<PAGE>
PLEASE READ THIS CONTRACT CAREFULLY
ANNUITY BENEFIT PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED
ON THE INVESTMENT PERFORMANCE OF THE VARIABLE ACCOUNT, MAY INCREASE OR DECREASE
AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. PLEASE REFER TO THE VALUE OF
THE VARIABLE ACCOUNT SECTION FOR ADDITIONAL INFORMATION.
Values removed from a Guarantee Period Account prior to the end of its Guarantee
Period may be subject to a Market Value Adjustment that may increase or decrease
the values. A negative Market Value Adjustment will never be applied to the
Death Benefit. A positive Market Value Adjustment, if applicable, will be added
to the Death Benefit when the benefit paid is the contract's Accumulated Value.
Please refer to the Market Value Adjustment section for additional information.
RIGHT TO EXAMINE CONTRACT
The Owner may cancel this contract by returning it to the Company or one of its
authorized representatives within ten days after receipt. If returned, the
Company will refund an amount equal to the Accumulated Value, after application
of any Market Value Adjustment, plus any fees or other charges imposed. If,
however, the contract is issued as an Individual Retirement Annuity (IRA), the
Company will refund the greater of the above or the gross payment.
ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY
Home Office: Dover, Delaware
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653
This is a legal contract between Allmerica Financial Life Insurance and Annuity
Company (the Company) and the Owner and is issued in consideration of the
Initial Payment shown on the Specifications page. Additional Payments are
permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account
or Guarantee Period Accounts. While this contract is in effect, the Company
agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a
Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date.
President Secretary
Flexible Payment Deferred Variable and Fixed Annuity
Annuity Benefit Payments Payable on the Annuity Date
Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date
Non-Participating
FORM A3035-00 1
<PAGE>
<TABLE>
<CAPTION>
Table of Contents
<S> <C>
SPECIFICATIONS .................................................................................3
DEFINITIONS.....................................................................................7
OWNER, ANNUITANT AND BENEFICIARY................................................................9
THE ACCUMULATION PHASE
PAYMENTS..............................................................................11
VALUES................................................................................11
VALUE ENHANCEMENT.....................................................................13
TRANSFER........................................................... ..................14
WITHDRAWAL AND SURRENDER..............................................................14
DEATH BENEFIT.........................................................................17
THE PAYOUT PHASE
ANNUITY BENEFIT.......................................................................19
TRANSFER..............................................................................20
WITHDRAWAL............................................................................21
PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS.............................................23
DEATH OF THE ANNUITANT................................................................23
ANNUITY BENEFIT PAYMENT OPTIONS.......................................................24
ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS.............................................24
ANNUITY OPTION RATE TABLES............................................................25
GENERAL PROVISIONS.............................................................................28
</TABLE>
FORM A3035-00 2
<PAGE>
<TABLE>
<CAPTION>
SPECIFICATIONS
<S> <C> <C> <C>
Contract Type: [NQ] Contract Number: [00000000]
Issue Date: [01/01/2000] Annuity Date: [01/01/2010]
(Must be at least [2] years after the issue date)
Owner: [John Doe] Owner Date of Birth: [01/01/1960]
Joint Owner: [Jack Doe] Joint Owner Date of Birth: [01/01/1960]
Annuitant: [Mary Doe] Annuitant Date of Birth: [01/01/1950]
Joint Annuitant: [Michael Doe] Joint Annuitant Date of Birth: [01/01/1950]
Annuitant Sex: [Female] Beneficiary(ies):
Joint Annuitant Sex: [Male] Primary: Surviving Joint Owner, if any
1st Contingent: [Michael Doe]
2nd Contingent: [Jack Doe]
Minimum Fixed Account Minimum Additional Payment
Guaranteed Interest Rate: [2.75%] Amount: [$50.00]
Guarantee Period Account Guarantee Period Account
Minimum Interest Rate: [2.75%] Minimum Allocation Amount: [$1,000.00]
Minimum Withdrawal Minimum Accumulated Value
Amount: [$100.00] After Withdrawal: [$1,000.00]
Minimum Annuity Maximum Alternative Annuity Date: [01/01/2059]
Benefit Payment: [$100.00] (Must be at least [2] years after the issue date)
Value Enhancement Percentage: [1%]
Value Enhancement Date(s): every [3rd] contract anniversary
Surrender Charge Table:
Years From Surrender Charge as a
Date of Payment Percent of the Payments
To Date of Withdrawal Withdrawn
-----------------------------------------------------------
Less Than: [1 8 1/2%
2 8 1/2%
3 8 1/2%
4 8 1/2%
5 7 1/2%
6 6 1/2%
7 5 1/2%
8 3 1/2%
9 1 1/2%
Thereafter 0%]
Withdrawal Without Surrender Charge Amount: [[12%] of Gross Payment Base (reduced by any prior
Withdrawal Without Surrender Charge made in the same calendar year)]
Mortality and Expense Risk Charge: [1.30%] on an annual basis of the daily value of the Sub-Account assets.
Administrative Charge: [.15%] on an annual basis of the daily value of the Sub-Account assets.
Contract Fee: [$35, if the Accumulated Value is less than $75,000.00. Waived for 401(K)s]
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653 [(1-800-782-8380)]
</TABLE>
FORM A8035-00 3
<PAGE>
<TABLE>
<CAPTION>
SPECIFICATIONS (continued)
<S> <C> <C>
Owner: [John Doe] Contract Number: [00000000]
Joint Owner: [Jack Doe]
Initial Payment: [$25,000.00]
Payment Allocation: (The Initial Payment is allocated in the following manner:)
Variable Sub-Accounts:
----------------------
<S> <C>
[Alger American Balanced Portfolio Kemper Value+Growth Portfolio
Alger American Leveraged AllCap Portfolio KVS Dreman Financial Services Portfolio
Dreyfus MidCap Stock Portfolio KVS Dreman High Return Equity Portfolio
Dreyfus Socially Responsible Growth Fund KVS Focused Large Cap Growth Portfolio
Kemper Aggressive Growth Portfolio KVS Growth & Income Portfolio
Kemper Blue Chip Portfolio KVS Growth Opportunities Portfolio
Kemper Contrarian Value Portfolio KVS Index 500 Portfolio
Kemper Global Blue Chip Portfolio Scudder 21st Century Growth Portfolio
Kemper Government Securities Portfolio Scudder International Portfolio
Kemper Growth Portfolio Scudder Global Discovery Portfolio
Kemper High Yield Portfolio Scudder Capital Growth Portfolio
Kemper Horizon 5 Portfolio Scudder Growth and Income
Kemper Horizon 10+ Portfolio Warburg Pincus Emerging Markets Portfolio
Kemper Horizon 20+ Portfolio Warburg Pincus Global Post-Venture Capital Portfolio]
Kemper International Portfolio
Kemper Investment Grade Bond Portfolio
Kemper Money Market Portfolio
Kemper New Europe Portfolio
Kemper Small Cap Growth Portfolio
Kemper Small Cap Value Portfolio
Kemper Strategic Income Portfolio
Kemper Technology Growth Portfolio
Kemper Total Return Portfolio
Fixed Account
-------------
</TABLE>
FORM A8035-00 4
<PAGE>
<TABLE>
<CAPTION>
SPECIFICATIONS (continued)
<S> <C> <C>
Owner: [John Doe] Contract Number: [00000000]
Joint Owner: [Jack Doe]
Guarantee Period Accounts
-------------------------
Guarantee Interest Expiration
Period Rate Date
------ ---- ----
[ 2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years]
-------
100% TOTAL PAYMENT ALLOCATION
</TABLE>
FORM A8035-00 4
<PAGE>
<TABLE>
<CAPTION>
SPECIFICATIONS (continued)
<S> <C> <C>
Owner: [John Doe] Contract Number: [00000000]
Joint Owner: [Jack Doe]
RIDER(S) SELECTED:
[Enhanced Death Benefit Rider:]
[EDB Effective Annual Yield [5%]]
[EDB Charge:
For amounts allocated to the variable Sub-Accounts: [.25%] on an annual basis of the daily value of the
Sub-Account assets.
