Exhibit (4)(a) Form of Contract for the Allstate Variable Annuity 3
THE PERSONS INVOLVED
Owner Unless changed, the person(s) named at the time of application is (are)
the Owner(s) of this Certificate. The Owner has all rights, title and interest
in this Certificate. As Owner, you will receive any income payments made under
an income plan.
You may exercise all rights and options stated in this Certificate, subject to
the rights of any irrevocable Beneficiary.
You may change the Owner or Beneficiary at any time. If you are a Natural
Person, you may change the Annuitant prior to the Payout Start Date. Once we
have received a satisfactory written request for an Owner, Beneficiary or
Annuitant change, 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 from you. We are not responsible for the tax consequences of
an Owner, Beneficiary or Annuitant change.
You may not assign an interest in this Certificate as collateral or security for
a loan. Otherwise, you may assign benefits under this Certificate prior to the
payout start date. No Beneficiary may assign benefits under the Certificate
until they are due. No assignment will bind us unless it is signed by you and
filed with us. We are not responsible for the validity of an assignment.
If the Owner is more than one person:
o "Owner" as used in this Certificate means any and all persons named as the
Owner, unless otherwise indicated;
o any assignment or request for a change must be signed by all the persons
named as the Owner; and
o on the death of any one person named as Owner, Ownership rights, title and
interest shall be retained by the surviving person(s) named as the Owners.
See the section titled Accumulation Phase for the details concerning the
death of an Owner.
Annuitant The Annuitant is the person whose life may affect the timing or amount
of the payout under this Certificate. The Owner is the Annuitant unless a
different Annuitant has been designated.
Beneficiary The death benefit is payable to the Beneficiary if the sole
surviving Owner dies during the accumulation phase, subject to any prior claims.
Details, including the special treatment of a Beneficiary who is the Owner's
spouse, are stated in the section titled Accumulation Phase.
If the Owner dies during the payout phase the surviving Owner(s) will become the
payee of any income payments scheduled to continue after the Owner's death. If
there are no surviving Owners the Beneficiary will become the payee of any such
payments.
The Beneficiary is as named in the most recent written request we have received
from you. If you do not name a Beneficiary or if the Beneficiary named by you is
no longer living when the death benefit becomes payable, the Beneficiary will
be:
o your spouse if living; otherwise
o your children equally if living; otherwise
o your estate.
ACCUMULATION PHASE
Accumulation Phase Defined The accumulation phase is the first of two phases in
the life of your Certificate. During this period your Certificate Value results
from purchase payments made, investment experience of the Variable Account,
interest credited to the fixed accounts, and charges deducted. Any withdrawals
you make and associated charges, if any, will reduce your Certificate Value.
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The accumulation phase begins on the issue date stated on the Annuity Data page.
This phase will continue until the payout start date unless the Certificate is
terminated before that date. Time during the accumulation phase is measured in
Certificate years. Certificate years are those years that begin with the issue
date or an anniversary of the issue date.
Your Certificate will stay in force until the payout start date, unless your
Certificate Value is reduced to zero.
Purchase Payments Purchase payments may be made at any time during the
accumulation phase. While this Certificate allows purchase payments after the
initial purchase payment, they are not required. We may limit the amount of
purchase payments we will accept. 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%. For each purchase payment,
the minimum amount that may be allocated to any of the Fixed Account Options is
$500.
Allocation of your purchase payments will be made as you requested at the time
of application. 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 this notification.
Investment Alternatives Investment alternatives are the Sub-Accounts of the
Variable Account and the Fixed Accounts.
Variable Account The Variable Account for this Certificate is the Allstate Life
of New York Variable Annuity Account II. This Variable Account is our separate
investment account to which we allocate certain assets contributed under this
and other Certificates. These assets remain our property but will not be charged
with liabilities arising from any other business we may have.
Sub-accounts The Variable Account is divided into Sub-Accounts. Each Sub-Account
invests solely in the shares of the mutual fund(s) underlying that Sub-Account.
Fixed Account Options The Fixed Account Options are the Standard Fixed Account,
the Six Month Dollar Cost Averaging Fixed Account and the Twelve Month Dollar
Cost Averaging Fixed Account.
Standard Fixed Account Money in the Standard Fixed Account will earn interest at
the current rate in effect at the time of allocation or transfer to the Standard
Fixed Account for the guarantee period. We will offer a six year guarantee
period. Other guarantee periods will be offered at our discretion. After the
guarantee period, a renewal rate will be declared. Subsequent renewal dates will
be on anniversaries of the first renewal date. The interest rate for the
Standard Fixed Account will never be less than the minimum guaranteed rate shown
on the Annuity Data Page.
