Exhibit 4(t)(i)
[CUNA MUTUAL GROUP LOGO]
CUNA Mutual Insurance Society
A Mutual Insurance Company
0000 Xxxxxxxx Xxx
Xxxxxxx, XX 00000
Phone: 0-000-000-0000
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
CONTRACT NUMBER: 123456789
READ YOUR CONTRACT CAREFULLY. This is a legal contract between the owner and
CUNA Mutual Insurance Society, and hereafter will be referred to as the
contract.
This contract is issued to the owner in consideration of the application and the
initial purchase payment. CUNA Mutual Insurance Society will pay the benefits of
this contract, subject to its terms and conditions, which will never be less
than the amount required by state law.
THE DOLLAR AMOUNT OF ANY INCOME PAYMENTS AND OTHER VALUES PROVIDED BY THIS
CONTRACT WILL INCREASE OR DECREASE BASED ON THE INVESTMENT EXPERIENCE OF THE
SUBACCOUNTS SELECTED. THE VARIABLE PROVISIONS ARE DESCRIBED IN SECTION 6.
THIS CONTRACT MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT WHICH CAN RESULT IN
EITHER AN UPWARD OR DOWNWARD ADJUSTMENT UPON SURRENDER OR PARTIAL WITHDRAWAL ON
ANY FIXED ACCOUNT VALUE. SEE THE MARKET VALUE ADJUSTMENT SECTION OF THE FIXED
ACCOUNT ENDORSEMENT, IF INCLUDED IN YOUR CONTRACT.
Signed for CUNA Mutual Insurance Society, Waverly, Iowa, on the Contract Issue
Date.
/s/ Illegible
-------------------------------
President
RIGHT TO EXAMINE THIS CONTRACT. IF FOR ANY REASON YOU DECIDE NOT TO KEEP THIS
CONTRACT, YOU MAY RETURN IT TO US WITHIN [10] DAYS AFTER YOU RECEIVE IT. IF THIS
CONTRACT IS A REPLACEMENT FOR AN EXISTING CONTRACT, YOU MAY RETURN IT TO US
WITHIN [30] DAYS AFTER YOU RECEIVE IT. YOU MAY RETURN IT TO EITHER OUR HOME
OFFICE OR TO THE AGENT WHO SOLD IT TO YOU. WE WILL CONSIDER IT VOID FROM THE
BEGINNING AND WILL PAY YOU A REFUND WITHIN 7 DAYS OF RECEIPT OF THE CONTRACT IN
THE HOME OFFICE. WE WILL REFUND ANY NET PURCHASE PAYMENTS ADJUSTED TO REFLECT
GAIN OR LOSS FROM THE DATE OF ALLOCATION TO THE DATE OF CANCELLATION; PLUS ANY
APPLICABLE PREMIUM EXPENSE CHARGES WHICH HAVE BEEN DEDUCTED PRIOR TO ALLOCATION.
IF THIS CONTRACT IS AN INDIVIDUAL RETIREMENT ANNUITY, DURING THE FIRST [10] DAYS
OF YOUR RIGHT TO EXAMINE PERIOD, WE WILL, INSTEAD OF THE FOREGOING, REFUND ANY
PURCHASE PAYMENTS RECEIVED BY US.
Flexible Purchase Payments as Described Herein
Income Payments Starting on the Payout Date
Death Benefit Payable at Death Prior to the Payout Date
Participating
Countersignature by: Not Applicable
Duly Licensed Resident Agent (if required by law)
CONTRACT GUIDE AND INDEX
Data Page
Definitions........................................................ Section 1
General Information................................................ Section 2
Owner and Beneficiary.............................................. Section 3
Accumulation Period................................................ Section 4
Purchase Payments.................................................. Section 5
Variable Account................................................... Section 6
Transfer Privilege................................................. Section 7
Contract Value..................................................... Section 8
Withdrawal Provision............................................... Section 9
Death of Annuitant and/or Owner.................................... Section 10
Death Benefit Proceeds............................................. Section 11
Dividends.......................................................... Section 12
Payout Period...................................................... Section 13
Income Payments.................................................... Section 14
Death of Payee..................................................... Section 15
Option Tables...................................................... Section 16
Restrictions on Payment of Proceeds................................ Section 17
Additional Benefit Rider(s) and Endorsement(s)
SECTION 1. DEFINITIONS
1.1 WHAT ARE THE MOST ACCUMULATION UNIT - A unit of measure used to
COMMONLY USED TERMS AND calculate variable contract value.
WHAT DO THEY MEAN?
AGE - Age as of last birthday.
ANNUITANT - The person (or persons) whose life
(or lives) determines the income payment
benefits payable under the contract and whose
death determines the death benefit. No more
than two annuitants may be named. References to
the death of an annuitant mean the last
surviving annuitant.
BENEFICIARY - The person (or persons) named by
the owner to whom the proceeds payable on the
death of the annuitant will be paid. Prior to
the payout date, if no beneficiary survives the
annuitant, you or your estate will be the
beneficiary.
THE CODE - The Internal Revenue Code of 1986,
as amended.
CONTRACT ANNIVERSARY - The same day and month
as the contract issue date for each year the
contract remains in force.
CONTRACT ISSUE DATE - The date shown on the
data page of the contract which is used to
determine contract years and contract
anniversaries.
CONTRACT YEAR - A twelve-month period beginning
on a contract anniversary.
CONTRACT VALUE - The total amount invested
under the contract. It is the sum of values in
the variable account and values in all other
account(s) provided for by endorsement.
DUE PROOF OF DEATH - Proof of death
satisfactory to us. Such proof may consist of a
certified copy of the death record, a certified
copy of a court decree reciting a finding of
death or any other proof satisfactory to us.
FUND - Each investment portfolio (sometimes
called a Series) of the Ultra Series Fund or
any other open-end management investment
company or unit investment trust in which a
subaccount invests.
GENERAL ACCOUNT - Our assets other than those
allocated to the variable account or any other
separate account of CUNA Mutual Insurance
Society.
HOME OFFICE - CUNA Mutual Insurance Society,
0000 Xxxxxxxx Xxx, Xxxxxxx, xxxx, 00000.
INCOME UNIT - A unit of measure used to
calculate variable income payments.
INVESTMENT OPTIONS - Choices made available
under the contract for allocation of net
purchase payments, including subaccounts of the
variable account and any other account choices
provided by endorsement. The available
investment options as of the contract issue
date are listed on the data page.
NET PURCHASE PAYMENT - A purchase payment less
any deduction for applicable premium expense
charges.
OWNER - The person(s) (or entity) who own(s)
the contract and who is entitled to exercise
all rights and privileges provided in the
contract. After the payout date, the payee is
the owner.
PAYEE - The person (or entity) receiving income
payments or any successor. The owner is the
payee unless the owner designates another
person (or entity) as payee.
PAYOUT DATE - The date when income payments
will begin, if the annuitant is still living.
The anticipated payout date is shown on the
data page.
PREMIUM EXPENSE CHARGE - An amount we deduct
from your purchase payments to cover taxes we
are currently charged by your state of
residence. The initial charge is shown on the
data page.
PRO-RATA - A method of distribution of contract
value. The distribution is in the same
proportion that the value in each investment
option has to the total value of the affected
investment option(s).
SEC - U.S. Securities and Exchange Commission.
SUBACCOUNT - A subdivision of the variable
account, the assets of which are invested in a
corresponding fund.
SURRENDER VALUE - The contract value, less any
applicable surrender charges, premium expense
charges not previously deducted, the annual
contract fee, and any applicable charge or
adjustments for riders or endorsements.
VALUATION DAY - Each day on which valuation of
the assets of a subaccount is required by
applicable law.
VALUATION PERIOD - The period beginning at the
close of the New York Stock Exchange of one
valuation day, and continuing to the close of
the New York Stock Exchange of the next
succeeding valuation day.
VARIABLE ACCOUNT - The CUNA Mutual Variable
Annuity Account. A segregated investment
account of CUNA Mutual Insurance Society into
which net purchase payments may be allocated.
