Northbrook Life Insurance Company
A Stock Company
Headquarters: 3100 Sanders Road, Northbrook, Illinois 60062
Flexible Premium Deferred Variable Annuity
We Will Make Periodic Income Payments Subject to the Provisions of This Contract
Beginning on the Payout Start Date Specified on the Annuity Data Page.
Death Benefits Are Provided Before the Payout Start Date. Income Payment Amounts
Are Not Guaranteed as to Dollar Amounts Before the Start Date.
Nonparticipating
This Is a Legal Contract Between You and Northbrook Life Insurance Company.
Please Read Your Contract Carefully.
Return Privilege
Upon written request, we will provide you with factual information regarding the
benefits and provisions contained in this Contract. If you are not satisfied
with this Contract for any reason, you may return it to us within 20 days after
you receive it. We will refund any purchase payments allocated to the Variable
Account, adjusted to reflect investment gain or loss from the date of allocation
to the date of cancellation, plus any purchase payments allocated to the Fixed
Account(s). If this Contract is qualified under Section 408 of the Internal
Revenue Code, we will refund the greater of any purchase payments or the
Contract Value.
The Contract Value or Income Payments May Increase or Decrease Based on the
Investment Experience of the Selected Sub-accounts of the Variable Account.
If you have any questions about your variable annuity, please contact Northbrook
Life at (800) 654-2397.
Secretary Chairman and
Chief Executive Officer
<PAGE>
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TABLE OF CONTENTS
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INDEX............................................3
CONTRACT SUMMARY.................................4
DEFINITIONS......................................5
THE PEOPLE INVOLVED..............................7
ACCUMULATION PHASE...............................8
PAYMENTS ON DEATH...............................11
PAYOUT PHASE....................................13
INCOME PAYMENT TABLES...........................15
GENERAL PROVISIONS..............................17
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NLU914
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INDEX
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Accounting Procedures.......................................................10
Administrative Expense Charge...............................................10
Annual Statement............................................................16
Annuitant....................................................................8
Annuity Transfers...........................................................13
Annuity Unit Value..........................................................13
Beneficiary..................................................................8
Certificate Value...........................................................10
Charges.....................................................................10
Crediting Interest...........................................................9
Death Benefit...............................................................12
Death of Owner or Annuitant.................................................11
Deferment of Payments.......................................................16
Entire Contract, The........................................................16
Fixed Amount Income Payments................................................13
Income Payments.............................................................13
Income Plans................................................................13
Incontestability............................................................16
Misstatement of Age or Sex..................................................16
Mortality and Expense Risk Charge...........................................11
Net Investment Factor.......................................................10
Owner........................................................................7
Payout Start Date...........................................................12
Payout Terms and Conditions.................................................14
Purchase Payments............................................................8
Settlements.................................................................12
Standard Fixed Account.......................................................9
Taxes.......................................................................11
Transfers....................................................................9
Variable Account Modifications..............................................17
Variable Amount Income Payments.............................................13
Withdrawal..................................................................11
<PAGE>
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CERTIFICATE SUMMARY
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This is a no sales load flexible premium deferred variable annuity. It provides
a Death Benefit if the Owner dies before the Payout Start Date. It also provides
periodic income payments if you are living on the Payout Start Date. The initial
purchase payment is shown on the Annuity Data Page. You may make additional
purchase payments subject to the limitations described in the Purchase Payment
provision.
The Certificate Value will vary according to how you allocate the purchase
payments. Allocations may be made to one or more of the Variable Sub-accounts
and to the Standard Fixed Account. The amount of the Certifictae Value will vary
with the investment performance of the selected Variable Sub-accounts and the
Standard Fixed Account.
You may withdraw part or all of the Certificate Value at any time on or before
the Payout Start Date. Any such withdrawal will cause the amount of periodic
income payments to be reduced.
Above is a brief description of the provisions of this Certificate. The
provisions are fully described on the remaining pages of the Certificate.
