PAGE 1
Flexible Payment Deferred Annuity Contract
American Centurion Life
A Stock Company
P.O. Box 5555
Albany, New York 12205-0555
This is a deferred annuity contract. It is a legal contract
between you, as the owner, and us, American Centurion Life
Assurance Company, a Stock Company, Indianapolis, Indiana. PLEASE
READ YOUR CONTRACT CAREFULLY.
If the annuitant is living on the Retirement Date, we will begin to
pay you monthly annuity payments. Any payments made by us are
subject to the terms of this contract. The owner and beneficiary
are as named in the application unless they are changed as provided
for in this contract.
We issue this contract in consideration of your application and the
payment of the purchase payments.
Signed for and issued by American Centurion Life Assurance Company
in Albany, New York, as of the contract date shown below.
ACCUMULATION VALUES, WHEN BASED ON THE INVESTMENT RESULTS OF THE
SEPARATE ACCOUNTS, ARE VARIABLE AND NOT GUARANTEED AS TO FIXED
DOLLAR AMOUNT. SEE PAGE 9 FOR VARIABLE PROVISIONS.
NOTICE OF YOUR RIGHT TO EXAMINE THIS CONTRACT FOR 10 DAYS. If for
any reason you are not satisfied with this contract, return it to
us or our agent within 10 days after you receive it. We will then
cancel this contract and refund all purchase payments which you
have made. This contract will then be considered void from its
start.
President
Secretary
o Flexible Purchase Payments
o Optional Fixed Dollar or Variable Accumulation Values and Annuity
Payments
o Annuity Payments to Begin on the Retirement Date
o This Contract is Nonparticipating - Dividends Are Not Payable
45054 A(11/95)
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CONTRACT DATA
Upon issuance of this contract your initial purchase payment has
been applied to the fixed and variable accounts as shown below.
You may make additional payments and change the purchase payment
allocation as provided in this contract. Refer to the purchase
payments provision on Page 6.
Purchase Payment
Variable Subaccounts/Funds Allocation Percentage
IDSL Capital Resource 10%
IDSL Special Income 10%
IDSL Moneyshare 10%
IDSL Managed 0%
IDSL International Equity 10%
IDSL Aggressive Growth 10%
OCC Managed 10%
OCC U.S. Gov't. Income 0%
G.T. Global New Pacific 0%
G.T. Global Latin America 0%
PCM New Opportunities 10%
PCM Growth & Income 0%
PCM High Yield 0%
PCM Diversified Income 10%
ACL Fixed Account 20%
Withdrawal Charge: If you withdraw all or a portion of this
contract, a withdrawal charge may apply. A withdrawal charge
applies if all or part of the contract value withdrawn is from
purchase payments received during the contract year of withdrawal
and during the six immediately preceding contract years.
Contract Years
From Payment Receipt Withdrawal Charge
1 7% of purchase payment withdrawn
2 6% of purchase payment withdrawn
3 5% of purchase payment withdrawn
4 4% of purchase payment withdrawn
5 3% of purchase payment withdrawn
6 2% of purchase payment withdrawn
7 1% of purchase payment withdrawn
Thereafter 0% of purchase payment withdrawn
After the first contract year, you may withdraw up to 10 percent of
your prior contract anniversary contract value each contract year
without incurring a withdrawal charge. Refer to the withdrawal
charge provision on Page 11 for additional withdrawal charge
information.
Contract Administrative Charge: See Page 8.
The Maximum Total Contract Purchase Payments (cumulative total all
contract years) is $1,000,000. We reserve the right to increase
this maximum on a uniform basis for all contract owners in a class.
The Guaranteed Minimum Effective Interest Rate to be credited to
the fixed account is 3%.
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CONTRACT DATA
Contract Number: 9930-SAMPLE
Initial Purchase Payment: $10,000.00
Annuitant: Xxxx Xxx
Contract Owner: Xxxx Xxx
Contract Date: January 1, 1996
Retirement Date: January 1, 2026
Contract Type: Non-qualified
45054
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Contents
Definitions Important words and meanings/Page 2
General Provisions Entire contract; Annuity tax
qualification; Contract modification;
Incontestability; Benefits based on
incorrect data; State laws; Reports
to owner; Evidence of survival;
Protection of proceeds; Payments by
us; Voting rights/Page 3
Ownership and Beneficiary Owner rights; Joint owners; Change of
ownership; Annuitant; Beneficiary;
Change of Beneficiary;
Assignment/Page 4
Payments to Beneficiary Describes options and amounts payable
upon death/Page 5
Purchase Payments Purchase payments amounts; Payment
limits; Allocations of purchase
payments/Page 6
Contract Value Describes the fixed and variable
account contract values; Interest to
be credited; Contract administrative
charge; Premium taxes; Transfers of
contract values/Page 7
Fixed and Variable Accounts Describes the fixed account;
Describes the variable subaccounts,
accumulation units and values; Net
investment factor; Mortality and
expense risk charge; Variable account
administrative charge; Distribution
charge; Annuity unit value/Page 9
Withdrawal Provisions Contract withdrawal for its
withdrawal value; Rules for
withdrawal; TSA distribution
restrictions/Page 11
Annuity Provisions When annuity payments begin;
Different ways to receive annuity
payments; Determination of payment
amounts/Page 13
Tables of Settlement Rates Tables showing the amount of the
first variable annuity payment and
the guaranteed fixed annuity payments
for the various payment plans/Page 15
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Definitions
The following words are used often in this contract. When we use
these words, this is what we mean:
Annuitant
The person or persons on whose life monthly annuity payments
depend.
You, Your
The owner of this contract. The owner may be someone other than
the annuitant. The owner is shown in the application unless the
owner has been changed as provided in this contract.
We, Us, Our
American Centurion Life Assurance Company
Accumulation Unit
An accumulation unit is an accounting unit of measure. It is
used to calculate the contract value prior to settlement.
Annuity Unit
An annuity unit is an accounting unit of measure. It is used to
calculate the value of annuity payments from the variable account
on and after the retirement date.
Contract Date
It is the date from which contract anniversaries, contract years,
and contract months are determined. Your contract date is shown
under Contract Data.
Contract Anniversary
The same day and month as the contract date each year that the
contract remains in force.
