VA790NY Thank you for choosing Jackson National Life Insurance Company of New York®, hereinafter also referred to as "the Company" or "Jackson of NY®." READ YOUR CONTRACT CAREFULLY. This annuity contract is issued by the Company and is a legal...
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VA790NY
Thank you for choosing Xxxxxxx National Life Insurance Company of New York®, hereinafter also referred to as
"the Company" or "Xxxxxxx of NY®."
READ YOUR CONTRACT CAREFULLY.
This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and Xxxxxxx
of NY.
AMOUNTS YOU ALLOCATE TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION AND ANNUITY
PERIODS ARE NOT GUARANTEED AND MAY INCREASE OR DECREASE IN VALUE BASED UPON THE
PERFORMANCE OF THE FUNDS UNDERLYING THE SEPARATE ACCOUNT.
IF THE ACTUAL INVESTMENT RATES EXPERIENCED BY THE SEPARATE ACCOUNT ASSETS (PRIOR TO
DEDUCTION OF THE ASSET-BASED CHARGES SPECIFIED IN THIS CONTRACT) ARE LESS THAN [1.45%],
VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME.
AMOUNTS ALLOCATED TO THE FIXED ACCOUNT(S) WILL EARN INTEREST AT THE CURRENT INTEREST
RATE FOR THE DURATION OF THE FIXED ACCOUNT OPTION PERIOD. THE INTEREST RATE CREDITED
FOR SUBSEQUENT PERIODS IS SUBJECT TO CHANGE AS DECLARED BY THE COMPANY.
THE FIXED ACCOUNT OPTIONS ARE SUBJECT TO A MARKET VALUE ADJUSTMENT FORMULA WHICH
MAY INCREASE OR DECREASE AMOUNTS TRANSFERRED OR WITHDRAWN, BUT THE FIXED ACCOUNT
CONTRACT VALUE WILL NEVER DECREASE TO AN AMOUNT LESS THAN THE FIXED ACCOUNT MINIMUM
VALUE.
THE CONTRACT VALUE HELD UNDER A FIXED ACCOUNT OPTION MAY BE WITHDRAWN WITHOUT A
MARKET VALUE ADJUSTMENT UPON RECEIPT OF WRITTEN NOTICE WITHIN 30 DAYS FOLLOWING THE
END OF THE CORRESPONDING FIXED ACCOUNT OPTION.
PLEASE READ THE IMPORTANT CONTRACT DISCLOSURES ON THE FOLLOWING
PAGE.
NOTICE OF RIGHT TO EXAMINE CONTRACT
YOU MAY RETURN THIS CONTRACT TO THE SELLING PRODUCER OR THE COMPANY WITHIN 20 DAYS
(60 DAYS IF IT WAS PURCHASED AS A REPLACEMENT CONTRACT) AFTER YOU RECEIVE IT. UPON
RECEIPT OF THIS CONTRACT, THE COMPANY WILL REFUND THE CONTRACT VALUE DETERMINED AS
OF THE BUSINESS DAY ON WHICH THE CONTRACT IS RETURNED TO THE SELLING PRODUCER OR THE
COMPANY, INCLUDING ANY FEES OR OTHER CHARGES DEDUCTED FROM THE PREMIUMS OR IMPOSED
UNDER THE CONTRACT. UPON SUCH REFUND, THIS CONTRACT SHALL BE VOID.
Please Note: The Company reserves the right to allocate all Premium received during the "Notice of Right to
Examine Contract" period to a money market Investment Division or the Fixed Account. After the "Notice of Right
to Examine Contract" period expires, the Company will allocate the Contract Value to the Contract Options You
have specified.
INDIVIDUAL DEFERRED VARIABLE AND FIXED
ANNUITY CONTRACT WITH MARKET VALUE
ADJUSTMENT. (FLEXIBLE PREMIUM).
DEATH BENEFIT AVAILABLE.
INCOME OPTIONS AVAILABLE.
NONPARTICIPATING.
This Contract is signed by the Company
President
Secretary
Home Office: Service Center:
[0000 Xxxxxxxxxxx Xxxxxx [P.O. Box 24068
Purchase, New York 10577] Lansing, MI 48909-4068
1-800-599-5651
xxx.xxxxxxx.xxx]
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VA790NY Contract Cover Page Continued
IMPORTANT - CONTRACT DISCLOSURES
PLEASE READ CAREFULLY
THE COMPANY WILL RE-DETERMINE THE CONTRACT'S FIXED ACCOUNT MINIMUM INTEREST RATE
EACH JANUARY ON THE REDETERMINATION DATE.
