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SUN LIFE ASSURANCE COMPANY OF CANADA (U.S.)
A WHOLLY-OWNED SUBSIDIARY OF SUN LIFE ASSURANCE COMPANY OF CANADA
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Executive Office: Home Office: Annuity Service Mailing Address:
[ONE SUN LIFE EXECUTIVE PARK] [WILMINGTON, DELAWARE] SUN LIFE OF CANADA (U.S.)
[WELLESLEY HILLS, MASSACHUSETTS 02481] RETIREMENT PRODUCTS AND SERVICES
P.O. BOX [#]
BOSTON, MASSACHUSETTS [ZIP CODE]
</TABLE>
This Certificate evidences the interest of the Participant named in the
Certificate Specifications Page in the combination variable and fixed group
annuity Contract ("Contract") issued by Sun Life Assurance Company of Canada
(U.S.) ("the Company").
The Contract is the legal Contract. This Certificate is merely a summary of
the rights, duties and benefits of that Contract. A copy of the Contract may
be obtained by requesting it in writing from the Company. If there is any
conflict between the provisions of the Contract and those of this
Certificate, the Contract is the controlling document.
The Company will pay an annuity commencing on the Annuity Commencement Date
by applying the adjusted value of the Participant's Account in accordance
with the settlement provisions.
If the Covered Person dies while the Contract is in effect and this
Certificate is in force and before the Annuity Commencement Date, the Company
may pay a Death Benefit to the Beneficiary upon receipt of Due Proof of Death
of the Covered Person.
Under certain circumstances, if the Participant dies prior to the Annuitant
and before the Annuity Commencement Date, a distribution is required by law.
All payments will be made to the persons and in the manner set forth in the
Contract. Signed by the Company at its Executive Office, Wellesley Hills,
Massachusetts, on the Date of Coverage.
/s/ C. James Prieur /s/ Ellen B. King
C. James Prieur Ellen B. King
President Secretary
CERTIFICATE FOR FLEXIBLE PAYMENT DEFERRED COMBINATION VARIABLE AND FIXED GROUP
ANNUITY CONTRACT
NONPARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CERTIFICATE WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
PAYMENTS AND VALUES BASED ON THE FIXED ACCOUNT ARE SUBJECT TO A MARKET VALUE
ADJUSTMENT FORMULA, THE OPERATION OF WHICH MAY RESULT IN UPWARD AND DOWNWARD
ADJUSTMENTS IN AMOUNTS PAYABLE TO A PARTICIPANT, INCLUDING WITHDRAWALS,
TRANSFERS AND AMOUNTS APPLIED TO PURCHASE AN ANNUITY. PAYMENTS MADE FROM
GUARANTEE AMOUNTS THAT ARE WITHIN 30 DAYS PRIOR TO THE END OF A GUARANTEE
PERIOD OR THE WITHDRAWAL OF INTEREST CREDITED TO GUARANTEE AMOUNTS DURING THE
CURRENT ACCOUNT YEAR ARE NOT SUBJECT TO THE MARKET VALUE ADJUSTMENT.
RIGHT TO RETURN CERTIFICATE: PLEASE READ THIS CERTIFICATE. IF NOT SATISFIED
WITH IT, THE PARTICIPANT MAY, WITHIN 10 DAYS AFTER ITS RECEIPT, RETURN IT BY
DELIVERING OR MAILING IT TO THE ANNUITY SERVICE MAILING ADDRESS INDICATED
ABOVE. IMMEDIATELY UPON RECEIPT OF THE CERTIFICATE BY THE COMPANY, THE
CERTIFICATE WILL BE DEEMED VOID AS THOUGH IT HAD NEVER BEEN APPLIED FOR, AND
THE PARTICIPANT'S ACCOUNT VALUE AT THE END OF THE VALUATION PERIOD DURING
WHICH THE COMPANY RECEIVES THE CERTIFICATE, WILL BE REFUNDED TO THE
PARTICIPANT.
IMPORTANT NOTICE: It is not necessary to employ any person to collect any
payment or benefit provided by the Contract. When you require help or advice,
write directly to the Company at its Annuity Service Mailing Address. The
Contract contains many benefits. In your own best interest you should consult
the Company if anyone advises you to surrender this Certificate or replace it
with a new contract.
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TABLE OF CONTENTS
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PAGE
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CERTIFICATE SPECIFICATIONS 4
DEFINITIONS 5
FIXED AND VARIABLE ACCOUNTS 8
Fixed Account 8
Variable Account and Sub-Accounts 8
Ownership of Assets 8
Investments of the Sub-Accounts 8
PURCHASE PAYMENTS 8
Payments 8
Account Continuation 8
Allocation of Net Purchase Payments 8
CONTRACT VALUES DURING ACCUMULATION PERIOD
Participant's Account 9
Variable Account Value 9
Crediting Variable Accumulation Units 9
Variable Accumulation Unit Value 9
Variable Accumulation Value 9
Net Investment Factor 9
Fixed Account Value 10
Guarantee Periods 10
Guaranteed Interest Rates 10
Fixed Accumulation Value 11
Transfer Privilege 11
Account Fee 11
CASH WITHDRAWALS, WITHDRAWAL CHARGES AND MARKET VALUE ADJUSTMENT 12
Cash Withdrawals 12
Withdrawal Charges 12
Nursing Home Withdrawal Privilege 13
Market Value Adjustment 13
DEATH BENEFIT 14
Death Benefit Provided by the Contract 14
Election and Effective Date of Election 14
Payment of Death Benefit 14
Amount of Death Benefit 15
SETTLEMENT PROVISIONS 15
General 15
Election and Effective Date of Election 15
Determination of Amount 16
Effect of Annuity Commencement Date on Participant's Account 16
Annuity Commencement Date 16
Fixed Annuity Payments 16
Variable Annuity Payments 16
Annuity Unit Value 17
Exchange of Variable Annuity Units 17
Account Fee 17
Description of Annuity Options 17
Amounts Payable on Death of Payee 18
Annuity Payment Rates 18
2
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OWNERSHIP PROVISIONS 21
Exercise of Contract Rights 21
Death of Participant 21
Voting of Fund Shares 21
Periodic Reports 22
Designation and Change of Beneficiary 22
GENERAL PROVISIONS 22
Age and Sex Misstatement 22
This Certificate 22
Currency 22
Determination of Values 22
Governing Law 23
Guarantees 23
Incontestability 23
Modification 23
Nonparticipating 23
Payments by the Company 23
Proof of Age 23
Proof of Survival 23
Splitting Units 23
Rights Reserved by the Company 23
QUALIFIED CERTIFICATE PROVISIONS
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3
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CERTIFICATE SPECIFICATIONS
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CERTIFICATE NUMBER [79-7900-123456]
CERTIFICATE TYPE [Non Qualified] or [Qualified plan under IRS Code
section 401, 403(b), 408(a) or 408A]
PARTICIPANT [John J. Doe]
ANNUITANT [Mary J. Doe]
AGE OF OLDEST PARTICIPANT [35]
AGE OF YOUNGEST ANNUITANT [35]
DATE OF COVERAGE [February 1, 2000]
COVERED PERSON [Participant]
CERTIFICATE ANNIVERSARY DATE [February 1, 2001]
INITIAL PURCHASE PAYMENT [$100,000]
MINIMUM INITIAL PURCHASE PAYMENT [$10,000] [if IRA $2,000]
MINIMUM ADDITIONAL PAYMENT [$1,000]
MAXIMUM PURCHASE PAYMENT [Any purchase payment that would NOT cause Account
(without prior approval of the Company) Value to exceed $2,000,000]
BENEFICIARY (RELATIONSHIP) [Susan J. Doe (Daughter)]
ANNUITY COMMENCEMENT DATE [July 1, 2060]
ANNUITY OPTION [Deferred]
Minimum Annuity Purchase Amount [$2,000]
Minimum Initial Annuity Payment Amount [$20]
Account Fee After Annuity Commencement Date [$50]
ACCOUNT FEE [$50]
MAXIMUM ACCOUNT FEE [$50]
MINIMUM ACCOUNT VALUE FOR WAIVER OF ACCOUNT FEE [$100,000]
WITHDRAWAL CHARGES Number of Complete Withdrawal Charges
Account Years From
Date of Coverage
-------------------- -------------------
[ 1 [6%
2 6%
3 5%
4 5%
4+] 0%]
FREE WITHDRAWAL AMOUNT [10%] of Purchase Payments, minus any withdrawals.
The Free Withdrawal Amount that is not used in an
Account Year is not cumulative.
INITIAL GUARANTEE PERIODS(S) ["1-10 Year" or "Non-Elected"]
GUARANTEED INTEREST RATE ["1YR-4.5%, "3YR-5.6%" or "N/A"]
Minimum Guarantee Period Amount [$1,000]
Minimum Guaranteed Interest Rate 3%
Market Value Adjustment ("b" Factor) [0%] Maximum 0.25%
CURRENT FEE PER TRANSFER [$0]
Maximum Fee Per Transfer [$15]
Maximum Number of Transfers per Year [12]
Minimum Transfer Amount [$1,000]
Minimum Remaining in Sub-Account after Transfer [$1,000]
ANNUAL ASSET CHARGE
Up to and including $1,000,000 [1.35%] or [1.50%] or [1.60%] or [1.75%]
[1.35] after Annuity Commencement Date
Over $1,000,000 [1.10%] or [1.25%] or [1.35] or [1.50%]
[1.10] after Annuity Commencement Date
BASIC DEATH BENEFIT [The greatest of 1, 2 or 3 shown in the "Amount of
Death Benefit" provision]
OPTIONAL DEATH BENEFIT (S)
(Only available if Participant is age 79 or younger) [None]
[EARNINGS ENHANCEMENT RIDER] [The Basic Death Benefit plus
- 40% of the lesser of Net Purchase Payments and the Accumulation
Account Value minus Net Purchase Payments if the Participant is 69
or younger on the Date of Coverage, or
- 25% of the lesser of Net Purchase Payments and the Accumulation
Account Value minus Net Purchase Payments if the Participant is
between 70 and 79 years old on the Date of Coverage]
[WHAT BENEFIT IS PAYABLE IN THE EVENT THE [If the spouse of the Participant chooses to continue this Certificate
PARTICIPANT'S SPOUSE CHOOSES TO CONTINUE THE after the Participant's death, the amount payable under this Rider will
CERTIFICATE AFTER THE PARTICIPANT'S DEATH?] be credited to the Accumulation Account Value as of the Death Benefit
Date. Thereafter, any Rider(s) will continue in force and be payable
upon the spouse's death.