Contract Value
The sum of the: (1) Fixed Account Contract Value; and (2) Variable
Account Contract Value.
Retirement Date
The date shown under Contract Data on which annuity payments are to
begin. This date may be changed as provided in this contract. You
will be notified prior to the retirement date in order to select an
appropriate annuity payment plan.
Settlement
The application of the contract value of this contract to provide
annuity payments.
Valuation Date
A valuation date is each day the New York Stock Exchange is open
for trading.
Valuation Period
A valuation period is the interval of time commencing at the close
of business on each valuation date and ending at the close of
business on the next valuation date.
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Fixed Account
The fixed account is made up of all our assets other than those in
any separate account.
Variable Account
The variable account is a separate investment account of ours. It
consists of several subaccounts. Each subaccount is named under
Contract Data.
Fixed Annuity
A fixed annuity is an annuity with payments which are guaranteed by
us as to dollar amount during the annuity payment period.
Variable Annuity
A variable annuity is an annuity with payments which are not
predetermined or guaranteed as to dollar amount and vary in amount
with the investment experience of one or more of the variable
subaccounts.
Written Request
A request in writing signed by you and delivered to us at our
administrative office.
Code
The Internal Revenue Code of 1986, as amended, and all related laws
and regulations which are in effect during the term of this
contract.
PAGE 7
General Provisions
Entire Contract
This contract form, any endorsements and the copy of the
application attached to it are the entire contract between you and
us.
No one except one of our corporate officers (President, Vice
President, Secretary or Assistant Secretary) can change or waive
any of our rights or requirements under this contract. That
person must do so in writing. None of our representatives or
other persons has the authority to change or waive any of our
rights or requirements under this contract.
Annuity Tax Qualification
This contract is intended to qualify as an annuity contract under
Section 72 of the Code for federal income tax purposes. To that
end, the provisions of this contract are to be interpreted to
ensure or maintain such tax-qualification, notwithstanding any
other provisions to the contrary.
Contract Modification
We reserve the right to modify this contract to the extent
necessary to qualify this contract as an annuity contract under
Section 72 of the Code and all related laws and regulations which
are in effect during the term of this contract.
We will obtain the approval of any regulatory authority for the
modifications and will provide you with notice and copy of such
change.
Incontestable
This contract is incontestable from its date of issue.
Benefits Based on Incorrect Data
Payments under the contract will be based on the annuitant's
birthdate and sex. If the annuitant's birthdate or sex has been
misstated, payments under this contract will be adjusted. They
will be based on what would have been provided at the correct
birthdate and sex. Any underpayments made by us will be made up
immediately with an interest credit of 6% per year. Any
overpayments made by us will be subtracted from the future payments
together with an interest charge of 6% per year.
State Laws
This contract is governed by the law of the state in which it is
delivered. The values and benefits of this contract are at least
equal to those required by such state. Any paid up annuity, cash
withdrawal or death benefits available under the contract are not
less than the minimum benefits required by any statute of the state
in which the contract is delivered.
Reports to Owner
At least once a year we will send you a statement showing the
contract value and the cash withdrawal value of this contract.
This statement will be based on any laws or regulations that apply
to contracts of this type.
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Evidence of Survival
Where any payments under this contract depend on the recipient or
annuitant being alive on a certain date, proof that such condition
has been met may be required by us. Such proof may be required
prior to making the payments.
Protection of Proceeds
Payments under this contract are not assignable by any
beneficiary prior to the time they are due. To the extent allowed
by law, payments are not subject to the claims of creditors or to
legal process.
Payments by Us
All sums payable by us are payable at our home office. Any
payment of a variable annuity or withdrawal based on the
variable contract value shall be payable only from the variable
account.
Voting Rights
So long as federal law requires, we will give certain voting
rights to contractowners. As contractowner, if you have voting
rights we will send a notice to you telling you the time and place
of a shareholder meeting. The notice will also explain matters
to be voted upon and how many votes you get.
PAGE 9
Ownership and Beneficiary
Owner Rights
As long as the annuitant is living and unless otherwise provided in
this contract, you may exercise all rights and privileges provided
in this contract or allowed by us.
Joint Owners
All joint owners must sign all ownership requests. Joint owners
must designate one address to which all communications are to be
sent. The death benefit described on Page 5 will be paid to the
beneficiary at the death of the first joint owner to die.
For joint spousal ownerships, the surviving spouse is deemed the
sole beneficiary superseding any other beneficiary designation.
This permits the surviving spouse the use of the spousal
continuation at death described on Page 5. The deemed surviving
spouse sole beneficiary may be overridden if specifically requested
in writing signed by both joint spousal owners.
Change of Ownership
You may change the ownership.
Any change of ownership must be made by written request on a form
approved by us. The change must be made while the annuitant is
living. Once the change is recorded by us, it will take effect as
of the date of your request, subject to any action taken or payment
made by us before the recording.
Annuitant
The annuitant is the person you named in the application. The only
permitted change of annuitant is to an eligible surviving spouse
electing spousal continuation as described on Page 5.
Beneficiary
Beneficiaries are those you have named in the application or later
changed as provided below, to receive benefits of this contract if
you or the annuitant die while this contract is in force.
Only those beneficiaries who are living when death benefits become
payable may share in the benefits, if any. If no beneficiary is
then living, we will pay the benefits to you, if living, otherwise
to your estate.
For joint spousal ownerships, the surviving spouse is deemed the
sole beneficiary superseding any other beneficiary designation.
This permits the surviving spouse the use of the spousal
continuation at death described on Page 5. The deemed surviving
spouse sole beneficiary may be overridden if specifically requested
in writing signed by both joint spousal owners.
Change of Beneficiary
You may change the beneficiary anytime while the annuitant is
living by satisfactory written request to us. Once the change is
recorded by us, it will take effect as of the date of your request,
subject to any action taken or payment made by us before the
recording.
PAGE 10
Assignment
You can assign this contract or any interest in it while the
annuitant is living. Your interest and the interest of any
beneficiary is subject to the interest of the assignee. An
assignment is not a change of ownership and an assignee is not an
owner as these terms are used in this contract. Any amounts
payable to the assignee will be paid in a single sum.