<PAGE>
Page 11
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DEFINITIONS
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Accumulation Phase The "Accumulation Phase" is the first of two phases of your
Certificate. During this phase, purchase payments are allocated to selected
Investment Alternatives and the Certificate Value accumulates. The Accumulation
Phase begins on the Issue Date of the Certificate stated on the Annuity Data
Page. This phase will continue until the Payout Start Date unless the
Certificate is terminated before that date.
Accumulation Unit An "Accumulation Unit" is a measure of your ownership interest
in a Variable Sub-account before the Payout Start Date.
Accumulation Unit Value The "Accumulation Unit Value" is the value of each
Accumulation Unit which is calculated each Valuation Date. Each Variable
Sub-account has its own Accumulation Unit Value.
Annuitant The "Annuitant" is the person whose life is used to determine the
duration and amount of any income payments. The Annuitant is named on the
Annuity Data Page but may be changed by the Owner.
Beneficiary The "Beneficiary" will become the new Owner as follows. If the sole
surviving Owner dies before the Payout Start Date, the Beneficiary, as the new
Owner, will receive the Death Benefit. If the sole surviving Owner dies after
the Payout Start Date, the Beneficiary, as the new Owner, will receive any
remaining guaranteed income payments. The Beneficiary is named on the Annuity
Data Page, but may be changed by the Owner.
Certificate Value "Certificate Value" is the total value of the amounts in the
Variable Sub-accounts plus the total value in the Standard Fixed Account as of
any Valuation Date on or before the Payout Start Date.
Certificate Year "Certificate Year" is a one year period beginning on the Issue
Date of the Certificate and on each anniversary of the Issue Date.
Death Benefit The "Death Benefit" is the amount we will pay if you, or the
Annuitant if you are not a Natural Person, die before the Payout Start Date. The
amount of the Death Benefit is defined in the Death Benefit provision.
Fixed Amount Income Payments "Fixed Amount Income Payments" are income payment
amounts that are fixed for the duration of the Income Plan.
<PAGE>
Investment Alternatives The "Investment Alternatives" are the Variable
Sub-accounts and the Standard Fixed Account shown on the enrollment. We may
offer additional Variable Sub-accounts at our discretion. We reserve the right
to limit the availability of the Investment Alternatives.
Income Plan An "Income Plan" is a series of payments on a scheduled basis
beginning on the Payout Start Date. The available Income Plans are described in
the Income Plans provision.
Issue Age "Issue Age" is the age of the Annuitant on the Annuitant's birthday on
or before the Issue Date.
Issue Date The "Issue Date" is the date when coverage under this Certificate
becomes effective. It is also the date used to determine Certificate Years. The
Issue Date is shown on the Annuity Data Page.
Joint Annuitant "Joint Annuitant" is applicable only if a Joint and Survivor
Income Plan is selected. The Joint Annuitant will be named at the time of Income
Plan selection.
Natural Person "Natural Person" is a living individual or trust entity that is
treated as an individual for Federal Income Tax purposes under the Internal
Revenue Code.
Net Investment Factor For each Variable Sub-account, the "Net Investment Factor"
is the proportional change in the Accumulation Unit Value during a Valuation
Period.
Owner The "Owner" is referred to as "you" and "your" in this Certificate. The
Owner is named on the Annuity Data Page, but may be changed.
Payout Phase The "Payout Phase" is the second of the two phases of your
Certificate. During this phase the Certificate Value less any applicable taxes
is applied to the Income Plan you choose and is paid out as provided in the
chosen plan. The Payout Phase begins on the Payout Start Date. It continues
until we make the last payment as provided by the Income Plan chosen.
Payout Start Date The "Payout Start Date" is the date the Certificate Value less
any applicable taxes is applied to an Income Plan. The anticipated Payout Start
Date is shown on the Annuity Data Page. You may change the Payout Start Date by
writing to us at least 30 days before this date.
