Exhibit 5
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
OWNER: [XXXX XXX]
ANNUITANT: [XXXX XXX]
CONTRACT NUMBER: [SPECIMEN]
ANNUITY DATE: [03/01/2028]
ISSUE AGE: [35]
ISSUE DATE: [03/01/1998]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY
XXXXXXX BENEFIT LIFE COMPANY promises to pay to you a monthly annuity starting
on the annuity date stated on Page 3. If you die prior to the annuity date, we
will pay a death benefit to the beneficiary, upon receipt of due proof of death.
PLEASE EXAMINE THE APPLICATION. We issued this contract based upon the answers
in the application. If all answers are not complete and true, the contract may
be affected.
RIGHT TO CANCEL YOUR CONTRACT. If you are not satisfied with this contract for
any reason, you may return it to Lincoln Benefit Life Company, PO Box 82532,
Lincoln, NE 68501-2532, or our agent within 10 days after you receive it. We
will refund any purchase payments allocated to the separate account, adjusted to
reflect investment gain or loss from the date of allocation to the date of
cancellation, plus any purchase payments allocated to the fixed account. If this
contract is qualified under Section 408 of the Internal Revenue code, you will
not receive less than your original purchase payments. READ YOUR CONTRACT
CAREFULLY.
Executed for the company at its home office in Lincoln, Nebraska on its issue
date.
Xxxx X. Xxxxxx B. Xxxxxx Xxxxxx
Vice President and Secretary President
LINCOLN BENEFIT LIFE COMPANY
Lincoln Benefit Life Centre
Lincoln, NE 68501
000-000-0000
A Legal Reserve Stock Life Insurance Company
Nonparticipating
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Flexible Premium Payments
Benefit Paid in the Event of Death Prior to the Annuity Date
Withdrawal and Surrender Rights
The dollar amount of annuity payments or other values provided by this contract,
when based on the investment experience of the separate account, will vary to
reflect the performance of the separate account. For amounts in the Guaranteed
Maturity Fixed Account, the withdrawal benefit, the death benefit, transfers to
other investment alternatives and any periodic annuity payments may be subject
to a market value adjustment which may result in an upward or downward
adjustment of the amount distributed.
SUMMARY OF CONTRACT
This flexible premium deferred variable annuity provides a monthly annuity which
will be paid to you starting on the annuity date. If you die before the annuity
date, a death benefit will be paid to the beneficiary.
The premium for this contract is flexible and may be established by you subject
to the terms of this contract.
During the lifetime of the annuitant, and prior to the annuity date, you may:
... withdraw any portion of the surrender value (a withdrawal charge and
market value adjustment may apply);
... change the beneficiary;
... assign an interest in the contract;
... change the annuity date;
... exercise the other rights provided, subject to the rights of any
irrevocable beneficiary or assignee.
This is only a summary of the contract terms. The detailed provisions of this
contract will control. The provisions are set forth in the following sections:
Annuity Data Page 3
Definitions Page 4
Annuity Benefit Page 5
Purchase Payments Page 8
Contract Value Page 9
Surrender Value Page 12
Death Benefit Page 13
Beneficiary Page 15
Ownership Page 15
Other Terms of your Contract Page 15
ANNUITY DATA
OWNER: [XXXX XXX]
ANNUITANT: [XXXX XXX]
CONTRACT NUMBER: [SPECIMEN]
ANNUITY DATE: [03/01/2033]
ISSUE AGE: [35]
ISSUE DATE: [03/01/1998]
Initial Purchase Payment: [$10,000.00]
Tax Qualification: [IRA]
Credit Enhancement
Matching Benefit: [4%]
Initial Allocation of Purchase Payment:
Allocated
Variable Sub-Accounts Amount (%)
[Sub-account A] [10%]
[Sub-account B] [10%]
[Sub-account C] [10%]
[Sub-account D] [10%]
Allocated Guaranteed Rate
Guaranteed Maturity Fixed Account Amount (%) Interest Rate Guaranteed Through
[1 Year Guarantee Period] [10%] [4.25%] [03/01/1999]
[3 Year Guarantee Period] [10%] [4.45%] [03/01/2001]
[5 Year Guarantee Period] [10%] [5.00%] [03/01/2003]
[7 Year Guarantee Period] [10%] [5.20%] [03/01/2005]
[10 Year Guarantee Period] [10%] [5.45%] [03/01/2008]
Dollar Cost Averaging Fixed Account
1 Year Guarantee Period [10%] [7.00%] [03/01/1999]
Minimum Guaranteed Rate
Dollar Cost Averaging Fixed Account 3.00%
Beneficiary
Relationship
Beneficiary To Owner Percentage
[Xxxx Xxx] [Wife] [100%]
DEFINITIONS
When these words are used in this contract, they have the meaning stated:
"accumulation unit"
A unit of measurement which we use to calculate the value of a subaccount before
annuity payments begin.
"annuitant"
The natural person named on Page 3 whose life determines the annuity payment
made under this contract.
"annuitized value"
The amount applied to purchase annuity payments under the contract, equal to the
contract value adjusted by any market value adjustment and less any applicable
taxes.
"annuity date"
The date on which annuity payments are scheduled to begin.
"annuity unit"
A unit of measurement which we use to calculate the amount of variable annuity
payments.
"app"
The application which you completed requesting this policy
"beneficiary(ies)"
The person(s) designated to receive any death benefit under the contract.
"contract anniversary"
The anniversary of the issue date in subsequent years.