For amounts allocated to the Fixed Account: The credited rate will be
[.25%] lower than if the rider was not selected.
For amounts allocated to the Guarantee Period Accounts: The Guaranteed
Interest Rate will be [.25%] lower than if the rider was not selected.]
The EDB charge only applies during the Accumulation Phase.]
</TABLE>
FORM A8035-00 5
<PAGE>
<TABLE>
<CAPTION>
SPECIFICATIONS (supplement)
<S> <C> <C> <C>
Contract Type: [Non-qualified] Contract Number: [00000000]
Owner: [John Doe] Owner Date of Birth: [01/01/1960]
Joint Owner: [Jack Doe] Joint Owner Date of Birth: [01/01/1960]
Annuitant: [Mary Doe] Annuitant Date of Birth: [01/01/1950]
Joint Annuitant: [Michael Doe] Joint Annuitant Date of Birth: [01/01/1950]
Annuitant Sex: [Female] Beneficiary(ies):
Joint Annuitant Sex: [Male] Primary: Surviving Joint Owner, if any
1st Contingent: [Michael Doe]
2nd Contingent: [Jack Doe]
Payee: [John Doe]
Payee Address: [1 Main Street, Anywhere, USA 00000]
Annuity Date: [01/01/2010]
Annuity Benefit Payment Option: [Joint with 2/3 Survivor Life Option]
Survivor Annuity Benefit Percentage: [66 2/3%]
Percentage under a Fixed Annuity Option: [30%]
Percentage under a Variable Annuity Option: [70%]
Assumed Investment Return: [3%]
Annuity Benefit Payment Change Frequency: [Annual]
Annuity Benefit Frequency: [Monthly]
Variable Allocation on Annuity Date:
Sub-Accounts:
-------------
[Alger American Balanced Portfolio Kemper Value+Growth Portfolio
Alger American Leveraged AllCap Portfolio KVS Dreman Financial Services Portfolio
Dreyfus MidCap Stock Portfolio KVS Dreman High Return Equity Portfolio
Dreyfus Socially Responsible Growth Fund KVS Focused Large Cap Growth Portfolio
Kemper Aggressive Growth Portfolio KVS Growth & Income Portfolio
Kemper Blue Chip Portfolio KVS Growth Opportunities Portfolio
Kemper Contrarian Value Portfolio KVS Index 500 Portfolio
Kemper Global Blue Chip Portfolio Scudder 21st Century Growth Portfolio
Kemper Government Securities Portfolio Scudder International Portfolio
Kemper Growth Portfolio Scudder Global Discovery Portfolio
Kemper High Yield Portfolio Scudder Capital Growth Portfolio
Kemper Horizon 5 Portfolio Scudder Growth and Income
Kemper Horizon 10+ Portfolio Warburg Pincus Emerging Markets Portfolio
Kemper Horizon 20+ Portfolio Warburg Pincus Global Post-Venture Capital Portfolio]
Kemper International Portfolio
Kemper Investment Grade Bond Portfolio
Kemper Money Market Portfolio
Kemper New Europe Portfolio
Kemper Small Cap Growth Portfolio
Kemper Small Cap Value Portfolio
Kemper Strategic Income Portfolio
Kemper Technology Growth Portfolio
Kemper Total Return Portfolio
</TABLE>
FORM A8035-00 3a
<PAGE>
<TABLE>
<CAPTION>
SPECIFICATIONS (supplement)
<S> <C>
[Payment Withdrawal Amount [[10] times the previous monthly annuity benefit payment [but not more
than the remaining guaranteed annuity benefit payments]]]
[Present Value Withdrawal Amount: [[75%] of Present Value of remaining guaranteed annuity benefit
payments.]
[[100%] of Present Value of remaining guaranteed annuity benefit payments
for a period certain option]]
Mortality and Expense Risk Charge: [1.30%] on an annual basis of the daily value of the Sub-Account assets.
Administrative Charge: [.15%] on an annual basis of the daily value of the Sub-Account
assets.
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653 [(1-800-782-8380)]
</TABLE>
FORM A8035-00 3a
<PAGE>
DEFINITIONS
<TABLE>
<S> <C>
Accumulated Value The aggregate value of all accounts in
this contract before the Annuity Date. As
long as the Accumulated Value is greater
than zero, the contract will stay in effect.
Accumulation Unit A measure used to calculate the value
of a Sub-Account before annuity benefit
payments begin.
Annuitant On and after the Annuity Date, the person
upon whose continuation of life annuity
benefit payments involving life contingency
depend. Joint Annuitants are permitted and
unless otherwise indicated, any reference to
Annuitant shall include Joint Annuitants.
Annuity Date The date annuity benefit payments
begin. The Annuity Date is shown on the
Specifications page.
Annuity Unit A measure used to calculate annuity
benefit payments under a variable annuity
option.
Beneficiary The person, persons or entity entitled to
the Death Benefit prior to the Annuity Date
or any annuity benefit payments upon the
death of the Owner on or after the Annuity
Date.
Company Allmerica Financial Life Insurance and Annuity Company.
Contract Year A one-year period based on the issue date or an anniversary
thereof.
Cumulative Earnings Accumulated Value reduced by total Payments not previously
withdrawn.
Effective Valuation Date The Valuation Date on or
immediately following the day a Payment,
request for transfer, withdrawal or
surrender, or proof of death is received at
the Principal Office.
Fixed Account The part of the Company's General Account to which all or
a portion of a Payment or transfer may be allocated.
Fund Each separate investment company, investment
series or portfolio eligible for investment
by a Sub-Account of the Variable Account.
General Account All assets of the Company that are not allocated to a Separate Account.
Gross Payment Base Total gross payments made to
the contract reduced by withdrawals which
exceed the Withdrawal without Surrender
Charge amount.
Guarantee Period The number of years that a Guaranteed
Interest Rate may be credited to a Guarantee
Period Account.
Guarantee Period Account An account which corresponds
to a Guaranteed Interest Rate for a
specified Guarantee Period and is supported
by assets in a Separate Account. The Owner
may only invest in a Guarantee Period
Account prior to the Annuity Date.
Guaranteed Interest Rate The annual effective rate of
interest after daily compounding credited to
a Guarantee Period Account.
FORM A3035-00 7
<PAGE>
Market Value Adjustment A positive or negative
adjustment to earnings in a Guarantee Period
Account assessed if any portion of a
Guarantee Period Account is withdrawn or
transferred prior to the end of its
Guarantee Period.