For purposes of calculating this benefit upon
the spouse's death, the Accumulation Account Value on the Participant's
Death Benefit Date (inclusive of any Death Benefit Amount increases)
will be considered the Initial Net Purchase Payment. If a benefit is
payable on the spouse's Death Benefit Date, the percentage payable (40%
vs. 25%) will be based on the spouse's age on the Date of Coverage.]
[and]
[MAXIMUM ANNIVERSARY ACCOUNT VALUE RIDER] [The greater of the Basic Death Benefit and the highest Accumulation
Account Value on any Contract Anniversary prior to the Participant's
81st birthday, adjusted for any subsequent Purchase Payments and
Partial Withdrawals and Charges made between such Account Anniversary
and the Death Benefit Date.]
[and]
[5% PREMIUM ROLL-UP RIDER] [The greater of the Basic Death Benefit and total purchase payments
plus interest accrued (adjusted for Partial Withdrawals) as follows:
- Interest will accrue on Purchase Payments allocated to and
transfers to the Variable Account while they remain in the Variable
Account at 5% per year until the first day of the month following
the Participant's 80th birthday or until the Purchase Payment or
amount transferred has doubled in amount, whichever is earlier.]
[HOW WILL THE BENEFITS OFFERED BY THESE RIDERS BE [MAXIMUM ANNIVERSARY ACCOUNT VALUE RIDER AND 5% PREMIUM ROLL-UP RIDER
CALCULATED IF MORE THAN ONE IS ELECTED?]
The death benefit will equal the greatest of the following values:
- Maximum Anniversary Account Value
- 5% Premium Roll-Up value
- The Basic Death Benefit]
[MAXIMUM ANNIVERSARY ACCOUNT VALUE RIDER AND EARNINGS ENHANCEMENT RIDER
The death benefit will equal the greater of the following values:
- Maximum Anniversary Account Value
- The Basic Death Benefit
-PLUS-
THE AMOUNT CALCULATED UNDER THE EARNINGS ENHANCEMENT RIDER USING THE
BASIC DEATH BENEFIT AS THE ACCUMULATION ACCOUNT VALUE]
[5% PREMIUM ROLL-UP RIDER AND EARNINGS ENHANCEMENT RIDER
The death benefit will equal the greater of the following values:
- 5% Premium Roll-Up value
- the Basic Death Benefit
-PLUS-
THE AMOUNT CALCULATED UNDER THE EARNINGS ENHANCEMENT RIDER USING THE
BASIC DEATH BENEFIT AS THE ACCUMULATION ACCOUNT VALUE]
[MAXIMUM ANNIVERSARY ACCOUNT VALUE RIDER, 5% PREMIUM ROLL-UP RIDER AND
EARNINGS ENHANCEMENT RIDER]
The death benefit will equal the greatest of the following values:
- Maximum Anniversary Account Value
- 5% Premium Roll-Up value
- The Basic Death Benefit
-PLUS-
THE AMOUNT CALCULATED UNDER THE EARNINGS ENHANCEMENT RIDER USING THE
BASIC DEATH BENEFIT AS THE ACCUMULATION ACCOUNT VALUE]
Available Options
[ ]
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4
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DEFINITIONS
Any reference in this Certificate to "RECEIPT" and "RECEIVED" by the Company
means receipt at the Company's Annuity Service Mailing Address shown on the
first page of this Certificate.
ACCOUNT YEAR AND ACCOUNT ANNIVERSARY: The Account Year shall be the period of
365 days measured from the Date of Coverage. The Account Anniversary is the
last day of an Account Year
ACCUMULATION PERIOD: The period before the Annuity Commencement Date and
during the lifetime of the Participant.
ANNUITANT: The person or persons named on the Certificate Specifications page
and on whose life the first annuity payment is to be made. If the Annuitant
dies prior to the Annuity Commencement Date, the new Annuitant will be the
Co-Annuitant, if any. If the Co-Annuitant dies or if no Co-Annuitant is
named, the Participant becomes the Annuitant upon the Annuitant's death prior
to the Annuity Commencement Date.
*ANNUITY COMMENCEMENT DATE: The date on which the first annuity payment is to
be made.
ANNUITY OPTION: The method chosen for making annuity payments.
ANNUITY UNIT: A unit of measure used in the calculation of the amount of the
second and each subsequent Variable Annuity payment from the Variable Account.
APPLICATION: The document, if any, signed by each Participant that serves as
his or her Application for participation under the Contract, a copy of which
may be attached to and made part of this Certificate.
*BENEFICIARY: Prior to the Annuity Commencement Date, the person or entity
having the right to receive the Death Benefit set forth in this Certificate
and, for a Non-Qualified Contract, who, in the event of the Covered Person's
death, is the "designated Beneficiary" for purposes of Section 72(s) of the
Code. After the Annuity Commencement date, the person or entity having the
right to receive any payments due under the Annuity Option elected, if
applicable, upon the death of the Payee. This Certificate must be owned by a
natural person or agent for a natural person for the Certificate to receive
favorable income tax treatment as an annuity.
CODE: The Internal Revenue Code of 1986, as amended.
COMPANY: Sun Life Assurance Company of Canada (U.S.).
CONTRACT APPLICATION: The document, if any, signed by the Owner that
evidences the Owner's Application for the Contract.
COVERED PERSON: The person upon whose death the Death Benefit will be paid.
DATE OF COVERAGE: The date on which this Certificate becomes effective.
DEATH BENEFIT DATE: The later of (a) the date on which the Company receives
the Beneficiary's election and (b) the date on which the Company receives due
proof of death. If the Company does not receive the Beneficiary's election
within 60 days after receipt of due proof of death, the Death Benefit Date
will be the last day of the 60-day period and the Company will pay a Death
Benefit in one lump sum.
DUE PROOF OF DEATH: An original or certified copy of an official death
certificate, an original certified copy of a decree of a court of competent
jurisdiction as to the finding of death, or any other proof satisfactory to
the Company.
FIXED ACCOUNT: Part of the General Account of the Company, consisting of all
assets of the Company other than those allocated to a separate account of the
Company.
FIXED ANNUITY: An annuity with payments that do not vary as to dollar amount.
5
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FUND(S): One or more open-end management investment companies or "mutual
funds" registered under the Investment Company Act of 1940, in which assets
of a Sub-Account may be invested.
GUARANTEE AMOUNT: Any portion of a Participant's Account Value allocated to a
particular Guarantee Period with a particular Renewal Date (including
interest earned thereon).
GUARANTEE PERIOD: The period for which a Guaranteed Interest Rate is credited.
GUARANTEED INTEREST RATE: The rate of interest credited by the Company on a
compound annual basis during any Guarantee Period.
NET INVESTMENT FACTOR: An index applied by the Company to measure the
investment performance of a Sub-Account from one Valuation Period to the
next. The Net Investment Factor may be greater than, less than, or equal to
one.
NET PURCHASE PAYMENT: The portion of a Purchase Payment that remains after
the deduction of any applicable front-end sales load or premium or similar
tax, if any. This is also the term used to describe the total contributions
made to the Certificate minus the total withdrawal.
NON-QUALIFIED CONTRACT: A Contract used in connection with a retirement plan
which does not receive favorable federal income tax treatment under Sections
401, 403, 408, or 408A of the Code. The Participant's interest in the
Contract evidenced by this Certificate must be owned by a natural person or
an agent for a natural person for the Contract to receive favorable income
tax treatment as an annuity.
OWNER: The person, persons or entity entitled to the ownership rights stated
in the Contract and in whose name or names the Contract is issued. The Owner
may designate a trustee or custodian of a retirement plan that meets the
requirements of Section 401, Section 408(c), Section 408(k), or Section
408(p) of the Code to serve as legal owner of assets of a retirement plan.
The term Owner, as used herein refers to the organization entering into the
Contract.
*PARTICIPANT: The person named in the Certificate Specifications page who is
entitled to exercise all rights and privileges of ownership under the
Certificate, except as reserved by the Owner.
PARTICIPANT'S ACCOUNT: An account to which Net Purchase Payments are credited.
PARTICIPANT'S ACCOUNT VALUE: The variable accumulation value, if any, plus
the fixed accumulation value, if any, of a Participant's Account for any
Valuation Period.
PAYEE: A recipient of payments relating to this Certificate.
PURCHASE PAYMENT (PAYMENT): The amount paid to the Company as consideration
for the benefits provided by the Contract.
QUALIFIED CONTRACT: A Contract used in connection with a retirement plan
which may receive favorable federal income tax treatment under Sections 401,
403, 408 or 408A of the Code.
RENEWAL DATE: The last day of a Guarantee Period.
SUB-ACCOUNT: That portion of the Variable Account that invests in shares of
specific series or sub-series of a Fund.
