PLEASE READ THIS CONTRACT CAREFULLY
Annuity benefit payments and other values provided by this contract, when based
on the investment performance of the Variable Account, may increase or decrease
and are not guaranteed as to fixed dollar amount. Please refer to the Value of
the Variable Account section for additional information.
VALUES REMOVED FROM A GUARANTEE PERIOD ACCOUNT PRIOR TO THE END OF ITS GUARANTEE
PERIOD MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT THAT MAY INCREASE OR DECREASE
THE VALUES. A NEGATIVE MARKET VALUE ADJUSTMENT WILL NEVER BE APPLIED TO THE
DEATH BENEFIT. A POSITIVE MARKET VALUE ADJUSTMENT, IF APPLICABLE, WILL BE ADDED
TO THE DEATH BENEFIT WHEN THE BENEFIT PAID IS THE CONTRACT'S ACCUMULATED VALUE.
A TRANSFER, WITHDRAWAL OR SURRENDER FROM A GUARANTEE PERIOD ACCOUNT AFTER THE
EXPIRATION OF ITS GUARANTEE PERIOD WILL NOT BE SUBJECT TO A MARKET VALUE
ADJUSTMENT. PLEASE REFER TO THE MARKET VALUE ADJUSTMENT SECTION FOR ADDITIONAL
INFORMATION.
RIGHT TO EXAMINE CONTRACT
FOR NON-INDIVIDUAL RETIREMENT ANNUITIES (IRAs): The Owner may cancel this
contract by returning it to the Company or one of its authorized representatives
within ten days (or sixty days if this contract replaces an existing contract)
after receipt. If returned, the Company will refund an amount equal to the
Accumulated Value, after application of the Market Value Adjustment, plus any
fees or other charges imposed.
FOR IRAs: The Owner may cancel this contract by returning it to the Company or
one of its authorized representatives within ten days (or sixty days if this
contract replaces an existing contract) after receipt. If returned, the Company
will refund gross payments. In a replacement situation, if the contract is
returned after ten days but prior to sixty days after receipt, the Company will
refund an amount equal to the Accumulated Value, after application of any Market
Value Adjustment, plus any fees or other charges imposed.
FIRST ALLMERICA FINANCIAL LIFE INSURANCE COMPANY
Home Office: Worcester, Massachusetts
Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000
This contract is a legal contract between First Allmerica Financial Life
Insurance Company (the Company) and the Owner and is issued in consideration of
the Initial Payment shown on the Specifications page. Additional Payments are
permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account
or Guarantee Period Accounts. While this contract is in effect, the Company
agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a
Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date.
Sub-Account Charges: Mortality and Expense Risk Charge of 1.60%; and
Administrative Charge of .15%; both charges on an annual basis of the daily
value of the Sub-Account assets; if a rider was selected, additional charges may
apply. See Specifications Page for further information.
A Monthly Variable Annuity Benefit Payment will not decrease if the annual
performance of the applicable Sub-Account(s) is 4.75% (with a 3% Assumed
Investment Return).
/s/ Xxxx X. X'Xxxxx /s/ Xxxxxxx X. Xxxxxx
President Secretary
Flexible Payment Deferred Variable, Fixed and Market Value Adjusted Annuity
Annuity Benefit Payments Payable on the Annuity Date
Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date
Non-Participating
Form A3037-02NY 1 NYLS1
TABLE OF CONTENTS
SPECIFICATONS ............................................... 3
DEFINITIONS ................................................. 9
OWNER, ANNUITANT AND BENEFICIARY ............................ 12
THE ACCUMULATION PHASE
PAYMENTS ........................................... 14
VALUES ............................................. 14
TRANSFER ........................................... 16
XXXXXXXXXX AND SURRENDER ........................... 16
DEATH BENEFIT ...................................... 20
THE PAYOUT PHASE
ANNUITY BENEFIT .................................... 22
TRANSFER ........................................... 24
WITHDRAWAL ......................................... 24
PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS .......... 25
DEATH OF THE ANNUITANT ............................. 25
ANNUITY BENEFIT PAYMENT OPTIONS .................... 26
ANNUITY LIFE GUARANTEE OPTIONS ..................... 26
ANNUITY OPTION RATE TABLES ......................... 26
GENERAL PROVISIONS .......................................... 30
Form A3037-02NY 2 NYLS1
SPECIFICATIONS
(TO BE ISSUED ON THE ISSUE DATE)
Contract Type: Non-Qualified Contract Number: zz00600000
Issue Date: 01/01/02 Annuity Date: 01/01/2040
(Must be at least 30 days after issue date)
Owner: Xxxx Xxx Owner Date of Birth: 01/01/1950
Joint Owner: Xxxx Xxx Joint Owner Date of Birth: 01/01/1950
Annuitant: Xxxx Xxx Xxxxxxxxx Date of Birth: 01/01/1950
Joint Annuitant: Xxxx Xxx Joint Annuitant Date of Birth: 01/01/1950
Annuitant Sex: Male Beneficiary(ies):
Joint Annuitant Sex: Male Primary: Surviving Joint Owner, if any
1st Contingent: Xxxx Xxx
2nd Contingent: Xxx Xxx
Minimum Fixed Account Minimum Additional Payment
Guaranteed Interest Rate: 3% Amount: $50.00
Guarantee Period Account Guarantee Period Account
Minimum Interest Rate: 3% Minimum Allocation Amount: $1,000.00
Minimum Withdrawal Maximum Alternative Annuity Date: 01/01/2040
Amount: $100.00 (Must be at least 30 days after issue date)
Minimum Annuity
Benefit Payment: $20.00
Surrender Charge Table:
YEARS FROM SURRENDER CHARGE AS A
DATE OF PAYMENT PERCENT OF THE PAYMENTS
TO DATE OF WITHDRAWAL WITHDRAWN
Less Than: 1 7%
2 6%
3 4%
Thereafter 0%
Withdrawal Without Surrender Charge Percentage: 10% of Gross Payment Base
(reduced by any prior Withdrawal Without Surrender Charge in the same calendar
year)
Mortality and Expense Risk Charge: 1.60% on an annual basis of the daily value
of the Sub-Account assets.
Administrative Charge: .15% on an annual basis of the daily value of the
Sub-Account assets.
Contract Fee: $30, if the Accumulated Value is less than $75,000.00. Waived for
401(k)s.
Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000
[(0-000-000-0000)]
Form A8037-02NY 3 NYLS2
SPECIFICATIONS
(TO BE ISSUED ON THE ISSUE DATE)
Owner: Xxxx Xxx Contract Number: zzz0000000
Joint Owner: Xxxx Xxx
Initial Payment: $10,000.00
Payment Allocation: The Initial Payment is allocated in the following manner:
VARIABLE SUB-ACCOUNTS:
[Select Emerging Markets Fund Fidelity VIP Growth Portfolio
Select International Equity Fund Select Growth Fund
Xxxxxxxxxxx Global Securities Fund VA Allmerica Core Equity Fund
FT VIP Xxxxxxxxx Foreign Securities Fund Allmerica Equity Index Fund
MFS New Discovery Series AIM V.I. Blue Chip Fund
AIM V.I. Aggressive Growth Fund FT VIP Franklin Large Cap Growth Securities Fund
FT VIP Small Cap Fund Alliance Growth & Income Portfolio
Select Strategic Growth Fund MFS Total Return Series
AllianceBernstein Small Cap Value Portfolio MFS Utilities Series
Fidelity VIP Value Strategies Portfolio Xxxxxxxxxxx Main Street Growth & Income Fund VA
FT VIP Small Cap Value Securities Fund Fidelity VIP Contrafund
MFS Mid Cap Growth Series AIM V.I. Basic Value Fund
Fidelity VIP III Mid Cap Portfolio Xxxxxxxxxxx Multiple Strategies Fund VA
AIM V.I. Capital Development Fund Fidelity Equity Income Fund
Select Capital Appreciation Fund AllianceBernstein Value Portfolio
FT VIP Mutual Shares Securities Fund Select Growth & Income Fund
Select Value Opportunity Fund Xxxxxxxxxxx High Income Fund VA
Alliance Premier Growth Portfolio Select Investment Grade Income Fund
Alliance Technology Portfolio Select Strategic Income Fund
Xxxxxxxxxxx Capital Appreciation Fund VA Allmerica Government Bond Fund
AIM V.I. Premier Equity Fund Allmerica Money Market Fund]
Select Aggressive Growth Fund
FIXED ACCOUNT
Initial Interest Rate (applies only to Initial Payment) [3.0%]
Form A8037-02NY 4 NYLS2
SPECIFICATIONS (CONTINUED)
(TO BE ISSUED ON THE ISSUE DATE)
Owner: Xxxx Xxx Contract Number: zz00000000
Joint Owner: Xxxx Xxx
GUARANTEE PERIOD ACCOUNTS:
GUARANTEE PERIOD INTEREST RATE EXPIRATION DATE
[2 years [3.00% [1/01/2004
3 years 3.40% 1/01/2005
4 years 3.85% 1/01/2006
5 years 4.35% 1/01/2007
6 years 4.60% 1/01/2008
7 years 4.85% 1/01/2009
8 years 5.05% 1/01/2010
9 years 5.15% 1/01/2011
10 years] 5.20%] 1/01/2012]
A Market Value Adjustment may apply to withdrawals or transfers from a Guarantee
Period Account prior to the expiration of the Guarantee Period. This adjustment
may increase or decrease the values removed from the Guarantee Period Account.
See the "Market Value Adjustment" section for additional information.
--------------
100% TOTAL OF ALL ACCOUNTS
Form A8037-02NY 5 NYLS2
SPECIFICATIONS (CONTINUED)
(TO BE ISSUED ON THE ISSUE DATE)
Owner: Xxxx Xxx Contract Number: zzz0000000
Joint Owner: Xxxx Xxx
--------------------------------------------------------------------------------
APPLICABLE RIDER(S) AND/OR ENDORSEMENT(S):
[Annual Ratchet Enhanced Death Benefit Rider]
[See Rider for Benefit and Charge]
[15% Breakthrough Enhanced Death Benefit Rider]
[See Rider for Benefit and Charge]
[Enhanced Automatic Transfers (Dollar Cost Averaging) Program Endorsement]
[Unisex Contract Endorsement]
[403(b) Tax Sheltered Annuity Endorsement]
[Individual Retirement Annuity Plan Endorsement]
[Xxxx Individual Retirement Annuity Plan Endorsement]
Form A8037-02NY 6 NYLS2
THIS PAGE INTENTIONALLY LEFT BLANK
Form A8037-02NY 7 NYLS2
THIS PAGE INTENTIONALLY LEFT BLANK
Form A8037-02NY 8 NYLS2
DEFINITIONS
Accumulated Value The aggregate value of all accounts in
this contract before the Annuity Date. As
long as the Accumulated Value is greater
than zero, the contract will stay in effect.
Accumulation Unit A measure used to calculate the value of a
Sub-Account before annuity benefit payments
begin.
Annuitant On and after the Annuity Date, the person
upon whose continuation of life annuity
benefit payments involving life contingency
depend. Joint Annuitants are permitted and
unless otherwise indicated, any reference to
Annuitant shall include Joint Annuitants.
Annuity Date The date annuity benefit payments begin. The
Annuity Date is shown on the Specifications
page. The Annuity Date is based on the age
of the oldest Owner. If there is a
non-natural Owner, the Annuity Date is based
upon the age of the oldest Annuitant. The
Annuity Date can be changed to the maximum
alternative Annuity Date (see Specifications
page), which can be no later than the later
of the oldest Owner's age ninety or ten
years after the Issue Date.
Annuity Unit A measure used to calculate annuity benefit
payments under a variable annuity option.
Beneficiary The person, persons or entity entitled to
the Death Benefit prior to the Annuity Date
or any annuity benefit payments upon the
death of the Owner on or after the Annuity
Date.
Company First Allmerica Financial Life Insurance
Company.
Contract Year A one-year period based on the issue date or
an anniversary thereof.
Effective Valuation Date The Valuation Date on or immediately
following the day a Payment, request for
transfer, withdrawal or surrender, or Proof
of Death is received at the Principal
Office.
Fixed Account The part of the Company's General Account to
which all or a portion of a Payment or
transfer may be allocated.
Fund Each separate investment company, investment
series or portfolio eligible for investment
by a Sub-Account of the Variable Account.
General Account All assets of the Company that are not
allocated to a Separate Account.
Gross Payment Base Total gross payments made to the contract
reduced by withdrawals which exceed the
Withdrawal Without Surrender Charge amount.
Guarantee Period The number of years that a Guaranteed
Interest Rate may be credited to a Guarantee
Period Account. The Guarantee Period may
range from two to ten years.
Guarantee Period Account An account which corresponds
to a Guaranteed Interest Rate for a
specified Guarantee Period and is supported
by assets in a Separate Account. The Owner
may only invest in a Guarantee Period
Account prior to the Annuity Date.
Form A3037-02NY 9 NYLS1
Guaranteed Interest Rate The annual effective rate of interest, after
daily compounding, credited to a Guarantee
Period Account.
Market Value Adjustment A positive or negative adjustment to
earnings in a Guarantee Period Account
assessed if any portion of a Guarantee
Period Account is withdrawn or transferred
prior to the end of its Guarantee Period.
Owner The person, persons or entity entitled to
exercise the rights and privileges of
ownership under this contract. Joint Owners
are permitted and unless otherwise
indicated, any reference to Owner shall
include joint Owners.
Pro Rata How a Payment or withdrawal may be
allocated among the accounts. A Pro Rata
allocation or withdrawal will be made in the
same proportion that the value of each
account bears to the Accumulated Value.
Proof of Death The date on which both the death
certificate and all necessary claim
paperwork, as determined by the Company,
have been received at the Principal Office.
Request A request or notice made by the Owner, in a
manner consistent with the Company's current
procedures, which is received by the
Company.
Separate Account A segregated account established by the
Company. The assets in a Separate Account
are owned by the Company and are not
commingled with the Company's general assets
and obligations. The assets of a Separate
Account are not subject to claims arising
out of any other business the Company may
conduct. The amount of assets held in the
Separate Account will have a value at least
equal to the Accumulated Value of the
contracts that apply to the Separate Account
and the reserves for annuities in the course
of payment that vary with the experience of
the Separate Account for those contracts.
