<PAGE>
Exhibit 99.B4
AMERICAN NATIONAL INSURANCE COMPANY
One Moody Plaza
Galveston, TX 77550
A Stock Life Insurance Company
GROUP UNALLOCATED DEFERRED VARIABLE ANNUITY
CONTRACT OWNER ABC Company
------------------------------
______________________________
CONTRACT NUMBER 12345678
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DATE OF ISSUE May 1, 2000
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American National Insurance Company (the "Company") agrees to pay the benefits
provided in this Contract, subject to its terms and conditions. The Contract
consists of this twelve page document, the Application of the Contract Owner,
and any attached riders.
THE ACCUMULATION VALUE IN AMERICAN NATIONAL VARIABLE ANNUITY SEPARATE ACCOUNT IS
BASED ON THE INVESTMENT EXPERIENCE OF THAT SEPARATE ACCOUNT AND MAY INCREASE OR
DECREASE DAILY. THE ACCUMULATION VALUE IS NOT GUARANTEED.
Signed at Galveston, Texas on the Date of Issue, as if the signatures appeared
at the end of the Contract.
/s/ [ILLEGIBLE]^^ /s/ [ILLEGIBLE]^^
Secretary President
Page 16
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TABLE OF CONTENTS
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Page
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ARTICLE I DEFINITIONS........................................................................... 3
ARTICLE II THE CONTRACT, PURCHASE PAYMENTS, SEPARATE ACCOUNT, SUBACCOUNTS, TRANSFERS,
ADDITIONS, AND SERVICES............................................................... 3
Section 1 - The Contract......................................................................... 3
Section 2 - Purchase Payments.................................................................... 4
Section 3 - American National Variable Annuity Separate Account.................................. 4
Section 4 - Subaccounts.......................................................................... 4
Section 5 - Transfers............................................................................ 4
Section 6 - Addition, Deletion, or Substitution of Investments................................... 4
Section 7 - Company Services and Contract Owner Cooperation...................................... 5
ARTICLE III ACCUMULATION VALUE.................................................................... 5
Section 1 - Allocation of Purchase Payments...................................................... 5
Section 2 - Crediting of Accumulation Units...................................................... 5
Section 3 - Determining Accumulation Unit Values................................................. 5
Section 4 - Separate Account Charges............................................................. 6
ARTICLE IV BENEFIT PAYMENTS...................................................................... 6
Section 1 - Benefit Purchases.................................................................... 6
Section 2 - Forms of Benefits.................................................................... 6
Section 3 - Supplementary Contracts.............................................................. 7
ARTICLE V PARTIAL WITHDRAWALS, SURRENDER CHARGES, AND TERMINATION OF CONTRACT.................. 7
Section 1 - Partial Withdrawals.................................................................. 7
Section 2 - Surrender Charges.................................................................... 8
Section 3 - Effective Date of Termination........................................................ 8
Section 4 - Termination of Contract.............................................................. 8
ARTICLE VI GENERAL PROVISIONS.................................................................... 9
Section 1 - Waiver or Modification............................................................... 9
Section 2 - Amendments........................................................................... 9
Section 3 - Assignment........................................................................... 9
Section 4 - Misstatements........................................................................ 9
Section 5 - Information, Proofs and Determination of Facts....................................... 10
SETTLEMENT OPTION TABLES............................................................................ 11
</TABLE>
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<PAGE>
ARTICLE I
DEFINITIONS
For purposes of this Contract:
Accumulation Period. The time between the date Accumulation Units are first
purchased by the Company, and the date the Contract is terminated.
Accumulation Unit. A unit used by the Company to calculate a Contract's value
during the Accumulation Period.
Accumulation Value. The sum of the value of your Accumulation Units.
Contract Owner ("you" or "your"). Unless changed by notice to us, the Contract
Owner is as stated in the application.
Contract Anniversary. An anniversary of the Date of Issue.
Contract Year. A one-year period commencing on either the Date of Issue or a
Contract Anniversary.
Date of Issue. The date a Contract is issued.
Eligible Portfolio. A Portfolio which corresponds to a subaccount under this
Contract's separate account.