VARIABLE CONTRACT VALUE - The value of the
contract in the variable account.
WE, OUR, US - CUNA Mutual Insurance Society.
WRITTEN REQUEST - A signed and dated written
notice in a form satisfactory to us and
received in our home office.
YOU, YOUR - The owner or owners of this
contract who are entitled to exercise all
rights and privileges in the policy.
SECTION 2. GENERAL INFORMATION
2.1 WHAT IS THE ENTIRE This contract form, the data page, any attached
CONTRACT? riders and endorsements, and a copy of the
application, if attached to it, are the entire
contract between you and us. No one except our
president or secretary can change or waive any
of our rights or requirements under this
contract. Any change must be in writing.
2.2 WHEN DOES THIS This contract is incontestable from its
CONTRACT BECOME contract issue date. The statements contained
INCONTESTABLE? in the application (in the absence of fraud)
are considered representations and not
warranties.
2.3 WHAT IF THE If an annuitant's date of birth has been
ANNUITANT'S DATE OF misstated, we will adjust the income payments
BIRTH OR GENDER HAS under this contract based on his or her correct
BEEN MISSTATED? date of birth. If an annuitant's gender has
been misstated and the Type A life income rates
apply (see the data page and Section 16), we
will adjust the income payments under this
contract based on his or her correct gender.
Any underpayment will be added to the next
payment. Any overpayment will be subtracted
from future payments. No interest will be
credited or charged to any underpayment or
overpayment adjustments.
2.4 WHAT IS THE ANNUAL The maximum annual contract fee is shown on the
CONTRACT FEE? data page. The annual contract fee we charge
will never be greater than the maximum. During
the accumulation period, the contract fee will
be deducted pro-rata from your contract value
in the investment options on each contract
anniversary. This contract fee will also be
deducted on the date of any full surrender, if
not on a contract anniversary. During the
payout period, it will be deducted in equal
amounts from any variable income payments made
during a contract year. This fee is to
reimburse us for the expense of maintaining
this contract.
2.5 WHEN WILL PREMIUM Any applicable premium expense charge will be
EXPENSE CHARGES BE deducted upon full surrender of the contract,
DEDUCTED? payment of death benefit proceeds or selection
of an income payout option. However, we reserve
the right to charge for the premium expense
charge when it is incurred. The premium expense
charge rate for your state as of the contract
issue date is shown on the data page.
In addition, we reserve the right to deduct
certain other premium expense charges upon full
surrender of the contract, payment of death
benefit proceeds or selection of an income
payout option, as appropriate. Such premium
expense charges may include taxes levied by any
government entity which we, in our sole
discretion, determine have resulted from the
establishment or maintenance of the variable
account, or from the receipt by us of purchase
payments, or from the issuance or termination
of this contract, or from the commencement or
continuance of income payments under this
contract.
2.6 WILL ANNUAL REPORTS BE We will send you a report, without charge, at
SENT? least annually which provides information about
your contract required by any applicable law.
2.7 CAN WE MODIFY THE Upon notice to you, we may modify the contract
CONTRACT? if:
a.) necessary to permit the contract or
the variable account to comply with
any applicable law or regulation
issued by a government agency;
b.) necessary to assure continued
qualification of the contract under
the code or other federal or state
laws relating to retirement annuities
or variable annuity contracts;
c.) necessary to reflect a change in the
operation of the variable account; or
d.) the modification provides additional
investment options.
In the event of most such modifications, the
company will make appropriate endorsement to
the contract.
SECTION 3. OWNER AND BENEFICIARY
3.1 WHAT ARE YOUR RIGHTS The owner has all rights, title and interest in
AS OWNER OF THIS this contract during the accumulation period
CONTRACT? while the annuitant is living. You may exercise
all rights and options stated in this contract,
subject to the rights of any irrevocable
beneficiary. Assignment of your contract as
collateral security will not be allowed.
3.2 HOW CAN YOU CHANGE You may change the owner or beneficiary of this
THE OWNER OR BENEFICIARY contract by written request at any time while
OF THIS CONTRACT? the annuitant is alive. The change will take
effect as of the date you signed it. We are not
liable for any payment we make or action we
take before receiving any such written request.
If there is more than one owner, the written
request for change must be signed by all
persons named as owner. A request for change of
beneficiary must also be signed by any
irrevocable beneficiary.
SECTION 4. ACCUMULATION PERIOD
4.1 WHAT IS THE The accumulation period is the first of two
ACCUMULATION PERIOD? periods of your contract. The accumulation
period begins on the contract issue date stated
on the data page. This period will continue
until the payout date unless the contract is
terminated before that date.
SECTION 5. PURCHASE PAYMENTS
5.1 WHEN CAN PURCHASE The initial purchase payment made is shown on
PAYMENTS BE MADE? the data page.
Additional purchase payments may be made to the
home office at any time during the accumulation
period. The minimum additional purchase payment
is shown on the data page.
We may not accept purchase payments beyond the
contract anniversary following the annuitant's
85th birthday. We reserve the right to decline
a purchase payment in excess of one million
dollars.
5.2 ARE ADDITIONAL Additional purchase payments after the initial
PURCHASE PAYMENTS purchase payment are not required.
REQUIRED?
5.3 HOW WILL NET PURCHASE Net purchase payments will be allocated as you
PAYMENTS BE initially designated. Your initial allocation
ALLOCATED? percentage is shown on the data page. This
contract allows you to allocate net purchase
payments to any available investment option.
Net purchase payments allocated to a subaccount
become part of the variable contract value
which fluctuates according to the investment
performance of the selected subaccount(s).
You may change the allocation of subsequent net
purchase payments at any time, without charge,
by written request. The allocation may be 100%
to any available investment option, or may be
divided among any of the investment options in
whole percentage points totaling 100%. The
minimum allocation is 1%. Any change will be
effective at the time we receive your written
request.
SECTION 6. VARIABLE ACCOUNT
6.1 WHAT IS THE VARIABLE The variable account is a segregated investment
ACCOUNT? account to which we allocate certain assets and
liabilities related to the contract and to
other variable annuity contracts. The variable
account is registered with the SEC as a unit
investment trust under the Investment Company
Act of 1940 (the "1940 Act"). We own the assets
of the variable account. We value the assets of
the variable account each valuation day.
That portion of the assets of the variable
account equal to the reserves and other
contract liabilities of the contracts supported
by the variable account will not be charged
with liabilities arising from any other
business that we may conduct. We have the right
to transfer to our general account any assets
of the variable account that are in excess of
such reserves and other contract liabilities.
The income, gains and losses, realized or
unrealized, from the assets allocated to the
variable account will be credited to or charged
against the variable account, without regard to
our other income, gains or losses.
The variable account is divided into
subaccounts. The subaccounts as of the contract
issue date are shown on the data page. Each
subaccount invests its assets solely in the
shares or units of designated funds of
underlying investment companies. The funds
corresponding to the subaccounts available as
of the contract issue date are shown on the
data page. Net purchase payments allocated and
transfers to a subaccount are invested in the
fund supporting that subaccount.
6.2 CAN THE VARIABLE Subject to obtaining approval or consent
ACCOUNT BE MODIFIED? required by applicable law, we reserve the
right to:
a.) combine the variable account with any
of our other separate accounts;
b.) eliminate or combine any subaccounts
and transfer the assets of any
subaccount to any other subaccount;
c.) add new subaccounts and make such
subaccounts available to any class of
contracts as we deem appropriate;
d.) add new funds or remove existing
funds;
e.) substitute a different fund for any
existing fund, if shares or units of
a fund are no longer available for
investment or if we determine that
investment in a fund is no longer
appropriate;
f.) deregister the variable account under
the 1940 Act if such registration is
no longer required;
g.) operate the variable account as a
management investment company under
the 1940 Act (including managing the
variable account under the direction
of a committee) or in any other form
permitted by law;
h.) restrict or eliminate any voting
rights of owners or other persons
having such rights as to the variable
account; and
i.) make any other changes to the
variable account or its operations as
may be required by the 1940 Act or
other applicable law or regulations.