"contract value"
The sum of the values of your interests in the subaccounts of the Separate
Account and the Fixed Account.
"contract year"
A period of twelve months beginning on the issue date or any contract
anniversary.
"contribution year"
A twelve month period beginning on the date a purchase payment is applied to the
contract value, or an anniversary of that date.
"credit enhancement"
The amount we add to your contract value whenever a purchase payment is
received. This is equal to the matching benefit stated on Page 3 multiplied by
the applicable purchase payment.
"due proof of death"
(1) A certified copy of a death certificate; or
(2) a certified copy of a decree of a court of competent jurisdiction as to the
finding of death; or
(3) a written statement by a medical doctor who attended the deceased at the
time of death; or
(4) any other proof satisfactory to us.
"fixed account"
The portion of contract value allocated to our general account.
"fixed annuity"
Annuity payments that are fixed in amount.
"investment alternative"
A subaccount of the separate account, a guarantee period of the Guaranteed
Maturity Fixed Account, and the Dollar Cost Averaging Fixed Account.
"issue age"
The age of the annuitant at the time this contract was issued (issue date)
determined by the annuitant's last birthday.
"issue date"
The date when this contract becomes effective if the annuitant is then living
and the initial premium has been paid. The issue date is shown on Page 3.
"natural person"
A living individual or trust entity that is treated as an individual for Federal
Income Tax purposes under the Internal Revenue Code.
"net investment factor"
An index applied to measure the net investment performance of a subaccount from
one valuation date to the next. It is used to determine the value of an
accumulation unit and annuity unit in any valuation period.
"portfolio(s)"
The underlying mutual fund(s) (or investment series thereof) in which the
subaccounts invest.
"purchase payments"
Amounts paid to us in the form of a premium for the contract by or on behalf of
an owner.
"separate account"
A segregated investment account of the Company entitled Lincoln Benefit Life
Separate Variable Annuity Account.
"subaccount"
A subdivision the Separate account invested wholly in shares of one of the
portfolios.
"surrender value"
The amount you would receive upon surrender of this contract, equal to the
contract value adjusted by any market value adjustment, less any applicable
taxes and withdrawal charges.
"valuation date"
Each day the New York Stock Exchange ("NYSE") is open for business.
"valuation period"
The period commencing at the close of normal trading on the NYSE (currently 4:00
p.m. Eastern time) on each valuation date and ending at the close of the NYSE on
the next succeeding valuation date.
"variable annuity"
Annuity payments which vary in accordance with the investment experience of the
subaccounts to which contract values have been allocated.
""we", "us", "our""
Our Company, Lincoln Benefit Life Company.
"you"
The owner of the contract.
ANNUITY BENEFIT
annuitant
The annuitant is the person named on Page 3. The annuitant must be a living
individual. If the annuitant dies prior to the annuity date, the new annuitant
will be:
- the youngest owner; otherwise,
- the youngest beneficiary.
annuity date
The monthly annuity will begin on the annuity date. The annuity date must always
be the business day on or immediately following the tenth calendar day of a
month. The annuity date is the date the annuitized value is applied to an
annuity option. The anticipated annuity date is shown on Page 3. You may change
the annuity date by writing us at least 30 days prior to this date.
The annuity date must be on or before the later of:
- the annuitant's 90th birthday; or
- the 10th anniversary of the contract issue date.
The initial payment purchased by each $1000 of annuitized value depends upon the
annuity option selected and the age and sex of the annuitant on the annuity
date. The payments are based upon the 1983a Annuity Mortality table and 3.5%
interest.
annuity options
The following annuity options are available under the contract. Each is
available in the form of either a fixed annuity or a variable annuity (or a
combination of both fixed and variable annuity). Fixed account contract values
will be applied to provide a fixed annuity
Option A, Life Annuity with Payments Guaranteed for 5 to 20 years
Monthly payments are made beginning on the annuity date. Payment will continue
as long as the annuitant lives. If the annuitant dies before all of the
guaranteed payments have been made, we will continue installments of the
guaranteed payments to the beneficiary.
Option B, Joint and Survivor Annuity with Payments Guaranteed for 5 to 20 years
Monthly payments are made beginning with the annuity date. Payments will
continue as long as either the annuitant or the joint annuitant is alive.
If both the annuitant and the joint annuitant die before all of the guaranteed
payments have been made, we will continue installments of the guaranteed
payments to the beneficiary.
Option C, Payments for a Specified Period Certain of 5 to 30 years
Monthly payments are made starting on the annuity date and continuing for the
specified period of time as elected. If the annuitant dies before all of the
guaranteed payments have been made, we will continue installments of the
guaranteed payments to the beneficiary. Payments for less than 120 months may be
subject to a withdrawal charge.
We reserve the right to make available other annuity options.
No lump sum settlement option is available under the contract. You may surrender
the contract prior to the annuity date; however, any applicable withdrawal
charges will be deducted from the contract value.
The initial monthly payments purchased per $1000 applied for Option A, with 120
months guaranteed are shown below. The factors for other options will be
calculated using the same basis as those shown and are available by writing to
us.