Valuation Date A "Valuation Date" is any date the New York Stock Exchange is
open for trading except for days in which there is insufficient trading in the
Variable Account's portfolio securities such that the value of accumulation or
annuity units might not be materially affected by changes in the value of the
portfolio securities.
<PAGE>
Valuation Period A "Valuation Period" is the period that begins on the close of
one Valuation Date and ends on the close of the succeeding Valuation Date.
Variable Account The "Variable Account" for this Certificate is the Northbrook
Variable Annuity Account II. This account is a separate investment account to
which we allocate assets contributed under this and certain other certificates
and contracts. These assets will not be charged with liabilities arising from
any other business we may have.
Variable Sub-accounts The Variable Account is divided into Sub-accounts. Each
"Variable Sub-account" invests solely in the shares of the mutual fund
underlying that Sub-account.
Variable Amount Income Payments "Variable Amount Income Payments" are income
payment amounts that vary based on any Variable Sub-account.
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THE PERSONS INVOLVED
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Owner The person named at the time of enrollment is the Owner of this
Certificate unless subsequently changed. As Owner, you will receive any periodic
income payments, unless you have directed us to pay them to someone else.
You may exercise all rights stated in this Certificate, subject to the rights of
any irrevocable Beneficiary.
You may change the Owner or Beneficiary at any time. You may name a new
Annuitant only upon the death of the current Annuitant. Once we have received a
satisfactory written request for a change of Owner or Beneficiary, the change
will take effect as of the date you signed it. We are not liable for any payment
we make or other action we take before receiving any written request for a
change from you. You may not assign an interest in this Certificate as
collateral or security for a loan.
You may not assign an interest in this Contract as collateral or security for a
loan. However, you may assign periodic income payments under this Contract
before the Payout Start Date. We are bound by an assignment only if it is signed
by the assignor and filed with us. We are not responsible for the validity of an
assignment.
If the sole surviving Owner dies before the Payout Start Date, the Beneficiary
becomes the new Owner. If the sole surviving Owner dies after the Payout Start
Date, the Beneficiary becomes the new Owner and will receive any subsequent
guaranteed income payments.
If more than one person is designated as Owner:
o Owner as used in this Certificate refers to all persons named as Owners,
unless otherwise indicated;
<PAGE>
o any request to exercise ownership rights must be signed by all Owners; and
o on the death of any person who is an Owner, the surviving person(s) named
as Owner will continue as Owner.
Annuitant The Annuitant is the person named on the Annuity Data Page. The
Annuitant must be a living individual. If the Annuittant dies before the payout
start date, the new Annuitant will be:
o the youngest Owner, if the Owner(s) are living; otherwise,
o the youngest Beneficiary
Beneficiary The Beneficiary is the person(s) named on the Annuity Data Page, but
may be changed by the Owner, as described above. We will determine the
Beneficiary from the most recent written request we have received from you. If
you do not name a Beneficiary or if the Beneficiary named is no longer living,
the Beneficiary will be:
o your spouse if living; otherwise
o your children equally if living; otherwise
o your estate.
The Beneficiary may become the Owner under the circumstances described in the
Owner provision above.
Natural Person As used in this Certificate, Natural Person means a living
individual or trust entity that is treated as an individual for Federal Income
Tax purposes under the Internal Revenue Code.
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ACCUMULATION PHASE
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Purchase Payments The initial purchase payment is shown on the Annuity Data
Page. You may make subsequent purchase payments during the Accumulation Phase.
The number of purchase payments is unlimited. The minimum amount of additional
purchase payments we will accept is $100.
We will invest the purchase payments in the Investment Alternatives you select.
You may allocate any portion of your purchase payment in whole percents from 0%
to 100% to any of the Investment Alternatives. The total allocation must equal
100%.
