.
18
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 1 OPTION 4 OPTION 4
AGE OF LIFE ANNUITY LIFE ANNUITY
PAYEE 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
85 14.16 12.48 8.97 8.74 5.51 5.50
19
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
PAYEE AGE OF FEMALE PAYEE
----- -------------------
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
PAYEE AGE OF FEMALE PAYEE
----- -------------------
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 1V OPTION 4V OPTION 4V
AGE OF LIFE ANNUITY LIFE ANNUITY
PAYEE 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
21
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
PAYEE AGE OF FEMALE PAYEE
----- -------------------
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
PAYEE AGE OF FEMALE PAYEE
----- -------------------
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
22
ANCHOR NATIONAL LIFE INSURANCE COMPANY
A STOCK COMPANY LOS ANGELES, CALIFORNIA
INDIVIDUAL FIXED AND
VARIABLE ANNUITY CONTRACT
Nonparticipating
23