In the event of any such substitution or other
change, we may make changes to this and other
contracts as may be necessary or appropriate to
reflect such substitution or other changes.
SECTION 7. TRANSFER PRIVILEGE
7.1 CAN YOU TRANSFER Subject to our right to modify, suspend or
VALUES BETWEEN terminate the transfer privilege, you may
INVESTMENT OPTIONS? transfer contract value between the subaccounts
or to any other available investment option
provided by endorsement as allowed by that
endorsement. Transfers are subject to all of
the following:
a.) the transfer request must be by
written request;
b.) the transfer request must be received
in our home office prior to the
payout date;
c.) the transfer is to a subaccount or
any other available investment option
provided by endorsement; and
d.) the deduction of any transfer fees
that we may impose. We reserve the
right to impose a transfer fee, not
to exceed $10 per requested transfer.
A transfer fee, if imposed, will be
deducted from the investment option
from which the transfer is made. If a
transfer is made from more than one
investment option at the same time,
the transfer fee will be deducted
pro-rata from the value in such
investment option(s).
We reserve the right to modify, suspend or
terminate the transfer privilege for any
contract or class of contracts at any time for
any reason. We also reserve the right to impose
restrictions on your ability to transfer
contract value between or among subaccounts.
For most classes of contracts, we anticipate
imposing restrictions on the ability to
transfer contract value and reserve the right
to change such restrictions for any class of
contracts at any time. The current prospectus,
or other disclosure statement, will disclose
the details of such restrictions. Such
restrictions may include, but are not limited
to, the requirement of a minimum time period
between each transfer or limiting the dollar
amount that can be transferred to and from the
subaccounts at any one time. In addition to
such restrictions, we may impose or collect any
fees by a fund in connection with the
redemption of its shares or otherwise required
by applicable law. We reserve the right to
refuse any transfer instructions that, in our
judgement and in our sole discretion, may be
harmful to the separate account, any subaccount
or underlying fund, or to other owners.
SECTION 8. CONTRACT VALUE
8.1 WHAT IS YOUR CONTRACT Your contract value at any time is equal to the
VALUE? sum of values you have in the variable account
and values in all other account(s) provided for
by endorsement.
8.2 HOW IS YOUR VARIABLE Your variable contract value for any valuation
CONTRACT VALUE period is the total of your subaccount values.
DETERMINED? Your value for each subaccount is equal to:
a.) the number of that subaccount's
accumulation units credited to you;
b.) multiplied by the accumulation unit
value for that subaccount at the end
of the valuation period for which the
determination is being made.
8.3 HOW ARE The accumulation unit value for each subaccount
ACCUMULATION UNIT was arbitrarily set initially at $10.
VALUES DETERMINED? Thereafter, the accumulation unit value for
each subaccount at the end of every valuation
period is determined by subtracting (b) from
(a) and dividing the result by (c) (i.e.,
(a-b)/c), where:
a.) is the net result of:
1.) the net assets of the subaccount
attributable to the accumulation
units (i.e., the aggregate value
of the underlying fund shares
held by the subaccounts) as of
the end of such valuation
period;
2.) plus or minus the cumulative
credit or charge with respect to
any taxes reserved for by us
during the valuation period
which we determine to be
attributable to the operation of
the subaccount.
b.) is the cumulative unpaid charge for
the mortality and expense risk charge
and administrative expense charge and
any applicable charge for fund
redemption fees. The charge for a
valuation period is equal to the
daily charge for the mortality and
expense risk charge and
administrative expense charge and any
applicable charge for fund redemption
fees multiplied by the number of days
in the valuation period.
c.) is the number of accumulation units
outstanding at the end of such
valuation period.
For each subaccount, net purchase payments or
transferred amounts are converted into
accumulation units. The number of accumulation
units credited is determined by dividing the
dollar amount directed to each subaccount by
the value of the accumulation unit for that
subaccount at the end of the valuation period
in which the net purchase payment or amount is
received.
Cancellation of the appropriate number of
accumulation units from a subaccount will occur
upon:
a.) a partial withdrawal or surrender;
b.) a transfer from a subaccount;
c.) payment of the death benefit;
d.) the payout date;
e.) the deduction of the annual contract
fee;
f.) the deduction of any transfer fees
that we may impose;
g.) the deduction of any fees imposed by
fund in connection with the
redemption of its shares or otherwise
imposed by applicable law;
h.) the deduction of the applicable
charge for riders, if any; and
i.) the deduction of applicable fees or
charges provided for by any
endorsement attached to your
contract.
Accumulation units will be cancelled as of the
end of the valuation period in which we receive
notice of or instructions regarding the event.
SECTION 9. WITHDRAWAL PROVISION
9.1 WHAT ARE THE RULES FOR You may make partial withdrawals during the
A PARTIAL WITHDRAWAL OF accumulation period by written request. You
THE SURRENDER VALUE? must specify the investment option(s) from
which the partial withdrawal is to be made.
We will pay you the amount you request in
connection with a partial withdrawal by
canceling accumulation units from appropriate
subaccount(s) and/or reducing applicable
amount(s) from any other investment option
provided for by endorsement. Partial
withdrawals generally will be effective as of
the date we receive written request.
Any applicable surrender charge will be
deducted from the remaining value in the
investment option(s) from which the partial
withdrawal is being made. If such remaining
investment option values are insufficient for
this purpose, the surrender charge will be
deducted pro-rata from all investment options
under the contract based on the remaining
contract value in each investment option.
If a partial withdrawal would cause the
surrender value to be less than $2,000, we will
treat your request as a full surrender.
9.2 WHAT ARE THE RULES FOR You have the right to surrender this contract
A FULL SURRENDER OF THE during the accumulation period by written
CONTRACT? request. You will be paid the surrender value.
The surrender value is equal to:
a.) the contract value at the end of the
valuation period in which we receive
your request;
b.) minus any applicable surrender
charge;
c.) minus the annual contract fee and any
applicable charge for rider(s) if the
surrender does not occur on a
contract anniversary;
d.) minus any applicable premium expense
charges not previously deducted; and
e.) minus any applicable adjustment(s) or
deduction(s) provided for by any
endorsement attached to your
contract.
The surrender value will not be less than the
amount required by state law.
Upon payment of the above surrender value, this
contract is terminated and we have no further
obligation under this contract. We may require
you to return your contract to our home office
prior to making payment.
9.3 WHEN WILL A SURRENDER A surrender charge is imposed on withdrawals as
CHARGE BE APPLIED AND described on the contract data page. The
HOW IS IT CALCULATED? surrender charge schedule, description of how a
surrender charge is calculated and free
withdrawal amount is shown on the data page.
9.4 ARE THERE ANY We reserve the right to postpone payment of any
RESTRICTIONS ON partial withdrawal or full surrender from the
PAYMENT OF PARTIAL variable account as described in Section 17.
WITHDRAWALS OR FULL
SURRENDERS?
SECTION 10. DEATH OF ANNUITANT AND/OR OWNER
10.1 WHAT HAPPENS IF THE If the sole annuitant dies during the
SOLE ANNUITANT DIES accumulation period, we will pay the death
DURING THE ACCUMULATION benefit proceeds to the beneficiary. The
PERIOD? beneficiary may elect one of the following
options within 60 days of the date we receive
due proof of death:
a.) receive the death benefit in a single
sum within five (5) years of the
deceased annuitant's death;
b.) apply the death benefit proceeds
under one of the income payout
options as payee, provided:
1.) payments under the income payout
option begin within one (1) year
of the deceased annuitant's
death; and
2.) payments are made over the life
of the beneficiary, or over a
period not greater than the
beneficiary's life expectancy.
c.) continue the contract, if the
beneficiary is the deceased
annuitant's spouse. If the
beneficiary is not the deceased
annuitant's spouse, this option is
not available.
10.2 WHAT HAPPENS IF AN If an annuitant dies during the accumulation
ANNUITANT DIES period, and there is a surviving annuitant, no
DURING THE death benefit will be paid and the contract
ACCUMULATION PERIOD will continue.
AND THERE IS A
SURVIVING ANNUITANT?