THE COMPANY MAY RESTRICT OR REFUSE FUTURE PREMIUM PAYMENTS, PREMIUM ALLOCATION,
TRANSFERS TO, OR DISCONTINUE THE FIXED ACCOUNT OPTION(S) AT ANY TIME, ON A
NONDISCRIMINATORY BASIS, IF THE YIELD ON INVESTMENT WOULD NOT SUPPORT THE MINIMUM
INTEREST RATE GUARANTEED UNDER THE FIXED ACCOUNT(S). SHOULD THE COMPANY IMPOSE
SUCH RESTRICTIONS, THE COMPANY WILL GIVE AT LEAST 30 DAYS ADVANCE NOTICE TO YOU.
THE COMPANY WILL ALSO PROVIDE WRITTEN NOTICE WHEN SUCH RESTRICTIONS NO LONGER
EXIST.
ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE
DATE. PLEASE CHECK THE CONTRACT DATA PAGE TO DETERMINE WHICH DCA+ FIXED ACCOUNT
OPTIONS ARE CURRENTLY AVAILABLE.
ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE AFTER ISSUE OF
THIS CONTRACT.
Home Office: Service Center:
[0000 Xxxxxxxxxxx Xxxxxx [P.O. Box 24068
Purchase, New York 10577] Lansing, MI 48909-4068
1-800-599-5651
xxx.xxxxxxx.xxx]
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VA790NY 2
TABLE OF CONTENTS
Provision Page Number
Contract Data Pages [3a
Definitions 4
General Provisions 7
Accumulation Provisions 12
Withdrawal Provisions 15
Death Benefit Provisions 16
Income Provisions 18
Termination Provision 22]
If You have questions about this Contract or require information about coverage or complaint
resolutions, You may contact the Company's Service Center identified on the Contract's cover
page.
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VA790NY-FB1 3a
CONTRACT DATA PAGES
Contract Number: [1234567890]
Owner: [Xxxx Xxx]
Owner Issue Age: [35]
Joint Owner: [Xxxx Xxx]
Joint Owner Issue Age: [35]
Annuitant: [Xxxx Xxx]
Annuitant Issue Age: [35]
Joint Annuitant: [Xxxx Xxx]
Joint Annuitant Issue Age: [35]
Initial Premium: [$25,000]
Issue Date: [November 1, 2017]
Issue State: New York
Income Date: [November 1, 2076]
Primary Beneficiary(ies): [Xxxxx Xxx]
Contingent Beneficiary(ies): [Xxxx Xxx]
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VA790NY-FB1 3b
CONTRACT DATA PAGES (CONT'D)
FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION:
Initial Fixed Account Minimum Interest Rate: [1.00%]
The Company will re-determine the Fixed Account Minimum Interest Rate each January on the
Redetermination Date. The Fixed Account Minimum Interest Rate is the guaranteed minimum
interest rate under the Contract and may change each year on the Redetermination Date.
Initial Base Interest Rate: [1.00% for the 1-Year Fixed Option Period
1.00% for the 3-Year Fixed Option Period
1.00% for the 5-Year Fixed Option Period
1.00% for the 7-Year Fixed Option Period]
Initial Current Interest Rate: [1.00% for the 1-Year Fixed Option Period
1.00% for the 3-Year Fixed Option Period
1.00% for the 5-Year Fixed Option Period
1.00% for the 7-Year Fixed Option Period]
Initial Current DCA+ Interest Rate: [6-month [X.XX%] [NOT CURRENTLY AVAILABLE]
[12-month [X.XX%] [NOT CURRENTLY VAILABLE]
ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON
THE ISSUE DATE. AVAILABILITY IS INDICATED ABOVE.
Maximum DCA+ Rate: [8.00%] over the net investment earnings rate.
Misstatement of Age or Sex Interest Rate for Adjustments: [1.00%]
Annual Contract Maintenance Charge: [$30.00]
The Company will deduct the Annual Contract Maintenance Charge from the Contract Value on
each Contract Anniversary that occurs on or before the Income Date and when You withdraw the
Contract Value in full on a date other than the Contract Anniversary. The Company will deduct
the Annual Contract Maintenance Charge from Contracts with a Contract Value less than
[$50,000] on each Contract Anniversary.
Core Contract Charge: [0.4500%]
The Core Contract Charge is an annual percentage of the daily Separate Account Contract Value.
The Company will reduce the Core Contract Charge to [0.4000%] if the Contract Value on the
later of the Issue Date or the most recent Contract Quarterly Anniversary is greater than or equal
to [$1,000,000]. If the Contract Value subsequently falls below [$1,000,000] on any Contract
Quarterly Anniversary, the Company will reinstate the charge of [0.4500%].
Total Asset-Based Charges: [0.4500%]
The Total Asset-Based Charges are an annual percentage of the daily Separate Account Contract
Value. The Company will deduct asset-based charges daily as part of the Accumulation Unit
Value calculation. Total asset-based charges include the Core Contract Charge and asset-based
charges for optional benefits.