<PAGE>
The allocation of the initial purchase payment is shown on the Annuity Data
Page. Allocation of each subsequent purchase payment will be the same as the
allocation for the most recent purchase payment unless you change the
allocation. You may change the allocation of subsequent purchase payments at any
time, without charge, simply by giving us written notice. Any change will be
effective at the time we receive the notice and will reflect the next computed
price(s).
Standard Fixed Account We reserve the right to offer a Standard Fixed Account at
our discretion. The guarantee periods of the Standard Fixed Account may range
from 1 - 10 years. We reserve the right to offer any of these guarantee periods
at our discretion. Money in the Standard Fixed Account will earn interest for
the guarantee period chosen at the current rate in effect at the time of
allocation or transfer to the Standard Fixed Account. After the guarantee period
expires, a renewal rate will be declared at our discretion. Subsequent renewal
dates will be on anniversaries of the first renewal date.
Crediting Interest We credit interest daily to money allocated to each Standard
Fixed Account at a rate which compounds over one year to the interest rate we
guaranteed when the money was allocated. We will credit interest to the initial
purchase payment from the Issue Date. We will credit interest to subsequent
purchase payments from the date we receive them at a rate declared by us. We
will credit interest to transfers from the date the transfer is made. The
interest rate for each Standard Fixed Account will never be less than 3.0% as
shown on the Annuity Data Page.
Transfers Before the Payout Start Date, you may transfer amounts among
Investment Alternatives. You may make 12 transfers during each Certificate Year
without charge. Each transfer after the 12th transfer in any Certificate Year
may be assessed a $10 transfer fee. All transfers made at the same time will be
treated as one request.
We reserve the right to limit the number of transfers in any Certificate Year or
to refuse any transfer request for an Owner or certain Owners if, in our sole
discretion, we believe that:
o excessive trading by such Owner or Owners or a specific transfer
request or group of transfer requests may have a detrimental effect on
Unit Values or the share prices of the underlying mutual funds or would
be to the disadvantage of other Certificate Owners; or
o we are informed by one or more of the underlying mutual funds that the
purchase or redemption of shares is to be restricted because of
excessive trading or a specific transfer or group of transfers is
deemed to have a detrimental effect on share prices of affected
underlying mutual funds.
Such restrictions may be applied in any manner which is reasonably designed to
prevent any use of the transfer right which is considered by us to be to the
disadvantage of the other Certificate Owners.
<PAGE>
We reserve the right to waive the transfer fees and restrictions contained in
this Certificate.
Certificate Value On the Issue Date of the Certificate, the Certificate Value is
equal to the initial purchase payment. After the Issue Date, the "Certificate
Value" is equal to the sum of:
o the number of Accumulation Units you hold in each Variable Sub-account
multiplied by the Accumulation Unit Value for that Sub-account on the
most recent Valuation Date; plus
o the total value you have in the Standard Fixed Account.
If you withdraw the entire Certificate Value, you may receive an amount less
than the Certificate Value because income tax withholding, and a premium tax
charge may apply.
Accounting Procedures The portion of the Certificate Value attributed to each
Variable Sub-account is maintained in Accumulation Units. Amounts which you
allocate to a Variable Sub-account are used to purchase Accumulation Units in
that Sub-account. Additions or transfers to a Variable Sub-account will increase
the number of Accumulation Units for that Sub-account. Withdrawals or transfers
from a Variable Sub-account will decrease the number of Accumulation Units for
that Sub-account.
An Accumulation Unit Value is determined for each Valuation Date. The
Accumulation Unit Value for each Sub-account at the end of any Valuation Period
is equal to the Accumulation Unit Value at the end of the immediately preceding
Valuation Period times the Sub-account's Net Investment Factor for the Valuation
Period. Each Accumulation Unit Value may go up or down based on the performance
of the mutual fund underlying the Sub-account.
