Exhibit 24(b)(4)(a)(i)
(XXXX XXXXXXX(R) LOGO) XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK
HOME OFFICE: [000 Xxxxxx Xxxx Xxxxx, 0xx Xxxxx
Valhalla, NY 10595]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
This Contract is issued in consideration of the Payments. Xxxx Xxxxxxx Life
Insurance Company of New York, a stock company, agrees to pay the benefits of
this Contract in accordance with its terms.
VARIABLE ACCOUNT PROVISIONS
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT WHEN BASED ON THE
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE, MAY INCREASE OR
DECREASE IN ACCORDANCE WITH THE FLUCTUATIONS IN THE INVESTMENT RESULTS, AS
APPLICABLE AND NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE
ACCOUNT PROVISIONS BEGIN ON PAGE 6.
The smallest annual rate of investment return which is required to be earned on
the assets of the separate account so that the dollar amount of variable annuity
payments will not decrease is [2.17%]. Explicit annual charges against the
assets of the separate account are as follows:
Contract Asset Fee Charge: Not greater than [1.15%]
RIGHT TO REVIEW
You may cancel the Contract by returning it to our Annuities Service Center or
the registered representative who sold it to you at any time within [10] days
after receipt of the Contract. Within 7 days of receipt of the Contract by us,
we will pay the Contract Value computed at the end of the Business Day on which
the Contract is delivered to us plus the sum of all fees and charges deducted
from the gross Payments to the Owner.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this [10] day period, we will return the greater of (i) Contract
Value computed at the end of the Business Day on which the Contract is delivered
to us plus the sum of all fees and charges deducted from the gross Payments or
(ii) sum of all Payments less any Withdrawals. If you return the Contract to us
after the first 7 days and before the [10]-day period has elapsed, we will
refund an amount determined as described in the paragraph above.
SIGNED FOR THE COMPANY at its Main Administration Office in Boston,
Massachusetts, on the Contract Date.
/s/ Xxxxx X. Xxxxxxxxx /s/ Xxxxxxx Xxxxx
[Xxxxx X. Xxxxxxxxx, President] [Xxxxxxx Xxxxx, Secretary]
INDIVIDUAL FLEXIBLE PAYMENT DEFERRED VARIABLE ANNUITY
Variable Accumulation prior to Annuity Commencement Date
Variable and Fixed Annuity Options
Death Benefit Proceeds Payable prior to Annuity Commencement Date
Withdrawal Charge Waiver Benefit
Non-Participating
DOLLAR COST AVERAGING (DCA) ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE ISSUE
DATE. REFER TO THE AVAILABLE INVESTMENT OPTIONS ON THE SPECIFICATIONS
PAGES FOR DETAILS.
ANNUITIES SERVICE CENTER:
[P.O. Box 9506 Portsmouth, NH 03802-9506] [0-000-000-0000] [www.jhannuitiesnew
xxxx.xxx]
OVERNIGHT MAILING ADDRESS:
[000 Xxxxxxxxx Xxxxx Xxxxxxxxxx, XX 00000-0000]
VENTURE-B.11-NY SAMPLE
TABLE OF CONTENTS
Specifications Pages ..................................................... S.1
Part 1 - Definitions ..................................................... 1
Part 2 - Parties to the Contract ......................................... 4
Part 3 - Payments ........................................................ 5
Part 4 - Fees And Deductions ............................................. 6
Part 5 - Variable Account Provisions ..................................... 6
Part 6 - Transfers ....................................................... 8
Part 7 - Withdrawal Provisions .......................................... 9
Part 8 - Death Benefits .................................................. 11
Part 9 - Contract Maturity ............................................... 13
Part 10 - Annuity Payments ............................................... 13
Part 11 - Annuity Options ................................................ 15
Part 12 - General Provisions ............................................. 15
Part 13 - Contract Termination ........................................... 17
INTRODUCTION
This is an individual flexible payment deferred variable annuity contract. This
Contract provides that, prior to the Annuity Commencement Date, the Contract
Value will accumulate on a variable basis. You allocate Payments among one or
more Investment Options. The initial Investment Options are identified on the
Specifications Pages. The Contract Value will vary with the investment
performance of your Investment Account. Subject to the provisions of the
Contract, you may take withdrawals and transfer amounts among the Investment
Options.
After the Annuity Commencement Date, Annuity Payments may be either fixed or
variable, or a combination of fixed and variable. If you select Annuity Payments
on a variable basis, the payment amount will vary with the investment
performance of the Variable Account.
If the Owner (Annuitant if the Owner is not an individual) dies while this
Contract is in effect prior to the Annuity Commencement Date, we will pay a
Death Benefit to the Beneficiary upon receipt of all required claim forms and
proof of death of the Owner at the Annuities Service Center.
VENTURE-B.11-NY SAMPLE
SPECIFICATIONS PAGE
TYPE OF CONTRACT: [Qualified] CONTRACT DATE: [06/15/2011]
CONTRACT NUMBER: [000000005] ISSUE STATE: NY
OWNER: [Xxxx X. Xxx] OWNER'S AGE & SEX: [55] [Male]
ANNUITANT: [Xxxx X. Xxx] ANNUITANT'S AGE & SEX: [55] [Male]
[CO-OWNER:] [ ] [CO-OWNER'S AGE & SEX:] [ ] [ ]
[CO-ANNUITANT:] [ ] [CO-ANNUITANT'S AGE & SEX:] [ ] [ ]
PLAN [VENTURE 7 Series]
FEES AND CHARGES
CONTRACT ASSET FEE [1.15% years 1-7]
[1.10% years 8 +]
ANNUAL CONTRACT FEE Electronic-Delivery of Financial
Owner Elects Electronic Delivery of Transaction Confirmations is
Financial Transaction Confirmations Not Elected by Owner
----------------------------------- --------------------------------
[$0] [$50]
[RIDER FEE(S) See Optional Riders section on page S.[4]]
PAYMENT LIMITS
PAYMENT LIMITS - Minimum Additional Payment Amount: [$30]
- Total Additional Payments: [$100,000]
- Maximum Amount: [$1,000,000]
VENTURE-B.11-NY S.1 SAMPLE
LIMITS--TRANSFERS AND AMOUNT OF PARTIAL WITHDRAWALS
TRANSFER CHARGES AND LIMITATIONS-- - Minimum Transfer Amount: $300
BEFORE ANNUITY COMMENCEMENT - Minimum Investment Account Value: $100
DATE - Number of Transfers Per Contract Year: two per month
- Transfer Charge: the lesser of $25 or 2% of the amount of
each transfer in excess of 12 per Contract Year
TRANSFER LIMITATIONS - ON OR AFTER - Number of Transfers Per Contract Year: 4
ANNUITY COMMENCEMENT DATE
LIMITATIONS ON AMOUNT OF - Minimum Amount of Partial Withdrawal: [$300]
PARTIAL WITHDRAWALS
- Minimum Investment Account Balance: $100
- Minimum Remaining Contract Value: $1,000
WITHDRAWALS CHARGES
TABLE OF WITHDRAWAL CHARGES Number of Complete Years Withdrawal Charge
Payment has been in Contract Percentage
---------------------------- -----------------
0 8%
1 7%
2 6%
3 5%
4 4%
5 3%
6 2%
7+ 0%
[Withdrawal Charges will be waived for any
contract issued to an employee of the Company.]