10.3 WHAT HAPPENS IF THE If the sole owner (who is also an annuitant)
SOLE OWNER (WHO IS dies during the accumulation period, one of the
ALSO AN ANNUITANT) following applies:
DIES DURING THE
ACCUMULATION PERIOD? a.) if the deceased owner is also the
sole annuitant, we will pay the death
benefit to the beneficiary, as
described in Section 10.1; or
b.) if the deceased owner is an annuitant
and there is a surviving annuitant,
no death benefit will be paid and the
contract will continue. See Section
10.2.
10.4 WHAT HAPPENS IF THE If the sole owner (who is not also an
SOLE OWNER (WHO IS annuitant) dies during the accumulation period,
NOT ALSO AN no death benefit will be paid, and the
ANNUITANT) DIES annuitant becomes the new owner.
DURING THE ACCUMULATION
PERIOD? If the new owner (previously the annuitant) is
the deceased owner's spouse, the contract may
be continued. If the new owner is someone other
than the deceased owner's spouse, the surrender
value (described in Section 9) must be:
a.) distributed in a single sum to the
surviving owner within five (5) years
of the deceased owner's death; or
b.) taken by the surviving owner as payee
under one of the income payment
options, provided:
1.) payments under the income payout
option begin within one (1) year
of the deceased owner's death;
and
2.) payments are made over the life
of the payee or over a period
not greater than the payee's
life expectancy.
10.5 WHAT HAPPENS IF AN If an owner dies during the accumulation
OWNER DIES DURING period, and there is a surviving owner, no
THE ACCUMULATION death benefit will be paid and one of the
PERIOD, AND THERE IS A following applies:
SURVIVING OWNER?
a.) if the deceased owner is not the
annuitant, and the surviving owner is
the deceased owner's spouse, he or
she will become the sole owner and
the contract will continue;
b.) if the deceased owner is not the
annuitant, and the surviving owner is
someone other than the deceased
owner's spouse, the surrender value
(described in Section 9) must be:
1.) distributed in a single sum to
the surviving owner within 5
years of the deceased owner's
death; or
2.) taken by the surviving owner as
payee under one of the income
payment options, provided:
i.) payments under the income
payout option begin within
one (1) year of the
deceased owner's death; and
ii.) payments are made over the
life of the payee or over a
period not greater than the
payee's life expectancy.
c.) if the deceased owner is also the
sole annuitant, we will pay the death
benefit to the beneficiary, as
described in Section 10.1.
SECTION 11. DEATH BENEFIT PROCEEDS
11.1 WHAT AMOUNT WILL BE The amount that will be paid under this
PAID AS DEATH BENEFIT contract as death benefit proceeds is equal to
PROCEEDS DURING THE the greater of a.) or b.) as follows:
ACCUMULATION PERIOD?
a.) The sum of your net purchase payments
made as of the date due proof of
death is received, minus an
adjustment for each partial
withdrawal made as of the date due
proof of death is received, equal to
(1) divided by (2), with the result
multiplied by (3), where:
(1) = the partial withdrawal amount;
(2) = the contract value immediately
prior to the partial
withdrawal; and
(3) = the sum of your net purchase
payments immediately prior to
the partial withdrawal, less
any adjustments for prior
partial withdrawals.
b.) The contract value as of the date due
proof of death is received.
The death benefit described above will be
reduced by any applicable premium expense
charges not previously deducted.
SECTION 12. DIVIDENDS
12.1 WILL DIVIDENDS BE We anticipate that no dividends will be payable
PAID? on your contract. However, while your contract
is in force, we will annually determine your
contract's share in our divisible surplus. Your
contract's share, if any, will be paid as a
dividend on your contract anniversary.
You may request that we apply your dividends
by:
a.) allocating them to your investment
option(s) in the same proportion as
designated for purchase payments; or
b.) paying them to you in cash.
Unless you tell us otherwise, dividend option
a.) above will be used.
SECTION 13. PAYOUT PERIOD
13.1 WHAT IS THE PAYOUT The payout period is the second of the two
PERIOD? periods of your contract. The payout period
begins on the payout date. It continues until
we make the last payment as provided by the
income payout option chosen.
On the first day of this period, the contract
value (adjusted as described below) will be
applied to the anticipated income payout option
shown on the data page, unless you have
selected another option. Income payments will
begin as provided under that option.
The contract value applied to an income payout
option will be adjusted as follows:
a.) any applicable surrender charge will
be deducted for amounts applied to
Option 1 and Option 2B;
b.) any applicable premium expense charge
will be deducted;
c.) any applicable charge for riders will
be deducted, if the payout date is
not on the contract anniversary;
d.) any other applicable adjustments or
deductions described in any
endorsement attached to your contract
will be deducted; and
e.) if the payout date is not on the
contract anniversary, the annual
contract fee will be deducted on a
pro-rated basis.
SECTION 14. INCOME PAYMENTS
14.1 WHEN WILL INCOME The first income payment will be paid as of the
PAYMENTS BEGIN? payout date. The anticipated payout date is
shown on the data page. You may change the
payout date by written request, provided the
request is received at our home office at least
30 days prior to the requested payout date.
Unless otherwise restricted by law or
regulation, the latest payout date is the later
of the contract anniversary following the
annuitant's 85th birthday or 10 years after the
contract issue date.
Unless changed as described above, we will use
the anticipated payout date shown on the data
page.
14.2 WHAT INCOME PAYOUT There are different ways to receive income
OPTIONS ARE AVAILABLE? payments. We call these income payout options.
Seven income payout options are described
below. The terms "payee" and "annuitant", when
used in the income payout descriptions below,
include any beneficiary who elects to apply
death benefit proceeds under an income payout
option as allowed under Section 10.
Options 1 and 2A are available only as a fixed
income payment. Option 2B is available only as
a variable income payment. Options 3A, 3B, 4A
and 4B are available in two forms - as a
variable income payment in connection with the
variable account and as a fixed income payment.
Other income payout options may be available
with our consent.
Unless otherwise noted, once an option is
selected, and income payments begin, the value
of any remaining payments can not be
surrendered and paid in one sum.
OPTION 1 - INTEREST OPTION (FIXED INCOME
PAYMENTS ONLY). We will pay interest on the
proceeds which we will hold as a principal sum
during the lifetime of the annuitant. The payee
may choose to receive interest payments either
once a year or once a month. We will determine
the effective rate of interest from time to
time, but it will not be less than an effective
annual interest rate of 2.00%.
The payee has the right to surrender the
proceeds applied to this option and to receive
one single sum at any time by written request.
OPTION 2A - INSTALLMENT OPTION (FIXED INCOME
PAYMENTS ONLY). We will pay monthly income
payments to the payee for a chosen number of
years, not less than 5, nor more than 30. If
the original payee dies before income payments
have been made for the chosen number of years:
(a) income payments will be continued for the
remainder of the period to the successor payee;
or (b) the present value of the remaining
income payments, computed at the interest rate
used to create the Option 2A rates, will be
paid to the successor payee or to the last
surviving payee's estate, if there is no
successor payee.
Dividends, if any, will be payable as
determined by us. We do not anticipate any
dividends will be paid.
OPTION 2B - INSTALLMENT OPTION (VARIABLE INCOME
PAYMENTS ONLY). We will pay monthly income
payments to the payee for a chosen number of
years, not less than 5, nor more than 30. If
the original payee dies before income payments
have been made for the chosen number of years:
(a) income payments will be continued for the
remainder of the period to the successor payee;
or (b) the present value of the remaining
income payments, computed at the interest rate
used to create the Option 2B rates, will be
paid to the successor payee or to the last
surviving payee's estate, if there is no
successor payee.
The payee has the right to surrender the value
of all remaining variable income payments due
under this option and receive one single sum at
any time by written request. The single sum
paid upon surrender will be equal to the
present value of the remaining variable income
payments, computed at the interest rate used to
create the Option 2B rates.
Dividends, if any, will be payable as
determined by us. We do not anticipate any
dividends will be paid.
