<PAGE>
PLEASE READ THIS CERTIFICATE CAREFULLY
THE CERTIFICATE VALUES, WHEN BASED ON THE INVESTMENT PERFORMANCE OF THE
VARIABLE ACCOUNT, MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO A
FIXED DOLLAR AMOUNT. PLEASE REFER TO THE VARIABLE ACCOUNT SECTION FOR
ADDITIONAL INFORMATION. WE AGREE TO PAY THE BENEFITS OF THIS CERTIFICATE IN
ACCORDANCE WITH ITS TERMS.
The value in the Fixed Account will accumulate at a rate which will not be
less than 4% a year; 5 1/2% on Certificate Value securing a Preferred Loan
(see page 19). Additional interest in excess of the guaranteed rate may be
credited at our discretion.
THE AMOUNT OF THE DEATH BENEFIT AND THE LENGTH OF TIME THIS CERTIFICATE WILL
REMAIN IN FORCE MAY BE VARIABLE OR FIXED AS DESCRIBED IN THE DEATH BENEFIT
PROVISION OF THIS CERTIFICATE. THE METHOD FOR DETERMINING THE AMOUNT OF THE
DEATH BENEFIT IS FOUND ON PAGE 27.
RIGHT TO CANCEL
We want you to be satisfied with the certificate you have purchased and we
urge you to examine it closely. If for any reason you are not satisfied, you
may return the certificate to us or an authorized representative within 10
days after receipt of the certificate.
If you return the certificate, it will be void from the Date of Issue, and
you will receive a refund equal to the total of payments made.
FIRST ALLMERICA FINANCIAL LIFE INSURANCE COMPANY
Home Office and
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653
This is a legal contract between First Allmerica Financial Life Insurance
Company and the owner. It is issued in consideration of the payment shown on
the Specifications Page. We agree to pay the benefits of this certificate in
accordance with its terms.
<PAGE>
MODIFIED SINGLE PAYMENT VARIABLE LIFE INSURANCE CERTIFICATE
NON-PARTICIPATING
FORM 1030-99GRC
<PAGE>
TABLE OF CONTENTS
SPECIFICATIONS ...................................................... 3
DEFINITIONS ......................................................... 7
GENERAL TERMS ........................................................ 9
INFORMATION ABOUT YOU AND THE BENEFICIARY ............................ 11
WHAT YOU SHOULD KNOW ABOUT:
THE PAYMENTS .................................................... 12
YOUR CERTIFICATE VALUE ............................................ 14
THE VARIABLE ACCOUNT .............................................. 16
THE FIXED ACCOUNT ................................................. 19
TRANSFERS ......................................................... 21
DOLLAR COST AVERAGING ............................................ 22
AUTOMATIC ACCOUNT REBALANCING ..................................... 23
BORROWING FROM YOUR CERTIFICATE ................................... 24
SURRENDERS AND PARTIAL WITHDRAWALS ............................... 25
THE DEATH BENEFIT ................................................. 27
THE BENEFIT OPTIONS .............................................. 28
FORM 1030-99GRC 2
<PAGE>
SPECIFICATIONS
<TABLE>
<S> <C>
Group Contractholder: First Allmerica Financial Group Life Insurance Trust
Certificate Number: Specimen
============================================================================================================
Certificate Owner: John Doe
First Insured: John Doe First Insured's Sex: Male
First Insured's Age: 35 First Insured's Underwriting Risk Class: Standard Non-Smoker
------------------------------------------------------------------------------------------------------------------------
Second Insured's: Mary Doe Second Insured's Sex: Female
Second Insured's Age: 35 Second Insured's Underwriting Risk Class: Standard Non-Smoker
------------------------------------------------------------------------------------------------------------------------
Date of Issue: 08/20/1999 Contract Plan: Allmerica Estate Optimizer
Modified Single
Payment Variable Life
Insurance Certificate
Face Amount: $674,149 Monthly Processing Date: 1st of each month
Owner(s): John Doe Rider: [ ]
Beneficiary at Issue: Mary Doe Rider Date of Issue: 08/20/1999
-----------------------------------------------------------------------------------------------------------------------
Payment: $50,000
Maximum Payment: The greater of [$50,000] or [$5,157.47] times the current certificate year.
-----------------------------------------------------------------------------------------------------------------------
Final Payment Date: 08/20/2064
Initial Payment Allocation:
Variable Accounts Managed by:
----------------- -----------
[4.00% Select Aggressive Growth [Nicholas-Applegate Capital Mgmt.
4.00% Select Capital Appreciation T. Rowe Price Associates, Inc.
5.00% Select Value Opportunity Cramer Rosenthal McGlynn, LLC
4.00% Select Emerging Markets Schroder Capital Mgmt Int'l, Inc.
4.00% T. Rowe Price Int'l Stock Row Price-Fleming Int'l, Inc.
4.00% Fidelity VIP Overseas Fidelity Management & Research Co.
4.00% Select International Equity Bank of Ireland Asset Management
4.00% Delaware Int'l Eqty Ser Delaware Int'l Advisors Ltd.
4.00% Fidelity VIP Growth Fidelity Management & Research Co.
4.00% Select Growth Putnam Investment Management, Inc.
4.00% Select Strategic Growth Cambiar Investors, Inc.
4.00% Allmerica Growth Fund Miller, Anderson & Sherrerd, LLP
4.00% Allmerica Equity Index Allmerica Asset Management, Inc.
4.00% Fidelity VIP Equity-Income Fidelity Management & Research Co.
4.00% Select Growth & Income J.P. Morgan Investment Mgmt, Inc.
4.00% Fidelity VIP II Asset Mgr. Fidelity Management & Research Co.
4.00% Fidelity VIP High Income Fidelity Management & Research Co.
4.00% Allmerica Invest Grade Inc. Allmerica Asset Management, Inc.
4.00% Select Income Standish, Ayer & Wood, Inc.
4.00% Allmerica Government Bond] Allmerica Asset Management, Inc.]
Fixed Account:
30.00% Initial Interest Rate: 5.25%
FORM 9030AE.1-99J GRC 3
<PAGE>
SPECIFICATIONS (continued)
First Insured: John Doe Certificate Number: Specimen
Second Insured: Mary Doe
========================================================================================================================
Minimum Additional Payment: $10,000
Minimum Fixed Account Interest Rate: 4% of value not subject to Outstanding Loan
4% of value securing Outstanding Loan - not preferred loan
5 1/2% of value securing Outstanding Loan - preferred loan
Outstanding Loan Interest Rate: 6%
Maximum Loan Amount: 90% of Certificate Value less the surrender charge
Minimum Loan Amount: $1,000
Minimum Balance After Withdrawal: $25,000
Free Withdrawal Amount: 10% of Certificate Value
Partial Withdrawal Transaction Charges: If you withdraw part of your funds, you will pay a transaction charge of
$25 or 2% of the amount withdrawn, whichever is less.
Partial Withdrawal Surrender Charge: You may also pay a surrender charge on any "excess" withdrawal.
This charge will not be higher than the surrender charge; see page
25.
Fees and Deductions: Current Guaranteed
Administration Charge: 0.20% Annually (1) 0.20% Annually (1)
Distribution Fee (Certificate Years 1 - 10): 0.90% Annually (1) 0.90% Annually (1)
Federal & State payment Tax Charge (Certificate Year 1): 1.50% Annually (1) 1.50% Annually (1)
Insurance Protection Charge (Certificate Years 1 - 10): 0.30% Annually (1) See Page 5
Insurance Protection Charge (Certificate Years 11 +): 0.20% Annually (1) See Page 5
Mortality & Expense Risk Charge: 0.90% Annually (2) 0.90% Annually (2)
Monthly Maintenance Fee: $2.50 Monthly (3) $2.50 Monthly (3)
(1) This charge is deducted monthly from the Certificate Value on a Pro Rata
basis. The monthly charge is equal to one -twelfth of this factor times the
Certificate Value.
(2) This charge is deducted daily from the Variable accounts on a pro rata
basis.
(3) This charge is deducted only when the Certificate Value is less than $100.
The insurance protection charge is currently expressed as a percentage of the
Certificate Value. This charge will never exceed the maximum guaranteed cost
based on the insurance protection amount. The use of a percentage of the
Certificate Value is done for simplicity and may not always bear a close
relationship to the actual cost of providing the coverage. Changes in this
insurance protection charge will be based on our expectations of future
mortality, persistency, and expense. Such changes may also be affected by past
investment performance to the extent that it affects our expectations as to the
future insurance risk. For example, we may increase the percentage of Account
Value used in determining the insurance charge solely as a result of poor past
investment performance.
If you have any questions, need information about you coverage or require
assistance, please call our Principal Office. The number is 1-800-917-1909.
Any interest credited to the Fixed Account which exceeds 4% is not guaranteed to
continue. We have the right to change both the interest rate credited to the
Fixed Account and the insurance protection charges, subject to the guarantees in
the certificate. The surrender value may become insufficient to continue the
certificate in force to the final premium payment date due to the following
factors: certificate loans, partial withdrawals, additional riders, increased
current insurance protection charges, decreased interest rates credited to the
Fixed Account, adverse investment experience of the Variable Account and, if
applicable, the amount and frequency of payments. Such changes may require more
payments than were illustrated; otherwise the certificate values will be less
than illustrated.
FORM 9030AE.1-99J GRC 4
<PAGE>
SPECIFICATIONS (continued)
First Insured: John Doe Certificate Number: Specimen
Second Insured: Mary Doe
====================================================================================================================
GUARANTEED MAXIMUM MONTHLY INSURANCE PROTECTION RATE TABLE
---------------------------------------------------------------------------------------------------------------------
Age Younger Insurance Protection Age Younger Insurance Protection
Insured Rate Per $1,000 Insured Rate Per $1,000
---------------------------------------------------------------------------------------------------------------------
35 0.000217 65 0.439078
36 0.000703 66 0.521200
37 0.001289 67 0.614749
38 0.001993 68 0.721506
39 0.002834 69 0.846015
40 0.003872 70 0.994310
41 0.005115 71 1.174155
42 0.006577 72 1.394700
43 0.008295 73 1.662531
44 0.010299 74 1.980498
45 0.012685 75 2.349532
46 0.015474 76 2.769071
47 0.018745 77 3.239642
48 0.022562 78 3.766606
49 0.027067 79 4.364118
50 0.032434 80 5.052298
51 0.038844 81 5.852153
52 0.046605 82 6.785037
53 0.055953 83 7.856533
54 0.066934 84 9.061063
55 0.079933 85 10.387235
56 0.094971 86 11.826072
57 0.112050 87 13.369670
58 0.131727 88 15.016091
59 0.154948 89 16.779858
60 0.182582 90 18.679678
61 0.215910 91 20.762219
62 0.256952 92 23.114261
63 0.307443 93 25.938583
64 0.367923 94 29.711151
95 35.461372
96 45.577846
97 66.332209
98 83.333333
99 83.333333
---------------------------------------------------------------------------------------------------------------------
The cost of insurance rates include an expense factor and a mortality factor.
The expense factor covers a portion of our acquisition costs and administrative
expenses. The mortality factor is based on the younger insured's: age, sex and
underwriting class. The guaranteed rates shown above are based on:
[Second To Die Life, Male, Age 35, Standard, Non-Smoker]
[Female, Age 35, Standard, Non-smoker]
[1980 CSO Age Last Birthday Table]
FORM 9030AE.1-99J GRC 5
<PAGE>
SPECIFICATIONS (continued)
First Insured: John Doe Certificate Number: Specimen
Second Insured: Mary Doe
=====================================================================================================================
GUIDELINE MINIMUM SUM INSURED TABLE
---------------------------------------------------------------------------------------------------------------------
Age Percentage Age Percentage
---------------------------------------------------------------------------------------------------------------------
0 thru 40 265% 59 149%
41 258% 60 145%
42 251% 61 143%
43 244% 62 141%
44 237% 63 139%
45 230% 64 137%
46 224% 65 135%
47 218% 66 134%
48 212% 67 133%
49 206% 68 132%
50 200% 69 131%
51 193% 70 130%
52 186% 71 128%
53 179% 72 thru 95 127%
54 172% 96 120%
55 165% 97 113%
56 161% 98 106%
57 157% 99 and over 100%
58 153%
---------------------------------------------------------------------------------------------------------------------
SURRENDER CHARGE TABLE (PERCENT OF TOTAL PREMIUM PAYMENTS WITHDRAWN)
--------------------------------------------------------
Certificate Total Surrender
Year* Charge
--------------------------------------------------------
1 10.00%
2 9.25%
3 8.50%
4 7.75%
5 7.00%
6 6.25%
7 4.75%
8 3.25%
9 1.50%
10 0%
--------------------------------------------------------
*For a Certificate that lapses and is restored, see Reinstatement provisions.
</TABLE>
FORM 9030AE.1-96J GRC 6
<PAGE>
<TABLE>
<CAPTION>
<S> <C>
DEFINITIONS
AGE means how old the Insured is on his/her last birthday
measured on the Date of Issue and each certificate anniversary.
APPLICATION is the form you complete to apply for this certificate. It shows
your payment, payment allocation and other information that enables
us to prepare this certificate. If a medical questionnaire or other
forms are required, they become a part of the application. The
application is signed by you and the Insured and becomes a part
of this certificate.
ASSIGNEE is the person to whom you have transferred your ownership of this certificate.
CERTIFICATE CHANGE means any change in the Underwriting Risk Class or the addition or
deletion of a Rider.
CERTIFICATE VALUE is the sum of your values in the Variable Account and the Fixed Account.
COMPANY means First Allmerica Financial Life Insurance Company, also referred to
as we, our and us.
DATE OF ISSUE is stated on the Specifications Page. Certificate months, years and
anniversaries are measured from this date.
EARNINGS means the amount by which the Certificate Value exceeds the sum of
the payments made less any payments that were previously considered
withdrawn. Earnings are calculated on each Monthly Processing Date.
EVIDENCE OF INSURABILITY is the information, including medical information, that we use to decide the
Underwriting Risk Class of the Insured.
FACE AMOUNT is the amount of insurance coverage you elect to buy. The Face Amount is shown
on the Specifications Page of the certificate. Except as otherwise provided in
the Paid-Up Insurance Option, the death benefit prior to the Final
Payment Date is based on the Face Amount; see the Death Benefit section.
FINAL PAYMENT DATE is the certificate anniversary before the insured's 100th birthday. This date is shown
on the Specifications Page. No payments may be made by you after this date. The net death
benefit after this date will equal the Certificate Value minus any Outstanding Loan.
FIXED ACCOUNT is the part of the Company's General Account to which all or a portion of a payment or transfer
may be allocated.
FUND is a separate investment series for investment by a Sub-Account of the Variable Account.
GENERAL ACCOUNT is the assets of the Company that are not allocated to a Separate Account.
GROUP LIFE INSURANCE means the Group Contract issued by us to the group Contract holder.
CONTRACT OR CONTRACT indicated on the Specification Page.
HOME OFFICE means our office located at 440 Lincoln St., Worcester, Massachusetts 01653.
FORM 1030-99GRC 7
<PAGE>
INSURANCE PROTECTION is the death benefit minus the Certificate Value.
AMOUNT
INSURED is the person covered as indicated on the Specifications Page.
MAXIMUM PAYMENT is determined according to rules in the federal tax law, and will be adjusted as that law
changes. If the Maximum limit applies to this certificate, we will return any excess payment
you have made with interest to you within 60 days after the certificate anniversary. We
will pay interest on each refund at the Fixed Account interest rate in effect on the date we
receive payment.
MONTHLY INSURANCE is the amount of money that we deduct from the certificate Value each
PROTECTION CHARGE month to pay for the insurance; see pages 14 and 15 for details.
MONTHLY PROCESSING DATE is the date the monthly charges are deducted from the Certificate Value. This date is shown
on the Specifications Page. If the Company is not open on this date, the Monthly Processing
Date will be the next business day.