Owner The person, persons or entity entitled to
exercise the rights and privileges under
this contract. Joint Owners are permitted
and unless otherwise indicated, any
reference to Owner shall include joint
Owners.
Pro Rata How a Payment or withdrawal may be
allocated among the accounts. A Pro Rata
allocation or withdrawal will be made in the
same proportion that the value of each
account bears to the Accumulated Value.
Request A request or notice made by the Owner, in a
manner consistent with the Company's current
procedures, which is received and recorded
by the Company.
Qualified Contract A contract that is purchased in
connection with a retirement plan which
meets the requirements of Sections 401, 403,
408 and 408A of the Internal Revenue Code.
Separate Account A segregated account established by
the Company. The assets in a Separate
Account are not commingled with the
Company's general assets and obligations.
The assets of a Separate Account are not
subject to claims arising out of any other
business the Company may conduct.
State The state or jurisdiction in which the contract is issued.
Sub-Account A Variable Account subdivision that invests
exclusively in shares of a corresponding
Fund.
Surrender Value The amount payable to the Owner on
full surrender after application of any
Market Value Adjustment, surrender charge
and Contract Fee.
Survivor Annuity Benefit The number of Annuity Units (under a variable joint
life annuitization Percentage option) or the dollar
value of the annuity benefit payments (under a fixed joint
life annuitization option) paid during the
surviving Annuitant's life may be less than
or equal to the number of Annuity Units or
dollars paid when both individuals are
living. The Survivor Annuity Benefit
Percentage is the percentage of total
Annuity Units or dollars paid in each
annuity benefit payment during the
survivor's life. For example, with a Joint
and Two-thirds Survivor Option, the Survivor
Annuity Benefit Percentage is 66 2/3%.
This percentage is only applicable after the
death of the first Annuitant.
Valuation Date A day the values of all units are
determined. Valuation Dates occur on each
day the New York Stock Exchange is open for
trading, or such other dates when there is
sufficient trading in a Fund's portfolio
securities such that the current unit value
may be materially affected.
Valuation Period The interval between two consecutive Valuation Dates.
Variable Account The Company's Separate Account,
consisting of Sub-Accounts that invest in
the underlying Funds.
FORM A3035-00 8
<PAGE>
OWNER, ANNUITANT AND BENEFICIARY
Owner When the contract is issued, the Owner will
be as shown on the Specifications page. The
Owner may be changed in accordance with the
terms of this contract. Upon the death of an
Owner prior to the Annuity Date, a Death
Benefit is paid. The Maximum Alternative
Annuity Date is based upon the age of the
Owner.
The Owner may exercise all rights and
options granted in this contract or by the
Company, subject to the consent of any
irrevocable Beneficiary. Where there are
joint Owners, the consent of both is
required in order to exercise any ownership
rights.
Assignment Prior to the Annuity Date and prior to the death of an
Owner, the Owner may be changed at any time. Only the Owner
may assign this contract. An absolute assignment will
transfer ownership to the assignee. This contract may also
be collaterally assigned as security. The limitations on
ownership rights while the collateral assignment is in
effect are stated in the assignment. Additional limitations
may exist for contracts issued under provisions of the
Internal Revenue Code.
An assignment will take place only when the
Company has actually received a Request in
writing and recorded the change at the
Principal Office. The Company will not be
deemed to know of the assignment until such
time. When recorded, the assignment will
take effect as of the date it was signed.
The assignment will be subject to payments
made or actions taken by the Company before
the change was recorded.
The Company will not be responsible for the
validity of any assignment nor the extent of
any assignee's interest. The interests of
the Beneficiary will be subject to any
assignment.
Annuitant When the contract is issued, the Annuitant will be as shown
on the Specifications page. The Annuitant may be changed in
accordance with the terms of this contract. Prior to the
Annuity Date, an Annuitant may be replaced or added unless
the Owner is a non-natural person. At all times there must
be at least one Annuitant. If the Annuitant dies and a
replacement is not named, the Owner will be considered to be
the new Annuitant. Upon the death of an Annuitant prior to
the Annuity Date, a Death Benefit is not paid unless the
Owner is a non-natural person.
A change of Annuitant will take place only
when the Company has actually received a
Request in writing and recorded the change
at the Principal Office. The Company will
not be deemed to know of the change of
Annuitant until such time. When recorded,
the change of Annuitant will take effect as
of the date it was signed. The change of
Annuitant will be subject to payments made
or actions taken by the Company before the
change was recorded.
FORM A3035-00 9
<PAGE>
Beneficiary The Beneficiary is as named on the
Specifications page unless subsequently
changed. The Owner may declare any
Beneficiary to be revocable or irrevocable.
A revocable Beneficiary may be changed at
any time prior to the Annuity Date and
before the death of an Owner or after the
Annuity Date and before the death of the
Annuitant. An irrevocable Beneficiary must
consent in writing to any change. Unless
otherwise indicated, the Beneficiary will be
revocable.
A Beneficiary change must be made in writing
in a form acceptable to the Company and will
be subject to the rights of any assignee of
record. When the Company receives the form,
the change will take place as of the date it
was signed, even if an Owner or the
Annuitant dies after the form is signed but
prior to the Company's receipt of the form.
Any rights created by the change will be
subject to payments made or actions taken by
the Company before the change was recorded.
All benefits payable to the Beneficiary
under this contract will be divided equally
among the surviving Beneficiaries of the
same class, unless the Owner directs
otherwise. If there is no surviving
Beneficiary in a particular class, then the
benefit is divided equally among the
surviving Beneficiaries of the next class.
If there is no surviving Beneficiary, the
deceased Beneficiary's interest will pass to
the Owner or the Owner's estate. At the
death of the first joint Owner prior to the
Annuity Date, the surviving joint Owner is
the sole, primary Beneficiary
notwithstanding that the designated
Beneficiary may be different.
The Beneficiary can not assign, transfer,
commute, anticipate or encumber the proceeds
or payments unless given that right by the
Owner.
Protection of Proceeds To the extent allowed by law,
this contract and any payments made under it
will be exempt from the claims of creditors.
FORM A3035-00 10
<PAGE>
THE ACCUMULATION PHASE
PAYMENTS
Payments Each Payment is equal to the gross payment
less the amount of any applicable premium
tax. The Company reserves the right to
deduct the amount of the premium tax from
the Accumulated Value at a later date rather
than when the premium tax liability is first
incurred by the Company. In no event will an
amount be deducted for premium taxes before
the Company has incurred a tax liability
under applicable State law.
Initial Payment The Initial Payment is shown on the Specifications page.
Additional Payments Prior to the Annuity Date and
before the death of an Owner, the Owner may
make additional Payments of at least the
Minimum Additional Payment Amount (see
Specifications page). Total Payments made
may not exceed [$5,000,000] without the
Company's consent.
Payment Allocations The Initial Payment is allocated
in accordance with the Payment Allocation,
shown on the Specifications page. Each
subsequent Payment will be allocated in the
same manner unless allocation instructions
accompany the Payment or the Payment
Allocation is changed by the Owner.
The minimum amount that may be allocated to
the Guarantee Period Account is shown on the
Specifications page. If the Owner requests
an allocation less than the minimum amount,
the Company reserves the right to apply that
amount to the [money market Sub-Account.]