Net Investment Factor For each Variable Sub-account, the "Net Investment Factor"
for a Valuation Period is equal to:
o The sum of:
o the net asset value per share of the mutual fund underlying the
Sub-account determined at the end of the current Valuation Period,
plus
o the per share amount of any dividend or capital gain distributions
made by the mutual fund underlying the Sub-account during the current
Valuation Period.
o Divided by the net asset value per share of the mutual fund underlying
the Sub-account determined as of the end of the immediately preceding
Valuation Period.
o The result is reduced by the Administrative Expense Charge and the
Mortality and Expense Risk Charge corresponding to the portion of the
current calendar year that is in the current Valuation Period.
Charges The charges for this Certificate include Administrative Expense Charges,
Mortality and Expense Risk Charges, transfer fees, and taxes.
<PAGE>
Administrative Expense Charge The annualized Administrative Expense Charge will
never be greater than 0.10%. (See Net Investment Factor for a description of how
this charge is applied.)
Mortality and Expense Risk Charge The annualized Mortality and Expense Risk
Charge will never be greater than 0.50%. (See Net Investment Factor for a
description of how this charge is applied.)
Our actual mortality and expense experience will not adversely affect the dollar
amount of variable benefits or other contractual payments or values under this
Certificate.
Taxes Any premium tax or income tax withholding relating to this Certificate may
be deducted from purchase payments or the Certificate Value when the tax is
incurred or at a later time.
Withdrawal You have the right to withdraw part or all of your Certificate Value
at any time on or before the Payout Start Date. A withdrawal must be at least
$50. If any withdrawal reduces the Certificate Value to less than $1,000, we
will treat the request as a withdrawal of the entire Certificate Value. If you
withdraw the entire Certificate Value, the Certificate will terminate.
You must specify the Investment Alternative(s) from which you wish to make a
withdrawal. When you make a withdrawal, your Certificate Value will be reduced
by any applicable taxes and the amount paid to you.
We reserve the right to waive the withdrawal restrictions contained in this
Certificate.
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PAYMENTS ON DEATH
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Death of Owner or Annuitant A benefit may be paid to the Owner determined
immediately after the death if, before the Payout Start Date:
o any Owner dies; or
o the Annuitant dies and the Owner is not a Natural Person.
If the Owner eligible to receive a benefit is not a Natural Person, the Owner
may elect to receive the benefit in one or more distributions. Otherwise, if the
Owner is a Natural Person, the Owner may elect to receive a benefit either in
one or more distributions or by periodic payments through an Income Plan.
The entire value of the Certificate must be distributed within five (5) years
after the date of death unless an Income Plan is elected or a surviving spouse
continues the Certificate in accordance with the provisions below.
If an Income Plan is elected, payments from the Income Plan must begin within
one year of the date of death and must be payable throughout:
o the life of the Owner; or
<PAGE>
o a period not to exceed the life expectancy of the Owner; or
o the life of the Owner with payments guaranteed for a period not to exceed
the life expectancy of the Owner.
If the surviving spouse of the deceased Owner is the new Owner, then the spouse
may elect one of the options listed above or may continue the Certificate in the
Accumulation Phase as if the death had not occurred.
Death Benefit Before the Payout Start Date, the Death Benefit is equal to the
greater of the following Death Benefit alternatives:
o the sum of all purchase payments less any prior withdrawals and premium
taxes; or
o the Certificate Value on the date we determine the Death Benefit.
We will determine the value of the Death Benefit as of the end of the Valuation
Period during which we receive a complete request for payment of the Death
Benefit. A complete request includes due proof of death.
Settlements We may require that this Certificate be returned to us before any
settlement. We must receive due proof of death of the Owner or Annuitant before
settlement of a death claim.
Any full withdrawal or Death Benefit under this Certificate will not be less
than the minimum benefits required by any statute of the state in which the
Certificate is delivered.
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PAYOUT PHASE
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Payout Start Date The anticipated Payout Start Date is shown on the Annuity Data
Page. You may change the Payout Start Date by writing to us at least 30 days
before this date.