State The state or jurisdiction in which the
contract is issued.
Sub-Account A Variable Account subdivision that invests
exclusively in shares of a corresponding
Fund.
Surrender Value The amount payable to the Owner on
full surrender equal to the Accumulated
Value after application of any Market Value
Adjustment and less any surrender charge and
Contract Fee.
Survivor Annuity Benefit The number of Annuity Units (under a
Percentage variable joint life annuitization option) or
the dollar value of the annuity benefit
payments (under a fixed joint life
annuitization option) paid during the
surviving Annuitant's life may be less than
or equal to the number of Annuity Units paid
when both individuals are living. The
Survivor Annuity Benefit Percentage is the
percentage of total Annuity Units or dollars
paid in each annuity benefit during the
survivor's life. For example, with a Joint
and Two-thirds Survivor Option, the Survivor
Annuity Benefit Percentage is 66 2/3%. This
percentage is only applicable after the
death of the first Annuitant.
Valuation Date A day the values of all units are
determined. Valuation Dates occur on each
day the New York Stock Exchange is open for
trading, or such other dates when there is
sufficient trading in a Fund's portfolio
securities such that the current unit value
may be materially affected.
Valuation Period The interval between two consecutive
Valuation Dates.
Form A3037-02NY 10 NYLS1
Variable Account The Company's Separate Account,
consisting of Sub-Accounts that invest in
the underlying Funds.
Form A3037-02NY 11 NYLS1
OWNER, ANNUITANT AND BENEFICIARY
Owner When the contract is issued, the Owner will be as shown
on the Specifications page. The Owner may be changed in
accordance with the terms of this contract. Upon the
death of an Owner prior to the Annuity Date, a Death
Benefit is paid and the contract will no longer
continue. The Maximum Alternative Annuity Date is based
upon the age of the oldest Owner.
The Owner may exercise all rights and options granted in
this contract or by the Company, subject to the consent
of any irrevocable Beneficiary. Where there are joint
Owners, the consent of both is required in order to
exercise any ownership rights.
Assignment Prior to the Annuity Date and prior to the death of an
Owner, the Owner may be changed at any time. Only the
Owner may assign this contract. An absolute assignment
will transfer ownership to the assignee. This contract
may also be collaterally assigned as security. The
limitations on ownership rights while the collateral
assignment is in effect are stated in the assignment.
Additional limitations may exist for contracts issued
under provisions of the Internal Revenue Code.
An assignment will take place only when the Company has
actually received a written Request at the Principal
Office. The Company will not be deemed to know of the
assignment until such time. When received, the
assignment will take effect as of the date it was
signed. The assignment will be subject to payments made
or actions taken by the Company before the change was
received.
The Company will not be responsible for the validity of
any assignment nor the extent of any assignee's
interest. The interests of the Beneficiary will be
subject to any assignment.
Annuitant When the contract is issued, the Annuitant will be as
shown on the Specifications page. The Annuitant may be
changed in accordance with the terms of this contract.
Prior to the Annuity Date, an Annuitant may be replaced
or added unless the Owner is a non-natural person. At
all times there must be at least one Annuitant. If the
Annuitant dies and a replacement is not named, the Owner
will be considered to be the new Annuitant. Upon the
death of an Annuitant prior to the Annuity Date, a Death
Benefit is not paid unless the Owner is a non-natural
person. If an annuitant is also an Owner and dies, then
the Owner death benefit will apply.
A change of Annuitant will take place only when the
Company has actually received a Request indicating the
change at the Principal Office. The Company will not be
deemed to know of the change of Annuitant until such
time. When received, the change of Annuitant will take
effect as of the date it was signed. The change of
Annuitant will be subject to payments made or actions
taken by the Company before the change was received.
Form A3037-02NY 12 NYLS1
Beneficiary The Beneficiary is as named on the Specifications page
unless subsequently changed. The Owner may declare any
Beneficiary to be revocable or irrevocable. A revocable
Beneficiary may be changed at any time prior to the
Annuity Date and before the death of an Owner or after
the Annuity Date and before the death of the Annuitant.
An irrevocable Beneficiary must consent in writing to
any change. Unless otherwise indicated, the Beneficiary
will be revocable.
A Beneficiary change must be made in writing on a
Beneficiary designation form and will be subject to the
rights of any assignee of record. When the Company
receives the form, the change will take place as of the
date it was signed, even if an Owner or the Annuitant
dies after the form is signed but prior to the Company's
receipt of the form. Any rights created by the change
will be subject to payments made or actions taken by the
Company before the change was received.
All benefits payable to the Beneficiary under this
contract will be divided equally among the surviving
Beneficiaries of the same class, unless the Owner
directs otherwise. If there is no surviving Beneficiary
in a particular class (e.g., 1st Contingent Beneficiary,
see Specifications page), then the benefit is divided
equally among the surviving Beneficiaries of the next
class. If there is no surviving Beneficiary, the
deceased Beneficiary's interest will pass to the Owner
or the Owner's estate. At the death of the first joint
Owner prior to the Annuity Date, the surviving joint
Owner is the sole, primary Beneficiary notwithstanding
that the designated Beneficiary may be different.
The Beneficiary can not assign, transfer, commute,
anticipate or encumber the proceeds or payments unless
given that right by the Owner.
Protection of Proceeds To the extent allowed by law, this contract and any
payments made under it will be exempt from the claims of
creditors.
Form A3037-02NY 13 NYLS1
THE ACCUMULATION PHASE
PAYMENTS
Payments Each Payment is equal to the gross payment applied to
the contract.
Initial Payment The Initial Payment is shown on the Specifications page.
Additional Payments Prior to the Annuity Date and before the death of an
Owner, the Owner may make additional Payments of at
least the Minimum Additional Payment Amount (see
Specifications page). Total Payments made may not exceed
$2,000,000 without the Company's consent.
Payment Allocations Payments will be allocated in accordance with the
Payment Allocation, shown on the Specifications page.
Each subsequent Payment will be allocated in the same
manner unless allocation instructions accompany the
Payment or the Payment Allocation is changed by the
Owner.
The minimum amount that may be allocated to the
Guarantee Period Account is shown on the Specifications
page. If the Owner requests an allocation less than the
minimum amount, the Company will apply that amount to
the money market Sub-Account.
VALUES
Value of the Variable The value of a Sub-Account on a Valuation Date is
Account determined by multiplying the Accumulation Units in that
Sub-Account by the Accumulation Unit Value as of the
Valuation Date.
Accumulation Units are purchased when an amount is
allocated to a Sub-Account. The number of Accumulation
Units purchased equals that amount divided by the
applicable Accumulation Unit Value as of the Valuation
Date.
Accumulation Unit The value of a Sub-Account Accumulation Unit as of any
Values Valuation Date is determined by multiplying the value of
an Accumulation Unit for the preceding Valuation Date by
the Net Investment Factor for that Valuation Period.