A copy of any assignment must be submitted to us at our home
office. Any assignment is subject to any action taken or payment
made by us before the assignment was recorded at our home office.
We are not responsible for the validity of any assignment.
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Payments to Beneficiary
Death Benefits Before the Retirement Date
If you or the annuitant die before the retirement date while this
contract is in force, and both you and the annuitant were age 75
or younger on the contract date, and if all withdrawals you have
made from this contract have been without withdrawal charge, we
will pay the beneficiary the greater of:
1. the contract value; or
2. the total purchase payments paid less any amounts withdrawn; or
3. on or after the fifth contract anniversary, the death benefit as
of the most recent fifth contract anniversary adjusted by adding
any purchase payments made since that most recent fifth contract
anniversary and by subtracting any amounts withdrawn since that
most recent fifth contract anniversary.
If you or the annuitant die before the retirement date while this
contract is in force, and both you and the annuitant were age 75 or
younger on the contract date, and you have made withdrawals subject
to withdrawal charge, we will pay the beneficiary the contract
value.
If you or the annuitant die before the retirement date while this
contract is in force, and either you or the annuitant were age 76
or older on the contract date, we will pay the beneficiary the
contract value.
If the annuity is jointly owned, the death benefit described above
will be paid to the beneficiary at the death of the first joint
owner to die. For joint spousal ownerships, the surviving spouse
is deemed the sole beneficiary superseding any other beneficiary
designation. This permits the surviving spouse the use of the
spousal continuation at death described on Page 5. The deemed
surviving spouse sole beneficiary may be overridden if specifically
requested in writing signed by both joint spousal owners.
Federal law requires distribution at the annuitant's death if the
owner is a corporation or other non-individual.
Payment of Death Benefit Before the Retirement Date
The above death benefit will be payable in a lump sum upon the
receipt of due proof of death of you or the annuitant, whichever
first occurs. The beneficiary may elect to receive payment anytime
within five years after the date of death.
In lieu of a lump sum, payment may be made under an Annuity Payment
Plan, provided:
1. the beneficiary elects the plan within 60 days after we receive
due proof of death; and
2. the plan provides payments over a period which does not exceed
the life or life expectancy of the beneficiary; and
PAGE 12
3. payments must begin no later than one year after the date of
death.
In this event, the reference to "annuitant" in the Annuity
Provisions shall apply to the beneficiary.
Any amounts payable or applied by us as described in this section
will be based on the contract value as of the valuation date on or
next following the date on which due proof of death is received at
our home office.
Spouse's Option to Continue Contract
If you die prior to the retirement date and your spouse is the sole
beneficiary or co-owner of the contract, your spouse may keep the
contract in force as owner and may make additional purchase
payments to the contract.
Death After the Retirement Date
If you (the owner) die while payments are being made under an
Annuity Payment Plan, those payments will continue according to the
plan you chose.
If the annuitant dies while payments are being made under an
Annuity Payment Plan, those payments will end unless the plan you
chose calls for payments to continue after the annuitant's death.
If you chose Annuity Payment Plan B, C or E (see Annuity Payment
Plans on Page 13), any remaining guaranteed payments will be
continued to your beneficiary, if living; if not, to you, if
living; if not, to your estate.
PAGE 13
Purchase Payments
Purchase Payments
Purchase payments are the payments you make for this contract and
the benefits it provides. Purchase payments must be paid or mailed
to us at our home office or to an authorized agent. If requested,
we'll give you a receipt for your purchase payments. Upon payment
to us, purchase payments become our property.
Net purchase payments are that part of your purchase payments
applied to the contract value. A net purchase payment is equal to
the purchase payment less any applicable premium tax charge.
Additional Purchase Payments
Additional purchase payments may be made until the earlier of:
1. the date this contract terminates by withdrawal or otherwise; or
2. the date on which annuity payments begin.
Additional purchase payments are subject to the "Payment Limits
Provision" below.
Payment Limits Provision
Maximum Purchase Payments - The maximum total contract purchase
payments may not exceed the amounts shown under Contract Data. We
reserve the right to increase the maximums.
Additional Purchase Payments - You may make additional purchase
payments of at least $500.
All purchase payments must be made in cash. If you die before the
entire interest in this contract has been distributed to you, and
your beneficiary is other than your surviving spouse, no additional
purchase payments will be accepted from your beneficiary under this
contract.
Allocation of Purchase Payments
You instruct us on how you want your purchase payments allocated
among the fixed account and variable subaccounts. Your choice for
the fixed account and each variable subaccount may be made in any
whole percent from 0% to 100%. No allocation may be made that
would result in a fixed account or variable subaccount value of
less than $500. Your allocation instructions as of the contract
date are shown under Contract Data.
By written request, or by another method agreed to by us, you may
change your choice of accounts or percentages. Net purchase
payments will be allocated as of the end of the valuation period
during which we receive the payment at our home office.
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Contract Value
Contract Value
The contract value at any time is the sum of:
1. the Fixed Account Contract Value; and
2. the Variable Account Contract Value.
If: 1. part or all of the contract value is withdrawn; or
2. charges described herein are made against the contract
value;
then a number of accumulation units from the variable subaccounts
and an amount from the fixed account will be deducted to equal such
amount. For withdrawals, deductions will be made from the fixed or
variable subaccounts that you specify. Otherwise, the number of
units from the variable subaccounts and the amount from the fixed
account will be deducted in the same proportion that your interest
in each bears to the total contract value.
Variable Account Contract Value
The variable account contract value at any time will be:
1. the sum of the value of all variable subaccount accumulation
units under this contract resulting from purchase payments so
allocated, or transfers among the variable and fixed accounts;
less
2. the value of any units deducted for charges or withdrawals.
Fixed Account Contract Value
The fixed account contract value at any time will be:
1. the sum of all purchase payments allocated to the fixed account,
plus interest credited; plus
2. any amounts transferred to the fixed account from any variable
subaccount, plus interest credited; less
3. any amounts transferred from the fixed account to any variable
subaccount; less
4. any amounts deducted for charges or withdrawals.
Interest to be Credited
We will credit interest to the fixed account contract value.
Interest will begin to accrue on the date the purchase payments are
received in our home office. Such interest will be credited at
rates that we determine from time to time. However, we guarantee
that the rate will not be less than a 3% effective annual interest
rate.