The Payout Start Date must be on or before the later of:
o the Annuitant's 90th birthday; or
o the 10th anniversary of the Certificate's Issue Date.
Income Plans The Certificate Value on the Payout Start Date, less any applicable
taxes, will be applied to your Income Plan choice from the following list:
1. Life Income with Guaranteed Payments. We will make payments for as long as
the Annuitant lives. If the Annuitant dies before the selected number of
guaranteed payments have been made, we will continue to pay the remainder
of the guaranteed payments.
<PAGE>
2. Joint and Survivor Life Income with Guaranteed Payments. We will make
payments for as long as either the Annuitant or Joint Annuitant lives. If
both the Annuitant and the Joint Annuitant die before the selected number
of guaranteed payments have been made, we will continue to pay the
remainder of the guaranteed payments.
3. Guaranteed Number of Payments. We will make payments for a specified number
of months beginning on the Payout Start Date. These payments do not depend
on the Annuitant's life. The number of months guaranteed may be from 60 to
360.
We reserve the right to make available other Income Plans.
Income Payments Income payment amounts may be Variable Amount Income Payments,
Fixed Amount Income Payments, or both. The method of calculating the initial
payment is different for the two types of payments.
Variable Amount Income Payments Variable Amount Income Payments will vary to
reflect the performance of the Variable Account. The portion of the initial
income payment based upon a particular Variable Sub-account is determined by
applying the amount of the Certificate Value in that Sub-account on the Payout
Start Date, less any applicable premium tax, to the appropriate value from the
Income Payment Table. This portion of the initial income payment is divided by
the Annuity Unit Value on the Payout Start Date for that Variable Sub-account to
determine the number of Annuity Units from that Sub-account which will be used
to determine subsequent income payments. Unless transfers are made among
Variable Sub-accounts, each subsequent income payment from that Sub-account will
be that number of Annuity Units times the Annuity Unit Value for the Sub-account
for the Valuation Date on which the income payment is made.
Annuity Unit Value The Annuity Unit Value for each Variable Sub-account at the
end of any Valuation Period is calculated by:
o multiplying the Annuity Unit Value at the end of the immediately preceding
Valuation Period by the Sub-account's Net Investment Factor during the
period; and then
o dividing the result by 1.000 plus the assumed investment rate for the
period. The assumed investment rate is an effective annual rate of 3%. We
reserve the right to offer an assumed investment rate greater than 3%.
Fixed Amount Income Payments The income payment amount derived from any money
allocated to the Fixed Account Options during the Accumulation Phase is fixed
for the duration of the Income Plan. The Fixed Amount Income Payment is
calculated by applying the portion of the Certificate Value in the Fixed Account
Options on the Payout Start Date, less any applicable premium tax, to the
greater of the appropriate value from the Income Payment Table selected or such
other value as we are offering at that time.
<PAGE>
Annuity Transfers After the Payout Start Date, no transfers may be made from the
Fixed Amount Income Payment. Transfers between Variable Sub-accounts, or from
the Variable Amount Income Payment to the Fixed Amount Income Payment, may not
be made for six months after the Payout Start Date. Transfers may be made once
every six months thereafter.
Payout Terms and Conditions The income payments are subject to the following
terms and conditions:
o If the Certificate Value is less than $2,000, or not enough to provide
an initial payment of at least $20, we reserve the right to:
o change the payment frequency to make the payment at least $20; or
o terminate the Certificate and pay you the Certificate Value, less
any applicable taxes, in a lump sum.
o If we do not receive a written choice of an Income Plan from you at
least 30 days before the Payout Start Date, the Income Plan will be
Life Income with Guaranteed Payments for 120 months.
o If you choose an Income Plan which depends on any person's life, we may
require:
o proof of age and sex before income payments begin; and
o proof that the Annuitant or Joint Annuitant is still alive before
we make each payment.
o After the Payout Start Date, the Income Plan cannot be changed and
withdrawals cannot be made unless income payments are being made from
the Variable Account under Income Plan 3. You may terminate the income
payments being made from the Variable Account under Income Plan 3 at
any time and withdraw their value.
o If any Owner dies during the Payout Phase, the remaining income
payments will be paid to the successor Owner as scheduled.
