Exhibit 4(p)
THE FRANKLIN LIFE INSURANCE COMPANY
Franklin Square
SPRINGFIELD, ILLINOIS 62713
A Stock Company
Contract Number 1234567
Date of Issue DECEMBER 1, 1981
Name of Xxxxxxxxx XXXXXXXX XXXXXXXX 65 Age
Total Purchase Price $10,000.00 $5,000.00 For Fixed Dollar Annuity Payment
$5,000.00 For Separate Account Annuity Units
Amount of Fixed Dollar
Annuity Payment $43.25
Number of Separate Account
Annuity Units 43.252
Frequency of Income
Payments MONTHLY
Date of First Income
Payment JANUARY 1, 1982
The Franklin Life Insurance Company agrees to pay the Annuitant income
payments with the frequency shown above, the first payment to be made on the
date shown above if the Annuitant is then living, and to continue such payments
so long as the Annuitant shall live. The dollar amount of each payment shall be
determined as provided in provision 2.
The provisions on this and the following pages are part of the contract.
NOTICE OF 10 DAY RIGHT TO EXAMINE CONTRACT
At any time within 10 days after its receipt by the Insured, this contract
may be returned by delivering it or mailing it to the Company or to the agent
through whom it was purchased. Immediately upon such delivery or mailing, the
contract will be deemed void from the beginning, and any premium paid on it will
be refunded.
Signed for the Company at Springfield, Illinois.
Secretary President
A BRIEF DESCRIPTION OF THIS CONTRACT
This is a Single Payment Life Annuity. Income is payable for the lifetime of
the Annuitant. The contract is nonparticipating.
ALL INCOME PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT,
WHEN BASED ON INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT,
ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR
AMOUNT.
FORM 1177
ALPHABETIC GUIDE TO YOUR CONTRACT
Page
Age 1
Age and Sex Misstatement 3
Amount of Fixed Dollar Annuity Payment 1
Application Last Page
Assignment 2
Brief Description of Contract 1
Change of Ownership 2
Consideration - Entire Contract 2
Contract Number 1
Date of First Income Payment 1
Date of Issue 1
Determination of Amount of Income Payment 2
Evidence that Annuitant is Living 3
Frequency of Income Payments 1
General Definitions 2
Incontestability 3
Page
Modification of Contract 2
Name of Annuitant 1
*Name of Contingent Annuitant 1
Nonparticipating 3
Number of Separate Account Annuity Units 1
Owner 2
Ownership of Assets and Determination of Values 3
Right to Examine Contract 1
Separate Account Annuity Unit Values 2
Separate Account Net Investment Rate and Net Investment Factor 2
Statements in Application 2
Termination of Contract 3
Total Purchase Price 1
Voting Rights 3
*This provision is not included in all contracts.
FORM 8435
1. GENERAL DEFINITIONS As used in this contract, the terms:
(a) "Variable Annuity" means an annuity with payments varying in amount in
accordance with the net investment experience of the Separate Account;
(b) "Fixed Dollar Annuity" means an annuity with payments which remain
fixed as to dollar amount throughout the payment period;
(c) "Income Payment" means the sum of the variable annuity payment and the
fixed dollar annuity payment;
(d) "General Account" means all assets of the Company other than those in
the Separate Account or any other separate accounts of the Company.
Reserves for any fixed dollar benefits shall be maintained in the
General Account;
(e) "Separate Account" means those assets of the Company in a segregated
investment account entitled "Franklin Life Variable Annuity Fund C"
established by the Company pursuant to Illinois law;
(f) "Valuation Date" means the date as of which the Separate Account Net
Investment Rate is determined. This value is determined on each day
that the New York Stock Exchange is open, as of the close of trading
on that day;
(g) "Valuation Period" means the period, commencing on a Valuation Date
and ending on the next Valuation Date;
(h) "Separate Account Annuity Unit" means a unit used to determine the
amount of each variable annuity payment; (See provision 4 dealing with
Separate Account Annuity Unit values.)
(i) "Written request" means a written request satisfactory to the Company,
filed at its Home Office in Springfield, Illinois.
2. DETERMINATION OF THE AMOUNT OF INCOME PAYMENT--
(a) Variable Annuity--The dollar amount of the Variable Annuity Payment
is not predetermined and may change from one payment to the next.
The actual amount of any such payment is determined by multiplying the
number of Separate Account Annuity Units shown on page 1 by the
Separate Account Annuity Unit value, determined is described in
provision 4, for the date on which the payment is due.
The Company guarantees that the dollar amount of each payment shall
not be affected by variations in mortality experience from mortality
assumptions on which the first payment is based.
(b) Fixed Dollar Annuity--Fixed Dollar Annuity payments remain fixed as to
dollar amount throughout the payment period. The dollar amount is as
stated on page 1.
3. SEPARATE ACCOUNT NET INVESTMENT RATE AND NET INVESTMENT FACTOR--The
Separate Account net investment rate for any Valuation Period is equal to
the gross investment rate expressed in decimal form to 8 places less a
deduction of not more than .00006164 for each day of such Valuation
Period. The deduction may be reduced by the Company. Such gross
investment rate is equal to (i) the investment income for the valuation
period plus capital gains and minus capital losses for the period,
whether realized or unrealized, on the assets of the Separate Account
less a deduction for any applicable taxes arising from such income and
realized and unrealized capital gains attributable to the assets of the
Separate Account, divided by (ii) the value of assets in the Separate
Account at the beginning of the Valuation Period. The gross investment
rate may be positive or negative. The net investment factor for the
Separate Account is 1.00000000 plus the Separate Account net investment
rate for the period.