Interest is credited to the Standard Fixed Account daily during the accumulation
phase. The rates we quote when referring to interest credits are effective
annual interest rates. "Effective annual rate" means the yield earned when
interest credits at the underlying daily rate have compounded for a full year.
Dollar Cost Averaging Fixed Account Money in the Dollar Cost Averaging Fixed
Account will earn interest at the current rate in effect at the time of
allocation to the Dollar Cost Averaging Fixed Account for a period of six months
or twelve months. After the first year, a renewal rate will be declared. The
current rate and the renewal rate(s) will never be less than the minimum
guaranteed rate shown on the Annuity Data Page. Subsequent renewal dates will be
on the anniversaries of the first renewal date.
Six Month Dollar Cost Averaging Fixed Account Money in the Six Month Dollar Cost
Averaging Fixed Account will earn interest at the annual rate in effect at the
time of allocation to the Six Month Dollar Cost Averaging Fixed Account.
Crediting rates for the Six Month Dollar Cost Averaging Fixed Account will never
be less than the minimum guaranteed rate shown on the Annuity Data Page. Each
purchase payment and associated interest in the Six Month Dollar Cost Averaging
Fixed Account must be transferred to Sub-Accounts of the Variable Account in
equal monthly installments within the six-month transfer period. If we do not
receive an allocation from you within one month of the date of payment, the
payment plus associated interest will be transferred to the Money Market
Sub-Account in equal monthly installments using the longest transfer period
being offered at the time the purchase payment is made. If the Six Month Dollar
Cost Averaging Fixed Account is discontinued prior to the last scheduled
transfer to the Money Market Sub-Account unless a different Variable Sub-Account
is requested. No transfers are permitted into the Three-Six-Month Dollar Cost
Averaging Fixed Account. The Six Month Dollar Cost Averaging Fixed Account will
be offered at our discretion.
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Twelve Month Dollar Cost Averaging Fixed Account Money in the Twelve-Month
Dollar Cost Averaging Fixed Account will earn interest at the annual rate in
effect at the time of allocation to the Twelve Month Dollar Cost Averaging Fixed
Account. Each purchase payment and associated interest in the Twelve Month
Dollar Cost Averaging Fixed Account must be transferred to Sub-Accounts of the
Variable Account in equal monthly installments within the twelve month transfer
period. If we do not receive an allocation from you within one month of the date
of payment, the payment plus associated interest will be transferred to the
money market Sub-Account in equal monthly installments using the longest
transfer period being offered at the time the purchase payment is made. If the
Twelve Month Dollar Cost Averaging Fixed Account is discontinued prior to the
last scheduled transfer, the remaining balance in the Twelve Month Dollar Cost
Averaging Fixed Account will immediately be transferred to the money market
Sub-Account unless a different Variable Sub-Account is requested. No transfers
are permitted into the Twelve Month Dollar Cost Averaging Fixed Account. The
Twelve Month Dollar Cost Averaging Fixed Account will be offered at our
discretion.
Certificate Value Your Certificate Value is equal to the sum of:
o the number of accumulation units you hold in each Sub-Account of the
Variable 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 Fixed Account Options.
Accumulation Units Amounts which you allocate to a Sub-Account of the Variable
Account are used to purchase accumulation units in that Sub-Account. The
accumulation unit value for each Sub-Account at the end of any valuation period
is calculated by multiplying the prior value by the Sub-Account's net investment
factor for the valuation period. The accumulation unit values may go up or down.
Additions or transfers to Sub-Accounts of the Variable Account will increase the
number of accumulation units for those Sub-Accounts. Withdrawals or transfers
from Sub-Accounts of the Variable Account will result in cancellation of
accumulation units from those Sub-Accounts.
Valuation Period A valuation period is the time interval between the closing of
the New York Stock Exchange on consecutive valuation dates. 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.
Net Investment Factor For each Sub-Account of the Variable Account, the net
investment factor for a valuation period is (A) divided by (B), minus (C) where:
(A) is the sum of:
(1) the net asset value per share of the mutual fund(s) underlying the
Sub-Account determined at the end of the current valuation period,
plus
(2) the per share amount of any dividend or capital gain distributions
made by the mutual fund(s) underlying the Sub-Account during the
current valuation period.
(B) is the net asset value per share of the mutual fund(s) underlying the
Sub-Account determined as of the end of the immediately preceding valuation
period.