OUTSTANDING LOAN means all unpaid certificate loans plus interest due or accrued on such loans.
PRO RATA refers to an allocation among the Sub-Accounts of the Variable Account and the Fixed Account.
A Pro Rata allocation will be in the same proportion that the Certificate Value in each
Sub-Account of the Variable Account and the Certificate Value in the Fixed Account (other
than value that is subject to Outstanding Loan) have to the total Certificate Value.
RIDER is an optional benefit that may be added to your certificate for an additional charge.
SEPARATE ACCOUNT is a segregated account established by the Company. The assets are not commingled with
the Company's general assets.
SPECIFICATIONS PAGES contain information specific to your certificate and are located after the Table of
Contents.
SUB-ACCOUNTS are subdivisions of the Variable Account investing exclusively in the shares of one or
more Funds.
UNDERWRITING RISK CLASS means the insurance risk classification that we assign to the Insured based on the information
in the Application and any other Evidence of Insurability we obtain. The Underwriting Risk
Class affects the Monthly Insurance Protection Charge and the amount of payments required to
keep the certificate in force.
VARIABLE ACCOUNT is the Company's Separate Account, consisting of Sub-Accounts that invest in the underlying
Funds.
WRITTEN REQUEST is a request you make in written form that is satisfactory to us and filed at our Home Office.
YOU OR YOUR means the owner of this certificate as shown in the Application or in the latest change filed
with us.
FORM 1030-99GRC 8
<PAGE>
GENERAL TERMS
ENTIRE CONTRACT This certificate, with a copy of the Application, and any attached endorsements, is
the entire contract between you and us. The entire contract also includes: a copy of any
Application to change to a better Underwriting Risk Class, any new Specifications Pages, and
any supplemental pages issued. Nothing in the group insurance policy under which this
certificate is issued shall invalidate or impair the rights granted to you by law and by
this certificate.
All statements in the application or enrollment form are considered representations and not
warranties. The Company may not use any statement to contest this certificate or deny a
claim unless the statement is in the application or enrollment form. Our
representatives are not permitted to change this certificate or extend the time for making
payments. Only our President, a Vice President or Secretary may change the provisions of this
certificate, and then only in writing.
RIGHT TO CONTEST THE A contest is any action taken by us to cancel your insurance or deny a claim based on material
CERTIFICATE IS LIMITED misrepresentations in your Application. Except for failure to pay premiums, we cannot contest
this certificate if it has been in force for two years from the Date of Issue and the Insured
is alive at the end of this two-year period.
If the Underwriting Risk Class is changed at your request, we cannot contest the change
after it has been in force for two years from its effective date and the Insured is alive.
NON-PARTICIPATING No insurance dividends will be paid on this certificate.
ADJUSTMENT OF COST We determine the monthly insurance protection charge and Fixed Account interest rates which
FACTORS are used to calculate the certificate value, subject to the guarantees noted in this
certificate. Any changes in these charges and rates will be made by underwriting class only,
and will be based on changes in our future expectations for such things as: our investment
earnings, our expenses, life expectancy rates, and how many certificate owners keep their
certificates.
SUICIDE EXCLUSION If an Insured commits suicide within two years of the Date of Issue of this certificate, we
will not pay a death benefit. The beneficiary will receive only the total amount of payments
made to us less any Outstanding Loan and amounts withdrawn.
MISSTATEMENT OF AGE On the date of death of the insured, the death benefit will be reduced or increased if the
OR SEX Age or Sex is misstated. The adjustment will be based upon the ratio of the Maximum Payment
for this certificate to the Maximum Payment for the certificate issued at the correct Age or
Sex.
PROTECTION OF BENEFITS To the extent allowed by law, the benefits provided by this certificate cannot be reached
by the beneficiary's creditors. No beneficiary may assign, transfer, anticipate, or encumber
the Certificate Value or benefit unless you give them this right.
FORM 1030-99GRC 9
<PAGE>
PERIODIC REPORT We will mail a report to you at your last known address at least once a year. This report will
provide the following information:
- Certificate Values in each Sub-Account and in the Fixed Account;
- the value of the certificate if surrendered;
- payments made by you and charges deducted by us since the last report;
- the Outstanding Loan and any other information required by law; and
- the death benefit.
FORM 1030-99GRC 10
<PAGE>
INFORMATION ABOUT YOU AND THE BENEFICIARY
OWNER The original owner of the certificate is shown on the Specifications
Page. The owner may change the ownership of this certificate without the consent
of any beneficiary.
ASSIGNMENT You may change the ownership of this certificate by sending us a
Written Request. An absolute assignment will transfer ownership of the
certificate from you to another person called the Assignee.
You may also assign this certificate as collateral to a collateral Assignee. The
limitations on your ownership rights while a collateral assignment is in effect
are specified in the assignment.
An assignment will take place when the Written Request is received at our Home
Office. When received, it will take effect on the date it was signed by you.
Any rights created by the assignment will be subject to any payments made or
actions taken by us before the change is received. We are not responsible for
assuring that any assignment or any Assignee's interest is valid.
BENEFICIARY You name the beneficiary to receive the net death benefit. The
beneficiary's interest will be affected by any assignment you make. If you
assign this certificate as collateral, all or a portion of the net death benefit
will first be paid to the collateral Assignee; any money left over from the
amount due the Assignee will go to those otherwise entitled to it.
Your choice of beneficiary may be revocable or irrevocable. You may change a
revocable beneficiary at any time by Written Request; but an irrevocable
beneficiary must agree to any change in writing. You will also need an
irrevocable beneficiary's permission to exercise other rights and options
granted by this certificate. Unless you have asked otherwise, the beneficiary
will be revocable.
Any change of the beneficiary must be made while the Insured is living. This
change will take place on the date the request is signed, even if the Insured is
not living on the day we receive it at the Home Office. Any rights created by
the change will be subject to any payments made, or actions taken, before we
receive the Written Request.
If a beneficiary dies before the Insured, his or her interest in this
certificate will pass to any surviving beneficiaries in proportion to their
share in the net death benefit, unless you have requested otherwise. If all
beneficiaries die before the Insured, the net death benefit will pass to you or
your estate.
COMMON DISASTER The common disaster option may be elected by Written Request. If the common
OPTION disaster option is in effect on the date of the Insured's death, the beneficiary
must be alive a certain number of days following the Insured's date of death in
order to be entitled to receive a benefit; otherwise, we will pay the net death
benefit as though the beneficiary died before the Insured. The number of days that
the beneficiary must live after the Insured's death is selected by you when you
elect the common disaster option.
FORM 1030-99GRC 11
<PAGE>
WHAT YOU SHOULD KNOW ABOUT THE PAYMENTS
PAYMENTS This certificate will not be in force until the payment is made to us.
The payment must be sent to either our Home Office or an authorized
representative. If you request it in writing, we will send you a signed receipt
after the payment is received.
Except as otherwise provided in the Paid Up Insurance Option, additional
payments under the certificate will be permitted prior to the Final Payment Date
only under the following circumstances:
1. An additional payment is required to keep the certificate in force
according to the Grace Period provisions.
2. An additional payment is required for reinstatement.
3. Additional payments may be made at any time provided the sum of the
payments less withdrawals does not exceed the Maximum Payment shown on the
Specifications Page. The minimum amount of the additional payment is
indicated on the Specifications Page.
Subject to the limitations set forth above, We will accept any payment (or
portion thereof) which does not increase the Amount at Risk; see Minimum Death
Benefit Provision. Any payment (or portion thereof) which would increase the
Amount at Risk shall be returned to the Certificate Owner by Us. No additional
payments which increase the Amount at Risk will be accepted and no additional
death benefit shall be provided until the following conditions have been met:
(1) Evidence of Insurability has been received by Us; and (2) We have notified
the Certificate Owner that the Insured is in a satisfactory Underwriting Risk
Class. The notification shall include a copy of the Application Form containing
the information relied on by Us in making Our determination. The Certificate
Owner may make payments which increase the Amount at Risk for 60 days following
the date of such notification by Us that the conditions have been met, but not
later than the Final Premium Payment Date.
A payment received while there is an Outstanding Loan on the certificate will be
considered a loan repayment rather than an additional payment.
GRACE PERIOD This certificate will terminate 62 days after a Monthly Processing Date on which
the surrender value is less than zero. The 62 day period is a grace period.
At least 61 days before the end of the grace period, we will mail the owner
and any Assignee written notice of the amount of payment that will be required
to continue this certificate in force. We also will send a notice to your
last known address at least 15 and not more than 45 days prior to the end of
the grace period if the surrender value is not adequate to prevent lapse. The
required payment will be no greater than the amount required to pay the
monthly deductions for three months as of the day the grace period began. If
that payment is not paid by the end of the grace period, the certificate will
terminate without value.
The death benefit during the grace period will be reduced by any overdue
charges. The certificate will lapse if the amount shown in the notice remains
unpaid at the end of the grace period. The certificate terminates on the date
of lapse.
FORM 1030-99GRC 12
<PAGE>
REINSTATEMENT If this certificate has lapsed or foreclosed for failure to pay
loan interest and has not been surrendered, it may be restored (called
"reinstated" in this certificate) within three years after the date of default
or foreclosure. We will reinstate the certificate on the Monthly Processing
Date following the day we receive all of the following items:
- a written Application for reinstatement;
- Evidence of Insurability showing the Insured is insurable according to our
underwriting rules at that time;
- a payment large enough to keep the certificate in force for three months;
and
- a payment or reinstatement of any loans against the certificate that
existed at the end of the grace period.
Your reinstatement payment will be allocated to the Fixed Account until we
approve your Application. At that time, we will transfer the reinstatement
payment, plus accrued interest, as you directed in your last payment allocation
request.
The Certificate Value on the reinstatement date is:
- the payment to reinstate the certificate, including the interest earned
from the date we received your payment; plus
- an amount equal to the Certificate Value less any Outstanding Loan on the
default date; less
- the monthly deductions due on the reinstatement date.
For the purpose of measuring the surrender charge period, the certificate will
be reinstated as of the date of default. The surrender charge on the
reinstatement date is the charge that was in effect on the date of default.
REINSTATEMENT OF PAID-UP If this certificate is in force as paid-up insurance and later terminates
INSURANCE for failure to pay certificate loan interest, the paid-up insurance
may be reinstated during the insured's lifetime, but no more than three years
after the date of foreclosure, by providing us with the following:
evidence of insurability showing the insured is acceptable according to our
underwriting rules; and
payment or reinstatement of the outstanding loan on the date of the default.
Interest is payable on this outstanding loan from the date of termination to the
date of reinstatement at the interest rate of 6% per year.
The date of reinstatement is the later of the date we approve the reinstatement
application or the date the payment required to reinstate this certificate is
received by us. The death benefit of the reinstated paid-up insurance will be
the same as the death benefit on the date of termination.
FORM 1030-99GRC 13
<PAGE>
WHAT YOU SHOULD KNOW ABOUT YOUR CERTIFICATE VALUE
Your Certificate Value is the sum of the Variable Account value and the Fixed
Account value.
ALLOCATION OF INITIAL If you make a payment with your Application or at any time before your right
PAYMENTS to examine the certificate expires, we may put that payment into the Money
Market Fund Sub-Account on the date it is received at our Home Office or the
Date of Issue, if later. We will transfer the Certificate Value as you
directed in your Application, or by later request, no later than the expiration
of the period during which you may exercise your right to cancel the
certificate.
MONTHLY DEDUCTION Beginning on the date this certificate is issued and on
every Monthly Processing Date until the Final Payment Date, we will deduct the
following monthly charges Pro Rata from the Certificate Value:
- the Administration Charge;
- the Distribution Fee;
- the Federal & State Payment Tax Charge;
- the Insurance Protection Charge; and
- the Monthly Maintenance Fee.
Except as otherwise prescribed in the paid-up insurance option, you may choose a
sub-account from which this monthly charge will be deducted. These amounts are
shown on the Specifications Page of the Certificate.
Charges allocated to the Fixed Account will be deducted on a last-in, first-out
basis. This means that we use the most recent payments to pay the fees.
ADMINISTRATION CHARGE The Administration Charge compensates us for the cost
of providing administrative services attributable to this Certificate.
DISTRIBUTION FEE The Distribution Fee compensates us for distribution expenses.
FEDERAL & STATE PAYMENT This charge compensates us for federal, state and local taxes we must pay.
TAX CHARGE
INSURANCE PROTECTION The Insurance Protection Charge compensates us for the cost of
CHARGE providing a death benefit in excess of the Certificate Value. This
charge will not exceed the guaranteed maximum Insurance Protection Charge. The
guaranteed maximum Insurance Protection Charge for any certificate month is
equal to (a) times (b), where;
(a) is the rate shown in the Guaranteed Maximum Monthly Insurance Protection
Table shown on the Specifications Page, and
(b) is the Insurance Protection Amount.
FORM 1030-99GRC 14
<PAGE>
The insurance protection rates actually charged will usually be lower than, and
never will be higher than, the guaranteed rates. We will determine the
Insurance Protection charge each month. Any change in insurance protection
rates will apply to all individuals in the same Underwriting Risk Class as the
Insured. We will review the actual insurance protection rates for this
certificate whenever we change these rates for new certificates. In any event,
rates will be reviewed no more often than once each year, but not less than once
in a five-year period.
MONTHLY MAINTENANCE The Monthly Maintenance Fee shown on the Specifications Page will be
FEE deducted on each Monthly Processing Date.
FORM 1030-99GRC 15
<PAGE>
WHAT YOU SHOULD KNOW ABOUT THE VARIABLE ACCOUNT
VARIABLE ACCOUNT The value of your certificate will vary if it is funded
through investments in the Sub-Accounts of the Variable Account. This account is
separate from our Fixed Account. We have exclusive and absolute ownership and
control of all assets, including those in the Variable Account. However, the
portion of assets in the Variable Account equal to the reserves and liabilities
of the certificates that are supported by this account will not be charged with
liabilities that arise out of any other business we conduct.
This account, established to support variable life insurance contracts, called
SPVL, is registered with the Securities and Exchange Commission (SEC) as a unit
investment trust under the Investment Company Act of 1940. It is also governed
by the laws of the State of Massachusetts and the State of New York. The laws
of the state in which the certificate is delivered will apply.
This account has several Sub-Accounts. Each Sub-Account invests its assets in a
separate series of a registered investment company (called a "Fund"). We
reserve the right, when the law allows, to change the name of the Variable
Account or any of its Sub-Accounts. A list of the available Sub-Accounts in
which you may choose to invest is on the Application.
VARIABLE ACCOUNT The payment you make to us will be allocated to the Money Market Fund Sub-Account
CERTIFICATE VALUE on the date we receive the payment or the Date of Issue, if it occurs after the
date we receive the payment. This value will be transferred to the Sub-Accounts in
accordance with your payment allocation no later than the expiration of the period
during which you may exercise your right to cancel the certificate. Payments made
thereafter that are allocated to the Sub-Accounts will purchase additional units
of the Sub-Accounts.
The number of units purchased in each Sub-Account is equal to the portion of the
payment allocated to the Sub-Account, divided by the value of the applicable
unit as of the valuation date the payment is received at our Home Office, or on
the valuation date that value is transferred to the Sub-Account from another
Sub-Account or the Fixed Account.
The number of units will remain fixed unless (1) changed by a subsequent split
of unit value, or (2) reduced because of a transfer, certificate loan, partial
withdrawal, partial withdrawal transaction charge, monthly deductions, surrender
or surrender charge allocated to the Sub-Account or (3) changed due to
subsequent payments. Any transaction described in (2) will result in the
cancellation of an appropriate number of units. On each valuation date, we will
value the assets of each Sub-Account where activity has occurred. The
Certificate Value in a Sub-Account at any time is equal to the number of units
this certificate then has in that Sub-Account multiplied by the Sub-Account's
unit value. The value of a unit for any Sub-Account for any valuation period is
determined by multiplying that Sub-Account's unit value for the immediately
preceding valuation period by the net investment factor for the valuation period
for which the unit value is being calculated. The unit value will reflect the
investment advisory fee and other expenses incurred by the registered investment
companies.
