EXHIBIT 4(a)
FORM OF GROUP VARIABLE ANNUITY CONTRACT
OF KEYPORT LIFE INSURANCE COMPANY
KEYPORT
LIFE INSURANCE COMPANY
----------------------
----------------------
A Stock Company
This Group Contract, as issued to the Group Contract Owner by Us with any
riders or endorsements, alone makes up the agreement under which benefits are
paid. The Group Contract may be inspected at the office of the Group Contract
Owner. In consideration of any application for a Certificate and the payment
of purchase payments, We agree, subject to the terms and conditions of the
Group Contract, to provide the benefits described in the Certificate to the
Certificate Owner.
If a Certificate is In Force on the Income Date, We will begin making income
payments to the Annuitant. We will make such payments according to the terms
of the Certificate and Group Contract.
RIGHT TO EXAMINE CERTIFICATE: A Certificate Owner may return a Certificate to
Us or the agent through whom it was purchased within 10 days of receipt. If
so returned, We will treat the Certificate as though it were never issued.
Upon receipt We will promptly refund the Certificate Value as of the date the
returned Certificate is received by Us plus any charges We may have
previously deducted.
READ THIS CONTRACT CAREFULLY.
Secretary President
GROUP VARIABLE ANNUITY CONTRACT
FLEXIBLE PURCHASE PAYMENTS
DEFERRED INCOME PAYMENTS
NONPARTICIPATING -- NO DIVIDENDS
ANNUITY PAYMENTS AND OTHER VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF
A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
THIS IS EXPLAINED FURTHER ON PAGES 11 AND 18.
DVA(1) PAGE 1
TABLE OF CONTENTS
Page
Right to Examine Certificate..................................1
Definitions...................................................2
Contract Schedule.............................................3A
General Provisions............................................5
Variable Account Provisions...................................10
Transfers.....................................................13
Partial Withdrawals and Total Surrender.......................14
Death Provisions..............................................15
Annuity Provisions............................................16
Endorsements (if any) are before page.........................22
DEFINITIONS
ACCUMULATION PERIOD: The period prior to the Income Date during which
Purchase Payments may be made by a Certificate Owner.
ACCUMULATION UNIT: An accounting unit used to calculate a Certificate Owner's
interest in a Sub-account of the Variable Account during the Accumulation
Period.
ADJUSTED CERTIFICATE VALUE: The Certificate Value less any applicable taxes
relating to a Certificate and Certificate Maintenance Charge. This amount is
applied to the applicable Annuity Tables to determine Annuity Payments.
ANNUITANT: The natural person on whose life Annuity Payments are based, and
to whom any Annuity Payments will be made starting on the Income Date.
ANNUITY OPTIONS: Options available for Annuity Payments.
ANNUITY PAYMENTS: The series of payments made to the Annuitant, starting on
the Income Date, under the Annuity Option selected.
ANNUITY PERIOD: The period after the Income Date during which Annuity
Payments are made.
ANNUITY UNIT: An accounting unit used to calculate Variable Annuity Payments
during the Annuity Period.
BENEFICIARY: The person(s) or entity(ies) who controls the Certificate if any
Certificate Owner dies before the Income Date.
(Definitions continue on page 4)
DVA(1) PAGE 2
KEYPORT LIFE INSURANCE COMPANY
000 XXXX XXXXXX, XXXXXX, XX 00000
CONTRACT SCHEDULE
GROUP CONTRACT OWNER [Keyport Insurance Trust]
GROUP CONTRACT NUMBER [678999]
GROUP CONTRACT ISSUE DATE [1/30/96]
MINIMUM INITIAL PAYMENT [$5,000]
MINIMUM ADDITIONAL PAYMENT [$1,000]
CHARGES
DISTRIBUTION CHARGE [We deduct [0.000411%] of the assets in each Variable
Account Sub-Account on a daily basis (equivalent to an annual rate of [0.15%])
to compensate Us for a portion of Our distribution costs.]
ADMINISTRATIVE CHARGE [We deduct [0.000411%] of the assets in each Variable
Account Sub-account on a daily basis (equivalent to an annual rate of [0.15%])
to compensate Us for a portion of Our administrative expenses.]
MORTALITY AND EXPENSE RISK CHARGE [We deduct [0.003863%] of the assets in each
Variable Account Sub-account on a daily basis (equivalent to an annual rate of
[1.25%]) for Our mortality and expense risks.]
CERTIFICATE MAINTENANCE CHARGE [We charge [$36] to cover a portion of Our
ongoing Certificate maintenance expenses. The charge is incurred at the
beginning of the Certificate Year and is deducted on each Certificate
Anniversary and at the time of total surrender.]
TRANSFER CHARGE [Currently none, however, We reserve the right to charge [$25]
for a transfer if a Certificate Owner makes more than [12] transfers per
Certificate Year.]
SURRENDER CHARGE [At the time of each partial withdrawal or at total surrender
a contingent
DVA(1) PAGE 3A
deferred sales charge is imposed as a percentage of each Purchase Payment
during the [seven] years after the date of its payment, as follows:
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7
7% 6% 5% 4% 3% 2% 1%
Thereafter 0%].
INITIAL PURCHASE PAYMENT ALLOCATION
Currently, Certificate Owners can select [7] Sub-accounts [and the Fixed
Account]. We reserve the right to increase or decrease the number of
available Sub-accounts. The minimum a Certificate Owner may allocate to any
Sub-account [or the Fixed Account] is [10%] of any Purchase Payment. An
initial Purchase Payment may be invested as follows:
[Y - 1
Y - 2
Y - 3
X - 1
X - 2
X - 3
Fixed Account]
TRANSFER GUIDELINES
NUMBER OF TRANSFERS AND TRANSFER CHARGE: [Currently, Certificate Owners are
permitted [12] transfers per Certificate Year during the Accumulation Period
and [1] transfer every [6] months during the Annuity Period. We reserve the
right to change, upon notice, the frequency of transfers a Certificate Owner
can make. We also reserve the right to impose a charge for any transfer in
excess of [12] per Certificate Year. The transfer charge is shown in the
Charges section of the Schedule.]
MINIMUM AMOUNT TO BE TRANSFERRED: [None]
MINIMUM AMOUNT WHICH MUST REMAIN IN A SUB-ACCOUNT AFTER TRANSFER: [None]
[LIMITATIONS ON TRANSFERS FROM FIXED ACCOUNT: Transfers during a Certificate
Year from the Fixed Account to the Variable Account are limited to [25%] of
the Fixed Account Value at the beginning of the Certificate Year. This
limitation will be waived if a systematic program of monthly transfers has
been established.]
PARTIAL WITHDRAWALS
A Certificate Owner may make partial withdrawals during the Accumulation
Period without
DVA(1) PAGE 3B
incurring a surrender charge[, as follows:
(1) In any Certificate Year a Certificate Owner may withdraw an
aggregate amount not to exceed, at the time of withdrawal:
(a) the Certificate Value, less
(b) the portion of the Purchase Payments not previously withdrawn
by that Certificate Owner; and
(2) In any Certificate Year after the first, a Certificate Owner may
also withdraw the positive difference, if any, between the amount
withdrawn pursuant to (1) above in any such subsequent year and 10%
of the Certificate Value as of the preceding Certificate
Anniversary.
We will collect the surrender charge shown on the Schedule with respect to
partial withdrawals in excess of the amounts described in (1) and (2) above].
MINIMUM WITHDRAWAL AMOUNT: [$300], unless the withdrawal is made pursuant to
Our systematic withdrawal program, in which case the minimum withdrawal is
[$100].
MINIMUM CERTIFICATE VALUE WHICH MUST REMAIN AFTER A PARTIAL WITHDRAWAL:
[$2,500].
DEATH BENEFITS
ADJUSTMENT OF CERTIFICATE VALUE
When We receive due proof of death of the Certificate Owner, [any Joint
Certificate Owner,] or the Annuitant if the Certificate Owner is a non-natural
Person, We will compare, as of the date of death, the Certificate Value to the
Death Benefit amount defined in the Certificate Schedule. If the Certificate
Value is less than the Death Benefit, We will increase the current Certificate
Value by the amount of the difference. Any amount credited will be allocated
to the Variable Account [and/or the Fixed Account] based on the Purchase
Payment allocation selection that is in effect when We receive due proof of
death.
[WAIVER OF SURRENDER CHARGES
If the Certificate is surrendered within [90] days of the date of death of the
Certificate Owner, [any Joint Certificate Owner,] or the Annuitant if the
Certificate Owner is a non-natural Person, any applicable surrender charges
will not be deducted from the Certificate Withdrawal Value.]
DEATH BENEFIT AMOUNT
A Certificate Schedule will contain one [or more] of the following Death
Benefit provisions.
[PURCHASE PAYMENT DEATH BENEFIT
On the Certificate Date the Death Benefit is the initial Purchase Payment. On
subsequent Valuation Dates, the Death Benefit is calculated as follows:
(1) Start with the Death Benefit from the prior Valuation Date;
DVA(1) PAGE 3C
(2) Add to (1) any additional Purchase Payments paid during the current
Valuation Period and subtract from (1) any partial withdrawals
(including any associated surrender charge incurred) made during the
current Valuation Period.]
[CERTIFICATE ANNIVERSARY DEATH BENEFIT
On the Certificate Date, the Death Benefit is the initial Purchase Payment.
On subsequent Valuation Dates, the Death Benefit is calculated as follows:
(1) (a) Start with the Death Benefit from the Certificate Date;
(b) Add to (a) any additional Purchase Payments paid since the
Certificate Date and subtract from (a) any partial withdrawals
(including any associated surrender charge incurred) made since
the Certificate Date;
(2) (a) Determine the Certificate Value for each Certificate
Anniversary (the "Anniversary Value") before the [81st] birthday
of the Certificate Owner or, if the Certificate Owner is a
non-natural Person, the Annuitant;
(b) Increase each "Anniversary Value" by any Purchase Payments made
after that Value's Anniversary;
(c) Decrease each "Anniversary Value" by the following amount
calculated at the time of each partial withdrawal made after
that Value's Anniversary: (i) the partial withdrawal amount
(including any associated surrender charge incurred) divided by
the Certificate Value immediately preceding the withdrawal,
(ii) multiplied by the "Anniversary Value" immediately
preceding the withdrawal;
(d) Select the highest "Anniversary Value" after the adjustments in
(b) and (c) above;
(3) Set the Death Benefit equal to the greater of (1) and (2).]
[If there is a change of Certificate Owner, the new Certificate Owner's age
will be used to determine the amount in (2) above.]
[INTEREST ACCUMULATING DEATH BENEFIT
On the Certificate Date, the Death Benefit is the initial Purchase Payment.
On subsequent Valuation Dates, the Death Benefit is calculated as follows:
(1) Start with the Death Benefit from the Prior Valuation Date;
(2) Calculate interest on (1) for the current Valuation Period at
the Death Benefit Interest Rate;
(3) Add (1) and (2);
(4) Add any additional Purchase Payments paid during the current
Valuation Period to (3);
(5) Subtract partial withdrawals made during the current Valuation
Period from (4);
Each accumulated initial or additional Purchase Payment, reduced by any
partial withdrawals (including any associated surrender charge incurred)
allocated to such Purchase Payment, will continue to grow at the Death Benefit
Interest Rate until reaching its Maximum Guaranteed Death Benefit.
DVA(1) PAGE 3D
The Death Benefit is accumulated at the Death Benefit Interest Rate of [7%]
compounded annually, except:
(1) Amounts in the [XX-1 Sub-account] are accumulated at the net rate of
return for Such Sub-account during the current Valuation Period if
less than [7%] compounded annually; and
(2) Amounts in the [YY-1 Sub-account] are accumulated at the net rate of
return for such Sub-account during the current Valuation Period if
less than [7%]compounded annually; and
(3) Amounts in a Fixed Allocation are accumulated at the interest rate
being credited to such Fixed Allocation during the current Valuation
Period if less than [7%] compounded annually.
The net rate of return used in (1) and (2) equals the net investment factor
defined on page 11 less 1.0.
The Maximum Guaranteed Death Benefit is initially equal to [two] times the
initial or additional Purchase Payment paid. Thereafter, the Maximum
Guaranteed Death Benefit as of the effective date of a partial withdrawal is
reduced first by the amount of any partial withdrawal representing earnings
and second in proportion to the reduction in Certificate Value for any partial
withdrawal representing Purchase Payments (in each case, including any
associated surrender charge incurred).]
[If there is a change of Certificate Owner and the new Certificate Owner's age
is less than or equal to 75, the Death Benefit described above will remain in
effect. If the new Certificate Owner's age is greater than 75, the Death
Benefit in effect will not apply; the Death Benefit will be the sum of the
Purchase Payments less any partial withdrawals (including any associated
surrender charge incurred) made since the Certificate Date.]
THE VARIABLE SEPARATE ACCOUNT[S]
[SUB-ACCOUNTS INVESTING IN SHARES OF MUTUAL FUNDS
Variable Account [A] is a unit investment trust variable separate account,
organized in and governed by the laws of the State of Rhode Island, Our state
of domicile. Variable Account [A] is divided into Sub-accounts. Each Sub-
account listed below invests in shares of the corresponding Portfolio of the
Eligible Fund shown.
SUB-ACCOUNT ELIGIBLE FUND AND PORTFOLIO
[YYYYY FUND]
[TEXT HERE WILL DESCRIBE FUNDS AND INVESTMENT OBJECTIVES]
[XXXXX TRUST]
[TEXT HERE WILL DESCRIBE FUNDS AND INVESTMENT OBJECTIVES]
[SUB-ACCOUNTS INVESTING DIRECTLY IN SECURITIES
DVA(1) PAGE 3E
Variable Account [B] is an investment company variable separate account which
invests directly in securities, organized in and governed by the laws of the
State of Rhode Island, Our state of domicile. Variable Account [B] is divided
into Sub-accounts. The investment advisor to each Sub-account is set forth
opposite each Sub-account shown below:
Sub-account Investment Advisor
[Currently, none] [Currently, none] ]
THE FIXED ACCOUNT
[The Fixed Account is part of Our General Account, which consists of all of
Our assets except the assets of the Variable Account and the assets of other
separate accounts that We maintain. Subject to applicable law, We have sole
discretion over investments of the assets of the Fixed Account. If a
Certificate Owner allocates assets to the Fixed Account, the Certificate
Owner's accumulation values and annuity payments will have guaranteed minimums.
Before the Income Date, a Certificate Owner's interest in the Fixed Account is
measured by the Fixed Account Value. When annuity payments begin, the payee's
interest in the Fixed Account is measured by the amount of each periodic
payment.
Benefits from the Fixed Account will not be less than the minimum values
required by any law of the jurisdiction where the Certificate is delivered.
Purchase Payments will be allocated to the Fixed Account in accordance with a
Certificate Owner's selection at the Certificate Issue Date. A Certificate
Owner may change such selection by Written Request.
The Fixed Account Value at any time is equal to:
(1) all Purchase Payments allocated to the Fixed Account plus the
interest subsequently credited on those payments; plus
(2) any Variable Account Value transferred to the Fixed Account
plus the interest subsequently credited on the transferred
value; less
(3) any prior partial withdrawals from the Fixed Account;less
(4) any Fixed Account Value transferred to the Variable Account.
We will credit interest to Purchase Payments allocated to the Fixed Account at
rates declared by Us for Guarantee Periods of one [or more] year[s] from the
month and day of allocation. The minimum Guaranteed Interest Rate is [3%] per
year.]
DVA(1) PAGE 3E
DEFINITIONS (CONTINUED)
CERTIFICATE: The document issued to a Certificate Owner to evidence a
Certificate Owner's participation under the Group Contract. The Certificate
summarizes the benefits and provisions of the Group Contract.
CERTIFICATE ANNIVERSARY: An anniversary of the Certificate Issue Date.
CERTIFICATE ISSUE DATE: The date a Certificate is issued to a Certificate
Owner. The Certificate Issue Date is shown on the Certificate Schedule.
CERTIFICATE OWNER: The person who owns a Certificate under the Group
Contract. Any Joint Certificate Owners and the Certificate Owner own the
Certificate equally with rights of survivorship. All Owners must exercise
ownership rights and privileges together, including the signing of Written
Requests.
CERTIFICATE VALUE: The sum of the Certificate Owner's interest in the Sub-
accounts of the Variable Account and the Fixed Account during the Accumulation
Period.
CERTIFICATE YEAR: The first Certificate Year is the annual period which
begins on the Certificate Issue Date. Subsequent Certificate Years begin on
each Certificate Anniversary.
ELIGIBLE FUND: An investment entity shown on the Certificate Schedule.
FIXED ACCOUNT: The account We establish to support Fixed Allocations. The
Contract Schedule shows whether the Fixed Account is available under the
Certificates.
FIXED ACCOUNT VALUE: The value of all Fixed Account amounts accumulated under
a Certificate prior to the Income Date.
FIXED ALLOCATION: An amount allocated to the Fixed Account that is credited
with a Guaranteed Interest Rate for a specified Guarantee Period.
FIXED ANNUITY: An annuity with a series of payments made during the Annuity
Period which are guaranteed as to dollar amount by Us.
GENERAL ACCOUNT: Our general investment account which contains all of Our
assets except those in the Variable Account and Our other separate accounts.
GROUP CONTRACT OWNER: The person or entity to which the Group Contract is
issued.
GUARANTEED INTEREST RATE: The effective annual interest rate which We will
credit for a specified Guarantee Period.
GUARANTEE PERIOD: The period of year(s) a rate of interest is guaranteed to
be credited within
DVA(1) PAGE 4
the Fixed Account.
INCOME DATE: The date on which Annuity Payments begin. The Income Date is
shown on the Certificate Schedule.
IN FORCE: The status of a Certificate before the Income Date so long as it
has not been totally surrendered and there has not been a death of a
Certificate Owner or Joint Certificate Owner that will cause the Certificate
to end within five years of the date of death.
OFFICE: Our executive office shown on the Certificate Schedule.
PERSON: A human being, trust, corporation, or any other legally recognized
entity.
PORTFOLIO: A series of an Eligible Fund which constitutes a separate and
distinct class of shares.
PURCHASE PAYMENT: A payment made by or on behalf of a Certificate Owner with
respect to a Certificate.
SUB-ACCOUNT: Variable Account assets are divided into Sub-accounts. Assets
of each Sub-account will be invested in shares of a Portfolio of an Eligible
Fund, or directly in portfolio securities.
VALUATION DATE: Each day on which We and the New York Stock Exchange ("NYSE")
are open for business, or any other day that the Securities and Exchange
Commission requires that mutual funds, unit investment trusts or other
investment portfolios be valued.
VALUATION PERIOD: The period of time beginning at the close of business of
the NYSE on each Valuation Date and ending at the close of business on the
next succeeding Valuation Date.
VARIABLE ACCOUNT: Our Variable Account(s) shown on the Certificate Schedule.
VARIABLE ANNUITY: An annuity with payments which vary as to dollar amount in
relation to the investment performance of specified Sub-accounts of the
Variable Account.
WE, US, OUR: Keyport Life Insurance Company.
WRITTEN REQUEST: A request in writing, in a form satisfactory to Us, and
received by Us at Our Office.
GENERAL PROVISIONS
PURCHASE PAYMENTS
The initial Purchase Payment is due on the Certificate Issue Date. It must be
paid at Our Office in United States currency. Coverage under a Certificate
does not take effect until We have accepted the initial Purchase Payment
during a Certificate Owner's lifetime. Each Purchase
DVA(1) PAGE 5
Payment after the Certificate Issue Date must be at least the amount shown on
the Certificate Schedule. Provided the Certificate Value under a Certificate
does not go to zero, a Certificate will stay in force until the Income Date
even if a Certificate Owner make no payments after the initial one. We
reserve the right to reject any subsequent Purchase Payment.
ALLOCATION OF PURCHASE PAYMENTS
An initial Purchase Payment is allocated to the Sub-accounts of the Variable
Account, and to the Fixed Account if available, in accordance with the
selections made by a Certificate Owner at the Certificate Issue Date. Unless
otherwise changed by a Certificate Owner, subsequent Purchase Payments are
allocated in the same manner as the initial Purchase Payment. Allocation of
Purchase Payments is subject to the terms and conditions imposed by Us. We
reserve the right to allocate initial Purchase Payments to the money market
Sub-account until the expiration of the Right to Examine Certificate period
set forth on the first page of the Group Contract and the Certificate.
THE CONTRACT
The Group Contract, including the application, if any, and any attached rider
or endorsement constitute the entire contract between the Group Contract Owner
and Us. All statements made by the Group Contract Owner, any Certificate
Owner or any Annuitant will be deemed representations and not warranties. No
such statement will be used in any contest unless it is contained in the
application signed by the Group Contract Owner or in a written instrument
signed by the Certificate Owner, a copy of which has been furnished to the
Certificate Owner, the Beneficiary or to the Group Contract Owner.
Only Our President or Secretary may agree to change any of the terms of the
Group Contract. Any changes must be in writing. Any change to the terms of a
Certificate must be in writing and with Certificate Owner's consent, unless
provided otherwise by the Group Contract and the Certificate.
To assure that the Group Contract and the Certificate will maintain their
status as a variable annuity under the Internal Revenue Code, We reserve the
right to change the Group Contract and any Certificate issued thereunder to
comply with future changes in the Internal Revenue Code, any regulations or
rulings issued thereunder, and any requirements otherwise imposed by the
Internal Revenue Service. The Group Contract Owner and the affected
Certificate Owner will be sent a copy of any such amendment.
We reserve the right, subject to compliance with the law as currently
applicable or subsequently changed, to: (a) operate the Variable Account in
any form permitted under the Investment Company Act of 1940, as amended, (the
"1940 Act"), or in any other form permitted by law; (b) take any action
necessary to comply with or obtain and continue any exemptions from the 1940
Act, or to comply with any other applicable law; (c) transfer any assets in
any Sub-account to another Sub-account, or to one or more separate investment
accounts, or the General Account; or to add, combine or remove Sub-accounts in
the Variable Account; and (d) change the way We assess charges, so long as We
do not increase the aggregate amount beyond that currently charged to the
Variable Account and the Eligible Funds in connection with a Certificate. If
the
DVA(1) PAGE 6
shares of any of the Eligible Funds should become unavailable for investment
by the Variable Account or if in Our judgment further investment in such
Portfolio shares should become inappropriate in view of the purpose of the
Certificate, We may add or substitute shares of another mutual fund for the
Portfolio shares already purchased under the Certificate. No substitution of
Portfolio shares in any Sub-account may take place without prior approval of
the Securities and Exchange Commission and notice to the affected Certificate
Owners, to the extent required by the 1940 Act.
CERTIFICATE OWNER
A Certificate Owner has all rights and may receive all benefits under a
Certificate. A Certificate Owner is the person designated as such on the
Certificate Issue Date, unless changed. A Certificate Owner may exercise all
rights of a Certificate while it is In Force, subject to the rights of (a) any
assignee under an assignment filed with Us, and (b) any irrevocably named
Beneficiary.
JOINT CERTIFICATE OWNER
A Certificate can be owned by Joint Certificate Owners. Upon the death of any
Certificate Owner or Joint Certificate Owner, the surviving owner(s) will be
the primary Beneficiary(ies). Any other beneficiary designation will be
treated as a Contingent Beneficiary unless otherwise indicated in a Written
Request filed with Us.
ANNUITANT
The Annuitant is the person on whose life Annuity Payments are based. The
Annuitant is the person designated by a Certificate Owner at the Certificate
Issue Date, unless changed prior to the Income Date. Any change of Annuitant
is subject to Our underwriting rules then in effect. The Annuitant may not be
changed in a Certificate which is owned by a non-natural person. A Certificate
Owner may name a Contingent Annuitant. The Contingent Annuitant becomes the
Annuitant if the Annuitant dies while a Certificate is In Force. If the
Annuitant dies and no Contingent Annuitant has been named, We will allow a
Certificate Owner sixty days to designate someone other than the Certificate
Owner as Annuitant. The Certificate Owner will be the Contingent Annuitant
unless the Certificate Owner names someone else. If the Certificate is owned
by a non-natural person, the death of the Annuitant will be treated as the
death of the Certificate Owner and a new Annuitant may not be designated.
BENEFICIARY
The Beneficiary is the person who controls the Certificate if any Certificate
Owner dies prior to the Income Date. If the Certificate is owned by Joint
Certificate Owners, upon the death of any Certificate Owner or Joint
Certificate Owner, the surviving owner(s) will become the primary Beneficiary.
Any other beneficiary designation will be treated as a Contingent Beneficiary
unless otherwise indicated in a Written Request filed with Us. If a
Certificate Owner names more than one Person as Primary Beneficiary or as
Contingent Beneficiary, and does not state otherwise on an application or in a
Written Request to Us, any non-survivors will not receive a benefit. The
survivors will receive equal shares. Subject to the rights of any
DVA(1) PAGE 7
irrevocable Beneficiary(ies), a Certificate Owner may change primary or
contingent Beneficiary(ies). A change must be made by Written Request and will
be effective as of the date the Written Request is signed. We will not be
liable for any payment We make or action We take before We receive the Written
Request.
GROUP CONTRACT OWNER
The Group Contract Owner has title to the Group Contract. The Group Contract
and any amount accumulated under any Certificate are not subject to the claims
of the Group Contract Owner or any of its creditors. The Group Contract Owner
may transfer ownership of this Group Contract. Any transfer of ownership
terminates the interest of any existing Group Contract Owner. It does not
change the rights of any Certificate Owner.
CHANGE OF CERTIFICATE OWNER, BENEFICIARY OR CONTINGENT ANNUITANT
While a Certificate is In Force, a Certificate Owner may by Written Request
change the primary Certificate Owner, Joint Certificate Owner, primary
Beneficiary, Contingent Beneficiary, Contingent Annuitant, or in certain
instances, the Annuitant. An irrevocably named Person may be changed only
with the written consent of such Person. The change will be effective,
following Our receipt of the Written Request, as of the date the Written
Request is signed. The change will not affect any payments We make or actions
We take prior to the time We receive the Written Request.
ASSIGNMENT OF THE CERTIFICATE
A Certificate Owner may assign a Certificate at any time while it is In Force.
The assignment must be in writing and a copy must be filed at Our Office. A
Certificate Owner's rights and those of any revocably named Person will be
subject to the assignment. An assignment will not affect any payments We make
or actions We take before We receive the assignment. We are not responsible
for the validity of any assignment.
MISSTATEMENT OF AGE OR SEX
If the age or sex of the Annuitant or any payee has been misstated, We will
compute the amount payable based on the correct age and sex. If Annuity
Payments have begun, any underpayment(s) that have been made will be paid in
full with the next Annuity Payment. Any overpayment, unless repaid to Us in
one sum, will be deducted from future Annuity Payments otherwise due until We
are repaid in full.
NON-PARTICIPATING
A Certificate does not participate in Our divisible surplus.
EVIDENCE OF DEATH, AGE, SEX OR SURVIVAL
If a Certificate provision relates to the death of a natural Person, We will
require proof of death before We will act under that provision. Proof of
death shall be: (a) a certified death certificate;
DVA(1) PAGE 8
or (b) a certified decree of a court of competent jurisdiction as to the
finding of death; or (c) a written statement by a medical doctor who attended
the deceased; or (d) any other document constituting due proof of death under
applicable state law. If Our action under a Certificate provision is based on
the age, sex, or survival of any Person, We may require evidence of the
particular fact before We act under that provision.
PROTECTION OF PROCEEDS
No Beneficiary or payee may commute or assign any payments under a Certificate
before they are due. To the extent permitted by law, no payments shall be
subject to the debts of any Beneficiary or payee or to any judicial process
for payment of those debts.
REPORTS
We will send Certificate Owners a report that shows the Certificate Value at
least once each Certificate Year. We will send any other reports that may be
required by law.
TAXES
Any taxes paid to any governmental entity relating to a Certificate will be
deducted from the Purchase Payments or Certificate Value. We may, in Our sole
discretion, delay the deduction until a later date. By not deducting tax
payments at the time of Our payment, We do not waive any right We may have to
deduct amounts at a later date. We will, in Our sole discretion, determine
when taxes relate to a Certificate or to the operation of the Variable
Account. We reserve the right to establish a provision for federal income
taxes if We determine, in Our sole discretion, that We will incur a tax as a
result of the operation of the Variable Account. Such a provision will be
reflected in the Accumulation and Annuity Unit Values. We will deduct for any
income taxes incurred by Us as a result of the operation of the Variable
Account whether or not there was a provision for taxes and whether or not it
was sufficient. We will deduct from any payment under a Certificate any
withholding taxes required by applicable law.
REGULATORY REQUIREMENTS
All values payable under a Certificate will not be less than the minimum
benefits required by the laws and regulations of the states in which the
Certificate is delivered.
SUSPENSION OR DEFERRAL OF PAYMENTS
We reserve the right to suspend or postpone payments for a withdrawal,
transfer, surrender or death benefit for any period when:
(1) the New York Stock Exchange is closed (other than customary weekend
and holiday closings); or
(2) trading on the New York Stock Exchange is restricted; or
(3) an emergency exists as a result of which valuation or disposal of
the assets and
DVA(1) PAGE 9
securities of the Variable Account is not reasonably practicable; or
(4) the Securities and Exchange Commission, by order or pronouncement,
so permits for the protection of Certificate Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission govern as to whether the conditions described in (2) and (3) above
exist.
We reserve the right to delay payment of amounts allocated to the Fixed
Account for up to six months.
VARIABLE ACCOUNT PROVISIONS
THE VARIABLE ACCOUNT
The Variable Account(s) is designated on the Certificate Schedule and consists
of assets set aside by Us, which are kept separate from Our general assets and
all other variable account assets We maintain. We own the assets of the
Variable Account. Variable Account assets equal to reserves and other
contract liabilities will not be chargeable with liabilities arising out of
any other business We may conduct. We may transfer to Our General Account
assets which exceed the reserves and other liabilities of the Variable
Account. Income and realized and unrealized gains or losses from assets in
the Variable Account are credited to or charged against the account without
regard to other income, gains or losses in Our other investment accounts.
The Variable Account assets are divided into Sub-accounts. The Sub-accounts
which are available under the Certificate are shown on the Certificate
Schedule. The assets of the Sub-accounts of the unit investment trust
variable separate account are allocated to the Eligible Fund(s) and the
Portfolio(s), if applicable, within an Eligible Fund shown on the Certificate
Schedule. The assets of the Sub-accounts of the investment company variable
separate account, if applicable, are invested in portfolios of securities
designed to meet the objectives of the Sub-Account shown on the Certificate
Schedule. We may, from time to time, add additional Sub-accounts, Eligible
Funds or Portfolios to those shown on the Certificate Schedule. A Certificate
Owner may be permitted to transfer Certificate Values or allocate Purchase
Payments to the additional Sub-Accounts, Eligible Funds or Portfolios.
However, the right to make such transfers or allocations will be limited by
the terms and conditions imposed by Us.
We also have the right to eliminate Sub-accounts from the Variable Account, to
combine two or more Sub-accounts or to substitute a new Portfolio for the
Portfolio in which a Sub-account invests. A substitution may become necessary
if, in Our discretion, a Portfolio or Sub-account no longer suits the purposes
of the Group Contract. This may happen: due to a change in laws or
regulations or a change in a Portfolio's investment objectives or
restrictions; because the Portfolio or Sub-account is no longer available for
investment; or for some other reason. We will obtain any prior approvals
that may be required from the insurance department of Our state of domicile,
and from the SEC or any other governmental entity before making such a
substitution.
DVA(1) PAGE 10
When permitted by law, We reserve the right to:
(1) Deregister a Variable Account under the 1940 Act;
(2) Operate a Variable Account as a management company under the 1940
Act, if it is operating as a unit investment trust;
(3) Operate a Variable Account as a unit investment trust under the 1940
Act, if it is operating as a management company;
(4) Restrict or eliminate any voting rights as to the account;
(5) Combine the Variable Account with any other variable account.
VALUATION OF ASSETS
The assets of the Variable Account are valued at their fair market value in
accordance with Our procedures.
ACCUMULATION UNITS
A Certificate Owner's Variable Account Value will fluctuate in accordance with
the investment results of the Sub-accounts to which the Certificate Owner has
allocated his or her Purchase Payments or Certificate Value. In order to
determine how these fluctuations affect a Certificate Owner's Certificate
Value, We use an Accumulation Unit value. Accumulation Units are used to
account for all amounts allocated to or withdrawn from the Sub-accounts of the
Variable Account as a result of Purchase Payments, partial withdrawals,
transfers, or charges deducted from the Certificate Value. We determine the
number of Accumulation Units of a Sub-account purchased or cancelled by
dividing the amount allocated to, or withdrawn from, the Sub-account by the
dollar value of one Accumulation Unit of the Sub-account as of the end of the
Valuation Period during which We receive the request for the transaction.
ACCUMULATION UNIT VALUE
The Accumulation Unit Value for each Sub-account was initially set at $10.
Subsequent Accumulation Unit Values for each Sub-account are determined by
multiplying the Accumulation Unit Value for the immediately preceding
Valuation Period by a net investment factor for the Sub-account for the
current period. This factor may be greater or less than 1.0; therefore, the
Accumulation Unit Value may increase or decrease from Valuation Period to
Valuation Period.
We calculate the net investment factor for each Sub-account investing in
shares of mutual funds by dividing (a) by (b) and then subtracting (c) where:
(a) is equal to:
(i) the net asset value per share of the Portfolio in which
the Sub-account invests at the end of the Valuation
Period; plus
(ii) any dividend per share declared for the Portfolio that has
an ex-dividend date within the current Valuation Period.
(b) is the net asset value per share of the Portfolio at the end of the
preceding Valuation Period.
DVA(1) PAGE 11
(c) is equal to:
(i) the sum of each Valuation Period equivalent of the annual
rate for the mortality and expense risk charge, for the
administrative charge, and for the distribution charge, if
any, which are shown on the Certificate Schedule; plus
(ii) a charge factor, if any, for any tax provision established
by Us a result of the operation of the Sub-account.
We calculate the net investment factor for each Sub-account investing directly
in securities with the same formula, except:
(a) is equal to:
(i) the value of the assets in the Sub-account at the end of
the preceding Valuation Period; plus
(ii) any investment income and capital gains, realized or
unrealized, credited to the assets during the current
Valuation Period; less
(iii) any capital losses, realized or unrealized, charged
against the assets during the current Valuation Period;
less
(iv) all operating and investment expenses relating to the
assets that are incurred during the current Valuation
Period.
(b) is the value of the assets in the Sub-account at the end of the
preceding Valuation Period.
MORTALITY AND EXPENSE RISK CHARGE
Each Valuation Period We deduct a mortality and expense risk charge from each
Sub-account of the Variable Account which is equal, on an annual basis, to the
amount shown on the Certificate Schedule. The mortality and expense risk
charge compensates Us for assuming the mortality and expense risks with
respect to the Certificates We issue. We guarantee the dollar amount of each
Annuity Payment after the first Annuity Payment will not be affected by
variations in mortality or expense experience.
ADMINISTRATIVE CHARGE
Each Valuation Period We deduct an administrative charge from the Variable
Account which is equal, on an annual basis, to the amount shown on the
Certificate Schedule. The administrative charge compensates Us for the costs
associated with administration of the Variable Account and the Certificates We
issue.
DISTRIBUTION CHARGE
Each Valuation Period We deduct a distribution charge from the Variable
Account which is equal, on an annual basis, to the amount shown on the
Certificate Schedule. The distribution charge compensates Us for the costs
associated with the distribution of the Certificates We issue.
DVA(1) PAGE 12
CERTIFICATE MAINTENANCE CHARGE
We deduct a certificate maintenance charge from the Certificate Value by
cancelling Accumulation Units from each applicable Sub-account to reimburse
Us for expenses relating to the maintenance of the Certificate. We will
deduct the certificate maintenance charge from the Sub-accounts of the
Variable Account in the same proportion that the amount of Certificate Value
in each Sub-account bears to the Certificate Value. The certificate
maintenance charge is shown on the Certificate Schedule. The certificate
maintenance charge will be deducted from the Certificate Value on each
Certificate Anniversary during the Accumulation Period.
If a total surrender is made on a date other than a Certificate Anniversary,
the certificate maintenance charge will be deducted at the time of surrender.
During the Annuity Period, the certificate maintenance charge will be deducted
on a pro-rata basis from each Annuity Payment.
TRANSFERS
TRANSFERS: Subject to any limitation We impose on the number of transfers
permitted in a Certificate Year, a Certificate Owner may transfer all or part
of Certificate Owner's Certificate Value among the Sub-accounts and the Fixed
Account, if any, by Written Request or by telephone without the imposition of
any fees or charges. Transfers among the Sub-accounts and the Fixed Account
are permitted only during the Accumulation Period. The number of permitted
transfers, and the charge for transfers in excess of that number, are shown on
the Certificate Schedule. All transfers are subject to the following:
(1) If more than the number of free transfers, shown on the Certificate
Schedule, are made in a Certificate Year, We will deduct a transfer charge,
shown on the Certificate Schedule, for each subsequent transfer. The transfer
fee will be deducted from the Sub-account from which the transfer is made.
However, if Certificate Owner transfers his or her entire interest in a
Sub-account, the transfer fee will be deducted from the amount transferred.
If a Certificate Owner makes a transfer from more than one Sub-account, any
transfer fee will be allocated pro-rata among such Sub-accounts in proportion
to the amount transferred from each.
(2) During the Annuity Period, transfers of values between Sub-accounts
will be made by converting the number of Annuity Units being transferred to
the number of Annuity Units in the Sub-account to which a transfer is made, 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. Thereafter, Annuity
Payments will reflect changes in the value of the new Annuity Units.
(3) The minimum amount which can be transferred is shown on the
Certificate Schedule. The minimum amount which must remain in a Sub-account
after a transfer is shown on the Certificate Schedule.
DVA(1) PAGE 13
(4) If 100% of the value of any Sub-account is transferred and the
current allocation for Purchase Payments includes that Sub-account,
the allocation for future Purchase Payments will change to reflect a
Certificate Owner's allocation of Certificate Value following the
transfer.
(5) We reserve the right, at any time and without prior notice to any
party, to terminate, suspend or modify the transfer privileges
described above.
We will not be liable for transfers made in accordance with a Certificate
Owner's instructions. All amounts and Accumulation Units will be determined
as of the end of the Valuation Period in which We receive the request for
transfer.
PARTIAL WITHDRAWALS AND TOTAL SURRENDER
PARTIAL WITHDRAWALS
During the Accumulation Period while the Certificate is In Force, a
Certificate Owner may, upon Written Request, make a partial withdrawal,
subject to the provisions and limitations shown on the Certificate Schedule.
For purposes of determining whether a surrender charge is applicable to a
partial withdrawal:
(1) A partial withdrawal will first be taken from the portion of a
Contract Owner's Certificate Value which is in excess of Purchase
Payments, and then from Purchase Payments; and
(2) We will allocate partial withdrawals to Purchase Payments in the
order in which the Purchase Payments were made, starting with the
first.
A withdrawal will result in the cancellation of Accumulation Units from each
applicable Sub-account in the ratio that a Certificate Owner's interest in the
Sub-account bears to his or her Certificate Value in all the Sub-accounts. A
Certificate Owner must specify by Written Request in advance if he or she
wants Accumulation Units to be cancelled in a manner other than the method
described above. If there is no value or insufficient value in the Variable
Account, then the amount withdrawn, or the insufficient portion, will be
deducted from the Fixed Account. If a Certificate Owner has multiple
Guarantee Periods, We will deduct such amount from each Guarantee Period's
values in the ratio that each Period's values bears to the total Fixed Account
Value. A Certificate Owner must specify by Written Request in advance if he
or she wants multiple Guarantee Periods to be reduced in a manner other than
the method described above.
Each partial withdrawal must be for an amount not less than the amount shown
on the Certificate Schedule. The Certificate Value which must remain in a Sub-
account, and in a Certificate, is shown on the Certificate Schedule. The
Certificate Schedule also shows any charge.
TOTAL SURRENDER
During the Accumulation Period while the Certificate is In Force, a
Certificate Owner may, upon Written Request, make a total surrender of the
Certificate Withdrawal Value. The
DVA(1) PAGE 14
Certificate Withdrawal Value is:
(1) the Certificate Value as of the end of the Valuation Period during
which We receive a Written Request for a withdrawal or surrender; less
(2) any applicable taxes not previously deducted; less
(3) any surrender charge; less
(4) any certificate maintenance charge.
We will pay the amount of any withdrawal or surrender within seven days unless
the Suspension or Deferral of Payments Provision is in effect.
DEATH PROVISIONS
DEATH OF CERTIFICATE OWNER
These provisions apply if, during the Accumulation Period while the
Certificate is In Force, the Certificate Owner or any Joint Certificate Owner
dies (whether or not the decedent is also the Annuitant) or the Annuitant dies
under a Certificate owned by a non-natural Person. The "designated
beneficiary" will control the contract after such a death. This "designated
beneficiary" will be the first Person among the following who is alive on the
date of death: Certificate Owner; Joint Certificate Owner; primary
Beneficiary; Contingent Beneficiary; and Certificate Owner's estate. If the
Certificate Owner and Joint Certificate Owner are both alive, they shall be
the "designated beneficiary" together.
IF THE DECEDENT'S SURVIVING SPOUSE (IF ANY) IS THE SOLE "DESIGNATED
BENEFICIARY", the surviving spouse will automatically become the new sole
Certificate Owner as of the date of the death. And, if the Annuitant is the
decedent, the new Annuitant will be any living Contingent Annuitant, otherwise
the surviving spouse. The Certificate may stay in force until another death
occurs (i.e., until the death of the Certificate Owner or Joint Certificate
Owner). Except for this paragraph, all of "Death Provisions" will apply to
that subsequent death.
IN ALL OTHER CASES, the Certificate may stay in force up to five years from
the date of death. During this period, the "designated beneficiary" may
exercise all ownership rights, including the right to make transfers or
partial withdrawals or the right to surrender the Certificate for its
Certificate Withdrawal Value. If this Certificate is still in force at the
end of the five-year period, We will automatically end it then by paying to
the "designated beneficiary" the Certificate Withdrawal Value without the
deduction of any applicable surrender charges. If the "designated
beneficiary" is not alive then, We will pay any Person(s) named by the
"designated beneficiary" in a Written Request; otherwise the "designated
beneficiary's" estate.
DEATH OF ANNUITANT
These provisions apply if during the Accumulation Period while the Certificate
is In Force, (a)
DVA(1) PAGE 15
the Annuitant dies, (b) the Annuitant is not an Owner, and (c) the Owner is a
natural person. The Certificate will continue In Force after the Annuitant's
death. The new Annuitant will be any living Contingent Annuitant, otherwise
the Certificate Owner.
PAYMENT OF BENEFITS
Instead of receiving a lump sum, a Certificate Owner or any "designated
beneficiary" may by Written Request direct that We pay any benefit of $5,000
or more under an Annuity Option that meets the following: (a) the first
payment to the "designated beneficiary" must be made no later than one year
after the date of death; (b) payments must be made over the life of the
"designated beneficiary" or over a period not extending beyond that person's
life expectancy; and (c) any Annuity Option that provides for payments to
continue after the death of the "designated beneficiary" will not allow the
successor payee to extend the period of time over which the remaining payments
are to be made.
ANNUITY PROVISIONS
GENERAL
If the Certificate is In Force on the Income Date, the Adjusted Certificate
Value will be applied under the Annuity Option selected by a Certificate
Owner. Annuity Payments may be made on a fixed or variable basis or both.
INCOME DATE
The Income Date may be selected by a Certificate Owner. It is shown on the
Certificate Schedule. The Income Date can be any time after the Certificate
Issue Date for variable payments and any time after the first Certificate
Anniversary for fixed payments. The Income Date may not be later than the
earlier of when the Annuitant reaches attained age 90 or that required under
state law. If no Income Date is selected, it will be the earlier of when the
Annuitant reaches attained age 90 or the maximum date permitted under state
law, if any.
Prior to the Income Date, a Certificate Owner may change the Income Date by
Written Request. Any change must be requested at least 30 days prior to the
new Income Date.
SELECTION OF AN ANNUITY OPTION
An Annuity Option may be selected by a Certificate Owner. If no Annuity
Option is selected, Option B will automatically be applied. Prior to the
Income Date, a Certificate Owner can change the Annuity Option selected by
Written Request. Any change must be requested at least 30 days prior to the
Income Date.
FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS
Annuity Payments are paid in monthly installments unless quarterly, semi-
annual or annual payments are chosen. The Adjusted Certificate Value is
applied to the Annuity Table for the
DVA(1) PAGE 16
Annuity Option selected. If the Adjusted Certificate Value to be applied
under an Annuity Option is less than $5,000, We reserve the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment would be
or becomes less than $100, We will reduce the frequency of payments to a
longer interval which will result in each payment being at least $100.
ANNUITY OPTIONS
The following Annuity Options or any other Annuity Option acceptable to Us may
be selected:
OPTION A. ANNUITY FOR A FIXED NUMBER OF YEARS: Annuity Payments for a
chosen number of years, not less than 5. If the payee dies during the
payment period and the Beneficiary does not desire payments to continue
for the remainder of the period, he/she may elect to have the present
value of the remaining payments commuted and paid in a lump sum. During
the payment period of a Variable Annuity, the payee may elect by Written
Request to receive the following amount: (a) the present value of the
remaining payments commuted; less (b) any surrender charge that may be
due by treating the value defined in (a) as a surrender. Instead of
receiving a lump sum, the payee may elect another Annuity Option. The
amount applied to that Option would not be reduced by the charge defined
in (b).
OPTION B. LIFE ANNUITY WITH PERIOD CERTAIN OF 10 YEARS: Annuity Payments
during the lifetime of the payee and in any event for 10 years certain.
If the payee dies during the guaranteed payment period and the
Beneficiary does not desire payments to continue for the remainder of the
guaranteed period, he/she may elect to have the present value of the
guaranteed payments remaining commuted and paid in a lump sum.
OPTION C. JOINT AND SURVIVOR ANNUITY: Annuity Payments payable during the
joint lifetime of the payee and a designated second natural person and
then during the lifetime of the survivor.
Unless the Annuity Option provides for commutation by the payee, a payee may
not withdraw or otherwise end an Annuity Option after it begins. Payments
will end upon the payee's death unless the Annuity Option provides for
payments continuing to a successor payee. No successor payee may extend the
period of time over which the remaining payments are to be made.
ANNUITY
If a Certificate Owner selects a Fixed Annuity, the Adjusted Certificate Value
is allocated to the General Account and the Annuity is paid as a Fixed
Annuity. If the Certificate Owner selects a Variable Annuity, the Adjusted
Certificate Value will be allocated to the Sub-accounts of the Separate
Account in accordance with the selection he or she makes, and the Annuity will
be paid as a Variable Annuity. A Certificate Owner can also select a
combination of a Fixed and Variable Annuity and the Adjusted Certificate Value
will be allocated accordingly. If a Certificate Owner does not select between
a Fixed Annuity and a Variable Annuity, any Adjusted Certificate Value in the
Variable Account will be applied to a Variable Annuity and any Adjusted
Certificate Value in the Fixed Account will be applied to a Fixed Annuity.
DVA(1) PAGE 17
The Adjusted Certificate Value will be applied to the applicable Annuity Table
contained in the Certificate based upon the Annuity Option a Certificate Owner
selects. If, as of the Income Date, the current Annuity Option rates
applicable to the class of Certificates issued under the Group Contract
provide an initial Annuity Payment greater than the initial Annuity Payment
guaranteed under the applicable Annuity Table in the Certificate, the greater
payment will be made.
FIXED ANNUITY
The minimum dollar amount of each Fixed Annuity Payment for each $1,000 of
Adjusted Certificate Value is shown in the Annuity Tables. After the initial
Fixed Annuity payment, the payments will not change regardless of investment,
mortality or expense experience.
VARIABLE ANNUITY
Variable Annuity Payments reflect the investment performance of the Variable
Account in accordance with the allocation of the Adjusted Certificate Value to
the Sub-accounts during the Annuity Period. Variable Annuity payments are not
guaranteed as to dollar amount.
The dollar amount of the first Variable Annuity payment for each $1,000 of
Adjusted Certificate Value is shown in the Annuity Tables. The dollar amount
of Variable Annuity payments for each applicable Sub-account after the first
Variable Annuity Payment is determined as follows:
(1) the dollar amount of the first Variable Annuity payment is divided by
the value of an Annuity Unit for each applicable Sub-account as of the
Income Date. This sets the number of Annuity Units for each monthly
payment for the applicable Sub-account. The number of Annuity Units
for each applicable Sub-account remains fixed during the Annuity
Period;
(2) the fixed number of Annuity Units per payment in each Sub-account is
multiplied by the Annuity Unit Value for that Sub-account for the last
Valuation Period of the month preceding the month for which the
payment is due. This result is the dollar amount of the payment for
each applicable Sub-account.
The total dollar amount of each Variable Annuity payment is the sum of all Sub-
account Variable Annuity payments reduced by the applicable portion of the
Certificate Maintenance Charge.
ANNUITY UNIT
The value of any Annuity Unit for each Sub-Account of the Separate Account was
initially set at $10.
The Sub-account Annuity Unit Value at the end of any subsequent Valuation
Period is determined as follows:
(1) the net investment factor calculated as set forth on pages 11-12
(but without the
DVA(1) PAGE 18
distribution charge, if any) for the current Valuation Period is
multiplied by the value of the Annuity Unit for the Sub-account for
the immediately preceding Valuation Period.
(2) the result in (1) is then divided by the Assumed Investment Rate
Factor which equals 1.00 plus the Valuation Period equivalent of the
Assumed Investment Rate for the number of days in the current
Valuation Period. The Assumed Investment Rate is equal to 6% per
year.
The value of an Annuity Unit may increase or decrease from Valuation Period to
Valuation Period.
USING THE TABLES
Tables 2, 3, 5, and 6 are age-dependent. The amount of the first annuity
payment will be based on an age a specified number of years younger than the
person's then-attained age (i.e., age last birthday). This age setback is as
follows:
DATE OF FIRST PAYMENT AGE SETBACK
1996-1999 1 year
2000-2009 2 years
2010-2019 4 years
2020-2029 5 years
2030 or later 6 years
We will calculate the amount for a payment frequency other than monthly and
for any ages not shown in Tables 2, 3, 5, and 6 in accordance with the next
section. Upon request, We will tell a Certificate Owner any such amount.
BASIS OF CALCULATION
Tables 1 and 4 are based on interest at 6% and 3%, respectively. Tables 2, 3,
5, and 6 are based on the 1983 Individual Annuity Valuation Tables, weighted
40% male and 60% female, with interest at 6% (Tables 2 and 3) and 3% (Tables 5
and 6), projected dynamically with Projection Scale G.
DVA(1) PAGE 19
TABLE 1: FIRST MONTHLY PAYMENT PAYABLE UNDER VARIABLE OPTION A FOR EACH $1,000 APPLIED
YEARS PAYMENT YEARS PAYMENT YEARS PAYMENT YEARS PAYMENT
-------------------------------------------------------------------------------
5 $19.17 12 $9.63 19 $7.24 25 $6.32
6 16.42 13 9.12 20 7.04 26 6.21
7 14.46 14 8.69 21 6.86 27 6.11
8 13.00 15 8.31 22 6.70 28 6.02
9 11.87 16 7.99 23 6.56 29 5.94
10 10.97 17 7.71 24 6.43 30 5.87
11 10.24 18 7.46
TABLE 2: FIRST MONTHLY PAYMENT PAYABLE UNDER VARIABLE OPTION B FOR EACH $1,000 APPLIED
AGE PAYMENT AGE PAYMENT AGE PAYMENT AGE PAYMENT AGE PAYMENT
---------------------------------------------------------------------------------------------------
30 $5.09 43 $5.40 56 $6.06 69 $7.47 82 $ 9.72
31 5.11 44 5.44 57 6.13 70 7.63 83 9.87
32 5.13 45 5.47 58 6.21 71 7.79 84 10.02
33 5.14 46 5.51 59 6.30 72 7.95 85 10.15
34 5.16 47 5.55 60 6.39 73 8.12 86 10.27
35 5.18 48 5.60 61 6.48 74 8.30 87 10.38
36 5.20 49 5.64 62 6.59 75 8.48 88 10.48
37 5.23 50 5.69 63 6.69 76 8.66 89 10.57
38 5.25 51 5.74 64 6.81 77 8.84 90 10.65
39 5.28 52 5.80 65 6.93 78 9.03 91 10.72
40 5.31 53 5.86 66 7.05 79 9.21 92 10.77
41 5.34 54 5.92 67 7.19 80 9.38 93 10.82
42 5.37 55 5.99 68 7.33 81 9.55 94 10.86
95 10.89
TABLE 3: FIRST MONTHLY PAYMENT PAYABLE UNDER VARIABLE OPTION C FOR EACH $1,000 APPLIED
COMBINATION OF AGES
30 35 40 45 50 55 60 65 70 75 80 85 90 95
30 $4.97 $4.99 $5.00 $5.02 $5.04 $5.05 $5.06 $5.07 $5.08 $5.09 $5.09 $5.09 $5.10 $5.10
35 5.01 5.04 5.07 5.09 5.11 5.13 5.15 5.16 5.17 5.18 5.18 5.19 5.19
40 5.08 5.12 5.16 5.19 5.22 5.25 5.27 5.29 5.30 5.31 5.31 5.32
45 5.18 5.23 5.29 5.34 5.38 5.41 5.44 5.46 5.48 5.49 5.49
50 5.32 5.40 5.47 5.54 5.60 5.64 5.68 5.70 5.72 5.72
55 5.51 5.62 5.73 5.85 5.90 5.96 6.00 6.02 6.04
60 5.79 5.95 6.11 6.24 6.34 6.41 6.45 6.48
65 6.20 6.44 6.66 6.84 6.97 7.05 7.10
70 6.80 7.15 7.47 7.71 7.87 7.97
75 7.69 8.22 8.66 8.99 9.20
80 9.03 9.81 10.43 10.87
85 11.02 12.11 12.98
90 13.82 15.34
95 17.66
DVA(1) PAGE 20
TABLE 4: MINIMUM MONTHLY PAYMENT PAYABLE UNDER FIXED OPTION A FOR EACH $1,000 APPLIED
YEARS PAYMENT YEARS PAYMENT YEARS PAYMENT YEARS PAYMENT
-------------------------------------------------------------------------------
5 $17.91 12 $8.24 19 $5.73 25 $4.71
6 15.14 13 7.71 20 5.51 26 4.59
7 13.16 14 7.26 21 5.32 27 4.47
8 11.68 15 6.87 22 5.15 28 4.37
9 10.53 16 6.53 23 4.99 29 4.27
10 9.61 17 6.23 24 4.84 30 4.18
11 8.86 18 5.96
TABLE 5: MINIMUM MONTHLY PAYMENT PAYABLE UNDER FIXED OPTION B FOR EACH $1,000 APPLIED
AGE PAYMENT AGE PAYMENT AGE PAYMENT AGE PAYMENT AGE PAYMENT
----------------------------------------------------------------------------------------------------
30 $3.05 43 $3.46 56 $4.24 69 $5.79 82 $8.24
31 3.07 44 3.50 57 4.32 70 5.96 83 8.41
32 3.09 45 3.55 58 4.41 71 6.13 84 8.57
33 3.12 46 3.60 59 4.51 72 6.31 85 8.72
34 3.15 47 3.65 60 4.61 73 6.50 86 8.85
35 3.18 48 3.70 61 4.71 74 6.69 87 8.97
36 3.21 49 3.76 62 4.82 75 6.88 88 9.08
37 3.24 50 3.82 63 4.94 76 7.08 89 9.18
38 3.27 51 3.88 64 5.07 77 7.28 90 9.27
39 3.31 52 3.94 65 5.20 78 7.48 91 9.34
40 3.34 53 4.01 66 5.34 79 7.68 92 9.40
41 3.38 54 4.08 67 5.48 80 7.87 93 9.46
42 3.42 55 4.16 68 5.63 81 8.06 94 9.50
95 9.53
TABLE 6: MINIMUM MONTHLY PAYMENT PAYABLE UNDER FIXED OPTION C FOR EACH $1,000 APPLIED
COMBINATION OF AGES
30 35 40 45 50 55 60 65 70 75 80 85 90 95
30 $2.88 $2.92 $2.95 $2.98 $3.00 $3.01 $3.02 $3.03 $3.04 $3.04 $3.04 $3.05 $3.05 $3.05
35 2.97 3.02 3.06 3.09 3.12 3.14 3.15 3.16 3.17 3.17 3.18 3.18 3.18
40 3.09 3.15 3.20 3.24 3.27 3.30 3.32 3.33 3.34 3.34 3.34 3.35
45 3.24 3.31 3.38 3.44 3.48 3.51 3.53 3.54 3.55 3.56 3.56
50 3.43 3.53 3.62 3.69 3.74 3.78 3.80 3.82 3.83 3.83
55 3.68 3.81 3.93 4.02 4.09 4.13 4.16 4.18 4.19
60 4.01 4.19 4.35 4.47 4.56 4.61 4.65 4.66
65 4.47 4.73 4.94 5.11 5.21 5.28 5.32
70 5.11 5.48 5.78 6.00 6.13 6.21
75 6.04 6.57 6.99 7.28 7.46
80 7.40 8.16 8.75 9.15
85 9.38 10.46 11.29
90 12.18 13.68
95 16.02
DVA(1) PAGE 21
ENDORSEMENTS
To be inserted only by Us
DVA(1) PAGE 22
KEYPORT
LIFE INSURANCE COMPANY
------------------------
------------------------
Providence, Rhode Island
GROUP VARIABLE ANNUITY CONTRACT
FLEXIBLE PURCHASE PAYMENTS
DEFERRED INCOME PAYMENTS
NONPARTICIPATING -- NO DIVIDENDS
DVA(1) PAGE 23