Net Investment Factor The Net Investment Factor measures the investment
performance of a Sub-Account from one Valuation Period
to the next. This factor is equal to 1.000000 plus the
result (which may be positive or negative) from dividing
(a) by (b) and subtracting (c) and (d) where:
(a) is the investment income of a Sub-Account for
the Valuation Period, including realized or
unrealized capital gains and losses during the
Valuation Period, adjusted for provisions made
for taxes, if any;
(b) is the value of that Sub-Account's assets at
the beginning of the Valuation Period;
(c) is the Mortality and Expense Risk Charge
applicable to the current Valuation Period (see
Specifications page) plus any applicable Rider
charges; and
Form A3037-02NY 14 NYLS1
(d) is the Administrative Charge applicable to the
current Valuation Period (see Specifications
page).
The Company assumes the risk that its actual mortality
and expense experience may exceed the amounts provided
under the contract. The Company guarantees that the
charge for mortality and expense risks and the
administrative charge will not be increased. Subject to
applicable State and federal laws, these charges may be
decreased or the method used to determine the Net
Investment Factor may be changed.
Value of the Fixed Amounts allocated to the Fixed Account receive interest
Account at rates periodically set by the Company. The Company
guarantees that the initial rate of interest in effect
when an amount is allocated to the Fixed Account will
remain in effect for that amount for one year or until
such amount is transferred out of the Fixed Account,
whichever is sooner. Thereafter, the rate of interest
for that amount will be the Company's current interest
rate, but no less than the Minimum Fixed Account
Guaranteed Interest Rate (see Specifications page).
The value of the Fixed Account on any date is the sum of
amounts allocated to the Fixed Account plus interest
compounded and credited daily at the rates applicable to
those amounts. The value of the Fixed Account will be at
least equal to the minimum required by law in the State.
Value of the Guarantee A Guarantee Period Account will be established on the
Period Accounts date a net Payment or transfer is allocated to a
specific Guarantee Period. Amounts allocated to the same
Guarantee Period Account on the same day will be treated
as one Guarantee Period Account. The interest rate in
effect when an amount is allocated to a Guarantee Period
Account is guaranteed for the duration of the Guarantee
Period. Additional amounts allocated to Guarantee
Periods of the same or different durations will result
in additional Guarantee Period Accounts, each with its
own Guaranteed Interest Rate and expiration date.
The value of a Guarantee Period Account on any date is
the sum of amounts allocated to that Guarantee Period
Account plus interest compounded and credited daily at
the rate applicable to that amount.
Guaranteed Interest The Company will periodically set Guaranteed Interest
Rates Rates for each available Guarantee Period. These rates
will be guaranteed for the duration of the respective
Guarantee Periods. A Guaranteed Interest Rate will never
be less than the Guarantee Period Account Minimum
Interest Rate (see Specifications page).
Renewal Guarantee At least 15 days (but not more than 45 days) prior to
Periods the end of a Guarantee Period, the Company will notify
the Owner in writing of the expiration of that Guarantee
Period and of the right to reallocate and/or withdraw
amounts without any Market Value Adjustment during the
30 day period following the expiration date. Following
receipt of the Guarantee Period Account expiration
notice, the Owner may submit a written Request to
withdraw the monies in the account and/or to transfer
amounts to the Sub-Accounts, the Fixed Account and/or to
a new Guarantee Period Account of any duration then
offered by the Company. Guaranteed Interest Rates
corresponding to the available Guarantee Periods may be
higher or lower than the previous Guaranteed Interest
Rate. The Owner's reallocation is to be the date
following the Guarantee Period Account's expiration
date. If the Owner's reallocation/withdrawal request is
not received at the Principal Office by the expiration
date of a Guarantee Period Account, then the day
following the expiration date of the Guarantee Period
Account, the value will be automatically applied to a
new Guarantee Period Account with the same duration as
the expired Guarantee Period Account unless:
Form A3037-02NY 15 NYLS1
(a) the Guarantee Period Account value is less than
the Guarantee Period Account Minimum Allocation
Amount (see Specifications page) on its
expiration date; or
(b) the Guarantee Period would extend beyond the
Annuity Date or is no longer available.
In such cases, the Guarantee Period Account value will
be transferred to the money market Sub-Account. If,
however, a reallocation/withdrawal request for the prior
Guarantee Period Account is received within 30 days
after being automatically applied to a new Guarantee
Period Account, the Company will transfer and/or
withdraw the payment as requested without applying a
Market Value Adjustment.
Contract Fee Prior to the Annuity Date on each contract Anniversary
and when the contract is surrendered, the Company will
deduct a Contract Fee (see Specifications page) Pro
Rata.
TRANSFER
Prior to the Annuity Date, the Owner may transfer
amounts among accounts by Request to the Principal
Office. Transfers to a Guarantee Period Account must be
at least equal to the Guarantee Period Account Minimum
Allocation Amount (see Specifications page). If the
Owner requests the transfer of a smaller amount to the
Guarantee Period Account, the Company will transfer that
amount to the money market Sub-Account.
Any transfer from a Guarantee Period Account prior to
the end of its Guarantee Period will be subject to a
Market Value Adjustment.
There is no charge for the first twelve transfers per
contract year. A transfer charge of up to $25 may be
imposed on each additional transfer.
The contract is not designed for use by individuals,
professional market timing organizations, or other
entities that do "market timing," programmed transfers,
frequent transfers, or transfers that are large in
relation to the total assets of a Fund. If there is a
pattern of transfers that coincides with a market timing
strategy and/or that is disruptive to the Funds, the
Company reserves the right to refuse transfers or to
take other action (including, but not limited to,
limiting additional payments) to limit the use of such
activities.
XXXXXXXXXX AND SURRENDER
Prior to the Annuity Date, the Owner may, by Request,
withdraw a part of the Surrender Value or surrender the
contract for its Surrender Value.
Any withdrawal must be at least the Minimum Withdrawal
Amount (see Specifications page). The Request must
indicate the dollar amount to be withdrawn and the
accounts from which it is to be withdrawn. A withdrawal
from a Guarantee Period Account will be subject to a
Market Value Adjustment.
When surrendered, this contract terminates and the
Company has no further liability under it. The Surrender
Value will be based on the Accumulated Value on the
Effective Valuation Date less any surrender charge,
Contract fee and Market Value Adjustment, if applicable.
Form A3037-02NY 16 NYLS1
Amounts taken from the Variable Account will be paid
within 7 days of the date a Request is received. The
Company reserves the right to defer surrenders and
withdrawals of amounts in the Variable Account for up to
six months during any period when (1) trading on the New
York Stock Exchange is closed for other than weekends
and holidays; (2) the Securities and Exchange Commission
by order has permitted such a suspension; or (3) an
emergency exists as determined by the Securities and
Exchange Commission such that disposal of portfolio
securities or valuation of assets of the Separate
Account is not reasonably practicable.
Amounts taken from the Fixed Account or the Guarantee
Period Accounts will normally be paid within 7 days of
the date a Request is received. The Company may defer
payment for up to six months from the date a Request is
received. If deferred for 10 days or more, the amount
payable will be credited interest at the rate(s) then
being credited by the Company. However, no interest will
be paid if it is less than $25 or if the delay is
pursuant to State insurance law.
Withdrawal Without Prior to the Annuity Date, in each calendar year, by
Surrender Charge Request, the Owner may take withdrawals up to the
Withdrawal Without Surrender Charge Amount (see
Specifications page) as of the Effective Valuation Date.
The Withdrawal Without Surrender Charge will first be
deducted from cumulative earnings. To the extent that it
exceeds cumulative earnings, the excess will be
considered withdrawn on a last-in, first-out basis from
Payments not previously withdrawn.