VALUATION PERIOD: The period of time from one determination of Variable
Accumulation Unit and Annuity Unit values to the next subsequent
determination of these values. Such determination shall be made as of the
close of the New York Stock Exchange on each day that the Exchange is open
for trading and on such other days on which there is a sufficient degree of
trading in the portfolio securities of the Variable Account so that the
values of the Variable Account's Accumulation Units and Annuity Units might
be materially affected.
6
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VARIABLE ACCOUNT: A separate account of the Company consisting of assets set
aside by the Company, the investment performance of which is kept separate
from that of the general assets of the Company.
VARIABLE ACCUMULATION UNIT: A unit of measure used in the calculation of the
value of the variable portion of a Participant's Account.
VARIABLE ANNUITY: An annuity with payments which vary as to dollar amount in
relation to the investment performance of specified Sub-Accounts of the
Variable Account.
*As specified in the Certificate Specifications page, unless changed.
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FIXED AND VARIABLE ACCOUNTS
FIXED ACCOUNT
The Fixed Account consists of all assets of the Company other than those
allocated to any separate account of the Company. Any portion of a Net
Purchase Payment allocated by a Participant to any Guarantee Period will
become part of the Fixed Account.
VARIABLE ACCOUNT AND SUB-ACCOUNTS
The Variable Account to which the variable accumulation values and Variable
Annuity payments, if any, under the Contract relate is the Sun Life of Canada
(U.S.) Variable Account F. The Company established the Variable Account
pursuant to a resolution of its Board of Directors. The Company has
registered the Variable Account as a unit investment trust under the
Investment Company Act of 1940. That portion of the assets of the Variable
Account equal to the reserves and other contract liabilities with respect to
the Variable Account shall not be chargeable with liabilities arising out of
any other business the Company may conduct.
The assets of the Variable Account are divided into Sub-Accounts. Each
Sub-Account invests exclusively in shares of a designated series or
sub-series of a Fund. The values of the Variable Accumulation Units and the
Annuity Units described in the Contract reflect the investment performance of
the Sub-Accounts.
OWNERSHIP OF ASSETS
The Company shall have exclusive and absolute ownership and control of its
assets, including all assets of the Sub-Accounts. The Company reserves the
right to transfer the assets of a Sub-Account, in excess of the reserves and
other policy liabilities with respect to that Sub-Account, to another
Sub-Account or to the Company's General Account.
INVESTMENTS OF THE SUB-ACCOUNTS
All amounts allocated to a Sub-Account will be used to purchase shares of a
specific series or sub-series of a Fund. The Fund shares available on the
Date of Coverage are shown on the Certificate Specifications Page, more
series and/or Funds may be subsequently added or deleted. Each Fund is an
open-end investment company (`mutual fund") registered under the Investment
Company Act of 1940. Any and all distributions made by a Fund with respect to
shares held by a Sub-Account will be reinvested to purchase additional shares
of that series at net asset value. Deductions from the Sub-Accounts will, in
effect, be made by redeeming a number of Fund shares at Net Asset Value equal
in total value to the amount to be deducted. Each Sub-Account will be fully
invested in Fund shares at all times.
PURCHASE PAYMENTS
PAYMENTS
All Purchase Payments must be paid to the Company at its Annuity Service
Mailing Address. The amount of Purchase Payments may vary; however, the
Company will not accept an initial Purchase Payment for any Certificate that
is less than the minimum amount specified on the Certificate Specifications
page. Each additional Purchase Payment must be at least the minimum
additional amount specified on the Certificate Specifications page. In
addition, the prior approval of the Company is required before it will accept
a Purchase Payment which would cause the Participant's Account Value to
exceed the maximum Purchase Payment. This amount is specified on the
Certificate Specifications page. If the Participant's Account Value exceeds
such maximum amount, no additional Purchase Payments will be allocated
without the prior approval of the Company.
ACCOUNT CONTINUATION
A Participant's Account shall be continued automatically in full force during
the lifetime of the Participant until the Annuity Commencement Date or until
the Participant's Account is surrendered.
ALLOCATION OF NET PURCHASE PAYMENTS
The Net Purchase Payment is that portion of a Purchase Payment that remains
after deduction of any applicable front-end sales load and premium tax or
similar tax. The Company will allocate each Net Purchase Payment to the
Participant's Account upon receipt, either to the Sub-Accounts or to the
Fixed Account or to both according to the allocation specified in the
Application, or as subsequently changed by the Participant.
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A Participant may change the allocation for new Purchase Payments among the
Guarantee Periods and the Sub-Accounts at any time by giving notice of the
change to the Company, in accordance with the Company's procedures then in
effect. The Participant may effect such change directly, or through an
authorized third party, subject to the Company's approval given in its sole
discretion, and further subject to adherence to such Company procedures as
may be adopted from time to time. Any change will take effect with the first
Purchase Payment received with or after receipt of notice of the change by
the Company and will continue in effect until subsequently changed.
CONTRACT VALUES DURING ACCUMULATION PERIOD
PARTICIPANT'S ACCOUNT
The Company will establish a Participant's Account for each Participant under
the Contract and will maintain the Participant's Account during the
Accumulation Period. The Participant's Account Value for any Valuation Period
is equal to the variable accumulation value, if any, plus the fixed
accumulation value, if any, of the Participant's Account for that Valuation
Period.
VARIABLE ACCOUNT VALUE
CREDITING VARIABLE ACCUMULATION UNITS
When the Company receives a Purchase Payment, it will credit all or that
portion, if any, of the Net Purchase Payment to be allocated to the
Sub-Accounts, to the Participant's Account in the form of Variable
Accumulation Units. The number of particular Variable Accumulation Units that
the Company will credit is determined by dividing the dollar amount allocated
to the particular Sub-Account by the Variable Accumulation Unit value of the
particular Sub-Account for the Valuation Period during which the Company
receives the Purchase Payment.
VARIABLE ACCUMULATION UNIT VALUE
The Company established the Variable Accumulation Unit value for each
Sub-Account at $10.00 for the first Valuation Period of the particular
Sub-Account. The Company determines the Variable Accumulation Unit value for
the particular Sub-Account for any subsequent Valuation Period by methodology
that is the mathematical equivalent of multiplying the Variable Accumulation
Unit value for the particular Sub-Account for the immediately preceding
Valuation Period by the Net Investment Factor for the particular Sub-Account
for such subsequent Valuation Period. The Variable Accumulation Unit value
for each Sub-Account for any Valuation Period is the value determined as of
the end of the particular Valuation Period and may increase, decrease or
remain constant from Valuation Period to Valuation Period in accordance with
the Net Investment Factor described below.
VARIABLE ACCUMULATION VALUE
The variable accumulation value, if any, of a Participant's Account for any
Valuation Period is equal to the sum of the value of all Variable
Accumulation Units of each Sub-Account credited to the Participant's Account
for such Valuation Period. The variable accumulation value of each
Sub-Account is determined by multiplying the number of Variable Accumulation
Units, if any, credited to each Sub-Account by the Variable Accumulation Unit
value of the particular Sub-Account for such Valuation Period.
NET INVESTMENT FACTOR
The Net Investment Factor is an index applied to measure the investment
performance of a Sub-Account from one Valuation Period to the next. The Net
Investment Factor may be greater than, less than, or equal to one; therefore,
the value of a Variable Accumulation Unit may increase, decrease or remain
unchanged.
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The Net Investment Factor for any Sub-Account for any Valuation Period is
determined by dividing (a) by (b) and then subtracting (c) from the result
where:
(a) is the net result of:
1) the net asset value of a Fund share held in the Sub-Account
determined as of the end of the Valuation Period, plus
2) the per share amount of any dividend or other distribution
declared by the Fund on the shares held in the Sub-Account if
the ex-dividend date occurs during the Valuation Period, plus
or minus
3) a per share credit or charge with respect to any taxes paid
or reserved for by the Company during the Valuation Period
which are determined by the Company to be attributable to the
operation of the Sub-Account;
(b) is the net asset value of a Fund share held in the Sub-Account
determined as of the end of the preceding Valuation Period; and
(c) is the asset charge factor that the Company determines for the
Valuation Period to reflect the charges for assuming the mortality
and expense risks and administrative expense risks.
The asset charge factor for any Valuation Period is equal to the daily asset
charge factor multiplied by the number of 24-hour periods in the Valuation
Period. The Company will determine the daily asset charge factor based upon
the Annual Asset Charge shown on the Certificate Specification page.
FIXED ACCOUNT VALUE
GUARANTEE PERIODS
The Participant elects one or more Guarantee Period(s) from among those made
available by the Company. The period(s) elected will determine the Guaranteed
Interest Rate(s). A Purchase Payment, a portion thereof (at least $1,000), or
an amount transferred in accordance with the "Transfer Privilege" described
below, allocated to a particular Guarantee Period, less any applicable
premium taxes or similar taxes and any amounts subsequently withdrawn, will
earn interest at the Guaranteed Interest Rate in effect during the Guarantee
Period. Initial Guarantee Periods begin on the date a Net Purchase Payment is
applied or, in the case of a transfer, on the effective date of the transfer.
A Guarantee Period ends when the number of calendar years in the Guarantee
Period elected (measured from the end of the calendar month in which the
amount was allocated to the Guarantee Period) has elapsed. The last day of a
Guarantee Period is the Renewal Date. Subsequent Guarantee Periods begin on
the first day following the Renewal Date.
A Guarantee Amount is any portion of a Participant's Account Value allocated
to a particular Guarantee Period with a particular Renewal Date (including
interest earned thereon). Guarantee Amounts allocated to Guarantee Periods of
the same duration may have different Renewal Dates as a result of additional
Purchase Payments, renewals, and transfers of portions of the Participant's
Account Value. Each Guarantee Amount will be treated separately for purposes
of determining any market value adjustment.