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Table of Fixed Account Guaranteed
Minimum Values
Per $2,000 Annual Payments
Allocated 100% to the Fixed Account
Based on the 3% Minimum Interest Guarantee
Guaranteed Guaranteed
End of minimum minimum
contract fixed account fixed account
year contract values withdrawal values
1 $ 2,030.00 $ 1,901.90
2 4,120.90 3,866.65
3 6,274.53 5,924.16
4 8,492.76 8,062.19
5 10,777.55 10,282.57
6 13,130.87 12,590.87
7 15,554.80 14,994.85
8 18,051.44 17,491.44
9 20,622.99 20,062.99
10 23,271.68 22,711.68
11 25,999.83 25,439.83
12 28,809.82 28,249.82
13 31,704.11 31,144.11
14 34,685.24 34,125.24
15 37,755.80 37,195.80
16 40,918.47 40,358.47
17 44,176.02 43,616.02
18 47,531.30 46,971.30
19 50,987.24 50,427.24
20 54,546.86 53,986.86
If there are any additional payments, transfers to or from the
variable subaccounts, withdrawals or premium tax adjustments, the
above values will be adjusted as described in this contract.
Variable subaccount contract and withdrawal values are not
guaranteed and cannot be projected.
Contract Administrative Charge
We charge a fee for establishing and maintaining our records for
this contract. The charge is $30 per year and is deducted from the
contract value at the end of each contract year. The charge
deducted will be prorated among the variable subaccounts and the
fixed account in the same proportion your interest in each bears to
the total contract value.
We waive the annual contract administrative charge for any contract
year where the contract value immediately prior to the deduction of
the contract administrative charge is $50,000 or more.
If you make a full withdrawal of this contract, we deduct the full
$30 contract administrative charge at the time of full withdrawal.
The charge does not apply after settlement of this contract.
PAGE 16
Premium Tax Charges
A charge will be made by us against the contract value of this
contract for any premium taxes not previously deducted.
Transfers of Contract Values
While this contract is in force prior to the settlement date,
transfers of contract values may be made as outlined below:
1. You may transfer all or a part of the values held in one or more
of the variable subaccounts to another one or more of the
variable subaccounts. Subject to item 2, you may also transfer
values held in one or more of the variable subaccounts to the
fixed account.
2. On or within the 30 days before or after a contract anniversary
you may transfer values from the fixed account to one or more
of the variable subaccounts. If such a transfer is made, no
transfers from any variable subaccount to the fixed account may
be made for six months.
You may make a transfer by written request. There is no fee or
charge for these transfers. However, the minimum transfer amount
is $500, or if less, the entire value in the subaccount or in the
fixed account from which the transfer is being made, or other such
minimum amounts agreed to by us.
We reserve the right to modify your right to transfer all or part
of the values held in one or more of the variable subaccounts or
the fixed account to another one or more of the variable
subaccounts or the fixed account if we determine, in our sole
discretion, that the exercise of that right by one or more Contract
Owners is, or would be, to the disadvantage of other Contract
Owners. Modifications could include, but are not limited to, the
requirement of a minimum time period between each transfer, not
accepting transfer requests of an agent acting under power of
attorney on behalf of more than one Contract Owner or limiting the
dollar amount that may be transferred between one or more of the
variable subaccounts and the fixed account at any one time. Such
restrictions may be applied in any manner reasonably designed to
prevent any use of the transfer right which we consider to be to
the disadvantage of other Contract Owners.
PAGE 17
Fixed and Variable Accounts
The Fixed Account
The fixed account is our general account. It is made up of all our
assets other than
1. those in the variable accounts; and
2. those in any other segregated asset account.
The Variable Account
The variable account is a separate investment account of ours. It
consists of several subaccounts which are named under Contract
Data. We have allocated a part of our assets for this and certain
other contracts to the variable account. Such assets remain our
property. However, they may not be charged with the liabilities
from any other business in which we may take part.
Investments of the Variable Account
Purchase payments applied to the variable account will be allocated
as specified by the owner. Each variable subaccount will buy, at
net asset value, shares of the fund shown for that subaccount under
Contract Data or as later added or changed.
We may change the funds the variable subaccounts buy shares from if
laws or regulations change, the existing funds become unavailable
or, in the judgment of American Centurion Life, the funds are no
longer suitable for the subaccounts. If any of these situations
occur, we would have the right to substitute funds other than those
shown under Contract Data. We may also add additional subaccounts
investing in other funds.
We would first seek approval of the Securities and Exchange
Commission and, where required, the insurance regulator of the
state where this contract is delivered.
Valuation of Assets
Fund shares in the variable subaccounts will be valued at their net
asset value.
Variable Account Accumulation Units
The number of accumulation units for each of the variable
subaccounts is found by adding the number of accumulation units
resulting from:
1. purchase payments allocated to the subaccount; and
2. transfers to the subaccount;
and subtracting the number of accumulation units resulting from:
1. transfers from the subaccount; and
2. withdrawals (including withdrawal charges) from the subaccount;
and
3. contract administrative charge deductions from the subaccount.
The number of accumulation units added or subtracted for each of
the above transactions is found by dividing
PAGE 18
1. the amount allocated to or deducted from the subaccount; by
2. the accumulation unit value for the subaccount for the
respective valuation period during which we received the
purchase payment or transfer value, or during which we deducted
transfers, withdrawals, withdrawal charges or contract
administrative charges.
Variable Account Accumulation Unit Value
The value of an accumulation unit for each of the variable
subaccounts was set at $1 when the first fund shares were bought.
The value for any later valuation period is found as follows:
The accumulation unit value for each variable subaccount for the
last prior valuation period is multiplied by the net investment
factor for the same subaccount for the next following valuation
period. The result is the accumulation unit value. The value of
an accumulation unit may increase or decrease from one valuation
period to the next.
Net Investment Factor
The net investment factor is an index applied to measure the
investment performance of a variable subaccount from one valuation
period to the next. The net investment factor may be greater or
less than one; therefore, the value of an accumulation unit may
increase or decrease.