OPTION 3A - SINGLE LIFE INCOME OPTION -
GUARANTEED PERIOD CERTAIN (FIXED OR VARIABLE
INCOME PAYMENTS). We will pay monthly income
payments to the payee for as long as the
annuitant lives. If the original payee dies
before all of the income payments have been
made for the guaranteed period certain: (a)
income payments will be continued during the
remainder of the guaranteed period certain to
the successor payee; or (b) the present value
of the remaining income payments, computed at
the interest rate used to create the Option 3A
rates, will be paid to the successor payee or
to the last surviving payee's estate, if there
is no successor payee.
The guaranteed period certain choices are:
a.) 5 years;
b.) 10 years;
c.) 15 years; or
d.) 20 years.
Dividends, if any, will be payable as
determined by us. We do not anticipate any
dividends will be paid.
OPTION 3B - SINGLE LIFE INCOME OPTION -
LIFETIME PAYOUT (FIXED OR VARIABLE INCOME
PAYMENTS ONLY). We will pay monthly income
payments to the payee for as long as the
annuitant lives.
Dividends, if any, will be payable as
determined by us. We do not anticipate any
dividends to be paid.
OPTION 4A - JOINT AND SURVIVOR LIFE INCOME
OPTION - GUARANTEED PERIOD CERTAIN (FIXED OR
VARIABLE INCOME PAYMENTS). We will pay monthly
income payments to the payee for as long as
either of the co-annuitants is living. If at
the death of the second surviving annuitant,
income payments have been made for less than
the guaranteed period certain: (a) income
payments will be continued during the remainder
of the guaranteed period certain to the
successor payee; or (b) the present value of
the remaining income payments, computed at the
interest rate used to create the Option 4A
rates, will be paid to the successor payee or
to the last surviving payee's estate, if there
is no successor payee.
The guaranteed period certain choices are:
a.) 5 years;
b.) 10 years;
c.) 15 years; or
d.) 20 years.
Dividends, if any, will be payable as
determined by us. We do not anticipate any
dividends to be paid.
OPTION 4B - JOINT AND SURVIVOR LIFE INCOME
OPTION - LIFETIME PAYOUT (FIXED OR VARIABLE
INCOME PAYMENTS ONLY). We will pay monthly
income payments to the payee for as long as
either of the co-annuitants is living.
Dividends, if any, will be payable as
determined by us. We do not anticipate any
dividends to be paid.
14.3 WHAT ARE THE We will automatically make income payments
REQUIREMENTS FOR according to a life income payment option with
CHOOSING AN INCOME a guaranteed period certain of 10 years,
PAYOUT OPTION? starting on the payout date, unless you choose
another guaranteed period certain or income
payout option. We will apply your adjusted
contract value (described in Section 13) to
purchase a variable and/or fixed income payment
in the same proportion as your contract value
is distributed among the investment options.
You may change the anticipated income payout
option by written request on or prior to the
payout date to an income payout option that is
acceptable to us.
The minimum adjusted contract value which can
be applied under Option 1 is $2,500. If the
monthly interest payment for Option 1 is less
than $20, we reserve the right to pay interest
annually.
The minimum adjusted contract value which can
be applied under Options 2A, 2B, 3A, 3B, 4A or
4B is the greater of $2,500 or the amount
required to provide an initial monthly income
payment of $20.
We may require due proof of the age of any
annuitant on whose life an income payout option
is based. For Type A life income rates, we may
also require due proof of the gender of any
annuitant on whose life an income payout option
is based.
The payee may name a successor payee to receive
any remaining income payments due after the
payee's death. The payee may exercise any
ownership rights that continue after the payout
date.
14.4 HOW WILL FIXED The minimum dollar amount of each fixed income
INCOME PAYMENT payment will be determined by dividing the
VALUES BE DETERMINED? amount applied by $1,000, and multiplying the
result by the applicable option rate shown in
Section 16. Higher current option rates may be
available on the payout date and are available
upon request to our home office.
14.5 HOW WILL VARIABLE The dollar amount of the initial variable
INCOME PAYMENT income payment attributable to each subaccount
VALUES BE will be determined by dividing the amount
DETERMINED? applied by $1,000, and multiplying the result
by the applicable option rate shown in Section
16. The total initial variable income payment
is the sum of the initial variable income
payments attributable to the subaccount(s).
The dollar amount of the subsequent variable
income payments attributable to each subaccount
will be based on the number of income units
credited to the contract for that subaccount
and is determined by multiplying (a) by (b),
where:
(a) = the number of subaccount income
units; and
(b) = the subaccount income unit value for
the valuation period immediately
preceding the due date of the
payment.
The number of income units attributable to each
subaccount remains fixed unless there is an
exchange of income units.
The number of income units is derived by
dividing that portion of the initial variable
income payment attributable to the subaccount
by the subaccount's income unit value for the
valuation period which ends immediately
preceding the payout date.
The income unit value for each subaccount was
arbitrarily set initially at $100. Thereafter,
the income unit value for each subaccount in
any valuation period is determined by dividing
(a) by (b), then multiplying by (c) and
adjusting the result to compensate for the
assumed net investment rate for the option
selected, where:
a.) is the accumulation unit value for
the current valuation period;
b.) is the accumulation unit value for
the immediately preceding valuation
period; and
c.) is the income unit value for the
immediately preceding valuation
period.
Payments after the initial payment may
increase, decrease or remain constant based on
whether the actual annualized investment return
of the selected subaccount(s) is greater or
less than the assumed net investment rate for
the option selected. The option rates used to
determine the initial variable income payment
(shown in Section 16) are based on an assumed
net investment rate of 3.50% per year.
14.6 CAN VARIABLE ANNUITY The payee may exchange the dollar value of a
UNITS BE EXCHANGED? designated number of income units of a
particular subaccount for an equivalent dollar
amount of income units of another subaccount by
written request. On the date of the exchange,
the dollar amount of an income payment would be
unaffected by the fact of the exchange.
No more than 4 exchanges of income units may be
made during any contract year.
SECTION 15. DEATH OF PAYEE
15.1 WHAT IF THE PAYEE If the payee dies on or after the payout date,
DIES DURING THE any remaining proceeds will be distributed at
PAYOUT PERIOD? least as rapidly as provided by the income
payout option in effect.
SECTION 16. OPTION TABLES
16.1 WHAT RATES WILL BE The rates shown in the following tables are
USED TO DETERMINE used to determine the minimum payment values
PAYMENT VALUES? for monthly fixed income payments. Higher
current rates may be available on the payout
date, and are available upon request to our
home office. These rates are also used to
determine the initial monthly variable income
payment amount.
The Option 2A rates are based on 2.00% interest
per year. The Option 2B rates are based on
3.50% interest per year. The Option 3A, 3B, 4A
and 4B rates are based on the Annuity 2000
Table and with compound interest at the
effective rate of 3.50% per year.
Rates for ages not shown will be calculated on
an actuarially equivalent basis and will be
available upon request. Rates for initial
variable income payments at an assumed net
investment rate other than 3.50% per year may
also be available with our consent. Other
assumed net investment rates that are made
available will be calculated on an actuarially
equivalent basis.
The Type A life income rates for Options 3A,
3B, 4A and 4B are based on the annuitant's age
and gender; or the beneficiary's age and gender
if the beneficiary elects to apply death
benefit proceeds under an income payout option.
The Type B life income rates are based on the
annuitant's age; or the beneficiary's age if
the beneficiary elects to apply death benefit
proceeds under an income payout option. The
life income rates type for this contract is
shown on the data page.