The Company will notify the Participant in writing at least 45 and no more
than 75 days prior to the Renewal Date of any Guarantee Amount. A new
Guarantee Period of the same duration as the previous Guarantee Period will
commence automatically at the end of the previous Guarantee Period unless the
Company receives, in writing prior to the end of such Guarantee Period, the
Participant's election of a different Guarantee Period from among those that
the Company offers such time, or instructions to transfer all or a portion of
the Guarantee Amount to one or more Sub-Accounts in accordance with the
"Transfer Privilege" provision. A Guarantee Amount will not renew into a
Guarantee Period that will extend beyond the Certificate's maximum Annuity
Commencement Date. In these situations the next available Guarantee Period
will be used. Each new Guarantee Amount must be at least the amount set forth
on the Certificate Specifications page unless it is equal to the entire
Guarantee Amount being transferred.
GUARANTEED INTEREST RATES
The Company will periodically establish an applicable Guaranteed Interest
Rate for each Guarantee Period that it offers. The Company will guarantee
these rates for the duration of the respective Guarantee Periods.
No Guaranteed Interest Rate will be less than the minimum rate per year set
forth on the Certificate Specifications page, compounded annually.
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FIXED ACCUMULATION VALUE
Upon the Company's receipt of a Purchase Payment, all or that portion, if
any, of the Net Purchase Payment allocated to the Fixed Account, will be
credited to the Participant's Account and allocated to the Guarantee
Period(s) that the Participant selects. The fixed accumulation value, if any,
of a Participant's Account for any Valuation Period is equal to the sum of
the values of all Guarantee Amounts credited to the Participant's Account for
such Valuation Period.
TRANSFER PRIVILEGE
At any time during the Accumulation Period the Participant may transfer all
or part of the Participant's Account Value to one or more Sub-Accounts or
Guarantee Periods, subject to the conditions set forth below. Except as
described below, a transfer will generally be effective on the date that the
Company receives the request for transfer.
Transfers involving Sub-Accounts will reflect the purchase or cancellation of
Variable Accumulation Units having an aggregate value equal to the dollar
amount being transferred to or from a particular Sub-Account. The purchase or
cancellation of such units shall be made using Variable Accumulation Unit
values of the applicable Sub-Account for the Valuation Period during which
the transfer is effective. Transfers to a Guarantee Period will result in a
new Guarantee Period for the amount being transferred. Any such Guarantee
period will begin on the effective date of the transfer and end on the
Renewal Date. The amount transferred into such Guarantee Period will earn
interest at the Guaranteed Interest Rate declared by the Company for that
Guarantee Period as of the effective date of the transfer.
Transfers will be subject to the following conditions: (1) not more than 12
transfers may be made in any Account Year; (2) a minimum of 30 calendar days
must elapse between transfers made to or from the Fixed Account or among
Guarantee Periods within the Fixed Account; (3) the amount being transferred
from a Sub-Account may not be less than the amount set forth on the
Certificate Specifications page unless the total Participant's Account Value
attributable to a Sub-Account is being transferred; (4) any Participant's
Account Value remaining in a Sub-Account may not be less than the amount set
forth on the Certificate Specifications page; and (5) the total Participant's
Account Value attributable to the Guarantee Amount must be transferred,
except for an "interest out" transfer (with an "interest out" transfer, the
entire amount of interest credited to all Guarantee Amounts during the
current Account Year is transferred to one or more Sub-Accounts). In
addition, transfers of a Guarantee Amount (except interest credited to such
Guarantee Amount during the current Account Year) will be subject to the
market value adjustment described below unless the transfer is effective
within 30 days prior to the Renewal Date applicable to the Guarantee Amount.
Transfers involving Variable Accumulation Units shall be subject to such
terms and conditions as the Funds may impose. Similarly, the Company reserves
the right to delay the effective date of any transfer involving the Fixed
Account for reasons similar to those underlying delays of transfers among
Sub-Accounts. The Company also reserves the right to refuse or delay all
transfer requests initiated on behalf of a Participant by any third party
authorized by the Participant to make such transfer requests. Currently,
there is no charge for transfers; however, the Company reserves the right to
impose a charge for each transfer as shown on the Certificate Specifications
page. The Company reserves the right to limit the amount that may be
transferred from the Sub-Accounts to the Fixed Account.
ACCOUNT FEE
On each Account Anniversary prior to the Annuity Commencement Date, the
Company will deduct from the value of each Participant's Account an annual
account fee to reimburse the Company for administrative expenses relating to
the Contract and the Participant's Account. The account fee is the amount
specified on the Certificate Specifications Page. The Company will deduct the
account fee on a PRO RATA basis from amounts allocated to each Guarantee
Period and each Sub-Account in which the Participant's Account is invested at
the time of such deduction. If a Participant's Account is surrendered for its
full value on other than an Account Anniversary, the Company will deduct the
full account fee at the time of such surrender. The Company will waive the
account fee when either (a) the entire Participant's Account Value has been
allocated to the Fixed Account during the entire previous Account Year, or
(b) the Participant's Account Value is greater than the amount specified on
the Certificate Specifications page on the Account Anniversary. On the
Annuity Commencement Date the value of the Participant's Account will be
reduced by a proportionate amount of the account fee to reflect the time
elapsed between the last Account Anniversary and the day before the Annuity
Commencement Date.
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After the Annuity Commencement Date, the Company will deduct an annual
account fee in an amount specified on the Certificate Specifications page in
equal amounts from each Variable Annuity payment made during the year. The
Company makes no such deduction from Fixed Annuity payments.
CASH WITHDRAWALS, WITHDRAWAL CHARGES AND MARKET VALUE ADJUSTMENT
CASH WITHDRAWALS
At any time before the Annuity Commencement Date, the Participant may elect
to receive a cash withdrawal payment from the Company by filing with the
Company, at its Annuity Service Mailing Address, a written election in such
form as the Company may require. Any such election shall specify the amount
of the withdrawal and will be effective on the date that the Company receives
it. Any cash withdrawal payment will be paid within seven days from the date
the election becomes effective, except as the Company may be permitted to
defer such payment in accordance with the Investment Company Act of 1940. The
Company reserves the right to defer the payment of amounts withdrawn from the
Fixed Account for a period not to exceed six months from the date that the
Company receives the written request for such withdrawal.
The Participant may request a full surrender or a partial withdrawal. A full
surrender will result in a cash withdrawal payment equal to the value of the
Participant's Account at the end of the Valuation Period during which the
election becomes effective less the account fee, plus or minus any applicable
market value adjustment, and less any applicable withdrawal charge. A partial
withdrawal (I.E., a payment of an amount less than that paid under a full
surrender) will result in the cancellation of a portion of the Participant's
Account Value with an aggregate dollar value equal to the dollar amount of
the cash withdrawal payment, plus or minus any applicable market value
adjustment and plus any applicable withdrawal charge.
In the case of a partial withdrawal, the Participant may instruct the Company
as to the amounts to be withdrawn from each Sub-Account and/or Guarantee
Amount. If not so instructed, the Company will effect the partial withdrawal
PRO RATA from each Sub-Account and Guarantee Amount in which the
Participant's Account Value is invested at the end of the Valuation Period
during which the withdrawal becomes effective. If a partial withdrawal is
requested which would leave a Participant's Account Value lower than the
account fee, then the Company will treat such partial withdrawal as a full
surrender.
Cash withdrawals from a Sub-Account will result in the cancellation of
Variable Accumulation Units attributable to the Participant's Account with an
aggregate value on the effective date of the withdrawal equal to the total
amount by which the Sub-Account is reduced. The cancellation of such units
will be based on the Variable Accumulation Unit value(s) of the
Sub-Account(s) for the Valuation Period during which the cash withdrawal is
effective.
All cash withdrawals of any Guarantee Amount, except those effective within
30 days prior to the Renewal Date of such Guarantee Amount, or the withdrawal
of interest credited to such Guarantee Amount during the current Account
Year, will be subject to the market value adjustment described below.
WITHDRAWAL CHARGES
If a cash withdrawal is made, the Company may assess a withdrawal charge. The
amount of any withdrawal charge is determined as follows:
ORDER OF LIQUIDATION: For purposes of a full surrender or partial
withdrawal, each withdrawal is allocated first to the free withdrawal
amount and then to previously unliquidated Payments (on a first-in,
first-out basis) until all Purchase Payments have been liquidated.
FREE WITHDRAWAL AMOUNT: As defined in the Certificate Specifications
Page.
MAXIMUM WITHDRAWAL AMOUNT WITHOUT A WITHDRAWAL CHARGE: The maximum amount
that can be withdrawn without a withdrawal charge during the first four
Account Years is the free withdrawal amount as specified on the
Certificate Specifications Page. At the completion of the fourth Account
Year, all money will be free of withdrawal charges.
AMOUNT SUBJECT TO WITHDRAWAL CHARGE: For any partial withdrawal or full
surrender, the amount subject to withdrawal charge is the amount of the
partial withdrawal or full surrender less the maximum withdrawal amount
without a withdrawal charge, up to a maximum of the sum of all
unliquidated Payments.
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WITHDRAWAL CHARGE PERCENTAGE: The withdrawal charge percentage varies
according to the number of complete Account Years between the Date of
Coverage and the Account Year in which the withdrawal is made.
AMOUNT OF WITHDRAWAL CHARGE: The Company determines the amount of the
withdrawal charge by multiplying the amount subject to a withdrawal
charge by the withdrawal charge percentage(s) set forth on the
Certificate Specifications page.
The Company imposes no withdrawal charge on amounts applied to purchase an
annuity. For any Qualified Certificate, the free withdrawal amount in any
Account Year will be the greater of the free withdrawal amount described
above and any amounts required to be withdrawn to comply with the minimum
distribution requirements of the Code. This applies only to the portion of
the required minimum distribution attributable to that Qualified Certificate.