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VA790NY-FB1 3c
CONTRACT DATA PAGES (CONT'D)
FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION (continued):
Transfer Charge: [$25.00]
The Company charges a fee for each transfer between Contract Options You make in excess of
[25] in any Contract Year. The Company deducts Transfer Charges from the amount You seek to
transfer before allocation to the new Contract Option. The Company does not assess Transfer
Charges on transfers You make pursuant to any of the Company's systematic investment
programs, and the Company does not count those transfers against the [25] free transfers the
Company allows in a Contract Year. Free transfers not utilized during a given Contract Year
cannot be carried forward to subsequent Contract Years.
Optional Benefit Charges.
If applicable, refer to any attached endorsements and supplemental contract data pages for
additional charges and fees associated with Your Contract.
WITHDRAWALS:
Minimum partial withdrawal amount unless in connection with a systematic withdrawal program:
[$500]
Minimum partial withdrawal amount in connection with a systematic withdrawal program: [$50]
Minimum Contract Value remaining after a partial withdrawal: [$2,000]
MARKET VALUE ADJUSTMENT:
A Market Value Adjustment is a positive or negative adjustment the Company applies to amounts
You remove from a Fixed Account Option due to withdrawals or transfers.
The Market Value Adjustment reflects the movement in the Base Interest Rate (as defined by
Your Contract) since the date of Your allocation to the Fixed Account Option from which You
remove Fixed Account Contract Value, which is valued over the number of months remaining in
the Fixed Account Option period.
The Market Value Adjustment may:
1. reduce the value of the amount paid or transferred if the Base Interest Rate on the date You
remove Fixed Account Contract Value from a Fixed Account Option is greater than the Base
Interest Rate on the date of Your allocation to that Fixed Account Option; or
2. increase the value of the amount paid or transferred if the Base Interest Rate on the date You
remove Fixed Account Contract Value from a Fixed Account Option is less than the Base
Interest Rate on the date of Your allocation to that Fixed Account Option.
The Company applies the same Market Value Adjustment formula regardless of whether the
formula results in an increase or decrease to amounts You remove from a Fixed Account Option.
The Company applies the Market Value Adjustment formula to the amount You remove less any
applicable charges.
Market Value Adjustment formula. The Company calculates the Market Value Adjustment by
multiplying the amount You remove from a Fixed Account Option by the result of the formula
below:
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VA790NY-FB1 3d
CONTRACT DATA PAGES (CONT'D)
MARKET VALUE ADJUSTMENT (continued):
-1 [1+ I ]
(m/12)
[1+ J ] (m/12)
where:
I is the Base Interest Rate the Company credits to the Fixed Account Option from which You
are removing Fixed Account Contract Value.
J is the Base Interest Rate the Company credits on new allocations to Fixed Account Options
with a duration equal to the number of years remaining in the Fixed Account Option from
which You remove Fixed Account Contract Value, increased by 0.0025. If the Company
does not offer such a Fixed Account Option on the date of the removal, the Company will
establish "J" by straight-line interpolation between the two (2) Fixed Account Options with
durations closest to the number of years remaining in the Fixed Account Option from which
You remove Fixed Account Contract Value.
m is the number of complete months remaining from the date of Your removal to the end of the
Fixed Account Option period from which You are removing Fixed Account Contract Value.
The 0.0025 adjustment accounts for direct and indirect costs to the Company associated with
liquidating general account assets prior to the end of the Fixed Account Option period. The
Company makes no Market Value Adjustment when J is greater than I by less than 0.0025.
In no event will a total withdrawal from a Fixed Account Option be less than the Fixed Account
Minimum Value.
Unavailability of Base Interest Rate. In the event that the Base Interest Rate cannot be
determined on the date You remove Fixed Account Contract Value from a Fixed Account Option,
the Market Value Adjustment will be determined by using the asked yield to maturity of the U.S.
Treasury Notes with the same remaining term, using straight-line interpolation where necessary
as published in The Wall Street Journal on the next succeeding business day following the
effective date of the Market Value Adjustment.
See the Market Value Adjustment section of the Accumulation Provisions for additional
information about the Market Value Adjustment.
TRANSFER:
Transfer among Investment Divisions. At any time, You may transfer all or a portion of Your
Contract Value in any Investment Division to any available Investment Division(s).
Transfer from Investment Division to a Fixed Account Option. Before the Income Date, You
may transfer all or a portion of Your Contract Value in an Investment Division to any available
Fixed Account Option(s). Additional details regarding restrictions on transfers are outlined in the
Transfer provisions on page 10.
Transfer from a Fixed Account Option to an Investment Division or to a Fixed Account
Option. Before the Income Date, You may transfer all or a portion of Your Contract Value in a
Fixed Account Option to any available Investment Division(s) or any available Fixed Account
Option(s), subject to any applicable Market Value Adjustment. Additional details regarding
restrictions on transfers are outlined in the Transfer provisions on page 10 and in the Fixed
Account provisions on page 13.
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VA790NY-FB1 3e
CONTRACT DATA PAGES (CONT'D)
TRANSFER (continued):
Transfer Effective Date: Transfers You request are effective at the end of the Business Day
upon which the Company receives Your transfer request in Good Order at the Service Center.
