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FORM: A97367 - ENDORSEMENT
This policy is amended on the Policy Date by deleting the Death Benefit
provision and adding the following provision:
Death Benefit. If the Annuitant dies prior to the first Policy Anniversary
and the Annuity Date and a death benefit is payable, the amount paid will be
the greater of (1) or (2) with each determined on the date we receive due
proof of the Annuitant's death:
(1) the sum of all premiums paid less any withdrawals and any applicable
surrender charges deducted.
(2) the Policy Accumulation Value.
If the Annuitant dies on or after the first Policy Anniversary and before the
Annuity Date and a death benefit is payable, the amount paid will be the
greatest of (1), (2) or (3) with each determined on the date we receive due
proof of the Annuitant's death:
(1) the sum of all premiums paid less any withdrawals and any applicable
surrender charges deducted.
(2) the Policy Accumulation Value.
(3) the Maximum Anniversary Value on the Policy Anniversary on or immediately
preceding the date we receive due proof of the Annuitant's death plus any
premiums received on and after that Policy Anniversary less any withdrawals and
any applicable surrender charges deducted on and after that Policy Anniversary.
The Maximum Anniversary Value on the first Policy Anniversary is the greater of
(1) or (2):
(1) Any premiums received on and after the Policy Date but prior to the first
Policy Anniversary less any withdrawals and any applicable surrender charges
deducted on and after the Policy Date but prior to the first Policy Anniversary.
(2) The Policy Accumulation Value on the first Policy Anniversary before any
transactions are processed on that date.
The Maximum Anniversary Value on each Policy Anniversary after the first and
until the Policy Anniversary when the Annuitant is age 80, is the greater of (1)
or (2):
(1) The Maximum Anniversary Value on the previous Policy Anniversary plus any
premiums received on and after that Policy Anniversary but prior to the current
Policy Anniversary less any withdrawals and any applicable surrender charges
deducted on and after that Policy Anniversary but prior to the current Policy
Anniversary.
(2) The Policy Accumulation Value on the current Policy Anniversary before any
transactions are processed on that date.
The Maximum Anniversary Value on each Policy Anniversary after the Policy
Anniversary when the Annuitant is age 80, will be the Maximum Anniversary Value
applicable on the Policy Anniversary when the Annuitant was age 80 plus any
premiums received on and after that Policy Anniversary but prior to the current
Policy Anniversary less any withdrawals and any applicable surrender charges
deducted on and after that Policy Anniversary but prior to the current Policy
Anniversary.
State Farm Life and Accident Assurance Company