NURSING HOME WITHDRAWAL PRIVILEGE
The Company will waive the withdrawal charge arising from a full surrender
if: (1) at least one year has elapsed since the Certificate's Date of
Coverage, and (2) the Participant is confined to an eligible nursing home and
has been confined there for at least the preceding one hundred eighty (180)
days. Proof of the Participant's confinement to an eligible nursing home must
be provided to the Company at its Annuity Service Mailing Address in such
form as the Company may require.
For purposes of this section, an eligible nursing home is a licensed hospital
or licensed skilled or intermediate care nursing facility at which medical
treatment is available on a daily basis and daily medical records are kept
for each patient.
MARKET VALUE ADJUSTMENT
Any cash withdrawal (which for purposes of this section includes transfers
and amounts applied to purchase an annuity) of a Guarantee Amount, other than
a withdrawal effective within 30 days prior to the Renewal Date of the
Guarantee Amount, the withdrawal of interest credited on such Guarantee
Amount during the current Account Year, or automatic transfers from a
Guarantee Period as part of our dollar-cost averaging program, will be
subject to a market value adjustment.
The market value adjustment will reflect the relationship between the current
rate (as described in the formula below) for the amount being withdrawn and
the Guaranteed Interest Rate applicable to the amount being withdrawn. It
also reflects the time remaining in the applicable Guarantee Period.
The Company will determine the market value adjustment by multiplying the
amount being withdrawn after the deduction of any applicable account fee and
before deduction of any applicable withdrawal charge by the market value
adjustment factor. The market value adjustment factor is:
N/12
[(1 + I)/(1 + J + b)] - 1
where,
- I is the Guaranteed Interest Rate being credited to the Guarantee Amount
subject to the market value adjustment,
- J is the Guaranteed Interest Rate that the Company declares, as of the
effective date of the application of the market value adjustment, for
current allocations to Guarantee Periods equal to the balance of the
Guarantee Period of the Guarantee Amount subject to the market value
adjustment, rounded to the next higher number of complete years. For any
Guarantee Period of less than one year J is the Guaranteed Interest Rate
we declare for a Guarantee Period of the same length as your Guarantee
Period (the current rate).
- b is a factor which the Company will determine for each Certificate and
which is set forth on the Certificate Specifications page and which will
not exceed .25%, and
- N is the number of complete months remaining in the Guarantee Period of
the Guarantee Amount subject to the market value adjustment.
In the determination of J, if the Company does not currently offer the
applicable Guarantee Period, then the Company will determine the rate by
linear interpolation of the current rates for Guarantee Periods that are
available.
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DEATH BENEFIT
DEATH BENEFIT PROVIDED BY THE CONTRACT
If the Covered person dies while the Contract and this Certificate are in
effect and before the Annuity Commencement Date, the Company, upon receipt of
Due Proof of Death of the Covered person, may pay a Death Benefit to the
Beneficiary in accordance with this Death Benefit provision. If the Covered
Person is not a natural person, the Annuitant is considered the Participant
for the purpose of this Death Benefit provision.
If there is no Designated Beneficiary living on the date of death of the
Covered Person, the Company will pay the Death Benefit upon receipt of Due
Proof of Death of the Covered Person and the Beneficiary, if applicable, in
one sum to the estate of the deceased Covered Person. If the death of the
Covered Person occurs on or after the Annuity Commencement Date, no Death
Benefit will be payable under the Contract except as may be provided under
the form of annuity elected.
ELECTION AND EFFECTIVE DATE OF ELECTION
During the lifetime of the Participant and prior to the Annuity Commencement
Date, the Participant may elect to have the Death Benefit applied under one
or more of the Annuity Options in accordance with the Certificate's
settlement provisions. The Participant may elect a Variable Annuity or a
Fixed Annuity or a combination of both for the Beneficiary as Payee after the
death of the Participant. The Participant may make or subsequently revoke
this election by filing with the Company, at its Annuity Service Mailing
Address, a written election or revocation of an election in such form as the
Company may require. The Participant's election or revocation of an election
of a method of settlement of the Death Benefit will become effective on the
date that the Company receives it. For the purposes of the "Payment of Death
Benefit" section below, the Participant's election of the method of
settlement of the Death Benefit that is in effect on the date of death of the
Covered Person will be deemed effective on the date that the Company receives
Due Proof of Death of the Covered Person.
If no election of a method of settlement of the Death Benefit by the Participant
is in effect on the date of death of the Covered Person, the Beneficiary may
elect to (a) receive the Death Benefit in the form of a cash payment, in which
event the Company will cancel the Participant's Account; or (b) have the Death
Benefit applied under one or more of the Annuity Options in accordance with the
settlement provisions to effect, on the Annuity Commencement Date determined in
the "Payment of Death Benefit" section below, a Variable Annuity or a Fixed
Annuity or a combination of both for the Beneficiary as Payee. In no event shall
any method of settlement be exercised which would violate the mandatory
distribution requirements of Section 72(s) of the Code. For additional options
available if the designated Beneficiary is the surviving spouse, please refer to
the section of this Certificate entitled "OWNERSHIP PROVISIONS - Death of
Participant."
The Participant may elect a method of settlement by filing with the Company,
at its Annuity Service Mailing Address, a written election in such form as
the Company may require. Any written election of a method of settlement of
the Death Benefit by the Beneficiary will become effective on the later of
(a) the date that the Company receives the election; or (b) the date that the
Company receives Due Proof of Death of the Participant. If the Company does
not receive the Beneficiary's written election within 60 days following the
date that the Company receives Due Proof of Death of the Participant, the
Beneficiary shall be deemed to have elected a cash payment as of the last day
of such 60-day period.
PAYMENT OF DEATH BENEFIT
If the Death Benefit is to be paid in cash, the Company will make the payment
within seven days of the Death Benefit Date, except as the Company may be
permitted to defer any such payment in accordance with the Investment Company
Act of 1940. If settlement under one or more of the Annuity Options is
elected, the Annuity Commencement Date will be the first day of the second
calendar month following the effective date of the election and the Company
will maintain the Covered Person's Account in effect until the Annuity
Commencement Date.
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AMOUNT OF DEATH BENEFIT
The Death Benefit is determined as of the Death Benefit Date.
If the Covered Person was age 85 or less on the Date of Coverage, the Death
Benefit is equal to the greatest of:
(1) the Participant's Account Value for the Valuation Period in which
the Death Benefit Date occurs;
(2) the amount which would have been payable in the event of a full
surrender of the Participant's Account on the
(3) Net Purchase Payments, adjusted for any partial withdrawals, as of
the Death Benefit Date; or
(4) any Optional Death Benefit, if elected on or before the Date of
Coverage, as shown on the Certificate Specifications page.
If the Covered Person was age 86 or older on the Date of Coverage, the Death
Benefit will be equal to (2) above.
A partial withdrawal will affect the amount payable under (3) and (4) on a
basis proportional to the deduction in Participant's Account Value brought
about by such withdrawal. That is, any partial withdrawal will reduce the
Death Benefit amount to an amount equal to the Death Benefit amount
immediately before the withdrawal multiplied by the ratio of the
Participant's Account Value immediately after the withdrawal to the
Participant's Account Value immediately before the withdrawal.
If (2), (3) or (4) is operative, the excess of (2), (3) or (4), over (1) will
increase the Participant's Account Value. The increase will be allocated to
the Sub-Accounts based on the respective values of the Sub-Accounts on the
Death Benefit Date. If any Optional Death Benefit Rider is elected and is
operative, the Participant's Account Value will be increased by the excess of
(4) over (1) and the Company will allocate the increase as described above.
If no portion of the Participant's Account is allocated to the Sub-Accounts,
the Company will allocate the entire increase to the Sub-Account invested in
either a money market fund, if available, or the Company's General Account.
SETTLEMENT PROVISIONS
GENERAL
On the Annuity Commencement Date, the Company will apply the adjusted value
of the Participant's Account as determined in accordance with the
"Determination of Amount" provision below, as the Participant specifies,
under one or more of the Annuity Options provided in the Contract and this
Certificate or under such other settlement options as may be agreed to by the
Company. However, if the amount to be applied under any Annuity Option is
less than the Minimum Annuity Purchase Amount set forth on the Certificate
Specifications page, or if the first annuity payment payable in accordance
with such option is less than the Minimum Initial Annuity Payment Amount set
forth on the Certificate Specifications page, the Company will pay the amount
to be applied in a single payment to the Payee.
After the Annuity Commencement Date, no change of Annuity Option is permitted
and no payments may be requested under the Cash Withdrawals provision of the
Contract. Exchanges of Variable Annuity Units are permitted.
ELECTION AND EFFECTIVE DATE OF ELECTION
During the lifetime of the Participant and prior to the Annuity Commencement
Date, the Participant may elect to have the adjusted value of the
Participant's Account applied on the Annuity Commencement Date under one or
more of the Annuity Options provided in the Contract. If more than one person
is named as Annuitant, the Participant may elect to name one of such persons
to be the sole Annuitant as of the Annuity Commencement Date.
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The Participant may also change any election but any election or change of
election must be effective at least 30 days prior to the Annuity Commencement
Date. This election or change of election may be made by filing with the
Company at its Annuity Service Mailing Address, a written election or change
of election in such form as the Company may require. Any such election or
change of election will become effective on the date that the Company
receives it. If no such election is in effect on the 30th day prior to the
Annuity Commencement Date, the adjusted value of the Participant's Account
will be applied under Annuity Option B, for a life annuity with 120 monthly
payments certain. If there is no election of a sole Annuitant on the 30th day
prior to the Annuity Commencement date, the person designated as Co-Annuitant
will be the Payee under the applicable Annuity Option.