Additional details on transfer restrictions are outlined in the Transfer of Funds Restrictions section
of the General Provisions.
PREMIUM(S):
This is a flexible Premium Contract. You may change the amount, frequency and timing of
Premium payments, subject to the minimum and maximum Premium payment amounts specified
below.
Your initial Premium payment must be not less than [$25,000] for Non-Qualified Plan Contracts
and [$25,000] for Qualified Plan Contracts. Any subsequent Premium payments must be not less
than [$500] ([$50] if made in connection with an automatic payment plan). You may not make
total Premium payments to this Contract in excess of [$1,000,000] or such lesser amount the
Company establishes.
You may allocate Premium payments among Fixed Account Option(s) and Investment Divisions
available at the time of payment in amounts not less than [$100]. The Company may restrict or
refuse Premium allocations to a Fixed Account Option(s) at any time as outlined in the Transfer
provisions on page 10 and in the Fixed Account provisions on page 13. The Company will allocate
any Premium payment subsequent to issue according to Your most recent instructions on file with
the Company, provided that each allocation complies with the Company's then current minimum
amounts and restrictions.
Systematic Investment Allocation Amount. The minimum Contract Value required to
participate in the enhanced interest rate dollar cost averaging program is [$15,000].
CONTRACT OPTIONS:
Separate Account. [JNLNY Separate Account I]
Investment Division(s). Investment Division(s) available at issue are identified in the Contract
application, current prospectus and any supplements. The Company may offer new Investment
Divisions, or eliminate, substitute, or combine Investment Divisions.
Fixed Account Options. [1-Year Period; 3-Year Period; 5-Year Period; and 7-Year Period; the
availability of each option will be determined by the Company.] The 1-Year, 3-Year, 5-Year, and
7-Year periods may not be available at all times. In the event the Company discontinues the
availability of the Fixed Account Option(s) a money market Investment Division will be made
available for Premium allocation and transfers.
Available Fixed Account Options are identified in the current prospectus and any supplements.
Maximum Contract Option Allocations Allowed. The number of allocations to the Contract
Options may not exceed [99] at any time.
The Company will identify the Contract Options You select in a confirmation the Company sends
You on or after the Issue Date. The Contract Options You select are stated in the Contract
application attached to this Contract.
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VA790NY-FB1 3f
CONTRACT DATA PAGES (CONT'D)
TABLE OF INCOME OPTIONS
The following table describes values for each $1,000 of net proceeds applied to the income option.
UNDER OPTION 4 MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3
No. of
Monthly
Install-
ments
Monthly
Install-
ments
Age of
Annui-
tant
No. of Mos.
Certain
Age of
Annui-
tant
No. of Mos.
Certain
Age of
Annui-
tant
No. of Mos.
Certain
Age of
Annui-
tant
No. of Mos.
Certain
Male Life 120 240 Male Life 120 240 Female Life 120 240 Female Life 120 240
60 17.09 40 2.33 2.32 2.31 68 4.72 4.57 4.02 40 2.22 2.22 2.21 68 4.36 4.26 3.86
72 14.31 41 2.37 2.36 2.35 69 4.90 4.72 4.09 41 2.26 2.26 2.25 69 4.52 4.40 3.94
84 12.33 42 2.41 2.41 2.39 70 5.09 4.89 4.16 42 2.30 2.30 2.29 70 4.69 4.55 4.02
96 10.84 43 2.45 2.45 2.43 71 5.31 5.06 4.23 43 2.34 2.34 2.32 71 4.87 4.70 4.09
108 9.68 44 2.50 2.50 2.47 72 5.54 5.24 4.29 44 2.38 2.38 2.36 72 5.06 4.87 4.16
120 8.76 45 2.55 2.54 2.52 73 5.79 5.43 4.34 45 2.42 2.42 2.40 73 5.28 5.04 4.22
132 8.00 46 2.60 2.59 2.56 74 6.06 5.63 4.39 46 2.47 2.47 2.45 74 5.51 5.23 4.28
144 7.37 47 2.65 2.64 2.61 75 6.35 5.83 4.43 47 2.52 2.51 2.49 75 5.76 5.42 4.34
156 6.84 48 2.71 2.70 2.66 76 6.67 6.04 4.47 48 2.57 2.56 2.54 76 6.03 5.62 4.38
168 6.38 49 2.77 2.76 2.71 77 7.02 6.26 4.50 49 2.62 2.61 2.59 77 6.33 5.83 4.43
180 5.98 50 2.83 2.82 2.76 78 7.40 6.48 4.52 50 2.67 2.67 2.64 78 6.65 6.04 4.46
192 5.64 51 2.89 2.88 2.82 79 7.81 6.70 4.54 51 2.73 2.72 2.69 79 7.01 6.26 4.49
204 5.33 52 2.96 2.94 2.88 80 8.27 6.92 4.56 52 2.79 2.78 2.74 80 7.40 6.48 4.52