The net investment factor for any such subaccount for any valuation
period is determined by: dividing (1) by (2) and subtracting (3)
and (4) from the result. This is done where:
1. is the sum of:
a. the net asset value per share of the fund held in the
variable subaccount determined at the end of the current
valuation period; plus
b. the per share amount of any dividend or capital gain
distribution made by the fund held in the variable
subaccount, if the "ex-dividend" date occurs during the
current valuation period.
2. is the net asset value per share of the fund held in the
variable subaccount, determined at the end of the last prior
valuation period.
3. is a factor representing the mortality and expense risk charge.
4. is a factor representing the variable account administrative
charge.
Mortality and Expense Risk Charge
In calculating accumulation unit values, we will deduct a mortality
and expense risk charge from the variable subaccounts equal, on an
annual basis, to 1.25% of the daily net asset value. This
deduction is made to compensate us for assuming the mortality and
expense risks under contracts of this type. The deduction will be:
1. made from each variable subaccount; and
2. computed on a daily basis.
PAGE 19
Variable Account Administrative Charge
In calculating accumulation unit values we will deduct a variable
account administrative charge from the variable subaccounts equal,
on an annual basis, to 0.10% of the daily net asset value. This
deduction is made to compensate us for certain administrative and
operating expenses for contracts of this type. The deduction will
be:
1. made from each variable subaccount; and
2. computed on a daily basis
Annuity Unit Value
The value of an annuity unit for each variable account was
arbitrarily set at $1 when the first fund shares were bought. The
value for any later valuation period is found as follows:
1. The annuity unit value for each variable account for the last
prior valuation period is multiplied by the net investment
factor for the account for the valuation period for which the
annuity unit value is being calculated.
2. The result is multiplied by an interest factor. This is done to
neutralize the assumed investment rate which is built into the
annuity tables on Page 15.
PAGE 20
Withdrawal Provisions
Withdrawal
By written request and subject to the rules below you may:
1. withdraw this contract for the total withdrawal value; or
2. partially withdraw this contract for a part of the withdrawal
value.
Rules for Withdrawal
All withdrawals will have the following conditions:
1. You must apply by written request or other method agreed to by
us:
(a) while this contract is in force; and
(b) prior to the earlier of the retirement date or the death of
the annuitant.
2. You must withdraw an amount equal to at least $500. Each
variable subaccount value and the fixed account value after a
partial withdrawal must be either $0 or at least $500.
3. The amount withdrawn, less any charges, will normally be mailed
to you within seven days of the receipt of your written request
and this contract, if required.
For withdrawals from the fixed account, we have the right to
defer payment to you for up to six months from the date we
receive your request.
4. For partial withdrawals, if you do not specify from which
account the withdrawal is to be made, the withdrawal will be
made from the variable subaccounts and the fixed account in the
same proportion as your interest in each bears to the contract
value.
5. Any amounts withdrawn and charges which may apply cannot be
repaid.
Upon withdrawal for the full withdrawal value this contract will
terminate. We may require that you return the contract to us
before we pay the full withdrawal value.
Withdrawal Value
The withdrawal value at any time will be:
1. the contract value;
2. minus the contract administrative charge, prorated based on the
number of days from your last contract anniversary to the date
of full withdrawal;
3. minus any withdrawal charge.
PAGE 21
Withdrawal Charge
If you withdraw all or part of your contract, you may be subject to
a withdrawal charge. A withdrawal charge applies if all or part of
the contract value you withdraw is from new payments. Refer to
"Waiver of Withdrawal Charges" for situations when withdrawal
charges are not deducted.
For the contract year of your withdrawal:
o Old Payments are purchase payments we received in any contract
year six or more years prior to the contract year of withdrawal.
o New Payments are purchase payments we received during the
contract year of withdrawal and during the six immediately
preceding contract years.
We determine your withdrawal charge by multiplying each of your new
payments by the applicable withdrawal charge percentage, and then
summing the total withdrawal charges.
The new payment withdrawal charge percentage depends on the number
of contract years since you made the payment(s):
Contract Years From
Payment Receipt Withdrawal Charge Percentage
1 7%
2 6%
3 5%
4 4%
5 3%
6 2%
7 1%
Thereafter 0%
Waiver of Withdrawal Charges
Withdrawal charges are waived in these situations:
1. After the first contract year, withdrawals during the year
totaling up to 10% of your prior contract anniversary contract
value; and
2. Contract earnings - if any - in excess of the annual 10% free
withdrawal amount; and
3. Settlement payments using an annuity payment plan; and
4. Payments made in the event of the death of the owner or
annuitant.
Withdrawal Order
We use this order to determine withdrawal charges:
1. First, withdrawals up to 10% of your prior anniversary account
value not previously withdrawn during this contract year. (No
withdrawal charge.)
PAGE 22
2. Next, withdrawals are from contract earnings - if any - in
excess of the annual 10% free withdrawal amount. (No withdrawal
charge.)
3. Next, withdrawals are from old payments not previously
withdrawn. (No withdrawal charge.)
4. Last, withdrawals are from new payments. There is a withdrawal
charge for withdrawals from new payments.
Withdrawal Charge Calculation Example
We determine your withdrawal charge by multiplying each of your new
payments by the applicable withdrawal charge percentages, and then
summing the total withdrawal charges.
For example, the withdrawal charge on a total withdrawal request
for a contract with this history:
o The contract date is July 1, 1995 with a contract year of July 1
through June 30 and with an anniversary date of July 1 each year
o We received these payments - $10,000 July 1, 1995, $8,000
December 31, 2001 and $6,000 February 20, 2003
o The owner withdraws the contract for its total withdrawal value
of $38,101 on August 5, 2005 and had not made any other
withdrawals during that contract year
o The prior anniversary July 1, 2005 contract value was $38,488
is calculated this way:
Withdrawal
Charge Explanation
$ 0 $3,848.80 is 10% of the prior anniversary
account value withdrawn without withdrawal
charge; and
$ 0 $10,252.20 is contract earnings in excess of
the 10% free withdrawal amount withdrawn
without withdrawal charge.