Any such election may specify the proportion of the adjusted value of the
Participant's Account to be applied to provide a Fixed Annuity and/or a
Variable Annuity. In the event the election does not so specify, then the
portion of the adjusted value of the Participant's Account to be applied to
provide a Fixed Annuity and/or a Variable Annuity will be determined on a PRO
RATA basis from the composition of the Participant's Account on the Annuity
Commencement Date.
The Annuity Options in the Contract may also be elected as provided in the
"Death Benefit" section of the Contract.
DETERMINATION OF AMOUNT
The adjusted value of the Participant's Account is applied to provide a
Variable Annuity or a Fixed Annuity or a combination of both. This value
shall be equal to the Participant's Account Value for the Valuation Period
which ends immediately preceding the Annuity Commencement Date, minus a
proportionate amount of the account fee to reflect the time elapsed between
the last Account Anniversary and the day before the Annuity Commencement
Date, plus or minus any applicable market value adjustment and minus any
applicable premium or similar tax. We will not assess market value adjustment
on the maximum Annuity Commencement Date.
EFFECT OF ANNUITY COMMENCEMENT DATE ON PARTICIPANT'S ACCOUNT
The Company will cancel the Participant's Account on the Annuity Commencement
Date.
ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is set forth on the Certificate Specifications
page. The Participant may change this date from time to time provided that
each change is effective at least 30 days prior to the then current Annuity
Commencement Date. The new Annuity Commencement Date must be a date that is:
(1) at least 30 days after the effective date of the change; (2) the first
day of a month; and (3) not later than the first day of the first month
following the Annuitant's 95th birthday, unless otherwise restricted, in the
case of a Qualified Contract, by the particular retirement plan or by
applicable law. For a Charitable Remainder Trust, the Annuity Commencement
Date in (3) is the Annuitant's 100th birthday. If more than one person is
named as Annuitant, the Annuity Commencement Date will not be later than the
first day of the first month following the 95th birthday of the youngest of
those persons so named (or the 100th birthday in the case of a Charitable
Remainder Trust). The Participant may change the Annuity Commencement Date by
filing with the Company, at its Annuity Service Mailing Address, a written
designation of a new Annuity Commencement Date in such form as the Company
may require. Any such change will become effective on the date that the
Company receives the designation.
The Annuity Commencement Date may also be changed by an election of a
settlement option as provided in the "Death Benefit" section of the Contract.
FIXED ANNUITY PAYMENTS
The dollar amount of each Fixed Annuity payment shall be determined in
accordance with the annuity payment rates shown on page 20, which are based
on the minimum guaranteed interest rate of 2.5% per year or, if more
favorable to the Payee(s), in accordance with the annuity payment rates
published by the Company and in use on the Annuity Commencement Date.
VARIABLE ANNUITY PAYMENTS
The dollar amount of the first Variable Annuity payment shall be determined
in accordance with the annuity payment rates shown on page 19, which are
based on an assumed interest rate of 3% per year.
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All Variable Annuity payments other than the first are determined by means of
Annuity Units credited with respect to the particular Payee. The number of
Annuity Units that the Company will credit in respect of a particular
Sub-Account is determined by dividing that portion of the first Variable
Annuity payment attributable to that Sub-Account by the Annuity Unit value of
that Sub-Account for the Valuation Period which ends immediately preceding
the Annuity Commencement Date. The resulting number of Annuity Units of each
Sub-Account credited with respect to the Payee remains fixed unless an
exchange of Annuity Units is made pursuant to the Exchange of Variable
Annuity Units section below. The dollar amount of each Variable Annuity
payment after the first may increase, decrease or remain constant, and is
equal to the sum of the amounts determined by multiplying the number of
Annuity Units of a particular Sub-Account credited with respect to the Payee
by the Annuity Unit value for the particular Sub-Account for the Valuation
Period which ends immediately preceding the due date of each subsequent
Variable Annuity payment.
ANNUITY UNIT VALUE
The Company established the Annuity Unit Value for each Sub-Account at $10.00
for the first Valuation Period of the particular Sub-Account. The Company
determines the Annuity Unit value for the particular Sub-Account for any
subsequent Valuation Period by multiplying the Annuity Unit value for the
particular Sub-Account for the immediately preceding Valuation Period by the
Net Investment Factor for the particular Sub-Account for the current
Valuation Period. The Company then multiplies that product by a factor to
neutralize the assumed interest rate of 3% per year used to establish the
annuity payment rates found in the Contract.
EXCHANGE OF VARIABLE ANNUITY UNITS
After the Annuity Commencement Date the Payee may, by filing a written
request with the Company at its Annuity Service Mailing Address, exchange the
value of a designated number of Annuity Units of a particular Sub-Account
then credited with respect to such Payee for other Annuity Units, the value
of which would be such that the dollar amount of an annuity payment made on
the date of the exchange would be unaffected by such exchange. The maximum
number of exchanges that a Payee may make in any Account Year is set forth on
the Certificate Specifications page.
Exchanges may be made among the Sub-Accounts only. Exchanges shall be made
using the Annuity Unit values for the Valuation Period during which the
Company receives the request for exchange.
ACCOUNT FEE
After the Annuity Commencement Date, the Company will deduct, in equal
amounts from each Variable Annuity payment made during the year, an annual
account fee equal to the amount specified on the Certificate Specifications
page. The Company makes no such deduction from Fixed Annuity payments.
DESCRIPTION OF ANNUITY OPTIONS
Annuity Options A, B, C and D are available on either a Fixed Annuity or a
Variable Annuity basis.
ANNUITY OPTION A. LIFE ANNUITY:
Monthly payments during the lifetime of the Payee. These payments will
terminate at the death of the Payee. There is no provision for
continuation of payments to a Beneficiary.
ANNUITY OPTION B. LIFE ANNUITY WITH 60, 120, 180 OR 240 MONTHLY
PAYMENTS CERTAIN: Monthly payments during the lifetime of the Payee and
in any event for sixty (60), one hundred twenty (120), one hundred
eighty (180) or two hundred forty (240) months certain as elected.
ANNUITY OPTION C. JOINT AND SURVIVOR ANNUITY:
Monthly payments payable during the joint lifetime of the Payee and a
designated second person and during the lifetime of the survivor.
During the lifetime of the survivor variable monthly payments, if any,
will be determined using the percentage chosen at the time of the
election of this option of the number of each type of Annuity Unit
credited with respect to the Payee. Each fixed monthly payment, if any,
will be equal to the same percentage of the fixed monthly payment
payable during the joint lifetime of the Payee and the designated
second person.
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ANNUITY OPTION D. MONTHLY PAYMENTS FOR A SPECIFIED PERIOD CERTAIN:
Monthly payments for any specified period of time (at least 5 years but
not exceeding 30 years), as elected. Monthly payments for a Specified
Period Certain of 5 to 9 years are not available during the first four
Account Years.
AMOUNTS PAYABLE ON DEATH OF PAYEE
In the event of the death of the Payee on or after the Annuity Commencement
Date, the Company will pay any remaining payments under any Annuity Option
then in effect to the Payee's designated Beneficiary as they become due. If
there is no designated Beneficiary entitled to these remaining payments then
living, the Company will pay, in one sum to the deceased Payee's estate, the
amount specified in the schedule below for any Annuity Option then in effect.
Any Beneficiary who becomes entitled to any remaining payments under any
Annuity Option may elect to receive the amount specified in the schedule
below for such option in one sum. In the event of the death of a Beneficiary
who has become entitled to receive any remaining payments under any Annuity
Option, the Company will pay, in one sum to the deceased Beneficiary's
estate, the amount specified for such option in the schedule below. All
payments that the Company makes in one lump sum, as provided in this
paragraph, are made in lieu of paying any remaining payments under the
Annuity Option then in effect.
OPTION AMOUNT
------ ------
B The discounted value of the remaining payments, if any, for the
certain period.
D The discounted value of the remaining payments, if any, for the
certain period.
In the case of Options B and D, the discounted value will be based, for
payments being made on a variable basis, on interest compounded annually at
the assumed interest rate and on the assumptions that the particular Annuity
Unit values applicable to the remaining payments will be the particular
Annuity Unit values for the Valuation Period which ends on the day before the
date of the determination and that the discounted value will remain unchanged
thereafter.
ANNUITY PAYMENT RATES
The annuity payment rate tables below show, for each $1,000 applied, the
dollar amount of both (a) the first monthly Variable Annuity payment based on
the assumed interest rate of 3% and (b) the monthly Fixed Annuity payment,
when the payment is based on the minimum guaranteed interest rate of 2.5% per
year.
The mortality table used in determining the annuity payment rates for Annuity
Options A, B and C is the 2000 Individual Annuitant Mortality Table A. In
using this mortality table, ages of Annuitants will be reduced by one year
for Annuity Commencement Dates occurring during the years 2010-2019, reduced
by two years for Annuity Commencement Dates occurring during the decade
2020-2029, and so on.
The annuity payment rates in the tables shown below reflect rates of
mortality appropriate for Annuity Commencement Dates occurring during the
years 2000-2009. Thus, for Annuity Commencement Dates occurring in the decade
2010-2019 the term ADJUSTED AGE as used in the tables below means actual age
less one year. ADJUSTED AGE shall mean actual age less two years for Annuity
Commencement Dates occurring in the decade 2020-2029, and so on.
ADJUSTED AGES will be determined based on the actual age(s) of the
Annuitant(s), in completed years and months, as of the Annuity Commencement
Date. The tables below show annuity payment rates for exact ADJUSTED AGES,
rates for ADJUSTED AGES expressed in completed years and months will be based
on straight line interpolation between the appropriate annuity payment rates.