General Account. All of our assets except those segregated in separate
accounts.
Participant. An individual defined as such in the Plan.
Plan A document or agreement defining retirement or other benefits and who is
eligible to receive them. A Plan is not a part of a Contract and the Company is
not a party to a Plan.
Portfolio. A series of a mutual fund designed to meet specified investment
objectives.
Purchase Payment. A payment made to the Company during the Accumulation
Period.
Valuation Date. Each day the New York Stock Exchange ("NYSE") is open for
regular trading. A redemption, transfer, or purchase can be made only on days
that the Company is open. The Company is not always open when the NYSE is open.
Valuation Period. The close of business on one Valuation Date to the close of
business on the next Valuation Date.
Variable Annuity. An annuity with value that varies in dollar amount based on
performance of the investments you choose.
<PAGE>
ARTICLE II
THE CONTRACT, PURCHASE PAYMENTS, SEPARATE ACCOUNT, SUBACCOUNTS, TRANSFERS, AND
SERVICES
Section 1. The Contract
This document, your Application, a copy of which is attached, and any attached
riders shall constitute the entire Contract between the parties.
The Company's obligations are strictly limited to those set forth in the
Contract. The Company is not a party to nor bound by the provisions of the
Plan. The Company assumes no responsibility to the Plan. Further, the Company
assumes no responsibility regarding the qualified status of the Plan under the
Internal Revenue Code. The Plan is mentioned merely for reference purposes.
Neither Participant, nor any person deriving any rights or benefits from a
Participant, will at any time have any right or interest in the Accumulation
Value. The Company incurs no liability or obligation to any Participant until
there has been a benefit purchased on behalf of a Participant or person deriving
rights from a Participant, in accordance with the provisions of this Contract.
The Company's sole responsibility to any such Participant or person deriving
rights from a Participant will be the payment of such benefits purchased on his
behalf, as described in ARTICLE IV.
Section 2. Purchase Payments
Purchase Payments may be paid to the Company on any date on or after the Date of
Issue. The Company must approve any Purchase Payment exceeding $1,000,000.
Purchase Payments must be for the purpose of providing Plan benefits.
The Company assumes no liability as to the sufficiency of the Accumulation Value
to provide benefits according to the provisions of the Plan. The Purchase
Payments received by the Company under this Contract shall become a part of the
American National Variable Annuity Separate Account. All Purchase Payments are
payable directly to the Company at its Home Office, One Moody Plaza, Galveston,
Texas 77550.
Section 3. American National Variable Annuity Separate Account
The Company established the American National Variable Annuity Separate Account
and the separate account's assets are held exclusively for the benefit of
persons entitled to payments under variable annuity contracts issued by the
Company. The Company is the legal holder of the separate account's assets and
will cause the total market value of such assets to be at least equal to the
separate account's reserve and other contract liabilities. Such assets are held
separate and apart from the Company's general account assets. Liabilities
arising out of any other business the Company conducts cannot be charged against
the assets of the separate account. Income, as well as both realized and
unrealized gains or losses from the separate account's assets, is credited to or
charged against the separate account without regard to income, gains, or losses
arising out of other business that the Company conducts. However, if the
separate account's assets exceed its liabilities, the excess is available to
cover the liabilities of the Company's General Account.
The separate account is registered with the Securities and Exchange Commission
as a unit investment trust, which is a type of investment company. The separate
account is also subject to the laws of the State of Texas.
Section 4. Subaccounts
The American National Variable Annuity Separate Account has multiple
subaccounts. Each subaccount will invest exclusively in shares of the
corresponding Eligible Portfolio. Each Eligible Portfolio represents a separate
investment portfolio. The subaccounts of the American National Variable Annuity
Separate Account are selected in the application. You will share only in the
income, gains, and losses of the particular subaccounts to which Purchase
Payments have been allocated. We will value each subaccount of the American
National Variable Annuity Separate Account at the end of each Valuation Period.
<PAGE>
Section 5. Transfers
At any time that this Contract is in effect, you may transfer all or a portion
of the amounts from one subaccount to another subaccount. Transfers are
unlimited and are made without charge.
