[COMPANY LOGO]
Allianz Life Insurance Company of North America
1750 Hennepin Avenue
Minneapolis, MN 55403-2195
A Stock Company
This is a legal Contract between the Contract Owner (referred to in this
Contract as you and your) and Allianz Life Insurance Company of North America
(herein referred to as we, us and our). We will make Annuity Payments as set
forth in this Contract beginning on the Income Date.
This Contract is issued in consideration of the payment of the initial Purchase
Payment.
READ YOUR CONTRACT CAREFULLY
RIGHT TO EXAMINE: This Contract may be returned within 10 days after you receive
it. It can be mailed or delivered to either us or the agent who sold it. Return
of this Contract by mail is effective on being postmarked, properly addressed
<PAGE>
and postage prepaid. The returned Contract will be treated as if we had never
issued it. We will promptly refund the Contract Value in states where permitted.
This may be more or less than the Purchase Payments. We have the right to
allocate payments to the Money Market Sub-Account until the expiration of the
Right to Examine period. If we so allocate payments, we will refund the greater
of the Purchase Payments, less any withdrawals, or the Contract Value.
Benefits available under this Contract are not less than those required by
statute of the state in which this Contract is delivered.
This is a Variable Annuity Contract with Annuity Payments and Contract Values
increasing or decreasing depending on the experience of the Variable Account
which is set forth in the Contract Schedule.
Signed for Allianz Life Insurance Company of North America by:
/s/ /s/
Vice President and Secretary President
INDIVIDUAL MULTIPLE PAYMENT VARIABLE ANNUITY
NON-PARTICIPATING
<PAGE>
TABLE OF CONTENTS
RIGHT TO EXAMINE........................................................1
CONTRACT SCHEDULE..................................................i-viii
DEFINITIONS.............................................................4
PURCHASE PAYMENTS.......................................................6
PURCHASE PAYMENTS..................................................6
CHANGE IN PURCHASE PAYMENTS........................................6
NO DEFAULT.........................................................6
ALLOCATION OF PURCHASE PAYMENTS....................................6
VARIABLE ACCOUNT........................................................6
THE VARIABLE ACCOUNT...............................................6
VALUATION OF ASSETS................................................6
ACCUMULATION UNITS.................................................6
ACCUMULATION UNIT VALUE............................................7
NET INVESTMENT FACTOR..............................................7
MORTALITY AND EXPENSE RISK CHARGE..................................7
ADMINISTRATIVE CHARGE..............................................7
DISTRIBUTION EXPENSE CHARGE.......................................7
MORTALITY AND EXPENSE GUARANTEE....................................8
CONTRACT VALUE..........................................................8
CONTRACT MAINTENANCE CHARGE.............................................8
TRANSFERS...............................................................8
WITHDRAWAL PROVISIONS..................................................9
WITHDRAWALS........................................................9
WITHDRAWAL CHARGE..................................................9
PROCEEDS PAYABLE ON DEATH..............................................10
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD............10
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD...............10
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD..............10
DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD.................11
DEATH OF ANNUITANT................................................11
PAYMENT OF DEATH BENEFIT..........................................11
BENEFICIARY.......................................................11
CHANGE OF BENEFICIARY.............................................11
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION...........................12
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS.......................12
CONTRACT OWNER....................................................12
JOINT OWNER.......................................................12
ANNUITANT.........................................................12
ASSIGNMENT OF A CONTRACT..........................................12
ANNUITY PROVISIONS.....................................................13
GENERAL...........................................................13
FIXED ANNUITY.....................................................13
VARIABLE ANNUITY..................................................13
INCOME DATE.......................................................14
SELECTION OF AN ANNUITY OPTION....................................14
ANNUITY OPTIONS...................................................14
OPTION 1 - LIFE ANNUITY.......................................14
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15,
OR 20 YEARS GUARANTEED........................................14
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY....................15
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY
PAYMENTS OVER 5, 10, 15, OR 20 YEARS GUARANTEED...............15
OPTION 5 - REFUND LIFE ANNUITY................................16
OPTION 6 - SPECIFIED PERIOD CERTAIN ANNUITY...................16
GENERAL PROVISIONS.....................................................16
THE CONTRACT......................................................16
NON-PARTICIPATING IN SURPLUS......................................16
MISSTATEMENT OF AGE OR SEX........................................16
CONTRACT SETTLEMENT................................. .............16
REPORTS...........................................................17
TAXES.............................................................17
EVIDENCE OF SURVIVAL..............................................17
PROTECTION OF PROCEEDS............................................17
MODIFICATION OF CONTRACT..........................................17
TABLE OF ANNUITY PAYMENT AMOUNTS..................................18
<PAGE>
CONTRACT SCHEDULE
CONTRACT OWNER: [John Doe] CONTRACT NUMBER: [??687456]
JOINT OWNER: [Jane Doe] ISSUE DATE: [10/01/00]
ANNUITANT: [John Doe] INCOME DATE: [04/15/07]
JOINT ANNUITANT: [Jane Doe]
PURCHASE PAYMENTS:
INITIAL PURCHASE PAYMENT: [$10,000]
MINIMUM SUBSEQUENT
PURCHASE PAYMENT: [None; Subsequent Purchase
Payments can only be made within
the first six months from the
Issue Date.]
MAXIMUM TOTAL
PURCHASE PAYMENTS: [$1 million; higher amounts may
be accepted with our prior
approval]
ALLOCATION GUIDELINES:
[1. Currently, you can select up to 10 of the Investment Options.
2. If allocations are made in percentages, whole numbers must be
used.]
INVESTMENT OPTIONS:
VARIABLE ACCOUNT: [Allianz Life Variable Account B]
Sub-Accounts are assigned to [six] Investment Classes. The
Sub-Accounts' investment objective and strategy are taken into account
to classify them into one of the following Investment Classes.
[AGGRESSIVE GROWTH:]
[AIM V.I. CAPITAL APPRECIATION]
[ALGER AMERICAN LEVERAGED ALLCAP]
[ALGER AMERICAN SMALL CAPITALIZATION]
[FRANKLIN SMALL CAP]
[SELIGMAN GLOBAL TECHNOLOGY]
[SELIGMAN SMALL-CAP VALUE]
[INTERNATIONAL GROWTH:]
[AIM V.I. INTERNATIONAL EQUITY]
[J.P. MORGAN INTERNATIONAL OPPORTUNITIES]
[MUTUAL DISCOVERY SECURITIES]
[OPPENHEIMER GLOBAL SECURITIES/VA]
[SP JENNISON INTERNATIONAL GROWTH]
[TEMPLETON DEVELOPING MARKETS SECURITIES]
[TEMPLETON GROWTH SECURITIES]
[TEMPLETON PACIFIC GROWTH SECURITIES]
<PAGE>
[USALLIANZ VIP GLOBAL OPPORTUNITIES]
[DOMESTIC GROWTH:]
[AIM V.I. GROWTH]
[AIM V.I. VALUE]
[ALGER AMERICAN GROWTH]
[ALGER AMERICAN MIDCAP GROWTH]
[DAVIS VA FINANCIAL]
[DAVIS VA VALUE]
[SP STRATEGIC PARTNERS FOCUSED GROWTH]
[USALLIANZ VIP GROWTH]
[VAN KAMPEN LIT ENTERPRISE]
[GROWTH AND INCOME:]
[DAVIS VA REAL ESTATE]
[FRANKLIN GROWTH AND INCOME SECURITIES]
[FRANKLIN RISING DIVIDENDS SECURITIES]
[J.P. MORGAN U.S. DISCIPLINED EQUITY]
[MUTUAL SHARES SECURITIES]
[OPPENHEIMER MAIN STREET GROWTH & INCOME/VA]
[PIMCO VIT STOCKS PLUS GROWTH AND INCOME]
[USALLIANZ VIP DIVERSIFIED ASSETS]
[VAN KAMPEN LIT GROWTH & INCOME]
[BONDS:]
[FRANKLIN U.S. GOVERNMENT]
[OPPENHEIMER HIGH INCOME/VA]
[PIMCO VIT HIGH YIELD BOND]
[PIMCO VIT TOTAL RETURN BOND]
[CONSERVATIVE FIXED INCOME:]
[USALLIANZ VIP FIXED INCOME]
[USALLIANZ VIP MONEY MARKET]
[ALLIANZ LIFE GENERAL ACCOUNT]:
--------------------------------
[ALLIANZ LIFE FIXED ACCOUNT]
[DIMENSIONS] ASSET ALLOCATION MODEL: If you have chosen to meet the requirements
of this model, your guaranteed value protection charge is lower. These
requirements are:
(1) that a maximum percentage is allocated into each Investment Class, as
follows:
o [30%] maximum percentage can be allocated into the [Aggressive Growth]
Investment Class.
o [20%] maximum percentage can be allocated into the [International Growth]
Investment Class.
o [60%] maximum percentage can be allocated into the [Domestic Growth]
<PAGE>
Investment Class.
(2) that at least [10%] is allocated into the [Conservative Fixed Income]
Investment Class (including the Allianz Life Fixed Account).
(3) that quarterly rebalancing occurs automatically on [March 20th, June 20th,
September 20th and December 20th].
The maximum and minimum percentages can be changed for future Contract Years by
the Company. Within each Investment Class, you can choose among the Investment
Options available.
You can terminate participation of the [Dimensions] Asset Allocation Model.