(C) is the sum of the annualized administrative expense and the annualized
mortality and expense risk charges divided by 365 and then multiplied by
the number of calendar days in the current valuation period.
Transfers Prior to the payout start date, you may transfer amounts between
investment alternatives. You may make 12 transfers per Certificate year without
charge. Each transfer after the 12th transfer in any Certificate year, except
those from a dollar cost averaging Fixed Account, will be assessed a $25
transfer fee. Transfers are subject to the following restrictions:
o The minimum amount that may be transferred from an investment alternative
is $100; if the total amount in an investment alternative is less than
$100, the entire amount may be transferred.
o The minimum transfer to any one guarantee period of the Standard Fixed
Account is $500. No transfers are allowed into any dollar cost averaging
Fixed Account.
o The following limits do not apply to transfers from any dollar cost
averaging Fixed Account. The maximum amount which may be transferred from
the Standard Fixed Account to the Variable Account or between guarantee
periods of the Standard Fixed Account in any Certificate year is limited to
the greater of:
- 25% of the value in the Standard Fixed Account on the most recent
Certificate Anniversary. If 25% of the most recent value is greater
than zero but less than $1,000, then up to $1,000 may be transferred;
or
- 25% of the sum of purchase payments allocated to the Standard Fixed
Account and transfers to the Standard Fixed Account, all as of the
most recent Certificate Anniversary.
o If the first renewal interest rate is less than the current rate that was
in effect at the time money was allocated or transferred to the Standard
Fixed Account, the 25% transfer restriction for that money and the
accumulated interest thereon will be waived during the 60 day period
following the first renewal date.
o We reserve the right to limit transfer amounts among Sub-Accounts if we
determine, in our sole discretion, that the exercise of that right by one
or more Certificate Owners, or any agent or duly authorized representative
of such Owner or Owners, is , or would be, to the disadvantage of other
Certificate Owners. Transfer limitations could be applied to transfers to
or from some or all of the Sub-Accounts and could include but not be
limited to:
o The requirement of a minimum time period between each transfer;
o The requirement of a minimum time period between each transfer;
o Not accepting transfer requests of an agent or duly authorized
representative acting under a power-of-attorney, or similar instrument on
behalf of any Certificate Owner; or,
o Limiting the dollar amount that may be transferred among any of the
Sub-Accounts and the Fixed Accounts by a Certificate Owner at any one time.
Such restrictions, individually or in the aggregate, may be applied in any
manner reasonably designed to prevent any use of the transfer right which is
considered by us to be to the disadvantage of other Certificate Owners.
We reserve the right to waive the transfer fees and/or restrictions contained in
this Certificate.
Charges The charges for this Certificate include taxes as defined below,
certificate maintenance charges, administrative expense charges, and mortality
and expense risk charges. If withdrawals are made, the Certificate may be
subject to early withdrawal charges.
Taxes Any premium tax or income tax withholding imposed on amounts relating to
this Certificate may be deducted from purchase payments or Certificate Values
when the tax is incurred or, at our discretion, at a later time.
Certificate Maintenance Charge The certificate maintenance charge will be
deducted each year from your Certificate Value to reimburse us for the expenses
of maintaining this Certificate. This charge will never be greater than $30 per
Certificate year. Prior to the payout start date, the certificate maintenance
charge will be deducted from your Certificate Value on each Certificate
Anniversary. The charge will be deducted on a pro-rata basis from each
Sub-Account in the proportion that your investment in each bears to your
Certificate Value. The certificate maintenance charge will also be deducted in
full if the Certificate is surrendered on any date other than a Certificate
Anniversary.
Administrative Expense Charge Both before and after the payout start date, we
will deduct an administrative expense charge from the assets in the Variable
Account on a daily basis. The administrative expense charge is to reimburse us
for administrative expenses incurred in maintaining this Certificate that are
not covered by the certificate maintenance charge. The annualized administrative
expense charge will never be greater than 0.10%. (See the calculation under Net
Investment Factor.) This charge will also be reflected in the net interest rate
credited to assets in the Fixed Account Options.
Mortality and Expense Risk Charge Both before and after the payout start date,
we will deduct a mortality and expense risk charge from the assets in the
Variable Account on a daily basis. The annualized mortality and expense risk
charge will never be greater than 1.25%. (See the calculation under Net
Investment Factor.) This charge will also be reflected in the net interest rate
credited to assets in the Fixed Account Options.