Monthly Annuity
Payment for 120
Annuitant's Age on Months & Lifetime
Annuity Date For Each $1,000.00
Male Female
50 4.53 4.19
51 4.60 4.25
52 4.67 4.31
53 4.75 4.38
54 4.84 4.45
55 4.93 4.52
56 5.02 4.60
57 5.12 4.68
58 5.22 4.77
59 5.33 4.86
60 5.44 4.95
61 5.56 5.05
62 5.69 5.16
63 5.82 5.27
64 5.96 5.39
65 6.11 5.52
66 6.26 5.65
67 6.41 5.79
68 6.57 5.94
69 6.74 6.10
70 6.91 6.26
71 7.08 6.43
72 7.25 6.61
73 7.43 6.79
74 7.61 6.98
75 7.78 7.18
76 7.96 7.38
77 8.13 7.58`
78 8.29 7.79
79 8.45 7.98
80 8.61 8.17
81 8.75 8.36
82 8.89 8.54
83 9.01 8.71
84 9.13 8.86
85 or over 9.23 9.01
annuity payments
The contract provides for two types of annuity payments. "Variable annuity
payments" vary in amount based on changes in the subaccounts that you have
selected. "Fixed annuity payments" do not vary in amount and are paid in an
amount determined when you annuitize. Your annuity payments may consist of a
mixture of the two types of payments or may be entirely one or the other. The
method of calculating the initial payment is different for the two accounts. The
contract maintenance charge will be deducted in equal payments from each annuity
payment. The contract maintenance charge will be waived if the contract value on
the annuity date is $50,000 or more or if all payments are fixed amount annuity
payments.
payment terms and conditions
The annuity payments are subject to the following terms and conditions:
If the contract value is less than $5,000, or not enough to provide an initial
payment of at least $50, and state law permits, we reserve the right to:
- change the payment frequency to make the payment at least $50 or
- terminate the contract and pay you the contract value adjusted by any
market value adjustment and less any applicable taxes in a lump sum.
If we do not receive a written choice of an annuity option from you at least 30
days before the annuity date, the income plan will be Life Income with
Guaranteed Payments for 120 months.
If you choose an annuity option which depends on any person's life, we may
require:
- proof of age and sex before income payments begin; and
- proof that the annuitant or joint annuitant is still alive before we make
each payment.
After the annuity date, the annuity option cannot be changed and withdrawals
cannot be made unless annuity payments are being made from the separate account
under annuity Option C. You may terminate annuity payments being made from the
separate account under annuity Option C at any time and withdraw their value,
subject to withdrawal charges.
If any owner dies before all annuity payments have been made, the remaining
annuity payments will be paid to the successor owner as scheduled.
fixed annuity
You may choose to apply a portion of your annuitized value to purchase a fixed
annuity. You must notify us, within 30 days of the annuity date, of that portion
of your annuitized value with which you wish to purchase a fixed annuity. Any
annuitized value in the fixed account will be automatically applied to provide a
fixed annuity. We will reduce your interest in the subaccounts on the annuity
date to reflect your choice.
The initial annuity payment for any portion of the annuitized value applied to
purchase a fixed annuity is determined by applying it to the per $1000 payment
factors for the annuity option selected. Subsequent payments will be fixed in
amount, equal to the initial payment, and paid according to the annuity option
selected.
variable annuity and annuity units
The initial annuity payment attributable to a subaccount is determined by
applying the annuitized value attributable to that subaccount on the annuity
date to the annuity option selected. The initial annuity payment for a
subaccount is divided by the subaccount's annuity unit value on the annuity date
to determine the number of annuity units purchased. Subsequent annuity payments
attributable to a subaccount will be equal to the number of annuity units for
the subaccount multiplied by the annuity unit value for the subaccount on the
payment date. The total variable annuity payment will be the sum of the payments
attributable to each subaccount in which you have an interest.
annuity unit value
The annuity unit value of a subaccount for any valuation period is calculated by
multiplying the annuity unit value at the end of the immediately preceding
valuation period by the subaccount's net investment factor for the valuation
period and dividing this product by 1.000 plus the assumed investment rate for
the period. The assumed investment rate is an effective annual rate of 3.5%. The
net investment factor is described in detail on page 10.
PURCHASE PAYMENTS
Purchase payments for this contract are flexible. The initial purchase payment
shown on Page 3 must be paid on the issue date. Thereafter, you may make
payments of at least $500 at any time prior to the annuity date. We may limit
the maximum amount of premium payments we will accept.
Purchase payments are payable to us at our home office. We will supply a receipt
if you ask us.
allocation of purchase payments
We will invest the purchase payments in the investment alternatives as you have
selected. You may allocate any portion of your purchase payment, in whole
percents from 0% to 100%, or in exact dollar amounts to any of the subaccounts
or the fixed account options. The total allocation must equal 100%. The
allocation of the initial purchase payment is shown on page 3. Allocation of
each subsequent purchase payment will be the same as the allocation for the most
recent purchase payment unless you change the allocation. You may change the
allocation percentages at any time by writing us. Any change will be effective
when we receive it.
credit enhancement
A credit enhancement will be allocated to the investment alternatives you have
selected at the time of any purchase payment. It will be allocated among the
investment alternatives in the same ratio as the appropriate purchase payment.
fixed account options
The fixed account options are the Dollar Cost Averaging Fixed Account Option and
the Guaranteed Maturity Fixed Account.
Dollar Cost Averaging Fixed Account
Money allocated to the Dollar Cost Averaging Fixed Account option will earn
interest for one year at the current rate in effect at the time of allocation.
Each purchase payment and associated interest in the Dollar Cost Averaging Fixed
Account option must be transferred to other investment alternatives in equal
monthly installments. The number of monthly installments must be no more than
12. At the end of 12 months from the date of a purchase payment allocation to
the Dollar Cost Averaging Fixed Account, any remaining portion of the purchase
payment and interest in the Dollar Cost Averaging Fixed Account will be
allocated to other investment alternatives as defined by the current Dollar Cost
Averaging Fixed Account allocation. You may only allocate money to the Dollar
Cost Averaging Fixed Account option by allocating a portion of a purchase
payment. No amount may be transferred into the Dollar Cost Averaging Fixed
Account.
Guaranteed Maturity Fixed Account Option
We will pay a specified interest rate for a specified Guarantee Period on each
amount allocated to the Guaranteed Maturity Fixed Account Option. You choose the
applicable Guarantee Period from among the choices that we make available at our
discretion. Each Guarantee Period we offer may have a different interest rate.
We may change the rate we offer for new Guarantee Periods at any time at our
discretion.
New Guarantee Periods begin when:
- you make a purchase payment; or
- you select a new Guarantee Period after the prior Guarantee Period expires;
or
- you transfer an amount from an existing subaccount of the separate account,
from the Dollar Cost Averaging Fixed Account option, or you allocate funds
in the fixed account to a new Guarantee Period before the end of the
existing Guarantee Period.
You must select the Guarantee Period for all purchase payments and transfers
allocated to the Guaranteed Maturity Fixed Account option. If you do not select
a Guarantee Period for a purchase payment or transfer, we will assign the same
period(s) as used for the most recent purchase payment.
We will mail you a notice prior to the expiration of a Guarantee Period
outlining the options available at the end of the Guarantee Period. During the
30 day period after a Guarantee Period expires you may:
- take no action and we will automatically apply the relevant amount to a new
Guarantee Period of the same duration as the expiring Guarantee Period
beginning on the day the previous guarantee period expired. The interest
rate will be the rate we are then offering for Guarantee Periods of that
duration, or
- notify us to allocate the relevant amount to one or more new Guarantee
Periods beginning on the day the previous guarantee period expired; or
- notify us to allocate the relevant amount to one or more subaccounts on the
day we receive the notification; or
- withdraw all or a portion of the relevant amount through a partial
withdrawal. You may be required to pay a withdrawal charge, but we will not
adjust the amount withdrawn to include a Market Value Adjustment. In this
case, the amount withdrawn will be deemed to have been withdrawn on the day
the guarantee period expired.
crediting interest
We credit interest daily to money allocated to the fixed account options at a
rate which compounds over one year to the interest rate we guaranteed when the
money was allocated. We will credit interest on the initial purchase payment
plus any credit enhancement from the issue date. We will credit interest to
subsequent purchase payments from the date we receive them. We will credit
interest to transfers from the date the transfer is made. The interest rate for
the Dollar Cost Averaging Fixed Account will never be less than the minimum
guaranteed rate shown on Page 3.
We will credit interest on any credit enhancement from the day the appropriate
purchase payment is credited interest.
CONTRACT VALUE
On the issue date of the contract, the contract value is equal to the initial
purchase payment, plus any credit enhancement. After the issue date, the
contract value is equal to the sum of:
- the number of accumulation units you hold in each subaccount of the
separate account multiplied by the accumulation unit value for that
subaccount on the most recent valuation date; plus
- the total value you have in the Dollar Cost Averaging Fixed Account Option;
plus
- the total values you have in the Guaranteed Maturity Fixed Account Option.
If you withdraw the entire contract value, you may receive an amount greater or
less than the contract value because a market value adjustment, a withdrawal
charge, income tax withholding, and a premium tax charge may apply.
subaccount values
The value of a subaccount is equal to the number of accumulation units you hold
for that subaccount multiplied by the accumulation unit value for that
subaccount on the most recent valuation date.
accumulation units and accumulation unit values
Amounts which are allocated to a subaccount are used to purchase accumulation
units in that subaccount. The number of accumulation units purchased is
determined by dividing the amount allocated by the subaccount's accumulation
unit value as of the end of the valuation period when the allocation occurs.
Accumulation unit value is determined Monday through Friday on each day that the
New York Stock Exchange is open for business. A separate accumulation unit value
is determined for each subaccount. The accumulation unit value for each
subaccount will vary with the price of a share in the portfolio the subaccount
invests in, and in accordance with the mortality and expense risk charge,
administrative expense charge, and any provision for taxes. Assessments of
withdrawal charges, transfers and contract maintenance charges are done
separately for each contract. They are made by redemption of accumulation units
and do not affect accumulation unit value.
The accumulation unit value of a subaccount for any valuation period equals the
accumulation unit value as of the immediately preceding valuation period,
multiplied by the net investment factor for that subaccount for the current
valuation period.
net investment factor
The net investment factor for any subaccount of the separate account for any
valuation period is (1) divided by (2) minus (3) where:
1. is the net result of:
- the net asset value of a portfolio share held in the the mutual
fund underlying the subaccount determined at the end of the
valuation period, plus
- the per share amount of any dividend or capital gain
distributions declared by the portfolio underlying the subaccount
during the current valuation period, plus or minus
- a per share credit or charge with respect to any taxes which we
paid or for which we reserved during the valuation period which
are determined by us to be attributable to the operation of the
subaccount (no federal income taxes are applicable under present
law).
2. is the net asset value per share of a portfolio share held in the
subaccount as of the end of the immediately preceding valuation period; and
3. is the sum of the annualized mortality and expense risk charge and the
annualized administrative expense charge divided by the number of days in
the current calendar year and then multiplied by the number of calendar
days in the current valuation period.
The net investment factor may be greater or less than or equal to one;
therefore, the value of an accumulation unit may increase, decrease, or remain
the same.
mortality and expense risk charge
Both before and after the annuity date, we deduct a mortality and expense risk
charge from each subaccount during the valuation period. The annualized
aggregate mortality and expense risk charge is equal to 1.40% of the net asset
value of each subaccount. Our expense and mortality experience will not
adversely affect the dollar amount of variable benefits or other contractual
payments or values under this contract.
administrative expense charge
Both before and after the annuity date, we deduct an administrative expense
charge from each subaccount during the valuation period. The annualized
administrative expense charge is .10% of the net asset value of the subaccount.
This charge compensates us for the cost of administering the contracts and the
separate account.
contract maintenance charge
Prior to the annuity date, a contract maintenance charge will be deducted from
your contract value on each contract anniversary. The charge is only deducted
from the subaccounts. The charge will be deducted on a pro-rata basis from each
subaccount of the separate account in the proportion that your value in each
bears to your total value in all subaccounts. A full contract maintenance charge
will be deducted if the contract is terminated on any date other than a contract
anniversary. The annualized charge will never be greater than $35 per contract
year. The contract maintenance charge will be waived if total purchase payments
are $50,000 or more or if all money is allocated to the fixed account options on
the contract anniversary.
After the annuity date the contract maintenance charge will be deducted in equal
parts from each annuity payment. The contract maintenance charge will be waived
if the contract value on the annuity date is $50,000 or more or if all payments
are fixed amount annuity payments.
transfers and transfer fee
You may transfer amounts between investment alternatives prior to the annuity
date. We reserve the right to impose a $10 transfer fee on the second transfer
within a calendar month, and to impose a minimum size on transfer amounts.
Transfers are subject to the following restrictions:
- Any transfer from a Fixed Account will be subject to a Market
Value adjustment unless:
- the transfer occurs during the 30 day period after the applicable
guarantee period expires; or
- the transfer is made as part of a dollar cost averaging program.
- At the end of 12 months from the date of a purchase payment
allocation to the dollar cost averaging fixed account, any
remaining portion of the purchase payment and interest in the
dollar cost averaging fixed account will be allocated to other
investment alternatives as defined by the current dollar cost
averaging fixed account allocation.
- No amount may be transferred into the dollar cost averaging fixed
account.
We reserve the right to waive the transfer fees and restrictions contained in
this contract.
annuity transfers
After the annuity date, no transfers may be made from the fixed amount annuity
payment. Transfers between subaccounts, or from the variable amount annuity
payment to the fixed amount annuity payment may not be made for six months after
the annuity date.
Transfers may be made once every six months thereafter.
taxes
Any premium taxes or income tax withholding relating to the contract may be
deducted from purchase payments or the contract value when the tax is incurred
or at a later time.
SURRENDER VALUE
surrender
You may surrender this contract before the annuity date. We will pay you the
surrender value upon surrender.
The surrender value is equal to the contract value, adjusted by any market value
adjustment, less any applicable taxes and withdrawal charges.
A surrender stops coverage under this contract.
withdrawal
You have the right to withdraw part or all of your surrender value before the
annuity date. You must specify the investment alternative(s) from which you wish
to make a withdrawal. When you make a withdrawal, your contract value will be
reduced by the amount paid to you and any applicable withdrawal charge, market
value adjustment, and taxes. A contract maintenance charge will also be deducted
if the contract is terminated. Any withdrawal charge will be waived on
withdrawals taken to satisfy IRS minimum distribution rules. This waiver is
permitted only for withdrawals which satisfy distributions resulting from this
contract.
Each withdrawal must be at least $50. If any withdrawal reduces the contract
value to less than $500, we will treat the request as a withdrawal of the entire
contract value. If you withdraw the entire contract value, the contract will
terminate.
withdrawal charge
A withdrawal charge may be imposed on certain withdrawals. The withdrawal charge
is a percentage of purchase payments withdrawn that are less than seven years
old and not eligible for a free withdrawal, in accordance with the table shown
below:
Contribution Withdrawal Charge
Year Percentage
First 8
Second and Third 7
Fourth and Fifth 6
Sixth 5
Seventh 4
Eighth 3
Ninth and Later 0
The withdrawal charge is deducted from remaining contract value so that the
actual reduction in contract value as a result of the withdrawal will be greater
than the withdrawal amount requested and paid.
For purposes of determining the withdrawal charge, the contract value is deemed
to be withdrawn in the following order:
First. Earnings--The amount of contract value in excess of all purchase payments
and purchase payment matches that have not previously been withdrawn;
Second. Old Purchase Payments--Purchase payments received by us more than eight
years prior to the date of withdrawal, and their associated purchase payment
matches, which have not been previously withdrawn;
Third. Any additional amounts available as a free withdrawal, as described
below; and
Fourth. New Purchase Payments--Purchase payments received by us less than eight
years prior to the date of withdrawal, and their associated purchase payment
matches. These amounts are deemed to be withdrawn on a first-in, first-out
basis.
The contribution year for purchase payments and their associated purchase
payment matches is measured from the date we received the purchase payment. The
withdrawal charge is determined by multiplying the percentage corresponding to
the contribution year times that part of each purchase payment withdrawal that
is in excess of the free withdrawal amount.
free withdrawal
Withdrawals of the following amounts are never subject to the withdrawal charge:
a. In any contract year, the greater of earnings not previously withdrawn, or
15 percent of new purchase payments; and
b. Any old purchase payments which have not been previously withdrawn.