INITIAL ALLOCATION OF NET PAYMENT (See Following Page for All Available Investment Options)
INITIAL PAYMENT [$100,000.00]
[DCA ACCOUNT OPTIONS:] [INITIAL INTEREST RATE] [INITIAL GUARANTEE PERIOD EXPIRES]
[6 Month DCA Account] [25.00%] [1.00%] [12/15/2011]
[THE INTEREST RATE FOR THE DCA ACCOUNT OPTION ABOVE MAY CONTAIN AN ENHANCEMENT
THAT MAY
NOT BE PROVIDED IN SUBSEQUENT GUARANTEE PERIODS.]
VARIABLE INVESTMENT OPTIONS:
[Lifestyle Balanced PS] [75.00%]
TOTAL 100.00%
VENTURE-B.11-NY S.2 SAMPLE
AVAILABLE INVESTMENT OPTIONS
VARIABLE ACCOUNT: XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK SEPARATE
ACCOUNT A
VARIABLE INVESTMENT OPTIONS:
[Lifestyle Balanced]
[Lifestyle Balanced PS]
[Lifestyle Conservative]
[Lifestyle Conservative PS]
[Lifestyle Growth]
[Lifestyle Growth PS]
[Lifestyle Moderate]
[Lifestyle Moderate PS]
[Ultra Short Term Bond]
DOLLAR COST AVERAGING (DCA) ACCOUNT INVESTMENT OPTIONS:
6 Month DCA Account
[6 Month DCA Not Currently Available NO6MODCA03]
12 Month DCA Account
[12 Month DCA Not Currently Available NO12MODCA03]
VENTURE-B.11-NY S.3 SAMPLE
OPTIONAL RIDERS
[ENHANCED DEATH BENEFIT RIDER: MARKETING NAME]
- [Rider Date:] [06/15/2011]
- [Rider Fee Percentage:] [0.30%]
- [Total Asset Fee Percentage [1.45% years 1-7]
(Contract Asset Fee from Pg S.1 + [1.40% years 8+]
Rider Fee Percentage):]
[GUARANTEED MINIMUM WITHDRAWAL BENEFIT RIDER: MARKETING NAME]
- [Rider Date:] [06/15/2011]
- [Maximum Rider Fee Percentage:] [1.50%]
ANNUITY BENEFITS
MATURITY DATE: [10/25/2046]
ANNUITY OPTION: Life 10-Year Certain
ANNUITY PAYMENTS -- GENERAL The rates for Annuity Payments are determined based on:
INFORMATION
- Mortality Table: Annuity 2000 Table projected
from 2002 to date of annuitization at Scale G,
100% female blend
- Fixed Annuity Payment Interest Rate: 1.00%
interest per year
- Variable Annuity Payment Assumed Interest Rate:
1.00%
The amount of each Annuity Payment will depend
upon the age of the Annuitant, the Co-Annuitant,
if any, or other payee.
VENTURE-B.11-NY S.4 SAMPLE
AMOUNT OF FIRST MONTHLY PAYMENT
PER $1000 OF CONTRACT VALUE
FOR AN ANNUITANT BORN IN 1952
OPTION 1: LIFE ANNUITY
Option 1(A): Non-Refund Option 1(B): 10 Year Certain
----------------------- ----------------------------
Age of Age of
Xxxxxxxxx Xxxxxxxxx
--------- ---------
55 N/A 55 N/A
60 3.08 60 3.06
65 3.50 65 3.47
70 4.07 70 3.99
75 4.85 75 4.66
80 5.91 80 5.46
85 7.40 85 6.35
OPTION 2: JOINT AND SURVIVOR LIFE ANNUITY
Option 2(A): Non-Refund
Age of Co-Annuitant
----------------------------------------------
Age of 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
--------- -------- ------- ---- ------- --------
55 N/A N/A N/A N/A N/A
60 2.29 2.46 2.62 2.77 2.88
65 2.51 2.72 2.93 3.11 3.26
70 2.78 3.05 3.33 3.57 3.77
75 3.13 3.49 3.86 4.19 4.45
80 3.59 4.08 4.58 5.03 5.38
85 4.22 4.88 5.57 6.17 6.62
Option 2(B): 10 Year Certain
Age of Co-Annuitant
----------------------------------------------
Age of 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
--------- -------- ------- ---- ------- --------
55 N/A N/A N/A N/A N/A
60 2.29 2.46 2.62 2.77 2.88
65 2.51 2.72 2.93 3.11 3.26
70 2.78 3.05 3.32 3.57 3.75
75 3.13 3.49 3.85 4.16 4.40
80 3.58 4.06 4.53 4.93 5.20
85 4.18 4.80 5.38 5.83 6.12
Monthly installments for ages not shown and other years of birth will be
furnished on request.
VENTURE-B.11-NY S.5 SAMPLE
BENEFICIARY INFORMATION
[Xxxx Xxx]
DISCLOSURES
PURSUANT TO SECTION 3 OF THE FEDERAL DEFENSE OF MARRIAGE ACT ("DOMA"), SAME
SEX-MARRIAGES, DOMESTIC PARTNERSHIPS AND CIVIL UNIONS CURRENTLY ARE NOT
RECOGNIZED FOR PURPOSES OF FEDERAL LAW. THEREFORE, THE FAVORABLE INCOME-DEFERRAL
OPTIONS AFFORDED BY FEDERAL TAX LAW TO AN OPPOSITE-SEX SPOUSE UNDER INTERNAL
REVENUE CODE SECTIONS 72(S) AND 401(A)(9) ARE CURRENTLY NOT AVAILABLE TO A
SAME-SEX SPOUSE, DOMESTIC PARTNER OR CIVIL UNION PARTNER. SAME-SEX SPOUSES,
DOMESTIC PARTNERS OR CIVIL UNION PARTNERS WHO OWN OR ARE CONSIDERING THE
PURCHASE OF ANNUITY PRODUCTS THAT PROVIDE BENEFITS BASED UPON STATUS AS A SPOUSE
SHOULD CONSULT A TAX ADVISOR. TO THE EXTENT THAT AN ANNUITY CONTRACT ACCORDS TO
SPOUSES OTHER RIGHTS OR BENEFITS THAT ARE NOT AFFECTED BY DOMA, SAME-SEX
SPOUSES, DOMESTIC PARTNERS AND CIVIL UNION PARTNERS RECOGNIZED BY THE ISSUE
STATE REMAIN ENTITLED TO SUCH RIGHTS OR BENEFITS TO THE SAME EXTENT AS ANY
ANNUITY HOLDER'S SPOUSE.