Our expense and mortality experience will not adversely affect the dollar amount
of variable benefits or other contractual payments or values under this
Certificate.
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Withdrawal and Surrender You have the right to make a partial withdrawal or full
surrender at any time during the accumulation phase. You must specify the
investment alternative(s) from which you wish to make a withdrawal. The amount
of any withdrawal you request, plus an early withdrawal charge, premium tax, and
income tax withholding when applicable, will reduce your Certificate Value.
Any withdrawal must be at least $500. If a withdrawal would leave a Certificate
Value of less than $500, we will treat the request as a full surrender.
If you surrender your Certificate, we will pay you the Certificate Value, less
any applicable early withdrawal charges, premium tax,, or income tax
withholding, and the Certificate will terminate.
Early Withdrawal Charge An early withdrawal charge may be applied to a full
surrender or partial withdrawal of Certificate Value in excess of the preferred
withdrawal amount. For the purpose of assessing an early withdrawal charge,
withdrawals are assumed to come from purchase payments first, beginning with the
oldest payment.
Early withdrawal charges will be based on the age(s) of the purchase payment(s)
associated with the withdrawal according to the following schedule:
Maximum
Complete Certificate Withdrawal
Years since Purchase Charge
Payment was made Percent
0 6%
1 5%
2 5%
3 4%
4 3%
5 2%
6 or more 0%
Once all purchase payments have been withdrawn, additional withdrawals will not
be assessed an early withdrawal charge. The maximum aggregate early withdrawal
charge is 6% of your purchase payments.
Preferred Withdrawal Amount A preferred withdrawal amount will be available in
each Certificate year. This preferred withdrawal amount may be withdrawn over
the course of the Certificate year without incurring early withdrawal charges.
The preferred withdrawal amount is 15% of the amount of purchase payments as of
the issue date or the most recent Certificate Anniversary, whichever is later.
As with all withdrawals, the preferred withdrawal amount will be assumed to come
from the oldest remaining purchase payments first. A preferred withdrawal amount
not withdrawn in a Certificate year may not be carried over to increase the
preferred withdrawal amount in a subsequent Certificate year.
Withdrawal charges will be waived on partial withdrawals taken to satisfy
qualified plan required minimum distribution rules as described in the Internal
Revenue Code. This waiver is permitted only for withdrawals which satisfy
distributions resulting from this Certificate.
Death of Owner If you die prior to the payout start date, the new Owner will be
the surviving Owner(s). If there is (are) no surviving Owner(s), the new Owner
will be the Beneficiary(ies). The new Owner will have the options described in
the Options of New Owner subsection below.
If you are Owner and Annuitant and you die, then the new Annuitant will be the
oldest new Owner. However, if the new Owner is a corporation, trust, or other
non-Natural Person, the Certificate will terminate, the death benefit as
described below will be paid to the new Owner, and the new Owner will not have
the options described below.
If you are Owner and a non-Natural Person, then the Owner must receive the Death
Benefit in a lump sum upon the Annuitant's death.
Options of New Owner If the sole new Owner is your spouse:
o Your spouse may elect, within 60 days of the date of your death, to receive
the death benefit described below.
o If your spouse does not make this election, then the accumulation phase
continues as if the death had not occurred. On the date the Certificate is
continued, the Certificate Value will equal the amount of the death benefit
as determined as of the valuation date on which we received due proof of
death (the next valuation date, if we received due proof of death after 3
p.m. Central Time). If your Certificate is continued in the accumulation
phase, the surviving spouse may make a single withdrawal of any amount
within one year of the date of death without incurring a withdrawal charge.
All Ownership rights under the Certificate are then available to your spouse as
the new Owner.
If the new Owner is not your spouse, then this new Owner has the following
options:
o The new Owner may elect, within 60 days of the date of your death, to
receive the death benefit described below.
o The new Owner may elect, within 60 days of the date of your death, to
receive the settlement value payable in a lump sum within 5 years of your
date of death. If the new Owner elects this option the new Owner may make a
single withdrawal of any amount within one year of the date of death
without incurring a withdrawal charge.
o The new Owner may elect, within one year of the date of your death, to
receive the settlement value paid out under one of the income plans
described in the payout phase section. The payout start date must be within
one year of your date of death. Income payments must be over the life of
the new Owner or over a period not to exceed the life expectancy of the new
Owner.
o If the new Owner does not make one of the above described elections, the
settlement value will be paid to the new Owner on the mandatory
distribution date 5 years after your date of death.