NET INVESTMENT FACTOR This measures the investment performance of a Sub-Account during the valuation
period that has just ended. The net investment factor is the result of [ (a)
plus (b), divided by (c)], minus (d) where:
(a) is the net asset value per share of a Fund share held in the Sub-Account
determined at the end of the current valuation period, plus
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(b) is the per share amount of any dividend or capital gain distributions made
by the Fund on shares held in the Sub-Account if the "ex-dividend" date occurs
during the current valuation period.
(c) is the net asset value per share of a Fund share held in the Sub-Account
determined as of the end of the immediately preceding valuation period.
(d) is a charge for mortality and expense risks in the valuation period. The
current mortality and expense risk charge is shown on the Specifications Page.
This charge may be increased or decreased, but will never exceed the maximum
mortality and expense risk charge shown on the Specifications Page of the
Certificate. Expense and mortality results shall not adversely affect this
maximum charge.
Since the net investment factor may be more or less than one, the unit value may
increase or decrease. You bear the investment risk. We reserve the right,
subject to any required regulatory approvals, to change the method we use to
determine the net investment factor.
VALUATION DATES AND A valuation date is each day that the New York Stock Exchange (NYSE)
PERIODS is open for business and any other day that there is enough trading in
the Variable Account's underlying portfolio securities to materially affect the
value of the Variable Account. A valuation period is the period between
valuation dates.
ADDITION, DELETION OR We may not change the investment policy of the Variable Account without
SUBSTITUTION OF the approval of the Insurance Commissioner of Massachusetts and the
INVESTMENTS Superintendent of Insurance in New York. This approval process
is on file with the Superintendent.
We reserve the right, subject to compliance with applicable law, to add, delete,
or substitute the shares of a Fund that are held by the Variable Account or that
the Variable Account may purchase. We also reserve the right to eliminate the
shares of any Fund if they are no longer available for investment, or if we
believe investing more in any Fund is no longer appropriate for the purposes of
the Variable Account.
We will notify you before we substitute any of your shares in the Variable
Account. This will not, however, prevent the Variable Account from buying other
shares of underlying securities for other series or classes of policies, or from
permitting a conversion between series or classes of policies or certificates
when requested by the certificate owner.
We reserve the right to establish other Sub-Accounts, and to make them available
to any class or series of policies as we think appropriate. Each new
Sub-Account would invest in a new investment company or in shares of another
open-end investment company. We also reserve the right to eliminate or combine
existing Sub-Accounts of the Variable Account and to transfer the assets between
Sub-Accounts, when allowed by law.
If we make any substitutions or changes that we believe are necessary or
appropriate, we may make changes in this certificate by written notice to
reflect the substitution or change. If we think it is in the best interests of
our certificate owners, we may operate the Variable Account as a management
company under the Investment Company Act of 1940, or we may de-register it under
that Act if registration is no longer required. We may also combine it with
other Separate Accounts.
FORM 1030-99GRC 17
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No material change in the underlying investment policy of a sub-account of the
Variable Account shall be made until 60 days have elapsed from the date of such
change has been filed with the New York Superintendent of Insurance or such
shorter period as the Superintendent may permit. In the event of a material
change in the underlying investment policy of a sub-account of the Variable
Account, you will be notified of the change. If you have certificate value in
that sub-account, we will transfer it without charge on written request by you
to another sub-account of the Variable Account or the Fixed Account. We must
receive your written request within sixty (60) days of the later of (1) the
effective date of such change in the investment policy or (2) the receipt of
notice of your right to transfer. You may then change your payment and deduction
allocation percentages.
FEDERAL TAXES If we must pay taxes on the Variable Account, we will charge you
for that tax. Although the Variable Account is currently not taxable, we
reserve the right to charge for taxes if it becomes taxable.
SPLITTING OF UNITS We reserve the right to split the value of a unit, to either
increase or decrease the number of units. Any splitting of units will have no
material effect on certificate benefits.
FORM 1030-99GRC 18
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WHAT YOU SHOULD KNOW ABOUT THE FIXED ACCOUNT
FIXED ACCOUNT The Fixed Account is a part of our General Account. The General
Account consists of all assets owned by us, other than those in the Variable
Account and other Separate Accounts. Except as limited by law, we have sole
control over the investment of these General Account assets. You do not share
directly in the investment experience of the General Account, but are allowed to
allocate and transfer funds into the Fixed Account.
FIXED ACCOUNT INTEREST The interest rate credited to Certificate Value in the Fixed Account is set
RATES by us. We will review this interest rate from time to time, at least
once a year. The following guarantees apply to money in the Fixed Account:
- The interest rate in effect on the Date of Issue is guaranteed until the
next certificate anniversary, unless you borrow money from that Certificate
Value.
- The interest rate in effect on the day funds are transferred from a
Sub-Account of the Variable Account to the Fixed Account is guaranteed until the
next certificate anniversary, unless you borrow from that Certificate Value.
- The interest rate in effect on a certificate anniversary is guaranteed for
one year for those Certificate Values in the Fixed Account on the certificate
anniversary as long as those values remain in the Fixed Account and are not
borrowed.
- The interest rate(s) we use for that portion of the Certificate Value that
equals the Outstanding Loan will be at least the minimum rates shown on the
Specifications Page. One of the rates shown is the Preferred Loan Rate which
applies only to the portion of the Outstanding Loan that is secured by Earnings.
FIXED ACCOUNT The Fixed Account certificate value on the date of issue is the net payment
CERTIFICATE VALUE allocated to the Fixed Account minus the first insurance protection charge allocated
to the Fixed Account. On each Monthly Processing Date
thereafter, the Certificate Value of the Fixed Account is equal to:
- the Certificate Value in this account on the preceding Monthly Processing
Date, if any, increased by one month's interest, plus
- payments received since the last Monthly Processing Date that are allocated
to the Fixed Account plus the interest accrued from the date the payments are
received by us, plus
- Variable Account Certificate Value transferred to the Fixed Account from
any Sub-Accounts since the preceding Monthly Processing Date, increased by
interest from the date the Certificate Value is transferred, minus
- Certificate Value transferred from the Fixed Account to a Sub-Account since
the preceding Monthly Processing Date and interest accrued on these transfers
from the transfer date to the Monthly Processing Date, minus
FORM 1030-99GRC 19
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- partial withdrawals from the Fixed Account, partial withdrawal transaction
charges and surrender charges since the last Monthly Processing Date, interest
accrued on these withdrawals, and charges from the withdrawal date to the
Monthly Processing Date, minus
- the portion of the Monthly Deductions allocated to the Certificate Value in
the Fixed Account.
During any certificate month the Fixed Account Certificate Value will be
calculated on a consistent basis. In no event will the Fixed Account
Certificate Value be less than the guaranteed cash value shown in the Paid-Up
Insurance Table after the paid-up option has been exercised.
BASIS OF VALUE OF THE We base the minimum surrender value in the Fixed Account on the
FIXED ACCOUNT minimum Fixed Account interest rates and mortality table shown on
the Specifications Page. Actual Certificate Values are based on interest and
insurance protection rates that we set. We have filed a detailed description of
the way we determine this value with the State Insurance Department. All values
equal or exceed the minimums required by law in the state in which this
certificate is delivered.
In no event will the Fixed Account Certificate Value be less than the guaranteed
cash value shown in the Paid-Up Insurance Table after the Paid-Up Option has
been exercised.
FORM 1030-99GRC 20
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WHAT YOU SHOULD KNOW ABOUT TRANSFERS
While the certificate is in force other than as paid-up insurance, you may
transfer amounts between the Fixed Account and the Sub-Accounts or among
Sub-Accounts on request.
You may transfer, without charge, all of the Certificate Value in the Variable
Account to the Fixed Account once during the first 24 months after the
certificate is issued in order to convert to a fixed-only product. If you do
so, future payments will be allocated to the Fixed Account unless you specify
otherwise. All other transfers are subject to the following rules and will be
permitted with our approval.
The minimum and maximum amounts that may be transferred from the Fixed Account
to the Variable Account shall be determined by us. In no event will our rules
provide for a minimum transfer of more than $500. The maximum transfer amount
will not be less than the lesser of $10,000 or 10% of the certificate value.
Transfers to any sub-account of the Variable Account from the Fixed Account are
permitted only if there has been at least a 180-day period since the last
transfer from the Fixed Account. There is no limit on the number of transfers
between the sub-accounts of the Variable Account and there is no limit on the
number of transfers between the sub-accounts of the Variable Account to the
Fixed Account.
If a transfer would reduce the Certificate Value in a Sub-Account to less than
$100, we reserve the right to include the remaining value in the amount
transferred.
You will not be charged for the first twelve transfers in a certificate year,
but a transfer charge of up to $25 may be made on each additional transfer. Any
transfer charge will be deducted from the amount that is transferred. Transfers
that result from a certificate loan or repayment of a loan are not subject to
these rules.
FORM 1030-99GRC 21
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WHAT YOU SHOULD KNOW ABOUT DOLLAR COST AVERAGING
You may elect automatic transfers of at least $100 to be made from one
sub-account (called the DCA sub-account in this provision) to one or more of the
other sub-accounts of the Variable Account. We will permit you to designate the
Money Market sub-account as the DCA sub-account. Other sub-accounts or the
Fixed Account may be designated by you as the DCA sub-account subject to our
consent.
Automatic transfers may be made monthly, quarterly, or on any other frequency
permitted by the Company. The Dollar Cost Averaging Option will be treated as
one of the twelve free transfers permitted in a year without regard to how many
sub-accounts are elected or the transfer frequency. We reserve the right to
limit the number of sub-accounts that may be utilized and we may discontinue
this option at any time upon advance written notice to the Owner.
If an automatic transfer reduces the balance in the DCA sub-account to less than
$100, the entire balance will be transferred proportionately to the chosen
Sub-Account(s).
The Dollar Cost Averaging Option will end:
- on the date specified in a notice sent by the Company when the remaining
amount in the DCA sub-account is zero following an automatic transfer; or;
- upon request.
We will send you a written notice when the Dollar Cost Averaging Option ends.
Payments allocated to the sub-account designated as the DCA sub-account after
this option has ended will not automatically reinstate the option; you must make
a new election.
The Dollar Cost Averaging Option and the Automatic Rebalancing Option may not be
in effect at the same time.
FORM 1030-99GRC 22
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WHAT YOU SHOULD KNOW ABOUT AUTOMATIC REBALANCING
By electing this option you may automatically rebalance the sub-accounts of the
Variable Account. You may direct us to process such transfers monthly,
quarterly, or on any other frequency permitted by the Company. When this option
is elected, you will designate the percentage allocation for each of the
Sub-Accounts chosen. On each periodic transfer date we will review the
percentage allocation in the various Sub-Accounts and, as necessary, transfer
funds in order to reestablish the designated percentage allocation mix.
The automatic Rebalancing Option will be treated as one of the twelve free
transfers permitted in a certificate year without regard to how many
sub-accounts are elected or the transfer frequency. If the amount necessary to
reestablish the designated mix on any transfer date is less than $100, no
transfer will be made. The arrangement may be terminated on written request.
We reserve the right to limit the number of Sub-Accounts that may be utilized
for automatic rebalancing and to discontinue the option upon advance written
notice to you.
The Dollar Cost Averaging Option and the Automatic Rebalancing Option may not be
in effect at the same time.
FORM 1030-99GRC 23
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WHAT YOU SHOULD KNOW ABOUT BORROWING FROM YOUR CERTIFICATE
To borrow from this certificate, the only collateral you will need is the
certificate itself.
AMOUNT YOU MAY BORROW Except as otherwise provided in the paid-up insurance
option, the maximum loan amount is 90% of the Certificate Value less the
surrender charge. You may borrow an amount subject to the minimum shown on the
Specifications Page, up to the maximum loan amount minus any Outstanding Loan.
You are advised to consult with a tax advisor before making a Certificate Loan.
If you do not specify from which accounts you want to borrow, we will allocate
the loan Pro Rata. In order to secure the Outstanding Loan, we will transfer
the Certificate Value in each Sub-Account equal to the certificate loan
allocated to each Sub-Account to the Fixed Account.
LOAN INTEREST You will pay interest on your loan at an annual rate indicated on
the Specifications Page. Interest accrues daily and is payable at the end of
each certificate year. Any interest that is not paid on time will be added to
the loan principal and bear interest at the same rate. If this makes the
principal higher than the Certificate Value in the Fixed Account, we will offset
this shortfall by transferring funds from the Sub- Accounts to the Fixed
Account. We will allocate the transferred amount among the Sub-Accounts in the
same proportion that the value in each Sub-Account has to the total value in all
of them.
PREFERRED LOAN The Preferred Loan is that portion of the Certificate Loan which
is secured by Earnings. The guaranteed minimum interest rate credited to the
Certificate Value which secures a Preferred loan is shown in the Specifications
Page.
REPAYING THE You may repay the Outstanding Loan at any time before this certificate
OUTSTANDING LOAN lapses. When you repay it, we will transfer the Certificate
Value that is securing the loan in the Fixed Account to the various Sub-Accounts
and increase the value in them. You may tell us how to allocate repayments.
Otherwise, we will allocate them according to the most recent payment allocation
choices you have made. Loan repayments made to the Variable Account cannot be
higher than the amounts you transferred to secure the Outstanding Loan.
FORECLOSURE If at any time the amount of the Outstanding Loan is higher than
the Certificate Value minus the surrender charge, we will terminate the
certificate. We will mail a notice of this termination to the last known
address of you and any Assignee. If the excess Outstanding Loan is not paid
within 62 days after this notice is mailed, the certificate will terminate with
no value. You may reinstate this certificate according to the Reinstatement
provision.
FORM 1030-99GRC 24
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WHAT YOU SHOULD KNOW ABOUT SURRENDERS AND PARTIAL WITHDRAWALS
SURRENDER You may cancel this certificate and receive its surrender value as
long as the Insured is living on the date we receive your Written Request at our
Home Office. The certificate will be canceled on that day. You may choose to
receive the surrender value in a lump sum or under a benefit option.
SURRENDER VALUE Except as otherwise provided in the paid-up insurance option, the
surrender value equals the Certificate Value minus the Outstanding Loan and
surrender charge. You will find the surrender charge on the Specifications
Page.
PARTIAL WITHDRAWALS Partial withdrawals are not allowed if your certificate is
in force as paid-up insurance. You may withdraw part of the surrender value on
Written Request prior to the Final Payment Date. Each withdrawal must be at
least $1,000. We will deduct a 2% withdrawal transaction charge (maximum $25)
from the Certificate Value each time you make a partial withdrawal.
We will not permit a partial withdrawal if it reduces the Certificate Value
amount to less than the minimum amount shown on the Specifications Page.
The Face Amount will be reduced proportionately based on the ratio of the amount
of the partial withdrawal and charges to the Certificate Value on the date of
withdrawal. The Certificate Value will be reduced by the amount of the partial
withdrawal, the partial withdrawal transaction charge and any applicable
surrender charges.
For example, the Face Amount is $500,000 and the Certificate Value is $95,000.
If you make a withdrawal of $25,000 (including the partial withdrawal charge and
surrender charge), the adjustment will be calculated as follows:
1. $25,000 divided by $95,000 = 26.3%
2. $500,000 x 26.3 = $131,500 (amount of reduction)
3. $500,000 - $131,500 = $368,500 (resulting Face Amount)
4. $95,000 - $25,000 = $70,000 (resulting Certificate Value)
FREE WITHDRAWAL AMOUNT The free withdrawal amount will not be subject to the
surrender charge as described on the Specifications Page. This amount equals
(a) minus (b), where:
(a) is the free withdrawal amount shown on the Specifications Page, and
(b) is the total of the withdrawals (or portions of them) made in the same
certificate year that were exempt from the surrender charge.
The free withdrawal amount is first deducted from Earnings. Withdrawals in
excess of the free withdrawal amount are deducted from payments not previously
considered withdrawn on a last-in, first-out basis. Surrender charges
applicable to the excess withdrawal are described on the Specifications Page.
If you do not allocate a partial withdrawal and its charges between the Fixed
Account and each Sub-Account, we will automatically allocate them Pro Rata.
FORM 1030-99GRC 25
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POSTPONEMENT OF We may postpone any transfer from the Variable Account, or payment
PAYMENT allocated to the Variable Account of any amount payable on:
- surrender
- partial withdrawal
- transfer
- certificate loan
- death of the Insured
The postponement will continue during any period when:
- the NYSE is closed for days other than weekends and holidays, or
- the SEC has determined that such an emergency exists that disposal of
portfolio securities or valuation of assets is not reasonably practical.
We also may postpone any transfer from the Fixed Account or payment of any
portion of the amount payable on a surrender, partial withdrawal or certificate
loan from the Fixed Account for not more than six months from the day we receive
your Written Request and your certificate, if it is required. We will pay
interest if our payment is not mailed or delivered within ten days of the date a
valid request is made; however, no interest shall be paid if such interest is
less than $25 or the delay in payment is pursuant to New York law. A "valid
request" is made when all documentation necessary to complete the transaction is
received at Home Office. The interest rate credited will be the same rate
applied to proceeds held by us under Payment Option C. No payment will be
deferred to pay premiums on policies with the Company.
PAID UP INSURANCE OPTION
BENEFIT This is insurance, usually having a reduced face amount for the
lifetime of the insured with no further premiums due. The amount of paid-up
insurance is the amount that the surrender value can purchase for a net single
premium at the insured's age and underwriting class on the date this option is
exercised. The paid-up insurance death benefit may not exceed the death benefit
in effect on the date this option is exercised, any excess surrender value will
be paid to you.
BASIS OF VALUES The certificate value and net single premium of the paid-up
insurance meet the minimum standards which are set by state law. The net single
premium is based on the Commissioners 1980 Standard Ordinary Mortality Table,
Smoker or Non-Smoker, Male, Female (or appropriate increases in such tables for
non-standard risks). Interest will not be less than 4 1/2%. See page 6a for
the table showing the guaranteed net single premiums per $1,000 of insurance.
EXERCISE OF OPTION The paid-up insurance option may be exercised by you on
written request. Certificate value in the Variable Account will be transferred
to the Fixed Account on the date your written request to exercise this option is
received in our Principal Office. We will issue supplemental specification
pages that show the certificate is paid up effective as of the monthly payment
date following receipt of the written request.
The supplemental specification pages will show:
The effective date of paid up insurance,
The paid-up death benefit,
Guaranteed cash surrender values, and
Riders.
FORM 1030-99GRC 26
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EFFECT ON THE After the certificate becomes paid up, no further
CERTIFICATE payments may be made by you. You may not make partial withdrawals or transfer
funds to the Variable Account; however, you may make certificate loans or
surrender the certificate for its net cash value. Riders will continue only
with our consent. The guaranteed cash value of the paid-up insurance equals the
net single premium for the paid-up insurance at the insured's attained age. The
net single premium is determined on the same basis as is used for the purchase
price of the paid-up insurance. The net cash value is the cash value less any
outstanding loan. The loan value of paid-up insurance is the amount that, with
interest at 6% per year, equals the cash value of the paid-up certificate as of
the next certificate anniversary.
WHAT YOU SHOULD KNOW ABOUT THE DEATH BENEFIT
NET DEATH BENEFIT If the Insured dies before the Final Payment Date, we will
pay the net death benefit upon receipt at the Home Office of proof of the
Insured's death. Except as otherwise provided in the Paid-Up Insurance Option,
the net death benefit is the Face Amount at the time of death or the guideline
minimum sum insured, if greater, reduced by any Outstanding Loan, rider charges
and monthly deductions due and unpaid through the certificate month in which the
Insured dies, as well as any partial withdrawals and surrender charges. We will
pay interest from the date of death to the date the net death benefit is paid.
If the Insured dies after the Final Payment Date, and the Paid-Up Insurance
Option has not been exercised, we will pay the Certificate Value minus any
Outstanding Loans. We will pay interest from the date we receive the death
certificate. If you choose a lump sum payment, the interest rate will be at
least 3% a year, or the minimum rate set by law, if greater.
REQUIRED MINIMUM In order to qualify as "life insurance" under the federal tax law, this
AMOUNT OF DEATH BENEFIT certificate must provide a minimum death benefit. This is called the "guideline
minimum sum insured" in the tax code. This is calculated by multiplying the
Certificate Value by the percentages shown in the Guideline Minimum Sum Insured
Table on the Specifications Page. The guideline minimum sum insured varies by Age.
The amounts shown in the Table are determined according to federal tax law, and
will be adjusted according to any changes in that law.
CONTINUATION OF INSURED'S COVERAGE AFTER DISCONTINUATION OF THE POLICY
If the group policy is discontinued, any certificate then in effect will remain
in force under the discontinued policy, provided it is not cancelled or
surrendered by the certificate owner.
FORM 1030-99GRC 27
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WHAT YOU SHOULD KNOW ABOUT THE BENEFIT OPTIONS
BENEFIT OPTIONS You may choose one of the following options for receiving the
surrender value or the net death benefit. We will give the payee a certificate
describing the benefit option you selected. If you make no choice, we will pay
the benefits in a single, lump sum.
We will pay all benefits from the Fixed Account. Benefits may not be allocated
to the Variable Account. The amounts payable under these options, for each
$1,000 applied, will be:
(a) the rate per $1,000 of benefit based on our non-guaranteed current benefit
option rates for this class of certificates, or
(b) the rate in this certificate for the applicable benefit option, whichever
is greater.
If you choose a benefit option, the beneficiary may, when filing a proof of
claim, pay us any amount that otherwise would be deducted from the proceeds.
OPTION A: BENEFITS FOR A We will make equal payments for any selected number of years up to 30
SPECIFIED NUMBER OF years. These payments may be made annually, semi-annually, quarterly
YEARS (TABLE A) or monthly, whichever you choose.
OPTION B: LIFETIME Benefits are based on the age of the person who receives the money (called
MONTHLY BENEFIT (TABLE B) the payee) on the date the first payment will be made. You may choose one of the
three following options to specify when benefits will cease:
- when the payee dies with no further benefits due (Life Annuity);
- when the payee dies but not before the total benefit payments made by us
equals the amount applied under this option (Life Annuity with Installment
Refund); or
- when the payee dies but not before 10 years have elapsed from the date of
the first payment (Life Annuity with Payments Guaranteed for 10 years).
OPTION C: INTEREST We will pay interest at a rate we determine each year. It will not be less
BENEFITS than 3% per year. We will make payments annually, semi-annually,
quarterly, or monthly, whichever is preferred. These benefits will stop when
the amount left has been withdrawn. If the payee dies, any unpaid balance plus
accrued interest will be paid in a lump sum.
OPTION D: BENEFITS FOR A Interest will be credited to the unpaid balance and we will make payments
SPECIFIED AMOUNT until the unpaid balance is gone. We will credit interest
at a rate we determine each year, but not less than 3%. We will make payments
annually, semi-annually, quarterly, or monthly, whichever is preferred. The
benefit level chosen must provide for an annual benefit of at least 8% of the
amount applied.
OPTION E: LIFETIME We will pay a benefit jointly to two payees during their joint lifetime.
MONTHLY BENEFITS FOR TWO After one payee dies, the benefits to the survivor will be:
PAYEES (TABLE E)
- the same as the original amount, or
- in an amount equal to 2/3 of the original amount.
FORM 1030-99GRC 28
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Benefits are based on the payees' ages on the date the first payment is due.
Benefits will end when the second payee dies.
SELECTING BENEFIT The amount we apply under any one option for any one payee must be at least $5,000,
OPTIONS and the periodic payment for any one payee must be at least $50.
You may change any option you select before the net death benefit is paid,
subject to the Owner and Beneficiary provisions. If you make no selection, the
beneficiary may choose an option when the benefits become payable.
If the amount of monthly income benefits under Option B for the age of the payee
is the same for different periods certain, the payee will be entitled to the
longest period certain for the payee's age.
You may give the beneficiary the right to change from Option C or D to any other
option at any time. If Option C or D is chosen by the payee when this
certificate becomes a claim, the payee may reserve the right to change to any
other option. The payee who elects to change options must be the payee under
the option selected.
ADDITIONAL DEPOSITS An additional deposit may be added to any proceeds when they
are applied under Option B and E. We reserve the right to limit the amount of
any additional deposit. We may levy a charge of no more than 3% on any
additional deposits.
RIGHTS AND LIMITATIONS A payee has no right to assign any amount payable under
any option, nor to demand a lump sum benefit in place of any amount payable
under Options B or E. A payee will have the right to receive a lump sum in
place of installments under Option A. The payee must provide us with a Written
Request to reserve this right. If the right to receive a lump sum is exercised,
we will determine the lump sum benefit at the same interest rates used to
calculate the installments. The amount left under Option C and any unpaid
balance under Option D, may be withdrawn only as noted in the Written Request
selecting the option.
A corporate or fiduciary payee may select only Option A, C or D, subject to our
approval.
BENEFIT DATES The first payment under any option, except Option C, will be due
on the date this certificate matures, by death or otherwise, unless another date
is designated. Benefits under Option C begin at the end of the first benefit
period.
The last payment under any option will be made as stated in the option's
description. However, if a payee under Options B or E dies before the due date
of the second monthly payment, the amount applied, minus the first monthly
payment, will be paid in a lump sum or under any option other than Option E.
This payment will be made to the surviving payee under Option E or the
succeeding payee under Option B.
BENEFIT RATES The Benefit Option Tables show benefit amounts for Option A, B
and E. If you choose one of these options, either within five years of the date
of surrender or the date the proceeds are otherwise payable, we will apply
either the benefit rates listed in the Tables, or the rates we use on the date
the proceeds are paid, whichever is more favorable. Benefits that begin more
than five years after that date, or as a result of additional deposits, will be
based on the rates we use on the date the first benefit is due.
FORM 1030-99GRC 29
</TABLE>
<PAGE>
BENEFIT OPTIONS
<TABLE>
<CAPTION>
YEARS ANNUAL SEMI-ANNUAL QUARTERLY MONTHLY
<S> <C> <C> <C> <C> <C>
TABLE A 1 1000.00 504.30 253.23 84.65
BENEFITS FOR SPECIFIED NUMBER 2 508.60 256.49 128.79 43.05
OF YEARS 3 344.86 173.91 87.33 29.19
PAYMENT FOR EACH $1,000 OF CERTIFICATE 4 263.04 132.65 66.61 22.27
VALUE APPLIED 5 213.99 107.92 54.19 18.12
These tables are based on an annual interest 6 181.32 91.44 43.92 15.35
rate of 3 1/2%. 7 158.01 79.69 40.01 13.38
8 140.56 70.88 35.59 11.90
9 127.00 64.05 32.16 10.75
10 116.18 58.59 29.42 9.83
11 107.34 54.13 27.18 9.09
12 99.98 50.42 25.32 8.46
13 93.78 47.29 23.75 7.94
14 88.47 44.62 22.40 7.49
15 83.89 42.31 21.24 7.10
16 79.89 40.29 20.23 6.76
17 76.37 38.51 19.34 6.47
18 73.25 36.94 18.55 6.20
19 70.47 35.54 17.85 5.97
20 67.98 34.28 17.22 5.75
21 65.74 33.15 16.65 5.56
22 63.70 32.13 16.13 5.39
23 61.85 31.19 15.66 5.24
24 60.17 30.34 15.24 5.09
25 58.62 29.56 14.85 4.96
26 57.20 28.85 14.49 4.84
27 55.90 28.19 14.15 4.73
28 54.69 27.58 13.85 4.63
29 53.57 27.02 13.57 4.53
30 52.53 26.49 13.30 4.45
</TABLE>
FORM 1030-99GRC 30
<PAGE>
BENEFIT OPTIONS (CONTINUED)
LIFE INCOME OPTION TABLES
MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF CERTIFICATE VALUE APPLIED
TABLE B
<TABLE>
<CAPTION>
Life Annuity with
Age Nearest Payments Guaranteed for Life Annuity with
Birthday 10 Years "Life Annuity" Installment Refund
<S> <C> <C> <C>
50 4.22 4.24 4.14
51 4.28 4.31 4.19
52 4.34 4.37 4.25
53 4.41 4.44 4.31
54 4.48 4.52 4.37
55 4.55 4.59 4.43
56 4.63 4.68 4.50
57 4.71 4.76 4.57
58 4.80 4.86 4.65
59 4.89 4.96 4.73
60 4.98 5.06 4.82
61 5.08 5.18 4.90
62 5.19 5.30 5.00
63 5.30 5.43 5.10
64 5.42 5.56 5.20
65 5.55 5.71 5.31
66 5.68 5.87 5.43
67 5.81 6.04 5.55
68 5.96 6.22 5.68
69 6.11 6.41 5.81
70 6.26 6.62 5.96
71 6.43 6.84 6.11
72 6.60 7.08 6.27
74 6.95 7.62 6.62
75 7.13 7.91 6.81
</TABLE>
These tables are based on an annual interest rate of 31/2% and the 1983(a)
Individual Mortality Table using a blend reflecting 40% of the male rate and
60% of the female rate.
FORM 1030-99GRC 31
<PAGE>
BENEFIT OPTIONS (CONTINUED)
MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF CERTIFICATE VALUE APPLIED
TABLE E1 TABLE E2
<TABLE>
<CAPTION>
Joint and Survivor Life Annuity Older Age Joint and Two-Thirds Survivor Life
Annuity Older Age
<S> <C>
50 55 60 65 70 75 80 50 55 60 65 70 75 80
Y 50 3.91 3.97 4.02 4.05 4.07 4.09 4.10 4.25 4.40 4.57 4.76 4.96 5.18
O 55 4.18 4.26 4.32 4.36 4.39 4.41 4.60 4.80 5.02 5.26 5.50
U 60 4.54 4.65 4.73 4.78 4.81 5.08 5.35 5.63 5.92
N 65 5.04 5.19 5.29 5.35 5.74 6.10 6.46
G 70 5.75 5.95 6.08 6.67 7.15
E 75 6.77 7.06 8.04
R 80 8.29
A
G
E
These tables are based on an annual interest rate of 3 1/2%
and the 1983(a) Individual Mortality Table using a blend reflecting 40% of the
male & 60% of the female rate.
MODIFIED SINGLE PAYMENT VARIABLE LIFE INSURANCE CERTIFICATE
NON PARTICIPATING
</TABLE>
FORM 1030-99GRC 32
<PAGE>
PLEASE READ THIS CERTIFICATE CAREFULLY
THE CERTIFICATE VALUES, WHEN BASED ON THE INVESTMENT PERFORMANCE OF THE
VARIABLE ACCOUNT, MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO A
FIXED DOLLAR AMOUNT. PLEASE REFER TO THE VARIABLE ACCOUNT SECTION FOR
ADDITIONAL INFORMATION. WE AGREE TO PAY THE BENEFITS OF THIS CERTIFICATE IN
ACCORDANCE WITH ITS TERMS.
The value in the Fixed Account will accumulate at a rate which will not be
less than 4% a year; 5 1/2% on Certificate Value securing a Preferred Loan
(see page 19). Additional interest in excess of the guaranteed rate may be
credited at our discretion.
