EXHIBIT 4
[PRUDENTIAL FINANCIAL LOGO]
[PRUDENTIAL FINANCIAL LOGO]
Pruco Life Insurance Company
Phoenix, Arizona 85014
a Prudential Company
This is an annuity contract. Subject to the provisions of the Contract, and in
consideration of the Purchase Payments you make and we accept, we will make
Annuity Payments starting on the Annuity Date shown on the Contract Data pages.
A death benefit is payable before the Annuity Date.
PAYMENTS AND VALUES PROVIDED UNDER THIS CONTRACT ARE SUBJECT TO A MARKET VALUE
ADJUSTMENT FORMULA, THE OPERATION OF WHICH MAY RESULT IN UPWARD AND DOWNWARD
ADJUSTMENTS IN AMOUNTS PAYABLE AND ARE NOT GUARANTEED. THE MARKET VALUE
ADJUSTMENT APPLIES TO WITHDRAWALS AND AMOUNTS APPLIED TO PURCHASE AN ANNUITY.
HOWEVER, SUCH PAYMENTS MADE BY US WITHIN THE 30 DAYS PRIOR TO THE END OF A
GUARANTEED INTEREST RATE PERIOD, PAYMENT OF THE CHARGE-FREE AMOUNT, AND DEATH
BENEFIT PAID DURING THE ACCUMULATION PHASE ARE NOT SUBJECT TO A MARKET VALUE
ADJUSTMENT. SEE PAGE 10 FOR MARKET VALUE ADJUSTMENT PROVISION.
Please read the Contract carefully; it is a legal contract between you and Pruco
Life Insurance Company. If you have a question about the Contract, or a claim,
see your representative or contact the Annuity Service Center at
[1-888-PRU-2888.]
RIGHT TO CANCEL CONTRACT
This Contract may be returned within 10 days (15 days in Colorado; 20 days in
Idaho and North Dakota; and, if you are 60 years of age or older, 30 days in
California) after you receive it. The Contract may be mailed or delivered to the
Annuity Service Center, or to the representative who sold it to you. Return of
this Contract by mail is effective on being postmarked, properly addressed and
postage prepaid. The returned Contract will be canceled upon our receipt, and we
will return your money in accordance with applicable law. A Market Value
Adjustment will not be applied to the amount paid during the Right to Cancel
period.
READ YOUR CONTRACT CAREFULLY
Signed for Pruco Life Insurance Company,
an Arizona Corporation.
/s/ XXXXXXXX X. XXXXXX
Secretary President
INDIVIDUAL MULTIPLE PURCHASE PAYMENT MODIFIED GUARANTEED
DEFERRED ANNUITY CONTRACT
NONPARTICIPATING
MVA-2002
TABLE OF CONTENTS
CONTRACT DATA PAGES...........................................................3
DEFINITIONS...................................................................5
PURCHASE PAYMENTS.............................................................8
CONTRACT VALUE................................................................8
SUBSEQUENT GUARANTEED INTEREST RATE PERIODS...................................9
MARKET VALUE ADJUSTMENT......................................................10
WITHDRAWALS..................................................................11
BENEFICIARY..................................................................12
DEATH BENEFIT................................................................13
GENERAL PROVISIONS...........................................................14
VALUES AND BENEFITS..........................................................15
ANNUITY AND SETTLEMENT OPTIONS...............................................16
ANNUITY SETTLEMENT TABLES....................................................17
2
CONTRACT DATA
OWNER: [Xxxx Xxx] SEX: [M] AGE AT ISSUE: [35]
JOINT OWNER: [Xxxx Xxx] SEX: [F] AGE AT ISSUE: [35]
ANNUITANT: [Xxxx Xxx] SEX: [M] AGE AT ISSUE: [35]
CO-ANNUITANT: [Xxxx Xxx] SEX: [F] AGE AT ISSUE: [35]
CONTRACT NUMBER: [12345] CONTRACT DATE: [September 1, 2002]
PLAN TYPE: [Non-Qualified] ANNUITY DATE: [September 1, 2062]
INITIAL PURCHASE PAYMENT: [$5,000.00]
INITIAL PURCHASE PAYMENT LIMIT: The initial Purchase Payment made into this
Contract may not exceed [$5,000,000]. Purchase Payments of greater value may be
allowed with our prior approval.
MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$1,000]
AGGREGATE PURCHASE PAYMENT LIMIT: The total of all Purchase Payments made into
this Contract may not exceed [$10,000,000]. Purchase Payments of greater value
may be allowed with our prior approval.
INITIAL GUARANTEED INTEREST RATE PERIOD: [1-10] Contract Years
INITIAL GUARANTEED INTEREST RATE: [xxxxx]% annually for the first [1-10]
Contract Years
GUARANTEED MINIMUM INTEREST RATE: [3%]
[ ADDITIONAL INTEREST RATE CREDIT
In the first Contract Year, we will increase the initial Guaranteed Interest
Rate based on the amount of the initial Purchase Payment. [ An Additional
Interest Rate Credit is not available for a one-year or three-year Guaranteed
Interest Rate Period. ] The Additional Interest Rate Credit is based on the
initial Purchase Payment, and is equal to the corresponding percentage listed
below. ]
[INITIAL PURCHASE ADDITIONAL INTEREST RATE
PAYMENT AMOUNT CREDIT PERCENTAGE
$0 - $24,999 0.0%
$25,000 - $74,999 0.5%
$75,000 + 1.0% ]
BENEFICIARY:
As designated by Owner at Contract Date unless changed in accordance with
the Contract provisions.