The dollar amount of each annuity payment for any adjusted age or combination
of adjusted ages not shown below or for any other form of Annuity Option
agreed to by the Company will be quoted by the Company upon request.
18
<PAGE>
AMOUNT OF FIRST MONTHLY VARIABLE ANNUITY PAYMENT PER $1,000
SINGLE LIFE ANNUITY (INTEREST AT 3.0%)
<TABLE>
<CAPTION>
OPTION A OPTION B
LIFE ANNUITY LIFE ANNUITY WITH PAYMENTS CERTAIN
----------------------------------- ------------------------------------------------------------------------------------
ADJUSTED 60 PAYMENTS 120 PAYMENTS 180 PAYMENTS 240 PAYMENTS
------------- -------------- -------------- --------------
AGE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
----------------------------------- ------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
20 2.98 2.91 2.98 2.91 2.98 2.90 2.98 2.90 2.97 2.90
25 3.08 2.99 3.08 2.99 3.07 2.99 3.07 2.98 3.07 2.98
30 3.19 3.09 3.19 3.09 3.19 3.09 3.19 3.08 3.18 3.08
35 3.34 3.21 3.34 3.21 3.34 3.21 3.33 3.21 3.32 3.20
40 3.53 3.37 3.53 3.37 3.52 3.37 3.51 3.36 3.49 3.35
45 3.77 3.57 3.77 3.57 3.76 3.56 3.73 3.55 3.70 3.53
50 4.07 3.82 4.07 3.82 4.04 3.81 4.00 3.79 3.94 3.76
55 4.46 4.15 4.45 4.14 4.41 4.12 4.34 4.09 4.23 4.03
60 4.97 4.58 4.95 4.57 4.88 4.53 4.74 4.46 4.55 4.35
65 5.68 5.17 5.64 5.15 5.48 5.07 5.22 4.92 4.88 4.71
70 6.67 6.01 6.56 5.95 6.23 5.78 5.73 5.47 5.16 5.05
75 8.02 7.22 7.77 7.08 7.08 6.67 6.19 6.02 5.36 5.31
80 9.92 9.02 9.32 8.65 7.95 7.66 6.54 6.47 5.46 5.44
85 12.56 11.71 11.17 10.68 8.69 8.55 6.75 6.72 5.50 5.49
90 16.17 15.54 13.14 12.87 9.20 9.15 6.84 6.83 5.51 5.51
----------------------------------- ------------------------------------------------------------------------------------
</TABLE>
<TABLE>
<CAPTION>
OPTION C
JOINT AND SURVIVOR ANNUITY
(ASSUMED ELECTION OF JOINT AND TWO-THIRDS SURVIVOR)
----------------------------------------------------------------------------------------------
ADJUSTED AGE ADJUSTED AGE OF FEMALE
OF MALE
----------------------------------------------------------------------------------------------
55 60 65 70 75
----------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
55 4.11 4.31 4.53 4.77 5.04
60 4.29 4.52 4.79 5.09 5.42
65 4.48 4.76 5.09 5.46 5.88
70 4.70 5.02 5.41 5.88 6.41
75 4.91 5.28 5.74 6.31 6.99
----------------------------------------------------------------------------------------------
</TABLE>
<TABLE>
<CAPTION>
OPTION D
PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
--------------------------------------------------------------------------------
YEARS AMOUNT YEARS AMOUNT YEARS AMOUNT
--------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
10 9.61 17 6.22 24 4.84
11 8.86 18 5.96 25 4.70
12 8.23 19 5.72 26 4.58
13 7.71 20 5.51 27 4.47
14 7.25 21 5.31 28 4.37
15 6.86 22 5.14 29 4.27
16 6.52 23 4.98 30 4.18
--------------------------------------------------------------------------------
</TABLE>
19
<PAGE>
AMOUNT OF EACH FIXED MONTHLY ANNUITY PAYMENT PER $1,000
SINGLE LIFE ANNUITY (INTEREST AT 2.5%)
<TABLE>
<CAPTION>
OPTION A OPTION B
LIFE ANNUITY LIFE ANNUITY WITH PAYMENTS CERTAIN
------------------------------ ------------------------------------------------------------------------------------------
ADJUSTED 60 PAYMENTS 120 PAYMENTS 180 PAYMENTS 240 PAYMENTS
-------------- --------------- -------------- --------------
AGE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
------------------------------ ------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
20 2.67 2.59 2.67 2.59 2.67 2.59 2.67 2.59 2.67 2.59
25 2.77 2.68 2.77 2.68 2.77 2.68 2.77 2.68 2.77 2.68
30 2.90 2.79 2.90 2.79 2.89 2.79 2.89 2.79 2.89 2.78
35 3.05 2.92 3.05 2.92 3.05 2.92 3.04 2.91 3.03 2.91
40 3.24 3.08 3.24 3.08 3.24 3.08 3.23 3.07 3.21 3.06
45 3.49 3.29 3.48 3.28 3.47 3.28 3.45 3.27 3.42 3.25
50 3.79 3.54 3.79 3.54 3.77 3.53 3.73 3.51 3.67 3.48
55 4.18 3.87 4.17 3.87 4.13 3.85 4.08 3.82 3.97 3.76
60 4.70 4.31 4.67 4.30 4.61 4.26 4.48 4.20 4.30 4.09
65 5.40 4.90 5.36 4.88 5.22 4.81 4.97 4.67 4.63 4.45
70 6.38 5.73 6.28 5.68 5.97 5.52 5.48 5.22 4.92 4.81
75 7.73 6.94 7.49 6.82 6.83 6.41 5.96 5.78 5.12 5.07
80 9.62 8.74 9.05 8.38 7.71 7.42 6.31 6.23 5.22 5.21
85 12.25 11.41 10.91 10.42 8.46 8.32 6.52 6.50 5.27 5.26
90 15.86 15.23 12.89 12.62 8.98 8.93 6.61 6.61 5.27 5.27
------------------------------ ------------------------------------------------------------------------------------------
</TABLE>
OPTION C
JOINT AND SURVIVOR ANNUITY
(ASSUMED ELECTION OF JOINT AND TWO-THIRDS SURVIVOR)
<TABLE>
<CAPTION>
ADJUSTED AGE ADJUSTED AGE OF FEMALE
OF MALE
----------------------------------------------------------------------------------------------------------------
55 60 65 70 75
----------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
55 3.83 4.03 4.25 4.49 4.75
60 4.01 4.25 4.52 4.82 5.14
65 4.20 4.49 4.82 5.19 5.60
70 4.41 4.74 5.14 5.60 6.14
75 4.61 4.99 5.46 6.03 6.71
----------------------------------------------------------------------------------------------------------------
</TABLE>
OPTION D
PAYMENTS FOR A SPECIFIED PERIOD CERTAIN
<TABLE>
<CAPTION>
-------------------------------------------------------------------------------------
YEARS AMOUNT YEARS AMOUNT YEARS AMOUNT
-------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
10 9.39 17 6.00 24 4.60
11 8.64 18 5.73 25 4.46
12 8.02 19 5.49 26 4.34
13 7.49 20 5.27 27 4.22
14 7.03 21 5.08 28 4.12
15 6.64 22 4.90 29 4.02
16 6.30 23 4.74 30 3.93
-------------------------------------------------------------------------------------
</TABLE>
20
<PAGE>
OWNERSHIP PROVISIONS
EXERCISE OF CONTRACT RIGHTS
The Contract shall belong to the Owner. The Participant shall be entitled to
exercise all rights and privileges in connection with this Certificate unless
the Owner has expressly reserved any rights and privileges. In any case, such
rights and privileges can be exercised without the consent of the Beneficiary
(other than an irrevocable Beneficiary) or any other person. Such rights and
privileges may be exercised only during the lifetime of the Participant and
prior to the Annuity Commencement Date, except as the Contract otherwise
provides.
The Annuitant becomes the Payee on and after the Annuity Commencement Date.
The Beneficiary becomes the Payee on the death of the Covered Person prior to
the Annuity Commencement Date or on the death of the Annuitant after the
Annuity Commencement Date. Such Payees may thereafter exercise such rights
and privileges, if any, of ownership that continue.
DEATH OF PARTICIPANT
If a Participant under a Non-Qualified Contract dies prior to the Annuity
Commencement Date, that Participant's Account must be distributed to the
"designated Beneficiary" (as defined below) either (1) as a lump sum within
five years after the date of death of the Participant, or (2) as an annuity
over some period not greater than the life or expected life of the designated
Beneficiary or for a period certain of between five and nine years, with
annuity payment beginning within one year after the date of death of the
Participant. For this purpose (and for purposes of Section 72(s) of the
Code), the person named as Beneficiary shall be considered the designated
Beneficiary and if no person then living has been so named, then the
Annuitant shall automatically be the designated Beneficiary. If the
designated Beneficiary is the surviving spouse of the deceased Participant,
that spouse can elect to continue the Certificate in his or her own name as
Participant, in which case the mandatory distribution requirements will apply
on the spouse's death. As designated Beneficiary, the surviving spouse may
also choose to have the Participant's Account distributed over some period
not greater than his or her life or expected life, with annuity payments
beginning within one year after the date of death of the Participant.
If the Payee dies on or after the Annuity Commencement Date and before the
entire accumulation under such Participant's Account has been distributed,
the remaining portion of such Participant's Account, if any, must be
distributed as least as rapidly as the method of distribution then in effect.
In any case in which a non-natural person constitutes a holder of the
Certificate for the purposes of Section 72(s) of the Code, the distribution
requirements described above shall apply upon the death of any Annuitant, and
a change in any Annuitant shall be treated as the death of such Annuitant.