THE AMOUNT OF THE DEATH BENEFIT AND THE LENGTH OF TIME THIS CERTIFICATE WILL
REMAIN IN FORCE MAY BE VARIABLE OR FIXED AS DESCRIBED IN THE DEATH BENEFIT
PROVISION OF THIS CERTIFICATE. THE METHOD FOR DETERMINING THE AMOUNT OF THE
DEATH BENEFIT IS FOUND ON PAGE 27.
RIGHT TO CANCEL
We want you to be satisfied with the certificate you have purchased and we
urge you to examine it closely. If for any reason you are not satisfied, you
may return the certificate to us or an authorized representative within 10
days after receipt of the certificate.
If you return the certificate, it will be void from the Date of Issue, and
you will receive a refund equal to the total of payments made.
FIRST ALLMERICA FINANCIAL LIFE INSURANCE COMPANY
Home Office and
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653
This is a legal contract between First Allmerica Financial Life Insurance
Company and the owner. It is issued in consideration of the payment shown on
the Specifications Page. We agree to pay the benefits of this certificate in
accordance with its terms.
MODIFIED SINGLE PAYMENT SECOND-TO-DIE VARIABLE LIFE INSURANCE CERTIFICATE
NON-PARTICIPATING
FORM 1030-99GRCJ
<PAGE>
TABLE OF CONTENTS
SPECIFICATIONS .................................................. 3
DEFINITIONS ..................................................... 7
GENERAL TERMS ................................................... 9
INFORMATION ABOUT YOU AND THE BENEFICIARY ....................... 11
WHAT YOU SHOULD KNOW ABOUT:
THE PAYMENTS ................................................. 12
YOUR CERTIFICATE VALUE ....................................... 14
THE VARIABLE ACCOUNT ......................................... 16
THE FIXED ACCOUNT ............................................ 19
TRANSFERS .................................................... 21
DOLLAR COST AVERAGING ........................................ 22
AUTOMATIC ACCOUNT REBALANCING ................................ 23
BORROWING FROM YOUR CERTIFICATE .............................. 24
SURRENDERS AND PARTIAL WITHDRAWALS ........................... 25
THE DEATH BENEFIT ............................................ 27
THE BENEFIT OPTIONS .......................................... 28
FORM 1030-99GRCJ 2
<PAGE>
SPECIFICATIONS
<TABLE>
<S> <C>
Group Contractholder: First Allmerica Financial Group Life Insurance Trust
Certificate Number: Specimen
============================================================================================================
Certificate Owner: John Doe
Insured: John Doe Insured's Sex: Male
Insured's Age: 35 Insured's Underwriting Risk Class: Standard Non-Smoker
------------------------------------------------------------------------------------------------------------
Date of Issue: 08/20/1999 Contract Plan: Allmerica Estate Optimizer
Modified Single
Payment Variable Life
Insurance Certificate
Face Amount: $361,437 Monthly Processing Date: 1st of each month
Owner(s): John Doe Rider: [ ]
Beneficiary at Issue: Mary Doe Rider Date of Issue: 08/20/1999
---------------------------------------------------------------------------------------------------
Payment: $50,000
Maximum Payment: The greater of [$50,000] or [$4,445.08] times the current certificate year.
Final Payment Date: 08/20/2064
Initial Payment Allocation:
Variable Accounts Managed by:
----------------- -----------
[4.00% Select Aggressive Growth [Nicholas-Applegate Capital Mgmt.
4.00% Select Capital Appreciation T. Rowe Price Associates, Inc.
4.00% Select Value Opportunity Cramer Rosenthal McGlynn, LLC
4.00% Select Emerging Markets Schroder Capital Mgmt Int'l, Inc.
4.00% T. Rowe Price Int'l Stock Row Price-Fleming Int'l, Inc.
4.00% Fidelity VIP Overseas Fidelity Management & Research Co.
4.00% Select International Equity Bank of Ireland Asset Management
4.00% Delaware Int'l Eqty Ser Delaware Int'l Advisors Ltd.
4.00% Fidelity VIP Growth Fidelity Management & Research Co.
4.00% Select Growth Putnam Investment Management, Inc.
4.00% Select Strategic Growth Cambiar Investors, Inc.
4.00% Allmerica Growth Fund Miller, Anderson & Sherrerd, LLP
4.00% Allmerica Equity Index Allmerica Asset Management, Inc.
4.00% Fidelity VIP Equity-Income Fidelity Management & Research Co.
4.00% Select Growth & Income J.P. Morgan Investment Mgmt, Inc.
4.00% Fidelity VIP II Asset Mgr. Fidelity Management & Research Co.
4.00% Fidelity VIP High Income Fidelity Management & Research Co.
4.00% Allmerica Invest Grade Inc. Allmerica Asset Management, Inc.
4.00% Select Income Standish, Ayer & Wood, Inc.
4.00% Allmerica Government Bond] Allmerica Asset Management, Inc.]
Fixed Account:
30.00% Initial Interest Rate: 5.25%
FORM 9030AE.1-99S GRC 3
<PAGE>
SPECIFICATIONS (continued)
Insured: John Doe Certificate Number: Specimen
====================================================================================================================
Minimum Additional Payment: $10,000
Minimum Fixed Account Interest Rate: 4% of value not subject to Outstanding Loan
4% of value securing Outstanding Loan - not preferred loan
5 1/2% of value securing Outstanding Loan - preferred loan
Outstanding Loan Interest Rate: 6%
Maximum Loan Amount: 90% of Certificate Value less the surrender charge
Minimum Loan Amount: $1,000
Minimum Balance After Withdrawal: $25,000
Free Withdrawal Amount: 10% of Certificate Value
Partial Withdrawal Transaction Charges: If you withdraw part of your funds, you will pay a transaction charge
of $25 or 2% of the amount withdrawn, whichever is less.
Partial Withdrawal Surrender Charge: You may also pay a surrender charge on any "excess" withdrawal.
This charge will not be higher than the certificate surrender charge:
see page 25.
Fees and Deductions: Current Guaranteed
Administration Charge: 0.20% Annually (1) 0.20% Annually (1)
Distribution Fee (Certificate Years 1 - 10): 0.90% Annually (1) 0.90% Annually (1)
Federal & State payment Tax Charge (Certificate Year 1): 1.50% Annually (1) 1.50% Annually (1)
Insurance Protection Charge (Certificate Years 1 - 10): 0.60% Annually (1) See Page 5
Insurance Protection Charge (Certificate Years 11 +): 0.40% Annually (1) See Page 5
Mortality & Expense Risk Charge: 0.90% Annually (2) 0.90% Annually (2)
Monthly Maintenance Fee: $2.50 Monthly (3) $2.50 Monthly (3)
(1) This charge is deducted monthly from the Certificate Value on a Pro Rata
basis. The monthly charge is equal to one -twelfth of this factor times the
Certificate Value.
(2) This charge is deducted daily from the Variable Accounts on a pro rata
basis.
(3) This charge is deducted only when the Certificate Value is less than $100.
The insurance protection charge is currently expressed as a percentage of the
Certificate Value. This charge will never exceed the maximum guaranteed cost
based on the insurance protection amount. The use of a percentage of the
Certificate Value is done for simplicity and may not always bear a close
relationship to the actual cost of providing the coverage. Changes in this
insurance protection charge will be based on our expectations of future
mortality, persistency, and expense. Such changes may also be affected by past
investment performance to the extent that it affects our expectations as to the
future insurance risk. For example, we may increase the percentage of Account
Value used in determining the insurance charge solely as a result of poor past
investment performance.
If you have any questions, need information about you coverage or require
assistance, please call our Principal Office. The number is 1-800-917-1909.
Any interest credited to the Fixed Account which exceeds 4% is not guaranteed to
continue. We have the right to change both the interest rate credited to the
Fixed Account and the insurance protection charges, subject to the guarantees in
the certificate. The surrender value may become insufficient to continue the
certificate in force to the final premium payment date due to the following
factors: certificate loans, partial withdrawals, additional riders, increased
current insurance protection charges, decreased interest rates credited to the
Fixed Account, adverse investment experience of the Variable Account and, if
applicable, the amount and frequency of payments. Such changes may require more
payments than were illustrated; otherwise the certificate values will be less
than illustrated.
FORM 9030AE.1-99S GRC 4
<PAGE>
SPECIFICATIONS (continued)
Insured: John Doe Certificate Number: Specimen
=====================================================================================================================
GUARANTEED MAXIMUM MONTHLY INSURANCE PROTECTION RATE TABLE
---------------------------------------------------------------------------------------------------------------------
Age Insurance Protection Age Insurance Protection
Rate Per $1,000 Rate Per $1,000
---------------------------------------------------------------------------------------------------------------------
35 0.140000 65 1.870000
36 0.150000 66 2.070000
37 0.160000 67 2.290000
38 0.170000 68 2.530000
39 0.180000 69 2.790000
40 0.190000 70 3.090000
41 0.210000 71 3.440000
42 0.220000 72 3.830000
43 0.240000 73 4.290000
44 0.260000 74 4.790000
45 0.280000 75 5.330000
46 0.310000 76 5.900000
47 0.330000 77 6.510000
48 0.360000 78 7.150000
49 0.390000 79 7.840000
50 0.420000 80 8.620000
51 0.460000 81 9.490000
52 0.510000 82 10.500000
53 0.560000 83 11.620000
54 0.620000 84 12.860000
55 0.680000 85 14.170000
56 0.750000 86 15.560000
57 0.830000 87 17.000000
58 0.910000 88 18.480000
59 1.010000 89 20.040000
60 1.110000 90 21.690000
61 1.230000 91 23.480000
62 1.360000 92 25.500000
63 1.510000 93 27.960000
64 1.690000 94 31.380000
95 36.790000
96 46.580000
97 67.040000
98 83.330000
99 83.330000
---------------------------------------------------------------------------------------------------------------------
The cost of insurance rates include an expense factor and a mortality factor.
The expense factor covers a portion of our acquisition costs and administrative
expenses. The mortality factor is based on the insured's: age, sex and
underwriting class. The guaranteed rates shown above are based on:
[Single life, Male, Age 35, Standard, Non-Smoker]
Based on 1980 CSO Age Last Birthday Table]
FORM 9030AE.1-99S GRC 5
<PAGE>
SPECIFICATIONS (continued)
Insured: John Doe Certificate Number: Specimen
=====================================================================================================================
GUIDELINE MINIMUM SUM INSURED TABLE
---------------------------------------------------------------------------------------------------------------------
Age Percentage Age Percentage
---------------------------------------------------------------------------------------------------------------------
35 265% 68 132%
36 265% 69 131%
37 265% 70 130%
38 265% 71 128%
39 265% 72 127%
40 265% 73 127%
41 258% 74 127%
42 251% 75 127%
43 244% 76 127%
44 237% 77 127%
45 230% 78 127%
46 224% 79 127%
47 218% 80 127%
48 212% 81 127%
49 206% 82 127%
50 200% 83 127%
51 193% 84 127%
52 186% 85 127%
53 179% 86 127%
54 172% 87 127%
55 165% 88 127%
56 161% 89 127%
57 157% 90 127%
58 153% 91 127%
59 149% 92 127%
60 145% 93 127%
61 143% 94 127%
62 141% 95 127%
63 139% 96 120%
64 137% 97 113%
65 135% 98 106%
66 134% 99 100%
67 133%
67 133%
---------------------------------------------------------------------------------------------------------------------
SURRENDER CHARGE TABLE (PERCENT OF TOTAL PREMIUM PAYMENTS WITHDRAWN)
--------------------------------------------------------
Certificate Total Surrender
Year* Charge
--------------------------------------------------------
1 10.00%
2 9.25%
3 8.50%
4 7.75%
5 7.00%
6 6.25%
7 4.75%
8 3.25%
9 1.50%
10 0%
--------------------------------------------------------
*For a Certificate that lapses and is restored, see Reinstatement provisions.
</TABLE>
FORM 9030AE.1-99S GRC 6
<PAGE>
<TABLE>
<CAPTION>
DEFINITIONS
<S> <C>
AGE means the ages of the insureds on his/her last birthday measured on the
Date of Issue and each certificate anniversary.
APPLICATION is the form both insureds complete to apply for this certificate. It
shows your payment, payment allocation and other information that enables
us to prepare this certificate. If a medical questionnaire or other forms are
required, they become a part of the application. The application is signed by
you and both insureds and becomes a part of this certificate.
ASSIGNEE is the person to whom you have transferred your ownership of this
certificate.
CERTIFICATE CHANGE means any change in the Underwriting Risk Class or the addition or deletion
of a Rider.
CERTIFICATE VALUE is the sum of your values in the Variable Account and the Fixed Account.
COMPANY means First Allmerica Financial Life Insurance Company, also referred
to as we, our and us.
DATE OF ISSUE is stated on the Specifications Page. Certificate months, years and
anniversaries are measured from this date.
EARNINGS means the amount by which the Certificate Value exceeds the sum of the
payments made less any payments that were previously considered withdrawn.
Earnings are calculated on each Monthly Processing Date.
EVIDENCE OF INSURABILITY is the information, including medical information, that we use to determine
an insured's class of risk.
FACE AMOUNT is the amount of insurance coverage you elect to buy. The Face Amount is
shown on the Specifications Page of the certificate. Except as otherwise
provided in the Paid-Up Insurance Option, the death benefit prior to
the Final Payment Date is based on the Face Amount; see the Death Benefit
section.
FINAL PAYMENT DATE is the certificate anniversary before the younger insured's 100th birthday.
This date is shown on the Specifications Page. No payments may be made by
you after this date. The net death benefit after this date will equal the
Certificate Value minus any Outstanding Loan.
FIXED ACCOUNT is the part of the Company's General Account to which all or a portion of a
payment or transfer may be allocated.
FUND is a separate investment series for investment by a Sub-Account of the
Variable Account.
GENERAL ACCOUNT is the assets of the Company that are not allocated to a Separate Account.
GROUP LIFE INSURANCE means the Group Contract issued by us to the group Contract holder
CONTRACT OR CONTRACT indicated on the Specification Page.
HOME OFFICE means our office located at 440 Lincoln St., Worcester, Massachusetts 01653.
FORM 1030-99GRCJ 7
<PAGE>
INSURANCE PROTECTION is the death benefit minus the Certificate Value.
AMOUNT
INSURED means the First Insured and the Second Insured as indicated on the
Specifications Page. All provisions of the Certificate that are based on
the death of the "Insured" will be based on the date of death of the last
survivor of the persons named.
MAXIMUM PAYMENT is determined according to rules in the federal tax law, and will be
adjusted as that law changes. If the Maximum limit applies to this
certificate, we will return any excess payment you have made with interest to
you within 60 days after the certificate anniversary. We will pay interest on
each refund at the Fixed Account interest rate in effect on the date we receive
payment.
MONTHLY INSURANCE is the amount of money that we deduct from the certificate Value each
PROTECTION CHARGE month to pay for the insurance; see pages 14 and 15 for details.
MONTHLY PROCESSING DATE is the date the monthly charges are deducted from the Certificate Value.
This date is shown on the Specifications Page. If the Company is not open on
this date, the Monthly Processing Date will be the next business day.
OUTSTANDING LOAN means all unpaid certificate loans plus interest due or accrued on such loans.
PRO RATA refers to an allocation among the Sub-Accounts of the Variable Account
and the Fixed Account. A Pro Rata allocation will be in the same proportion
that the Certificate Value in each Sub-Account of the Variable Account and the
Certificate Value in the Fixed Account (other than value that is subject to
Outstanding Loan) have to the total Certificate Value.
RIDER is an optional benefit that may be added to your certificate for an
additional charge.
SECOND-TO-DIE means the last of the Insureds to die.
SEPARATE ACCOUNT is a segregated account established by the Company. The assets are not
commingled with the Company's general assets.
SPECIFICATIONS PAGES contain information specific to your certificate and are located after the
Table of Contents.
SUB-ACCOUNTS are subdivisions of the Variable Account investing exclusively in the shares of
one or more Funds.
UNDERWRITING RISK CLASS means the insurance risk classification that we assign to each Insured based on the
information in the Application and any other Evidence of Insurability we obtain. The
Underwriting Risk Class affects the Monthly Insurance Protection Charge and the amount
of payments required to keep the certificate in force.
VARIABLE ACCOUNT is the Company's Separate Account, consisting of Sub-Accounts that invest in the
underlying Funds.
WRITTEN REQUEST is a request you make in written form that is satisfactory to us and filed at our
Home Office.
YOU OR YOUR means the owner of this certificate as shown in the Application or in the latest
change filed with us.
FORM 1030-99GRCJ 8
<PAGE>
GENERAL TERMS
ENTIRE CONTRACT This certificate, with a copy of the Application, and any attached
endorsements, is the entire contract between you and us. The entire
contract also includes: a copy of any Application to change to a better
Underwriting Risk Class, any new Specifications Pages, and any supplemental
pages issued. Nothing in the group insurance policy under which this
certificate is issued shall invalidate or impair the rights granted to you by
law and by this certificate.
All statements in the application or enrollment form are considered
representations and not warranties. The Company may not use any statement to
contest this certificate or deny a claim unless the statement is in the
application or enrollment form. Our representatives are not permitted to change
this certificate or extend the time for making payments. Only our President, a
Vice President or Secretary may change the provisions of this certificate, and
then only in writing.
RIGHT TO CONTEST THE A contest is any action taken by us to cancel your insurance or deny a claim based
CERTIFICATE IS LIMITED on material misrepresentations in your Application. Except for failure to pay
premiums, we cannot contest this certificate if it has been in force for two years
from the Date of Issue and either Insured is alive at the end of this two-year period.
If the Underwriting Risk Class is changed at your request, we cannot contest the
change after it has been in force for two years from its effective date and
either Insured is alive.
NON-PARTICIPATING No insurance dividends will be paid on this certificate.
ADJUSTMENT OF We determine the monthly insurance protection charge and Fixed Account
COST FACTORS interest rates which are used to calculate the certificate value,
subject to the guarantees noted in this certificate. Any changes in these
charges and rates will be made by underwriting class only, and will be based on
changes in our future expectations for such things as: our investment earnings,
our expenses, life expectancy rates, and how many certificate owners keep their
certificates.
SUICIDE EXCLUSION The risk of suicide of either insured within two years of the date of issue of this
policy is not assumed. In such event, the policy will be exchanged as of the original
date of issue for a modified single premium adjustable life insurance policy without
evidence of insurability on the life of the surviving insured. The face amount of the new
policy will be the amount which can be purchased by the premiums which have been paid less
any policy loans and partial withdrawals at the guideline single premium for the new
policy. Alternatively, the Company will issue a policy having the same face amount as this
policy on the date of exchange upon receipt of the required additional premium. This additional
premium will be the guideline single premium for the face amount of the new policy less the
premiums paid on this policy reduced by any policy loans and partial withdrawals. The time
periods in the suicide and incontestability provisions of the new policy will expire on the
same date as such provisions in the policy would have expired. In the alternative, upon
written request of the owner, the Company will pay to the owner the sum of the premiums paid
less the sum of any outstanding debt and partial withdrawal amounts, and the policy will cease
and become void.
NOTICE OF FIRST-TO-DIE Upon the death of the insured who dies first, the owner agrees to mail to the Principal
Office, within 90 days of such death or as soon thereafter as is reasonably possible,
due proof of such death.
FORM 1030-99GRCJ 9
<PAGE>
MISSTATEMENT OF AGE OR On the date of death of the Second-to-Die, the death benefit will be reduced or
SEX increased if the Age or Sex of either or both insureds is misstated. The
adjustment will be based upon the ratio of the Maximum Payment for this
certificate to the Maximum Payment for the certificate issued at the correct Age
or Sex immediately prior to the date of death of the Second to Die.
PROTECTION OF BENEFITS To the extent allowed by law, the benefits provided by this certificate cannot be
reached by the beneficiary's creditors. No beneficiary may assign, transfer,
anticipate, or encumber the Certificate Value or benefit unless you give them
this right.
PERIODIC REPORT We will mail a report to you at your last known address at least once a year. This
report will provide the following information:
- Certificate Values in each Sub-Account and in the Fixed Account;
- the value of the certificate if surrendered;
- payments made by you and charges deducted by us since the last report;
- the Outstanding Loan and any other information required by law; and
- the death benefit.
FORM 1030-99GRCJ 10
<PAGE>
<CAPTION>
INFORMATION ABOUT YOU AND THE BENEFICIARY
OWNER The First Insured is the owner of this certificate unless another is
named as owner in the application. The original owner of the certificate is
shown on the Specifications Page. The owner may change the ownership of this
certificate without the consent of any beneficiary.
ASSIGNMENT You may change the ownership of this certificate by sending us a
Written Request. An absolute assignment will transfer ownership of the
certificate from you to another person called the Assignee.
You may also assign this certificate as collateral to a collateral Assignee. The
limitations on your ownership rights while a collateral assignment is in effect
are specified in the assignment.
An assignment will take place when the Written Request is received at our Home
Office. When received, it will take effect on the date it was signed by you.
Any rights created by the assignment will be subject to any payments made or
actions taken by us before the change is received. We are not responsible for
assuring that any assignment or any Assignee's interest is valid.
BENEFICIARY You name the beneficiary to receive the net death benefit. The
beneficiary's interest will be affected by any assignment you make. If you
assign this certificate as collateral, all or a portion of the net death benefit
will first be paid to the collateral Assignee; any money left over from the
amount due the Assignee will go to those otherwise entitled to it.
Your choice of beneficiary may be revocable or irrevocable. You may change a
revocable beneficiary at any time by Written Request; but an irrevocable
beneficiary must agree to any change in writing. You will also need an
irrevocable beneficiary's permission to exercise other rights and options
granted by this certificate. Unless you have asked otherwise, the beneficiary
will be revocable.
Any change of the beneficiary may be made while either of the insureds is
living. This change will take place on the date the request is signed, even if
neither insured is living on the day we receive it at the Home Office. Any
rights created by the change will be subject to any payments made, or actions
taken, before we receive the Written Request.
If a beneficiary dies before the second-to-die, his or her interest in this
certificate will pass to any surviving beneficiaries in proportion to their
share in the net death benefit, unless you have requested otherwise. If all
beneficiaries die before the Insured, the net death benefit will pass to you or
your estate.
COMMON DISASTER The common disaster option may be elected by Written Request while either
OPTION insured is living. If the common disaster option is in effect on the
date of the Insured's death, the beneficiary must be alive a certain number of
days following the Insured's date of death in order to be entitled to receive a
benefit; otherwise, we will pay the net death benefit as though the beneficiary
died before the Insured. The number of days that the beneficiary must live after
the Insured's death is selected by you when you elect the common disaster
option.
FORM 1030-99GRCJ 11
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WHAT YOU SHOULD KNOW ABOUT THE PAYMENTS
PAYMENTS This certificate will not be in force until the payment is made to us.
The payment must be sent to either our Home Office or an authorized
representative. If you request it in writing, we will send you a signed receipt
after the payment is received.
Except as otherwise provided in the Paid Up Insurance Option, additional
payments under the certificate will be permitted prior to the Final Payment Date
only under the following circumstances:
1. An additional payment is required to keep the certificate in force
according to the Grace Period provisions.
2. An additional payment is required for reinstatement.
3. Additional payments may be made at any time provided the sum of the
payments less withdrawals does not exceed the Maximum Payment shown on the
Specifications Page. The minimum amount of the additional payment is indicated
on the Specifications Page.
Subject to the limitations set forth above, We will accept any payment (or
portion thereof) which does not increase the Amount at Risk; see Minimum Death
Benefit Provision. Any payment (or portion thereof) which would increase the
Amount at Risk shall be returned to the Certificate Owner by Us. No additional
payments which increase the Amount at Risk will be accepted and no additional
death benefit shall be provided until the following conditions have been met:
(1) Evidence of Insurability has been received by Us; and (2) We have notified
the Certificate Owner that the Insured is in a satisfactory Underwriting Risk
Class. The notification shall include a copy of the Application Form containing
the information relied on by Us in making Our determination. The Certificate
Owner may make payments by Us that the conditions have been met, but not later
than the Final Premium Payment Date.
A payment received while there is an Outstanding Loan on the certificate will be
considered a loan repayment rather than an additional payment.
GRACE PERIOD This certificate will terminate 62 days after a Monthly Processing Date on which
the surrender value is less than zero. The 62 day period is a grace period. At
least 61 days before the end of the grace period, we will mail the owner and any
Assignee written notice of the amount of payment that will be required to continue
this certificate in force. We also will send a notice to your last known address
at least 15 and not more than 45 days prior to the end of the grace period if the
surrender value is not adequate to prevent lapse. The required payment will be no
greater than the amount required to pay the monthly deductions for three months as
of the day the grace period began. If that payment is not paid by the end of the
grace period, the certificate will terminate without value.
The death benefit during the grace period will be reduced by any overdue
charges. The certificate will lapse if the amount shown in the notice remains
unpaid at the end of the grace period. The certificate terminates on the date
of lapse.
FORM 1030-99GRCJ 12
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REINSTATEMENT If this certificate has lapsed or foreclosed for failure to pay
loan interest and has not been surrendered, it may be restored (called
"reinstated" in this certificate) before the death of the second-to-die within
three years after the date of default or foreclosure. We will reinstate the
certificate on the Monthly Processing Date following the day we receive all of
the following items:
- a written Application for reinstatement;
- Evidence of Insurability showing the insureds are insurable according to
our underwriting rules at that time;
- a payment large enough to keep the certificate in force for three months;
and
- a payment or reinstatement of any loans against the certificate that
existed at the end of the grace period.
You may not reinstate if one of the insureds dies after the date of lapse or
foreclosure.
Your reinstatement payment will be allocated to the Fixed Account until we
approve your Application. At that time, we will transfer the reinstatement
payment, plus accrued interest, as you directed in your last payment allocation
request.
The Certificate Value on the reinstatement date is:
- the payment to reinstate the certificate, including the interest earned
from the date we received your payment; plus
- an amount equal to the Certificate Value less any Outstanding Loan on the
default date; less
- the monthly deductions due on the reinstatement date.
For the purpose of measuring the surrender charge period, the certificate will
be reinstated as of the date of default. The surrender charge on the
reinstatement date is the charge that was in effect on the date of default.
REINSTATEMENT OF PAID-UP If this certificate is in force as paid-up insurance and later terminates
INSURANCE for failure to pay certificate loan interest, the paid-up insurance
may be reinstated during the insured's lifetime, but no more than three years
after the date of foreclosure, by providing us with the following:
evidence of insurability showing the insured is acceptable according to our
underwriting rules; and
payment or reinstatement of the outstanding loan on the date of the default.
Interest is payable on this outstanding loan from the date of termination to the
date of reinstatement at the interest rate of 6% per year.
Paid-up insurance may be reinstated only if both insureds are alive on the date
of reinstatement. The date of reinstatement is the later of the date we approve
the reinstatement application or the date the payment required to reinstate this
certificate is received by us. The death benefit of the reinstated paid-up
insurance will be the same as the death benefit on the date of termination.
FORM 1030-99GRCJ 13
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WHAT YOU SHOULD KNOW ABOUT YOUR CERTIFICATE VALUE
Your Certificate Value is the sum of the Variable Account value and the Fixed
Account value.
ALLOCATION OF INITIAL If you make a payment with your Application or at any time before your
PAYMENTS right to examine the certificate expires, we may put that payment into
the Money Market Fund Sub-Account on the date it is received at our Home Office
or the Date of Issue, if later. We will transfer the Certificate Value as you
directed in your Application, or by later request, no later than the expiration
of the period during which you may exercise your right to cancel the
certificate.
MONTHLY DEDUCTION Beginning on the date this certificate is issued and on every Monthly Processing
Date until the Final Payment Date, we will deduct the following monthly charges
Pro Rata from the Certificate Value:
- the Administration Charge;
- the Distribution Fee;
- the Federal & State Payment Tax Charge;
- the Insurance Protection Charge; and
- the Monthly Maintenance Fee.
Except as otherwise prescribed in the paid-up insurance option, you may choose a
sub-account from which this monthly charge will be deducted. These amounts are
shown on the Specifications Page of the Certificate.
Charges allocated to the Fixed Account will be deducted on a last-in, first-out
basis. This means that we use the most recent payments to pay the fees.
ADMINISTRATION CHARGE The Administration Charge compensates us for the cost of providing administrative
services attributable to this Certificate.
DISTRIBUTION FEE The Distribution Fee compensates us for distribution expenses.
FEDERAL & STATE PAYMENT This charge compensates us for federal, state and local
TAX CHARGE taxes we must pay.
INSURANCE PROTECTION The Insurance Protection Charge compensates us for the cost of providing a death
CHARGE benefit in excess of the Certificate Value. This charge will not exceed the
guaranteed maximum Insurance Protection Charge. The guaranteed maximum
Insurance Protection Charge for any certificate month is equal to (a)
times (b), where;
(a) is the rate shown in the Guaranteed Maximum Monthly Insurance Protection
Table shown on the Specifications Page, and
(b) is the Insurance Protection Amount.
FORM 1030-99GRCJ 14
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The insurance protection rates actually charged will usually be lower than, and
never will be higher than, the guaranteed rates. We will determine the
Insurance Protection charge each month. Any change in insurance protection
rates will apply to all individuals in the same Underwriting Risk Class as the
Insureds. We will review the actual insurance protection rates for this
certificate whenever we change these rates for new certificates. In any event,
rates will be reviewed no more often than once each year, but not less than once
in a five-year period.
MONTHLY MAINTENANCE The Monthly Maintenance Fee shown on the Specifications Page will be
FEE deducted on each Monthly Processing Date.
FORM 1030-99GRCJ 15
<PAGE>
WHAT YOU SHOULD KNOW ABOUT THE VARIABLE ACCOUNT
VARIABLE ACCOUNT The value of your certificate will vary if it is funded
through investments in the Sub-Accounts of the Variable Account. This account is
separate from our Fixed Account. We have exclusive and absolute ownership and
control of all assets, including those in the Variable Account. However, the
portion of assets in the Variable Account equal to the reserves and liabilities
of the certificates that are supported by this account will not be charged with
liabilities that arise out of any other business we conduct.
This account, established to support variable life insurance contracts, called
SPVL, is registered with the Securities and Exchange Commission (SEC) as a unit
investment trust under the Investment Company Act of 1940. It is also governed
by the laws of the State of Massachusetts and the State of New York. The laws
of the state in which the certificate is delivered will apply.
This account has several Sub-Accounts. Each Sub-Account invests its assets in a
separate series of a registered investment company (called a "Fund"). We
reserve the right, when the law allows, to change the name of the Variable
Account or any of its Sub-Accounts. A list of the available Sub-Accounts in
which you may choose to invest is on the Application.
VARIABLE ACCOUNT The payment you make to us will be allocated to the Money Market Fund
CERTIFICATE VALUE Sub-Account on the date we receive the payment or the Date
of Issue, if it occurs after the date we receive the payment. This value will
be transferred to the Sub-Accounts in accordance with your payment allocation no
later than the expiration of the period during which you may exercise your right
to cancel the certificate. Payments made thereafter that are allocated to the
Sub-Accounts will purchase additional units of the Sub-Accounts.
The number of units purchased in each Sub-Account is equal to the portion of the
payment allocated to the Sub-Account, divided by the value of the applicable
unit as of the valuation date the payment is received at our Home Office, or on
the valuation date that value is transferred to the Sub-Account from another
Sub-Account or the Fixed Account.