216 5.06 53 3.03 3.01 2.94 81 8.76 7.13 4.57 53 2.85 2.84 2.80 81 7.83 6.70 4.54
228 4.82 54 3.10 3.08 3.00 82 9.30 7.34 4.58 54 2.92 2.91 2.85 82 8.29 6.92 4.56
240 4.60 55 3.18 3.16 3.06 83 9.89 7.53 4.58 55 2.99 2.98 2.91 83 8.80 7.13 4.57
252 4.40 56 3.26 3.23 3.13 84 10.54 7.72 4.59 56 3.07 3.05 2.98 84 9.35 7.33 4.58
264 4.22 57 3.35 3.32 3.19 85 11.26 7.88 4.59 57 3.14 3.12 3.04 85 9.95 7.52 4.58
276 4.06 58 3.44 3.40 3.26 86 12.05 8.03 4.59 58 3.23 3.20 3.11 86 10.59 7.70 4.59
288 3.90 59 3.54 3.49 3.34 87 12.91 8.17 4.59 59 3.31 3.29 3.18 87 11.28 7.87 4.59
300 3.77 60 3.64 3.59 3.41 88 13.86 8.28 4.60 60 3.40 3.37 3.25 88 12.03 8.02 4.59
312 3.64 61 3.74 3.69 3.48 89 14.88 8.38 4.60 61 3.50 3.46 3.32 89 12.84 8.15 4.59
324 3.52 62 3.86 3.79 3.56 90 15.99 8.46 4.60 62 3.60 3.56 3.40 90 13.71 8.27 4.60
336 3.41 63 3.98 3.91 3.64 91 17.17 8.53 4.60 63 3.71 3.66 3.47 91 14.66 8.37 4.60
348 3.31 64 4.11 4.02 3.71 92 18.43 8.58 4.60 64 3.82 3.77 3.55 92 15.70 8.45 4.60
360 3.21 65 4.24 4.15 3.79 93 19.78 8.63 4.60 65 3.95 3.88 3.63 93 16.86 8.53 4.60
66 4.39 4.28 3.87 94 21.20 8.66 4.60 66 4.07 4.00 3.71 94 18.13 8.58 4.60
67 4.55 4.42 3.95 95 22.67 8.68 4.60 67 4.21 4.12 3.79 95 19.53 8.63 4.60
Note: Due to the volume of relevant information, the Table does not provide values for Option 2;
those values are available from the Company's Service Center upon request. You may contact
the Company's Service Center as specified on the cover page of the Contract.
BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, with an
assumed net investment rate of 1.00% and a 0% expense load, provides the actuarial basis for
the Table of Income Options. The Company will determine the interest rate it uses in the present
value calculation referred to in Options 3 and 4 as described in the Income Provisions, but in no
instance will that interest rate be greater than the rate the Company uses to calculate the initial
annuity payment. The Table of Income Options does not include any applicable tax.
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VA790NY 4
DEFINITIONS
ACCUMULATION UNIT. A unit of measure the Company uses before the Income Date to
calculate the value in an Investment Division.
ANNUITANT. The natural person(s) so designated on the Contract Data Page, or by subsequent
designation, on whose life the Company bases annuity payments provided by the Contract.
References to the Annuitant include all Joint Annuitants, if applicable.
ANNUITY UNIT. A unit of measure the Company uses to calculate the amount of each Variable
Annuity Payment.
BASE INTEREST RATE. The rate of interest the Company declares for a specified Fixed Account
Option period.
BENEFICIARY(IES). The natural person(s) or entity(ies) You initially or subsequently designate
as Primary and Contingent Beneficiary(ies) to receive any death benefit provided by the Contract.
The initial designated Beneficiary(ies) are identified on the Contract Data Page.
BUSINESS DAY. Any day that the New York Stock Exchange (NYSE) is open for business. The
Business Day ends when the NYSE closes for the day.
CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract described herein.
CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.
CONTRACT OPTION(S). The allocation options the Contract offers. Each Contract Option is
more fully explained in the Accumulation Provisions.
CONTRACT QUARTERLY ANNIVERSARY. Each three-month anniversary of the Issue Date.
CONTRACT VALUE. The sum of the Separate Account Contract Value and the Fixed Account
Contract Value.
CONTRACT YEAR. The twelve-month period beginning on the Issue Date and on any Contract
Anniversary thereafter while the Contract remains in force.
CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate the
Company credits, but never less than the Fixed Account Minimum Interest Rate.
DESIGNATED OPTION(S). The Investment Division(s) and/or Fixed Account Option(s) You
select to which amounts will be transferred from a Source Option pursuant to one of the
Company's systematic investment programs.
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VA790NY 8
GENERAL PROVISIONS (CONT'D)
MINIMUM BENEFITS. For any paid-up annuity option, cash value or death benefit, the amount
available under this Contract shall not be less than the minimum benefits required by the state of
New York.