3
WITHDRAWALS:
WITHDRAWAL CHARGE: The Withdrawal Charge is a percentage of the amount
withdrawn that is subject to a charge. For the initial Guaranteed Interest
Rate Period, the Withdrawal Charge Period is [equal in duration to the
number of years in the initial Guaranteed Interest Rate Period and the
Withdrawal Charge Percentage depends on the number of Contract
Anniversaries that have elapsed since the initial Purchase Payment was
made.] After the initial Guaranteed Interest Rate Period, the first
subsequent Guaranteed Interest Rate Period will begin a new Withdrawal
Charge Period equal to the number of years in the new Guaranteed Interest
Rate Period. No Withdrawal Charge will apply beginning with the second
subsequent Guaranteed Interest Rate Period. The Withdrawal Charge schedule
is shown below.
--------------------------------------------------------------------------------------------------------
[Number of Contract Anniversaries Since
Initial Purchase Payment or 0 1 2 3 4 5 6 7 8 9 10+
Start of the First Subsequent GIR Period
--------------------------------------------------------------------------------------------------------
Withdrawal Charge Percentage if
Annuitant 7% 7% 7% 6% 5% 5% 4% 3% 2% 1% 0%
Is Age 84 or less on Contract Date
--------------------------------------------------------------------------------------------------------
Withdrawal Charge Percentage if
Annuitant 7% 7% 7% 6% 5% 4% 3% 2% 1% 0% 0%]
Is Age 85 on Contract Date
--------------------------------------------------------------------------------------------------------
CHARGE-FREE AMOUNT: After the first Contract Year, you may withdraw an
amount equal to the interest credited in the prior Contract Year without
incurring a Withdrawal Charge or Market Value Adjustment.
MINIMUM AMOUNT WHICH MAY BE WITHDRAWN: The minimum amount that may be
withdrawn is [$250]. The minimum amount that may be withdrawn under an
automated withdrawal plan is [$100].
MINIMUM CONTRACT VALUE THAT MUST REMAIN IN THE CONTRACT AFTER A WITHDRAWAL:
The minimum Contract Value that must remain in the Contract in order to
keep the Contract inforce after a withdrawal is [$2,000].
ENDORSEMENTS:
[Individual Retirement Annuity Endorsement]
ANNUITY SERVICE CENTER:
[Annuity Service Center
P.O. Box 7960
Philadelphia, PA 19101]
4
DEFINITIONS
ACCUMULATION PERIOD: The period before the Annuity Date and during the lifetime
of the Owner or Joint Owner, if applicable.
ADDITIONAL INTEREST RATE CREDIT: An increase to your Guaranteed Interest Rate
that is credited in the first Contract Year, or in the first year of the first
subsequent GIR Period. The Additional Interest Rate Credit applicable in the
first Contract Year is shown on the Contract Data pages and is based on the
value of your initial Purchase Payment. We will notify you before the end of the
initial GIR period of the Additional Interest Rate Credit applicable for the
first subsequent GIR Period.
ADJUSTED CONTRACT VALUE: The Contract Value as of the Annuity Date less any
applicable Premium Tax Charge, Withdrawal Charge, and Market Value Adjustment.
This amount is applied to the applicable annuity table to determine the initial
Annuity Payment.
ANNUITANT: The person named on the Contract Data pages, unless subsequently
changed, upon whose continuation of life an Annuity Payment involving life
contingencies depends. If the Annuitant dies before the Annuity Date, the
Co-Annuitant, if applicable, becomes the Annuitant, if the requirements for
changing the Annuity Date are met (see definition of Annuity Date). If there is
no surviving or eligible Co-Annuitant, and the Annuitant is not the Owner, the
Owner becomes the Annuitant upon the death of the Annuitant. You then have 60
days from the date we receive Due Proof of Death of the Annuitant or
Co-Annuitant to name a new Annuitant. If no new Annuitant is named during that
60-day period, the Owner will remain the Annuitant. With our prior approval, you
may change, add or remove an Annuitant or Co-Annuitant.
ANNUITY DATE: The date the first Annuity or Settlement Payment to the Payee is
due. The Annuity Date is shown on the Contract Data pages. You must have our
permission to change the Annuity Date. If there is a new Annuitant due to the
death of the prior Annuitant or assignment of the Contract, and the new
Annuitant is older than the prior Annuitant, the Annuity Date will be based on
the age of the new Annuitant. If the new Annuitant is younger than the prior
Annuitant, the Annuity Date will not change. Any such changed Annuity Date
cannot be earlier than the second Contract anniversary, or later than the
Contract Anniversary next following the new Annuitant's 95th birthday and must
be consistent with applicable law at the time.
ANNUITY OR SETTLEMENT PAYMENTS: The series of payments made to you or any named
Payee after the Annuity Date as described under the Annuity or Settlement option
selected.
ANNUITY PERIOD: The period of time, beginning on the Annuity Date, during which
Annuity or Settlement Payments are made.
ANNUITY SERVICE CENTER: The office indicated on the Contract Data pages to which
notices, requests and Purchase Payments must be sent. The Annuity Service Center
address may be changed at any time. You will be notified in advance and in
writing of any change in address.
BENEFICIARY: The person(s) or entity(ies) who has the right to receive the death
benefit when the Owner or Joint Owner dies. The Owner must be the primary
Beneficiary of the Joint Owner, and the Joint Owner must be the primary
Beneficiary of the Owner.
BUSINESS DAY: Any day the Company is open for business.