The number of units will remain fixed unless (1) changed by a subsequent split
of unit value, or (2) reduced because of a transfer, certificate loan, partial
withdrawal, partial withdrawal transaction charge, monthly deductions, surrender
or surrender charge allocated to the Sub-Account or (3) changed due to
subsequent payments. Any transaction described in (2) will result in the
cancellation of an appropriate number of units. On each valuation date, we will
value the assets of each Sub-Account where activity has occurred. The
Certificate Value in a Sub-Account at any time is equal to the number of units
this certificate then has in that Sub-Account multiplied by the Sub-Account's
unit value. The value of a unit for any Sub-Account for any valuation period is
determined by multiplying that Sub-Account's unit value for the immediately
preceding valuation period by the net investment factor for the valuation period
for which the unit value is being calculated. The unit value will reflect the
investment advisory fee and other expenses incurred by the registered investment
companies.
NET INVESTMENT FACTOR This measures the investment performance of a Sub-Account during the valuation
period that has just ended. The net investment factor is the result of [(a) plus (b),
divided by (c)], minus (d) where:
(a) is the net asset value per share of a Fund share held in the Sub-Account
determined at the end of the current valuation period, plus
FORM 1030-99GRCJ 16
<PAGE>
(b) is the per share amount of any dividend or capital gain distributions made
by the Fund on shares held in the Sub-Account if the "ex-dividend" date occurs
during the current valuation period.
(c) is the net asset value per share of a Fund share held in the Sub-Account
determined as of the end of the immediately preceding valuation period.
(d) is a charge for mortality and expense risks in the valuation period. The
current mortality and expense risk charge is shown on the Specifications Page.
This charge may be increased or decreased, but will never exceed the maximum
mortality and expense risk charge shown on the Specifications Page of the
Certificate. Expense and mortality results shall not adversely affect this
maximum charge.
Since the net investment factor may be more or less than one, the unit value may
increase or decrease. You bear the investment risk. We reserve the right,
subject to any required regulatory approvals, to change the method we use to
determine the net investment factor.
VALUATION DATES AND A valuation date is each day that the New York Stock Exchange (NYSE) is open
PERIODS for business and any other day that there is enough trading in the
Variable Account's underlying portfolio securities to materially affect the
value of the Variable Account. A valuation period is the period between
valuation dates.
ADDITION, DELETION OR We may not change the investment policy of the Variable Account without
SUBSTITUTION OF the approval of the Insurance Commissioner of Massachusetts and the
INVESTMENTS Superintendent of Insurance in New York. This approval process
is on file with the Superintendent.
We reserve the right, subject to compliance with applicable law, to add, delete,
or substitute the shares of a Fund that are held by the Variable Account or that
the Variable Account may purchase. We also reserve the right to eliminate the
shares of any Fund if they are no longer available for investment, or if we
believe investing more in any Fund is no longer appropriate for the purposes of
the Variable Account.
We will notify you before we substitute any of your shares in the Variable
Account. This will not, however, prevent the Variable Account from buying other
shares of underlying securities for other series or classes of policies, or from
permitting a conversion between series or classes of policies or certificates
when requested by the certificate owner.
We reserve the right to establish other Sub-Accounts, and to make them available
to any class or series of policies as we think appropriate. Each new
Sub-Account would invest in a new investment company or in shares of another
open-end investment company. We also reserve the right to eliminate or combine
existing Sub-Accounts of the Variable Account and to transfer the assets between
Sub-Accounts, when allowed by law.
If we make any substitutions or changes that we believe are necessary or
appropriate, we may make changes in this certificate by written notice to
reflect the substitution or change. If we think it is in the best interests of
our certificate owners, we may operate the Variable Account as a management
company under the Investment Company Act of 1940, or we may de-register it under
that Act if registration is no longer required. We may also combine it with
other Separate Accounts.
FORM 1030-99GRCJ 17
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No material change in the underlying investment policy of a sub-account of the
Variable Account shall be made until 60 days have elapsed from the date of such
change has been filed with the New York Superintendent of Insurance or such
shorter period as the Superintendent may permit. In the event of a material
change in the underlying investment policy of a sub-account of the Variable
Account, you will be notified of the change. If you have certificate value in
that sub-account, we will transfer it without charge on written request by you
to another sub-account of the Variable Account or the Fixed Account. We must
receive your written request within sixty (60) days of the later of (1) the
effective date of such change in the investment policy or (2) the receipt of
notice of your right to transfer. You may then change your payment and deduction
allocation percentages.
FEDERAL TAXES If we must pay taxes on the Variable Account, we will charge you
for that tax. Although the Variable Account is currently not taxable, we
reserve the right to charge for taxes if it becomes taxable.
SPLITTING OF UNITS We reserve the right to split the value of a unit, to either
increase or decrease the number of units. Any splitting of units will have no
material effect on certificate benefits.
FORM 1030-99GRCJ 18
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WHAT YOU SHOULD KNOW ABOUT THE FIXED ACCOUNT
FIXED ACCOUNT The Fixed Account is a part of our General Account. The General
Account consists of all assets owned by us, other than those in the Variable
Account and other Separate Accounts. Except as limited by law, we have sole
control over the investment of these General Account assets. You do not share
directly in the investment experience of the General Account, but are allowed to
allocate and transfer funds into the Fixed Account.
FIXED ACCOUNT INTEREST The interest rate credited to Certificate Value in the Fixed Account is set by us.
RATES We will review this interest rate from time to time, at least once a
year. The following guarantees apply to money in the Fixed Account:
- The interest rate in effect on the Date of Issue is guaranteed until the
next certificate anniversary, unless you borrow money from that Certificate
Value.
- The interest rate in effect on the day funds are transferred from a
Sub-Account of the Variable Account to the Fixed Account is guaranteed until the
next certificate anniversary, unless you borrow from that Certificate Value.
- The interest rate in effect on a certificate anniversary is guaranteed for
one year for those Certificate Values in the Fixed Account on the certificate
anniversary as long as those values remain in the Fixed Account and are not
borrowed.
- The interest rate(s) we use for that portion of the Certificate Value that
equals the Outstanding Loan will be at least the minimum rates shown on the
Specifications Page. One of the rates shown is the Preferred Loan Rate which
applies only to the portion of the Outstanding Loan that is secured by Earnings.
FIXED ACCOUNT CERTIFICATE The Fixed Account certificate value on the date of issue is the net payment
VALUE allocated to the Fixed Account minus the first insurance protectin
charge allocated to the Fixed Account. On each Monthly Processing Date
thereafter, the Certificate Value of the Fixed Account is equal to:
- the Certificate Value in this account on the preceding Monthly Processing
Date, if any, increased by one month's interest, plus
- payments received since the last Monthly Processing Date that are allocated
to the Fixed Account plus the interest accrued from the date the payments are
received by us, plus
- Variable Account Certificate Value transferred to the Fixed Account from
any Sub-Accounts since the preceding Monthly Processing Date, increased by
interest from the date the Certificate Value is transferred, minus
- Certificate Value transferred from the Fixed Account to a Sub-Account since
the preceding Monthly Processing Date and interest accrued on these transfers
from the transfer date to the Monthly Processing Date, minus
FORM 1030-99GRCJ 19
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- partial withdrawals from the Fixed Account, partial withdrawal transaction
charges and surrender charges since the last Monthly Processing Date, interest
accrued on these withdrawals, and charges from the withdrawal date to the
Monthly Processing Date, minus
- the portion of the Monthly Deductions allocated to the Certificate Value in
the Fixed Account.
During any certificate month the Fixed Account Certificate Value will be
calculated on a consistent basis. In no event will the Fixed Account
Certificate Value be less than the guaranteed cash value shown in the Paid-Up
Insurance Table after the paid-up option has been exercised.
BASIS OF VALUE OF THE We base the minimum surrender value in the Fixed Account on the minimum
FIXED ACCOUNT Fixed Account interest rates and mortality table shown on the
Specifications Page. Actual Certificate Values are based on interest and
insurance protection rates that we set. We have filed a detailed description of
the way we determine this value with the State Insurance Department. All values
equal or exceed the minimums required by law in the state in which this
certificate is delivered.
In no event will the Fixed Account Certificate Value be less than the guaranteed
cash value shown in the Paid-Up Insurance Table after the Paid-Up Option has
been exercised.
FORM 1030-99GRCJ 20
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WHAT YOU SHOULD KNOW ABOUT TRANSFERS
While the certificate is in force other than as paid-up insurance, you may
transfer amounts between the Fixed Account and the Sub-Accounts or among
Sub-Accounts on request.
You may transfer, without charge, all of the Certificate Value in the Variable
Account to the Fixed Account once during the first 24 months after the
certificate is issued in order to convert to a fixed-only product. If you do
so, future payments will be allocated to the Fixed Account unless you specify
otherwise. All other transfers are subject to the following rules and will be
permitted with our approval.
The minimum and maximum amounts that may be transferred from the Fixed Account
to the Variable Account shall be determined by us. In no event will our rules
provide for a minimum transfer of more than $500. The maximum transfer amount
will not be less than the lesser of $10,000 or 10% of the certificate value.
Transfers to any sub-account of the Variable Account from the Fixed Account are
permitted only if there has been at least a 180-day period since the last
transfer from the Fixed Account. There is no limit on the number of transfers
between the sub-accounts of the Variable Account and there is no limit on the
number of transfers between the sub-accounts of the Variable Account to the
Fixed Account.
If a transfer would reduce the Certificate Value in a Sub-Account to less than
$100, we reserve the right to include the remaining value in the amount
transferred.
You will not be charged for the first twelve transfers in a certificate year,
but a transfer charge of up to $25 may be made on each additional transfer. Any
transfer charge will be deducted from the amount that is transferred. Transfers
that result from a certificate loan or repayment of a loan are not subject to
these rules.
FORM 1030-99GRCJ 21
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WHAT YOU SHOULD KNOW ABOUT DOLLAR COST AVERAGING
You may elect automatic transfers of at least $100 to be made from one
sub-account (called the DCA sub-account in this provision) to one or more of the
other sub-accounts of the Variable Account. We will permit you to designate the
Money Market sub-account as the DCA sub-account. Other sub-accounts or the
Fixed Account may be designated by you as the DCA sub-account subject to our
consent.
Automatic transfers may be made monthly, quarterly, or on any other frequency
permitted by the Company. The Dollar Cost Averaging Option will be treated as
one of the twelve free transfers permitted in a year without regard to how many
sub-accounts are elected or the transfer frequency. We reserve the right to
limit the number of sub-accounts that may be utilized and we may discontinue
this option at any time upon advance written notice to the Owner.
If an automatic transfer reduces the balance in the DCA sub-account to less than
$100, the entire balance will be transferred proportionately to the chosen
Sub-Account(s).
The Dollar Cost Averaging Option will end:
- on the date specified in a notice sent by the Company when the remaining
amount in the DCA sub-account is zero following an automatic transfer; or;
- upon request.
We will send you a written notice when the Dollar Cost Averaging Option ends.
Payments allocated to the sub-account designated as the DCA sub-account after
this option has ended will not automatically reinstate the option; you must make
a new election.
The Dollar Cost Averaging Option and the Automatic Rebalancing Option may not be
in effect at the same time.
FORM 1030-99GRCJ 22
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WHAT YOU SHOULD KNOW ABOUT AUTOMATIC REBALANCING
By electing this option you may automatically rebalance the sub-accounts of the
Variable Account. You may direct us to process such transfers monthly,
quarterly, or on any other frequency permitted by the Company. When this option
is elected, you will designate the percentage allocation for each of the
Sub-Accounts chosen. On each periodic transfer date we will review the
percentage allocation in the various Sub-Accounts and, as necessary, transfer
funds in order to reestablish the designated percentage allocation mix.
The automatic Rebalancing Option will be treated as one of the twelve free
transfers permitted in a certificate year without regard to how many
sub-accounts are elected or the transfer frequency. If the amount necessary to
reestablish the designated mix on any transfer date is less than $100, no
transfer will be made. The arrangement may be terminated on written request.
We reserve the right to limit the number of Sub-Accounts that may be utilized
for automatic rebalancing and to discontinue the option upon advance written
notice to you.
The Dollar Cost Averaging Option and the Automatic Rebalancing Option may not be
in effect at the same time.
FORM 1030-99GRCJ 23
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WHAT YOU SHOULD KNOW ABOUT BORROWING FROM YOUR CERTIFICATE
To borrow from this certificate, the only collateral you will need is the
certificate itself.
AMOUNT YOU MAY BORROW Except as otherwise provided in the paid-up insurance
option, the maximum loan amount is 90% of the Certificate Value less the
surrender charge. You may borrow an amount subject to the minimum shown on the
Specifications Page, up to the maximum loan amount minus any Outstanding Loan.
You are advised to consult with a tax advisor before making a Certificate Loan.
If you do not specify from which accounts you want to borrow, we will allocate
the loan Pro Rata. In order to secure the Outstanding Loan, we will transfer
the Certificate Value in each Sub-Account equal to the certificate loan
allocated to each Sub-Account to the Fixed Account.
LOAN INTEREST You will pay interest on your loan at an annual rate indicated on
the Specifications Page. Interest accrues daily and is payable at the end of
each certificate year. Any interest that is not paid on time will be added to
the loan principal and bear interest at the same rate. If this makes the
principal higher than the Certificate Value in the Fixed Account, we will offset
this shortfall by transferring funds from the Sub- Accounts to the Fixed
Account. We will allocate the transferred amount among the Sub-Accounts in the
same proportion that the value in each Sub-Account has to the total value in all
of them.
PREFERRED LOAN The Preferred Loan is that portion of the Certificate Loan which
is secured by Earnings. The guaranteed minimum interest rate credited to the
Certificate Value which secures a Preferred loan is shown in the Specifications
Page.
REPAYING THE You may repay the Outstanding Loan at any time before this certificate
OUTSTANDING LOAN lapses. When you repay it, we will transfer the Certificate
Value that is securing the loan in the Fixed Account to the various Sub-Accounts
and increase the value in them. You may tell us how to allocate repayments.
Otherwise, we will allocate them according to the most recent payment allocation
choices you have made. Loan repayments made to the Variable Account cannot be
higher than the amounts you transferred to secure the Outstanding Loan.
FORECLOSURE If at any time the amount of the Outstanding Loan is higher than
the Certificate Value minus the surrender charge, we will terminate the
certificate. We will mail a notice of this termination to the last known
address of you and any Assignee. If the excess Outstanding Loan is not paid
within 62 days after this notice is mailed, the certificate will terminate with
no value. You may reinstate this certificate according to the Reinstatement
provision.
FORM 1030-99GRCJ 24
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WHAT YOU SHOULD KNOW ABOUT SURRENDERS AND PARTIAL WITHDRAWALS
SURRENDER You may cancel this certificate and receive its surrender value as
long as either Insured is living on the date we receive your Written Request at
our Home Office. The certificate will be canceled on that day. You may choose
to receive the surrender value in a lump sum or under a benefit option.
SURRENDER VALUE Except as otherwise provided in the paid-up insurance option, the
surrender value equals the Certificate Value minus the Outstanding Loan and
surrender charge. You will find the surrender charge on the Specifications
Page.
PARTIAL WITHDRAWALS Partial withdrawals are not allowed if your certificate is
in force as paid-up insurance. You may withdraw part of the surrender value on
Written Request prior to the Final Payment Date. Each withdrawal must be at
least $1,000. We will deduct a 2% withdrawal transaction charge (maximum $25)
from the Certificate Value each time you make a partial withdrawal.
We will not permit a partial withdrawal if it reduces the Certificate Value
amount to less than the minimum amount shown on the Specifications Page.
The Face Amount will be reduced proportionately based on the ratio of the amount
of the partial withdrawal and charges to the Certificate Value on the date of
withdrawal. The Certificate Value will be reduced by the amount of the partial
withdrawal, the partial withdrawal transaction charge and any applicable
surrender charges.
For example, the Face Amount is $500,000 and the Certificate Value is $95,000.