VALUES
Value of the Variable The value of a Sub-Account on a Valuation Date is determined by
Account multiplying the Accumulation Units in that Sub-Account by the Accumulation
Unit Value as of the Valuation Date.
Accumulation Units are purchased when an
amount is allocated to a Sub-Account. The
number of Accumulation Units purchased
equals that amount divided by the applicable
Accumulation Unit Value as of the Valuation
Date.
FORM A3035-00 11
<PAGE>
Accumulation Unit The value of a Sub-Account Accumulation Unit as of any Valuation
Values Date is determined by multiplying the value of an Accumulation Unit for the
preceding Valuation Date by the Net Investment Factor for that Valuation Period.
Net Investment Factor The Net Investment Factor
measures the investment performance of a
Sub-Account from one Valuation Period to the
next. This factor is equal to 1.000000 plus
the result (which may be positive or
negative) from dividing (a) by (b) and
subtracting (c) and (d) where:
(a) is the investment income of a Sub-Account for the Valuation
Period, including realized or unrealized capital gains and losses
during the Valuation Period, adjusted for provisions made for
taxes, if any;
(b) is the value of that Sub-Account's assets at the beginning of the
Valuation Period;
(c) is the Mortality and Expense Risk Charge applicable to the
current Valuation Period (see Specifications page) plus any
applicable Rider charges; and
(d) is the Administrative Charge applicable to the current Valuation
Period (see Specifications page).
The Company assumes the risk that its actual
mortality expense experience may exceed the
amounts provided under the contract. The
Company guarantees that the charge for
mortality and expense risks and the
administrative charge will not be increased.
Subject to applicable State and federal
laws, these charges may be decreased or the
method used to determine the Net Investment
Factor may be changed.
Value of the Fixed Amounts allocated to the Fixed Account receive interest at rates periodically
Account set by the Company. The Company guarantees that the initial rate of interest
in effect when an amount is allocated to the
Fixed Account will remain in effect for that
amount for one year or until such amount is
transferred out of the Fixed Account,
whichever is sooner. Thereafter, the rate of
interest for that amount will be the
Company's current interest rate, but no less
than the Minimum Fixed Account Guaranteed
Interest Rate (see Specifications page).
The value of the Fixed Account on any date
is the sum of amounts allocated to the Fixed
Account plus interest compounded and
credited daily at the rates applicable to
those amounts. The value of the Fixed
Account will be at least equal to the
minimum required by law in the State in
which this contract is delivered.
FORM A3035-00 12
<PAGE>
Value of the Guarantee Amounts allocated to the same Guarantee Period Account on the same day will
Period Accounts be treated as one Guarantee Period Account. The interest rate in effect when an
amount is allocated to a Guarantee Period
Account is guaranteed for the duration of
the Guarantee Period. Each time the
Guaranteed Interest Rate changes for a
particular Guarantee Period, a new Guarantee
Period Account is established.
The value of a Guarantee Period Account on
any date is the sum of amounts allocated to
that Guarantee Period Account plus interest
compounded and credited daily at the rate
applicable to that amount.
Guaranteed Interest The Company will periodically set Guaranteed Interest Rates for each
Rates available Guarantee Period. These rates will be guaranteed for the duration of
the respective Guarantee Periods. A Guaranteed Interest Rate will never be less
than the Guarantee Period Account Minimum Interest Rate (see Specifications
page).
Renewal Guarantee At least 45 days (but not more than 75 days) prior to the end of a
Periods Guarantee Period, the Company will notify the Owner in writing of
the expiration of that Guarantee Period. The Owner may
transfer amounts to the Sub-Accounts, the Fixed Account or
establish a new Guarantee Period Account of any duration
then offered by the Company as of the day following the
expiration of the Guarantee Period. The transfer will not be
subject to a Market Value Adjustment; see "Market Value
Adjustment," page [16]. Guaranteed Interest Rates
corresponding to the available Guarantee Periods may be
higher or lower than the previous Guaranteed Interest Rate.
If reallocation instructions are not received at the
Principal Office before the end of a Guarantee Period, the
Guarantee Period Account value will be automatically applied
to a new Guarantee Period Account with the same Guarantee
Period unless:
(a) less than the Guarantee Period Account Minimum Allocation Amount
(see Specifications page) remains in the Guarantee Period Account
on its expiration date; or
(b) the Guarantee Period would extend beyond the Annuity Date or is
no longer available.
In such cases, the Guarantee Period Account
value will be transferred to the [money
market Sub-Account.]
Contract Fee Prior to the Annuity Date on each
contract anniversary and when the contract
is surrendered, the Company will deduct a
Contract Fee (see Specifications page) Pro
Rata.
VALUE ENHANCEMENT
Prior to the Annuity Date, on each Value
Enhancement Date, the Company will credit an
amount equal to the Accumulated Value
multiplied by the Value Enhancement
Percentage. (see Specifications page). This
amount will be credited to the contract's
Accumulated Value. Each Value Enhancement
will be allocated Pro-Rata.
FORM A3035-00 13
<PAGE>
TRANSFER
Prior to the Annuity Date, the Owner may
transfer amounts among accounts by Request
to the Principal Office. Transfers to a
Guarantee Period Account must be at least
equal to the Minimum Guarantee Period
Account Allocation Amount (see
Specifications page). If the Owner requests
the transfer of a smaller amount to the
Guarantee Period Account, the Company may
transfer that amount to the [money market
Sub-Account.]
Any transfer from a Guarantee Period Account
prior to the end of its Guarantee Period
will be subject to a Market Value
Adjustment.
There is no charge for the first twelve
transfers per contract year. A transfer
charge of up to $25 may be imposed on each
additional transfer.
The Company reserves the right to limit or
refuse transfers if it determines, in its
sole discretion, that the exercise of that
right by an Owner(s), or any agent or duly
authorized representative of such Owner(s)
is, or would be, to the disadvantage of
other Owners. Such transfer limitations
could be applied to transfers to or from
some or all of the accounts and could
include but not be limited to:
(a) the requirement of a minimum time period between each transfer;
(b) not accepting transfer requests of an agent or duly authorized
representative of such Owner(s) authorized to act on behalf of
such Owner(s); and
(c) limiting the dollar amount that may be transferred to or from any
of the accounts by an Owner(s) at any one time.
Such limitations, individually or in
aggregate, may be applied in any manner
reasonably designed to prevent any use of
the transfer right which is considered by
the Company to be to the disadvantage of
other Owners.
WITHDRAWAL AND SURRENDER
Prior to the Annuity Date, the Owner may, by
Request, withdraw a part of the Surrender
Value or surrender the contract for its
Surrender Value.
Any withdrawal must be at least the Minimum
Withdrawal Amount (see Specifications page).
A withdrawal will not be permitted to the
extent the Accumulated Value remaining in
the contract would be less than the Minimum
Accumulated Value After Withdrawal (see
Specifications page). The Request must
indicate the dollar amount to be paid and
the accounts from which it is to be
withdrawn. A withdrawal from a Guarantee
Period Account will be subject to a Market
Value Adjustment.
When surrendered, this contract terminates
and the Company has no further liability
under it. The Surrender Value will be based
on the Accumulated Value on the Effective
Valuation Date.