MISSTATEMENT OF AGE AND/OR SEX. If Your or the Annuitant's age and/or sex is misstated
at the time the Contract's Income Payments become payable, the Company will adjust the
payments to reflect income consistent with the correct age and/or sex. Immediately upon
discovery, the Company will adjust the next payment due as a credit or charge, as appropriate,
for any underpayments or overpayments using the Misstatement of Age or Sex Interest Rate
shown on the Contract Data Page.
MODIFICATION OF CONTRACT. No producer or financial representative has authority to
change or waive any of this Contract's provisions. No change to or waiver of this Contract's terms
is valid unless in writing and signed by the Company's President, a Vice President, Secretary or
Assistant Secretary and filed with the New York Department of Financial Services prior to use.
Written consent of the Owner will be obtained prior to changing any terms and conditions of the
Contract in a manner that diminishes the Owner's rights and/or benefits under the Contract.
NONPARTICIPATING. This Contract is nonparticipating and does not share in the Company's
surplus or earnings.
OWNER. You may change the Owner or any Joint Owner, but the Company will be bound by a
change of ownership only if submitted in a form acceptable to the Company, received in Good
Order at the Company's Service Center and recorded. No person whose age exceeds the
maximum issue age the Company had set as of the Issue Date may become a new Owner. Unless
You specify otherwise, a change of ownership will take effect on the date the request is signed
by You, subject to any payments the Company has made or other actions the Company has taken
before the Company receives and records the request. Joint Owners have equal ownership rights;
therefore, each Owner must authorize any exercise of Contract rights unless the Joint Owners
instruct the Company in writing to act upon authorization of an individual Joint Owner. The
Company reserves the right to limit the number of Joint Owners to two (2). The Company
assumes no responsibility for the validity or tax consequences of any ownership change.
If You make an ownership change, You may have to pay taxes. The Company encourages
You to seek legal and/or tax advice.
PROOF OF AGE, SEX AND/OR SURVIVAL. The Company at any time may require proof of age
and/or sex satisfactory to the Company. If any payment required by this Contract depends on a
living Annuitant, Owner or Beneficiary, the Company may require proof of that person's survival
satisfactory to the Company.
PROTECTION OF PROCEEDS. A Beneficiary may not assign Contract proceeds before the
proceeds are payable. Contract proceeds are not subject to the claims of creditors or to legal
process unless required by New York law.
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VA790NY 11
GENERAL PROVISIONS (CONT'D)
Systematic Investment. The Company may offer systematic investment programs that allow
You to transfer funds among the Investment Divisions and the Fixed Account Options from time
to time. These programs may include but are not limited to, dollar cost averaging, portfolio
rebalancing, and the automatic monthly transfer of earnings from the 1-Year Fixed Account Option
and/or money market Investment Division to other Investment Divisions and Fixed Account
Options. After issue of Your Contract, You may elect one of the programs by contacting the
Company's Service Center to obtain materials and forms that describe, and are required to
participate in, these programs. The Company makes no guarantee that these programs will result
in a profit or protect against loss in a declining market.
The Company's optional dollar cost averaging program permits You to authorize the automatic
monthly, quarterly, semiannual, or annual transfer of a fixed dollar amount or selected percentage
of the value of a Source Option to one (1) or more Designated Option(s).
The Company may offer an enhanced interest rate on Premium which an Owner that selects
dollar cost averaging allocates to the 1-Year Fixed Account Option (Source Option). You may
participate in the enhanced interest rate dollar cost averaging program only if Your Contract Value
is at least equal to the minimum amount specified on the Contract Data Page. Under an enhanced
interest rate dollar cost averaging program, amounts You allocate to the Source Option are
automatically transferred to the Designated Option(s) of Your choice at a monthly frequency within
a 6-month or 12-month duration until all amounts in the 1-Year Source Option have been
transferred. The Company may elect not to offer one or both durations at any time. When offered,
You may contact the Company's Service Center to request the interest rates and the specified
periods applicable to the enhanced interest rate dollar cost averaging program.
If You elected the enhanced interest rate dollar cost averaging program when this Contract was
issued, the duration and interest rates will be specified on the Contract Data Page. If You elect
this program after issue of Your Contract, a confirmation showing the duration and interest rate
applicable will be sent to You. The predetermined level monthly transfer amount is calculated
such that the entire balance of the Source Option will be completely transferred by the end of the
specified duration. In the event You cancel participation in the enhanced interest rate dollar cost
averaging program, the Company will transfer the Source Option balance, including any interest,
into the Designated Option(s) You selected.
WRITTEN NOTICE. Written information or instructions You intend to give the Company must be
in Good Order and delivered to the Company's Service Center, unless the Company advises You
otherwise. A notice relating to Owner, Beneficiary designation or assignment changes shall take
effect on the date the request is signed by You, subject to any payments the Company has made
or other actions the Company has taken before the Company receives and records the request.