If you make a withdrawal of $25,000 (including the partial withdrawal charge and
surrender charge), the adjustment will be calculated as follows:
1. $25,000 divided by $95,000 = 26.3%
2. $500,000 x 26.3 = $131,500 (amount of reduction)
3. $500,000 - $131,500 = $368,500 (resulting Face Amount)
4. $95,000 - $25,000 = $70,000 (resulting Certificate Value)
FREE WITHDRAWAL AMOUNT The free withdrawal amount will not be subject to the surrender charge as described on
the Specifications Page. This amount equals (a) minus (b), where:
(a) is the free withdrawal amount shown on the Specifications Page, and
(b) is the total of the withdrawals (or portions of them) made in the same
certificate year that were exempt from the surrender charge.
The free withdrawal amount is first deducted from Earnings. Withdrawals in
excess of the free withdrawal amount are deducted from payments not previously
considered withdrawn on a last-in, first-out basis. Surrender charges
applicable to the excess withdrawal are described on the Specifications Page.
If you do not allocate a partial withdrawal and its charges between the Fixed
Account and each Sub-Account, we will automatically allocate them Pro Rata.
FORM 1030-99GRCJ 25
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POSTPONEMENT OF We may postpone any transfer from the Variable Account, or payment
PAYMENT allocated to the Variable Account of any amount payable on:
- surrender
- partial withdrawal
- transfer
- certificate loan
- death of the Insured
The postponement will continue during any period when:
- the NYSE is closed for days other than weekends and holidays, or
- the SEC has determined that such an emergency exists that disposal of
portfolio securities or valuation of assets is not reasonably practical.
We also may postpone any transfer from the Fixed Account or payment of any
portion of the amount payable on a surrender, partial withdrawal or certificate
loan from the Fixed Account for not more than six months from the day we receive
your Written Request and your certificate, if it is required. We will pay
interest if our payment is not mailed or delivered within ten days of the date a
valid request is made; however, no interest shall be paid if such interest is
less than $25 or the delay in payment is pursuant to New York law. A "valid
request" is made when all documentation necessary to complete the transaction is
received at Home Office. The interest rate credited will be the same rate
applied to proceeds held by us under Payment Option C. No payment will be
deferred to pay premiums on policies with the Company.
PAID UP INSURANCE OPTION
BENEFIT This is second-to-die insurance, usually having a reduced face amount
for the lifetime of the insureds with no further premiums due. The amount of
paid-up insurance is the amount that the surrender value can purchase for a net
single premium at the insured's ages and underwriting classes on the date this
option is exercised. The paid-up insurance death benefit may not exceed the
death benefit in effect on the date this option is exercised, any excess
surrender value will be paid to you.
BASIS OF VALUES The certificate value and net single premium of the paid-up
insurance meet the minimum standards which are set by state law. The net single
premium for both insureds is based on the Commissioners 1980 Standard Ordinary
Mortality Table D, Smoker or Non-Smoker, (or appropriate increases in such
tables for non-standard risks). Interest will not be less than 4 1/2%. See page
6a for the table showing the guaranteed net single premiums per $1,000 of
insurance.
EXERCISE OF OPTION The paid-up insurance option may be exercised by you on written request while
either insured is living. Certificate value in the Variable Account will be
transferred to the Fixed Account on the date your written request to
exercise this option is received in our Principal Office. We will issue
supplemental specification pages that show the certificate is paid up
effective as of the monthly payment date following receipt of the written
request.
The supplemental specification pages will show:
The effective date of paid up insurance,
The paid-up death benefit,
Guaranteed cash surrender values, and
Riders.
FORM 1030-99GRCJ 26
<PAGE>
If both insureds die prior to the effective date, the Company will pay the death
proceeds in effect under this certificate on the date of death of the
second-to-die.
EFFECT ON THE CERTIFICATE After the certificate becomes paid up, no further payments may be made by you.
You may not make partial withdrawals or transfer funds to the Variable Account; however,
you may make certificate loans or surrender the certificate for its net cash value.
Riders will continue only with our consent. The guaranteed cash value of the paid-up
insurance equals the net single premium for the paid-up insurance at the insured's
attained age. The net single premium is determined on the same basis as is used for the
purchase price of the paid-up insurance. The net cash value is the cash value less any
outstanding loan. The loan value of paid-up insurance is the amount that, with
interest at 6% per year, equals the cash value of the paid-up certificate as of
the next certificate anniversary.
WHAT YOU SHOULD KNOW ABOUT THE DEATH BENEFIT
NET DEATH BENEFIT If the surviving Insured dies before the Final Payment Date,
we will pay the net death benefit upon receipt at the Home Office of proof of
the surviving Insured's death. Except as otherwise provided in the Paid-Up
Insurance Option, the net death benefit is the Face Amount at the time of death
of the second-to-die or the guideline minimum sum insured, if greater, reduced
by any Outstanding Loan, rider charges and monthly deductions due and unpaid
through the certificate month in which the surviving Insured dies, as well as
any partial withdrawals and surrender charges. We will pay interest from the
date of the second death to the date the net death benefit is paid. If the
surviving Insured dies after the Final Payment Date, and the Paid-Up Insurance
Option has not been exercised, we will pay the Certificate Value minus any
Outstanding Loans. We will pay interest from the date we receive the death
certificate. If you choose a lump sum payment, the interest rate will be at
least 3% a year, or the minimum rate set by law, if greater.
REQUIRED MINIMUM In order to qualify as "life insurance" under the federal tax law, this certificate
AMOUNT OF DEATH BENEFIT must provide a minimum death benefit. This is called the "guideline minimum sum
nsured" in the tax code. This is calculated by multiplying the Certificate Value
by the percentages shown in the Guideline Minimum Sum Insured Table on the
Specifications Page. The guideline minimum sum insured varies by the younger
insured's attained age. The amounts shown in the Table are determined according to
federal tax law, and will be adjusted according to any changes in that law.
CONTINUATION OF INSURED'S COVERAGE AFTER DISCONTINUATION OF THE POLICY
If the group policy is discontinued, any certificate then in effect will remain
in force under the discontinued policy, provided it is not cancelled or
surrendered by the certificate owner.
FORM 1030-99GRCJ 27
<PAGE>
WHAT YOU SHOULD KNOW ABOUT THE BENEFIT OPTIONS
BENEFIT OPTIONS You may choose one of the following options for receiving
the surrender value or the net death benefit. We will give the payee a
certificate describing the benefit option you selected. If you make no choice,
we will pay the benefits in a single, lump sum.
We will pay all benefits from the Fixed Account. Benefits may not be allocated
to the Variable Account. The amounts payable under these options, for each
$1,000 applied, will be:
(a) the rate per $1,000 of benefit based on our non-guaranteed current benefit
option rates for this class of certificates, or
(b) the rate in this certificate for the applicable benefit option, whichever
is greater.
If you choose a benefit option, the beneficiary may, when filing a proof of
claim, pay us any amount that otherwise would be deducted from the proceeds.
OPTION A: BENEFITS FOR A We will make equal payments for any selected number of years up to 30 years.
SPECIFIED NUMBER OF These payments may be made annually, semi-annually, quarterly or monthly,
YEARS (TABLE A) whichever you choose.
OPTION B: LIFETIME Benefits are based on the age of the person who receives the money (called
MONTHLY BENEFIT (TABLE B) the payee) on the date the first payment will be made. You may choose one of
the three following options to specify when benefits will cease:
- when the payee dies with no further benefits due (Life Annuity);
- when the payee dies but not before the total benefit payments made by us
equals the amount applied under this option (Life Annuity with Installment
Refund); or
- when the payee dies but not before 10 years have elapsed from the date of
the first payment (Life Annuity with Payments Guaranteed for 10 years).
OPTION C: INTEREST We will pay interest at a rate we determine each year. It will not be less than
BENEFITS 3% per year. We will make payments annually, semi-annually,
quarterly, or monthly, whichever is preferred. These benefits will stop when
the amount left has been withdrawn. If the payee dies, any unpaid balance plus
accrued interest will be paid in a lump sum.
OPTION D: BENEFITS FOR A Interest will be credited to the unpaid balance and we will make payments until
SPECIFIED AMOUNT the unpaid balance is gone. We will credit interest at a
rate we determine each year, but not less than 3%. We will make payments
annually, semi-annually, quarterly, or monthly, whichever is preferred. The
benefit level chosen must provide for an annual benefit of at least 8% of the
amount applied.
OPTION E: LIFETIME We will pay a benefit jointly to two payees during their joint lifetime.
MONTHLY BENEFITS FOR TWO After one payee dies, the benefits to the survivor will be:
PAYEES (TABLE E)
- the same as the original amount, or
- in an amount equal to 2/3 of the original amount.
FORM 1030-99GRCJ 28
<PAGE>
Benefits are based on the payees' ages on the date the first payment is due.
Benefits will end when the second payee dies.
SELECTING BENEFIT OPTIONS The amount we apply under any one option for any one payee must be at least $5,000,
and the periodic payment for any one payee must be at least $50.
You may change any option you select before the net death benefit is paid,
subject to the Owner and Beneficiary provisions. If you make no selection, the
beneficiary may choose an option when the benefits become payable.
If the amount of monthly income benefits under Option B for the age of the payee
is the same for different periods certain, the payee will be entitled to the
longest period certain for the payee's age.
You may give the beneficiary the right to change from Option C or D to any other
option at any time. If Option C or D is chosen by the payee when this
certificate becomes a claim, the payee may reserve the right to change to any
other option. The payee who elects to change options must be the payee under
the option selected.
ADDITIONAL DEPOSITS An additional deposit may be added to any proceeds when they are applied
under Option B and E. We reserve the right to limit the amount of
any additional deposit. We may levy a charge of no more than 3% on any
additional deposits.
RIGHTS AND LIMITATIONS A payee has no right to assign any amount payable under any option, nor to
demand a lump sum benefit in place of any amount payable under Options B or E.
A payee will have the right to receive a lump sum in place of installments under
Option A. The payee must provide us with a Written Request to reserve this right.
If the right to receive a lump sum is exercised, we will determine the lump sum
benefit at the same interest rates used to calculate the installments. The amount
left under Option C and any unpaid balance under Option D, may be withdrawn only as
noted in the Written Request selecting the option.
A corporate or fiduciary payee may select only Option A, C or D, subject to our
approval.
BENEFIT DATES The first payment under any option, except Option C, will be due
on the date this certificate matures, by death or otherwise, unless another date
is designated. Benefits under Option C begin at the end of the first benefit
period.
The last payment under any option will be made as stated in the option's
description. However, if a payee under Options B or E dies before the due date
of the second monthly payment, the amount applied, minus the first monthly
payment, will be paid in a lump sum or under any option other than Option E.
This payment will be made to the surviving payee under Option E or the
succeeding payee under Option B.
BENEFIT RATES The Benefit Option Tables show benefit amounts for Option A, B
and E. If you choose one of these options, either within five years of the date
of surrender or the date the proceeds are otherwise payable, we will apply
either the benefit rates listed in the Tables, or the rates we use on the date
the proceeds are paid, whichever is more favorable. Benefits that begin more
than five years after that date, or as a result of additional deposits, will be
based on the rates we use on the date the first benefit is due.
</TABLE>
FORM 1030-99GRCJ 29
<PAGE>
BENEFIT OPTIONS
<TABLE>
<CAPTION>
YEARS ANNUAL SEMI-ANNUAL QUARTERLY MONTHLY
<S> <C> <C> <C> <C> <C>
TABLE A 1 1000.00 504.30 53.23 84.65
BENEFITS FOR SPECIFIED NUMBER 2 508.60 256.49 128.79 43.05
OF YEARS 3 344.86 173.91 87.33 29.19
PAYMENT FOR EACH $1,000 OF CERTIFICATE 4 263.04 132.65 66.61 22.27
VALUE APPLIED 5 213.99 107.92 54.19 18.12
These tables are based on an annual interest 6 181.32 91.44 43.92 15.35
rate of 3 1/2%.
7 158.01 79.69 40.01 13.38
8 140.56 70.88 35.59 11.90
9 127.00 64.05 32.16 10.75
10 116.18 58.59 29.42 9.83
11 107.34 54.13 27.18 9.09
12 99.98 50.42 25.32 8.46
13 93.78 47.29 23.75 7.94
14 88.47 44.62 22.40 7.49
15 83.89 42.31 21.24 7.10
16 79.89 40.29 20.23 6.76
17 76.37 38.51 19.34 6.47
18 73.25 36.94 18.55 6.20
19 70.47 35.54 17.85 5.97
20 67.98 34.28 17.22 5.75
21 65.74 33.15 16.65 5.56
22 63.70 32.13 16.13 5.39
23 61.85 31.19 15.66 5.24
24 60.17 30.34 15.24 5.09
25 58.62 29.56 14.85 4.96
26 57.20 28.85 14.49 4.84
27 55.90 28.19 14.15 4.73
28 54.69 27.58 13.85 4.63
29 53.57 27.02 13.57 4.53
30 52.53 26.49 13.30 4.45
</TABLE>
FORM 1030-99GRCJ 30
<PAGE>
BENEFIT OPTIONS (CONTINUED)
LIFE INCOME OPTION TABLES
MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF CERTIFICATE VALUE APPLIED
TABLE B
<TABLE>
<CAPTION>
Life Annuity with
Age Nearest Payments Guaranteed for Life Annuity with
Birthday 10 Years "Life" Annuity Installment Refund
<S> <C> <C> <C>
50 4.22 4.24 4.14
51 4.28 4.31 4.19
52 4.34 4.37 4.25
53 4.41 4.44 4.31
54 4.48 4.52 4.37
55 4.55 4.59 4.43
56 4.63 4.68 4.50
57 4.71 4.76 4.57
58 4.80 4.86 4.65
59 4.89 4.96 4.73
60 4.98 5.06 4.82
61 5.08 5.18 4.90
62 5.19 5.30 5.00
63 5.30 5.43 5.10
64 5.42 5.56 5.20
65 5.55 5.71 5.31
66 5.68 5.87 5.43
67 5.81 6.04 5.55
68 5.96 6.22 5.68
69 6.11 6.41 5.81
70 6.26 6.62 5.96
71 6.43 6.84 6.11
72 6.60 7.08 6.27
73 6.77 7.34 6.44
74 6.95 7.62 6.62
75 7.13 7.91 6.81
These tables are based on an annual interest rate of 31/2% and the 1983(a)
Individual Mortality Table using a blend reflecting 40% of the male rate and 60% of the female rate.
</TABLE>
FORM 1030-99GRCJ 31
<PAGE>
BENEFIT OPTIONS (CONTINUED)
MONTHLY ANNUITY BENEFIT PAYMENT
FOR EACH $1,000 OF CERTIFICATE VALUE APPLIED
TABLE E1 TABLE E2
<TABLE>
<CAPTION>
<S> <C>
Joint and Survivor Life Annuity Older Age Joint and Two-Thirds Survivor Life Annuity
Older Age
50 55 60 65 70 75 80 50 55 60 65 70 75 80
Y 50 3.91 3.97 4.02 4.05 4.07 4.09 4.10 4.25 4.40 4.57 4.76 4.96 5.18
O 55 4.18 4.26 4.32 4.36 4.39 4.41 4.60 4.80 5.02 5.26 5.50
U 60 4.54 4.65 4.73 4.78 4.81 5.08 5.35 5.63 5.92
N 65 5.04 5.19 5.29 5.35 5.74 6.10 6.46
G 70 5.75 5.95 6.08 6.67 7.15
E 75 6.77 7.06 8.04
R 80 8.29
A
G
E
These tables are based on an annual interest rate of 3 1/2%
and the 1983(a) Individual Mortality Table using a proportional blend of 50%
male & 50% female.
MODIFIED SINGLE PAYMENT SECOND-TO-DIE VARIABLE LIFE INSURANCE CERTIFICATE
NON-PARTICIPATING
</TABLE>
FORM 1030-99GRCJ 32