Under any of these options, all Ownership rights are available to the new Owner
from the date of your death to the date on which the death benefit or settlement
value is paid.
Death Benefit The death benefit is the greater of:
o the sum of all purchase payments, less any withdrawals, applicable early
withdrawal charges and premium tax; or
o the Certificate Value on the date we receive due proof of death; or
o the Certificate Value on the most recent death benefit anniversary, less
any withdrawals, applicable early withdrawal charges, premium tax and
income tax withholding deducted from the Certificate Value since that
anniversary.
The death benefit anniversaries are those Certificate Anniversaries that are
multiples of 6 Certificate years, beginning with the 6th Certificate
Anniversary. For example, the 6th, 12th and 18th Certificate Anniversaries are
the first three death benefit anniversaries.
We will calculate the value of the death benefit at the end of the valuation
period coinciding with our receipt of a complete request for payment of the
death benefit. A complete request includes due proof of death.
Withdrawal Adjustment Example for Maximum Anniversary Value
(i) Maximum Anniversary Value Before Partial Withdrawal: $100
(ii) Certificate Value Before Partial Withdrawal: $50
(iii) Partial Withdrawal: $48
(iv) New Certificate Value: $2
(v) New Maximum Anniversary Value: $4
Settlement Value The settlement value is the Certificate Value less any
applicable early withdrawal charges, premium tax and income tax withholding. We
will calculate the settlement value at the end of the valuation period
coinciding with the receipt of a request for payment or on the mandatory
distribution date of 5 years after the date of death.
PAYOUT PHASE
Payout Phase Defined The payout phase is the second of the two phases in the
life of your Certificate. During this period the Certificate Value is applied to
the income plan you choose and is paid out as provided under that 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 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
prior to the payout start date.
The Payout Start Date must be on or before the Annuitant's 90th birthday.
Unless changed as described above, we will use the payout start date shown on
the Annuity Data Page.
Generally, you may not make withdrawals after the payout start date. One
exception to this rule applies if you are receiving income payments that do not
depend on the life of the Annuitant. In that case, you may terminate the receipt
of income payments at any time and receive a lump sum equal to the present value
of the remaining payments due. A withdrawal charge may apply. We also assess
applicable premium taxes against all income payments.
Income Plans An income plan is an arrangement for disbursing the Certificate
Value in installments. The Certificate Value on the payout start date, less any
applicable taxes, will be applied to your choice of income plan from the
following list:
1. Life Income with 120 Months Guaranteed We will make monthly payments for as
long as the Annuitant lives. If the Annuitant dies before 120 monthly
payments have been made, we will pay the remainder of the 120 guaranteed
monthly payments to the Owner.
2. Joint and Survivor Life Income We will make monthly payments for as long as
either the Annuitant or any joint Annuitant named by you lives. No income
payments will be made after the deaths of both the Annuitant and the joint
Annuitant.
3. Payments for a Specified Period We will make monthly payments beginning on
the payout start date for a specified period. These payments do not depend
on the Annuitant's life. Income payments for less than 120 months may be
subject to early withdrawal charges.
We reserve the right to accept other income plans.
Income Payments Income payments may be based on the Variable Account, the Fixed
Account Options or both. Your initial income payment will be based on the
division of your Certificate Value between the investment alternatives on the
payout start date. Each income payment represents a sum of payments derived from
each investment alternative in which you have an interest.
A portion of the certificate maintenance charge will be deducted from each
Sub-Account.
Variable Amount Income Payments Income payments attributable to sub-Accounts of
the Variable Account will vary in accordance with the investment results of the
mutual funds underlying the Sub-Accounts.
The amount of the first income payment from a Sub-Account of the Variable
Account is calculated by applying the portion of Certificate Value allocated to
the Sub-Account, less any applicable taxes, to the Income Payment Tables.
Subsequent income payments are based on the number of annuity units derived from
dividing the first income payment by the Sub-Account's annuity unit value on the
payout start date. The number of annuity units will remain the same unless a
transfer is made between Sub-Accounts or the Fixed Account Options.
Variable Amount Income Payments after the first will be equal to the number of
annuity units for each Sub-Account multiplied by the corresponding annuity unit
value on the date of payment.
Annuity Unit Value The annuity unit value for each Sub-Account of the Variable
Account at the end of any valuation period is calculated by:
o multiplying the prior value by the Sub-Account's net investment factor
during the period; and then
o dividing the product by 1.000 plus the assumed investment rate for the
period. The assumed investment rate is an effective annual rate of 3% (we
may offer other assumed investment rates in the future not less than 3%).