You can make transfers among the Investment Options within each Investment
Class. If you transfer money from an Investment Option within a particular
Investment Class to an Investment Option within another Investment Class, you
will have moved out of the model.
You will receive notification after you have moved out of the [Dimensions] Asset
Allocation model. Within 60 calendar days of the transaction, you can request to
return to the [Dimensions] Asset Allocation Model. After the 60-day period, you
will not be able to return to the [Dimensions] Asset Allocation Model.
MORTALITY AND EXPENSE RISK CHARGE: During the Accumulation Period, the mortality
and expense risk charge is equal on an annual basis to [1.50%] of the average
daily net assets of the Variable Account. During the Annuity Period, the
mortality and expense risk charge is equal on an annual basis to [1.50%] of the
average daily net assets of the Variable Account. We may decrease this charge,
but we may not increase it. [If you chose the Guaranteed Performance Accumulator
benefit and later terminate your benefit, your mortality and expense risk charge
will decrease by [.20%] after termination.]
ADMINISTRATIVE CHARGE: None
DISTRIBUTION EXPENSE CHARGE: None
CONTRACT MAINTENANCE CHARGE: The contract maintenance charge is currently [$40]
each Contract Year.
During the Accumulation Period, the contract maintenance charge will be deducted
from the Contract Value the last day of each Contract Year while this Contract
is in force. If a total withdrawal is made on a date other than a Contract
Anniversary and your Contract Value for the Valuation Period during which the
total withdrawal is made is less than [$50,000]; the full contract maintenance
charge will be deducted at the time of the total withdrawal. The contract
maintenance charge will be deducted from the Investment Options in the same
proportion that the amount of the Contract Value in each Investment Option bears
to the total Contract Value.
During the Annuity Period, the contract maintenance charge will be collected pro
rata from each Annuity Payment.
<PAGE>
If the total Contract Value is at least [$50,000], we will not assess the
contract maintenance charge.
In the event you own more than one Contract of the same type issued by the
Company, we will determine the total Contract Value for all of the Contracts. If
the Contract Owner is not a natural person, we will look to the Annuitant in
determining the foregoing.
GUARANTEED VALUE PROTECTION CHARGE:
The guaranteed value protection charge is a percentage of the Contract Value.
During the Accumulation Period, this charge will be deducted from the Contract
Value on the last day of each Contract Year while the Contract is in force.
The guaranteed value protection charge varies depending on your Target Value.
The Target Value is defined in the first Contract Year as the Purchase Payments
less any partial withdrawals accumulated to the end of the Contract Year. In
subsequent Contract Years, the Target Value is the Contract Value at the end of
the prior Contract Year, less partial withdrawals made in the Contract Year,
accumulated to the end of the Contract Year. The annual rate for accumulating
the Target Value is currently [10%], less the mortality and expense risk charge.
This rate is guaranteed for the first [ten] Contract Years. We reserve the right
to change this rate for Contract Years after the [tenth] year. We guarantee this
rate will never be less than 5%.
While the Guaranteed Value Protection Benefit is in effect, the charge in any
Contract Year is:
A.) If the [Dimensions] Asset Allocation Model is selected and your Contract
Value is greater than your Target Value, the guaranteed value protection
charge will be the percentage excess of the Contract Value over the Target
Value. This percentage charge is currently capped at [2%]. We guarantee
that this percentage charge cap will not be more than 5%. If we change the
percentage cap charge, it will be effective on the next Contract
Anniversary. You will have 30 calendar days from the effective date of an
increase in the percentage cap charge to cancel the Guaranteed Value
Protection Benefit.
B.) If the [Dimensions] Asset Allocation Model is not selected and your
Contract Value is greater than your Target Value, the guaranteed value
protection charge will the percentage excess of the Contract Value over the
Target Value. This percentage charge is currently capped at [3%]. However,
if at the beginning of any Contract quarter during the year, your asset
allocation meets the [Dimensions] Asset Allocation Model requirements (but
not necessarily the quarterly rebalancing requirement), this percentage
charge cap is deemed to be at [2%] for that quarter. At the time of
assessment of the charge, the average over the Contract Year is used as the
percentage cap. We guarantee that this percentage charge cap will not be
more than 5%.
C.) If the Target Value is greater than or equal to the Contract Value, the
guaranteed value protection charge will be 0%.
<PAGE>
D.) Beginning in the sixth Contract Year, if the average Contract Value in the
Contract Year is greater than [two] times the minimum value guarantee, the
guaranteed value protection charge will be 0%.
If the Contract is terminated for any reason, or when you elect to receive
Annuity Payments, or when your guarantee account drops to zero or less, we will
deduct the guaranteed value protection charge only for the period the benefit
was in effect during the Contract Year.
TRANSFERS:
NUMBER OF TRANSFERS PERMITTED: There are no limits on the number of
transfers that can be made. We reserve the right to change this, but
you will always be allowed at least 12 transfers in any Contract Year.
Currently, you are allowed [12] free transfers each Contract Year. This
applies to transfers prior to and after the Income Date.
TRANSFER FEE: For each transfer in excess of the free transfers
permitted, the transfer fee is [$25]. Transfers made at the end of the
Right to Examine period by us and any transfers made pursuant to a
regularly scheduled transfer will not be counted in determining the
application of the transfer fee.
MINIMUM AMOUNT TO BE TRANSFERRED: [None]
WITHDRAWALS:
WITHDRAWAL CHARGE: During the Accumulation Period, a withdrawal charge
is assessed against Purchase Payments withdrawn. The charge is
calculated at the time of each withdrawal. For partial withdrawals, the
charge is deducted from the remaining Contract Value and is deducted
from the Investment Options in the same proportion that the amount of
withdrawal from the Investment Options bears to the total of the
partial withdrawal. The withdrawal charge is based upon the length of
the time from the Issue Date. The withdrawal charges are as follows:
[WITHDRAWAL CHARGE - DURING THE ACCUMULATION PERIOD:
(as a percentage of total Purchase Payments)
Number of Complete Contract
Years since Issue Date Withdrawal Charge
---------------------- ------------------
0 8.0%
1 7.0%
2 7.0%
3 6.0%
4 5.0%
5 4.0%
6 3.0%
7 years or more 0.0%]
PARTIAL WITHDRAWAL PRIVILEGE: Each Contract Year, on a non-cumulative basis, you
can withdraw up to 10% of Purchase Payments during the first five Contract Years
without incurring a withdrawal charge. Beginning on the first day of the sixth
Contract Year and each Contract Year thereafter, you can withdraw up to [20%] of
Purchase Payments without incurring a withdrawal charge.
Complete withdrawals are assessed a withdrawal charge on the full Withdrawal
Charge Basis Amount with no reductions for the Partial Withdrawal Privilege.
MINIMUM PARTIAL WITHDRAWAL: [None]
MINIMUM CONTRACT VALUE THAT MUST REMAIN IN THE CONTRACT AFTER A PARTIAL
WITHDRAWAL: [None]
PARTIAL WITHDRAWAL EFFECT ON DEATH BENEFITS AFTER FIVE CONTRACT YEARS:
After the first five Contract Years, an adjusted partial withdrawal is equal to
the sum of:
(1) the partial withdrawal (including withdrawal charges), if the total partial
withdrawals (including withdrawal charges) in the Contract Year do not
exceed [20% of the Net Adjusted Purchase Payments], and
(2) the partial withdrawal in excess of (1), adjusted in the same manner as
described for partial withdrawals in the first five Contract Years.
PARTIAL WITHDRAWAL EFFECT ON THE GUARANTEED VALUE PROTECTION BENEFIT AFTER FIVE
CONTRACT YEARS:
After the first five Contract Years, a Guaranteed Value Protection adjusted
partial withdrawal is equal to the sum of:
(1) the partial withdrawal (including withdrawal charges), if the total partial
withdrawals (including withdrawal charges) in the Contract Year do not
exceed [20% of the Guaranteed Value Protection value], and
(2) the partial withdrawal in excess of (1), adjusted in the same manner as
described for partial withdrawals in the first five Contract Years.
AMOUNT AVAILABLE FOR ANNUITY PAYMENTS: For [Options 1 through 5]: [105%] of the
greater of the Contract Value or the guarantee account under the Guaranteed
Value Protection Benefit, the result less any applicable Premium Tax and the
guaranteed value protection charge.
For Fixed Annuity Option 6: The greater of the Adjusted Contract Value or the
guarantee account under the Guaranteed Value Protection Benefit, the result less
any applicable Premium Tax and the guaranteed value protection charge.
For Variable Annuity Option 6: The Adjusted Contract Value.
EARLIEST INCOME DATE: [The first day of the calendar month after the fifth
Contract Anniversary.]
<PAGE>
NUMBER OF YEARS BEFORE A PARTIAL LIQUIDATION IS AVAILABLE ON ANNUITY OPTION 2
AND 4: [5 years from the Income Date].
COMMUTATION FEE APPLICABLE TO ANNUITY OPTIONS 2 AND 4 - DURING THE ANNUITY
PERIOD (as a percentage of amount liquidated):
------------------------------- ----------------------
[Complete Years Since Income Commutation Fee
Date
------------------------------- ----------------------
------------------------------- ----------------------
5 7%
------------------------------- ----------------------
------------------------------- ----------------------
6 6%
------------------------------- ----------------------
------------------------------- ----------------------
7 5%
------------------------------- ----------------------
------------------------------- ----------------------
8 4%
------------------------------- ----------------------
------------------------------- ----------------------
9 3%
------------------------------- ----------------------
------------------------------- ----------------------
10 2%
------------------------------- ----------------------
------------------------------- ----------------------
Over 11 1%]
------------------------------- ----------------------
MAXIMUM CUMULATIVE PERCENTAGE FOR PARTIAL LIQUIDATION FOR ANNUITY OPTIONS 2 AND
4: [75%]
WITHDRAWAL CHARGE APPLICABLE TO ANNUITY OPTION 6 - DURING THE ANNUITY PERIOD (as
a percentage of amount liquidated):
------------------------------- -------------------------
[Number of Complete Contract Withdrawal Charge
Years since Issue Date
------------------------------- -------------------------
------------------------------- -------------------------
5 4.0%
------------------------------- -------------------------
------------------------------- -------------------------
6 3.0%
------------------------------- -------------------------
------------------------------- -------------------------
Over 7 0.0%]
------------------------------- -------------------------
<PAGE>
ASSUMED INVESTMENT RETURN: [5%]
FIXED ACCOUNT INITIAL RATE: [3%]
We guarantee this rate for one year from the Issue Date.
RIDERS ATTACHED TO THIS CONTRACT:
[Declared Interest Rate Fixed Account Endorsement]
[Double Principal Guaranteed Minimum Death Benefit Endorsement]
[Guaranteed Performance Accumulator Benefit Endorsement]
[Earnings Protection Guaranteed Minimum Death Benefit Endorsement]
[403 (b) Endorsement]
[Guaranteed Principal Protector Benefit Endorsement] [Group Pension
Plan Death Benefit Endorsement] [Individual Retirement Annuity
Endorsement] [Pension Plan and Profit Sharing Plan Endorsement] [Return
of Principal Guaranteed Minimum Death Benefit Endorsement] [Roth
Individual Retirement Annuity Endorsement] [Unisex Endorsement] [Waiver
of Withdrawal Charge Endorsement]
SERVICE OFFICE: [USALLIANZ] SERVICE CENTER
[300 Berwyn Park
P.O. Box 3031
Berwyn, PA 19312-0031
800-624-0197]
S20225
CONTRACT SCHEDULE
CONTRACT OWNER: [John Doe] CONTRACT NUMBER: [??687456]
JOINT OWNER: [Jane Doe] ISSUE DATE: [10/01/00]
ANNUITANT: [John Doe] INCOME DATE: [04/15/07]
JOINT ANNUITANT: [Jane Doe]
PURCHASE PAYMENTS:
INITIAL PURCHASE PAYMENT: [$10,000]
MINIMUM SUBSEQUENT
PURCHASE PAYMENT: [None; Subsequent Purchase
Payments can only be made within
the first six months from the
<PAGE>
Issue Date.]
MAXIMUM TOTAL
PURCHASE PAYMENTS: [$1 million; higher amounts may
be accepted with our prior
approval]
ALLOCATION GUIDELINES:
[1. Currently, you can select up to 10 of the Investment Options.
2. If allocations are made in percentages, whole numbers must be
used.]
INVESTMENT OPTIONS:
VARIABLE ACCOUNT: [Allianz Life Variable Account B]
Sub-Accounts are assigned to [six] Investment Classes. The
Sub-Accounts' investment objective and strategy are taken into account
to classify them into one of the following Investment Classes.
[AGGRESSIVE GROWTH:]
[AIM V.I. CAPITAL APPRECIATION]
[ALGER AMERICAN LEVERAGED ALLCAP]
[ALGER AMERICAN SMALL CAPITALIZATION]
[FRANKLIN SMALL CAP]
[SELIGMAN GLOBAL TECHNOLOGY]
[SELIGMAN SMALL-CAP VALUE]
[INTERNATIONAL GROWTH:]
[AIM V.I. INTERNATIONAL EQUITY]
[J.P. MORGAN INTERNATIONAL OPPORTUNITIES]
[MUTUAL DISCOVERY SECURITIES]
[OPPENHEIMER GLOBAL SECURITIES/VA]
[SP JENNISON INTERNATIONAL GROWTH]
[TEMPLETON DEVELOPING MARKETS SECURITIES]
[TEMPLETON GROWTH SECURITIES]
[TEMPLETON PACIFIC GROWTH SECURITIES]
[USALLIANZ VIP GLOBAL OPPORTUNITIES]
[DOMESTIC GROWTH:]
[AIM V.I. GROWTH]
[AIM V.I. VALUE]
[ALGER AMERICAN GROWTH]
[ALGER AMERICAN MIDCAP GROWTH]
[DAVIS VA FINANCIAL]
[DAVIS VA VALUE]
[SP STRATEGIC PARTNERS FOCUSED GROWTH]
[USALLIANZ VIP GROWTH]
[VAN KAMPEN LIT ENTERPRISE]
[GROWTH AND INCOME:]
[DAVIS VA REAL ESTATE]
<PAGE>
[FRANKLIN GROWTH AND INCOME SECURITIES]
[FRANKLIN RISING DIVIDENDS SECURITIES]
[J.P. MORGAN U.S. DISCIPLINED EQUITY]
[MUTUAL SHARES SECURITIES]
[OPPENHEIMER MAIN STREET GROWTH & INCOME/VA]
[PIMCO VIT STOCKS PLUS GROWTH AND INCOME]
[USALLIANZ VIP DIVERSIFIED ASSETS]
[VAN KAMPEN LIT GROWTH & INCOME]
[BONDS:]
[FRANKLIN U.S. GOVERNMENT]
[OPPENHEIMER HIGH INCOME/VA]
[PIMCO VIT HIGH YIELD BOND]
[PIMCO VIT TOTAL RETURN BOND]
[CONSERVATIVE FIXED INCOME:]
[USALLIANZ VIP FIXED INCOME]
[USALLIANZ VIP MONEY MARKET]
[ALLIANZ LIFE GENERAL ACCOUNT]:
--------------------------------
[ALLIANZ LIFE FIXED ACCOUNT]
[DIMENSIONS] ASSET ALLOCATION MODEL: If you have chosen to meet the requirements
of this model, your guaranteed value protection charge is lower. These
requirements are:
(1) that a maximum percentage is allocated into each Investment Class, as
follows:
o [30%] maximum percentage can be allocated into the [Aggressive Growth]
Investment Class.
o [20%] maximum percentage can be allocated into the [International Growth]
Investment Class.
o [60%] maximum percentage can be allocated into the [Domestic Growth]
Investment Class.
(2) that at least [10%] is allocated into the [Conservative Fixed Income]
Investment Class (including the Allianz Life Fixed Account).
(3) that quarterly rebalancing occurs automatically on [March 20th, June 20th,
September 20th and December 20th].
The maximum and minimum percentages can be changed for future Contract Years by
the Company. Within each Investment Class, you can choose among the Investment
Options available.
You can terminate participation of the [Dimensions] Asset Allocation Model.
<PAGE>
You can make transfers among the Investment Options within each Investment
Class. If you transfer money from an Investment Option within a particular
Investment Class to an Investment Option within another Investment Class, you
will have moved out of the model.
You will receive notification after you have moved out of the [Dimensions] Asset
Allocation model. Within 60 calendar days of the transaction, you can request to
return to the [Dimensions] Asset Allocation Model. After the 60-day period, you
will not be able to return to the [Dimensions] Asset Allocation Model.
MORTALITY AND EXPENSE RISK CHARGE: During the Accumulation Period, the mortality
and expense risk charge is equal on an annual basis to [1.50%] of the average
daily net assets of the Variable Account. During the Annuity Period, the
mortality and expense risk charge is equal on an annual basis to [1.50%] of the
average daily net assets of the Variable Account. We may decrease this charge,
but we may not increase it.
ADMINISTRATIVE CHARGE: None
DISTRIBUTION EXPENSE CHARGE: None
CONTRACT MAINTENANCE CHARGE: The contract maintenance charge is currently [$40]
each Contract Year.
During the Accumulation Period, the contract maintenance charge will be deducted
from the Contract Value the last day of each Contract Year while this Contract
is in force. If a total withdrawal is made on a date other than a Contract
Anniversary and your Contract Value for the Valuation Period during which the
total withdrawal is made is less than [$50,000]; the full contract maintenance
charge will be deducted at the time of the total withdrawal. The contract
maintenance charge will be deducted from the Investment Options in the same
proportion that the amount of the Contract Value in each Investment Option bears
to the total Contract Value.
During the Annuity Period, the contract maintenance charge will be collected pro
rata from each Annuity Payment.
If the total Contract Value is at least [$50,000], we will not assess the
contract maintenance charge.
In the event you own more than one Contract of the same type issued by the
Company, we will determine the total Contract Value for all of the Contracts. If
the Contract Owner is not a natural person, we will look to the Annuitant in
determining the foregoing.
GUARANTEED VALUE PROTECTION CHARGE:
The guaranteed value protection charge is a percentage of the Contract Value.
During the Accumulation Period, this charge will be deducted from the Contract
Value on the last day of each Contract Year while the Contract is in force.
The guaranteed value protection charge varies depending on your Target Value.
<PAGE>
The Target Value is defined in the first Contract Year as the Purchase Payments
less any partial withdrawals accumulated to the end of the Contract Year. In
subsequent Contract Years, the Target Value is the Contract Value at the end of
the prior Contract Year, less partial withdrawals made in the Contract Year,
accumulated to the end of the Contract Year. The annual rate for accumulating
the Target Value is currently [10%], less the mortality and expense risk charge.
This rate is guaranteed for the first [ten] Contract Years. We reserve the right
to change this rate for Contract Years after the [tenth] year. We guarantee this
rate will never be less than 5%.
While the Guaranteed Value Protection Benefit is in effect, the charge in any
Contract Year is:
A.) If the [Dimensions] Asset Allocation Model is selected and your
Contract Value is greater than your Target Value, the guaranteed
value protection charge will be the percentage excess of the
Contract Value over the Target Value. This percentage charge is
currently capped at [2%]. We guarantee that this percentage
charge cap will not be more than 5%. If we change the percentage
cap charge, it will be effective on the next Contract
Anniversary. You will have 30 calendar days from the effective
date of an increase in the percentage cap charge to cancel the
Guaranteed Value Protection Benefit.
B.) If the [Dimensions] Asset Allocation Model is not selected and
your Contract Value is greater than your Target Value, the
guaranteed value protection charge will the percentage excess of
the Contract Value over the Target Value. This percentage charge
is currently capped at [3%]. However, if at the beginning of any
Contract quarter during the year, your asset allocation meets the
[Dimensions] Asset Allocation Model requirements (but not
necessarily the quarterly rebalancing requirement), this
percentage charge cap is deemed to be at [2%] for that quarter.
At the time of assessment of the charge, the average over the
Contract Year is used as the percentage cap. We guarantee that
this percentage charge cap will not be more than 5%.
C.) If the Target Value is greater than or equal to the Contract
Value, the guaranteed value protection charge will be 0%.
D.) Beginning in the sixth Contract Year, if the average Contract
Value in the Contract Year is greater than [two] times the
minimum value guarantee, the guaranteed value protection charge
will be 0%.
If the Contract is terminated for any reason, or when you elect to receive
Annuity Payments, or when your guarantee account drops to zero or less, we will
deduct the guaranteed value protection charge only for the period the benefit
was in effect during the Contract Year.
TRANSFERS:
<PAGE>
NUMBER OF TRANSFERS PERMITTED: There are no limits on the number of
transfers that can be made. We reserve the right to change this, but
you will always be allowed at least 12 transfers in any Contract Year.
Currently, you are allowed [12] free transfers each Contract Year. This
applies to transfers prior to and after the Income Date.
TRANSFER FEE: For each transfer in excess of the free transfers
permitted, the transfer fee is [$25]. Transfers made at the end of the
Right to Examine period by us and any transfers made pursuant to a
regularly scheduled transfer will not be counted in determining the
application of the transfer fee.
MINIMUM AMOUNT TO BE TRANSFERRED: [None]
WITHDRAWALS:
WITHDRAWAL CHARGE: During the Accumulation Period, a withdrawal charge
is assessed against Purchase Payments withdrawn. The charge is
calculated at the time of each withdrawal. For partial withdrawals, the
charge is deducted from the remaining Contract Value and is deducted
from the Investment Options in the same proportion that the amount of
withdrawal from the Investment Options bears to the total of the
partial withdrawal. The withdrawal charge is based upon the length of
the time from the Issue Date. The withdrawal charges are as follows:
[WITHDRAWAL CHARGE - DURING THE ACCUMULATION PERIOD:
(as a percentage of total Purchase Payments)
Number of Complete Contract
Years since Issue Date Withdrawal Charge
---------------------- ------------------
0 8.0%
1 7.0%
2 7.0%
3 6.0%
4 5.0%
5 4.0%
6 3.0%
7 years or more 0.0%]
PARTIAL WITHDRAWAL PRIVILEGE: Each Contract Year, on a non-cumulative basis, you
can withdraw up to 10% of Purchase Payments during the first five Contract Years
without incurring a withdrawal charge. Beginning on the first day of the sixth
Contract Year and each Contract Year thereafter, you can withdraw up to [20%] of
Purchase Payments without incurring a withdrawal charge.
Complete withdrawals are assessed a withdrawal charge on the full Withdrawal
Charge Basis Amount with no reductions for the Partial Withdrawal Privilege.
MINIMUM PARTIAL WITHDRAWAL: [None]
MINIMUM CONTRACT VALUE THAT MUST REMAIN IN THE CONTRACT AFTER A PARTIAL
<PAGE>
WITHDRAWAL: [None]
PARTIAL WITHDRAWAL EFFECT ON DEATH BENEFITS AFTER FIVE CONTRACT YEARS:
After the first five Contract Years, an adjusted partial withdrawal is equal to
the sum of:
(1) the partial withdrawal (including withdrawal charges), if the total partial
withdrawals (including withdrawal charges) in the Contract Year do not
exceed [20% of the Net Adjusted Purchase Payments], and
(2) the partial withdrawal in excess of (1), adjusted in the same manner as
described for partial withdrawals in the first five Contract Years.
PARTIAL WITHDRAWAL EFFECT ON THE GUARANTEED VALUE PROTECTION BENEFIT AFTER FIVE
CONTRACT YEARS:
After the first five Contract Years, a Guaranteed Value Protection adjusted
partial withdrawal is equal to the sum of:
(1) the partial withdrawal (including withdrawal charges), if the total partial
withdrawals (including withdrawal charges) in the Contract Year do not
exceed [20% of the Guaranteed Value Protection value], and
(2) the partial withdrawal in excess of (1), adjusted in the same manner as
described for partial withdrawals in the first five Contract Years.
AMOUNT AVAILABLE FOR ANNUITY PAYMENTS: For [Options 1 through 5]: [105%] of the
greater of the Contract Value or the guarantee account under the Guaranteed
Value Protection Benefit, the result less any applicable Premium Tax and the
guaranteed value protection charge.
For Fixed Annuity Option 6: The greater of the Adjusted Contract Value or the
guarantee account under the Guaranteed Value Protection Benefit, the result less
any applicable Premium Tax and the guaranteed value protection charge.
For Variable Annuity Option 6: The Adjusted Contract Value.
EARLIEST INCOME DATE: [The first day of the calendar month after the fifth
Contract Anniversary.]
NUMBER OF YEARS BEFORE A PARTIAL LIQUIDATION IS AVAILABLE ON ANNUITY OPTION 2
AND 4: [5 years from the Income Date].
COMMUTATION FEE APPLICABLE TO ANNUITY OPTIONS 2 AND 4 - DURING THE ANNUITY
PERIOD (as a percentage of amount liquidated):
------------------------------- ----------------------
[Complete Years Since Income Commutation Fee
Date
------------------------------- ----------------------
------------------------------- ----------------------
5 7%
------------------------------- ----------------------
------------------------------- ----------------------
6 6%
------------------------------- ----------------------
------------------------------- ----------------------
7 5%
------------------------------- ----------------------
------------------------------- ----------------------
8 4%
------------------------------- ----------------------
------------------------------- ----------------------
9 3%
------------------------------- ----------------------
------------------------------- ----------------------
10 2%
------------------------------- ----------------------
------------------------------- ----------------------
Over 11 1%]
------------------------------- ----------------------
MAXIMUM CUMULATIVE PERCENTAGE FOR PARTIAL LIQUIDATION FOR ANNUITY OPTIONS 2 AND
4: [75%]
WITHDRAWAL CHARGE APPLICABLE TO ANNUITY OPTION 6 - DURING THE ANNUITY PERIOD (as
a percentage of amount liquidated):
------------------------------ -------------------------
[Number of Complete Contract Withdrawal Charge
Years since Issue Date
------------------------------ -------------------------
------------------------------ -------------------------
5 4.0%
------------------------------ -------------------------
------------------------------ -------------------------
6 3.0%
------------------------------ -------------------------
------------------------------ -------------------------
Over 7 0.0%]
------------------------------ -------------------------
ASSUMED INVESTMENT RETURN: [5%]
FIXED ACCOUNT INITIAL RATE: [3%]
We guarantee this rate for one year from the Issue Date.
RIDERS ATTACHED TO THIS CONTRACT:
<PAGE>
[Declared Interest Rate Fixed Account Endorsement]
[Double Principal Guaranteed Minimum Death Benefit Endorsement]
[Earnings Protection Guaranteed Minimum Death Benefit Endorsement]
[403 (b) Endorsement]
[Guaranteed Principal Protector Benefit Endorsement] [Group Pension
Plan Death Benefit Endorsement] [Individual Retirement Annuity
Endorsement] [Pension Plan and Profit Sharing Plan Endorsement] [Return
of Principal Guaranteed Minimum Death Benefit Endorsement] [Roth
Individual Retirement Annuity Endorsement] [Unisex Endorsement] [Waiver
of Withdrawal Charge Endorsement]
SERVICE OFFICE: [USALLIANZ] SERVICE CENTER
[300 Berwyn Park
P.O. Box 3031
Berwyn, PA 19312-0031
800-624-0197]
S20217
DEFINITIONS
ACCUMULATION PERIOD: The period prior to the Income Date.
ACCUMULATION UNIT: An accounting unit of measure used to calculate the Contract
Value prior to the Income Date.
ADJUSTED CONTRACT VALUE: The Contract Value less any applicable Premium Tax
and any applicable charges. This amount is used to determine the death benefit
or the initial Annuity Payment.
AGE: Age on last birthday unless otherwise specified.
ANNUITANT(S): The natural person(s) upon whose continuation of life any Annuity
Payment involving life contingencies depends. You may change the Annuitant(s) at
any time prior to the Income Date unless the Contract Owner is a non-individual.
ANNUITY OPTION: An arrangement under which Annuity Payments are made under this
Contract.
ANNUITY PAYMENTS: The series of payments made to you or any named payee after
the Income Date under the Annuity Option selected.
ANNUITY PERIOD: The period of time beginning on the Income Date during which
Annuity Payments are made.
<PAGE>
ANNUITY RESERVE: The assets which support the Annuity Option you have selected
during the Annuity Period.
ANNUITY UNIT: An accounting unit of measure used to calculate variable Annuity
Payments after the Income Date.
ASSUMED INVESTMENT RETURN: The investment return upon which the variable Annuity
Payments in the Contract are based.
AUTHORIZED REQUEST: A request, in a form satisfactory to the Company, which is
received by the Service Center.
BENEFICIARY: The person(s) or entity(ies) who will receive any death benefit
payable under this Contract.
COMMUTATION FEE: A fee assessed after the Income Date by the Company equal to
the percentage of the amount liquidated as shown on the Contract Schedule.
COMPANY: Allianz Life Insurance Company of North America.
CONTRACT ANNIVERSARY: An anniversary of the Issue Date of this Contract.
CONTRACT OWNER: The person(s) or entity(ies) entitled to the ownership rights
stated in this Contract. If Joint Owners are named, all references to Contract
Owner shall mean the Joint Owners.
CONTRACT VALUE: The Contract Value as of any Valuation Date.
CONTRACT YEAR: Any period of twelve (12) months commencing with the Issue Date
and each Contract Anniversary thereafter.
GENERAL ACCOUNT: Our general investment account which contains all the assets of
the Company with the exception of the Variable Account and other segregated
asset accounts.
INCOME DATE: The date on which Annuity Payments are to begin.
INVESTMENT OPTION(S): Those investments available under the Contract. Current
Investment Options are shown on the Contract Schedule.
ISSUE DATE: The date shown on the Contract Schedule on which the first Contract
Year begins.
JOINT OWNER: If there is more than one Contract Owner, each Contract Owner shall
be a Joint Owner of the Contract. Joint Owners have equal ownership rights and
must both authorize any exercising of those ownership rights unless otherwise
allowed by us. Any Joint Owner must be the spouse of the other Contract Owner,
unless limited by state law.
LIQUIDATION VALUE: The present value of any remaining guaranteed variable
Annuity Payments, based on their current value, after the Income Date to the end
of the period certain commuted at the Assumed Investment Return.
<PAGE>
NET ASSET VALUE: The value of a share of the underlying fund, less any
investment management and portfolio administration fees and expenses of the
underlying fund, held by the Sub-Account, as of the close of trading on a
Valuation Date.
NET ADJUSTED PURCHASE PAYMENTS: Purchase Payments less adjusted partial
withdrawals made within the first five Contract Years.
PREMIUM TAX: Any premium taxes owed to any governmental entity and assessed
against Purchase Payments or Contract Value.
PURCHASE PAYMENT: A payment made toward this Contract.
SERVICE CENTER: The office indicated on the Contract Schedule of this Contract
to which notices, requests and Purchase Payments must be sent.
SUB-ACCOUNT: Variable Account assets are divided into Sub-Accounts. The current
Sub-Accounts are shown on the Contract Schedule.
VALUATION DATE: The Variable Account will be valued each day that the New York
Stock Exchange is open for trading.
VALUATION PERIOD: The period commencing at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date.
VARIABLE ACCOUNT: A separate account maintained by us in which a portion of our
assets has been allocated for this and certain other contracts. It has been
designated on the Contract Schedule.
WITHDRAWAL CHARGE BASIS AMOUNT: All Purchase Payments less Purchase Payments
(including any withdrawal charges) previously withdrawn.
PURCHASE PAYMENTS
PURCHASE PAYMENTS: The initial Purchase Payment is due on the Issue Date. We
reserve the right to decline any Purchase Payment. The minimum subsequent
Purchase Payment and the maximum total Purchase Payments allowed are shown on
the Contract Schedule.
CHANGE IN PURCHASE PAYMENTS: You may elect to increase or decrease or to change
the frequency of Purchase Payments as set forth in the Contract Schedule.
NO DEFAULT: Unless a full withdrawal is made, this Contract remains in force and
will not be in default if no additional Purchase Payments are made.
ALLOCATION OF PURCHASE PAYMENTS: Purchase Payments are allocated to one or more
of the Investment Options in accordance with your selection. The allocation of
the initial Purchase Payment is made in accordance with your selection made at
the Issue Date. Unless you inform us otherwise, subsequent Purchase Payments are
allocated in the same manner as the initial Purchase Payment. However, the
<PAGE>
Company has reserved the right to allocate the initial Purchase Payment to the
Money Market Sub-Account until the expiration of the Right to Examine period.
All allocations of Purchase Payments are subject to the Allocation Guidelines
shown on the Contract Schedule. We guarantee that you will be allowed to select
at least five Investment Options for such allocations.
VARIABLE ACCOUNT
THE VARIABLE ACCOUNT: The Variable Account is designated on the Contract
Schedule. It consists of assets we have set aside and have kept separate from
the rest of our assets and those of our other separate accounts. The assets of
the Variable Account, equal to reserves and other liabilities of your Contract
and those of other Contract Owners, will not be charged with liabilities arising
out of any other business we may conduct.
The Variable Account assets are divided into Sub-Accounts as shown on the
Contract Schedule. We may add additional Sub-Accounts to those shown. You may be
permitted to transfer your Contract Value or allocate Purchase Payments to the
additional Sub-Accounts. However, the right to make such transfers or
allocations will be limited by any terms and conditions we may impose.
Should the shares of any Sub-Account become unavailable for investment by the
Variable Account, or our Board of Directors deems further investment in the
shares inappropriate, we may limit further purchase of such shares or substitute
shares of another Sub-Account for shares already purchased.
VALUATION OF ASSETS: Assets of the underlying fund of each Sub-Account will be
valued at their Net Asset Value on each Valuation Date.
ACCUMULATION UNITS: Accumulation Units shall be used to account for all amounts
allocated to or withdrawn from the Sub-Accounts of the Variable Account as a
result of Purchase Payments, withdrawals, transfers, or fees and charges. We
will determine the number of Accumulation Units of a Sub-Account purchased or
canceled. This will be done by dividing the amount allocated to (or the amount
withdrawn from) the Sub-Account by the dollar value of one Accumulation Unit of
the Sub-Account as of the end of the Valuation Period during which the
transaction is processed at the Service Center. Purchase Payments, withdrawals
and transfers from or to a Sub-Account will result in the addition of or the
cancellation of Accumulation Units in a Sub-Account.
ACCUMULATION UNIT VALUE: The Accumulation Unit value for each Sub-Account was
initially arbitrarily set. Subsequent Accumulation Unit values for each
Sub-Account are determined by multiplying the Accumulation Unit value for the
immediately preceding Valuation Period by the net investment factor for the
Sub-Account for the current period.
The Accumulation Unit value may increase or decrease from Valuation Period to
Valuation Period.
NET INVESTMENT FACTOR: The net investment factor for each Sub-Account is
determined by dividing A by B and multiplying by (1 - C) where:
<PAGE>
A is (i) the Net Asset Value per share of the underlying fund held by the
Sub-Account at the end of the current Valuation Period; plus
(ii) any dividend or capital gains per share declared on behalf of such
underlying fund held by the Sub-Account that has an ex-dividend date
within the current Valuation Period.
B is the Net Asset Value per share of the underlying fund held by the
Sub-Account for the immediately preceding Valuation Period.
C is (i) the Valuation Period equivalent of the mortality and expense risk
charge, the administrative charge and the distribution expense charge,
if any, which are shown on the Contract Schedule; plus
(ii) a charge factor, if any, for any taxes or any tax reserve we have
established as a result of the operation or maintenance of the
Sub-Account.
MORTALITY AND EXPENSE RISK CHARGE: Each Valuation Period, we deduct a mortality
and expense risk charge from the Variable Account which is equal, on an annual
basis, to the amount shown on the Contract Schedule. The mortality and expense
risk charge compensates the Company for assuming the mortality and expense risks
under this Contract.
ADMINISTRATIVE CHARGE: Each Valuation Period, we deduct an administrative charge
from the Variable Account which is equal, on an annual basis, to the amount
shown on the Contract Schedule. The administrative charge compensates us for the
costs associated with the administration of this Contract and the Variable
Account.
DISTRIBUTION EXPENSE CHARGE: Each Valuation Period, we deduct a distribution
expense charge from the Variable Account which is equal, on an annual basis, to
the amount shown on the Contract Schedule. The distribution expense charge
compensates the Company for costs associated with the distribution of Contracts.
MORTALITY AND EXPENSE GUARANTEE: We guarantee that the dollar amount of each
Annuity Payment after the first will not be affected by variations in mortality
or expense experience.
CONTRACT VALUE
The Contract Value for any Valuation Period is equal to the total dollar value
accumulated under this Contract in all of the Investment Options. The Contract
Value in a Sub-Account of the Variable Account is determined by multiplying the
number of Accumulation Units by the Accumulation Unit value.
CONTRACT MAINTENANCE CHARGE
We deduct an annual contract maintenance charge shown on the Contract Schedule.
Prior to the Income Date, this will be deducted from the Contract Value. The
number of Accumulation Units to be canceled from each applicable Investment
<PAGE>
Option is in the ratio that the value of each Investment Option bears to the
total Contract Value. After the Income Date, the contract maintenance charge is
deducted from the Annuity Payment.
TRANSFERS
You may transfer all or a part of your interest in an Investment Option to
another Investment Option. We reserve the right to charge for transfers if there
are more than the number of free transfers shown on the Contract Schedule. All
transfers are subject to the following:
1. The deduction of any transfer fee that may be imposed as shown on the
Contract Schedule. The transfer fee will be deducted from the Investment
Option from which the transfer is made. If the entire amount in the
Investment Option is transferred, then the transfer fee will be deducted
from the amount transferred. If there are multiple source Investment
Options, it will be treated as a single transfer. Any transfer fee will be
deducted proportionally from the source Investment Options if less than the
entire amount in the Investment Option is transferred.
2. We reserve the right to limit transfers until the expiration of the Right
to Examine period.
3. The minimum amount which can be transferred is shown on the Contract
Schedule.
4. No transfer will be effective within seven calendar days prior to the date
on which the first Annuity Payment is due.
5. Any transfer direction must clearly specify:
a. the amount which is to be transferred; and
b. the Investment Options which are to be affected.
6. After the Income Date, transfers may not be made from a fixed Annuity
Option to a variable Annuity Option.
7. After the Income Date, you can make transfers from a variable Annuity
Option to a fixed Annuity Option. The number of Annuity Units canceled from
the variable Annuity Option will be equal in value to the amount of the
Annuity Reserve transferred out of the Variable Account. The amount
transferred will purchase fixed Annuity Payments under the Annuity Option
in effect and based on the Age and sex of the Annuitant, where allowed, at
the time of the transfer.
8. Your right to make transfers is subject to modification if we determine in
our sole opinion, that the exercise of the right by one or more Contract
Owners is, or would be, to the disadvantage of other Contract Owners.
Restrictions may be applied in any manner reasonably designed to prevent
any use of the transfer right which we consider to be to the disadvantage
<PAGE>
of other Contract Owners. A modification could be applied to transfers to
or from one or more of the Investment Options, and could include, but is
not limited to:
a. the requirement of a minimum time period between each transfer;
b. not accepting a transfer request from an agent acting under a
power of attorney on behalf of more than one Contract Owner; or
c. limiting the dollar amount that may be transferred between the
Investment Options by a Contract Owner at any one time;
9. We reserve the right at any time and without prior notice to any party to
modify the transfer provisions described above. However, if we do modify
these provisions, we guarantee that they will not be any more restrictive
than the above.
If you elect to use this transfer privilege, we will not be liable for transfers
made in accordance with your instructions. All amounts and Accumulation Units
will be determined as of the end of the Valuation Period during which the
request for transfer is received at the Service Center.
WITHDRAWAL PROVISIONS
WITHDRAWALS: During the Accumulation Period, you may, upon Authorized Request,
make a total or partial withdrawal of the Contract Value. Withdrawals will
result in the cancellation of Accumulation Units from each Investment Option in
the ratio that the value of each Investment Option bears to the total Contract
Value. You must specify, by Authorized Request, which Accumulation Units are to
be canceled if other than the above mentioned method of cancellation is desired.
The Company will pay the amount of any withdrawal from the Variable Account
within seven (7) days of receipt of a request in good order unless the
Suspension or Deferral of Payments Provision is in effect.
Each partial withdrawal must be for an amount which is not less than the minimum
partial withdrawal amount shown on the Contract Schedule. The minimum Contract
Value, which must remain in the Contract after a partial withdrawal, is shown on
the Contract Schedule.
WITHDRAWAL CHARGE: Upon a total or partial withdrawal of this Contract, a
withdrawal charge as set forth on the Contract Schedule may be assessed. Under
certain circumstances, we allow withdrawals without the withdrawal charge as set
forth on the Contract Schedule. Purchase Payments withdrawn under the partial
withdrawal privilege are still subject to applicable withdrawal charges upon
total withdrawal of the Contract.
PROCEEDS PAYABLE ON DEATH
DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD: Upon the death of the
<PAGE>
Contract Owner, or any Joint Owner, during the Accumulation Period, the death
benefit will be paid to the Beneficiary(ies) designated by the Contract Owner.
Upon the death of a Joint Owner, the surviving Joint Owner, if any, will be
treated as the primary Beneficiary. Any other Beneficiary designation on record
at the time of death will be treated as a contingent Beneficiary. If the
Contract is owned by a non-individual, the death benefit will be paid upon the
death of an Annuitant.
DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: The death benefit will be
the Adjusted Contract Value determined as of the end of the Valuation Period
during which the Company receives both due proof of death and an election for
the payment method.
If the Beneficiary is the spouse of the Contract Owner, he or she may elect to
continue the Contract in his or her own name and exercise all the Contract
Owner's rights under the Contract. In this event, the Contract Value for the
Valuation Period during which this election is implemented will be adjusted to
equal the death benefit.
Any part of the death benefit amount that had been invested in the Variable
Account remains in the Variable Account until distribution begins. From the time
the death benefit is determined until complete distribution is made, any amount
in the Variable Account will be subject to investment risk, which is borne by
the Beneficiary.
DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: If the Owner has not
previously designated a death benefit option, a Beneficiary must request that
the death benefit be paid under one of the death benefit options below. In
addition, if the Beneficiary is the spouse of the Contract Owner, he or she may
elect to continue the Contract in his or her own name and exercise all the
Contract Owner's rights under the Contract.
Option A - lump sum payment of the death benefit. The contract
maintenance charge will not be assessed if the distribution is due to
death;
Option B - the payment of the entire death benefit within 5 years of
the date of the death of the Contract Owner or any Joint Owner. The
full contract maintenance charge is assessed each Beneficiary on each
Contract Anniversary; or
Option C - payment of the death benefit under an Annuity Option over
the lifetime of the Beneficiary or over a period not extending beyond
the life expectancy of the Beneficiary with distribution beginning
within one year of the date of death of the Contract Owner or any Joint
Owner. The full contract maintenance charge will continue to be
assessed to each Beneficiary.
Any portion of the death benefit not applied under Option C within one year of
the date of the Contract Owner's death must be distributed within five years of
the date of death.
<PAGE>
If a lump sum payment is requested, the amount from the Variable Account will be
paid within seven (7) days of receipt of proof of death and the valid election,
including any required governmental forms, unless the Suspension or Deferral of
Payments Provision is in effect.
Payment to the Beneficiary, other than in a lump sum, may only be elected during
the sixty-day period after the day on which such lump sum first became payable
by the Company.
DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD: If you, or any Joint Owner,
dies during the Annuity Period, and you are not an Annuitant, any remaining
payments under the Annuity Option elected will continue at least as rapidly as
under the method of distribution in effect at such Contract Owner's death. Upon
your death during the Annuity Period, the Beneficiary becomes the Contract
Owner.
DEATH OF ANNUITANT: Upon the death of an Annuitant (or death of both Joint
Annuitants), who is not the Contract Owner, during the Accumulation Period, you
will become the Annuitant, unless you designate another Annuitant within 30 days
of the death of the Annuitant. If the Contract Owner is a non-individual, the
death of an Annuitant will be treated as the death of the Contract Owner and a
new Annuitant may not be designated.
Upon the death of the Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.
PAYMENT OF DEATH BENEFIT: The Company will require due proof of death and
payment election and any required governmental forms before any death benefit is
paid. Due proof of death will be:
1. a certified death certificate; or
2. a certified decree of a court of competent jurisdiction as to the finding
of death; or
3. any other proof satisfactory to the Company.
All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.
BENEFICIARY: The Beneficiary designation in effect on the Issue Date will remain
in effect until changed. The Beneficiary is entitled to receive the benefits to
be paid at your death.
Unless you provide otherwise, the death benefit will be paid in equal shares to
the survivor(s) as follows:
1. to the primary Beneficiary(ies) who survive you and/or the Annuitant's
death, as applicable; or if there are none;
<PAGE>
2. to the contingent Beneficiary(ies) who survive you and/or the Annuitant's
death, as applicable; or if there are none;
3. to your estate.
CHANGE OF BENEFICIARY: Subject to the rights of any irrevocable
Beneficiary(ies), you may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Authorized Request. The change will
take effect as of the date the Authorized Request is signed. If the Authorized
Request reaches our Service Center after the Contract Owner dies but before any
payment is made, the change will be valid. The Company will not be liable for
any payment made or action taken before it records the change.
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION
The Company reserves the right to suspend or postpone payments from the Variable
Account for a withdrawal or transfer for any period when:
1. the New York Stock Exchange is closed (other than customary weekend and
holiday closings);
2. trading on the New York Stock Exchange is restricted;
3. an emergency exists as a result of which disposal of securities held in the
Variable Account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Variable Account's net assets; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of Contract Owners;
provided that applicable rules and regulations of the Securities and Exchange
Commission will govern as to whether the conditions described in (2) and (3)
exist.
CONTRACT OWNER, ANNUITANT, ASSIGNMENT PROVISIONS
CONTRACT OWNER: As the Contract Owner, you have all the interest and rights
under this Contract. The Contract Owner is the person designated as such on the
Issue Date, unless changed.
You may change owners of the Contract at any time by Authorized Request. A
change of Contract Owner will automatically revoke any prior designation of
Contract Owner. The change will become effective as of the date the Authorized
Request is signed. We will not be liable for any payment made or action taken
before the change is recorded. We will not be responsible for any tax
consequences of any such change.
JOINT OWNER: A Contract may be owned by Joint Owners. If Joint Owners are named,
any Joint Owner must be the spouse of the other Contract Owner, unless limited
by state law. Upon the death of either Contract Owner, the surviving Joint Owner
will be the primary Beneficiary. Any other Beneficiary designation will be
<PAGE>
treated as a contingent Beneficiary unless otherwise indicated in an Authorized
Request.
ANNUITANT: The Annuitant is the person on whose life Annuity Payments are based.
The Annuitant is the person designated by you subject to our underwriting rules
then in effect. The Annuitant may not be changed in a Contract that is owned by
a non-individual.
ASSIGNMENT OF A CONTRACT: An Authorized Request specifying the terms of an
assignment of a Contract must be provided to the Service Center. We will not be
liable for any payment made or action taken before we record the assignment.
We will not be responsible for the validity or tax consequences of any
assignment. Any assignment made after the death benefit has become payable will
be valid only with our consent.
If the Contract is assigned, your rights may only be exercised with the consent
of the assignee of record.
ANNUITY PROVISIONS
GENERAL: On the Income Date, the amount available for Annuity Payments as
specified in the Contract Schedule will be applied under the Annuity Option you
have selected. You may elect to have the amount available for Annuity Payments
applied to provide a fixed annuity, a variable annuity or a combination fixed
and variable annuity. If a combination is elected, you must specify what part of
the amount available for Annuity Payments is to be applied to the fixed and
variable Annuity Options. If you select a fixed annuity, the amount available
for Annuity Payments is allocated to the General Account and the annuity is paid
as a fixed annuity. If you select a variable annuity, the amount available for
Annuity Payments will be allocated to the Sub-Accounts of the Variable Account
in accordance with your selection, and the annuity will be paid as a variable
annuity. Unless you designate another payee, you will be the payee of the
Annuity Payments. The amount available for Annuity Payments will be applied to
the applicable annuity rate based upon the Annuity Option you have selected. We
may offer more favorable rates than those guaranteed here at the time your first
Annuity Payment is calculated. Annuity Payments will depend on the Age and,
where permitted, sex of the Annuitant.
FIXED ANNUITY: You may elect to have the amount available for Annuity Payments
applied to provide a fixed annuity. The dollar amount of each fixed Annuity
Payment is guaranteed to be at least an amount equal to the amount available for
Annuity Payments, divided first by $1000 and then multiplied by the appropriate
Annuity Payment amount for each $1000 of value for the Annuity Option selected.
The guaranteed rates, as set forth in the tables at the end of the Contract, are
based on an interest rate of 2 1/2% per year and the 1983(a) Individual Annuity
Mortality Table with mortality improvement projected 30 years using Mortality
Projection Scale G.
VARIABLE ANNUITY: You may elect to have the amount available for Annuity
Payments applied to provide a variable annuity. Variable Annuity Payments
<PAGE>
reflect the investment performance of the Variable Account in accordance with
the allocation of the amount available for Annuity Payments to the Sub-Accounts
during the Annuity Period. Variable Annuity Payments are not guaranteed as to
dollar amount.
On the Income Date, Annuity Units will be purchased as follows:
The first Annuity Payment is equal to the amount available for Annuity Payments,
divided first by $1000 and then multiplied by the appropriate Annuity Payment
amount for each $1000 of value for the Annuity Option selected as set forth in
the table at the end of the Contract. In each Sub-Account, the number of Annuity
Units is determined by dividing the amount of the initial Annuity Payment
determined for each Sub-Account by the Annuity Unit value on the Income Date.
Thereafter, the number of Annuity Units in each Sub-Account remains unchanged
unless you elect to transfer between Sub-Accounts. All calculations will
appropriately reflect the Annuity Payment frequency selected.
On each subsequent Annuity Payment date, the total Annuity Payment is the sum of
the Annuity Payments for each Sub-Account. The Annuity Payment in each
Sub-Account is determined by multiplying the number of Annuity Units then
allocated to such Sub-Account by the Annuity Unit value for that Sub-Account.
On each subsequent Valuation Date, the value of an Annuity Unit is determined in
the following way:
First: The net investment factor is determined as described under "Variable
Account - net investment factor" above.
Second: The value of an Annuity Unit for a Valuation Period is equal to:
a. the value of the Annuity Unit for the immediately preceding Valuation
Period;
b. multiplied by the net investment factor for the current Valuation Period;
c. divided by the assumed net investment factor (see below) for the Valuation
Period.
The assumed net investment factor is equal to one plus the Assumed Investment
Return which is used in determining the basis for the purchase of an Annuity,
adjusted to reflect the particular Valuation Period. The Assumed Investment
Return that we will use is shown on the Contract Schedule. However, we may agree
with you to use a different value. The Assumed Investment Return will never
exceed 7%.
INCOME DATE: You select an Income Date at the time of issue. The Income Date
must always be the first day of a calendar month. The earliest Income Date you
can select is set forth in Contract Schedule. The latest Income Date you can
select is the latest of the first day of the first calendar month following the
Annuitant's 90th birthday, 10 years from the Issue Date, or the maximum date
permitted under state law.
<PAGE>
SELECTION OF AN ANNUITY OPTION: You can select an Annuity Option by Authorized
Request. You may, by Authorized Request, 30 days prior to the Income Date,
select and/or change the Annuity Option.
ANNUITY OPTIONS: This Contract provides for Annuity Payments under one of the
Annuity Options described below. The Company may make available other annuity
options.
OPTION 1 - LIFE ANNUITY. We will make monthly Annuity Payments during the life
of the Annuitant and ceasing with the last Annuity Payment due prior to the
Annuitant's death.
OPTION 2 - LIFE ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15 OR 20 YEARS
GUARANTEED. We will make monthly Annuity Payments during the life of the
Annuitant with a guarantee that if, at the Annuitant's death, there have been
less than 60, 120, 180 or 240 monthly Annuity Payments made as selected, monthly
Annuity Payments will continue for the remainder of the guaranteed period.
Alternatively, the Contract Owner may elect to receive a lump-sum payment equal
to the present value of the guaranteed monthly Annuity Payments remaining, as of
the date the notice of the Annuitant's death is received at the Service Center,
commuted at an appropriate rate. Proof of the Annuitant's death and return of
the Contract are required prior to the payment of any commuted values. For a
fixed Annuity Option, the commutation rate will be the Statutory Calendar Year
Interest Rate based on the NAIC Standard Valuation Law for Single Premium
Immediate Annuities corresponding to the Income Date. For a variable Annuity
Option, the commutation rate will be the Assumed Investment Return as shown on
the Contract Schedule. For a variable Annuity Option, the guaranteed monthly
Annuity Payments remaining is based on the current value of the Annuity Units.
During the lifetime of the Annuitant and while the number of Annuity Payments
made is less than the guaranteed number of payments elected, the Contract Owner
electing a variable Annuity Option may request a withdrawal representing a
partial liquidation of the Liquidation Value. You will be allowed to make a
partial liquidation at least once per Contract Year beginning no earlier than
set forth in the Contract Schedule. The total of all partial liquidations,
measured as the sum of the percentages of the total Liquidation Value at the
time of each partial liquidation, cannot exceed the amount shown on the Contract
Schedule. A Commutation Fee will be subtracted from the amount liquidated before
the proceeds are paid out. Partial liquidations will be processed on the next
Annuity Payment date following your written request. After a partial
liquidation, the subsequent monthly Annuity Payments during the guaranteed
period certain will be reduced by the percentage of the Liquidation Value
liquidated, including the Commutation Fee. After the guaranteed number of
payments has been made, the number of Annuity Units used in calculating the
monthly payments will be restored to their original values as if no liquidations
had taken place.
OPTION 3 - JOINT AND LAST SURVIVOR ANNUITY. We will make monthly Annuity
Payments during the joint lifetime of the Annuitant and the Joint Annuitant.
Upon the death of the Annuitant, if the Joint Annuitant is then living, Annuity
Payments will continue to be paid during the remaining lifetime of the Joint
Annuitant at a level of 100%, 75% or 50% of the previous level, as selected.
<PAGE>
Monthly Annuity Payments cease with the final Annuity Payment due prior to the
last survivor's death.
OPTION 4 - JOINT AND LAST SURVIVOR ANNUITY WITH MONTHLY PAYMENTS OVER 5, 10, 15,
OR 20 YEARS GUARANTEED. We will make monthly Annuity Payments during the joint
lifetime of the Annuitant and the Joint Annuitant. Monthly Annuity Payments will
continue to be paid during the remaining lifetime of the Joint Annuitant at 100%
of the previous level. The Company guarantees that if at the last death of the
Annuitant and the Joint Annuitant, there have been less than 60, 120, 180, or
240 monthly Annuity Payments made as selected, monthly Annuity Payments will
continue to be made for the remainder of the guaranteed period. Alternatively,
the Contract Owner may elect to receive a lump-sum payment equal to the present
value of the guaranteed monthly Annuity Payments remaining, as of the date the
notice of the Annuitant's and Joint Annuitant's death is received at the Service
Center, commuted at an appropriate rate. Proof of death of the Annuitant and
Joint Annuitant and return of this Contract are required prior to the payment of
any commuted values. For a fixed Annuity Option, the commutation rate will be
the Statutory Calendar Year Interest Rate based on the NAIC Standard Valuation
Law for Single Premium Immediate Annuities corresponding to the Income Date. For
a variable Annuity Option, the commutation rate will be the Assumed Investment
Return as shown on the Contract Schedule.
During the lifetime of the Annuitant or Joint Annuitant and while the number of
Annuity Payments made is less than the guaranteed number of payments elected,
the Contract Owner electing a variable Annuity Option may request a withdrawal
representing a partial liquidation of the Liquidation Value. You will be allowed
to make a partial liquidation at least once per Contract Year beginning no
earlier than set forth in the Contract Schedule. The total of all partial
liquidations, measured as the sum of the percentages of the total Liquidation
Value at the time of each partial liquidation, cannot exceed the amount shown on
the Contract Schedule. A Commutation Fee will be subtracted from the amount
liquidated before the proceeds are paid out. Partial liquidations will be
processed on the next Annuity Payment date following your written request.
After a partial liquidation, the subsequent monthly Annuity Payments during the
guaranteed period certain will be reduced by the percentage of the Liquidation
Value liquidated, including the Commutation Fee. After the guaranteed number of
payments has been made, the number of Annuity Units used in calculating the
monthly payments will be restored to their original values as if no liquidations
had taken place.
OPTION 5 - REFUND LIFE ANNUITY. We will make monthly Annuity Payments during the
lifetime of the Annuitant ceasing with the last Annuity Payment due prior to the
Annuitant's death with a guarantee that at the Annuitant's death, you will
receive a refund. For a fixed Annuity Option, the amount of the refund will be
any excess of the amount of the amount available for Annuity Payments applied
under this Option over the total of all Annuity Payments made under this Option.
For a variable Annuity Option, the amount of the refund will be the then dollar
value of the number of Annuity Units equal to (1) the amount available for
Annuity Payments applied to this Option divided by the Annuity Unit value used
to determine the first Annuity Payment, minus (2) the product of the number of
the Annuity Units represented by each monthly Annuity Payment and the number of
<PAGE>
payments made. This calculation will be based upon the assumption that the
allocation of Annuity Units actually in-force at the time of the Annuitant's
death had been the allocation of Annuity Units at issue and at all times
thereafter. If the refund calculated above is not greater than zero, there will
be no refund paid.
OPTION 6 - SPECIFIED PERIOD CERTAIN ANNUITY. Monthly Annuity Payments are paid
for a specified period of time. The Specified Period Certain is elected by the
Contract Owner and must be specified as a whole number of years from 5 to 30. If
at the time of the last death of the Annuitant and any Joint Annuitant, the
Annuity Payments actually made have been for less than the Specified Period
Certain, then Annuity Payments will be continued thereafter to the Contract
Owner for the remainder of the Specified Period Certain.
If you have selected a variable payment option, a liquidation may be made at
least once per Contract Year up to 100% of the Total Liquidation Value in the
Contract. The Total Liquidation Value is equal to the present value of the
remaining Annuity Payments based on its current value, to the end of the
Specified Period Certain, commuted at the Assumed Investment Return, less a
Withdrawal Charge. The Withdrawal Charge is a percentage of the amount as shown
on the Contract Schedule. The liquidation will be processed on the next Annuity
Payment Date following your written request. The Company will require the return
of the Contract prior to the payment of the entire commuted value.
GENERAL PROVISIONS
THE CONTRACT: The entire Contract consists of this Contract, and any attached
endorsements or riders. This Contract may be changed or altered only by our
President or Secretary. Any change, modification or waiver must be made in
writing.
NON-PARTICIPATING IN SURPLUS: This Contract does not share in any distribution
of our profits or surplus.
MISSTATEMENT OF AGE OR SEX: We may require proof of Age of the Annuitant before
making any life contingent Annuity Payment provided for by this Contract. If the
Age or sex of the Annuitant has been misstated, the amount payable will be the
amount that the amount available for Annuity Payments Contract Value would have
provided at the true Age or sex.
Once Annuity Payments have begun, any underpayments will be made up in one sum
with the next Annuity Payment, and overpayments will be deducted from the future
Annuity Payments until the total is repaid.
CONTRACT SETTLEMENT: This Contract must be returned to us upon any settlement.
Prior to any settlement as a death claim, due proof of death must be submitted
to us. Any paid-up annuity, cash withdrawal or death benefits that may be
available are not less than the minimum benefits required by statute.
REPORTS: We will furnish you with a report showing the Contract Value at least
once each calendar year. This report will be sent to your last known address.
<PAGE>
TAXES: Any taxes paid to any governmental entity will be charged against the
Contract Value. We will, in our sole discretion, determine when taxes have
resulted from: the investment experience of the Variable Account; receipt by us
of the Purchase Payment(s); or commencement of Annuity Payments. We may, at our
discretion, pay taxes when due and deduct that amount from the Contract Value at
a later date. Payment at an earlier date does not waive any right we may have to
deduct amounts at a later date. We reserve the right to establish a provision
for federal income taxes if we determine, in our sole discretion, that we will
incur a tax as a result of the operation of the Variable Account. We will deduct
for any income taxes incurred by it as a result of the operation of the Variable
Account whether or not there was a provision for taxes and whether or not it was
sufficient. We will deduct any withholding taxes required by applicable law.
EVIDENCE OF SURVIVAL: Where any benefits under this Contract are contingent upon
the recipient being alive on a given date, we may require proof satisfactory to
us that the condition has been met.
PROTECTION OF PROCEEDS: No Beneficiary may commute, encumber, alienate or assign
any payments under this Contract before they are due. To the extent permitted by
law, no payments will be subject to the debts, contracts or engagements of any
Beneficiary or to any judicial process to levy upon or attach the same for
payment thereof.
MODIFICATION OF CONTRACT: This Contract may be modified by us in order to
maintain compliance with state and federal law. This Contract may be changed or
altered only by our President or our Secretary. A change or alteration will be
made in writing.
TABLE OF ANNUITY PAYMENT AMOUNTS: Table A below shows the guaranteed amount of
the Annuity Payment for each $1,000 of value applied under a fixed Annuity
Option. Table A is based on an interest rate of 2 1/2% per year and the 1983(a)
Individual Mortality Table with mortality improvement projected 30 years using
Mortality Projection Scale G.
Table B below shows the amount of the first monthly variable Annuity Payment,
based on an Assumed Investment Return of 5%, for each $1,000 of value applied
under a variable Annuity Option.
The amount of such Annuity Payments under Annuity Options 1, 2 and 5 will depend
on the sex and Age of the Annuitant on the Income Date. The amount of such
Annuity Payments under Option 3 and 4 will depend on the Age and sex of the
Annuitant and Joint Annuitant on the Income Date. Any amounts not shown for
Ages, guaranteed periods or other Annuity Options will be provided upon request.
<TABLE>
<CAPTION>
-----------------------------------------------------------------------------------------------------------------------------
Table A - Guaranteed Monthly Annuity Payments Per $1,000 of Value
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Fixed Annuity Options
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Age of Annuitant Option 1 Option 2 Option 3 Option 4 Option 5
Nearest Birthday
When First
Payment Is Made
----------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Guaranteed Guaranteed 100% Joint and Guaranteed
Period of Period of Last Survivor Period of
10 Years 20 Years 10 Years
----------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Male Female Male Female Male Female Male & Female Male & Female Male Female
Same Age Same Age
-----------------------------------------------------------------------------------------------------------------------------
30 2.85 2.72 2.84 2.72 2.84 2.71 2.61 2.61 2.81 2.70
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
40 3.17 2.97 3.16 2.97 3.14 2.96 2.82 2.82 3.10 2.94
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
50 3.67 3.38 3.65 3.37 3.58 3.34 3.14 3.14 3.51 3.29
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
60 4.50 4.03 4.43 4.01 4.18 3.90 3.67 3.67 4.13 3.84
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
70 6.03 5.23 5.70 5.10 4.83 4.62 4.59 4.58 5.11 4.72
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
80 8.92 7.68 7.43 6.88 5.21 5.16 6.40 6.21 6.66 6.18
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
90 14.75 13.12 8.94 8.74 5.27 5.27 10.23 8.42 9.39 8.81
-----------------------------------------------------------------------------------------------------------------------------
</TABLE>
<TABLE>
<CAPTION>
-----------------------------------------------------------------------------------------------------------------------------
Table B - Guaranteed Initial Monthly Annuity Payment Per $1,000 of Proceeds
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Variable Annuity Option Based on 5% Assumed Investment Return
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Age of Annuitant Option 1 Option 2 Option 3 Option 4 Option 5
Nearest Birthday
When First
Payment Is made
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Guaranteed Guaranteed 100% Joint and Guaranteed
Period of Period of Last Survivor Period of
10 Years 20 Years 10 Years
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
Male Female Male Female Male Female Male & Female Male & Female Male Female
Same Age Same Age
-----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
30 4.46 4.36 4.46 4.35 4.45 4.35 4.27 4.27 4.44 4.35
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
40 4.72 4.55 4.71 4.55 4.68 4.53 4.41 4.41 4.68 4.53
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
50 5.18 4.89 5.14 4.87 5.04 4.83 4.65 4.65 5.06 4.83
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
60 5.96 5.49 5.86 5.45 5.56 5.31 5.10 5.10 5.70 5.36
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
70 7.49 6.65 7.07 6.47 6.13 5.94 5.96 5.94 6.77 6.27
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
80 10.42 9.12 8.68 8.16 6.46 6.41 7.72 7.50 8.54 7.94
-----------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
90 16.30 14.63 10.08 9.89 6.51 6.51 11.54 9.58 11.63 10.92
-----------------------------------------------------------------------------------------------------------------------------
</TABLE>
INDIVIDUAL MULTIPLE PAYMENT VARIABLE ANNUITY
NON-PARTICIPATING
L40355