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INCOME PAYMENT TABLES
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The initial income payment will be at least the amount based on the adjusted age
of the Annuitant(s) and the tables below, less any federal income taxes which
are withheld. The adjusted age is the actual age on the Payout Start Date
reduced by one year for each six full years between January 1, 1983 and the
Payout Start Date. Income payments for ages and guaranteed payment periods not
shown below will be determined on a basis consistent with that used to determine
those that are shown. The Income Payment Tables are based on 3.0% interest and
the 1983a Annuity Mortality Tables.
<PAGE>
Income Plan 1 - Life Income with Guaranteed Payments for 120 Months
<TABLE>
<CAPTION>
============================================================================================================================
Monthly Income Payment for each $1,000 Applied to this Income Plan
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------------------- ---------------------- ---------------- ---------------------- ---------------- ------------------------
Annuitant's Adjusted Annuitant's Annuitant's
Age Male Female Adjusted Age Male Female Adjusted Age Male Female
------------------- ---------------------- ---------------- ---------------------- ---------------- ------------------------
------------------- ---------------------- ---------------- ---------------------- ---------------- ------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
35 $3.43 $3.25 49 $4.15 $3.82 63 $5.52 $4.97
36 3.47 3.28 50 4.22 3.88 64 5.66 5.09
37 3.51 3.31 51 4.29 3.94 65 5.80 5.22
38 3.55 3.34 52 4.37 4.01 66 5.95 5.35
39 3.60 3.38 53 4.45 4.07 67 6.11 5.49
40 3.64 3.41 54 4.53 4.14 68 6.27 5.64
41 3.69 3.45 55 4.62 4.22 69 6.44 5.80
42 3.74 3.49 56 4.71 4.29 70 6.61
43 3.79 3.53 57 4.81 4.38 71 5.96
44 3.84 3.58 58 4.92 4.46 72 6.78 6.13
45 3.90 3.62 59 5.02 4.55 73 6.96 6.31
46 3.96 3.67 60 5.14 4.65 74 7.13 6.50
47 4.02 3.72 61 5.26 4.75 75 7.31 6.69
48 4.08 3.77 62 5.39 4.86 7.49 6.88
=================== ====================== ================ ====================== ================ ========================
Income Plan 2 - Joint and Survivor Life Income with Guaranteed Payments for 120 Months
==============================================================================================================================
Monthly Income Payment for each $1,000 Applied to this Income Plan
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-------------------- ---------------------------------------------------------------------------------------------------------
Female Annuitant's Adjusted Age
-------------------- ---------------------------------------------------------------------------------------------------------
-------------------- ---------- ------------ ----------- ---------- ---------- ---------- ---------- --------- ---------------
Male
Annuitant's Adjusted 35 40 45 50 55 60 65 70 75
Age
-------------------- ---------- ------------ ----------- ---------- ---------- ---------- ---------- --------- ---------------
-------------------- ---------- ---------- ---------- ---------- ----------- ---------- ------------ ----------- -------------
35 $3.09 $3.16 $3.23 $3.28 $3.32 $3.36 $3.39 $3.40 $3.42
40 3.13 3.22 3.31 3.39 3.46 3.51 3.56 3.59 3.61
45 3.17 3.28 3.39 3.50 3.60 3.69 3.76 3.81 3.85
50 3.19 3.32 3.45 3.60 3.74 3.87 3.98 4.07 4.14
55 3.21 3.35 3.51 3.68 3.87 4.06 4.23 4.37 4.48
60 3.23 3.37 3.55 3.75 3.98 4.23 4.47 4.70 4.88
65 3.24 3.39 3.57 3.80 4.07 4.37 4.71 5.04 5.34
70 3.24 3.40 3.59 3.83 4.13 4.48 4.90 5.36 5.81
75 3.25 3.41 3.61 3.86 4.17 4.56 5.04 5.61 6.22
==================== ========== ========== ========== ========== =========== ========== ============ =========== =============
Income Plan 3 - Guaranteed Number of Payments
================================= ===============================================
Monthly Income Payment for each
Specified Period $1,000 Applied to this Income Plan
--------------------------------- ---------------------------------------------
--------------------------------- ---------------------------------------------
10 Years $9.61
11 Years 8.86
12 Years 8.24
13 Years 7.71
14 Years 7.26
15 Years 6.87
16 Years 6.53
17 Years 6.23
18 Years 5.96
19 Years 5.73
20 Years 5.51
================================= =============================================
</TABLE>
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The Entire Contract The entire contract consists of this Certificate, the
Master Policy, the Master Policy application, any written application, and
any Certificate endorsements and riders.