In all cases, no Participant or Beneficiary shall be entitled to exercise any
rights that would adversely affect the treatment of the Contract as an
annuity Contract under the Code.
VOTING OF FUND SHARES
The Company will vote Fund shares held by the Sub-Accounts at meetings of
shareholders of the Funds or in connection with similar solicitations, but
will follow voting instructions received from persons having the right to
give voting instructions. The Owner or Participant, as the case may be, is
the person having the right to give voting instructions prior to the Annuity
Commencement Date. On or after the Annuity Commencement Date the Payee is the
person having such voting rights. The Company will vote any shares
attributable to the Company and any Fund shares for which no timely voting
instructions have been received in the same proportion as the shares for
which instructions are received from persons having such voting rights.
Neither the Variable Account nor the Company is under any duty to provide
information concerning the voting instruction rights of persons who may have
such rights under retirement or deferred compensation plans, other than
rights afforded by the Investment Company Act of 1940, nor do they have any
duty to inquire as to the instructions received or the authority of Owners,
Participants, or others to instruct on the voting of Fund shares. Except as
the Variable Account or the Company has actual knowledge to the contrary, the
instructions given by Owners, Participants and Payees will be valid as they
affect the Variable Account, the Company and any others having voting
instruction rights with respect to the Variable Account.
21
<PAGE>
All Fund proxy material, together with an appropriate form to be used to give
voting instructions, will be provided to each Owner, each Participant and
each Payee having the right to give voting instructions at least ten days
prior to each meeting of the shareholders of the Fund. The Company will
determine the number of particular Fund shares as to which each such person
is entitled to give voting instructions as of a date not more than 90 days
prior to each such meeting. Prior to the Annuity Commencement Date, the
number of Fund shares as to which voting instructions may be given to the
Company is determined by dividing the value of all the Variable Accumulation
Units of the particular Sub-Account credited to the Participant's Account by
the net asset value of one Fund share as of the same date. On or after the
Annuity Commencement Date, the Company determines the number of Fund shares
as to which a Payee may give such instructions by dividing the reserve that
the Company holds in the particular Sub-Account with respect to the
particular Payee by the net asset value of a Fund share as of the same date.
PERIODIC REPORTS
During the Accumulation Period the Company will send to the Participant, or
such other person having voting rights, at least once during each Account
Year, a statement showing the number, type and value of Accumulation Units
credited to the Participant's Account and the fixed accumulation value of
such account. This statement shall be accurate as of a date not more than two
months previous to the date of mailing. In addition, every person having
voting rights will receive such reports or prospectuses concerning the
Variable Account and each Fund as may be required by the Investment Company
Act of 1940 and the Securities Act of 1933. The Company will also send such
statements reflecting transactions in the Participant's Account as may be
required by applicable laws, rules and regulations.
DESIGNATION AND CHANGE OF BENEFICIARY
The Beneficiary designation contained in any Application will remain in
effect until changed.
Subject to the rights of an irrevocable Beneficiary, the designation of
Beneficiary may be changed or revoked. Any change or revocation must be filed
with the Company at its Annuity Service Mailing Address in such form as the
Company may require. The change or revocation will not be binding until the
Company receives it. When the Company receives the change or revocation, it
will be effective as of the date on which the Beneficiary designation or
revocation was signed, but the change or revocation will be without prejudice
to the Company on account of any payment made or any action taken by the
Company before the Company receives and acknowledges the change or revocation.
GENERAL PROVISIONS
AGE AND SEX MISSTATEMENT
If any date of birth or sex, or both, has been misstated in the Application,
if any, or elsewhere, the amounts payable pursuant to the Contract under this
Certificate will be the amounts which would have been payable using the
correct age or sex, or both. Any deficiency in payments already made by the
Company shall be paid promptly and any excess in the payments already made by
the Company shall be charged against the benefits falling due after the
adjustment.
THIS CERTIFICATE
This Certificate is issued in consideration of the Application, if any, and
payment of the initial Purchase Payment. All statements made in any
Application will be deemed representations and not warranties, and no
statement will void the Certificate or be used in defense to a claim unless
it is contained in such Application, if any, or in a similar document, and a
copy is attached to the Certificate at issue. Only the President, a Vice
President, the Actuary or the Secretary of the Company has authority to agree
on the Company's behalf to any alteration of the Contract or any Certificate,
or to any waiver of the rights or requirements of the Company.
CURRENCY
All amounts due under the Contract are payable in U.S. dollars, lawful money
of the United States of America.
DETERMINATION OF VALUES
The method by which the Company determines the Net Investment Factor and the
number and value of Accumulation Units and Annuity Units shall be conclusive
upon the Owner, the Participant, any Payee and any Beneficiary.
22
<PAGE>
GOVERNING LAW
The laws of the jurisdiction where the Contract Application is signed will
govern the Contract and this Certificate.
GUARANTEES
Subject to the Net Investment Factor provision, the Company guarantees that
the dollar amount of Variable Annuity payments made during the lifetime of
the Payee(s) will not be adversely affected by the actual mortality
experience of the Company or by the actual expenses incurred by the Company
in excess of the expense deductions provided for in the Contract and other
Contracts providing benefits which vary in accordance with the investment
performance of the Sub-Accounts.
INCONTESTABILITY
The Contract and this Certificate are incontestable, subject to the Age and
Sex Misstatement, Proof of Age and Proof of Survival provisions contained
herein.
MODIFICATION
Upon notice to the Owner, the Participant(s) or the Payee(s) during the
annuity period, the Company may modify the Contract and this Certificate, but
only if such modification (a) is necessary to make the Contract, Certificate
or the Variable Account comply with any law or regulation issued by a
governmental agency to which the Company or the Variable Account is subject;
or (b) is necessary to assure continued qualification of the Contract and/or
Certificate under the Code or other federal or state laws relating to
retirement annuities or annuity Contracts; or (c) is necessary to reflect a
change in the operation of the Variable Account or the Sub-Accounts; or (d)
provides additional Variable Account and/or Fixed Account options; or (e) may
otherwise be in the best interests of Owners or Participants, as applicable.
In the event of any such modification, the Company may make appropriate
endorsement in the Contract and this Certificate to reflect such modification.
NONPARTICIPATING
The Contract is nonparticipating and will not share in any profits or surplus
earnings of the Company, and therefore, no dividends are payable.
PAYMENTS BY THE COMPANY
All sums payable by the Company pursuant to this Certificate are payable only
at its Executive Office or such other place as the Company may designate. The
Company may require surrender of the Certificate upon final payment of all
sums payable by the Company pursuant to the Certificate.
PROOF OF AGE
The Company shall have the right to require evidence of the age of any Payee
under Annuity Options A, B, and C prior to the Annuity Commencement Date.
PROOF OF SURVIVAL
The Company shall have the right to require evidence of the survival of any
Payee under Annuity Options A, B and C at the time that any payment payable
to such Payee is due.
SPLITTING UNITS
The Company reserves the right to split or combine the value of Variable
Accumulation Units, Annuity Unit or any of them. In effecting any such change
of unit values, strict equity will be preserved and no change will have a
material effect on the benefits or other provisions of this Certificate.
RIGHTS RESERVED BY THE COMPANY
The Company reserves the right, to the extent permitted by law, to: (1)
deregister the Variable Account under the Investment Company Act of 1940; (2)
combine any two or more Variable Accounts; (3) operate the Variable Account
as a management investment company or in any other form permitted by law; (4)
substitute shares of a Fund for shares of another investment company if
shares of such Fund are not available, or if, in the Company's judgment,
further investment in such Fund's shares is no longer appropriate; (5) add or
delete Funds, or series or sub-series thereof, and corresponding
Sub-Accounts; (6) add or remove Guarantee Periods available at any time for
election by a Participant; and (7) restrict or eliminate any of the voting
rights of Participants (or Owners) or other persons who have voting rights as
to the Variable Account.
23
<PAGE>
SUN LIFE ASSURANCE COMPANY OF CANADA (U.S.)
A WHOLLY-OWNED SUBSIDIARY OF SUN LIFE ASSURANCE COMPANY OF CANADA
<TABLE>
<CAPTION>
<S> <C> <C>
Executive Office: Home Office: Annuity Service Mailing Address:
[ONE SUN LIFE EXECUTIVE PARK] [WILMINGTON, DELAWARE] SUN LIFE OF CANADA (U.S.)
[WELLESLEY HILLS, MASSACHUSETTS 02481] RETIREMENT PRODUCTS AND SERVICES
P.O. BOX [#]
BOSTON, MASSACHUSETTS [ZIP CODE]
</TABLE>
CERTIFICATE FOR FLEXIBLE PAYMENT DEFERRED COMBINATION VARIABLE AND FIXED
GROUP ANNUITY CONTRACT
NONPARTICIPATING
ALL PAYMENTS AND VALUES PROVIDED BY THIS CERTIFICATE WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
PAYMENTS AND VALUES BASED ON THE FIXED ACCOUNT ARE SUBJECT TO A MARKET VALUE
ADJUSTMENT FORMULA, THE OPERATION OF WHICH MAY RESULT IN UPWARD AND DOWNWARD
ADJUSTMENTS IN AMOUNTS PAYABLE TO A PARTICIPANT, INCLUDING WITHDRAWALS,
TRANSFERS AND AMOUNTS APPLIED TO PURCHASE AN ANNUITY. PAYMENTS MADE FROM
GUARANTEE AMOUNTS THAT ARE WITHIN 30 DAYS PRIOR TO THE END OF A GUARANTEE
PERIOD OR THE WITHDRAWAL OF INTEREST CREDITED TO GUARANTEE AMOUNTS DURING THE
CURRENT ACCOUNT YEAR ARE NOT SUBJECT TO THE MARKET VALUE ADJUSTMENT.