Instructions included in the Written Notice will take effect on the date the Company receives the
notice in the Company's Service Center.
The Company will deliver any notice or communication to Your last address in the Company's
records unless You request otherwise in writing. You are responsible for promptly providing the
Company notice of any address change or any error in a Company notice sent to You. In the case
of Joint Owners, the Company will send notices and other communications to the primary Owner's
address.
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VA790NY 13
ACCUMULATION PROVISIONS (CONT'D)
You may allocate Premium, or make transfers from the Investment Divisions, to the Fixed Account
Options at any time before the Income Date, subject to the provisions of this Contract. You may
not select any Fixed Account Option, other than the 1-Year Fixed Account Option, that extends
beyond the Income Date.
Within at least fifteen (15) days, but not more than forty-five (45) days, prior to the end of any
Fixed Account Option period, the Company will notify You of Your ability to:
a) withdraw amounts allocated to the Fixed Account Option within thirty (30) days following the
end of that Fixed Account Option without a Market Value Adjustment;
b) elect any available Fixed Account Option of a different duration within thirty (30) days following
the end of that Fixed Account Option;
c) elect a transfer to Investment Division(s) within thirty (30) days following the end of that Fixed
Account Option; or
d) elect a Fixed Account Option with the same duration, if available, within thirty (30) days
following the end of that Fixed Account Option.
When Your selected Fixed Account Option ends:
1. If the option ends within one (1) year of the Income Date, the Company will renew You into
the 1-Year Fixed Account Option.
2. If the option ends more than one (1) year before the Income Date, You may specify a new
Fixed Account Option that does not extend beyond the Income Date within thirty (30) days of
the end of the expired Fixed Account Option.
3. If You do not specify a Fixed Account Option within thirty (30) days of the end of the expired
Fixed Account Option:
a. if the same option is available at the time and does not extend beyond the Income Date,
the Company will renew You into the same Fixed Account Option.
b. if the same option is available at the time but extends beyond the Income Date, the
Company will select the available Fixed Account Option that ends closest to but before
the Income Date.
c. if the same option is not available at the time but would not extend beyond the Income
Date were it available, the Company will select the available Fixed Account Option with
the duration closest to but less than the Fixed Account Option that just ended.
4. If there are no Fixed Account Option periods available at the end of the Fixed Account Option
period the Company will default to a money market Investment Division, unless You specify
otherwise.
The Company may restrict or refuse future Premium payments, Premium allocation and transfers
to the Fixed Account Option(s) at any time, on a nondiscriminatory basis, if the yield on investment
would not support the minimum interest rate guaranteed under the Fixed Account(s). Should the
Company impose such restrictions, the Company will give at least thirty (30) days advance notice
to the Owner. The Company will also provide Written Notice when such restrictions no longer
exist.
If the Company restricts or discontinues the Fixed Account Option(s) all transfers or withdrawals
will be at least equal to the Contract Value without being subject to a negative Market Value
Adjustment or Transfer Charges.
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VA790NY 15
WITHDRAWAL PROVISIONS
On or before the Income Date You may request a total or partial withdrawal of the Withdrawal
Value by submitting a request to the Company's Service Center in a form acceptable to the
Company.
Amounts You withdraw from a Fixed Account Option may incur a Market Value Adjustment.
Upon a total withdrawal, You will receive the Withdrawal Value. The Withdrawal Value will be
based on values determined at the end of the Business Day on which the Company receives Your
request for withdrawal in Good Order at the Company's Service Center. In the event You request
a total withdrawal, You must return this Contract or a completed Affidavit of Lost Contract to the
Company's Service Center.
No withdrawal may exceed the Withdrawal Value.
Any partial withdrawal must be either:
1. an amount not less than the minimum partial withdrawal amount specified on the Contract
Data Page; or
2. an amount equal to Your entire interest in an Investment Division or Fixed Account Option.
If the Contract Value is less than the minimum partial withdrawal amount specified on the Contract
Data Page, the Company will treat any withdrawal as a total withdrawal and the Company will pay
You the Withdrawal Value. The Company may vary the minimum withdrawal amount, specified
on the Contract Data Page, in connection with a systematic withdrawal program.
If a partial withdrawal is requested that would reduce the Contract Value below the minimum
Contract Value specified on the Contract Data Page, the Company will treat the withdrawal
request as a total withdrawal.
The Company will take the withdrawal amount from each Investment Division and Fixed Account
Option in proportion to the current value of those Contract Options, unless You specify otherwise.
The Company will determine values at the end of the Business Day on which the Company
receives the request for withdrawal in Good Order at the Company's Service Center.
You may take systematic monthly, quarterly, semiannual, or annual withdrawals of a specific
amount of the Contract Value, subject to the minimum partial withdrawal amount made in
connection with a systematic withdrawal program specified on the Contract Data Page.