$ 0 $10,000 7-1-95 payment is an old payment
withdrawn without withdrawal charge; and
$240 $8,000 00-00-00 payment is a new payment
in its fifth contract year from receipt,
withdrawn with a 3% withdrawal charge; and
$240 $6,000 2-20-03 payment is a new payment in
its fourth contract year from receipt
____ withdrawn with a 4% withdrawal charge.
$480
Suspension or Delay in Payment of Withdrawal
We have the right to suspend or delay the date of any withdrawal
payment from the variable subaccounts for any period:
PAGE 23
1. When the New York Stock Exchange is closed; or
2. When trading on the New York Stock Exchange is restricted; or
3. When an emergency exists as a result of which:
(a) disposal of securities held in the variable subaccounts is
not reasonably practical; or
(b) it is not reasonably practical to fairly determine the value
of the net assets of the variable subaccounts; or
4. During any other period when the Securities and Exchange
Commission, by order, so permits for the protection of security
holders.
Rules and regulations of the Securities and Exchange Commission
will govern as to whether the conditions set forth in 2 and 3
exist.
PAGE 24
Annuity Provisions
Settlement
When settlement occurs, the contract value will be applied to make
annuity payments. The first payment will be made as of the
retirement date. This date is shown under Contract Data. Before
payments begin we will require satisfactory proof that the
annuitant is alive. We may also require that you exchange this
contract for a supplemental contract which provides the annuity
payments.
Change of Retirement Date
You may change the retirement date shown for this contract. Tell
us the new date by written request. If you select a new date, it
must be at least 30 days after we receive your written request at
our home office.
The maximum retirement date is the annuitant's 85th birthday.
Annuity Payment Plans
Annuity payments may be made on a fixed dollar basis, a variable
basis or a combination of both. You can schedule receipt of
annuity payments according to one of the Plans A through E below or
another plan agreed to by us.
Plan A - This provides monthly annuity payments during the lifetime
of the annuitant. No payments will be made after the annuitant
dies.
Plan B - This provides monthly annuity payments during the lifetime
of the annuitant with a guarantee by us that payments will be made
for a period of at least five, 10 or 15 years. You must select the
guaranteed period.
Plan C - This provides monthly annuity payments during the lifetime
of the annuitant with a guarantee by us that payments will be made
for a certain number of months. We determine the number of months
by dividing the amount applied under this plan by the amount of the
first monthly annuity payment.
Plan D - Monthly payments will be paid during the lifetime of the
annuitant and joint annuitant. When either the annuitant or the
joint annuitant dies we will continue to make monthly payments
during the lifetime of the survivor. No payments will be made
after the death of both the annuitant and joint annuitant.
Plan E - This provides monthly fixed dollar annuity payments for a
period of years. The period of years may be no less than 10 nor
more than 30.
You may select the plan by written request to us at least 30 days
before the retirement date. If at least 30 days before the
retirement date we have not received at our home office your
written request to select a plan, we will make fixed dollar
payments according to Plan B with payments guaranteed for 10 years.
PAGE 25
If the amount to be applied to a plan would not provide an monthly
payment of at least $20, we have the right to change the frequency
of the payment or to make a lump sum payment of the contract value.
Fixed Annuity
A fixed annuity is an annuity with payments that are guaranteed by
us as to dollar amount. Fixed annuity payments remain the same.
At settlement the fixed account contract value will be applied the
applicable Annuity Table. This will be done in accordance with the
payment plan chosen. The minimum amount payable for each $1,000 so
applied is shown in Table B on Page 16.
In addition, the amount of such fixed annuity payments will not be
less than that which would be provided if a single payment
immediate annuity then offered by us to annuitants in the same
class were to be purchased with the contract's fixed account
contract value.
Variable Annuity
A variable annuity is an annuity with payments which:
1. are not predetermined or guaranteed as to dollar amount; and
2. vary in amount with the investment experience of the variable
accounts.
Determination of the First Variable Annuity Payment
At settlement, the variable account contract value will be applied
to the applicable Annuity Table. This will be done:
1. on the valuation date on or next preceding the seventh calendar
day before the retirement date; and
2. in accordance with the payment plan chosen. The amount payable
for the first payment for each $1,000 so applied is shown in
Table A on Page 15.
Variable Annuity Payments After the First Payment
Variable annuity payments after the first payment vary in amount.
The amount changes with the investment performance of the variable
accounts. The dollar amount of variable annuity payments after the
first is not fixed. It may change from month to month. The dollar
amount of such payments is determined as follows:
1. The dollar amount of the first annuity payment is divided by the
value of an annuity unit as of the valuation date on or next
preceding the seventh calendar day before the retirement date.
This result establishes the number of annuity units for each
monthly annuity payment after the first payment. This number of
annuity units remains fixed during the annuity payment period.
2. The fixed number of annuity units is multiplied by the annuity
unit value as of the valuation date on or next preceding the
seventh calendar day before the date the payment is due. The
result establishes the dollar amount of the payment.
PAGE 26
We guarantee that the dollar amount of each payment after the first
will not be affected by variations in expenses or mortality
experience.
Exchange of Annuity Units
Annuity units of any variable account may be exchanged for units of
any of the other variable accounts. This may be done no more than
once a year. Once annuity payments start no exchanges may be made
to or from any fixed annuity.
PAGE 27
Tables of Settlement Rates
Table A below shows the amount of the first monthly variable
annuity payment, based on a 5% assumed investment return, for each
$1,000 of value applied under any payment plan. The amount of the
first and all subsequent monthly fixed dollar annuity payments for
each $1,000 of value applied under any payment plan will be based
on our fixed dollar Table of Settlement Rates in effect on the
settlement date. Such rates are guaranteed to be not less than
those shown in Table B. The amount of such annuity payments under
Plans A, B and C will depend upon the sex and adjusted age of the
annuitant on the date of settlement. The amount of such annuity
payments under Plan D will depend upon the sex and the adjusted age
of the annuitant and the joint annuitant on the date of settlement.