FORM A3035-00 14
<PAGE>
Amounts taken from the Variable Account will
be paid within 7 days of the date a Request
is received. The Company reserves the right
to delay payments subject to applicable
laws, rules and regulations governing
variable annuities.
Amounts taken from the Fixed Account or the
Guarantee Period Accounts will normally be
paid within 7 days of the date a Request is
received. The Company may defer payment for
up to six months from the receipt date.
If deferred for 30 days or more, the amount
payable will be credited interest at a rate
of at least 3% or the rate mandated by the
appropriate State.
Withdrawal Without In each calendar year, withdrawals up to the Withdrawal Without Surrender
Surrender Charge Charge Amount (see Specifications page) as of the Effective Valuation Date may
be made.
The Withdrawal Without Surrender Charge will
first be deducted from Cumulative Earnings.
To the extent that it exceeds Cumulative
Earnings, the excess will be considered
withdrawn on a last-in, first-out basis from
Payments not previously withdrawn. Amounts
withdrawn from a Guarantee Period Account
prior to the end of the applicable Guarantee
Period will be subject to a Market Value
Adjustment.
[Life Expectancy For Qualified Contracts and contracts funding
Distribution Benefit employer-sponsored Internal Revenue Code section 457 plans,
in each calendar year, the amount of the Life
Expectancy Distribution ("LED") benefit
available under the Company's then current
LED rules that exceeds the Withdrawal
Without Surrender Charge amount may also be
withdrawn without a surrender charge. Each
calendar year the LED benefit available is
reduced by any prior Withdrawal Without
Surrender Charge in the same year. LED
benefits are based on the life expectancy of
the Owner or the joint life expectancies of
the Owner and the Beneficiary.]
Withdrawal With Any amounts withdrawn or surrendered in excess of the Withdrawal
Surrender Charge Without Surrender Charge amount or Life Expectancy Distribution
benefit, if applicable, may be subject to a surrender charge.
These amounts will be first taken on a
first-in, first-out basis from Payments not
previously considered withdrawn. These
amounts will then be considered withdrawn
from Cumulative Earnings. The Company will
compute applicable charges using the
Surrender Charge Table (see Specifications
page).
Waiver of Surrender The surrender charge will be waived if an Owner, or the
Charge Annuitant if the Owner is a non-natural person, is:
(a) admitted to a "medical care facility" after being named Owner or
Annuitant and remains confined there until the later of one year
after the issue date or 90 consecutive days;
(b) first diagnosed by a licensed "physician" as having a "fatal
illness" after the issue date and after being named Owner or
Annuitant; or
(c) physically disabled after the issue date and after being named
Owner or Annuitant and before attaining age 65. The Company may
require proof of continuing disability, and reserves the right to
obtain an examination by a licensed physician" of its choice and
at its expense.
FORM A3035-00 15
<PAGE>
"Medical care facility" means any State
licensed facility providing medically
necessary inpatient care which is prescribed
by a licensed "physician" in writing and
based on physical limitations which prohibit
daily living in a non-institutional setting.
"Fatal illness" means a condition diagnosed
by a licensed "physician" which is expected
to result in death within two years of the
diagnosis. "Physician" means a person other
than the Owner, the Annuitant or a member of
one of their families who is State licensed
to give medical care or treatment and is
acting within the scope of that license.
"Physically disabled" means the Owner or
Annuitant has been unable to engage in an
occupation or to conduct daily activities
for a period of at least 12 consecutive
months as a result of disease or bodily
injury.
No additional Payments are permitted after
this provision becomes effective.
Market Value Adjustment A transfer, withdrawal or surrender from a Guarantee Period Account after the
expiration of its Guarantee Period will not be subject to a Market Value
Adjustment. A Market Value Adjustment will apply to all other transfers,
withdrawals or surrenders from a Guarantee Period Account. Amounts in a
Guarantee Period Account that are applied under an Annuity Option are treated as
withdrawals when calculating the Market Value Adjustment. The Market Value
Adjustment will be determined by multiplying the amount taken from each
Guarantee Period Account by the market value factor. The market value factor
for each Guarantee Period Account is equal to:
(1+i) n/365
(1+j) -1
where:
i - is the Guaranteed Interest Rate
expressed as a decimal (for example:
3% = 0.03) being credited to the
current Guarantee Period;
j - is the new Guaranteed Interest
Rate (as adjusted due to selection
of any Rider, if applicable),
expressed as a decimal, for a
Guarantee Period with a duration
equal to the number of years
remaining in the current Guarantee
Period, rounded to the next higher
number of whole years. If that rate
is not available, the Company will
use a suitable rate or index allowed
by the Department of Insurance; and
n - is the number of days remaining
from the Effective Valuation Date to
the end of the current Guarantee
Period.
FORM A3035-00 16
<PAGE>
If the Guaranteed Interest Rate being
credited is lower than the new Guaranteed
Interest Rate, the Market Value Adjustment
will decrease the Guarantee Period Account
value. Similarly, if the Guaranteed Interest
Rate being credited is higher than the new
Guaranteed Interest Rate, the Market Value
Adjustment will increase the Guarantee
Period Account value. The Market Value
Adjustment will never result in a change to
the value more than the interest earned in
excess of an amount based on the Guarantee
Period Account Minimum Interest Rate (see
Specifications page).
DEATH BENEFIT
At the death of an Owner prior to the
Annuity Date, the Company will pay to the
Beneficiary a Death Benefit upon receipt at
the Principal Office of proof of death. If
the Owner is a non-natural person, prior to
the Annuity Date, a Death Benefit is paid on
the death of an Annuitant, upon receipt at
the Principal Office of proof of death.
Death Benefit The Death Benefit will be the greater of:
(a) the Accumulated Value on the Effective Valuation Date, increased
by any positive Market Value Adjustment; or
(b) the sum of the gross payments made under this contract prior to
the date of death, proportionately reduced to reflect all partial
withdrawals.
For each withdrawal, the proportionate reduction is
calculated by multiplying the Death Benefit under the (b)
option, immediately prior to the withdrawal, by the
following:
Amount of the withdrawal
------------------------
Accumulated Value immediately prior to the withdrawal
Payment of the Death Unless the Owner has specified otherwise, the Death Benefit will be paid to the
Benefit Beneficiary within 7 days of the Effective Valuation Date. Alternatively, the
Beneficiary may, by a Request in writing, elect to:
(a) defer distribution of the Death Benefit for a period no more than
5 years from the date of death; or
(b) receive distributions over his/her life expectancy (or over a
period not extending beyond such life expectancy). Distributions
must begin within one year from the date of death.
FORM A3035-00 17
<PAGE>
If distribution of the Death Benefit is
deferred under (a) or (b), any value in
Guarantee Period Accounts will be
transferred to the [money market
Sub-Account]. The excess, if any, of the
Death Benefit over the Accumulated Value
will also be transferred to the [money
market Sub-Account.] The Beneficiary may, by
a Request, effect transfers and withdrawals,
but may not make additional Payments. If
there are multiple Beneficiaries, the
consent of all is required.