CHARGE-FREE AMOUNT: The Charge-Free Amount is a portion of the Contract Value
that may be withdrawn without incurring a Withdrawal Charge or Market Value
Adjustment.
CO-ANNUITANT: The person shown on the Contract Data pages who becomes the
Annuitant upon the death of the Annuitant before the Annuity Date. No
Co-Annuitant may be designated if the Owner is a non-natural person.
COMPANY: Pruco Life Insurance Company, an Arizona corporation.
5
CONTRACT ANNIVERSARY: The same day and month as the Contract Date in each later
year.
CONTRACT DATE: The date shown on the Contract Data pages on which the first
Contract Year begins.
CONTRACT SURRENDER VALUE: The Contract Value less any applicable Premium Tax
Charge, Withdrawal Charge, and Market Value Adjustment.
CONTRACT VALUE: The dollar value prior to the Annuity Date of all amounts
accumulated under this Contract.
CONTRACT YEAR: A year that starts on the Contract Date or on a Contract
Anniversary.
DUE PROOF OF DEATH: An original certified copy of an official death certificate,
an original certified copy of a decree of a court of competent jurisdiction as
to the finding of death, and/or any other proof of death satisfactory to us.
EARNINGS: The excess of the Contract Value over the sum of the Purchase Payments
made and not yet withdrawn.
ELIGIBLE HOSPITAL: An institution that meets either of the following
requirements:
1. is accredited as a hospital under the Hospital Accreditation
Program of the Joint Commission on Accreditation of Healthcare
Organizations; or
2. is legally operated, has 24-hour a day supervision by a staff of
doctors, has 24-hour a day nursing service by registered graduate
nurses, and either:
(a) mainly provides general inpatient medical care and treatment
of sick and injured persons by the use of medical,
diagnostic and major surgical facilities. All such
facilities are located in it or are under its control; or
(b) mainly provides specialized inpatient medical care and
treatment of sick or injured persons by the use of medical
and diagnostic facilities (including x-ray and laboratory).
All such facilities are located in it, are under its
control, or are available to it under a written agreement
with a hospital (as defined above) or with a specialized
provider of these facilities.
An Eligible Hospital is not an institution, or part of one, that: (a)
furnishes mainly homelike or custodial care, or training in the routines of
daily living; or (b) is mainly a school.
ELIGIBLE NURSING HOME: An institution or special nursing unit of a hospital that
meets at least one of the following requirements:
1. is Medicare approved as a provider of skilled nursing care services;
or
2. operates pursuant to law as a skilled nursing home or as an
intermediate care facility by the state in which it is located; or
3. meets all the following requirements:
(a) is licensed as a nursing home by the state in which it is
located; and
(b) its main function is to provide skilled, intermediate, or
custodial nursing care; and
(c) is engaged in providing continuous room and board
accommodations to 3 or more persons; and
(d) is under the supervision of a registered nurse (RN) or
licensed practical nurse (LPN); and
(e) maintains a daily medical record of each patient; and
(f) maintains control and records for all medications dispensed.
6
FIRST TO DIE: "First to Die" as referenced in this Contract means the first
person to die of the Owner or Joint Owner, if applicable.
GUARANTEED INTEREST RATE OR GIR: Is the rate of interest guaranteed for a GIR
Period. The GIR is shown on the Contract Data pages for the initial GIR Period.
We will notify you at your last known address of the subsequent GIR Period
options and the corresponding Guaranteed Interest Rates offered by us at that
time. The declared rate may be higher or lower than the GIR for the preceding
GIR Period, but will never be less than the Guaranteed Minimum Interest Rate
shown on the Contract Data pages.
GUARANTEED INTEREST RATE PERIOD OR GIR PERIOD: Is the period of years during
which the GIR applies. The initial GIR Period is shown on the Contract Data
pages and begins on the Contract Date. Any subsequent GIR Period will begin on
the first day following the expiration date of the GIR Period then in effect.
GOOD ORDER: An instruction received at the Annuity Service Center, utilizing
such forms, signatures and datings as we require, that is sufficiently complete
and clear that we do not need to exercise any discretion to follow such
instructions. We will notify you if an instruction is not in Good Order.
JOINT OWNER: The Joint Owner, if any, is named on the Contract Data pages as the
Joint Owner, who shares ownership rights with the Owner as defined under this
Contract. You may add, change or remove a Joint Owner, subject to our
underwriting rules. The Contract may never have more than one Joint Owner. No
Joint Owner is permitted for IRAs or other qualified contracts.
MARKET VALUE ADJUSTMENT OR MVA: Is the amount by which any portion of the
Contract Value, in excess of the Charge-Free Amount, is adjusted if withdrawn or
annuitized more than 30 days prior to the end of the Guaranteed Interest Rate
Period. A Market Value Adjustment can be a positive or negative adjustment.
OWNER: The person or entity named on the Contract Data pages who has ownership
rights as defined under the Contract provided that, if a Joint Owner is named,
the Owner shares ownership rights with the Joint Owner. You may change the Owner
subject to our underwriting rules. Any change of an Owner will be effective when
we process the request.
PAYEE: The person who has a right to receive Annuity or Settlement Payments
under the Annuity and Settlement Options provision of this Contract. The Payee
can be designated as revocable or irrevocable at your discretion. If you do not
designate a Payee at least 5 Business Days before the Annuity Date, the Owner
will become the Payee.
PREMIUM TAX CHARGE: A charge that may be deducted from the Purchase Payment or
Contract Value for premium taxes owed by us to any governmental entity.
PURCHASE PAYMENT: The payment you make to this Contract that is accepted by us.
The initial Purchase Payment is made on the Contract Date. Subsequent Purchase
Payments may be made during the 30 day period prior to the end of a GIR Period.
TERMINALLY ILL: We consider someone terminally ill who has a life expectancy of
twelve months or less. Proof of Terminal Illness must include a certification by
a licensed physician.
WE, OUR AND US: Pruco Life Insurance Company.
WITHDRAWAL CHARGE: A charge assessed on partial or full withdrawals or upon the
Annuity Date (depending on the payout option chosen) during the Withdrawal
Charge Period. The Withdrawal Charge equals a percentage of the amount withdrawn
that is subject to a charge. The Withdrawal Charges are shown on the Contract
Data pages.
7
WITHDRAWAL CHARGE PERIOD: The period of time during the Accumulation Period,
during which we may impose a Withdrawal Charge. Withdrawal Charges are applied
to withdrawals of amounts in the Contract. The Withdrawal Charge Period is shown
on the Contract Data pages.
YOU AND YOUR: The Owner of the Contract if there is no Joint Owner. If there is
a Joint Owner, the Owner and Joint Owner acting together. If we receive written
authorization in Good Order from both the Owner and Joint Owner, upon our
consent we will allow either to represent the entire ownership interest in the
Contract, until either party has revoked that authorization. This Contract will
treat the Owner as having contributed 100% of the Purchase Payments. Therefore,
we will treat the Owner as the taxpayer with respect to all distributions made
under the Contract while he or she is the Owner, whether or not a Joint Owner is
also named.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: The initial Purchase Payment must be paid on the Contract
Date. Subsequent Purchase Payments may be made during the 30 day period prior to
the end of a GIR Period. We reserve the right to decline any Purchase Payment.
ALLOCATION OF PURCHASE PAYMENTS: The initial Purchase Payment may be allocated
to only one Guaranteed Interest Rate Period at a time. Subsequent Purchase
Payments will be combined with the existing Contract Value and allocated to a
single Guaranteed Interest Rate Period.
CONTRACT VALUE
Your Contract Value is the total of all amounts credited to your Contract as of
any Business Day as a result of your Purchase Payments and the increases and
decreases described below.
On the Contract Date, the Contract Value is equal to the initial Purchase
Payment less any Premium Tax charge. The Contract Value is increased by interest
credited and subsequent Purchase Payments.
Withdrawals and Withdrawal Charges and any Premium Tax Charge or other tax
charge decrease the Contract Value.
Application of an MVA may increase or decrease the Contract Value.
8
SUBSEQUENT GUARANTEED INTEREST RATE PERIODS
SUBSEQUENT GUARANTEED INTEREST RATE PERIODS: Prior to the end of a GIR Period,
we will notify you at your last known address of the subsequent GIR Period
options and the corresponding Guaranteed Interest Rates offered by us at that
time. You have 30 days prior to the end of the current GIR Period to provide us
a written request in Good Order to elect one of the following options.
1. Continue the Contract and elect a subsequent GIR Period. The
subsequent GIR Period can be of the same or different length of time
offered by us at the time of election. The new GIR Period elected must
end prior to the Annuity Date. If we do not offer a subsequent GIR
Period that ends prior to the Annuity Date, the Contract can be
continued with a one-year, or series of one-year GIR Periods until the
Annuity Date. You may also at this time make a subsequent Purchase
Payment which will be consolidated with your Contract Value and
allocated to the single GIR Period you elect.
2. Elect an Annuity or Settlement option.
3. Withdraw part of the Contract Value without incurring a Withdrawal
Charge or Market Value Adjustment and elect a GIR Period of the same
or different length as the current GIR Period for the remaining
Contract Value. The remaining Contract Value cannot be less than the
minimum amount shown on the Contract Data pages. If we do not offer a
subsequent GIR Period that ends prior to the Annuity Date, the
Contract can be continued with a one-year, or series of one-year GIR
Periods until the Annuity Date.
4. Withdraw the full Contract Value without incurring a Withdrawal Charge
or Market Value Adjustment and this Contract will terminate.
If we do not receive a written request in Good Order during the 30 day period
preceding the end of the current GIR Period, the new GIR Period will be the same
length as the GIR Period expiring with a new GIR equal to or greater than the
Guaranteed Minimum Interest Rate. If we do not offer such period, or if the
length of the new GIR Period would expire on or after the Annuity Date, the new
GIR Period will be one year. If the Annuitant is attained age 91 or older at the
end of the current GIR Period, all subsequent GIR periods will be one year.
WITHDRAWAL CHARGES: After the Initial GIR Period, the first subsequent GIR
Period will begin a new Withdrawal Charge Period equal to the number of years in
the new GIR Period. Reduced Withdrawal Charges will apply to withdrawals made
during the first subsequent GIR Period if the Annuitant is age 85 or older on
the first day of that first subsequent GIR Period. No Withdrawal Charges will
apply beginning with the second subsequent GIR Period.
No Withdrawal Charges will apply if any subsequent GIR Period is equal to one
year.
9
MARKET VALUE ADJUSTMENT
MARKET VALUE ADJUSTMENT: Amounts withdrawn or annuitized prior to the end of a
GIR Period may be subject to a Market Value Adjustment. The MVA is applied as a
positive or negative adjustment to the applicable portion of the Contract Value
by multiplying the withdrawal amount before deduction of any applicable
Withdrawal Charge by the MVA factor.
The MVA factor is equal to:
(n/12)
( 1+i )
(---------) - 1
(1+j+.0025)
where: i = is the Guaranteed Interest Rate currently credited to this
Contract at the time of the withdrawal, annuitization or
settlement.
j = is the current credited interest rate at the time of the
withdrawal, annuitization or settlement for a new issue of
this policy form with a GIR Period equal to the number of
whole years remaining in this Contract's GIR Period, plus
one. If such a GIR Period is not offered by us, the rate
will be determined using linear interpolation of the
nearest offered rates.
n = is the number of months remaining in this Contract's GIR
Period (rounded up).
A higher current interest rate for new issues of this policy form with a GIR
Period equal to the number of years remaining in the current GIR Period may
result in a negative MVA and thus a lower Contract Surrender Value. A lower
current interest rate for new issues of this policy form with a GIR Period equal
to the number of years remaining in the current GIR Period may result in a
positive MVA and thus a higher Contract Surrender Value.
A Market Value Adjustment will not be applied when the death benefit is payable,
for a Charge-Free Amount withdrawal or within 30 days prior to the end of the
current GIR Period.
10
WITHDRAWALS
WITHDRAWALS: During the Accumulation Period you may, upon a request in Good
Order, make a total or partial withdrawal of the Contract Surrender Value. Any
applicable Withdrawal Charge will be applied after any Market Value Adjustment.
We have the right to defer payment of any withdrawal for a period not to exceed
six months from the date your request is received in Good Order.
Each partial withdrawal must be for an amount that is not less than the minimum
amount shown on the Contract Data pages. The minimum Contract Value that must
remain in the Contract after a partial withdrawal in order to keep the Contract
inforce is shown on the Contract Data pages. If the amount of the withdrawal
requested would reduce the Contract Value below this minimum, we will give you
the maximum amount available that, with the Withdrawal Charge and Market Value
Adjustment, would not reduce the Contract Value below such minimum. Special
rules may apply for IRAs.
WITHDRAWAL CHARGE: A Withdrawal Charge may apply if you make a withdrawal during
the Withdrawal Charge Period. The Withdrawal Charge is a percentage of the
amount withdrawn that is subject to a charge. For the initial Guaranteed
Interest Rate Period, the Withdrawal Charge depends on the number of Contract
Anniversaries that have elapsed since the initial Purchase Payment was made.
After the initial Guaranteed Interest Rate Period, the first subsequent
Guaranteed Interest Rate Period will begin a new Withdrawal Charge Period equal
to the number of years in the new Guaranteed Interest Rate Period. No Withdrawal
Charge will apply beginning with the second subsequent GIR Period.
If a withdrawal is effective on the day before a Contract Anniversary, the
Withdrawal Charge percentage used will be the one as of the following Contract
Anniversary. If you request a partial withdrawal, we will deduct an amount from
the Contract Value that is sufficient to pay the Withdrawal Charge and any
applicable Market Value Adjustment, and provide you the amount requested. The
Withdrawal Charge schedule is shown on the Contract Data pages.
For purposes of determining the Withdrawal Charge, withdrawals of the
Charge-Free Amount will be taken first. Withdrawals in excess of the Charge-Free
Amount may be subject to a Withdrawal Charge.
We will waive all Withdrawal Charges upon receipt of due proof that the Owner or
Joint Owner is Terminally Ill, or has been confined to an Eligible Nursing Home
or Eligible Hospital continuously for at least three months, subsequent to the
Contract Date. This waiver is not available if the Contract has been assigned.
Withdrawal Charges will not be greater than that permitted by any applicable law
or regulation. Withdrawal Charges may be assessed upon the Annuity Date.
11
BENEFICIARY
BENEFICIARY: The Beneficiary designation in effect on the Contract Date will
remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the death of the First to Die, during the Accumulation
Period. The Owner must be the primary Beneficiary of the Joint Owner, and the
Joint Owner must be the primary Beneficiary of the Owner. Other than primary
Beneficiaries, Beneficiaries must be the same for both the Owner and Joint
Owner.
When a Beneficiary is designated, any relationship shown is to the Owner unless
otherwise specified.
To show priority among Beneficiaries, we will label the classes, so that the
class with first priority is called the primary class, the class with next
priority is called the secondary class, and so on. The following statements
apply to Beneficiaries unless the Contract Data pages, Contract endorsement or
any change request that we have processed specifies otherwise:
One who survives the First to Die will have the right to be paid only if no one
in a prior class survives the First to Die.
One who has the right to be paid will be the only one paid if no one else in the
same class survives the First to Die.
Two or more in the same class who have the right to be paid will be paid in
equal shares. If no one survives the sole Owner, we will pay in one sum to the
Owner's estate.
When there is insufficient evidence to determine the order of death then, unless
state law prohibits, we will deem the Owner to be the last survivor and make
payment to the Owner's Beneficiary.
Before we make a payment, we have the right to decide what proof we need of the
identity, age or any other facts about any persons designated as Beneficiaries.
If Beneficiaries are not designated by name and we make payment(s) based on that
proof, we will not have to make the payment(s) again.
CHANGE OF BENEFICIARY: To initiate a change of Beneficiary, call the toll-free
number listed on your statement or contact the representative who sold you the
Contract. We may also ask you to send us the Contract. The change will take
effect only when we process the request. Once changed any previous Beneficiary's
interest will end as of the date we receive the request in Good Order, even if
the Owner or Joint Owner is not living when we process the request. We will not
be liable for any payment made or action taken before we record the change.
12
DEATH BENEFIT
During the Accumulation Period, we will pay a death benefit to the Beneficiary
upon the death of the First to Die. The death benefit is payable as of the date
we receive Due Proof of Death, and any other documentation we request in Good
Order. No payment made prior to the date we receive Due Proof of Death will be
considered part of the death benefit payable to the Beneficiary.
The death benefit is equal to the Contract Value as of the date that Due Proof
of Death is received in Good Order at the Prudential Annuity Service Center,
less any applicable Premium Tax.
The Beneficiary may, within 60 calendar days of providing Due Proof of Death,
elect to take the death benefit under one of the death benefit payout options
listed below, provided that any payout option shall not include a period certain
that exceeds the life expectancy of the Beneficiary. The Beneficiary will be the
sole measuring life in determining the amount of any such payout option. If no
payout option is selected within the 60 days, the death benefit will be payable
as a lump sum.
If the Owner and Joint Owner are spouses at the time of death, the Contract will
continue and the surviving spouse will become the Owner. The surviving spouse
may, within 60 calendar days of providing Due Proof of Death, elect to take the
death benefit under any of the payout options available under this Contract. If
the Contract continues, and there is a new Annuitant who is older than the prior
Annuitant, the Annuity Date will be based on the age of the new Annuitant.
If the Owner and Joint Owner are not spouses at the time of the Owner or Joint
Owner's death, the Contract will not continue, the death benefit becomes
payable, and the Beneficiary will be required to choose one of the death benefit
payout options described below. In that event, the payout described in Choice 2
and the beginning of the distribution described in Choice 3 will be based on the
date of death of the First to Die.
The death benefit payout options are:
Choice 1 -- lump sum payment of the death benefit. We will not impose any
Withdrawal Charges or MVA on amounts paid as a lump sum payment; or
Choice 2 -- the payment of the entire death benefit within 5 years of the date
of death of the First to Die. We will impose an MVA on any
withdrawal made during the 5 year period unless taken within the 30
day period prior to the end of the GIR Period; or
Choice 3 -- payment of the death benefit under an Annuity or Settlement Option
over the lifetime of the Beneficiary or over a period not extending
beyond the life expectancy of the Beneficiary. Distribution must
begin within one year of the date of death of the First to Die.
Any portion of the death benefit not applied under Choice 3 within one year of
the date of death of the First to Die must be distributed within 5 years of the
date of death of the First to Die.
Once a death benefit becomes payable, the Payee's interest in any Annuity
Benefit under the Contract will cease. We have the right to defer payment of any
death benefit for a period not to exceed six months from the date of our receipt
of Due Proof of Death.
13
DEATH OF ANNUITANT DURING THE ACCUMULATION PERIOD: If the Annuitant dies before
the Annuity Date, the Co-Annuitant, if applicable, becomes the Annuitant. If
there is no surviving Co-Annuitant, and the Annuitant was not the Owner, the
Owner becomes the Annuitant. If the Owner becomes the Annuitant as a result of
the death of the Annuitant or Co-Annuitant, if any, the Owner has the right to
name a new Annuitant within 60 days from the date we receive Due Proof of Death
of the Annuitant or Co-Annuitant. If no new Annuitant is named during that
60-day period, the Owner will remain the Annuitant. If the Owner is a
non-natural person, the death of the Annuitant will be treated as the death of
the Owner, a new Annuitant may not be designated, and the Annuitant will be
deemed to be the Owner for purposes of determining the death benefit.
DEATH OF ANNUITANT DURING THE ANNUITY PERIOD: If the Annuitant dies on or after
the Annuity Date, the Annuity or Settlement Option then in effect will govern
whether or not we will continue to make any payments. The death of a
non-Annuitant Owner or Joint Owner has no effect on the payout during the
Annuity Period.
PAYMENT OF DEATH BENEFIT: We will require Due Proof of Death and any other
documentation we request in Good Order before any death benefit is paid. All
death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments. We have the right to defer payment of any
death benefit for a period not to exceed six months from the date of our receipt
of Due Proof of death.
SPECIAL TAX CONSIDERATIONS: There are special tax rules that apply to IRA and
other qualified contracts during both the Accumulation Period and Annuity Period
governing distributions upon the death of the Owner. These rules are contained
in provisions in the attached endorsements and supersede any other distribution
rules contained in the Contract.
The preceding provisions regarding the death of the Owner are intended to
satisfy the distribution at death requirements of section 72(s) of the Internal
Revenue Code of 1986, as amended. We reserve the right to amend this Contract by
subsequent endorsement as necessary to comply with applicable tax requirements,
if any, which are subject to change from time to time. Such additional
endorsements if necessary to comply with amended tax requirements, will be
mailed to you and become effective within 30 days of mailing, unless you notify
us in writing within that time frame that you reject the endorsement.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, and any attached
endorsements or riders. This Contract may be changed or altered only by our
President or Secretary. No agent may change this Contract. Any change,
modification or waiver must be made in writing. This Contract may not be
modified by us without your consent except as may be required by applicable law,
such as changes necessary to comply with IRS requirements for annuity contracts,
or as set forth in this Contract.
ASSIGNMENT OF A CONTRACT: A request in Good Order specifying the terms of an
assignment of a Contract must be provided to the Annuity Service Center. We are
under no obligation to verify the assignment's validity or sufficiency. We will
not be liable for any payment made or action taken before we record the
assignment. If any Owner is living on the Annuity Date and an assignment is in
effect on that date, we have the right to pay the Contract Surrender Value in
one lump sum to the assignee where notice in Good Order is received. Partial
assignments, collateral or otherwise, are not allowed without our approval. We
reserve the right to restrict or refuse any assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent. If the Contract is assigned, your rights may
only be exercised with the consent of the assignee of record.
NON-PARTICIPATING IN SURPLUS: This Contract does not share in any distribution
of our profits or surplus.
14
INCONTESTABILITY: We will not contest this Contract. We consider all statements
made in the application for this Contract to be representations, not warranties.
MISSTATEMENT OF AGE OR SEX: We may require proof of age of the Annuitant before
making any life contingent Annuity Payment provided for by this Contract. If the
age or sex of the Annuitant has been misstated, the amount payable will be the
amount that the Adjusted Contract Value would have provided at the true age or
sex.
Once Annuity Payments have begun, any underpayments including 5% interest, will
be made up in one sum with the next Annuity Payment. Overpayments including 5%
interest, will be deducted from the future Annuity Payments until the total is
repaid.
CONTRACT SETTLEMENT: This Contract must be returned to us upon any settlement.
REPORTS: We will send you a quarterly statement showing your Contract Value and
other relevant information about your Contract. This report will be sent to your
last known address.
TAXES: Any taxes, including any Premium Taxes and any other type of tax (or
component thereof) measured by or based upon any portion of the Purchase
Payments we receive or the Contract Value at the time of annuitization, paid to
any governmental entity will be charged against the Contract Value. We will, in
our sole discretion, determine when taxes have resulted from receipt by us of
the Purchase Payments or upon annuitization. At our discretion, we may pay taxes
when due and deduct that amount from the Contract Value at a later date. Payment
at an earlier date does not waive any right we may have to deduct amounts at a
later date. We will deduct any withholding taxes required by applicable law.
EVIDENCE OF SURVIVAL: Before we make a payment, we have the right to require
proof of continued life and any other documentation we need to make a payment.
We can require this proof for any person whose life or death determines whether
or to whom we must make the payment.
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under this Contract before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
VALUES AND BENEFITS
Any cash values, paid up annuities and death benefits that may be available
under this Contract are not less than the minimum benefits required by the law
of any state in which this Contract is delivered.
15
ANNUITY AND SETTLEMENT OPTIONS
GENERAL: On the Annuity Date, the Adjusted Contract Value will be applied under
the Annuity or Settlement Option you have selected. If the payment under any
option selected would be less than $20 per month, we reserve the right to pay
out the Adjusted Contract Value in a lump sum. We guarantee that the dollar
amount of each payment, once determined, will not be affected by variations in
mortality or expense experience.
SELECTION OF AN ANNUITY OR SETTLEMENT OPTION: You may select an Annuity or
Settlement Option by notifying us of the selected option in Good Order. If no
Annuity or Settlement Option is selected or if the chosen Option is not received
in Good Order, Option 2, Life Income Annuity Option, will automatically be
applied, unless prohibited by applicable law. You may send us a request in Good
Order at least 30 days in advance of the Annuity Date, to select or change the
Annuity or Settlement Option.
ANNUITY AND SETTLEMENT OPTIONS: This Contract provides for payments under one of
the Annuity or Settlement Options described below. Any other Annuity or
Settlement Option acceptable to us may be selected.
OPTION 1 - FIXED PERIOD ANNUITY OPTION. We will make equal payments for a period
you choose up to 25 years based on the Adjusted Contract Value on the Annuity
Date. At your choice, we will make such payments annually, semi-annually,
quarterly or monthly. Table 1 shows the minimum amounts we will pay.
OPTION 2 - LIFE INCOME ANNUITY OPTION. We will make payments for as long as the
Annuitant lives, with payments certain for 120 months. At your choice, we will
make such payments annually, semi-annually, quarterly or monthly. Table 2 shows
the minimum amounts we will pay.
OPTION 3 - INTEREST PAYMENT SETTLEMENT OPTION. We will credit interest on the
Adjusted Contract Value at the rate of at least 1.50% until you request payment
of all or part of the Adjusted Contract Value. At your choice, we will pay
interest on the Adjusted Contract Value not yet withdrawn annually,
semi-annually, quarterly or monthly. You may request full or partial payment of
the Adjusted Contract Value provided, however, that if a partial payment is
requested, the amount of any Adjusted Contract Value remaining after such
requested amount is paid must be at least $2,000. This option is not available
for qualified contracts.
OTHER ANNUITY OR SETTLEMENT OPTIONS: We may offer or consent to other settlement
options, including life income annuity options with payments certain for periods
other than 120 months. Contact the representative who sold you the Contract or
call the toll-free number listed on your quarterly statement for information.
ANNUITY: Unless you designate another Payee, you will be the Payee of the
Annuity Payments. The Adjusted Contract Value will be applied to the applicable
Annuity Table contained in this Contract based upon the annuity option you have
selected. The amount of the first payment for each $1,000 of Adjusted Contract
Value is shown in the Annuity Tables. If when Annuity Payments begin we are
using tables of annuity rates for these Contracts that result in larger Annuity
Payments, we will use those tables instead. Annuity Payments will depend on the
age and sex of the Annuitant, where permitted.