Systematic withdrawals from a Fixed Account Option may incur a Market Value Adjustment.
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VA790NY 19
INCOME PROVISIONS (CONT'D)
OPTION 2 - JOINT AND SURVIVOR INCOME. A monthly payment for the longer of the
Annuitant's lifetime or that of a second person You designate. Upon the occasion of the first
person to die, monthly payments continue during the survivor's lifetime at either the full amount
previously payable or as a percentage (either one-half or two-thirds) of the full amount, as You
select at the time You elect the income option. The Company will calculate Variable Annuity
Payments using either one-half or two-thirds of the number of each type of Annuity Unit credited
if reduced annuity payments to the survivor are desired. The Company will calculate Fixed Annuity
Payments equal to either one-half or two-thirds of the Fixed Annuity Payment payable during the
joint life of the Annuitant and the designated second person.
All payments end upon the death of the last surviving Annuitant. However, in the event of the
deaths of the Annuitant and the designated second person before the first monthly payment, the
Company will pay the amount allocated to this income option to You or, if You are deceased, Your
Beneficiary.
OPTION 3 - LIFE INCOME WITH 120 OR 240 MONTHLY PERIODS GUARANTEED. A monthly
payment for the Annuitant's lifetime with the guarantee that the Company will make no fewer than
120 or 240 monthly payments to You. If, at the Annuitant's death, fewer than the guaranteed
number of payments have been made, the remaining guaranteed payments will be made to You
as previously scheduled. In the event You die before the Company makes the specified number
of guaranteed payments, Your Beneficiary may elect to continue to receive the Income Payments
according to the terms of this Contract, or alternatively may elect to receive the present value of
any remaining guaranteed payments in a single lump-sum payment, the amount of which the
Company will calculate using the interest rate the Company originally used to determine the
benefit payments upon annuitization.
OPTION 4 - INCOME FOR A SPECIFIED PERIOD. A monthly payment for any number of years
ranging from 5 to 30. This election must be made for full 12-month periods. In the event You die
before the Company makes the specified number of payments, Your Beneficiary may elect to
continue to receive the Income Payments according to the terms of this Contract, or alternatively
may elect to receive the present value of any remaining guaranteed payments in a single lump-
sum payment, the amount of which the Company will calculate using the interest rate the
Company originally used to determine the benefit payments upon annuitization.
ADDITIONAL INCOME OPTIONS. The Company may make available other income options.
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VA790NY 20
INCOME PROVISIONS (CONT'D)
The Owner may elect either fixed or variable annuity payments as described below.
FIXED ANNUITY PAYMENTS. The Company will determine Fixed Annuity Payments by
applying annuity rates consistent with the age and sex of the Annuitant and, if applicable, the
designated second person, to the Contract Value. Annuity rates applied will not be less than
the rates provided in the Contract's Table of Income Options.
Once begun, the Company will not change the amount of Fixed Annuity Payments.
VARIABLE ANNUITY PAYMENTS. The Company will determine the initial Variable Annuity
Payment by applying annuity rates consistent with the age and sex of the Annuitant and, if
applicable, the designated second person, to the Contract Value allocated to the Investment
Divisions. Annuity rates applied will not be less than the rates provided in the Contract's Table of
Income Options.
The Company will determine the second and subsequent Variable Annuity Payments in two (2)
steps. First, the Company will divide the initial Variable Annuity Payment by the Annuity Unit Value
calculated on the Income Date to establish a number of Annuity Units. Second, the Company will
multiply the number of Annuity Units by the Annuity Unit Value determined on the Business Day
next preceding the date on which each payment is due. The result of each calculation determines
the Variable Annuity Payment due.
Once Variable Annuity Payments have begun, the number of Annuity Units remains constant
absent a reallocation of the Investment Divisions. Variable Annuity Payments are not affected by
expenses other than taxes.
Neither expenses actually incurred, other than taxes on the investment return, nor mortality
actually experienced, shall adversely affect the dollar amount of Variable Annuity Payments after
such payments have commenced.
Annuity Unit Value. The Company sets the initial value of an Annuity Unit of each Investment
Division when the Company establishes the Investment Division. The Annuity Unit Value reflects
the investment performance of an Investment Division and may increase or decrease from one
(1) Business Day to the next. The Contract's Table of Income Options assumes the net investment
rates described in the Contract's Basis of Computation provision. Therefore, if an Investment
Division's actual net investment rate is greater than or less than the assumed net investment rate,
Variable Annuity Payments will increase or decrease accordingly over time.
The Company calculates each Investment Division's Annuity Unit Value for any Business Day in
two (2) steps:
First, the Company multiplies the immediately preceding Business Day's Annuity Unit Value by
the Business Day's "net investment factor" determined on the day of the calculation. The
Company determines the "net investment factor", which reflects changes in the Investment
Division's net asset value, by dividing the value established at (1) below by the value established
at (2) below, and then subtracting the value established at (3) below, where: