EXHIBIT 4 (b)
ANNUITY CONTRACT
PHL VARIABLE INSURANCE COMPANY
[LOGO] Phoenix A STOCK COMPANY
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CONTRACT NUMBER: [0123456]
CERTIFICATE NUMBER: [100]
CERTIFICATE OWNER: [XXXX X. XXXXXXX]
CONTRACT DATE: [March 01, 2006]
STATE OF ISSUE: [Rhode Island]
To the Certificate Owner:
The PHL Variable Insurance Company ("the Company") agrees, subject to the
conditions and provisions of this certificate, to provide the benefits specified
in this certificate. If the certificate is in force on the Maturity Date, we
shall begin to pay a series of annuity payments automatically to the Certificate
Owner beginning on the Maturity Date for a period certain of 10 years and as
long thereafter as the Annuitant lives, unless another option is elected. The
amount of each annuity payment, as described in the Annuity Benefits section,
will be based on the Certificate Value on the Maturity Date and the annuity
payment factors.
We are issuing this certificate in consideration of the application, if any, and
our receipt of the Single Premium at our Annuity Operations Division. The
provisions of this and the following pages and any attachments make up your
certificate. This Certificate is governed by the laws of the state in which it
was delivered.
RIGHT TO RETURN THIS CERTIFICATE. THIS CERTIFICATE MAY BE RETURNED WITHIN 10
DAYS (20 DAYS FOR REPLACEMENTS) AFTER YOU RECEIVE IT FOR A REFUND OF THE SINGLE
PREMIUM, LESS ANY WITHDRAWALS MADE UNDER THIS CERTIFICATE AS OF THE DATE OF
CANCELLATION. THIS CERTIFICATE WILL BE VOID FROM ITS BEGINNING. YOU MAY RETURN
THE CERTIFICATE BY DELIVERING OR MAILING IT TO US AT THE ADDRESS BELOW OR BY
RETURNING IT TO THE AGENT OR AGENCY OFFICE THROUGH WHICH IT WAS DELIVERED.
PHL VARIABLE INSURANCE COMPANY
[Annuity Operations Division
PO Box 8027
Boston, MA 02266-8027
Telephone (000) 000-0000]
Signed for PHL Variable Insurance Company at Xxx Xxxxxxxx Xxx,
Xxxxxxxx, Xxxxxxxxxxx 00000.
/s/ Xxxxxx X. Xxxxxxxxxxx /s/ Xxxx X. Xxxxx
[---------------------------] [---------------------------]
[ President ] [ Secretary ]
READ YOUR CERTIFICATE CAREFULLY
IT IS A LEGAL CERTIFICATE BETWEEN THE CERTIFICATE OWNER AND
PHL VARIABLE INSURANCE COMPANY.
THE CERTIFICATE VALUE WILL DEPEND ON AMOUNTS CREDITED TO THE FIXED ACCOUNT AND
THE INDEXED ACCOUNTS. THE CERTIFICATE VALUE MAY INCREASE BASED ON THE INDEX
CALCULATION DESCRIBED IN THE INDEX ACCOUNT(S) YOU SELECTED. WHILE ACCOUNT VALUE
FOR EACH INDEXED ACCOUNT IS AFFECTED BY THE VALUE OF AN OUTSIDE INDEX, THE
CERTIFICATE DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK OR EQUITY INVESTMENT.
WITHDRAWALS OR A SURRENDER MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT, WHICH
MAY INCREASE OR DECREASE THE AMOUNT WITHDRAWN OR SURRENDERED. WITHDRAWALS OR A
SURRENDER MAY BE SUBJECT TO SURRENDER CHARGES.
05FNDEIA-C
Group Single Premium Deferred Equity Indexed Modified Guaranteed Annuity
Nonparticipating - not eligible for dividends
05FNDEIA-C
TABLE OF CONTENTS
Section Provision
1. Schedule Pages
2. Definitions
3. Entire Certificate
4. Certificate Owner(s) and Beneficiary(ies)
5. Premium, Allocation, and Reallocation
6. Fixed Account, Indexed Accounts
7. Withdrawals, Surrender, Termination
8. Market Value Adjustment Feature
9. Waiver Provisions
10. Death Benefit
11. Assignment
12. Deferral of Determinations
13. Proof Required for Payment
14. Misstatements
15. Change of Maturity Date
16. Statement of Account
17. Annuity Benefits
18. Annuity Payment Options
3
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SECTION 1: SCHEDULE PAGES
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
Single Premium: [$100,000.00]
Certificate Date: [February 1, 2006]
Maturity Date: [February 1, 2041]
Certificate Owner's Age: [35]
Certificate Owner's Sex: [Male]
Annuitant: [Xxxx Xxx]
Joint Annuitant: [None]
Beneficiary: [As specified later in this Section 1]
PREMIUM ALLOCATION PERCENTAGES
Fixed Account [100.00%]
Indexed Account A - Point-to-Point with Cap Indexed Account [000.00%]
Indexed Account B - Performance Trigger Indexed Account [000.00%]
Indexed Account C - Monthly Average with Spread Indexed Account [000.00%]
4
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SECTION 1: SCHEDULE PAGES (continued)
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
FIXED ACCOUNT
(THE VALUES BELOW APPLY ONLY
TO THE FIXED ACCOUNT)
Premium Allocation [$100,000.00]
Initial Interest Rate [3.00%]
Guaranteed Minimum Interest Rate [0.00% for each Certificate Year in
surrender charge period,
0.00% for each Certificate Year
thereafter]
INTEREST CREDITING
We will credit interest on Account Value allocated to the Fixed Account at rates
we declare on an annual effective basis. The initial interest rate applicable to
the Fixed Account applies to the first Certificate Year only. On each subsequent
Certificate Anniversary, a new interest rate will be declared and will be
guaranteed for the following Certificate Year. Subsequent interest rates may be
higher or lower than the initial interest rate, but in no event lower than the
Guaranteed Minimum Interest Rate as shown above.
5
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SECTION 1: SCHEDULE PAGES (continued)
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
INDEXED ACCOUNT A - POINT-TO-POINT WITH CAP INDEXED ACCOUNT
-----------------------------------------------------------
(THE VALUES BELOW APPLY ONLY
TO THE POINT-TO-POINT WITH CAP INDEXED ACCOUNT)
Premium Allocation [$0.00]
Index [S&P 500(R)*]
Index Value on the Certificate Date [1000.00]
Initial Index Cap [6.00%]
Guaranteed Minimum Index Cap [0.00% for each Certificate Year during
surrender charge period, 0.00% for each
Certificate Year thereafter]
Guaranteed Minimum Index Credit [0.00%]
Account Value allocated to the Point-to-Point with Cap Indexed Account earns an
Index Credit on each Certificate Anniversary that is based on the performance of
the Index for the past Certificate Year. The Index Credit equals the lesser of
the Index Growth, the calculation of which is described below, and the
applicable Index Cap, but in no event less than the Guaranteed Minimum Index
Credit as shown above. Index Credit will not be calculated or applied anytime
other than on the Certificate Anniversaries.
On each Certificate Anniversary the Index Growth is calculated as ((i) divided
by (ii)) minus 1, where:
(i) is the Index Value on the Certificate Anniversary, and
(ii) is the Index Value on the preceding Certificate Anniversary.
On the first Certificate Anniversary, the Certificate Date is deemed the
preceding Certificate Anniversary for the purpose of this calculation.
INDEX CAP
The Index Cap is the maximum Index Credit that can be applied to the Account
Value in any given Certificate Year. The initial Index Cap applies to the first
Certificate Year only. On each subsequent Certificate Anniversary, a new Index
Cap will be declared and will be guaranteed for the following Certificate Year.
Subsequent Index Caps may be higher or lower than the initial Index Cap, but in
no event lower than the Guaranteed Minimum Index Cap as shown above.
* ["Standard & Poor's(R)", "S&P(R)", "S&P 500(R)", "Standard & Poor's 500" and
"500" are trademarks of The XxXxxx-Xxxx Companies, Inc. and have been
licensed for use by Phoenix Life Insurance Company and its affiliates. This
annuity is not sponsored, endorsed, sold or promoted by Standard & Poor's and
Standard & Poor's makes no representation regarding the advisability of
purchasing this annuity.]
6
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SECTION 1: SCHEDULE PAGES (continued)
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
INDEXED ACCOUNT B - PERFORMANCE TRIGGER INDEXED ACCOUNT
-------------------------------------------------------
(THE VALUES BELOW APPLY ONLY
TO THE PERFORMANCE TRIGGER INDEXED ACCOUNT)
Premium Allocation [$0.00]
Index [S&P 500(R)*]
Index Value on the Certificate Date [1000.00]
Initial Triggered Rate [5.00%]
Guaranteed Minimum Triggered Rate [0.00% for each
Certificate Year during surrender charge
period, 0.00% for each Certificate Year
thereafter]
Guaranteed Minimum Index Credit [0.00%]
Account Value allocated to the Performance Trigger Indexed Account earns an
Index Credit on each Certificate Anniversary that is based on the performance of
the Index for the past Certificate Year.
On each Certificate Anniversary the Index Credit equals the Triggered Rate if
the Index Growth, the calculation of which is described below, is greater than
zero. The Index Credit equals the Guaranteed Minimum Index Credit as shown above
if the Index Growth is less than or equal to zero. Index Credit will not be
calculated or applied anytime other than on the Certificate Anniversaries.
The Index Growth is calculated as ((i) divided by (ii)) minus 1, where:
(i) is the Index Value on the Certificate Anniversary, and
(ii) is the Index Value on the preceding Certificate Anniversary.
On the first Certificate Anniversary, the Certificate Date is deemed the
preceding Certificate Anniversary for the purpose of this calculation.
TRIGGERED RATE
A Triggered Rate is applied to the Account Value if the Index Growth for the
Certificate Year is greater than zero. The initial Triggered Rate applies to the
first Certificate Year only. On each subsequent Certificate Anniversary, a new
Triggered Rate will be declared and will be guaranteed for the following
Certificate Year. Subsequent Triggered Rates may be higher or lower than the
initial Triggered Rate, but in no event lower than the Guaranteed Minimum
Triggered Rate as shown above.
* ["Standard & Poor's(R)", "S&P(R)", "S&P 500(R)", "Standard & Poor's 500" and
"500" are trademarks of The XxXxxx-Xxxx Companies, Inc. and have been
licensed for use by Phoenix Life Insurance Company and its affiliates. This
annuity is not sponsored, endorsed, sold or promoted by Standard & Poor's and
Standard & Poor's makes no representation regarding the advisability of
purchasing this annuity.]
7
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SECTION 1: SCHEDULE PAGES (continued)
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
INDEXED ACCOUNT C - MONTHLY AVERAGE WITH SPREAD INDEXED ACCOUNT
---------------------------------------------------------------
(THE VALUES BELOW APPLY ONLY
TO THE MONTHLY AVERAGE WITH SPREAD INDEXED ACCOUNT)
Premium Allocation [$0.00]
Index [S&P 500(R)*]
Index Value on the Certificate Date [1000.00]
Initial Index Spread [2.00%]
Guaranteed Maximum Index Spread [10.00% for each Certificate Year during
surrender charge period, 10.00% for each
Certificate Year thereafter]
Guaranteed Minimum Index Credit [0.00%]
Account Value allocated to the Monthly Average with Spread Indexed Account earns
an Index Credit on each Certificate Anniversary that is based on the performance
of the Index for the past Certificate Year.
On each Certificate Anniversary the Index Credit equals the Averaged Index
Growth, the calculation of which is described below, less the Index Spread, but
in no event less than the Guaranteed Minimum Index Credit as shown above. Index
Credit will not be calculated or applied anytime other than on the Certificate
Anniversaries.
The Averaged Index Growth is calculated as ((i) divided by (ii)) minus 1, where:
(i) is the sum of the Index Values on each Monthly Processing Date during
the Certificate Year, divided by 12, and
(ii) is the Index Value on the preceding Certificate Anniversary.
On the first Certificate Anniversary, the Certificate Date is deemed the
preceding Certificate Anniversary for the purpose of this calculation.
INDEX SPREAD
The Index Spread is the amount subtracted from the Averaged Index Growth when
the Index Credit is calculated. The initial Index Spread applies to the first
Certificate Year only. On each subsequent Certificate Anniversary, a new Index
Spread will be declared and will be guaranteed for the following Certificate
Year. Subsequent Index Spreads may be higher or lower than the initial Index
Spread, but in no event higher than the Guaranteed Maximum Index Spread as shown
above.
* ["Standard & Poor's(R)", "S&P(R)", "S&P 500(R)", "Standard & Poor's 500" and
"500" are trademarks of The XxXxxx-Xxxx Companies, Inc. and have been
licensed for use by Phoenix Life Insurance Company and its affiliates. This
annuity is not sponsored, endorsed, sold or promoted by Standard & Poor's and
Standard & Poor's makes no representation regarding the advisability of
purchasing this annuity.]
8
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SECTION 1: SCHEDULE PAGES (continued)
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
CERTIFICATE CHARGES
[Tax charge: 0.00% of Single Premium payment]
Surrender Charge: deducted in accordance with the following Surrender Charge
Schedule
Surrender Charge Schedule*
----------------------------------------------------------
Complete Certificate Surrender Charge
Years Percentage
---------------------------- -- --------------------------
[0 7%
---------------------------- -- --------------------------
1 7%
---------------------------- -- --------------------------
2 7%
---------------------------- -- --------------------------
3 6%
---------------------------- -- --------------------------
4 6%
---------------------------- -- --------------------------
5 5%
---------------------------- -- --------------------------
6 5%
---------------------------- -- --------------------------
7+ 0%]
----------------------------------------------------------
* See Section 7 for a description of how this charge is determined.
9
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SECTION 1: SCHEDULE PAGES (continued)
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Certificate Owner: [Xxxx Xxx]
Certificate Number: [13000000]
BENEFICIARY
[Xxxx Xxx]
10
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SECTION 2: DEFINITIONS
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The term "ACCOUNT" means an Indexed Account or a Fixed Account.
The term "ACCOUNT VALUE" means the value available in each Account for
annuitization or surrender, before the application of any surrender charge or
Market Value Adjustment.
The term "ANNUITANT/JOINT ANNUITANT" means the person or persons on whose
continuation of life or lives the annuity benefit is based upon for this
certificate. The Annuitant shown on the Schedule Page when the certificate was
issued is the Primary Annuitant. Unless otherwise prohibited by the terms of
this certificate and any attachments, the Annuitant/Joint Annuitant may be
changed prior to the Maturity Date; there may be tax consequences.
The term "BENEFICIARY" is as defined in Section 4.
The term "BUSINESS DAY" means any day we are open for business and the New York
Stock Exchange is open for trading. We will deem each Business Day to end at the
close of regularly scheduled trading of the New York Stock Exchange (currently
4:00 p.m. Eastern Time) on that day.
The term "CERTIFICATE ANNIVERSARY" means the same day and month of each year as
the Certificate Date following the Certificate Date. If the day does not exist
in a month, the last day of the month will be used.
The term "CERTIFICATE DATE" means the date this Certificate is issued and the
date from which Certificate Years are measured. The Certificate Date is shown on
the Schedule Pages. The certificate will begin in effect on the Certificate Date
provided the Single Premium is received and the Certificate Owner is alive.
The term "CERTIFICATE VALUE" is equal to the sum of the Account Value of each of
the Accounts.
The term "CERTIFICATE YEAR" means the 12-month period beginning on the
Certificate Date and each 12-month period thereafter.
The term "GROSS WITHDRAWAL" means the amount deducted from the Certificate Value
as a consequence of your request for a withdrawal.
The term "INDEX" means the measure used to determine the Index Credit for a
particular Indexed Account. The Index used for a particular Indexed Account is
shown on the Schedule Pages. If the Index is no longer available or if the Index
calculation is substantially changed, a suitable replacement index will be used,
subject to any required regulatory approval. We will notify you of the change.
The term "INDEX VALUE" means the published value of the Index, excluding any
dividends that may be paid by the firms that comprise the Index. The Index Value
on the Certificate Date, Certificate Anniversaries, or Monthly Processing Dates
will be the Index Value published as of the close of business on the Business
Day prior to the Certificate Date, Certificate Anniversary, or Monthly
Processing Date, respectively. If an Index Value is not published on any
particular day, the first preceding Index Value will be used.
The term "MATURITY DATE" is the date annuity payments commence in the form of an
annuity payment option. The Maturity Date is as shown on the Schedule Pages or
as later changed. For further details see Section 15.
The term "MONTHLY PROCESSING DATE" means the same date of each month as the
Certificate Date. If the day does not exist in a month, the last day of the
month will be used.
The term "NET WITHDRAWAL" means the payment you will receive as a consequence of
your request for a withdrawal, provided sufficient Certificate Value is
available. The Net Withdrawal is equal to the Gross Withdrawal, adjusted by any
applicable Market Value Adjustment, less any applicable Surrender Charges and
taxes.
The term "CERTIFICATE OWNER" or "CERTIFICATE OWNERS" means the person, persons,
or entity with Certificate Ownership rights in the Certificate. The Certificate
Owner is as shown on the Schedule Pages or as later changed. For further details
see Section 4.
The term "SURRENDER VALUE" is as defined in Section 7.
The terms "WE, US, AND OUR" refer to the Company.
The terms "WRITTEN REQUEST" and "WRITTEN NOTICE" mean a request or notice we
receive in writing at our Annuity Operations Division in a form satisfactory to
us.
11
The terms "YOU" and "YOUR" refer to the Certificate Owner(s) of this
certificate, as defined in Section 4, or the joint Certificate Owners of this
certificate if a joint Certificate Owner is named.
12
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SECTION 3: ENTIRE CERTIFICATE
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This certificate is an agreement between the Certificate Owner(s) and the
Company. This certificate and any attachments comprise the entire certificate.
Any change in terms of this certificate, as required to conform with law, must
be signed by one of our executive officers and countersigned by another one of
our executive officers. Any benefits payable under this certificate are payable
at our Annuity Operations Division. All paid-up annuity, surrender, and death
benefits under this certificate are not less than the minimum benefits required
by any statute of the state where this certificate is delivered or issued for
delivery. Any additional amounts we credit to the certificate will be treated as
any other gain in the certificate and will increase the paid-up annuity, cash
surrender, and death benefits. Paid-up annuity, cash surrender benefits and
death benefits will be reduced by any withdrawals.
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SECTION 4: CERTIFICATE OWNER(S) AND BENEFICIARY(IES)
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CERTIFICATE OWNER(S)
The Certificate Owner is the person, persons, or entity, with sole and absolute
power to exercise all rights and privileges without the consent of any other
party, except as otherwise provided by this certificate or unless you provide
otherwise by written notice. If there is more than one Certificate Owner, all
Certificate Owners must consent to any changes. If no Certificate Owner is
named, the Annuitant will be the Certificate Owner. If you are a non-natural
Certificate Owner, any change to or the death of the Primary Annuitant will be
treated as the death of an Certificate Owner. Under certificates used with
certain tax-qualified plans, the Certificate Owner must be the Annuitant. More
than one Certificate Owner may be named. If any Certificate Owner dies, all
rights vest equally in the surviving Certificate Owners. If any Certificate
Owner dies prior to the Maturity Date, the death benefit will be paid as
provided in Section 10.
BENEFICIARY(IES)
The Beneficiary is the person who receives death benefits under this
certificate. If there is no surviving Beneficiary when the death benefit becomes
payable in accordance with Section 10, the Certificate Owner will be the
Beneficiary. If the Certificate Owner is not living, then the estate of the
Certificate Owner will be the Beneficiary.
The Certificate Owner(s) and the Beneficiary will be as shown in the certificate
unless you change them or they are changed by the terms of this section.
CHANGES
While this certificate is in effect, you may change the Beneficiary. You may
also change the Certificate Owner or Annuitant with our consent. You may only
change the Certificate Owner by transferring Certificate Ownership of the entire
certificate between spouses or to a single grantor trust. If the Certificate
Owner is a natural person, You may change Annuitant(s) or name a new Annuitant
upon the death of the Primary Annuitant prior to the Maturity Date. If you do
not name a new Annuitant, and the Certificate Owner is a natural person, the
Certificate Owner will become the Annuitant.
A request to make any changes must be made by written request. If there is more
than one Certificate Owner, all Certificate Owners must sign the request. When
we receive it, the change will be effective as of the date it was signed by the
last Certificate Owner to sign, whether or not an Certificate Owner or Annuitant
is then alive. The change, however, will be subject to the rights of any
assignee of record with us and subject to any payment made or other action taken
by us before we received and filed the notice.
Your exercise of any rights will, to the extent thereof, assign, release, or
surrender the interest of the Annuitant and all beneficiaries and Certificate
Owners under this certificate.
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SECTION 5: PREMIUM, ALLOCATION, AND REALLOCATION
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PREMIUM
The amount applied to this certificate will be the Single Premium received minus
a deduction for any applicable tax including premium tax where applicable. The
Single Premium as shown on the Schedule Pages, is payable at Our Annuity
Operations Division, but may be given to an authorized agent for forwarding to
Our Annuity Operations Division. No benefit associated with any such Single
Premium will be provided until it is actually received by us at our Annuity
Operations Division, and only if received prior to the Certificate Date. The
Single Premium may not exceed $1,000,000 without our prior approval.
13
TAX
A Tax is any tax charged by a state or municipality on premium, whether or not
characterized as premium tax, any such other state or local taxes imposed or
other governmental charge which may be required based on the laws of the state
or municipality of delivery, or the state or municipality where the Certificate
Owner resides. The tax rate, if applicable, is shown on the Schedule Pages. We
will pay any tax due and will only reimburse ourselves upon the remittance of
the tax to the applicable state or municipality.
PREMIUM ALLOCATION
On the Certificate Date, the Premium will be allocated to the Fixed Account and
Indexed Account(s) you elected, as shown on the Schedule Pages.
SEPARATE ACCOUNT
Assets supporting our liabilities under this certificate are held in PHL
Variable Separate Account MVA1. PHL Variable Separate Account MVA1 ("Separate
Account") is a non-unitized separate account established under Connecticut law.
The terms and values of the certificate do not depend on the performance of the
assets in the Separate Account. There are no discrete units in the Separate
Account.
REALLOCATION AMONG ACCOUNTS
Within 30 days prior to each Certificate Anniversary, you may request to
reallocate your Account Value among Accounts then available. Reallocation will
be effective on such Certificate Anniversary. Requests for reallocation must be
received in a format satisfactory to us at our Annuity Operations Division prior
to the Certificate Anniversary for such requests to be effective.
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SECTION 6: FIXED ACCOUNT, INDEXED ACCOUNTS
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FIXED ACCOUNT
The Fixed Account earns interest daily. Fixed Account information is shown on
the Schedule Pages.
On the Certificate Date, the Account Value of the Fixed Account is equal to the
portion of the Premium allocated to the Fixed Account as of the Certificate
Date.
Thereafter, the Account Value for the Fixed Account equals:
1. the initial allocation and any reallocations to the Fixed Account, plus
2. interest credited, less
3. any reallocations from the Fixed Account, less
4. any Gross Withdrawals from the Fixed Account.
INDEXED ACCOUNTS
This certificate also provides for one or more Indexed Accounts. Indexed Account
information is shown on the Schedule Pages. We reserve the right to add
additional Indexed Accounts, or to cease offering one or more of the Indexed
Accounts at any time.
On the Certificate Date, the Account Value of an Indexed Account is equal to the
portion of the Premium allocated to such Indexed Account as of the Certificate
Date.
On each Certificate Anniversary, the Account Value for an Indexed Account
equals:
1. the Account Value immediately preceding the Certificate Anniversary,
multiplied by the resulting value of (1 + the applicable Index Credit),
less
2. any reallocations from the Indexed Account, plus
3. any reallocations to the Indexed Account, less
4. any Gross Withdrawals from the Indexed Account.
14
On any other date, the Account Value for an Indexed Account equals:
1. the Account Value for such Indexed Account on the preceding Certificate
Anniversary, less
2. any Gross Withdrawals from the applicable Indexed Account since the
preceding Certificate Anniversary.
For the first Certificate Year, the Certificate Date is deemed to be the
preceding Certificate Anniversary for purposes of this calculation.
An Index Credit is calculated on each Certificate Anniversary according to the
Indexed Accounts you elected as shown on the Schedule Pages, and vests
immediately. Amounts surrendered or withdrawn effective on a Certificate
Anniversary will receive the Index Credit for the preceding Certificate Year.
Amounts surrendered or withdrawn prior to the end of a Certificate Year will not
receive the Index Credit for such Certificate Year.
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SECTION 7: WITHDRAWALS, SURRENDER, TERMINATION
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WITHDRAWALS
You may request a withdrawal from the Certificate Value at any time prior to the
Maturity Date. Such withdrawals must be by written request and must include any
tax withholding information we may reasonably require. Applicable Surrender
Charges and Market Value Adjustments will be applied as described in this
Section 7 and in Section 8. The Account Value of each Account will be reduced
proportionately, unless otherwise agreed upon, by the Gross Withdrawal. The
payment you will receive is the Net Withdrawal.
In each Certificate Year, you may withdraw a portion of your Certificate Value
free of any Surrender Charge or Market Value Adjustment. This portion is called
the free withdrawal amount. During the first Certificate Year, the free
withdrawal amount is 10% of the Certificate Value at the time of the first
withdrawal. After the first Certificate Year, the free withdrawal amount is 10%
of the Certificate Value on the preceding Certificate Anniversary.
SURRENDER
You may request to withdraw the entire Certificate Value at any time prior to
the Maturity Date, which is referred to as a surrender. Surrenders must also be
by written request and must include any tax withholding information we may
reasonably require. Applicable Surrender Charges and Market Value Adjustments
will be applied as described in this Section 7 and in Section 8. The payment you
will receive is the Surrender Value. The Surrender Value is an amount equal to
the Certificate Value, adjusted by any applicable Market Value Adjustment, less
any applicable Surrender Charge and taxes.
SURRENDER CHARGE
A Surrender Charge may apply to a withdrawal or surrender, depending on the date
and amount of such withdrawal or surrender. The surrender charge schedule you
elected at issue is specified on the Schedule Pages. Surrender Charges will be
applied on Certificate Value surrendered or withdrawn in excess of the free
withdrawal amount, and after the application of any Market Value Adjustment, up
to the Premium less prior withdrawals for which a Surrender Charge was applied.
TERMINATION
If the Certificate Value becomes zero, the certificate will immediately
terminate, unless otherwise determined by an attached rider, amendment, or
endorsement. We will mail a written notice to you at your most recent post
office address on file at our Annuity Operations Division.
15
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SECTION 8: MARKET VALUE ADJUSTMENT FEATURE
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A Market Value Adjustment ("MVA") is applied to withdrawals or upon surrender
before the end of a surrender charge period. The MVA, which may be positive or
negative, applies to all Accounts within the certificate.
The Market Value Adjustment equals the Certificate Value withdrawn or
surrendered in excess of the free withdrawal amount multiplied by the following:
1+i (n/12)
[----------] -1
1+j+0.0050
where:
i - is the Treasury Constant Maturity yield as published by the Federal
Reserve on the business day prior to the Certificate Date for the maturity
matching the duration of the surrender charge period;
j - is the Treasury Constant Maturity yield as published by the Federal
Reserve on the business day prior to the date of withdrawal or surrender
for the maturity matching the remaining years in the surrender charge
period (fractional years rounded up to the next full year);
n - is the number of complete months from the time of withdrawal or
surrender to the end of the surrender charge period.
If a Treasury Constant Maturity yield for a particular maturity is not
published, the yield will be interpolated between the yields for maturities that
are published. If the Treasury Constant Maturity yields are no longer published,
we will choose a suitable replacement, subject to any regulatory approvals, and
provide you with notice accordingly.
A positive MVA will increase the amount withdrawn or surrendered. There is no
limit on a positive MVA. A negative MVA will decrease the amount withdrawn or
surrendered. A negative MVA will not decrease the amount withdrawn or
surrendered by more than the amount (i) exceeds (ii), where:
(i) equals the amount withdrawn or surrendered, and
(ii) equals the portion of the Premium associated with (i), adjusted by
prior withdrawals.
The MVA is waived on the free withdrawal amount, on death, and on annuitization
if annuitization occurs after five Certificate Years. The MVA is not waived on
nursing home waiver and terminal illness waiver.
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SECTION 9: WAIVER PROVISIONS
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NURSING HOME WAIVER
Prior to the Maturity Date, you may withdraw a portion or surrender all of your
Certificate Value, adjusted by any applicable Market Value Adjustment, without a
Surrender Charge, provided that:
a. more than one year has elapsed since the Certificate Date, and
b. the surrender is requested within two years of the Certificate Owner's
admission into a Licensed Nursing Home Facility, and
c. the Certificate Owner has been confined to a Licensed Nursing Home
Facility for at least the preceding 120 days.
A Licensed Nursing Home Facility is defined as a state licensed hospital or
state licensed skilled or intermediate care nursing facility at which medical
treatment is available on a daily basis. You must provide us with satisfactory
evidence of confinement by written notice.
16
TERMINAL ILLNESS WAIVER
Prior to the Maturity Date, you may withdraw a portion or surrender all of your
Certificate Value, adjusted by any applicable Market Value Adjustment, without a
Surrender Charge, provided that we receive proof, satisfactory to us of the
Certificate Owner's Terminal Illness. Terminal Illness is defined as an illness
or condition that is expected to result in the Certificate Owner's death within
six months.
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SECTION 10: DEATH BENEFIT
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The death benefit will be determined upon the death of any Certificate Owner.
The death benefit is equal to the Certificate Value as of the date of death. No
Surrender Charge, Market Value Adjustment or Index Credit for the year in which
the death occurred will be included in the death benefit calculation. The death
benefits provided under this certificate are not less than the minimum benefits
required under the laws of the state where this certificate is delivered or
issued for delivery.
DEATH BEFORE MATURITY DATE
If the certificate is held by a single Certificate Owner who dies before the
Maturity Date, we will pay the death benefit to the designated Beneficiary upon
receipt of a certified death certificate, or any other proof acceptable to us.
If there is more than one Certificate Owner and one of the Certificate Owners
dies before the Maturity Date, we will pay the death benefit to the surviving
Certificate Owner(s), if any, who will be deemed to be the designated
Beneficiary(s). If the spouse of a deceased Certificate Owner is entitled to
receive all or some portion of the death benefit amount, the spouse may elect to
continue the certificate as the new Certificate Owner. This election is only
allowed prior to the Maturity Date and can be elected only one time. When the
spouse elects to continue the certificate, the death benefit that the spouse is
entitled to receive will become the new Certificate Value for the continued
certificate.
If the certificate is owned by a non-natural person, such as a trust, and the
Primary Annuitant dies before the Maturity Date, we will pay the death benefit
to the Certificate Owner. If a Joint Annuitant dies prior to the Maturity Date,
a death benefit is not paid. The Certificate Owner may appoint a new Joint
Annuitant.
DISTRIBUTION AT DEATH REQUIREMENTS
Any Beneficiary who is a natural person entitled to a death benefit may, within
one year after the date of an Certificate Owner's death, elect to receive the
death benefit in the form of an annuity payment option. If an annuity payment
option is selected, it may not extend beyond such Beneficiary's life or life
expectancy and the payments must begin within one year after the date of death.
If an annuity payment option is not elected or the Beneficiary is a non-natural
person, the entire death benefit will be distributed in a lump sum no later than
five years after the date of death.
DEATH ON OR AFTER THE MATURITY DATE
If an Certificate Owner dies on or after the Maturity Date and there is no
surviving Certificate Owner, any remaining annuity payments will be paid to the
Beneficiary under the annuity payment option in effect on the date of death. If
there is a surviving Certificate Owner, the payments continue as if there had
been no death. Payments to the Beneficiary or surviving Certificate Owner may
not be deferred or otherwise extended. If the Annuitant and Joint Annuitant(s),
if any, die and are survived by any Certificate Owner, any remaining period
certain annuity payments will be paid to such Certificate Owner. Payments may
not be deferred or otherwise extended.
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SECTION 11: ASSIGNMENT
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You may assign your interest in this contact, except as otherwise provided,
without the consent of any person other than an irrevocable Beneficiary. Your
interest, any interest of the Annuitant, and of any revocable Beneficiary shall
be subject to the terms of the assignment.
We will not be considered to have notice of any assignment of an interest in
this certificate until we receive the original or copy of the written assignment
at our Annuity Operations Division. In no event will we be responsible for the
validity or sufficiency of any assignment. Any change will be subject to any
payment made or actions taken by us before we received the written assignment at
our Annuity Operations Division.
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If this certificate is issued in a tax-qualified plan, this certificate is
subject to assignment restrictions for Federal Income Tax purposes. In such
event, this certificate 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.
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SECTION 12: DEFERRAL OF DETERMINATIONS
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We may postpone the processing of any withdrawals or surrender for up to six
months from the date of request contingent upon approval by the insurance
supervisory official in the jurisdiction in which this certificate is issued.
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SECTION 13: PROOF REQUIRED FOR PAYMENT
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We may require proof of the correct age of the Annuitant and Joint Annuitant, if
any, before any annuity payments begin. We also have the right to require proof
of the identity, age, and survival of any person entitled to any payment under
this certificate or upon whose life any payments depend.
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SECTION 14: MISSTATEMENTS
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If the age or sex of the Annuitant or Joint Annuitant has been misstated, any
benefits payable will be adjusted to the amount that the Certificate Value would
have purchased based on the Annuitant's or Joint Annuitant's correct age and
sex. Any overpayment(s) and underpayment(s) made by us will be charged or
credited against future payments to be made under the certificate. We will
charge interest on any overpayments and credit interest on any underpayments at
the effective annual rate required by the state where this certificate is
delivered.
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SECTION 15: CHANGE OF MATURITY DATE
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You may, by written request, change your Maturity Date at any time within 30
days prior to the Maturity Date. The new Maturity Date must be no later than (a)
the Certificate Anniversary nearest the younger Annuitant's 95th birthday, or
(b) ten years from the Certificate Date, whichever is later, but in no event
earlier than the fifth Certificate Anniversary. If no change request is received
by us, the Maturity Date will be as shown on the Schedule Pages.
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SECTION 16: STATEMENT OF ACCOUNT
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We will send you a statement of account annually, or more frequently, as
required by law. The statement of account will include the Certificate Value,
Surrender Value, and withdrawals. The statement of account will show any other
information required by the state or Federal laws or regulations. The statement
will be mailed to your most recent post office address on file at our Annuity
Operations Division.