[THIS PLAN IS INTENDED TO QUALIFY UNDER THE INTERNAL REVENUE CODE FOR
TAX-FAVORED STATUS. LANGUAGE CONTAINED IN THIS CONTRACT REFERRING TO FEDERAL TAX
STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. PLEASE SEEK THE ADVICE OF
YOUR OWN TAX ADVISOR REGARDING YOUR INDIVIDUAL TAX TREATMENT.]
VENTURE-B.11-NY S.6 SAMPLE
PART 1 DEFINITIONS
WE AND YOU "We", "us" and "our" means the Company. "You" or "your"
means the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the value
of the Variable Account of this Contract before the
Annuity Commencement Date.
ANNUITANT Any individual person or persons whose life is used to
determine the duration of Xxxxxxx Payments involving
life contingencies. The Annuitant is as designated on
the Specifications Pages, unless changed.
ANNUITIES SERVICE CENTER Any office designated by us for the receipt of Payments
and processing of Owner requests.
ANNUITY COMMENCEMENT DATE The date Annuity Payments begin. This date may not be
earlier than six months following the Contract Date or
later than the Maturity Date. Annuity Payments may not
be scheduled under the Contract to begin earlier than
12 months from the Contract Date.
ANNUITY OPTION The method selected by you for Annuity Payments made by
us.
ANNUITY PAYMENT(S) Payment(s) by us to you, in accordance with the Annuity
Option elected under the terms of this Contract.
ANNUITY UNIT A unit of measure that is used after the Annuity
Commencement Date to calculate Variable Annuity
payments.
BENEFICIARY The person, persons or entity to whom certain benefits
are payable following the death of an Owner, or in
certain circumstances, an Annuitant. For purposes of
section 72(s) of the Internal Revenue code, the
"designated beneficiary" under the Contract shall be
the individual who is entitled to receive the amounts
payable on death of an Owner, or if any Owner is not an
individual, on any change in, or death of, of an
Annuitant
BUSINESS DAY Any date on which the New York Stock Exchange is open
for business and the net asset value of a Portfolio is
determined.
COMPANY The insurance company named on the first page of this
Contract (or any successor insurance company named by
endorsement to this Contract) that will pay benefits in
accordance with this Contract.
CONTRACT ANNIVERSARY The annual anniversary of the Contract beginning twelve
months from the Contract Date and each year thereafter.
CONTRACT DATE The date of issue of this Contract as designated on the
Specifications Pages.
CONTRACT VALUE The total of your Investment Account Values.
CONTRACT YEAR The period of time measured twelve consecutive months
from the Contract Date or any Contract Anniversary
thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled to
receive the Contract proceeds if all Beneficiaries die
before the Owner dies.
VENTURE-B.11-NY 1 SAMPLE
ENDORSEMENT An Endorsement modifies the contract to which it is
attached. Endorsements must be signed by an officer of
the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are predetermined
and guaranteed as to dollar amount.
GOOD ORDER The standard we apply when we determine whether an
instruction is satisfactory. An instruction will be
considered in Good Order if it is received at our
Annuities Service Center: (a) in a manner that is
satisfactory to us such that it is sufficiently
complete and clear that we do not need to exercise any
discretion to follow such instruction and complies with
all relevant laws and regulations and Company
requirements; (b) on specific forms, or by other means
we then permit (such as via telephone or electronic
submission); and/or (c) with any signatures and dates
we may require. We will notify you if an instruction is
not in Good Order.
INTERNAL REVENUE CODE (IRC) The Internal Revenue Code of 1986, as amended from time
to time, and any successor statute of similar purpose.
INVESTMENT ACCOUNT An account established by us which represents your
interest in an Investment Option prior to the Annuity
Commencement Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment Account.
INVESTMENT OPTIONS The Subaccount(s) of the Variable Account. The
Investment Options available under this Contract at
issue are shown on the Specifications Pages.
MATURITY DATE The latest date on which annuity benefits may commence.
It is the date listed on the Specifications Pages,
unless changed. Any extension of the maximum Maturity
Date beyond age 90 of the oldest Annuitant or the 10th
Contract Year will be subject to the laws and
regulations then in effect and our prior approval.
NET PAYMENT The Payment less the amount of premium tax, if any,
deducted from the Payment.
NET SURRENDER VALUE The Surrender Value less any amount withheld by us for
income taxes.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified Plans.
OWNER The person, persons or entity entitled to the ownership
rights under this Contract. The Owner is as designated
on the Specifications Pages, unless changed.
PORTFOLIO The investment choices available to the Variable
Account.
PAYMENT An amount paid to us by you as consideration for the
benefits provided by this Contract.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax treatment
under sections 401, 403, 408 or 457, of the Internal
Revenue Code of 1986, as amended.
RIDER A rider provides an optional benefit, which may result
in an additional charge to the Contract. A rider
supplements the contract to which it is attached.
Riders must be signed by an officer of the Company in
order to be effective.
VENTURE-B.11-NY 2 SAMPLE
SEPARATE ACCOUNT A segregated account of the Company that is not
commingled with our general assets and obligations.
SUBACCOUNT(S) A division of the Variable Account. Each Subaccount is
invested in shares of a different Portfolio.
SURRENDER VALUE The Contract Value on any Valuation Date, less, if
applicable, any contract fees, any rider charges, any
deduction for premium taxes or similar taxes, and any
Withdrawal Charge.
VALUATION PERIOD Any period from one Business Day to the next, measured
from the time on each such day that the net asset value
of each Portfolio is determined.
VARIABLE ACCOUNT The Company's Separate Account as shown on the
Specifications Pages.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount; and
(2) vary in relation to the investment experience of
one or more specified variable Subaccounts.
WITHDRAWAL AMOUNT The amount deducted from the Contract Value when you
take a withdrawal. This amount is the total of the
amount paid to you plus the following, if applicable:
any contract fees, any rider charges, any deduction for
premium taxes or similar taxes, any amount for income
taxes resulting from the withdrawal, and any Withdrawal
Charges. The Withdrawal Amount may not exceed the
Contract Value.
WRITTEN REQUEST A notice provided in a form acceptable to Us based on
the type of request and received in Good Order at our
Annuities Service Center.
VENTURE-B.11-NY 3 SAMPLE
PART 2 PARTIES TO THE CONTRACT
OWNER Before the Annuity Commencement Date, the Owner of this
Contract shall be the person, persons or entity
designated on the Specifications Pages or the latest
change filed with us. A co-Owner is not permitted under
this Contract if any Owner is an entity. On the Annuity
Commencement Date the Annuitant will become the Owner
of this Contract, unless the Owner is a trust or
custodian. If amounts become payable to the Beneficiary
under this Contract, the Beneficiary becomes the Owner
of this Contract. Unless indicated otherwise,
references to the Owner will also include the co-Owner.
ANNUITANT The Annuitant is the person designated as such on the
Specifications Pages or the latest change filed with
us. If you name more than one Xxxxxxxxx, the second
Annuitant is referred to as the co-Annuitant. Unless
indicated otherwise, references to the Annuitant will
also include the co-Annuitant.
BENEFICIARY The Beneficiary is as designated on the Specifications
Pages, unless changed. However, if there is a surviving
Owner, that person will be treated as the Beneficiary.
If no such Beneficiary is living, the Beneficiary is
the Contingent Beneficiary. If no Beneficiary or
Contingent Beneficiary is living, the Beneficiary is
the estate of the deceased Owner.
CHANGE OF OWNER, ANNUITANT, Subject to the rights of an irrevocable Beneficiary,
BENEFICIARY you may change the Owner, Annuitant, or Beneficiary by
Written Request. Any change will take effect on the
date the request is signed. Any change of Owner or
Annuitant is subject to our issue age limitations based
on age at the date of the change. The Annuitant may not
be changed after the Annuity Commencement Date. You
need not send us the Contract unless we request it. We
will not be liable for any payments or actions we take
before the Written Request is received.
The addition of any Owner may result in the resetting
of the Guaranteed Minimum Death Benefit to an amount
equal to the Contract Value as of the date of such
change. For purposes of subsequent calculations of the
Guaranteed Minimum Death Benefit, we will treat the
Contract Value on the date of the change as a Payment
made on that date. In addition, all anniversary values,
all Payments made and all amounts deducted in
connection with partial withdrawals prior to the date
of the addition of the Owner will not be considered in
the determination of the Guaranteed Minimum Death
Benefit.
If any Annuitant is changed and any Owner is not an
individual, the entire interest in the Contract must be
distributed to the Owner within five years of the
change.
ASSIGNMENT You may assign this Contract, except as otherwise
provided, at any time prior to the Annuity Commencement
Date. No assignment will be binding on us unless it is
in the form of a Written Request. We will not be liable
for any payments made or actions we take before the
assignment is received by us. An absolute assignment
will revoke the interest of any revocable Beneficiary.
We will not be responsible for the validity of any
assignment.
If this Contract is issued in a Qualified Plan, this
Contract is subject to assignment restrictions for
Federal Income Tax purposes. In such event, this
Contract shall not be sold, assigned, discounted, or
pledged as collateral for a loan or as security for the
performance of an obligation or for any other purpose,
to any person other than us.
VENTURE-B.11-NY 4 SAMPLE
PART 3 PAYMENTS
GENERAL The Contract is not effective until the Initial Payment
is received by us at our Annuities Service Center or
such other place designated by us. All Payments under
this Contract are payable at our Annuities Service
Center or such other place as we may designate.
PAYMENT LIMITS The Initial Payment is shown on the Specifications
Pages. Each additional Payment must be at least equal
to the Minimum Additional Payment Amount shown on the
Specifications Pages. No additional payment will be
accepted, without our prior approval, after the first
Contract Year that causes the total of all additional
Payments received after the first Contract Year to
exceed the Total Additional Payments amount shown on
the Specifications Pages. If a Payment would cause the
Contract Value on the date of such Payment to exceed
the Maximum Amount shown on the Specifications Pages,
or the Contract Value on the date of such Payment
already exceeds the Maximum Amount, no additional
Payments will be accepted without our prior approval.
ALLOCATION OF NET PAYMENTS When we receive Payments, the Net Payments will be
allocated among Investment Options in accordance with
the allocation percentages shown on the Specifications
Pages. You may change the allocation of subsequent Net
Payments at any time, without charge, by Written
Request.
VENTURE-B.11-NY 5 SAMPLE
PART 4 FEES AND DEDUCTIONS
CONTRACT ASSET FEE To compensate us for assuming mortality and expense
risks, and administration expenses, we deduct from each
variable Investment Option a fee each Valuation Period
at an annual rate set forth on the Specifications
Pages. A portion of this Asset Fee may also be used to
reimburse us for distribution expenses. This fee is
reflected in the Net Investment Factor used to
determine the value of Accumulation Units and Annuity
Units of the Contract.
ANNUAL CONTRACT FEE To compensate us for assuming administration expenses,
we charge an Annual Contract Fee as set forth on the
Specifications Pages. Prior to the Annuity Commencement
Date, the Annual Contract Fee is deducted on each
Contract Anniversary. We withdraw the Annual Contract
Fee from each Investment Option in the same proportion
that the value of the Investment Accounts of each
Investment Option bears to the Contract Value. If the
Contract Value is totally withdrawn on any date other
than the Contract Anniversary, we will deduct the total
amount of the Annual Contract Fee from the amount paid.
After the Annuity Commencement Date, we deduct the
Annual Contract Fee on a pro rata basis from each
Annuity Payment.
TAXES We reserve the right to charge certain taxes against
your Payments (either at the time of payment or
liquidation due to withdrawals, annuitization or death
benefit), or against the Contract Value, Death Benefit
proceeds, or Annuity Payments, as appropriate. Such
taxes may include premium taxes or other taxes levied
by any government entity which we, in our sole
discretion, determine have resulted from the
establishment or maintenance of the Variable Account,
or from the receipt by us of Payments, or from the
issuance of this Contract, or from the commencement or
continuance of Annuity Payments under this Contract.
RIDER FEE(S) We charge an additional fee to compensate us for the
additional benefits provided by any optional benefit
riders elected by you. The Rider Fee for each rider you
elect is shown on the Specifications Pages or in the
Rider. Rider Fees are deducted as described in the
applicable benefit Rider issued by us.
PART 5 VARIABLE ACCOUNT PROVISIONS
INVESTMENT ACCOUNT We will establish a separate Investment Account for you
for each variable Investment Option to which you
allocate amounts. The Investment Account represents the
number of your Accumulation Units in an Investment
Option.
INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment Account
is determined by (a) times (b) where:
(a) equals the number of Accumulation Units
credited to the Investment Account; and;
(b) equals the value of the appropriate
Accumulation Unit.
ACCUMULATION UNITS We will credit Net Payments to your Investment Accounts
in the form of Accumulation Units. The number of
Accumulation Units we will credit to each Investment
Account of the Contract will be determined by dividing
the Net Payment allocated to that Investment Account by
the Accumulation Unit value for that Investment
Account.
VENTURE-B.11-NY 6 SAMPLE
Accumulation Units will be adjusted for any transfers
and will be canceled on payment of a death benefit,
withdrawal, maturity or assessment of certain charges
based on their value for the Business Day on which such
transaction occurs.
VALUE OF ACCUMULATION UNIT We will determine the Accumulation Unit value for a
particular Investment Account for any Business Day by
multiplying the Accumulation Unit value for the
immediately preceding Business Day by the net
investment factor for the Valuation Period for which
the value is being determined. The value of an
Accumulation Unit may increase, decrease or remain the
same from one Business Day to the next.
NET INVESTMENT FACTOR The net investment factor is an index that measures the
investment performance of a Subaccount from one
Business Day to the next (" the Valuation Period"). The
net investment factor for any Valuation Period is
determined by dividing (a) by (b) and subtracting (c)
from the result where:
(a) is the net result of:
(i) the net asset value per share of a
Portfolio share held in the
Subaccount determined as of the end
of the current Valuation Period, plus
(ii) the per share amount of any dividend
or capital gain distributions made
by the Portfolio on shares held in
the Subaccount and received during
the current Valuation Period; and
(b) is the net asset value per share of a
Portfolio share held in the Subaccount
determined as of the end of the
immediately preceding Valuation Period;
and
(c) is the Contract Asset Fee shown on the
Specifications Pages divided by 365 and
multiplied by the number of calendar days
in the Valuation Period.
The net investment factor may be greater or less than,
or equal to, one.
ADDITION, DELETION, SUBSTITUTION We reserve the right, subject to prior approval of the
OR RESTRICTION OF INVESTMENT New York Superintendent of Insurance and in compliance
OPTIONS with applicable law, to make additions to, deletions
from, or substitutions for the Portfolio shares that
are held by the Variable Account or that the Variable
Account may purchase. We reserve the right to eliminate
the shares of any of the eligible Portfolios and to
substitute shares of another Portfolio. We will not
substitute any shares attributable to your interest in
a Subaccount without notice to you and prior approval
of the Securities and Exchange Commission to the extent
required by the Investment Company Act of 1940. Nothing
contained herein shall prevent the Variable Account
from purchasing other securities for other series or
classes of contracts, or from effecting a conversion
between shares of another open-end investment company.
We reserve the right, subject to prior approval of the
New York Superintendent of Insurance and in compliance
with applicable law, to establish additional
Subaccounts which would invest in shares of a new
Portfolio. We also reserve the right to eliminate
existing Subaccounts, to restrict or prohibit
additional allocations to a Subaccount, to combine
Subaccounts or to transfer assets in a Subaccount to
another Separate Account established by us or an
affiliated company. In the event of any such
substitution or change, we may, by appropriate
endorsement, make such changes in this and other
Contracts as may be necessary or appropriate to reflect
such substitutions or change. If deemed by us to be in
the best interests of persons having voting rights
under the Contracts, the Variable Account may be
operated as a management company under the Investment
Company Act of 1940 or it may be de-registered under
such Act in the event such registration is no longer
required.
VENTURE-B.11-NY 7 SAMPLE
INSULATION The portion of the assets of the Variable Account equal
to the reserves and other contract liabilities with
respect to such account shall not be charged with
liabilities arising out of any other business we may
conduct. Moreover, the income, gains and losses,
realized or unrealized, from assets allocated to the
Variable Account shall be credited to or charged
against such account without regard to our other
income, gains or losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets with
a value at least equal to the amounts accumulated in
accordance with the terms of the applicable agreements
with respect to the Separate Account and the reserves
for annuities, in the course of payment that vary with
the investment experience of the Separate Account.
PART 6 TRANSFERS
TRANSFERS BEFORE ANNUITY While this Contract is in effect prior to the Annuity
COMMENCEMENT DATE Commencement Date, you may transfer amounts among the
Investment Accounts of the Contract, subject to the
limitations below. Amounts will be canceled from the
Investment Accounts from which amounts are transferred
and credited to the Investment Account to which amounts
are transferred. We will effect such transfers so that
the Contract Value on the date of transfer will not be
affected by the transfer.
You must transfer at least the Minimum Transfer Amount
shown on the Specifications Pages or, if less, the
entire amount in the Investment Account each time you
make a transfer. If, after the transfer, the amount
remaining in the Investment Account from which the
transfer is made is less than Minimum Investment
Account Value shown on the Specifications Pages, then
we will transfer the entire amount instead of the
requested amount.
We limit the number of transfers you may make each
Contract Year among each Variable Investment Option as
shown in the Transfers Before Annuity Commencement Date
section on the Specifications Pages.
We do not impose a charge for the first 12 transfers in
a Contract Year. For each additional transfer during a
Contract Year, the Transfer Charge is shown on the
Specifications Pages.
TRANSFERS ON OR AFTER ANNUITY Once variable Annuity Payments have begun, you may
COMMENCEMENT DATE transfer all or part of the investment upon which your
variable Annuity Payments are based from one Subaccount
to another. To do this, we will convert the number of
variable Annuity Units you hold in the Subaccount from
which you are transferring to a number of variable
Annuity Units of the Subaccount to which you are
transferring so that the next Annuity Payment, if it
were made at that time, would be the same amount that
it would have been without the transfer. After the
transfer, the variable Annuity Payments will reflect
changes in the values of your new variable Annuity
Units. You must give us notice at least 30 days before
the due date of the first variable Annuity Payment to
which the transfer will apply.
We reserve the right, upon notice, to limit the number
of transfers that can be made after variable annuity
payments have begun. If such a limit is imposed, the
number of transfers per Contract Year will be no less
than the Minimum Number of Transfers Per Contract Year
shown in the Transfers On Or After Annuity Commencement
Date section on the Specifications Pages.
VENTURE-B.11-NY 8 SAMPLE
After the Annuity Commencement Date, transfers will not
be allowed from a fixed to a variable Annuity Option,
or from a variable to a fixed Annuity Option.
DEFERRAL, MODIFICATION OR We reserve the right to defer, modify or terminate the
TERMINATION OF TRANSFER transfer privilege at any time that we are unable to
PRIVILEGE purchase or redeem shares of the Portfolios. Transfer
charges and limitations are identified above and in the
Suspension of Payments provision in the Withdrawals
Provisions section.
PART 7 WITHDRAWAL PROVISIONS
PAYMENTS OF WITHDRAWALS You may withdraw part or all of the Surrender Value, at
any time before the earlier of the death of an Owner,
the Annuity Commencement Date or the Maturity Date, by
sending us a Written Request. We will pay all
withdrawals within seven days of receipt at the
Annuities Service Center subject to postponement in
certain circumstances, as specified below.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the entire
Contract Value, we will terminate the Contract and pay
you the Net Surrender Value.
PARTIAL WITHDRAWAL If you request to withdraw an amount less than the
Surrender Value, we will pay you the amount requested
and deduct the Withdrawal Amount from the Contract
Value. Unless you specify the amount to be withdrawn
from each Investment Option, the Withdrawal Amount will
be withdrawn from each Investment Option on a pro rata
basis.
Partial withdrawals will reduce the Death Benefit, as
described in the Death Benefit section.
FREQUENCY AND AMOUNT OF PARTIAL You may make as many partial withdrawals as you wish.
WITHDRAWALS Limitations on the amount of partial withdrawals are as
follows.
(a) Any withdrawal from an Investment Account
must be at least equal to the Minimum Amount
of Partial Withdrawal shown on the
Specifications Pages or the entire balance in
the Investment Account, if less.
(b) If after the withdrawal, the amount
remaining in the Investment Account is less
than the Minimum Investment Account Balance
shown on the Specifications Pages, then we
will consider the withdrawal request to be a
request for withdrawal of the entire amount
held in the Investment Account.
(c) If a partial withdrawal reduces the
Contract Value to less than the Minimum
Remaining Contract Value shown on the
Specifications Pages, or if the amount
requested is greater than or equal to the
amount available as a total withdrawal, then
we will treat the partial withdrawal as a
total withdrawal of the Contract Value.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from, or postpone
the date of payments from, the variable Investment
Accounts for any period when: (1) the New York Stock
Exchange is closed (other than customary weekend and
holiday closings); (2) trading on the New York Stock
Exchange is restricted; (3) an emergency exists as a
result of which disposal of securities held in the
Variable Account is not reasonably practicable or it is
not reasonably practicable to determine the value of
the Variable Account's net assets; or (4) the
Securities and Exchange Commission, by order, so
permits for the protection of security holders;
provided that applicable rules and regulations of the
Securities and Exchange Commission
VENTURE-B.11-NY 9 SAMPLE
shall govern as to whether the conditions described in
(2) and (3) exist.
WITHDRAWAL CHARGE If a withdrawal is made from the Contract we may assess
a Withdrawal Charge against Payments. The amount of the
Withdrawal Charge and when it is assessed is discussed
below.
(a) A Free Withdrawal Amount may be withdrawn free of
a Withdrawal Charge. The Free Withdrawal Amount is
the greater of:
(i) Earnings, which for purposes of these
Withdrawal Charge provisions, means the
excess of the Contract Value on the date of
withdrawal over the unliquidated Payments; or
(ii) the excess of a. over b. where
a. equals 10% times the total Payments; and
b. equals 100% of all prior partial
withdrawals in that Contract Year.
(b) Amounts will be withdrawn from the Contract in the
following order for purposes of calculating the
Withdrawal Charge:
(i) Earnings; then
(ii) any Free Withdrawal Amount in excess of
Earnings; then
(iii) Payments not previously liquidated, in the
order such Payments were received.
(c) Payments are liquidated when the Withdrawal Amount
exceeds Earnings. The amount of Payments
liquidated equals
(i) the lesser of the Withdrawal Amount or the
total unliquidated Payments; minus
(ii) Earnings.
(d) A total withdrawal will liquidate all unliquidated
Payments. Any Payments liquidated may be subject
to a Withdrawal Charge based on the length of time
the Payment has been in the Contract. The
Withdrawal Charge is determined by multiplying the
amount of the Payment being liquidated by the
applicable Withdrawal Charge percentage obtained
from the table shown on the Specifications Pages.
(e) The total Withdrawal Charge will be the sum of the
Withdrawal Charges for the Payments being
liquidated.
WAIVER OF WITHDRAWAL CHARGE A Withdrawal Charge is not applied if the withdrawal is:
(a) payment of the Death Benefit; or
(b) due to the application of the Contract Value to an
Annuity Option; or
(c) taken at the Maturity Date of the Contract; or
(d) a distribution required to satisfy Federal Income
Tax minimum distribution requirements that apply
to this Contract; or
(e) a withdrawal guaranteed under certain riders
attached to the Contract, as specified in the
rider.
VENTURE-B.11-NY 10 SAMPLE
PART 8 DEATH BENEFITS
DEATH BENEFIT BEFORE ANNUITY Prior to the Maturity Date or Annuity Commencement
COMMENCEMENT DATE Date, if earlier, we will determine the Death Benefit
as of the date on which written notice and proof of
death and all required claim forms are received in Good
Order at the Company's Annuities Service Center as
follows:
The Death Benefit will be determined as the greater of
the Contract Value or the Guaranteed Minimum Death
Benefit.
The Guaranteed Minimum Death Benefit is the sum of all
Payments made, less any amount deducted in connection
with partial withdrawals. For purposes of calculating
the Guaranteed Minimum Death Benefit, the amount
deducted in connection with partial withdrawals will be
equal to (i) times (ii), where (i) is equal to the
Guaranteed Minimum Death Benefit prior to the
withdrawal, and (ii) is equal to the amount of the
partial withdrawal divided by the Contract Value prior
to the partial withdrawal.
We will permit the Owner to limit the Death Benefit
option(s) to be offered any named Beneficiary, if the
Owner provides written notice to the Company prior to
death and the desired option(s) is one provided for in
this Contract.
Death benefit distributions prior to the Annuity
Commencement Date are governed by Internal Revenue Code
Section 72(s). Pursuant to Section 72(s) any reference
in this provision to "spouse" means a spouse as defined
in federal law.
DEATH OF ANNUITANT: On the death of the last surviving
Annuitant, the Owner becomes the new Annuitant, if the
Owner is an individual. If the Owner is not an
individual the death of any Annuitant is treated as the
death of an Owner and the Death Benefit will be
determined by substituting the Annuitant for the Owner
as described below.
DEATH OF OWNER: We will pay the Death Benefit to the
Beneficiary if any Owner dies prior to the Maturity
Date or Annuity Commencement Date, if earlier. The
Death Benefit may be taken in one sum immediately, in
which case the Contract will terminate. If the Death
Benefit is not taken in one sum immediately, the
Contract will continue subject to the following
provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit over the
Contract Value will be allocated to and among the
Investment Accounts in proportion to their values
as of the date on which the Death Benefit is
determined.
(c) No additional Payments may be applied to the
Contract.
(d) If the Beneficiary is not the deceased Owner's
spouse, the entire interest in the Contract must
be distributed under one of the following options:
(i) The entire interest in the Contract must be
distributed over the life of the Beneficiary,
or over a period not extending beyond the
life expectancy of the Beneficiary, with
distributions beginning within one year of
the Owner's death; or
VENTURE-B.11-NY 11 SAMPLE
(ii) the entire interest in the Contract must be
distributed within 5 years of the Owner's
Death, or
(iii) as Annuity Payments under one of the options
described in the Annuity Options section.
If the Beneficiary dies before the distributions
required by (i) or (ii) are complete, the entire
remaining Contract Value must be distributed in a
lump sum immediately.
(e) If the Beneficiary is the deceased Owner's spouse,
the Contract will continue with the surviving
spouse as the new Owner, subject to the provisions
of Internal Revenue Code Section 72(s). The
surviving spouse may name a new Beneficiary (and,
if no Beneficiary is so named, the surviving
spouse's estate will be the Beneficiary).
The spouse may also elect distributions under one
of the following options:
(i) the entire interest in the Contract may be
distributed over the life of the
Beneficiary, or over a period not extending
beyond the life expectancy of the
Beneficiary, with distributions beginning
within one year of the Owner's death; or
(ii) as Annuity Payments under one of the options
described in the Annuity Options section.
(f) We will waive Withdrawal Charges on any
withdrawals.
If there is more than one Beneficiary, the foregoing
provisions will independently apply to each
Beneficiary, to the extent of that Beneficiary's share.
DEATH BENEFIT ON OR AFTER If Annuity Payments have been selected based on an
ANNUITY Annuity Option providing for payments for a guaranteed
COMMENCEMENT DATE period, and the Annuitant dies on or after the Annuity
Commencement Date, we will make the remaining
guaranteed payments to the Beneficiary. Any remaining
payments will be made at least as rapidly as under the
method of distribution being used as of the date of the
Annuitant's death. If no Beneficiary is living, we will
commute any unpaid guaranteed payments to a single sum
(on the basis of the interest rate used in determining
the payments) and pay that single sum to the estate of
the last to die of the Annuitant and the Beneficiary.
PROOF OF DEATH We will require Proof of death upon the death of the
Annuitant or the Owner. Proof of death is one of the
following received at the Annuities Service Center:
(a) A certified copy of a death certificate;
(b) A certified copy of a decree of a court of
competent jurisdiction as to the finding of death;
or
(c) Any other proof satisfactory to us.
VENTURE-B.11-NY 12 SAMPLE
PART 9 CONTRACT MATURITY
CHANGE IN MATURITY DATE Prior to the Maturity Date, an Owner may make a Written
Request to change the Maturity Date. Any extension of
the Maturity Date will be subject to our prior approval
and any applicable law or regulation then in effect.
OPTIONS AT MATURITY DATE We will send You information about Your available
options prior to the Maturity Date. If by the Maturity
Date, you do not choose an Annuity Option, make a total
withdrawal of the Surrender Value, or ask us to change
the Maturity Date, we will automatically pay you
Annuity Payments under the Annuity Option shown on the
Specifications Pages and the Annuity Commencement Date
is considered to be the Maturity Date.
We will provide variable Annuity Payments unless
otherwise elected. You can change the Annuity Option at
any time before the Annuity Commencement Date.
PART 10 ANNUITY PAYMENTS
GENERAL The entire Contract Value or the entire amount of the
Beneficiary's portion of the Death Benefit may be
applied in accordance with one or more of the Annuity
Options described below, subject to any restrictions of
Internal Revenue Code section 72(s). Once Annuity
Payments commence, the Annuity Option may not be
changed. The "Life 10-Year Certain" Annuity Option
described under Part 11, Option 1 is the default
Annuity Option unless you request another option on or
prior to the Maturity Date or unless otherwise required
by the Internal Revenue Code.
You may select a Fixed or Variable Annuity. We will
provide variable Annuity Payments unless otherwise
elected. Once Annuity Payments commence, the Annuity
Option may not be changed.
The method used to calculate the amount of the initial
and subsequent Annuity Payments is described below.
We may pay the Contract Value or Death Benefit, on the
Annuity Commencement Date in one lump sum if the
corresponding monthly income is less than $20.
VARIABLE ANNUITY PAYMENTS We will determine the amount of the first Variable
Annuity Payment by applying the portion of the Contract
Value used to effect a Variable Annuity (minus any
applicable premium taxes) to the Annuity Option elected
based on the mortality table and assumed interest rate
shown in the Specifications Pages. We will provide a
table of the annuity factors upon Written Request. If
the current rates in use by us on the Annuity
Commencement Date are more favorable to you, we will
use the current rates. The portion of the Contract
Value used to effect a Variable Annuity will be
measured as of a date not more than 10 business days
prior to the Annuity Commencement Date.
VENTURE-B.11-NY 13 SAMPLE
Subsequent payments will be based on the investment
performance of one or more Subaccounts as you select.
The amount of such payments is determined by the number
of Annuity Units credited for each Subaccount. Such
number is determined by dividing the portion of the
first payment allocated to that Subaccount by the
Annuity Unit value for that Subaccount determined as of
the same date that the Contract Value used to effect
Annuity Payments was determined. We then multiply this
number of Annuity Units for each Subaccount by the
appropriate Annuity Unit value for each subsequent
determination date, which is a uniformly applied date
not more than 10 business days before the payment is
due.
Variable Annuity payments, at the time of their
commencement, will not be less than those that would be
provided by the application of the amount described
below to purchase a single premium immediate annuity
then offered to the same class of annuitants by us or a
company affiliated with us. Since no such annuity
currently exists, we will apply rates that are
reasonable in relation to the market single premium
immediate annuity rates. The amount applied would be
equal to the greater of;
(a) the Contract Value less applicable Withdrawal
Charges; or
(b) 95% of the Contract Value.