The withdrawal charge will be waived if a settlement option is selected which
provides for payments over at least 5 years or over the annuitant's lifetime.
market value adjustment
Activities in the Fixed Account that may be subject to a market value adjustment
are withdrawals in excess of the free withdrawal amount, transfers, death
benefits, and amounts applied to an annuity option. Any activity from the fixed
account will be subject to a market value adjustment unless:
- it occurs during the 30 day period after the applicable guarantee period
expires; or
- it is a transfer that is part of a dollar cost averaging program.
A market value adjustment is an increase or decrease in the amount reflecting
changes in the level of interest rates since the beginning of the applicable
Guarantee Period. As used in this provision, `treasury rate' means the U.S.
Treasury Note Constant Maturity yield as reported in Federal Reserve Bulletin
Release H.15. The market value adjustment is based on the following:
I = the Treasury Rate for a maturity equal to the guarantee period for the week
preceding the beginning of the Guarantee Period;
J = the Treasury Rate for a maturity equal to the guarantee period for the week
preceding the receipt of the withdrawal request, death benefit request, transfer
request, or annuity option request.
N = the number of whole and partial years from the date we receive the
withdrawal, transfer, or death benefit request, or from the annuity date, to the
end of the guarantee period.
An adjustment factor is determined from the following formula:
.9 x (I - J) x N
The amount subject to a market value adjustment that is deducted from the
guaranteed maturity fixed account is multiplied by the adjustment factor to
determine the amount of the market value adjustment.
Any market value adjustment will be waived on withdrawals taken to satisfy IRS
minimum distribution rules. This waiver is permitted only for withdrawals which
satisfy distributions resulting from this contract.
DEATH BENEFIT
death of owner or annuitant
We will pay the death benefit when we receive due proof of death while this
contract is in force and before the annuity date, if
-- any owner dies; or
-- the annuitant dies and the owner is not a natural person.
If the owner eligible to receive a benefit is not a natural person, the owner
may elect to receive the benefit in one or more distributions. Otherwise, if the
owner is a living individual, the owner may elect to receive a benefit either in
one or more distributions or by annuity payments through an annuity option.
A death benefit will be paid if:
- the owner elects to receive the death benefit within 180 days of the date
of death, and
- payment is made as of the date we determine the value of the death benefit,
as defined at the end of the death benefit provision.
Otherwise, the settlement value will be paid. In any event, the entire value of
the contract must be distributed within five (5) years after the date of death
unless an annuity option is elected or a surviving spouse continues the contract
in accordance with the following provisions. We reserve the right to extend the
180 day period when we will pay the death benefit.
If an annuity option is elected, payments from the annuity option must begin
within one year of the date of death and must be payable throughout:
- the life of the owner; or
- a period not to exceed the life expectancy of the owner, or
- the life of the owner with payments guaranteed for a period not to exceed
the life expectancy of the owner.
If the beneficiary is your spouse, and death occurs prior to the annuity date,
then the contract can continue as if death had not occurred. If the contract is
continued the surviving spouse may make a single withdrawal of any amount within
one year of the date of death without incurring a withdrawal charge or a market
value adjustment.
If there is no annuitant at that time, the new annuitant will be the surviving
spouse. The surviving spouse may also select one of the annuity options listed
above.
If the beneficiary is not a natural person, then the beneficiary must receive
the death benefit in a lump sum, and the options listed above are not available.
death benefit
Prior to the annuity date, the death benefit is equal to the greatest of the
following death benefit alternatives:
- the sum of all purchase payments reduced by a withdrawal adjustment, as
defined below; or
- the contract value on the date we determine the death benefit; or
- the amount that would have been payable in the event of a full withdrawal
of the contract value on the date we determine the death benefit; or
- the amount that would have been payable in the event of a full withdrawal
of the contract value on the date we determine the death benefit; or
- the contract value on each death benefit anniversary prior to the date we
determine the death benefit, increased by any purchase payments made since
that death benefit anniversary and reduced by a withdrawal adjustment, as
defined below.
The first death benefit anniversary is the 8th contract anniversary. Subsequent
death benefit anniversaries are those contract anniversaries that are multiples
of 8 contract years, beginning with the 16th contract anniversary. For example,
the 8th, 16th, and 24th contract anniversaries are the first three death benefit
anniversaries.
The withdrawal adjustment is equal to (a) divided by (b), with the result
multiplied by (c) where:
(a) equals the withdrawal amount.
(b) equals the contract value immediately prior to the withdrawal.
(c) equals the value of the applicable death benefit alternative immediately
prior to the withdrawal.
We will determine the value of the death benefit as of the end of the valuation
period during which we receive a complete request for payment of the death
benefit. A complete request includes due proof of death.
settlement value
The settlement value is the same amount that would be paid in the event of a
full withdrawal of the contract value. We will calculate the settlement value at
the end of the valuation period coinciding with the requested distribution date
for payment or on the mandatory distribution date of 5 years after the date of
death, whichever is earlier.
BENEFICIARY
The beneficiary will receive the death benefit when any owner dies. The
beneficiaries are as stated in the app unless changed.
If you do not name a beneficiary or if the beneficiary named is no longer
living, the beneficiary will be:
...your spouse if living, otherwise;
...your children equally if living, otherwise;
...your estate.