Withdrawal With Any amounts withdrawn or surrendered in excess of the
Surrender Charge Withdrawal Without Surrender Charge amount may be
subject to a surrender charge.
These amounts will be taken on a first-in, first-out
basis from Payments not previously considered withdrawn.
The Company will compute applicable charges using the
Surrender Charge Table (see Specifications page).
Waiver of Surrender The surrender charge will be waived if an Owner, or the
Charge Annuitant if the Owner is a non-natural person , is
"physically disabled" after the issue date and after
being named Owner or Annuitant and before attaining age
65. The Company may require proof of continuing
disability, and reserves the right to obtain an
examination by a licensed "physician" of its choice and
at its expense.
"Physically disabled" means the Owner or Xxxxxxxxx has
been unable to engage in an occupation for remuneration
or profit for a period of at least 12 consecutive months
as a result of disease or bodily injury. "Physician"
means a person other than the Owner, the Annuitant or a
member of one of their families who is State licensed to
give medical care or treatment and is acting within the
scope of that license.
No additional Payments are permitted after this
provision becomes effective.
Market Value A transfer, withdrawal or surrender from a Guarantee
Adjustment Period Account after the expiration of its Guarantee
Period will not be subject to a Market Value Adjustment.
A Market Value Adjustment will apply to all other
transfers, withdrawals, or surrenders from a Guarantee
Period Account on the date of the transaction. Amounts
in a Guarantee Period Account that are applied under an
Annuity Option are treated as withdrawals and a Market
Value Adjustment may apply. The Market Value Adjustment
will be determined
Form A3037-02NY 17 NYLS1
by multiplying the amount taken from each Guarantee
Period Account by the market value factor. The market
value factor for each Guarantee Period Account is equal
to:
[(1 + i)/(1 + j)](n/365) - 1
where:
i - is the Guaranteed Interest Rate expressed as
a decimal being credited to the current
Guarantee Period;
j - is the new Guaranteed Interest Rate,
expressed as a decimal, for a Guarantee Period
with a duration equal to the number of years
remaining in the current Guarantee Period,
rounded to the next nearest number of whole
years. If this rate is not available, then the
Company will employ a method based on the U.S.
Industrial BBB Bond Indices published in
Standard and Poor's Credit Week. These indices
are contained in a table titled "Treasury and
Corporate Bond Yields". j will be equal to the
index (at the time of the calculation of the
Market Value Adjustment) at a duration equal to
the number of years remaining in the initial
Guarantee Period, rounded to the nearest number
of whole years. If a duration is not available
in the table, an index will be calculated by
linearly interpolating between the next highest
and next lowest index in the table less 2.55%.
n - is the number of days remaining from the
Effective Valuation Date to the end of the
current Guarantee Period.
If the Guaranteed Interest Rate being credited is lower
than the new Guaranteed Interest Rate, the Market Value
Adjustment will decrease the Guarantee Period Account
value (negative Market Value Adjustment). Similarly, if
the Guaranteed Interest Rate being credited is higher
than the new Guaranteed Interest Rate, the Market Value
Adjustment will increase the Guarantee Period Account
value (positive Market Value Adjustment). A positive or
negative Market Value Adjustment will never result in a
change to the Guarantee Period Account Value more than
the interest earned in excess of the Guarantee Period
Account Minimum Interest Rate (see Specifications page)
compounded daily from the beginning of the current
Guarantee Period Account.
This calculation creates a ceiling (capped) and a floor
(uncapped) that limits the impact a Market Value
Adjustment will have when money is withdrawn,
transferred or surrendered prior to the expiration of
the Guarantee Period. Examples of this are as follows:
The market value factor is:
[(1+i)/(1+j)](n/365)-1
A detailed description of this information has been
filed with the Superintendent.
DEATH BENEFIT
At the death of an Owner prior to the Annuity Date, the
Company will pay to the Beneficiary a Death Benefit upon
receipt at the Principal Office of Proof of Death. If
the Owner is a non-natural person, prior to the Annuity
Date, a Death Benefit is paid on the death of an
Annuitant, upon receipt at the Principal Office of Proof
of Death.
Form A3037-02NY 18 NYLS1
Death Benefit The Death Benefit will be the greater of:
(a) the Accumulated Value on the Effective Valuation
Date, increased by any positive Market Value
Adjustment; or
(b) the sum of the gross payments made under this
contract prior to the date of death,
proportionately reduced to reflect all partial
withdrawals.
For each withdrawal, the proportionate reduction
is calculated by multiplying the Death Benefit
under (b) above, immediately prior to the
withdrawal, by the following:
Amount of the withdrawal
-----------------------------------------------------
Accumulated Value immediately prior to the withdrawal
For example assume:
- the amount of the withdrawal is $5,000
- the Accumulated Value immediately prior to the
withdrawal is $100,000
- the death benefit under (b) above, before the
withdrawal deduction, is $110,000.
Amount of the withdrawal $5,000
----------------------------- --------
Accumulated Value immediately = $100,000 = 5%
prior to the withdrawal
Therefore, the death benefit under (b)
above, after the withdrawal deduction, is
reduced by 5%. Thus, it would be equal to
$110,000 times .95 = $104,500.
Payment of the Death Unless the Owner has specified otherwise, the Death
Benefit Benefit will be paid to the Beneficiary within 7 days of
the Effective Valuation Date. If deferred for more than
7 days after the Effective Valuation Date, the amount
payable will be credited interest at the rate(s) then
being credited by the Company. No surrender charge will
apply when the Death Benefit is paid. Alternatively, the
Beneficiary may, by a Request in writing, elect to:
(a) defer distribution of the Death Benefit for a
period no more than 5 years from the date of
death; or
(b) receive distributions over his/her life
expectancy (or over a period not extending
beyond such life expectancy). Distributions must
begin within one year from the date of death.
If distribution of the Death Benefit is deferred under
(a) or (b), any value in the Guarantee Period Accounts
will be transferred to the money market Sub-Account. The
excess, if any, of the Death Benefit over the
Accumulated Value will also be transferred to the money
market Sub-Account. The Beneficiary may, by Request,
effect transfers and withdrawals, but may not make
additional Payments. If there are multiple
Beneficiaries, the consent of all is required.
If the sole Beneficiary is the deceased Owner's spouse,
the Beneficiary may, by a Request in writing, continue
the contract and become the new Owner and Annuitant
subject to the following:
(a) any value in the Guarantee Period Accounts will
be transferred to the money market Sub-Account;
Form A3037-02NY 12 NYLS1
(b) the excess, if any, of the Death Benefit over
the contract's Accumulated Value will be also
transferred to the money market Sub-Account;
(c) additional Payments may be made; and
(d) any subsequent spouse of the new Owner, if named
as the Beneficiary, may not continue the
contract.
Form A3037-02NY 20 NYLS1
THE PAYOUT PHASE
ANNUITY BENEFIT
Annuity Options Annuity Options are available on a fixed, variable or
combination fixed and variable basis. The Annuity
Options described below or any alternative option
offered by the Company may be chosen. If no option is
chosen, monthly benefit payments will be made under the
Life Annuity with 10 Years Period Certain option.