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SECTION 17: ANNUITY BENEFITS
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On or before the Maturity Date, you may elect any one of the annuity payment
options as described in Section 18. If no election is made, we shall begin to
pay a series of annuity payments automatically to the Certificate Owner
beginning on the Maturity Date for a period certain of 10 years and as long
thereafter as the Annuitant lives. The amount of each annuity payment will be
equal to the Certificate Value on the Maturity Date less any applicable tax,
divided by $1,000 and then multiplied by the applicable annuity payment factors.
If the amount to be applied on the Maturity Date is less than $2,000 or would
result in monthly payments of less than $20, we shall have the right to pay such
amount to you in one lump sum in lieu of providing such annuity. We also have
the right to change the annuity payment frequency to annual if the monthly
annuity payment would otherwise be less than $20.
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SECTION 18: ANNUITY PAYMENT OPTIONS
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Election of an annuity payment option must be made by written request. We
reserve the right to require that the election of a payment option be in the
form of a supplementary certificate distributed by us reflecting the terms of
the payment option elected. You may not change the annuity payment option you
elected after the first annuity payment is made. Where the election of an
annuity payment option is made
18
by the Beneficiary of any death benefit payable under this certificate, limited
as described in Section 10, the term "Annuitant" as used below shall refer to
such Beneficiary.
OPTION A - LIFE ANNUITY WITH SPECIFIED PERIOD CERTAIN
A fixed payout annuity payable monthly while the Annuitant is living or, if
later, the end of the specified period certain. The period certain may be
specified as 5, 10, or 20 years. The period certain must be specified at the
time this option is elected.
OPTION B - NON-REFUND LIFE ANNUITY
A fixed payout annuity payable monthly while the Annuitant is living. No monthly
payment, death benefit or refund is payable after the death of the Annuitant.
Under either Option A or B, the applicable annuity payment option factor used to
determine the payment amount will not be less than the rate based on the 2000
Individual Annuity Mortality Table with a 10-year age setback and an interest
rate of 2.5%. Other values and tables may be used for other payment options that
we may make available.
OTHER ANNUITY PAYMENT OPTIONS
We may offer other annuity payment options or alternative versions of the
options listed above.
TABLES OF FIXED ANNUITY PAYMENT FACTORS
The tables below provide the minimum annuity payment factors for a monthly life
annuity with payments on a fixed basis for each $1,000 applied. If our annuity
payment factors in effect on the Maturity Date are more favorable, we will use
those rates. Annuity payment factors for payment frequencies, periods, ages and
any current rate information not shown here will be provided upon request.
OPTIONS A - LIFE ANNUITY WITH SPECIFIED PERIOD CERTAIN
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5 YEARS CERTAIN 10 YEARS CERTAIN 20 YEARS CERTAIN
------------ ------------------------ ------------------------ -------------------------
AGE MALE FEMALE MALE FEMALE MALE FEMALE
------------ ------------ ----------- ------------ ----------- ----------- -------------
40 $2.90 $2.79 $2.89 $2.79 $2.89 $2.78
------------ ------------ ----------- ------------ ----------- ----------- -------------
45 3.05 2.92 3.05 2.92 3.03 2.91
------------ ------------ ----------- ------------ ----------- ----------- -------------
50 3.24 3.08 3.24 3.08 3.21 3.06
------------ ------------ ----------- ------------ ----------- ----------- -------------
55 3.48 3.28 3.47 3.28 3.42 3.25
------------ ------------ ----------- ------------ ----------- ----------- -------------
60 3.79 3.54 3.76 3.53 3.67 3.48
------------ ------------ ----------- ------------ ----------- ----------- -------------
65 4.17 3.87 4.13 3.85 3.97 3.76
------------ ------------ ----------- ------------ ----------- ----------- -------------
70 4.67 4.30 4.61 4.26 4.30 4.09
------------ ------------ ----------- ------------ ----------- ----------- -------------
75 5.36 4.88 5.21 4.81 4.63 4.45
------------ ------------ ----------- ------------ ----------- ----------- -------------
80 6.28 5.68 5.97 5.51 4.92 4.80
------------ ------------ ----------- ------------ ----------- ----------- -------------
85 7.49 6.81 6.82 6.41 5.12 5.07
------------ ------------ ----------- ------------ ----------- ----------- -------------
90 9.04 8.38 7.70 7.42 5.22 5.21
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OPTION B - NON-REFUND LIFE ANNUITY
-----------------------------------------
AGE MALE FEMALE
--------------- ------------ ------------
40 $2.90 $2.79
--------------- ------------ ------------
45 3.05 2.92
--------------- ------------ ------------
50 3.24 3.08
--------------- ------------ ------------
55 3.49 3.28
--------------- ------------ ------------
60 3.79 3.54
--------------- ------------ ------------
65 4.18 3.87
--------------- ------------ ------------
70 4.69 4.31
--------------- ------------ ------------
75 5.40 4.90
--------------- ------------ ------------
80 6.38 5.73
--------------- ------------ ------------
85 7.73 6.94
--------------- ------------ ------------
90 9.61 8.73
-----------------------------------------
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[LOGO] Phoenix(R)
Group Single Premium Deferred Equity Indexed Modified Guaranteed Annuity
Nonparticipating - not eligible for dividends
05FNDEIA-C