Fixed Amount Income Payments The income payment amount derived from any monies
allocated to the Fixed Account Options during the Accumulation Phase is fixed
for the duration of the Income Plan. Certificate Value from the Fixed Account
Options, less any applicable taxes, will be used to purchase a Single Premium
Immediate Annuity from us. Income payments from the Fixed Account Options will
at least be equal to an amount determined from the Income Payment Tables.
Annuity Transfers After the payout start date, no transfers may be made from the
Fixed Amount Income Payment. Transfers between Sub-Accounts of the Variable
Amount Income Payment, or from the Variable Amount Income Payment to the Fixed
Amount Income Payment, may not be made for six months subsequent to the payout
start date. Transfers may be made once every six months thereafter. Transfers
out of a Sub-Account of the Variable Amount Income Payment after the payout
start date will cancel annuity units from that Sub-Account.
Payout Terms and Conditions The income payments are subject to the following
terms and conditions:
o Income payments will start on the first day of the calendar month that
coincides with or next follows the payout start date.
o If we do not receive a written choice of income plan from you at least 30
days before the payout start date, we will use the income plan listed on
the Annuity Data Page.
o If you choose an income plan which depends on any person's life, we may
require proof of age and sex before income payments begin.
o We may require proof that the Annuitant or joint Annuitant is still alive
before we make any payment that depends on their continued life.
o Should the Certificate Value be less than $2,000, or not be 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 in a lump
sum.
GENERAL PROVISIONS
The Entire Certificate The entire Certificate consists of the Master Policy, the
Master Policy application, written enrollments, and any attached endorsements.
All statements made in written enrollments are representations and not
warranties. No statement will be used by us in defense of a claim or to void a
Certificate unless it is included in a written enrollment.
Only our officers may change the Master Policy or Certificate or waive a right
or requirement. No other individual may do this.
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.
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.
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 provided at the correct age or sex.
If we find the misstatement of age or sex after the income payments begin, we
will:
o pay promptly the sum of all amounts that we underpaid plus due interest; or
o stop payments until the total of the omitted payments at the corrected
amount plus due interest is equal to the total of the overpayments plus due
interest.
For purposes of the Misstatement of Age or Sex provision, due interest will be
calculated at an effective annual rate of 6%.
Annual Statement At least once a year, prior to the payout start date, we will
send you a statement containing information required by any applicable law.
Settlements We may require that this Certificate be returned to us prior to any
settlement. We must receive due proof of death of the Owner or Annuitant prior
to settlement of a death claim. Due proof of death is one of the following:
o a certified copy of a death certificate; or
o a certified copy of a decree of a court of competent jurisdiction as to a
finding of death; or
o any other proof acceptable to us.
Any cash surrender or death benefit under this Certificate will not be less than
the minimum benefits required by any statute of the state in which the Master
Policy is issued.
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.
We reserve the right to postpone payments or transfers from the Fixed Account
Options for up to six months.
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 Sub-Accounts of the Variable Account. We will not
substitute any shares attributable to your interest in a Sub-Account of the
Variable Account without notice to you and prior approval of the Securities and
Exchange Commission, to the extent required by the Investment Company Act of
1940.
We reserve the right to establish additional Sub- Accounts of the Variable
Account, each of which would invest in shares of another mutual fund. You may
then instruct us to allocate purchase payments 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 or it may be deregistered under such
Act in the event such registration is no longer required.
INCOME PAYMENT TABLES
The Income Payment Tables show the initial monthly income payment per $1,000 of
Certificate Value applied for each of the income plans listed in the Payout
section. The Income Payment Tables are based on 3% interest and the 1983a
Annuity Mortality Tables with the following age adjustment. The age(s) of the
Annuitant and any joint Annuitant at his or her last birthday on or prior to the
payout start date will be set back one year for each six full years between
January 1, 1983 and the payout start date. Income payments for ages not shown in
this section will be determined on a basis consistent with that used to
determine those that are shown.