WITHDRAWAL CHARGES: If you begin Annuity Payments or take a Settlement option at
a time other than the 30-day period prior to the end of a GIR Period, then we
will adjust your Contract Value by an MVA, and for any applicable Withdrawal
Charges, and Premium Taxes. Any amount used to provide income under Option 1 for
a period of 10 years or more, or under Option 2, will be applied without a
Withdrawal Charge. If you choose any other method of payment not described in
this Contract, prior to implementing your request, we will notify you if it is
subject to a Withdrawal Charge or Market Value Adjustment.
16
ANNUITY SETTLEMENT TABLES
Tables 1 and 2 below are applied to the Adjusted Contract Value to compute the
minimum amount of the annuity payment. Table 1 is used to compute the minimum
annuity payment under Option 1 (Fixed Period Annuity Option). Table 2 is used to
compute the minimum annuity payment under Option 2 (Life Income Annuity Option).
The rates in Tables 1 and 2 are applied per $1000 of Adjusted Contract Value as
applicable.
The annuity payments in Table 2 are based on the Annuitant's Adjusted Age and
sex. The Adjusted Age is the Annuitant's age last birthday prior to the date on
which the first Annuity payment is due, adjusted as shown in the "Translation of
Adjusted Age" Table.
When we computed the amounts shown in Table 2 we adjusted the Annuity 2000
Mortality Table to an age last birthday basis, less two years, with projected
mortality improvements (modified Scale G).
We will calculate annuity payments for other certain periods using the same
interest and mortality assumptions as in Table 2.
TABLE 1
---------------------------------------
Multiply the monthly amount by 2.993
for quarterly, 5.963 for semi-annual or
11.839 for annual payments.
---------------------------------------
Number of Years Monthly Payment
---------------------------------------
1 $84.47
---------------------------------------
2 42.86
---------------------------------------
3 28.99
---------------------------------------
4 22.06
---------------------------------------
5 17.91
---------------------------------------
6 15.14
---------------------------------------
7 13.16
---------------------------------------
8 11.68
---------------------------------------
9 10.53
---------------------------------------
10 9.61
---------------------------------------
11 8.86
---------------------------------------
12 8.24
---------------------------------------
13 7.71
---------------------------------------
14 7.26
---------------------------------------
15 6.87
---------------------------------------
16 6.53
---------------------------------------
17 6.23
---------------------------------------
18 5.96
---------------------------------------
19 5.73
---------------------------------------
20 5.51
---------------------------------------
21 5.32
---------------------------------------
22 5.15
---------------------------------------
23 4.99
---------------------------------------
24 4.84
---------------------------------------
25 4.71
---------------------------------------
17
----------------------------------------
TABLE 2
----------------------------------------
Multiply the monthly amount by 2.993 for
quarterly, 5.963 for semi-annual or
11.839 for annual payments.
----------------------------------------
Adjusted
Age Male Female
----------------------------------------
41 $3.40 $3.25
----------------------------------------
42 3.44 3.29
----------------------------------------
43 3.48 3.32
----------------------------------------
44 3.53 3.35
----------------------------------------
45 3.57 3.39
----------------------------------------
46 3.62 3.43
----------------------------------------
47 3.67 3.47
----------------------------------------
48 3.72 3.51
----------------------------------------
49 3.77 3.56
----------------------------------------
50 3.83 3.61
----------------------------------------
51 3.88 3.66
----------------------------------------
52 3.95 3.71
----------------------------------------
53 4.01 3.76
----------------------------------------
54 4.08 3.82
----------------------------------------
55 4.15 3.88
----------------------------------------
56 4.22 3.94
----------------------------------------
57 4.30 4.01
----------------------------------------
58 4.38 4.08
----------------------------------------
59 4.47 4.16
----------------------------------------
60 4.56 4.24
----------------------------------------
61 4.66 4.32
----------------------------------------
62 4.76 4.41
----------------------------------------
63 4.87 4.50
----------------------------------------
64 4.98 4.60
----------------------------------------
65 5.10 4.71
----------------------------------------
66 5.23 4.82
----------------------------------------
67 5.36 4.94
----------------------------------------
68 5.49 5.06
----------------------------------------
69 5.64 5.19
----------------------------------------
71 5.94 5.48
----------------------------------------
72 6.10 5.63
----------------------------------------
73 6.26 5.79
----------------------------------------
74 6.43 5.96
----------------------------------------
75 6.60 6.14
----------------------------------------
76 6.78 6.33
----------------------------------------
77 6.95 6.52
----------------------------------------
78 7.13 6.71
----------------------------------------
79 7.31 6.92
----------------------------------------
80 7.49 7.12
----------------------------------------
---------------------------------------------------
TRANSLATION OF ADJUSTED AGE
---------------------------------------------------
Calendar Year in Which Adjusted Age
First Payment is Due
---------------------------------------------------
Prior to 2010 Actual Age
---------------------------------------------------
2010 Through 2019 Actual Age minus 1
---------------------------------------------------
2020 Through 2029 Actual Age minus 2
---------------------------------------------------
2030 Through 2039 Actual Age minus 3
---------------------------------------------------
2040 Through 2049 Actual Age minus 4
---------------------------------------------------
2050 Through 2059 Actual Age minus 5
---------------------------------------------------
2060 Through 2069 Actual Age minus 6
---------------------------------------------------
2070 Through 2079 Actual Age minus 7
---------------------------------------------------
2080 Through 2089 Actual Age minus 8
---------------------------------------------------
2090 Through 2099 Actual Age minus 9
---------------------------------------------------
18
INDIVIDUAL MULTIPLE PURCHASE PAYMENT MODIFIED GUARANTEED
DEFERRED ANNUITY CONTRACT
NON-PARTICIPATING
19