Adjusted age shall be equal to the age nearest birthday minus an
"adjustment" depending on the calendar year of birth of the
annuitant as follows:
Calendar Calendar
Year of Year of
Annuitant's Adjust- Annuitant's Adjust-
Birth ment Birth ment
Prior to 1920 0 1945 through 1949 6
1920 through 1924 1 1950 through 1959 7
1925 through 1929 2 1960 through 1969 8
1930 through 1934 3 1970 through 1979 9
1935 through 1939 4 1980 through 1989 10
1940 through 1944 5 After 1989 11
PAGE 28
Table A - Dollar Amount of First Monthly Variable Annuity Payment Per $1,000 Applied
Plan A Plan B Plan C Plan D - Joint and Survivor
Life 5 Years 10 Years 15 Years With Adj. Adjusted Age of Female Joint Annuitant
Adj. Income Certain Certain Certain Refund Male 10 Yrs 5 Yrs Same 5 Yrs 10 Yrs
Age* M F M F M F M F M F Age* Younger Younger Age Older Older
45 5.16 4.87 5.15 4.87 5.12 4.86 5.07 4.84 5.06 4.82 45 4.45 4.54 4.63 4.72 4.81
46 5.21 4.91 5.20 4.91 5.17 4.90 5.12 4.88 5.11 4.86 46 4.47 4.56 4.66 4.76 4.85
47 5.28 4.96 5.26 4.96 5.23 4.94 5.17 4.92 5.16 4.91 47 4.50 4.59 4.69 4.80 4.90
48 5.34 5.01 5.33 5.00 5.29 4.99 5.23 4.96 5.21 4.95 48 4.52 4.62 4.73 4.84 4.94
49 5.41 5.06 5.39 5.05 5.35 5.04 5.28 5.01 5.27 4.99 49 4.55 4.65 4.76 4.88 5.00
50 5.48 5.12 5.46 5.11 5.41 5.09 5.34 5.06 5.33 5.04 50 4.57 4.68 4.80 4.93 5.05
51 5.55 5.17 5.53 5.17 5.48 5.14 5.40 5.11 5.39 5.09 51 4.60 4.72 4.85 4.98 5.11
52 5.63 5.23 5.61 5.23 5.55 5.20 5.46 5.16 5.46 5.15 52 4.63 4.75 4.89 5.03 5.17
53 5.71 5.30 5.69 5.29 5.63 5.26 5.53 5.22 5.53 5.20 53 4.66 4.79 4.94 5.09 5.23
54 5.80 5.37 5.77 5.36 5.70 5.33 5.60 5.28 5.60 5.26 54 4.70 4.84 4.99 5.15 5.30
55 5.89 5.44 5.86 5.43 5.79 5.40 5.67 5.34 5.68 5.33 55 4.73 4.88 5.04 5.21 5.38
56 5.99 5.52 5.96 5.51 5.88 5.47 5.74 5.40 5.76 5.39 56 4.77 4.93 5.10 5.28 5.46
57 6.10 5.60 6.06 5.59 5.97 5.54 5.82 5.47 5.84 5.47 57 4.81 4.98 5.16 5.35 5.54
58 6.21 5.69 6.17 5.68 6.07 5.62 5.90 5.54 5.94 5.54 58 4.85 5.03 5.23 5.43 5.63
59 6.33 5.79 6.29 5.77 6.17 5.71 5.98 5.62 6.03 5.62 59 4.90 5.09 5.30 5.52 5.73
60 6.46 5.89 6.42 5.87 6.28 5.80 6.07 5.69 6.13 5.70 60 4.94 5.15 5.37 5.61 5.83
61 6.60 6.00 6.55 5.97 6.40 5.90 6.16 5.78 6.24 5.79 61 5.00 5.21 5.45 5.70 5.95
62 6.75 6.11 6.69 6.08 6.52 6.00 6.25 5.86 6.36 5.89 62 5.05 5.28 5.54 5.81 6.07
63 6.91 6.23 6.84 6.20 6.64 6.11 6.34 5.95 6.48 5.99 63 5.11 5.35 5.63 5.92 6.20
64 7.09 6.37 7.01 6.33 6.78 6.22 6.43 6.04 6.61 6.10 64 5.17 5.43 5.73 6.04 6.34
65 7.27 6.51 7.18 6.47 6.91 6.34 6.52 6.14 6.74 6.21 65 5.23 5.52 5.83 6.17 6.49
66 7.47 6.66 7.36 6.61 7.06 6.47 6.62 6.24 6.88 6.33 66 5.30 5.61 5.95 6.30 6.65
67 7.68 6.82 7.56 6.77 7.21 6.60 6.71 6.34 7.04 6.46 67 5.38 5.70 6.07 6.45 6.82
68 7.91 7.00 7.76 6.73 7.36 6.74 6.81 6.44 7.19 6.60 68 5.46 5.80 6.20 6.61 7.01
69 8.15 7.19 7.98 7.11 7.52 6.89 6.90 6.54 7.36 6.74 69 5.54 5.92 6.34 6.79 7.21
70 8.41 7.39 8.21 7.31 7.68 7.04 6.98 6.65 7.54 6.90 70 5.63 6.03 6.49 6.97 7.42
71 8.69 7.62 8.46 7.51 7.84 7.21 7.07 6.75 7.73 7.06 71 5.73 6.16 6.65 7.17 7.66
72 8.99 7.86 8.71 7.74 8.01 7.38 7.15 6.86 7.92 7.24 72 5.84 6.30 6.83 7.39 7.90
73 9.31 8.12 8.98 7.98 8.18 7.56 7.23 6.96 8.13 7.42 73 5.95 6.44 7.02 7.62 8.17
74 9.65 8.41 9.27 8.23 8.35 7.74 7.30 7.06 8.35 7.63 74 6.07 6.60 7.22 7.87 8.46
75 10.02 8.72 9.57 8.51 8.52 7.93 7.37 7.15 8.58 7.84 75 6.19 6.77 7.44 8.14 8.77
*Adjusted age of annuitant. M = Male F = Female
Table A above is based on the "1983 Individual Annuitant Mortality Table A." Settlement rates for any age, or any combination of
age and sex not shown above, will be calculated on the same basis as those rates shown in the table above. Such rates will be
furnished by us upon request.