<TABLE>
<CAPTION>
Income Plan 1 - Life with 120 Months Guaranteed
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First Income Payment for Each $1,000 of Certificate Value
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Annuitant's Age Annuitant's Annuitant's
Male Female Age Male Female Age Male Female
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<S> <C> <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 5.96
43 3.79 3.53 57 4.81 4.38 71 6.78 6.13
44 3.84 3.58 58 4.92 4.46 72 6.96 6.31
45 3.90 3.62 59 5.02 4.55 73 7.13 6.50
46 3.96 3.67 60 5.14 4.65 74 7.31 6.69
47 4.02 3.72 61 5.26 4.75 75 7.49 6.88
48 4.08 3.77 62 5.39 4.86
-----------------------------------------------------------------------------------------------------------------------
Income Plan 2 - Joint and Survivor
-----------------------------------------------------------------------------------------------------------------------
Male First Income Payment for Each $1,000 of Certificate Value
Annuitant's
Age
-------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------
Female Annuitant's Age
35 40 45 50 55 60 65 70 75
-----------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------
35 $3.09 3.16 3.23 3.28 3.32 3.36 3.39 3.41 3.42
40 3.13 3.22 3.31 3.39 3.46 3.52 3.56 3.59 3.62
45 3.17 3.28 3.39 3.50 3.60 3.69 3.76 3.82 3.86
50 3.19 3.32 3.45 3.60 3.74 3.87 3.99 4.08 4.14
55 3.21 3.35 3.51 3.68 3.87 4.06 4.23 4.38 4.49
60 3.23 3.37 3.55 3.75 3.98 4.23 4.48 4.71 4.91
65 3.24 3.39 3.58 3.80 4.07 4.38 4.72 5.06 5.38
70 3.24 3.40 3.60 3.84 4.13 4.50 4.92 5.40 5.89
75 3.25 3.41 3.61 3.86 4.18 4.58 5.08 5.68 6.37
-----------------------------------------------------------------------------------------------------------------------
Income Plan 3 - Payments for a specified Period
-----------------------------------------------------------------------------
First Income Payment for Each
Specified Period $1,000 of Certificate Value
-----------------------------------------------------------------------------
-----------------------------------------------------------------------------
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>
<PAGE>
Exhibit (4)(b) Form of Performance Death Benefit Rider for the Allstate
Variable Annuity 3
NYLU438 (9/98)
ALLSTATE LIFE INSURANCE COMPANY
OF NEW YORK
(herein called "we" or "us")
Performance Death Benefit Rider
Due to the variable nature of the Certificate, this Rider does not guarantee
that the Performance Death Benefit will increase the Death Benefit found in the
Certificate.
This rider was issued because you selected the Performance Death Benefit.
For purposes of this rider, "Rider Date" is the date this rider was issued as a
part of your Certificate.
The Death Benefit provision of your Certificate is modified as follows:
I. If the Owner is a Natural Person, the Performance Death Benefit applies
only to the death of the Owner. If the Owner is not a Natural Person, the
Performance Death Benefit applies only to the death of the Annuitant. This
is unlike the death benefit defined in the Death Benefit provision of your
Certificate which may apply to the death of the Annuitant even if the Owner
is a Natural Person.
The Death Benefit will be the greatest of the values stated in your
Certificate, or the value of the Performance Death Benefit.
On the Rider Date, the Performance Death Benefit is equal to the Cash
Value.
After the Rider Date, the Performance Death Benefit is recalculated when a
purchase payment or withdrawal is made or on a Certificate anniversary as
follows:
A. For purchase payments, the Performance Death Benefit is equal to the
most recently calculated Performance Death Benefit plus the purchase
payment.
B. For withdrawals, the Performance Death Benefit is equal to the most
recently calculated Performance Death Benefit reduced by a withdrawal
adjustment.
The adjustment is equal to (1) divided by (2), with the result
multiplied by (3), where:
(1) = the withdrawal amount.
(2) = the Cash Value immediately prior to the withdrawal.
(3) = the most recently calculated Performance Death Benefit.
C. On each Certificate anniversary, the Performance Death Benefit is
equal to the greater of the Cash Value or the most recently calculated
Performance Death Benefit.
In the absence of any withdrawals or purchase payments, the
Performance Death Benefit will be the greatest of the Cash Value on
the Rider Date and all Certificate anniversary Cash Values between the
Rider Date and the date we calculate the death benefit.
The Performance Death Benefit will be recalculated for purchase
payments, withdrawals and on Certificate anniversaries until the
oldest Owner, or the Annuitant if the Owner is a non-Natural Person,
attains age 85.
<PAGE>
After age 85, the Performance Death Benefit will be recalculated only for
purchase payments and withdrawals.
II. The Mortality and Expense Risk Charge provision of your Certificate is
modified as follows:
On and after the Rider Date, the maximum annualized Mortality and Expense
Risk Charge is increased by 0.13% for this rider.
Except as amended by this rider, the Certificate remains unchanged.