We will pay the death benefit to the beneficiaries according to the most recent
written instruction we have received from you. If we do not have any written
instructions, we will pay the death benefit in equal shares to the beneficiaries
who are to share the funds. If there is more than one beneficiary in a class and
one of the beneficiaries predeceases you, the death benefit will be paid to the
surviving beneficiaries in that class.
You may name new beneficiaries. We will provide a form to be signed. You must
file it with us. Upon receipt, it is effective as of the date you signed the
form, subject to any action we have taken before we received it.
OWNERSHIP
The annuitant is the owner if no other person is named in the app as owner.
Unless you provide otherwise, as owner, you may exercise all rights granted by
the contract, subject to the rights of any irrevocable beneficiary, without the
consent of anyone else.
You may name a new annuitant before the annuity date. You may also name a new
owner. We will provide a form to be signed to request these changes. You must
file it with us. Upon receipt, it is effective as of the date you signed the
form. We are not liable for any payment we make or other action we take before
receiving any written request for a change from you.
You may assign this contract or an interest in it to another. You must do so in
writing and file the assignment with us. No assignment is binding on us until we
receive it. When we receive it your rights and those of the beneficiary will be
subject to the assignment. We are not responsible for the validity of any
assignment you make.
OTHER TERMS OF YOUR CONTRACT
our contract with you
These pages, including any endorsements and any riders are your entire contract
with us. We issued it based upon your app and the payment of the purchase
payment by you.
We will not use any statements, except those made in the app to challenge any
claim or to avoid any liability under this contract. The statements made in the
app will be treated as representations and not as warranties.
Only our officers have authority to change this contract. No agent may do this.
Any change must be written.
incontestability
This contract will be incontestable after its issue date. This means that we
cannot use any misstatement by you in the application to challenge any claim or
to avoid liability under this contract after this time.
misstatement of age or sex
If any age or sex has been misstated, we will pay the amounts which would have
been paid at the correct age and sex.
conformity with state law
This contract is subject to the laws of the state in which it is delivered. If
any part of the contract does not comply with the law, it will be treated by us
as if it did.
nonparticipating
This policy does not participate in our earnings.
evidence of survival
We may require evidence of the survival of the annuitant.
settlements
We may require that this contract be returned to us prior to any settlement. We
must receive due proof of death of the owner or annuitant prior to settlement of
death claim.
Any surrender or death benefit under this contract will not be less than the
minimum benefits required by the statute of the state in which the contract is
delivered.
deferment of payments
We will pay any amounts due under the separate account under this contract
within seven days, unless:
- The New York Stock Exchange is closed for other than usual weekends or
holiday, or trading on such exchange is restricted;
- An emergency exists as defined by the Securities and Exchange Commission;
or
- The Securities and Exchange Commission permits delay for the protection of
contract holders.
In addition, we may defer payment or transfers from the fixed account options
for up to 6 months after you ask for it. If we defer payment from the fixed
account for more than 30 days we will pay interest as required by applicable
law. Any interest would be payable from the date the withdrawal request is
received by us to the date the payment is made.
annual report
At least once a year, prior to the annuity date, we will send you a statement
containing contract information. We will provide you with contract value
information at any time upon request. The information presented will comply with
any applicable law.
separate account modifications
We reserve the right, subject to applicable law, to make additions to, deletions
from, or substitutions for the mutual fund shares underlying the subaccounts. We
will not substitute any share attributable to your interest in a subaccount
without notice to you and prior approval of the Securities and Exchange
Commission, to the extend required by the Investment Company Act of 1940, as
amended.
We reserve the right to establish additional subaccounts each of which would
invest in shares of another mutual fund. You may then instruct us to allocate
purchase payments or transfers to such subaccounts, subject to any terms set by
us or the mutual fund.
In the event of any such substitution or change, we may by endorsement make sure
changes as may be necessary or appropriate to reflect such substitution or
change.
If we deem it to be in the best interests of the persons having voting rights
under the contracts, the separate account may be operated as a management
company under the Investment Company Act of 1940, as amended or it may be
deregistered under such Act in the event such registration is no longer
required.
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT
Flexible Premium Payments
Benefit Paid in the Event of Death Prior to the Annuity Date
Withdrawal and Surrender Rights
The dollar amount of annuity payments or other values provided by this contract,
when based on the investment experience of the separate account, will vary to
reflect the performance of the separate account. For amounts in the Guaranteed
Maturity Fixed Account, the withdrawal benefit, the death benefit, transfers to
other investment alternatives and any periodic annuity payments may be subject
to a market value adjustment which may result in an upward or downward
adjustment of the amount distributed.
XXXXXXX BENEFIT LIFE COMPANY
ENHANCED DEATH BENEFIT RIDER
This rider was issued because you selected the Enhanced Death Benefit at the
time you applied for this annuity.
Enhanced Death Benefit
The Death Benefit provision of your Contract is modified as follows:
The Death Benefit will be the greater of the values stated in your contract, or
the value of the Enhanced Death Benefit.
The Enhanced Death Benefit is equal to the greater of the Enhanced Death Benefit
A or Enhanced Death Benefit B. The Enhanced Death Benefit will cease on the date
we determine the value of the Death Benefit.
Enhanced Death Benefit A
At issue, the Enhanced Death Benefit A is equal to the initial purchase payment.