All statements made in a written application are representations and not
warranties. No statement will be used by us in defense of a claim or to
void the Certificate unless it is included in a written application.
We may not modify this Certificate without your consent, except to make it
comply with any changes in the Internal Revenue Code or as required by any
other applicable law. Only our officers may change this Certificate. No
other individual may do this.
Master Policy Amendment or Termination The Master Policy may be amended by
us, terminated by us, or terminated by the Master Policyholder without the
consent of any other person. No termination completed after the issue date
of this Certificate will adversely affect your rights under this
Certificate.
Incontestability We will not contest the validity of this Certificate after
the issue date.
Misstatement of Age or Sex If any age or sex has been misstated, we will
pay the amounts which would have been paid at the correct age and sex.
If we find the misstatement of age or sex after the income payments begin,
we will:
o pay all amounts underpaid including interest calculated at an
effective annual rate of 6%; or
o stop payments until the total payments are equal to the corrected
amount.
Annual Statement At least once a year, before the Payout Start Date, we
will send you a statement containing Certificate Value information. We will
provide you with Certificate Value information at any time upon request.
The information presented will comply with any applicable law.
Deferment of Payments We will pay any amounts due from the Variable Account
under this Certificate within seven days, unless:
o the New York Stock Exchange is closed for other than usual
weekends or holidays, or trading on such Exchange is restricted;
o an emergency exists as defined by the Securities and Exchange
Commission; or
o the Securities and Exchange Commission permits delay for the
protection of Certificate holders.
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We reserve the right to postpone payments or transfers from the Standard Fixed
Account for up to six months. If we elect to postpone payments or transfers from
the Fixed Account Options for 30 days or more, we will pay interest as required
by applicable law. Any interest would be payable from the date the payment or
transfer request is received by us to the date the payment or transfer is made.
Variable Account Modifications We reserve the right, subject to applicable law,
to make additions to, deletions from, or substitutions for the mutual fund
shares underlying the Variable Sub-accounts. We will not substitute any shares
attributable to your interest in a Variable Sub-account without notice to you
and beforeapproval of the Securities and Exchange Commission, to the extent
required by the Investment Company Act of 1940, as amended.
We reserve the right to establish additional Variable Sub-accounts, each of
which would invest in shares of another mutual fund. You may then instruct us to
allocate purchase payments or transfers to such Sub-accounts, subject to any
terms set by us or the mutual fund.
In the event of any such substitution or change, we may by endorsement make such
changes as may be necessary or appropriate to reflect such substitution or
change.
If we deem it to be in the best interests of persons having voting rights under
the Certificates, the Variable Account may be operated as a management company
under the Investment Company Act of 1940, as amended, or it may be deregistered
under such Act in the event such registration is no longer required.