OPTION 2A - RATES - FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(FIXED INCOME PAYMENTS ONLY)
YEARS MONTHLY PAYMENT PAYABLE UNDER
PAYABLE OPTION 2 FOR EACH $1,000 APPLIED
------- --------------------------------
5 17.49
10 9.18
15 6.42
20 5.04
25 4.22
30 3.68
OPTION 2B - RATES - FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(VARIABLE INCOME PAYMENTS ONLY)
YEARS MONTHLY PAYMENT PAYABLE UNDER
PAYABLE OPTION 2 FOR EACH $1,000 APPLIED
------- --------------------------------
5 18.12
10 9.83
15 7.10
20 5.75
25 4.96
30 4.45
OPTION 3A - LIFE INCOME RATES - GUARANTEED PERIOD CERTAIN - FIRST PAYMENT DUE AT
BEGINNING OF PERIOD
(FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
AGE - MALE
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
5 5.24 5.36 5.49 5.62 5.77 5.92 6.08 6.26 6.44 6.64 6.84 7.06 7.28
10 5.16 5.27 5.38 5.50 5.63 5.76 5.90 6.04 6.19 6.34 6.50 6.66 6.82
15 5.02 5.11 5.20 5.30 5.39 5.49 5.59 5.69 5.79 5.89 5.99 6.08 6.18
20 4.82 4.89 4.95 5.02 5.08 5.14 5.20 5.26 5.31 5.37 5.42 5.46 5.50
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- -----
5 7.53 7.78 8.05 8.33 8.62 8.93 9.25 9.59 9.94 10.29 10.66 11.04 11.43
10 6.99 7.16 7.34 7.51 7.68 7.86 8.03 8.19 8.35 8.51 8.65 8.79 8.92
15 6.27 6.36 6.44 6.52 6.60 6.67 6.73 6.79 6.84 6.88 6.92 6.96 6.99
20 5.54 5.58 5.61 5.63 5.66 5.68 5.69 5.71 5.72 5.73 5.74 5.74 5.75
AGE - FEMALE
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
5 4.86 4.96 5.07 5.18 5.30 5.43 5.57 5.72 5.88 6.05 6.23 6.43 6.64
10 4.82 4.91 5.01 5.12 5.23 5.35 5.47 5.60 5.74 5.89 6.04 6.21 6.38
15 4.74 4.82 4.91 5.00 5.10 5.20 5.30 5.40 5.51 5.62 5.73 5.84 5.95
20 4.62 4.69 4.76 4.83 4.90 4.97 5.04 5.11 5.18 5.24 5.31 5.37 5.42
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- -----
5 6.86 7.10 7.36 7.63 7.93 8.24 8.57 8.92 9.29 9.68 10.08 10.50 10.94
10 6.55 6.74 6.93 7.12 7.32 7.51 7.71 7.91 8.10 8.29 8.47 8.63 8.79
15 6.06 6.17 6.27 6.37 6.47 6.56 6.64 6.71 6.77 6.83 6.88 6.92 6.96
20 5.47 5.52 5.56 5.59 5.62 5.65 5.67 5.69 5.71 5.72 5.73 5.74 5.74
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
AGE - UNISEX
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
5 4.93 5.04 5.15 5.26 5.39 5.52 5.67 5.82 5.98 6.15 6.34 6.54 6.75
10 4.88 4.98 5.08 5.19 5.30 5.42 5.55 5.69 5.83 5.97 6.13 6.29 6.46
15 4.79 4.88 4.97 5.06 5.15 5.25 5.35 5.46 5.56 5.67 5.78 5.89 5.99
20 4.66 4.73 4.80 4.87 4.94 5.01 5.07 5.14 5.21 5.27 5.33 5.38 5.44
YEARS 73 74 75 76 77 78 79 80 81 82 83 84 85
----- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- -----
5 6.98 7.22 7.48 7.76 8.05 8.36 8.69 9.03 9.40 9.78 10.18 10.59 11.02
10 6.63 6.81 7.00 7.19 7.38 7.58 7.77 7.96 8.15 8.33 8.50 8.66 8.81
15 6.10 6.20 6.31 6.40 6.49 6.58 6.65 6.72 6.78 6.84 6.89 6.93 6.96
20 5.48 5.53 5.57 5.60 5.63 5.65 5.68 5.69 5.71 5.72 5.73 5.74 5.74
OPTION 3B - SINGLE LIFE INCOME RATES - LIFETIME PAYOUT -
FIRST PAYMENT DUE AT BEGINNING OF PERIOD
(FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
AGE
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72 73
------ ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
MALE 5.26 5.39 5.52 5.66 5.81 5.97 6.15 6.33 6.53 6.74 6.96 7.20 7.45 7.72
FEMALE 4.87 4.97 5.08 5.20 5.33 5.46 5.60 5.75 5.92 6.10 6.29 6.49 6.72 6.96
YEARS 74 75 76 77 78 79 80 81 82 83 84 85
------ ---- ---- ---- ---- ---- ---- ----- ----- ----- ----- ----- -----
MALE 8.01 8.32 8.65 9.00 9.38 9.78 10.21 10.67 11.17 11.69 12.25 12.85
FEMALE 7.22 7.50 7.81 8.14 8.50 8.89 9.31 9.76 10.26 10.79 11.37 12.00
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
AGE
YEARS 60 61 62 63 64 65 66 67 68 69 70 71 72 73
------ ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ---- ----
UNISEX 4.95 5.05 5.17 5.29 5.42 5.55 5.70 5.86 6.03 6.21 6.41 6.62 6.85 7.09
YEARS 74 75 76 77 78 79 80 81 82 83 84 85
------ ---- ---- ---- ---- ---- ---- ---- ---- ----- ----- ----- -----
UNISEX 7.36 7.64 7.95 8.29 8.65 9.04 9.46 9.91 10.41 10.94 11.51 12.13
OPTION 4A - LIFE INCOME FACTORS - JOINT AND SURVIVOR - GUARANTEED PERIOD CERTAIN
- FIRST PAYMENT DUE AT BEGINNING OF PERIOD (FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
5 YEAR GUARANTEE PERIOD
AGE - FEMALE
AGE ---------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.38 4.59 4.79 4.95 5.07 5.15
65 5.52 4.82 5.11 5.38 5.59 5.74
70 4.64 5.01 5.42 5.83 6.19 6.47
75 4.72 5.16 5.69 6.27 6.84 7.32
80 4.78 5.27 5.90 6.65 7.47 8.24
85 4.82 5.35 6.04 6.94 8.01 9.12
10 YEAR GUARANTEE PERIOD
AGE - FEMALE
AGE ---------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.38 4.59 4.78 4.93 5.04 5.11
65 4.52 4.81 5.09 5.35 5.54 5.66
70 4.63 5.00 5.39 5.78 6.10 6.31
75 4.71 5.14 5.65 6.18 6.66 7.01
80 4.76 5.24 5.83 6.50 7.16 7.68
85 4.79 5.30 5.95 6.72 7.53 8.20
15 YEAR GUARANTEE PERIOD
AGE - FEMALE
AGE ---------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.37 4.57 4.75 4.88 4.97 5.00
65 4.50 4.78 5.04 5.25 5.39 5.46
70 4.61 4.95 5.30 5.61 5.82 5.93
75 4.67 5.07 5.50 5.91 6.20 6.36
80 4.71 5.14 5.63 6.11 6.47 6.68
85 4.73 5.18 5.70 6.22 6.63 6.86
20 YEAR GUARANTEE PERIOD
AGE - FEMALE
AGE ---------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.34 4.53 4.67 4.76 4.81 4.82
65 4.46 4.70 4.91 5.05 5.11 5.14
70 4.55 4.84 5.10 5.28 5.37 5.41
75 4.59 4.92 5.22 5.44 5.55 5.60
80 4.62 4.96 5.28 5.52 5.65 5.69
85 4.62 4.97 5.30 5.55 5.68 5.73
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
5 YEAR GUARANTEE PERIOD
AGE - UNISEX
AGE ---------------------------------------
UNISEX 60 65 70 75 80 85
------ ---- ---- ---- ---- ---- ----
60 4.32 4.49 4.64 4.75 4.83 4.88
65 4.49 4.74 4.97 5.17 5.32 5.41
70 4.64 4.97 5.32 5.65 5.92 6.11
75 4.75 5.17 5.65 6.15 6.61 6.98
80 4.83 5.32 5.92 6.61 7.33 7.98
85 4.88 5.41 6.11 6.98 7.98 8.99
10 YEAR GUARANTEE PERIOD
AGE - UNISEX
AGE ---------------------------------------
UNISEX 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.32 4.49 4.63 4.74 4.81 4.85
65 4.49 4.74 4.96 5.15 5.28 5.36
70 4.63 4.96 5.30 5.61 5.85 6.00
75 4.74 5.15 5.61 6.08 6.48 6.75
80 4.81 5.28 5.85 6.48 7.07 7.52
85 4.85 5.36 6.00 6.75 7.52 8.14
15 YEAR GUARANTEE PERIOD
AGE - UNISEX
AGE ---------------------------------------
UNISEX 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.32 4.48 4.61 4.70 4.76 4.78
65 4.48 4.71 4.93 5.09 5.18 5.23
70 4.61 4.93 5.23 5.49 5.65 5.74
75 4.70 5.09 5.49 5.85 6.10 6.24
80 4.76 5.18 5.65 6.10 6.44 6.62
85 4.78 5.23 5.74 6.24 6.62 6.84
20 YEAR GUARANTEE PERIOD
AGE - UNISEX
AGE ---------------------------------------
UNISEX 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.30 4.44 4.55 4.62 4.65 4.66
65 4.44 4.65 4.82 4.93 4.98 5.00
70 4.55 4.82 5.06 5.21 5.29 5.32
75 4.62 4.93 5.21 5.41 5.52 5.56
80 4.65 4.98 5.29 5.52 5.64 5.68
85 4.66 5.00 5.32 5.56 5.68 5.73
OPTION 4B - LIFE INCOME FACTORS - JOINT AND SURVIVOR - LIFETIME PAYOUT -
FIRST PAYMENT DUE AT BEGINNING OF PERIOD (FIXED OR VARIABLE INCOME PAYMENTS)
TYPE A LIFE INCOME RATES
PER $1,000 APPLIED
AGE - UNISEX
AGE ---------------------------------------
MALE 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.38 4.59 4.79 4.95 5.07 5.15
65 4.52 4.82 5.11 5.38 5.60 5.75
70 4.64 5.01 5.42 5.84 6.21 6.49
75 4.72 5.17 5.69 6.28 6.87 7.37
80 4.78 5.28 5.91 6.67 7.52 8.33
85 4.82 5.35 6.06 6.97 8.08 9.29
TYPE B LIFE INCOME RATES
PER $1,000 APPLIED
AGE - UNISEX
AGE ---------------------------------------
UNISEX 60 65 70 75 80 85
---- ---- ---- ---- ---- ---- ----
60 4.32 4.49 4.64 4.75 4.83 4.88
65 4.49 4.74 4.98 5.17 5.32 5.42
70 4.64 4.98 5.33 5.65 5.92 6.12
75 4.75 5.17 5.65 6.16 6.63 7.01
80 4.83 5.32 5.92 6.63 7.37 8.05
85 4.88 5.42 6.12 7.01 8.05 9.13
SECTION 17. RESTRICTIONS ON PAYMENT OF PROCEEDS
17.1 ARE THERE ANY Generally, the amount of any partial withdrawal
RESTRICTIONS ON PAYMENT or full surrender will be paid to you within
OF PROCEEDS FROM THE seven (7) days after we receive your written
VARIABLE ACCOUNT? request for partial withdrawal or full
surrender. Death benefit proceeds are payable
upon receipt of due proof of death in our home
office. Income payments are payable on your
payout date and monthly thereafter.
To the extent permitted by applicable law, we
reserve the right to postpone payment of any
partial withdrawal, full surrender, death
benefit or variable income payment from the
variable account for any period when:
a.) the New York Stock Exchange is closed
for other than customary weekend and
holiday closing or the SEC determines
that trading on the exchange is
restricted; or
b.) the SEC issues an order permitting
the postponement for the protection
of owners; or
c.) the SEC determines that an emergency
exists that makes the disposal of
securities held in the variable
account, or the determination of
their value, not reasonably
practicable.
FLEXIBLE PREMIUM DEFERRED
VARIABLE ANNUITY
Flexible Purchase Payments as Described Herein
Income Payments Starting on the Payout Date
Death Benefit Payable at Death Prior to the Payout Date
Participating
CUNA MUTUAL INSURANCE SOCIETY
0000 XXXXXXXX XXX, XXXXXXX, XXXX 00000
TELEPHONE: (000) 000-0000
DATA PAGE
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
WITH PURCHASE PAYMENT CREDIT BENEFIT
ANNUITANT: [Xxxx Xxx] CONTRACT NUMBER: [123456789]
CO-ANNUITANT: [Xxxx Xxx] CONTRACT ISSUE DATE: [October 31, 2007]
ANTICIPATED INCOME PAYOUT OPTION: [10 C & L] LIFE INCOME RATES: [Type A]
ANTICIPATED PAYOUT DATE: [October 31, 2057]
OWNER(S): [Xxxx Xxx, Xxxx Xxx]
INITIAL PURCHASE PAYMENT: $2,000
See application for allocation of initial purchase payment.
MINIMUM ADDITIONAL PURCHASE PAYMENT: [$100]
CHARGES AND FEES*:
Variable Account Mortality and Expense Risk Charge: [1.60% per year]**
Variable Account Administrative Charge: [0.15% per year]
Maximum Contract Fee: $30 per year
Premium Expense Charge on the contract issue date: [0.00%]
Surrender Charges: See the Surrender Charge Schedule Section of the Data
Page
Maximum Transfer Fees: $10
* We reserve the right to reduce or waive any of these charges or fees. Any
reduction or waiver will be administered in a non-discriminatory manner. We
reserve the right to impose or collect any other fees imposed by a fund in
connection with the redemption of its shares or otherwise imposed by
applicable law.
** This includes [0.45]% per year for the Purchase Payment Credit Benefit.
OPTIONAL DEATH BENEFIT RIDERS: ANNUAL PERCENTAGE CHARGE
------------------------------ ------------------------
Maximum Anniversary Value Death Benefit Rider [0.15%]
3% Annual Guarantee Death Benefit Rider [0.20%]
Spouse Beneficiary Death Benefit Rider [0.05%]
ADDITIONAL BENEFITS:
Fixed Account Endorsement
Additional Income Option Endorsement
Change of Annuitant Endorsement
Income Payment Increase Endorsement
Waiver of Surrender Charge Endorsement
Spousal Continuation Endorsement
Purchase Payment Credit Benefit Endorsement
DATA PAGE (CONTINUED)
INITIAL ALLOCATION OF NET PURCHASE PAYMENTS TO INVESTMENT OPTIONS:
VARIABLE ACCOUNT: CUNA Mutual Variable Annuity Account
Subaccounts Fund Percentage
----------------------- ------------ ----------
Mid Cap Value Ultra Series 0.00%
Large Cap Growth Ultra Series 0.00%
Large Cap Value Ultra Series 15.00%
Diversified Income Ultra Series 25.00%
Bond Ultra Series 10.00%
Money Market Ultra Series 0.00%
High Income Ultra Series 0.00%
International Stock Ultra Series 0.00%
Mid Cap Growth Ultra Series 0.00%
Global Securities Ultra Series 0.00%
Conservative Allocation Ultra Series 0.00%
Moderate Allocation Ultra Series 0.00%
Aggressive Allocation Ultra Series 0.00%
Small Cap Growth Ultra Series 0.00%
Small Cap Value Ultra Series 0.00%
FIXED ACCOUNT:
Fixed Current Guaranteed
Periods Interest Rate Percentage
----------------------- ------------------ ----------
1 Year* 3.05% 25.00%
DCA Fixed Periods
1 Year* 4.00% 15.00%
6 Month* 4.50% 10.00%
* THE MARKET VALUE ADJUSTMENT DESCRIBED IN THIS CONTRACT DOES NOT APPLY TO
THE FIXED PERIOD(S) OR TO THE DCA FIXED PERIOD(S) SHOWN.
FIXED ACCOUNT MINIMUM GUARANTEED INTEREST RATE: 3.00%.
DATA PAGE (CONTINUED)
SURRENDER CHARGE SCHEDULE: Each purchase payment has an individual surrender
charge schedule which begins when the purchase payment is credited to your
contract and continues for 7 years, as shown below. The amount of the surrender
charge is determined separately for each purchase payment and is expressed as a
percentage of the purchase payment as follows:
Number of Years Since Surrender Charge
Purchase Payment was Credited Percent
----------------------------- ----------------
Less than 1 9%
At least 1 but less than 2 8%
At least 2 but less than 3 7%
At least 3 but less than 4 6%
At least 4 but less than 5 5%
At least 5 but less than 6 4%
At least 6 but less than 7 3%
7 or more 0%
These percentages apply to partial withdrawals and full surrender of new
purchase payments in excess of the free withdrawal amount. The term "new
purchase payment" means a purchase payment that is subject to the surrender
charge schedule shown above as of the date of partial withdrawal or surrender.
The term "old purchase payment" means any purchase payment other than a new
purchase payment.
In the event of a partial withdrawal or full surrender, for purposes of
calculating the surrender charge, the withdrawal order will be:
1. old purchase payments (not subject to surrender charges);
2. the free withdrawal amount (described below);
3. new purchase payments (subject to surrender charges) on a first in,
first out basis; then
4. earnings.
The term "earnings" means your contract value less purchase payments not
previously withdrawn.
FREE WITHDRAWAL AMOUNT: The following amounts may be withdrawn without incurring
a surrender charge:
a.) old purchase payments not previously withdrawn; and
b.) your annual free withdrawal amount described below.
Your annual free withdrawal amount is equal to 10% of new purchase payments at
the time of withdrawal, less free withdrawal amounts previously withdrawn in the
current contract year. Free withdrawal amounts not withdrawn in a contract year
are not carried over to increase the free withdrawal amount in a subsequent
contract year.
PURCHASE PAYMENT CREDIT BENEFIT ENDORSEMENT
SECTION 1. GENERAL INFORMATION
1.1 WHAT IS OUR AGREEMENT Our agreement with you includes this
WITH YOU? endorsement as a part of the contract to which
it is attached. The provisions of the contract
apply to this endorsement unless changed by
this endorsement.
1.2 WHAT ARE THE MOST COMMONLY CREDIT - the increase amount that is calculated
USED TERMS AND WHAT DO as a result of this benefit endorsement.
THEY MEAN?
CREDIT VALUE - the amount of the credit plus
any increases for earnings or reductions for
investment losses due to the credit.
SECTION 2. PURCHASE PAYMENT CREDIT PROVISION
2.1 WHAT IS THE BENEFIT A purchase payment received on or after the
PROVIDED BY THIS contract issue date will result in a credit to
ENDORSEMENT? your contract value if your cumulative net
purchase payments meet or exceed a specific
amount.
Cumulative net purchase payments equal:
a.) total of all net purchase payments
received; less
b.) any partial withdrawals (including
any associated surrender charges).
The cumulative net purchase payment amounts and
associated increase percentages are:
CUMULATIVE NET PURCHASE PAYMENTS CREDIT PERCENTAGE
-------------------------------- -----------------
$0.00 through $249,999.99 4%
$250,000 and above 5%
The credit to your contract value will be
calculated as follows:
a.) cumulative net purchase payments;
multiplied by
b.) the applicable credit percentage;
minus
c.) any prior credits to your contract
value as a result of this
endorsement.
The credit will be allocated according to your
purchase payment allocation in effect as of the
date of the credit.
Credits will be treated as earnings under your
contract and will not be subject to any
applicable surrender charge.
In the event of a partial withdrawal or full
surrender, earnings are withdrawn last, as
described on the data page.
2.2 WHAT HAPPENS IF YOU If you exercise your Right To Examine, your
EXERCISE YOUR RIGHT refund will not include any credits or credit
TO EXAMINE? value. Your Right To Examine is described on
the cover page of your contract.
We reserve the right to waive the provision
described above if required by law to do so.
The current prospectus will disclose if such
waiver is in effect.
2.3 WILL CREDIT VALUE BE Only credit value resulting from credit(s) that
INCLUDED WHEN DETERMINING occurred at least one (1) full year prior to
THE AMOUNT OF DEATH the date of death will be included when
BENEFIT PROCEEDS PAYABLE? determining the amount of death benefit
proceeds payable. Any credit value resulting
from credit(s) that occurred within one (1)
year of the date of death will be canceled and
the contract value adjusted accordingly in
order to determine the death proceeds payable.
We reserve the right to waive the provision
described above if required by law to do so.
The current prospectus will disclose if such
waiver is in effect.
SECTION 3 BENEFIT CHARGES
3.1 IS THERE A CHARGE FOR The charge for this benefit is included in the
THIS BENEFIT? Variable Account Mortality and Expense Risk
Charge shown on the data page. The charge is
assessed on a daily basis. See the data page
and Section 8.3 of the contract.
CUNA Mutual Insurance Society
A Mutual Insurance Company
/s/ Xxxx Xxxx
------------------------------
President
PURCHASE PAYMENT CREDIT BENEFIT ENDORSEMENT
SECTION 1. GENERAL INFORMATION
1.1 WHAT IS OUR AGREEMENT Our agreement with you includes this
WITH YOU? endorsement as a part of the contract to which
it is attached. The provisions of the contract
apply to this endorsement unless changed by
this endorsement.
1.2 WHAT ARE THE MOST COMMONLY CREDIT - the increase amount that is calculated
USED TERMS AND WHAT DO as a result of this benefit endorsement.
THEY MEAN?
CREDIT VALUE - the amount of the credit plus
any increases for earnings or reductions for
investment losses due to the credit.
SECTION 2. PURCHASE PAYMENT CREDIT PROVISION
2.1 WHAT IS THE BENEFIT A purchase payment received on or after the
PROVIDED BY THIS contract issue date will result in a credit to
ENDORSEMENT? your contract value if your cumulative net
purchase payments meet or exceed a specific
amount.
Cumulative net purchase payments equal:
a.) total of all net purchase payments
received; less
b.) any partial withdrawals (including
any associated surrender charges).
The cumulative net purchase payment amounts and
associated increase percentages are:
CUMULATIVE NET PURCHASE PAYMENTS CREDIT PERCENTAGE
-------------------------------- -----------------
$0.00 through $249,999.99 4%
$250,000 and above 5%
The credit to your contract value will be
calculated as follows:
a.) cumulative net purchase payments;
multiplied by
b.) the applicable credit percentage;
minus
c.) any prior credits to your contract
value as a result of this
endorsement.
The credit will be allocated according to your
purchase payment allocation in effect as of the
date of the credit.
Credits will be treated as earnings under your
contract and will not be subject to any
applicable surrender charge.
In the event of a partial withdrawal or full
surrender, earnings are withdrawn last, as
described on the data page.
2.2 WHAT HAPPENS IF YOU If you exercise your Right To Examine, your
EXERCISE YOUR RIGHT refund will not include any credits or credit
TO EXAMINE? value. Your Right To Examine is described on
the cover page of your contract.
We reserve the right to waive the provision
described above if required by law to do so.
The current prospectus will disclose if such
waiver is in effect.
2.3 WILL CREDIT VALUE BE Only credit value resulting from credit(s) that
INCLUDED WHEN DETERMINING occurred at least one (1) full year prior to
THE AMOUNT OF DEATH the date of death will be included when
BENEFIT PROCEEDS PAYABLE? determining the amount of death benefit
proceeds payable. Any credit value resulting
from credit(s) that occurred within one (1)
year of the date of death will be canceled and
the contract value adjusted accordingly in
order to determine the death proceeds payable.
We reserve the right to waive the provision
described above if required by law to do so.
The current prospectus will disclose if such
waiver is in effect.
SECTION 3 BENEFIT CHARGES
3.1 IS THERE A CHARGE FOR The charge for this benefit is included in the
THIS BENEFIT? Variable Account Mortality and Expense Risk
Charge shown on the data page. The charge is
assessed on a daily basis. See the data page
and Section 8.3 of the contract.
CUNA Mutual Insurance Society
A Mutual Insurance Company
/s/ Xxxx Xxxx
------------------------------
President