PAGE 29
Table B - Dollar Amount of Each Monthly Fixed Dollar Annuity Payment Per $1,000 Applied
Plan A Plan B Plan C Plan D - Joint and Survivor
Life 5 Years 10 Years 15 Years With Adj. Adjusted Age of Female Joint Annuitant
Adj. Income Certain Certain Certain Refund Male 10 Yrs 5 Yrs Same 5 Yrs 10 Yrs
Age* M F M F M F M F M F Age* Younger Younger Age Older Older
45 3.93 3.63 3.92 3.63 3.90 3.63 3.87 3.61 3.80 3.57 45 3.17 3.28 3.39 3.50 3.61
46 3.99 3.68 3.98 3.68 3.96 3.67 3.92 3.66 3.85 3.61 46 3.20 3.31 3.43 3.55 3.66
47 4.05 3.73 4.05 3.73 4.02 3.72 3.98 3.71 3.90 3.66 47 3.23 3.35 3.47 3.59 3.71
48 4.12 3.79 4.11 3.79 4.09 3.77 4.04 3.76 3.96 3.70 48 3.26 3.38 3.51 3.64 3.76
49 4.19 3.84 4.18 3.84 4.15 3.83 4.10 3.81 4.01 3.75 49 3.29 3.42 3.56 3.69 3.82
50 4.27 3.90 4.26 3.90 4.22 3.89 4.17 3.86 4.08 3.80 50 3.32 3.46 3.60 3.75 3.88
51 4.34 3.97 4.33 3.96 4.29 3.95 4.23 3.92 4.14 3.86 51 3.36 3.50 3.65 3.80 3.94
52 4.43 4.03 4.41 4.03 4.37 4.01 4.30 3.98 4.20 3.91 52 3.39 3.54 3.70 3.86 4.01
53 4.51 4.10 4.50 4.10 4.45 4.08 4.37 4.04 4.27 3.97 53 3.43 3.59 3.76 3.93 4.08
54 4.60 4.18 4.59 4.17 4.54 4.15 4.45 4.11 4.35 4.03 54 3.47 3.64 3.82 3.99 4.16
55 4.70 4.25 4.68 4.25 4.62 4.22 4.53 4.18 4.42 4.10 55 3.51 3.69 3.88 4.06 4.23
56 4.80 4.34 4.78 4.33 4.72 4.30 4.61 4.25 4.50 4.17 56 3.56 3.74 3.94 4.14 4.32
57 4.91 4.42 4.89 4.41 4.82 4.38 4.69 4.32 4.58 4.24 57 3.60 3.80 4.01 4.22 4.41
58 5.03 4.52 5.00 4.50 4.92 4.47 4.78 4.40 4.67 4.31 58 3.65 3.86 4.08 4.30 4.51
59 5.15 4.61 5.12 4.60 5.03 4.56 4.87 4.48 4.76 4.39 59 3.70 3.92 4.15 4.39 4.61
60 5.28 4.72 5.25 4.70 5.14 4.66 4.96 4.57 4.86 4.48 60 3.76 3.99 4.24 4.49 4.72
61 5.42 4.83 5.39 4.81 5.26 4.76 5.06 4.66 4.96 4.56 61 3.81 4.06 4.32 4.59 4.83
62 5.57 4.95 5.53 4.93 5.39 4.86 5.16 4.75 5.07 4.66 62 3.87 4.13 4.41 4.70 4.96
63 5.74 5.07 5.69 5.05 5.52 4.98 5.26 4.85 5.19 4.75 63 3.94 4.21 4.51 4.81 5.09
64 5.91 5.21 5.85 5.18 5.66 5.10 5.36 4.95 5.30 4.86 64 4.00 4.29 4.61 4.94 5.24
65 6.10 5.35 6.03 5.32 5.81 5.22 5.46 5.05 5.43 4.97 65 4.07 4.38 4.72 5.07 5.39
66 6.29 5.51 6.21 5.47 5.96 5.36 5.56 5.16 5.56 5.08 66 4.15 4.48 4.84 5.21 5.55
67 6.50 5.67 6.41 5.63 6.11 5.50 5.66 5.26 5.70 5.20 67 4.23 4.58 4.97 5.36 5.73
68 6.73 5.85 6.62 5.80 6.28 5.65 5.76 5.37 5.85 5.33 68 4.31 4.69 5.10 5.53 5.92
69 6.97 6.04 6.84 5.98 6.44 5.80 5.86 5.49 6.00 5.47 69 4.40 4.80 5.25 5.70 6.12
70 7.23 6.25 7.07 6.18 6.61 5.96 5.96 5.60 6.16 5.61 70 4.50 4.93 5.40 5.89 6.34
71 7.51 6.47 7.32 6.39 6.78 6.14 6.05 5.71 6.33 5.76 71 4.60 5.06 5.57 6.10 6.57
72 7.80 6.71 7.58 6.62 6.96 6.31 6.14 5.83 6.51 5.93 72 4.71 5.20 5.75 6.31 6.82
73 8.12 6.97 7.85 6.86 7.14 6.50 6.23 5.94 6.70 6.10 73 4.83 5.35 5.94 6.55 7.09
74 8.45 7.26 8.14 7.12 7.32 6.69 6.31 6.04 6.90 6.28 74 4.95 5.51 6.15 6.80 7.37
75 8.82 7.56 8.44 7.39 7.49 6.89 6.38 6.14 7.11 6.48 75 5.08 5.68 6.37 7.07 7.68
*Adjusted age of annuitant. M = Male F = Female
Table B above is based on the "1983 Individual Annuitant Mortality Table A" assuming a 3% annual effective interest rate.
Settlement rates for any age, or any combination of age and sex not shown above, will be calculated on the same basis as those
rates shown in the table above. Such rates will be furnished by us upon request. Amounts shown in the table below are based on
assuming a 3% annual effective interest rate.
Plan E - Dollar Amount of Each Monthly Fixed Dollar Annuity Payment Per $1,000 Applied
Years Payable Monthly Payment Years Payable Monthly Payment Years Payable Monthly Payment
10 9.61 17 6.23 24 4.84
11 8.86 18 5.96 25 4.71
12 8.24 19 5.73 26 4.59
13 7.71 20 5.51 27 4.47
14 7.26 21 5.32 28 4.37
15 6.87 22 5.15 29 4.27
16 6.53 23 4.99 30 4.18
PAGE 30
Flexible Payment Deferred Annuity Contract
American Centurion Life
P.O. Box 5555
Albany, New York 12205-0555
o Flexible Purchase Payments
o Optional Fixed Dollar or Variable Accumulation Values and Annuity
Payments
o Annuity Payments to Begin on the Retirement Date
o This Contract is Nonparticipating - Dividends Are Not Payable