Fixed annuity options are funded through the General
Account. Variable annuity options may be funded through
one or more of the Sub-Accounts. Not all Sub-Accounts
may be made available.
Selection of Annuity The Owner must select an Annuity Benefit Payment Option
Benefit Payments prior to or after the issue date but before the Annuity
Date. Annuity benefit payments will be paid monthly or
at any other frequency currently offered by the Company.
If the first payment would be less than the Minimum
Annuity Benefit Payment (see Specifications page), a
single payment will be made instead. If a life annuity
option has been elected, satisfactory proof of the date
of birth of the Annuitant must be received at the
Principal Office before any payment is made. Also, if a
life annuity option has been elected, from time to time,
the Company may require satisfactory proof that the
Annuitant is alive. The annuity benefit payments
provided under this contract are not less than those
required by the State.
Selection or Change The Owner must select an Annuity Date when selecting an
Of Annuity Date Annuity Benefit Payment Option. Prior to such
Annuity Date, the Owner may change the Annuity Date
by Request. The Request must be received at the
Principal Office at least one month before the new
Annuity Date. To the extent permitted by applicable
laws, rules and regulations governing variable
annuities, the new Annuity Date must be no later than
the Maximum Alternative Annuity Date shown on the
Specifications page, which can be no later than the
later of the oldest Owner's age ninety or ten years
after the Issue Date.
Annuity Benefit Payment In the case of a variable annuity option, the Owner must
Change Frequency select an Annuity Benefit Payment Change Frequency. This
is the frequency of change in the dollar value of the
variable annuity benefit payments. For example, if an
annual Annuity Benefit Payment Change Frequency is
chosen, the dollar value of variable annuity benefit
payments will remain constant within each one-year
period. The Owner must also select the date of the first
change. The date of first change must be within one
Change Frequency of the Annuity Date.
Assumed Investment In the case of a variable annuity option, the Assumed
Return Investment Return ("AIR") is a rate used to determine
the initial variable annuity benefit payment and how the
payment will change over time in response to the
performance of the selected Sub-Accounts. If the actual
performance of any selected Sub-Account (as measured by
the Net Investment Factor) is equal to the AIR, the
annuity benefit payment attributable to that Sub-Account
will be constant. If the actual performance is greater
than the AIR, the annuity benefit payment will increase.
If the actual performance is less than the AIR, the
annuity benefit payment will decrease.
Annuity Value The Annuity Value will be the Accumulated Value, after
application of any Market Value Adjustment. The Annuity
Value applied under a variable Annuity
Form A3037-02NY 21 NYLS1
Option is based on the Accumulation Unit Value on a
Valuation Date, uniformly applied, before the Annuity
Date.
The amount of the first annuity benefit payment under
all available options except period certain options will
depend on the age and/or sex of the Annuitant on the
Annuity Date and the Annuity Value applied. Period
certain options are based only on the duration of
payments and the Annuity Value.
The annuity benefit payments under the contract will be
equal to or greater than the annuity benefit payments
under a single premium immediate annuity issued by the
Company at the time to the same class of annuitants
where the initial payment is equal to the greater of:
(a) the Surrender Value of the contract; or
(b) 95% of the Accumulated Value of the contract.
In addition, the fixed annuity benefit payments will be
equal to or greater than the annuity benefit payments
produced when the Accumulated Value is applied to the
guaranteed rates.
Annuity Unit Values A Sub-Account Annuity Unit Value on any Valuation Date
is equal to its value on the preceding Valuation Date
multiplied by the product of:
(a) a discount factor equivalent to the Assumed
Investment Return, calculated on a daily basis;
and
(b) the Net Investment Factor of the Sub-Account
funding the annuity benefit payments for the
applicable Valuation Period.
The value of an Annuity Unit as of any date other than a
Valuation Date is equal to its value as of the preceding
Valuation Date.
Each variable annuity benefit payment is equal to the
number of Annuity Units multiplied by the applicable
value of an Annuity Unit, except that under a Joint and
Survivor Option, after the first death, the number of
units in each payment is equal to the total number of
units multiplied by the Survivor Annuity Benefit
Percentage.
Variable annuity benefit payments will increase or
decrease with the value of the Annuity Units as of the
date of the first payment of each Annuity Benefit
Payment Change Frequency. The Company guarantees that
the amount of each variable annuity benefit payment will
not be affected by changes in mortality and expense
experience.
Number of Annuity Units For each Sub-Account the number of Annuity Units
determining the benefit payable is equal to the amount
of the first annuity benefit payment divided by the
value of the Annuity Unit as of the Valuation Date used
to calculate the amount of the first payment. Once
annuity benefit payments begin, the number of Annuity
Units will not change unless a split, a withdrawal or a
transfer is made.
Payment of Annuity Annuity Benefit Payments are paid to the Owner. By
Benefit Payments Request in writing, the Owner may direct that payments
are made to another person, persons or entity. If an
Owner, who is not also an Annuitant, dies on or after
the Annuity Date, the following occurs:
Form A3037-02NY 22 NYLS1
(a) If the deceased Owner was the sole Owner, then
the remaining annuity benefit payments will be
payable to the Beneficiary in accordance with
the terms of the Annuity Option selected. Upon
the death of a sole Owner, the Beneficiary
becomes the Owner of the contract.
(b) If the contract has joint Owners, then the
remaining annuity benefit payments will be
payable to the surviving joint Owner in
accordance with the terms of the Annuity Option
selected. Upon the death of the surviving joint
Owner, the Beneficiary becomes the Owner of the
contract.
TRANSFER
After the Annuity Date and prior to the death of the
Annuitant, the Owner may transfer among Sub-accounts by
Request to the Principal Office.
Transfers may increase or decrease the number of Annuity
Units in each subsequent payment.
There is no charge for the first twelve transfers per
contract year. A transfer charge of up to $25 may be
imposed on each additional transfer.
The contract is not designed for use by individuals,
professional market timing organizations, or other
entities that do "market timing," programmed transfers,
frequent transfers, or transfers that are large in
relation to the total assets of a Fund. If there is a
pattern of transfers that coincides with a market timing
strategy and/or that is disruptive to the Funds, the
Company reserves the right to refuse transfers or to
take other action to limit the use of such activities.
WITHDRAWAL
Present Value Withdrawals may be made in accordance with
this provision after the Annuity Date and prior to the
death of the Annuitant. Withdrawals are available if one
of the following Annuity Options is selected:
(a) Period Certain Annuity or
(b) Life with Period Xxxxxxx Xxxxxxx.
Over the life of the contract, the Owner may request
withdrawals that represent a percentage of the Present
Value of those remaining guaranteed annuity benefit
payments. "Guaranteed annuity benefit payments" refers
to the non-life contingent annuity benefit payments.
Each year a withdrawal is taken under this provision,
the Company records the percentage withdrawn. Each
withdrawal proportionately reduces future annuity
benefit payments. (See proportionate reduction
calculation below.) The total percentage withdrawn over
the life of the contract cannot exceed the Present Value
Withdrawal Amount (see Specifications page).
For the Life with Period Certain Annuity Option, only
one Request for a withdrawal may be made each calendar
year.