Secretary Chief Executive Officer
<PAGE>
NYLU493
Page 2
(6/00)
Allstate Life Insurance
Company of New York
A Stock Company
Headquarters: One Allstate Drive, Farmingville, New York 11738
Flexible Premium Deferred Variable Annuity Certificate
This Certificate is issued pursuant to the terms of Master Policy Number
64890027 issued by Allstate Life Insurance Company of New York to Dean Witter
Reynolds Inc., called the Master Policyholder. This Certificate is issued in the
state of New York and is governed by New York law.
Throughout this Certificate, "you" and "your" refer to the Certificate Owner(s).
"We", "us" and "our" refer to Allstate Life Insurance Company of New York.
Certificate Summary
This flexible premium deferred variable annuity provides a cash withdrawal
benefit and a death benefit during the accumulation phase and periodic income
payments beginning on the payout start date during the Payout Phase. The
Certificate Value or Income Payments may increase or decrease based on the
investment experience of the selected Sub-Accounts of the Variable Account. An
Administrative Expense and Mortality and Expense Risk Charge equivalent to
annualized charge of 1.35% will be deducted daily from the Variable Account.
A $30 Certificate Maintenance Charge will be deducted from the Variable Account
on each Certificate Anniversary.
The smallest annual rate of net investment return on the Variable Account assets
required to keep Variable Amount Income Payments from Decreasing is 3.00%
The dollar amount of income payments or other values provided by this
Certificate, when based on the investment experience of the Variable account,
will vary to reflect the performance of the Variable Account.
This Certificate and Master Policy do not pay dividends.
The tax status of this Certificate as it applies to the Owner should be reviewed
each year.
PLEASE READ YOUR CERTIFICATE CAREFULLY.
This is a legal contract between the Certificate Owners and Allstate Life
Insurance Company of New York.
Return Privilege
Upon written request, we will provide you with factual information regarding the
benefits and provisions contained in this Certificate. If you are not satisfied
with this Certificate for any reason, you may return it to us within 10 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 Options. If this Certificate is qualified under Section 408 of
the Internal Revenue Code, we will refund the greater of any purchase payments
or the Certificate Value.
If you have any questions about your Allstate Life Insurance Company of New York
variable annuity, please contact Allstate Life Insurance Company of New York at
(800) 692-4682.
Michael J. Velotta Thomas J. Wilson
Secretary Chairman and Chief Executive Officer
<PAGE>
-----------------------------------------------------------------------
TABLE OF CONTENTS
-----------------------------------------------------------------------
THE PERSONS INVOLVED.................................................3
ACCUMULATION PHASE...................................................3
PAYOUT PHASE.........................................................8
GENERAL PROVISIONS..................................................10
INCOME PAYMENT TABLES...............................................12
<PAGE>
NYDP493
------------------------------------------------------------------------------
ANNUITY DATA
------------------------------------------------------------------------------
CERTIFICATE NUMBER . . . . . . . . . . . . . . . . . . . . . . . . 444444444
ISSUE DATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . May 1, 2000
INITIAL PURCHASE PAYMENT:. . . . . . . . . . . . . . . . . . .. . . . $10,000
IRA
INITIAL ALLOCATION OF PURCHASE PAYMENTS:
Allocated
Amount %
VARIABLE SUB-ACCOUNTS
Sub-Account 1 40%
Sub-Account 2 10%
Sub-Account 3 10%
Sub-Account 4 10%
<TABLE>
<CAPTION>
Rate
Allocated Guaranteed Guaranteed
Amount % Interest Rate Through
STANDARD FIXED ACCOUNT
<S> <C> <C> <C>
6 Year Guaranteed Period 20% 5.00% 05/01/2006
DOLLAR COST AVERAGING FIXED ACCOUNT
1 Year Guarantee Period 10% 5.00% 05/01/2001
</TABLE>
MINIMUM GUARANTEED RATE
Fixed Account Options:. . . . . .. . . . . . . . . . . . . . .3.00%
PAYOUT START DATE. . . . . . . . . . . . . . . . . . . . . . . . May 1, 2055
OWNER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . John J. Doe
ANNUITANT. . . . . . . . . . . . . . . . . . . . . . . . . . . John J. Doe
AGE AT ISSUE. . . . . . . . . . . . . . . . . . . . . . . . . . 35
SEX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . MALE
BENEFICIARY PERCENTAGE
Jane Doe 100%
CONTINGENT
BENEFICIARY PERCENTAGE
June Doe EQUALLY
Jim Doe EQUALLY
<PAGE>