After issue, the Enhanced Death Benefit A is recalculated when a purchase
payment or withdrawal is made or on a contract anniversary as follows:
1. For purchase payments, the Enhanced Death Benefit A is equal to the most
recently calculated Enhanced Death Benefit A plus the purchase payment.
2. For withdrawals, the Enhanced Death Benefit A is equal to the most recently
calculated Enhanced Death Benefit A reduced by a withdrawal adjustment
defined below.
3. On each contract anniversary, the Enhanced Death Benefit A is equal to the
greater of the contract value or the most recently calculated Enhanced
Death Benefit A.
In the absence of any withdrawals or purchase payments, the Enhanced Death
Benefit A will be the greatest of all contract anniversary contract values on or
prior to the date we calculate the death benefit.
The Enhanced Death Benefit A will be recalculated for purchase payments,
with-drawals and on contract anniversaries until the oldest owner or the
annuitant, if the owner is not a living individual, attains age 85.
After age 85, the Enhanced Death Benefit A will be recalculated only for
purchase payments and withdrawals.
Enhanced Death Benefit B
The Enhanced Death Benefit B is equal to total purchase payments made reduced by
a withdrawal adjustment defined below. Each purchase payment and each withdrawal
adjustment will accumulate daily at a rate equivalent to 5% per year until the
earlier of:
1. the date we determine the death benefit, or
2. the first day of the month following the oldest owner's or, if the owner is
not a living individual, the annuitant's 85th birthday.
The Enhanced Death Benefit B will never be greater than the maximum death
benefit allowed by any nonforfeiture laws which govern the contract.
Withdrawal Adjustment
The withdrawal adjustment is equal to (a) divided by (b), with the result
multiplied by (c) where:
(a) equals the withdrawal amount.
(b) equals the contract value immediately prior to the withdrawal.
(c) equals the most recently calculated Enhanced Death Benefit A or B, as
applicable.
Mortality and Expense Risk Charge
The Mortality and Expense Risk Charge provision of your contract is modified as
follows:
The annualized mortality and expense risk charge of 1.40% is changed to 1.60%.
Except as amended in this rider, the contract remains unchanged.
X. Xxxxxx Xxxxxx
President
LINCOLN BENEFIT LIFE COMPANY
CONTRACT AMENDMENT FOR WAIVER OF CHARGES
The following provisions are added to your contract:
The benefits provided by this contract amendment do not impact any tax
liabilities or IRS penalties incurred as a result of a withdrawal. You are
responsible for all such liabilities and penalties.
Waiver for Confinement in Long Term Care Facility or Hospital
We will waive any withdrawal charge and market value adjustment prior to the
annuity date if at least 30 days after the issue date any owner, or, if the
owner is not a living individual, the annuitant is first confined to a Long Term
Care Facility or Hospital under the following conditions:
- confinement is for at least 90 consecutive days;
- confinement is prescribed by a physician;
- confinement is medically necessary; and
- the request for a withdrawal and due proof of confinement are received by
us no later than 90 days after discharge.
"Physician"
A licensed medical doctor (M.D.) or a licensed doctor of osteopathy (D.O.)
practicing within the scope of his or her license. Physician does not include
the individual, a spouse, children, parents, grandparents, grandchildren,
siblings, or in-laws.
"Due Proof"
Includes, but is not limited to, a letter signed by a Physician stating the
dates the owner or annuitant was confined, the name and location of the Long
Term Care Facility or Hospital, a statement that the confinement was Medically
Necessary, and, if released, the date the owner or annuitant was released from
the Long Term Care Facility or Hospital.
"Medically Necessary"
Confinement, care or treatment which is appropriate and consistent with the
diagnosis in accord with accepted standards of practice, and which could not
have been omitted without adversely affecting the individual's condition.
"Long Term Care Facility"
A facility which:
1. is located in the United States or its territories;
2. is licensed by the jurisdiction in which it is located;
3. provides custodial care under the supervision of a registered nurse (R.N.);
and
4. can accommodate three or more persons.
"Hospital"
A facility which:
1. is licensed as a hospital by the jurisdiction in which it is located;
2. is supervised by a staff of licensed physicians;
3. provides nursing services 24 hours a day by or under the supervision of a
registered nurse (R.N.);
4. operates primarily for the care and treatment of sick or injured persons as
inpatients for a charge; and
5. has access to medical, diagnostic and major surgical facilities.
Waiver for Terminal Illness
We will waive any withdrawal charge and market value adjustment prior to the
annuity date if at least 30 days after the issue date any owner, or, if the
owner is not a living individual, the annuitant is first diagnosed by a
Physician as having a terminal illness. The request for the withdrawal must be
received by us at least 30 days after the issue date. Due proof of the diagnosis
must be given to us prior to, or at the time of, the withdrawal request. We may
require a second opinion at our expense by a Physician chosen by us. In the
event that the first and second Physicians disagree, we will require a third
opinion at our expense by a Physician chosen by us. We will honor a consensus of
any two of the three Physicians.
"Physician"
A licensed medical doctor (M.D.) or a licensed doctor of osteopathy (D.O.)
practicing within the scope of his or her license. Physician does not include
the individual, a spouse, children, parents, grandparents, grandchildren,
siblings, or in-laws.
"Due Proof"
Includes, but is not limited to, a letter signed by a Physician stating the
owner or annuitant has a Terminal Illness and the date the Terminal Illness was
first diagnosed.
"Terminal Illness"
A condition which is expected to result in death within one year from the date
of onset for 80% of the diagnosed cases.
X. Xxxxxx Xxxxxx
President