For fixed Annuity Options, each withdrawal
proportionately reduces the dollar amount of each future
guaranteed annuity benefit payment. The proportionate
reduction is
Form A3037-02NY 23 NYLS1
calculated by multiplying the dollar amount of each
future guaranteed annuity benefit payment by the
following:
Amount of the withdrawal
-------------------------------------------------------
Present Value of all remaining fixed guaranteed annuity
benefit payments immediately prior to the withdrawal.
For variable Annuity Options, each withdrawal
proportionately reduces any remaining guaranteed
payments. The proportionate reduction is calculated by
multiplying the number of Annuity Units in each future
guaranteed annuity benefit payment by the following:
Amount of the withdrawal
--------------------------------------------------
Present Value of all remaining variable guaranteed
annuity benefit payments immediately prior to the
withdrawal.
If an Annuitant is still living after there are no
remaining guaranteed payments under a Life with Period
Certain Annuity Option:
(a) for variable Annuity Options, the number of
Annuity Units will increase to the number of
Annuity Units payable prior to any withdrawals,
adjusted for transfers.
(b) for fixed Annuity Options, the dollar amount of
the annuity benefit payments will increase to
the amount payable prior to any withdrawals,
adjusted for transfers.
Amounts withdrawn that were applied under a variable
Annuity Option will be paid within 7 days of the date a
Request is received. The Company reserves the right to
defer surrenders and withdrawals of amounts applied
under a variable Annuity Option for up to six months
during any period when (1) trading on the New York Stock
Exchange is closed for other than weekends and holidays;
(2) the Securities and Exchange Commission by order has
permitted such a suspension; or (3) an emergency exists
as determined by the Securities and Exchange Commission
such that disposal of portfolio securities or valuation
of assets of the Separate Account is not reasonably
practicable.
Amounts withdrawn that were applied under a fixed
Annuity Option will normally be paid within 7 days of
the date a Request is received. The Company may defer
payment for up to six months from the date a Request is
received. If deferred for 10 days or more, the amount
payable will be credited interest at the rate(s) then
being credited by the Company. However, no interest will
be paid if it is less than $25 or if the delay is
pursuant to State insurance law.
PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS
For a variety of purposes, it is at times necessary to
determine the Present Value of either all future annuity
benefit payments or of future guaranteed annuity benefit
payments. Present Values are calculated based on the
Annuity 2000 Mortality Table, male or female rates as
appropriate, and the interest rate or AIR used to
determine the annuity benefit payments.
DEATH OF THE ANNUITANT
Unless otherwise indicated by the Owner, upon the death
of the Annuitant, the Present Value of the remaining
guaranteed annuity benefit payments may be paid to the
Owner.
Form A3037-02NY 24 NYLS1
ANNUITY BENEFIT PAYMENT OPTIONS
PERIOD CERTAIN ANNUITY:
Periodic annuity benefit payments for a chosen number of
years. The number of years selected may be from 10 to
30, or any other period currently made available by the
Company.
LIFE ANNUITY:
(a) Single Life - Periodic annuity benefit payments
during the Annuitant's life. The annuity benefit
payments do not continue after the death of the
Annuitant.
(b) Joint and Survivor - Periodic annuity benefit
payments during the joint lifetime of the Joint
Annuitants. For variable options, after the
first death, the number of units in each payment
during the lifetime of the survivor is equal to
the total number of units prior to such death
multiplied by the Survivor Annuity Benefit
Percentage. For fixed options, after the first
death, the dollar amount of each payment during
the lifetime of the survivor is equal to the
dollar value of each payment paid prior to such
death multiplied by the Survivor Annuity Benefit
Percentage.
LIFE ANNUITY GUARANTEE OPTIONS
If a life Annuity Option has been elected, the Owner may
also select one of the following guarantees:
PERIOD CERTAIN
Periodic guaranteed payments for a period of 10 to 30
years, or any other period currently made available by
the Company.
CASH BACK
Upon notification of the Annuitant's death, any excess
of the Annuity Value applied over the total amount of
the annuity benefit payments will be paid to the Owner
or Beneficiary, whichever is applicable.
ANNUITY OPTION RATE TABLES
The first variable annuity benefit payment will be based
on the greater of the guaranteed minimum Annuity Option
Rates shown in the tables on the following pages or the
Annuity Option Rates made available by the Company on
the rate basis available at the time the Annuity Option
is selected. The fixed annuity benefit payments will be
based on the greater of the guaranteed minimum Annuity
Option Rates shown in the tables on the following pages
or the Company's non-guaranteed current Annuity Option
Rates applicable to this class of contracts. The Company
guarantees that once an Annuity Option is selected, the
annuity benefit payments will not be affected by changes
in mortality and expense experience.
Form A3037-02NY 25 NYLS1
ANNUITY OPTION TABLES
FIRST MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE APPLIED
AGE LIFE ANNUITY WITH LIFE LIFE ANNUITY
NEAREST 10 YEARS PERIOD CERTAIN ANNUITY WITH CASHBACK
PAYMENT
[MALE FEMALE [UNISEX [MALE FEMALE [UNISEX [MALE FEMALE [UNISEX
50 4.05 3.81 3.91 4.08 3.83 3.93 3.90 3.72 3.79
51 4.11 3.87 3.97 4.15 3.89 3.99 3.96 3.77 3.85
52 4.18 3.93 4.03 4.22 3.95 4.06 4.01 3.82 3.90
53 4.25 3.99 4.10 4.30 4.01 4.13 4.07 3.88 3.96
54 4.33 4.06 4.17 4.38 4.08 4.20 4.14 3.94 4.02
55 4.41 4.13 4.24 4.46 4.15 4.28 4.20 3.99 4.07
56 4.49 4.20 4.32 4.55 4.23 4.36 4.27 4.06 4.14
57 4.58 4.28 4.40 4.65 4.31 4.45 4.34 4.12 4.21
58 4.68 4.36 4.49 4.75 4.40 4.54 4.42 4.19 4.28
59 4.78 4.45 4.58 4.86 4.49 4.64 4.50 4.26 4.36
60 4.88 4.54 4.67 4.98 4.59 4.74 4.58 4.34 4.44
61 4.99 4.63 4.77 5.10 4.69 4.85 4.67 4.42 4.52
62 5.10 4.73 4.88 5.23 4.80 4.97 4.76 4.50 4.60
63 5.23 4.84 4.99 5.37 4.92 5.10 4.85 4.59 4.69
64 5.35 4.95 5.11 5.52 5.04 5.24 4.95 4.68 4.79
65 5.48 5.07 5.24 5.69 5.18 5.38 5.06 4.78 4.89
66 5.62 5.20 5.37 5.86 5.32 5.54 5.17 4.89 5.00
67 5.77 5.33 5.51 6.04 5.47 5.70 5.28 4.99 5.11
68 5.92 5.47 5.65 6.24 5.64 5.88 5.40 5.11 5.23
69 6.07 5.62 5.80 6.45 5.82 6.07 5.52 5.23 5.35
70 6.23 5.78 5.96 6.67 6.01 6.27 5.66 5.36 5.48
71 6.39 5.94 6.12 6.90 6.21 6.49 5.79 5.49 5.61
72 6.56 6.11 6.29 7.16 6.44 6.72 5.94 5.63 5.75
73 6.73 6.29 6.47 7.43 6.68 6.98 6.09 5.78 5.90
74 6.90 6.48 6.65 7.71 6.94 7.25 6.24 5.94 6.06
75 7.08 6.67] 6.83] 8.02 7.22] 7.54] 6.41 6.11] 6.23]
These tables are based on an annual interest rate of 3%
and the Annuity 2000 Mortality Table
Form A3037-02NY 26 NYLS1
ANNUITY OPTION TABLES (CONTINUED)
FIRST MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE APPLIED
JOINT AND SURVIVOR LIFE ANNUITY
OLDER AGE
50 55 60 65 70 75 80
Y 50 3.53 3.61 3.68 3.73 3.76 3.79 3.80
O 55 3.77 3.88 3.97 4.04 4.08 4.11
U 60 4.10 4.25 4.36 4.45 4.50
N 65 4.55 4.74 4.90 5.01
G 70 5.16 5.43 5.64
E 75 6.02 6.41
R 80 7.25
A
G
E
JOINT AND TWO-THIRDS SURVIVOR LIFE ANNUITY
OLDER AGE
50 55 60 65 70 75 80
Y 50 3.80 3.93 4.09 4.25 4.43 4.61 4.80
O 55 4.11 4.29 4.49 4.70 4.91 5.13
U 60 4.53 4.77 5.02 5.29 5.55
N 65 5.09 5.42 5.75 6.07
G 70 5.88 6.31 6.75
E 75 6.99 7.59
R 80 8.58
A
G
E
These tables are based on an annual interest rate of 3 %
and the Annuity 2000 Mortality Table
Form A3037-02NY 27 NYLS1
ANNUITY OPTION TABLES (CONTINUED)
FIRST MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE APPLIED
NUMBER OF VARIABLE OR FIXED ANNUITY FOR A
YEARS CERTAIN PERIOD
10 9.61
15 6.87
20 5.51
25 4.71
30 4.18
These tables are based on an annual interest rate of 3%
and the Annuity 2000 Mortality Table.