4. SEPARATE ACCOUNT ANNUITY UNIT VALUE--The value of a Separate Account
Annuity Unit on July 1, 1981 was established at $1, and for each day
thereafter is determined by multiplying the value of the Separate Account
Annuity Unit on the preceding day by the Annuity Change Factor for the
Valuation Period ending on the 10th preceding day or by 1.0 if no
Valuation Period ended on the 10th preceding day. The Annuity Change
Factor is equal to the amount determined by dividing the net investment
factor for such Valuation period by an amount equal to one (1) plus the
interest rate for the number of calendar days in such Valuation Period at
the effective annual rate of 3-1/2%.
5. CONSIDERATION--ENTIRE CONTRACT: This contract has been issued in
consideration of the application and of the Purchase Price.
This contract and the application, a copy of which is attached to and made
a part of this contract, constitute the entire contract and shall be
construed according to the laws of the jurisdiction where it is made.
6. STATEMENTS IN APPLICATION--All statements made in the application shall,
in the absence of fraud, be deemed representations and not warranties.
No statement shall be used in defense to a claim under this contract
unless it is contained in the application and unless a copy of the
application is attached to this contract when issued.
7. MODIFICATION OF CONTRACT-- Any change in this contract will be valid
only when it is approved in writing by the President or Secretary of
the Company, and the approval is endorsed on the contract or otherwise
recorded as the Company may require. No agent or person other than the
above has the authority to change, modify or waive any provision of this
contract.
8. OWNER--The Owner of this of this contract will be the Annuitant unless
otherwise designated in the application for this contract, or otherwise
provided by endorsement at date of issue or unless subsequently changed
as provided below. The relationship of the Owner is the relationship to
the Annuitant, unless otherwise stated.
During the Annuitant's lifetime, all rights under this contract belong
exclusively to the Owner unless the Owner provides otherwise by written
request. Such rights include the right to assign or surrender this
contract and to exercise, receive and enjoy every other right, option and
privilege conferred by this contract or allowed by the Company.
9. CHANGE OF OWNERSHIP--The Owner may designate a new owner and may
designate or change a Contingent Owner at any time during the
Annuitant's lifetime by filing a written request at the Home Office of the
Company. Such designation or change will take effect only when endorsed
upon this contract or otherwise recorded as the Company may require, but
upon endorsement or recording the change will relate back to, and take
effect as of, the date said written request was signed whether or not the
Annuitant be living at the time of such endorsement or recording, subject
to the rights of any Assignee of record with the Company and subject to any
payment made or action taken by the Company before the written request for
designation or change was received at the Home Office.
At the death of the Owner during the Annuitant's lifetime, the Contingent
Owner, if any, will be become the Owner, but if no Contingent Owner is then
living, ownership will pass to the estate of the Owner.
10. ASSIGNMENT--No assignment of this contract will be binding on the
Company unless the assignment is in writing and filed at the Home Office.
The Company is not responsible for the validity of any assignment.
FORM 1177 PAGE 2
11. INCONTESTABILITY--This contract will be incontestable after it has been
in force during the lifetime of the Annuitant for 2 years from its date of
issue.
12. AGE AND SEX--If the age or sex of the Annuitant has been misstated, the
amounts payable and any benefits accruing hereunder shall be such as the
Purchase Price would have purchased at the correct age and sex of the
Annuitant. Any underpayments already made by the Company shall be made
up immediately and any overpayments made by the Company shall be charged
against the benefits falling due after adjustment, with compound interest
at 5.7% a year in advance.
13. EVIDENCE THAT ANNUITANT IS LIVING--The Company shall as a condition of
each payment to the Annuitant have the right to require satisfactory
evidence that the Annuitant is living on the due date of such income
payment.
14. TERMINATION OF CONTRACT--On the death of the Annuitant, this contract shall
immediately cease and become void. The annuity herein provided shall
terminate with the last regular payment preceding said death, and there
shall be no payment due for time elapsed since the due date of the last
regular payment.
15. NONPARTICIPATING--This contract is nonparticipating and will not share in
the surplus earnings of the Company.
16. VOTING RIGHTS--The Owner shall have the right to vote only at the
meetings of the Separate Account Contract Owners.
Ownership of this contract shall not entitle any person to vote at any
meeting of shareholders of the Company. Votes attributable to the
contract shall be cast in conformity with the provisions of the Rules and
Regulations of the Separate Account.
17. OWNERSHIP OF ASSETS AND DETERMINATION OF VALUES--The Company shall have
exclusive and absolute ownership and control of its assets, including all
assets in the Separate Account. Determination by the Company of the value
of a Separate Account Unit by the method described in this contract will be
conclusive upon the Owner and the Annuitant.
FORM 1177 PAGE 3
THE FRANKLIN LIFE INSURANCE COMPANY
A BRIEF DESCRIPTION OF THIS CONTRACT
This is a Single Payment Life Annuity. Income is payable for the Iifetime of
the Annuitant. The contract is nonparticipating.
ALL INCOME PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT,
WHEN BASED ON INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT,
ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR
AMOUNT.
FORM 1177