MORTALITY AND EXPENSE GUARANTEE We guarantee that the dollar amount of each Variable
Annuity payment will not be affected by changes in
mortality and expense experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each Subaccount for
any Business Day is determined as follows:
(a) The net investment factor for the Subaccount for
the Valuation Period ending on the Business Day
for which the Annuity Unit value is being
calculated is multiplied by the value of the
Annuity Unit for the preceding Business Day; and
(b) The result is adjusted to compensate for the
interest rate used to determine the first Variable
Annuity payment.
The dollar value of Annuity Units may increase,
decrease or remain the same from one Valuation Period
to the next.
FIXED ANNUITY PAYMENTS We will determine the amount of each Fixed Annuity
payment by applying the portion of the Contract Value
used to effect a Fixed Annuity measured as of a date
not more than 10 business days prior to the Annuity
Commencement Date (minus any applicable premium taxes)
to the Annuity Option elected based on the mortality
table and interest rate shown on the Specifications
Pages. The Fixed Annuity payment will not be less than
that available by applying the amount described below
to purchase a single premium immediate annuity then
offered to the same class of annuitants by us or a
company affiliated with us. Such an amount would be
equal to the greater of:
(c) the Contract Value less applicable Withdrawal
Charges; or
(d) 95% of the Contract Value.
We guarantee the dollar amount of Fixed Annuity
payments.
VENTURE-B.11-NY 14 SAMPLE
PART 11 ANNUITY OPTIONS
DESCRIPTION OF ANNUITY OPTIONS Option 1: Life Annuity
a) Life Non-Refund. We will make Annuity Payments
during the lifetime of the Annuitant. No payments
are due after the death of the Annuitant.
b) Life with 10-Year Certain. We will make Annuity
Payments for 10 years and after that during the
lifetime of the Annuitant. No payments are due
after the death of the Annuitant or, if later, the
end of the 10-year period.
Option 2: Joint and Survivor Life Annuity
The second Annuitant named shall be referred to as the
Co-Annuitant.
a) Joint and Survivor Non-Refund. We will make
Annuity Payments during the joint lifetime of the
Annuitant and Co-Annuitant. Payments will then
continue during the remaining lifetime of the
survivor. No payments are due after the death of
the last survivor of the Annuitant and
Co-Annuitant.
b) Joint and Survivor with 10-Year Certain. We will
make Annuity Payments for 10 years and after that
during the joint lifetime of the Annuitant and
Co-Annuitant. Payments will then continue during
the remaining lifetime of the survivor. No
payments are due after the death of the survivor
of the Annuitant and Co-Annuitant or, if later,
the end of the 10-year period.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the Annuity
Options described above, you may choose an alternate
form of settlement acceptable to us. Once Annuity
Payments commence, the form of settlement may not be
changed.
PART 12 GENERAL PROVISIONS
ENTIRE CONTRACT The entire Contract consists of this Contract,
Endorsements and Riders, if any, and the application,
if one is attached to this Contract.
BENEFITS AND VALUES The benefits and values available under this Contract
are not less than the minimum required by any statute
of the state in which this Contract is delivered. We
have filed a detailed statement of the method used to
calculate the benefits and values with the Department
of Insurance in the state in which this Contract is
delivered, if required by law.
MODIFICATION Only the President, a Vice President, or the Secretary
of the Company has authority to agree on our behalf to
any alteration of the Contract or to any waiver of our
rights or requirements. The change or waiver must be in
writing. We will not change or modify this Contract
without prior approval of the New York Superintendent
of Insurance. No change that reduces benefits will be
made without your written consent.
VENTURE-B.11-NY 15 SAMPLE
CLAIMS OF CREDITORS All benefits and payments under this Contract shall be
exempt from the claims of creditors to the extent
permitted by law.
MISSTATEMENT AND PROOF OF AGE We may require proof of age or survival of any person
OR SURVIVAL upon whose age or survival any Annuity Payments or
other benefits provided by this Contract or any Rider
attached thereof depend. If the age of the Annuitant
has been misstated, the benefits will be those which
would have been provided for the correct age. If we
have made incorrect benefit payments, we will
immediately pay the amount of any underpayment adjusted
with interest at 3% per annum. We will deduct the
amount of any overpayment from future benefit payments
without adjustment for interest.
INCONTESTABILITY This Contract is not contestable.
NON-PARTICIPATING Your Contract is non-participating and will not share
in our profits or surplus earnings. We will pay no
dividends on your Contract.
REPORTS We provide periodic reports no less frequently than
annually without charge, containing the Investment
Account Value, the Contract Value and Death Benefit.
The report will include the number of Accumulation
Units credited to the Variable Account, the
Accumulation Unit value and the dollar value of the
Accumulation Unit of the Variable Account no more than
4 months prior to the date of the delivery of the
report. We will provide annual calendar year reports
concerning the status of the Contract and such
information concerning required minimum distributions
as is prescribed by the Commissioner of Internal
Revenue. We will provide additional status reports upon
request for a charge not to exceed $25 per request.
CURRENCY AND PLACE OF PAYMENTS All payments made to or by us shall be made in the
lawful currency of the United States of America at the
Annuities Service Center or elsewhere if we consent.
NOTICES AND ELECTIONS To be effective, all notices and elections you make
under this Contract must be in the form of a Written
Request. All notices, requests and elections will be
effective when signed. We will not be liable for any
payments made or actions taken before the Written
Request is received by us.
GOVERNING LAW This Contract will be governed by the laws of the
jurisdiction indicated on the Specifications Pages.
SECTION 72(S) The provisions of this Contract shall be interpreted so
as to comply with the requirements of Section 72(s) of
the Internal Revenue Code.
VENTURE-B.11-NY 16 SAMPLE
PART 13 CONTRACT TERMINATION
CANCELLATION FOR NONPAYMENT & If, prior to the Annuity Commencement Date, no Payments
MINIMUM ACCOUNT VALUE have been made for two consecutive Contract Years, and
if both:
(a) the total Payments made, less any partial
withdrawals, are less then $2,000; and
(b) the Contract Value at the end of such two year
period is less than $2,000; we may cancel this
Contract and pay you the Contract Value (measured
as of the Valuation Period during which the
cancellation occurs), less the Annual Contract
Fee.
OTHER This Contract will terminate on the earliest of :
(a) receipt of your request to withdraw the entire
Contract Value;
(b) the date a Death Benefit is payable and the
Beneficiary takes the Death Benefit as a lump sum;
or
(c) the date the Contract Value reduces to zero,
subject to the provisions of any benefit rider
attached to this Contract.
VENTURE-B.11-NY 17 SAMPLE
XXXX XXXXXXX LIFE INSURANCE COMPANY OF NEW YORK (XXXX XXXXXXX(R) LOGO)
HOME OFFICE: Valhalla, New York
VENTURE-B.11-NY SAMPLE