If the sole Beneficiary is the deceased
Owner's spouse, the Beneficiary may, by a
Request in writing, continue the contract
and become the new Owner and Annuitant
subject to the following:
(a) any value in the Guarantee Period Accounts will be transferred to
the [money market Sub-Account];
(b) the excess, if any, of the Death Benefit over the contract's
Accumulated Value will also be transferred to the [money market
Sub-Account];
(c) additional Payments may be made; and
(d) any subsequent spouse of the new Owner, if named as the
Beneficiary, may not continue the contract.
FORM A3035-00 18
<PAGE>
THE PAYOUT PHASE
ANNUITY BENEFIT
Annuity Options Annuity Options are available on a
fixed, variable or combination fixed and
variable basis. The Annuity Options
described below or any alternative option
offered by the Company may be chosen. If no
option is chosen, monthly annuity benefit
payments will be made under the Life with
Cash Back Annuity option.
The Owner may also elect to have the Death
Benefit applied under any Annuity Option not
extending beyond the Beneficiary's life
expectancy. Such an election may not be
altered by the Beneficiary.
Fixed annuity options are funded through the
General Account. Variable annuity options
may be funded through one or more of the
Sub-Accounts. Not all Sub-Accounts may be
made available.
Selection of Annuity The Owner must select an Annuity Benefit Payment Option. Annuity
Benefit Payments benefit payments will be paid monthly or at any other frequency currently
offered by the Company. If the first payment
would be less than the Minimum Annuity
Benefit Payment (see Specifications page), a
single payment will be made instead. If a
life annuity option has been elected,
satisfactory proof of the date of birth of
the Annuitant must be received at the
Principal Office before any payment is made.
Also, if a life annuity option has been
elected, the Company may require from time
to time satisfactory proof that the
Annuitant is alive.
Annuity Benefit Payment In the case of a variable annuity option, the Owner must select an Annuity
Change Frequency Benefit Payment Change Frequency. This is the frequency of change in the dollar
value of the variable annuity benefit
payments. For example, if an annual Annuity
Benefit Payment Change Frequency is chosen,
the dollar value of variable annuity benefit
payments will remain constant within each
one-year period. The Owner must also select
the date of the first change, which must be
within one Change Frequency from the Annuity
Date.
Assumed Investment In the case of a variable annuity option, the Owner must select an Assumed
Return Investment Return ("AIR"). This rate is used to determine the initial variable
annuity benefit payment and how the payment
will change over time in response to the
performance of the selected Sub-Accounts. If
the actual performance of any selected
Sub-Account (as measured by the Net
Investment Factor) is equal to the AIR, the
annuity benefit payment attributable to that
Sub-Account will be constant. If the actual
performance is greater than the AIR, the
annuity benefit payment will increase. If
the actual performance is less than the AIR,
the annuity benefit payment will decrease.
Annuity Value The Annuity Value will be the
Accumulated Value, after application of any
applicable Market Value Adjustment less any
applicable premium tax. For a Death Benefit
annuity, the Annuity Value will be the
amount of the Death Benefit, less any
applicable premium tax.
The amount of the first annuity benefit
payment under all available options except
period certain options will depend on the
age and/or sex of the Annuitant on the
Annuity Date and the Annuity Value applied.
Period certain options are based only on the
duration of payments and the Annuity Value.
FORM A3035-00 19
<PAGE>
Annuity Unit Values A Sub-Account Annuity Unit Value
on any Valuation Date is equal to its value
on the preceding Valuation Date multiplied
by the product of:
(a) a discount factor equivalent to the Assumed Investment Return;
and
(b) the Net Investment Factor of the Sub-Account funding the annuity
benefit payments for the applicable Valuation Period.
The value of an Annuity Unit as of any date
other than a Valuation Date is equal to its
value as of the preceding Valuation Date.
Each variable annuity benefit payment is
equal to the number of Annuity Units
multiplied by the applicable value of an
Annuity Unit, except that under a Joint and
Survivor Option, after the first death, the
number of units in each payment is equal to
the total number of units multiplied by the
Survivor Annuity Benefit Percentage.
Variable annuity benefit payments will
increase or decrease with the value of the
Annuity Units as of the date of the first
payment of each Annuity Benefit Payment
Change Frequency. The Company guarantees
that the amount of each variable annuity
benefit payment will not be affected by
changes in mortality and expense experience.
Number of Annuity Units For each Sub-Account the number of Annuity Units determining the
benefit payable is equal to the amount of
the first annuity benefit payment divided by
the value of the Annuity Unit as of the
Valuation Date used to calculate the amount
of the first payment. Once annuity benefit
payments begin, the number of Annuity Units
will not change unless a split, a withdrawal
or a transfer is made.
Payment of Annuity Annuity Benefit Payments are paid to the Owner. By Request in
Benefit Payments writing, the Owner may direct that payments are made to another
person, persons or entity. If an Owner, who is not also an Annuitant,
dies on or after the Annuity Date, the following occurs:
(a) If the deceased Owner was the sole Owner, then the remaining
annuity benefit payments will be payable to the Beneficiary in
accordance with the terms of the Annuity Option selected. Upon
the death of a sole Owner, the Beneficiary becomes the Owner of
the contract.
(b) If the contract has joint Owners, then the remaining annuity
benefit payments will be payable to the surviving joint Owner in
accordance with the terms of the Annuity Option selected. Upon
the death of the surviving joint Owner, the Beneficiary becomes
the Owner of the contract.
TRANSFER
After the Annuity Date and prior to the
death of the Annuitant, the Owner may
transfer among Sub-accounts by Request to
the Principal Office.
Transfers may increase or decrease the
number of Annuity Units in each subsequent
payment.
FORM A3035-00 20
<PAGE>
There is no charge for the first twelve
transfers per contract year. A transfer
charge of up to $25 may be imposed on each
additional transfer.
The Company reserves the right to limit or
refuse transfers if it determines, in its
sole discretion, that the exercise of that
right by an Owner(s), or any agent or duly
authorized representative of such Owner(s)
is, or would be, to the disadvantage of
other Owners. Such transfer limitations
could be applied to transfers to or from
some or all the accounts and could include
but not be limited to:
(d) the requirement of a minimum time period between each transfer;
(e) not accepting transfer requests of an agent or duly authorized
representative of such Owner(s) authorized to act on behalf of
such Owner(s); and
(f) limiting the dollar amount that may be transferred to or from any
of the account at any one time.
Such limitations, individually or in
aggregate, may be applied in any manner
reasonably designed to prevent any use of
the transfer right which is considered by
the Company to be to the disadvantage of
other Owners.
WITHDRAWAL
After the Annuity Date and prior to the
death of the Annuitant, the Owner may have
the right, based on the Annuity Option
selected, to make withdrawals. If the Death
Benefit is applied under an Annuity Option
the Beneficiary may also make withdrawals in
accordance with this provision.
Amounts withdrawn that were applied under a
variable Annuity Option will be paid within
7 days of the date a Request is received.
The Company reserves the right to delay
payments subject to applicable laws, rules
and regulations governing variable
annuities.
Amounts withdrawn that were applied under a
fixed Annuity Option will normally be paid
within 7 days of the date a Request is
received. The Company may defer payment for
up to six months from the date a Request is
received. If deferred for 30 days or more,
the amount payable will be credited interest
at a rate of at least 3% or the appropriate
rate mandated by the State.
Only one Request for withdrawal under each
provision may be made each calendar year,
unless a period certain option is chosen.
Payment Withdrawal Each calendar year, the Owner can request up to an amount
Amount Option equal to the Payment Withdrawal Amount (see Specifications page)
multiplied by the previous annuity benefit payment.
For fixed Annuity Options, each withdrawal
proportionately reduces the dollar amount of
each future annuity benefit payment. The
proportionate reduction is calculated by
multiplying the dollar amount of each future
annuity benefit payment by the following:
Amount of the withdrawal
------------------------
Present Value of all remaining fixed annuity
benefit payments immediately prior the withdrawal.
FORM A3035-00 21
<PAGE>
For variable Annuity Options, each
withdrawal proportionately reduces the
number of Annuity Units in each future
annuity benefit payment. The proportionate
reduction is calculated by multiplying the
number of Annuity Units in each future
annuity benefit payment by the following:
Amount of the withdrawal
------------------------
Present Value of all remaining variable annuity
benefit payments immediately prior to the withdrawal.
Present Value Over the life of the contract, for period certain, life with
Withdrawal Option period certain and cash back Annuity Options when there are
remaining guaranteed payments, the Owner may request withdrawals
which represent a percentage of the Present Value of those
remaining guaranteed annuity benefit payments. Each year a withdrawal is taken
under this provision, the Company records the percentage withdrawn. Each withdrawal
proportionately reduces future annuity benefit payments. (See proportionate
reduction calculation below.) The total percentage withdrawn over the life of the
contract cannot exceed the Present Value Withdrawal Amount (see Specifications page).
For fixed Annuity Options, each withdrawal
proportionately reduces the dollar amount of
each future annuity benefit payment. The
proportionate reduction is calculated by
multiplying the dollar amount of each future
annuity benefit payment by the following:
Amount of the withdrawal
------------------------
Present Value of all remaining fixed guaranteed annuity benefit
payments immediately prior to the withdrawal
For variable Annuity Options, each
withdrawal proportionately reduces any
remaining guaranteed payments. The
proportionate reduction is calculated by
multiplying the number of Annuity Units in
each future annuity benefit payment by the
following:
Amount of the withdrawal
------------------------
Present Value of all remaining variable guaranteed annuity benefit
payments immediately prior to the withdrawal
If an Annuitant is still living after there
are no remaining guaranteed payments under a
life with period certain or life with cash
back payout:
(a) for variable Annuity Options, the number of Annuity Units will
increase to the number of Annuity Units payable prior to any
withdrawals, adjusted for transfers.
(b) for fixed Annuity Options, the dollar amount of the annuity
benefit payments will increase to the amount payable prior to any
withdrawals, adjusted for transfers.
FORM A3035-00 22
<PAGE>
PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS
For a variety of purposes, it is at times
necessary to determine the Present Value of
either all future annuity benefit payments
or of future guaranteed annuity benefit
payments. Present Values are calculated
based on the Annuity 2000 Mortality Table,
male, female or unisex rates as appropriate,
and the interest rate or AIR used to
determine the annuity benefit payments
increased by the following adjustments:
Adjustment
Death of the Annuitant 0.00%
Withdrawals
7 or more years after the issue date 0.00%
Within 7 years of issue date:
15 or more years of annuity benefit payments being valued 1.00%
10-14 years of annuity benefit payments being valued 1.50%
Less than 10 years of annuity benefit payments being valued 2.00%
DEATH OF THE ANNUITANT
Unless otherwise indicated by the Owner,
upon the death of the Annuitant, the Present
Value of the remaining guaranteed annuity
benefit payments may be paid to the Owner.
FORM A3035-00 23
<PAGE>
ANNUITY BENEFIT PAYMENT OPTIONS
PERIOD CERTAIN ANNUITY:
Periodic annuity benefit payments for a
chosen number of years. The number of years
selected may be from 5 to 30, or any other
period currently made available by the
Company.
LIFE ANNUITY:
(a) Single Life - Periodic annuity benefit payments during the
Annuitant's life. The annuity benefit payments do not continue
after the death of the Annuitant.
(b) Joint and Survivor - Periodic annuity benefit payments during the
joint lifetime of the Joint Annuitants. For variable options,
after the first death, the number of units in each payment during
the lifetime of the survivor is equal to the total number of
units multiplied by the Survivor Annuity Benefit Percentage. For
fixed options, after the first death, the dollar amount of each
payment during the lifetime of the survivor is equal to the
dollar value of each payment paid prior to such death multiplied
by the Survivor Annuity Benefit Percentage.
ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS
If a life Annuity Option has been elected,
the Owner may also select one of the
following guarantees:
PERIOD CERTAIN (Life with Period Certain):
Periodic guaranteed annuity benefit payments
for a period of 5 to 30 years, or any other
period currently made available by the
Company.
CASH BACK (Life with Cash Back):
Upon notification of the Annuitant's death,
any excess of the Annuity Value applied over
the total amount of the annuity benefit
payments will be paid to the Owner or
Beneficiary, whichever is applicable.
ANNUITY OPTION RATE TABLES
The first variable annuity benefit payment
will be based on the Annuity Option Rates
made available by the Company on the rate
basis available at the time the Annuity
Option is selected. The fixed annuity
benefit payments will be based on the
greater of the guaranteed Annuity Option
Rates shown in the tables on the following
pages or the Company's non-guaranteed
current Annuity Option Rates applicable to
this class of contracts. The Company
guarantees that once an Annuity Option is
selected, the annuity benefit payments will
not be affected by changes in mortality and
expense experience.
FORM A3035-00 24
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
ANNUITY OPTION TABLES
FIRST MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE APPLIED
Age Life with 10 Year Life Life with
Nearest Period Certain Annuity Cash Back
Male Female Unisex Male Female Unisex Male Female Unisex
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
50 4.05 3.81 3.91 4.08 3.83 3.93 3.90 3.72 3.79
51 4.11 3.87 3.97 4.15 3.89 3.99 3.96 3.77 3.85
52 4.18 3.93 4.03 4.22 3.95 4.06 4.01 3.82 3.90
53 4.25 3.99 4.10 4.30 4.01 4.13 4.07 3.88 3.96
54 4.33 4.06 4.17 4.38 4.08 4.20 4.14 3.94 4.02
55 4.41 4.13 4.24 4.46 4.15 4.28 4.20 3.99 4.07
56 4.49 4.20 4.32 4.55 4.23 4.36 4.27 4.06 4.14
57 4.58 4.28 4.40 4.65 4.31 4.45 4.34 4.12 4.21
58 4.68 4.36 4.49 4.75 4.40 4.54 4.42 4.19 4.28
59 4.78 4.45 4.58 4.86 4.49 4.64 4.50 4.26 4.36
60 4.88 4.54 4.67 4.98 4.59 4.74 4.58 4.34 4.44
61 4.99 4.63 4.77 5.10 4.69 4.85 4.67 4.42 4.52
62 5.10 4.73 4.88 5.23 4.80 4.97 4.76 4.50 4.60
63 5.23 4.84 4.99 5.37 4.92 5.10 4.85 4.59 4.69
64 5.35 4.95 5.11 5.52 5.04 5.24 4.95 4.68 4.79
65 5.48 5.07 5.24 5.69 5.18 5.38 5.06 4.78 4.89
66 5.62 5.20 5.37 5.86 5.32 5.54 5.17 4.89 5.00
67 5.77 5.33 5.51 6.04 5.47 5.70 5.28 4.99 5.11
68 5.92 5.47 5.65 6.24 5.64 5.88 5.40 5.11 5.23
69 6.07 5.62 5.80 6.45 5.82 6.07 5.52 5.23 5.35
70 6.23 5.78 5.96 6.67 6.01 6.27 5.66 5.36 5.48
71 6.39 5.94 6.12 6.90 6.21 6.49 5.79 5.49 5.61
72 6.56 6.11 6.29 7.16 6.44 6.72 5.94 5.63 5.75
73 6.73 6.29 6.47 7.43 6.68 6.98 6.09 5.78 5.90
74 6.90 6.48 6.65 7.71 6.94 7.25 6.24 5.94 6.06
75 7.08 6.67 6.83 8.02 7.22 7.54 6.41 6.11 6.23
</TABLE>
These tables are based on an annual interest rate of 3%
and the Annuity 2000 Mortality Table
FORM A3035-00 25
<PAGE>
ANNUITY OPTION TABLES (Continued)
FIRST MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE APPLIED
Joint and Survivor Life Annuity
Older Age
<TABLE>
<CAPTION>
50 55 60 65 70 75 80
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Y 50 3.53 3.61 3.68 3.73 3.76 3.79 3.80
O 55 3.77 3.88 3.97 4.04 4.08 4.11
U 60 4.10 4.25 4.36 4.45 4.50
N 65 4.55 4.74 4.90 5.01
G 70 5.16 5.43 5.64
E 75 6.02 6.41
R 80 7.25
A
G
E
Joint and Two-Thirds Survivor Life Annuity
Older Age
50 55 60 65 70 75 80
<S> <C> <C> <C> <C> <C> <C> <C> <C>
Y 50 3.80 3.93 4.09 4.25 4.43 4.61 4.80
O 55 4.11 4.29 4.49 4.70 .491 5.13
U 60 4.53 4.77 5.02 5.29 5.55
N 65 5.09 5.42 5.75 6.07
G 70 5.88 6.31 6.75
E 75 6.99 7.59
R 80 8.58
A
G
E
</TABLE>
These tables are based on an annual interest rate
of 3% and the Annuity 2000 Mortality Table
FORM A3035-00 26
<PAGE>
ANNUITY OPTION TABLES (Continued)
FIRST MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF ANNUITY VALUE APPLIED
<TABLE>
<CAPTION>
Number of
Years Period Certain Annuity
<S> <C> <C>
5 17.91
10 9.61
15 6.87
20 5.51
25 4.71
30 4.18
</TABLE>
These tables are based on an annual interest rate of 3%
and the Annuity 2000 Mortality Tables.
FORM A3035-00 27
<PAGE>
PROVISIONS
<TABLE>
<S> <C>
Entire Contract The entire contract consists of
this contract, any application attached at
issue, riders, Specifications pages and
endorsements.
Misstatement of Age If the age or sex of an individual is misstated, the Company will adjust
or Sex all benefits payable to that which would be available at the correct age or
sex. Any underpayments already made by the
Company will be paid immediately. Any
overpayments will be deducted from future
annuity benefit payments.
Failure to Notify Company After the Annuity Date and once notified of the
Annuitant's Death Annuitant's death, the Company of reserves the right to
recover any overpaid annuity benefit payments.
Modifications Only the President or Vice President of the
Company may modify or waive any provisions
of this contract. Agents or Brokers are not
authorized to do so.
Incontestability The Company cannot challenge the validity of
this contract after it has been in force for
more than two years from the date of issue.
Change of Annuity Date The Owner may change the
Annuity Date by Request at any time after
the issue date. The request must be received
at the Principal Office at least one month
before the new Annuity Date. To the extent
permitted by applicable laws, rules and
regulations governing variable annuities,
the new Annuity Date must be no later than
the Maximum Alternative Annuity Date shown
on the Specifications page.
Minimums All values and benefits available under this
contract equal or exceed those required by
the State in which the contract is
delivered.
Annual Report The Company will furnish an annual
report to the Owner containing a statement
of the number and value of Accumulation
Units credited to the Sub-Accounts, the
value of the Fixed Account and the Guarantee
Period Accounts and any other information
required by applicable law, rules and
regulations.
Addition, Deletion, or The Company reserves the right, subject to compliance with applicable
Substitution of law, to add to, delete from, or substitute for the shares of a Fund that are
Investments held by the Sub-Accounts or that the Sub-Accounts may purchase. The Company
also reserves the right to eliminate the
shares of any Fund no longer available for
investment or if the Company believes
further investment in the Fund is no longer
appropriate for the purposes of the
Sub-Accounts. The Company will not
substitute shares attributable to any
interest in a Sub-Account without notice to
the Owner and prior approval of the
Securities and Exchange Commission as
required by the Investment Company Act of
1940. This will not prevent the Variable
Account from purchasing other securities for
other series or classes of contracts, or
from permitting a conversion between series
or classes of contracts on the basis of
requests made by Owners.
The Company reserves the right, subject to
compliance with applicable laws, to
establish additional Separate Accounts,
Guarantee Period Accounts and Sub-Accounts
and to make them available to any class or
series of contracts as the Company considers
appropriate. Each new Separate Account or
Sub-Account will invest in a new investment
company, or in shares of another open-end
investment company, or such other
investments as may be permitted under
FORM A3035-00 28
<PAGE>
applicable law. The Company also reserves
the right to eliminate or combine existing
Sub-Accounts and to transfer the assets of
any Sub-Accounts to any other Sub-Accounts.
In the event of any substitution or change,
the Company may, by appropriate notice, make
such changes in this and other contracts as
may be necessary or appropriate to reflect
the substitution or change. If the Company
considers it to be in the best interests of
the owners, the Variable Account or any
Sub-Account may be operated as a management
company under the Investment Company Act of
1940 or in any other form permitted by law,
or may be de-registered under the Act in the
event registration is no longer required, or
may be combined with other accounts of the
Company.
Changes in Law The Company reserves the right to
make any changes to provisions of the
contract to comply with, or give Owners the
benefit of, any federal or State statute,
rule, or regulation.
Change of Name Subject to compliance with
applicable law, the Company reserves the
right to change the names of the Variable
Account or the Sub-Accounts.
Federal Tax The Variable Account is not currently subject to tax, but the
Considerations Company reserves the right to assess a charge for taxes if the
Variable Account becomes subject to tax.
Splitting of Units The Company reserves the right to
split the value of a unit, either to
increase or decrease the number of units.
Any splitting of units will have no material
effect on the benefits, provisions or
investment return of this contract or upon
the Owner, the Annuitant, any Beneficiary,
or the Company.
Insulation of Separate The investment performance of Separate Account assets is determined
Account separately from the other assets of the Company. The assets of a Separate
Account equal to the reserves and
liabilities of the contracts supported by
the account will not be charged with
liabilities from any other business that the
Company may conduct.
</TABLE>
FORM A3035-00 29
<PAGE>
Flexible Payment Deferred Variable and Fixed Annuity
Annuity Benefit Payments Payable on the Annuity Date
Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date
Non-Participating