Form A3037-02NY 28 NYLS1
GENERAL PROVISIONS
Entire Contract The entire contract consists of this contract,
any application attached at issue, riders and
any endorsements. All statements made by the
Owner shall be deemed representations and not
warranties and no such statements shall be used
in any contest unless it is contained in a
written signed application. Nothing is
incorporated by reference, unless a copy is
endorsed upon or is attached to the contract. No
insertion in or other alteration of any written
application can be made by any person other than
the applicant without his/her written consent,
except that insertions may be made by the
Company for administrative purposes only in such
manner as to indicate clearly that the
insertions were not made by the applicant. This
contract is delivered in and governed by the
laws of the State.
Only the President or Secretary of the Company
may modify or waive any provisions of this
contract by written endorsement. Agents or
Brokers are not authorized to do so.
Misstatement of Age If the age or sex of an individual is misstated,
or Sex the Company will adjust all benefits payable to
that which would be available at the correct age
or sex. Any underpayments already made by the
Company will be paid immediately. Any
overpayments will be deducted from future
annuity benefit payments. Any overpayments or
underpayments will be charged or credited with
interest as applicable at a rate of 6%.
Failure to Notify Company Death After the Annuity Date and once notified
of Annuitant of the Annuitant's death, the Company reserves
the right to recover any overpaid annuity
benefit payments.
Incontestability The Company cannot challenge the validity of
this contract after it has been in force for
more than two years from the date of issue.
Minimums All values and benefits available under this
contract equal or exceed those required by the
State in which the contract is delivered.
Annual Report The Company will furnish an annual report to the
Owner containing a statement of the number and
value of Accumulation Units credited to the
Sub-Accounts, the value of the Fixed Account and
the Guarantee Period Accounts, the amount of the
death benefit, the Surrender Value, the
withdrawal charge, the method used to derive any
Market Value Adjustment (if applicable) and any
other information required by applicable law,
rules and regulations.
Addition, Deletion, or The Company reserves the right, subject to
Substitution of compliance with applicable law, to add to,
Investments delete from, or substitute for the shares of a
Fund that are held by the Sub-Accounts or that
the Sub-Accounts may purchase. The Company also
reserves the right to eliminate the shares of
any Fund no longer available for investment or
if the Company believes further investment in
the Fund is no longer appropriate for the
purposes of the Sub-Accounts.
The Company will not substitute shares
attributable to any interest in a Sub-Account
without notice to the Owner and prior approval
of the Securities and Exchange Commission as
required by the Investment Company Act of 1940.
This will not prevent the Variable Account from
purchasing other securities for other series or
classes of contracts, or from permitting a
conversion between series or classes of
contracts on the basis of requests made by
Owners.
Form A3037-02NY 29 NYLS1
The Company reserves the right, subject to
compliance with applicable laws, to establish
additional Separate Accounts, Guarantee Period
Accounts and Sub-Accounts and to make them
available to any class or series of contracts as
the Company considers appropriate. Each new
Separate Account or Sub-Account will invest in a
new investment company, or in shares of another
open-end investment company, or such other
investments as may be permitted under applicable
law. The Company also reserves the right to
eliminate or combine existing Sub-Accounts and
to transfer the assets of any Sub-Accounts to
any other Sub-Accounts. In the event of any
substitution or change, the Company may, by
appropriate notice, make such changes in this
and other contracts as may be necessary or
appropriate to reflect the substitution or
change. If the Company considers it to be in the
best interests of the owners, the Variable
Account or any Sub-Account may be operated as a
management company under the Investment Company
Act of 1940 or in any other form permitted by
law, or may be de-registered under the Act in
the event registration is no longer required, or
may be combined with other accounts of the
Company. No material changes in the investment
policy of a Variable Account or any Sub-Account
will be made without approval pursuant to the
applicable insurance laws of the State.
Changes in Law The Company reserves the right to make any
changes to provisions of the contract to comply
with, or give Owners the benefit of, any federal
or State statute, rule, or regulation.
Change of Name Subject to compliance with applicable law, the
Company reserves the right to change the names
of the Variable Account or the Sub-Accounts.
Federal Tax The Variable Account is not currently subject to
Considerations tax, but the Company reserves the right to
assess a charge for taxes if the Variable
Account becomes subject to tax, subject to prior
notification to the Superintendent of Insurance.
Splitting of Units The Company reserves the right to split the
value of a unit, either to increase or decrease
the number of units. Any splitting of units will
have no material effect on the benefits,
provisions or investment return of this contract
or upon the Owner, the Annuitant, any
Beneficiary, or the Company.
Prior to the Annuity Date, the number of shares
is determined by dividing the dollar value of
the Sub-Account Accumulation Units by the net
asset value of one Fund share. After the Annuity
Date, the number of Fund shares is determined by
dividing the reserves held in each sub-account
to meet the annuity obligations by the net asset
value of one Fund share.
Insulation of Separate The investment performance of Separate Account
Account assets is determined separately from the other
assets of the Company. The assets of a Separate
Account equal to the reserves and liabilities of
the contracts supported by the account will not
be charged with other income, gains or losses of
the Company or liabilities from any other
business that the Company may conduct.
Form A3037-02NY 30 NYLS1
Flexible Payment Deferred Variable, Fixed and Market Value Adjusted Annuity
Annuity Benefit Payments Payable on the Annuity Date
Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date
Non-Participating
Form A3037-02NY 31 NYLS1