You should periodically review allocations among the subaccounts to make sure
they fit the current situation and financial goals. You can make allocation
changes in writing or during the Company's normal business hours by telephone if
a telephone authorization form is on file. The Company will employ reasonable
procedures to confirm that telephone instructions are genuine. If the Company
follows those procedures, the Company will not be liable for losses due to
unauthorized or fraudulent instructions.
Section 6. Addition, Deletion, or Substitution of Investments
The Company has the right, subject to applicable law, to make additions to,
deletions from, or substitutions for the shares of a Portfolio that are held by
the American National Variable Annuity Separate Account or that the American
National Variable Annuity Separate Account may purchase. The Company reserves
the right to eliminate the shares of any Portfolio and to substitute shares of
another Portfolio or of another open-end management investment company if the
shares of the series are no longer available for investment. The Company
reserves the right to eliminate the shares of any Portfolio, if, in the
Company's judgment, further investment in the Portfolio should become
inappropriate in view of the purposes of the American National Variable Annuity
Separate Account. The Company will not substitute any shares attributable to
your interest in a subaccount of the American National Variable Annuity Separate
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. The
Company has the right to establish additional subaccounts of the American
National Variable Annuity Separate Account, each of which would invest only in a
new and corresponding Portfolio or in shares of another open-end management
investment company.
The Company also has the right to eliminate existing subaccounts of the American
National Variable Annuity Separate Account. In case of any substitution or
change, the Company may, by appropriate endorsement, make such changes in the
Contract as may be necessary or appropriate.
The Company also has the right, where permitted by law:
1. to operate the American National Variable Annuity Separate Account as a
management company under the Investment Company Act of 1940, ("Act");
2. to de-register the American National Variable Annuity Separate Account under
the Act; and
3. to combine the American National Variable Annuity Separate Account with
other separate accounts.
Section 7. Company Services and Contract Owner Cooperation
The Company agrees to perform the following services for you:
1. to administer the terms of this Contract; and
2. to report the status of the Accumulation Value no less than annually.
You agree to cooperate with the Company on all matters relating to the services
to be performed under this Contract.
Any other services, which you may desire the Company to perform, will be covered
by a separate agreement.
ARTICLE III
ACCUMULATION VALUE
Section 1. Allocation of Purchase Payments
Purchase Payments will be allocated to the subaccounts according to instructions
in the application. You can change these allocations at any time by written
instruction to the Company, or if a properly completed telephone transfer
<PAGE>
authorization form is on file with the Company, by telephone.
Section 2. Crediting of Accumulation Units
Purchase Payments will be used to purchase Accumulation Units in subaccounts as
you have instructed. The Company will determine the number of Accumulation
Units purchased by dividing the dollar amount of the Purchase Payment allocated
to a subaccount by the Accumulation Unit value for that subaccount computed
following such allocation. Purchase Payments are not credited until actually
received by the Company. A Plan Participant's contribution to a Plan will not
be credited until you forward such contribution to the Company as a Purchase
Payment.
Section 3. Determining Accumulation Unit Values
The Accumulation Unit value of each subaccount reflects the investment
performance of that subaccount. The Company calculates Accumulation Unit value
on each Valuation Date. The Accumulation Unit value on each Valuation Date is
equal to the Accumulation Unit value for the preceding Valuation Date,
multiplied by the net investment factor for that subaccount on that Valuation
Date.
A net investment factor is determined for each subaccount on a Valuation Date as
follows. First, the Company takes the net asset value of a share in the
corresponding Eligible Portfolio at the close of business that day, and then
adds the per share amount of any dividends or capital gains distributions
declared by the Eligible Portfolio during the Valuation Period. The Company
divides this amount by the per share net asset value on the preceding Valuation
Date. Then the Company reduces the result for the administrative asset fee and
the mortality and expense risk fee.
The Company will calculate the Accumulation Unit value for each subaccount at
the end of each Valuation Period. Investment performance of the Eligible
Portfolios, their expenses and the deduction of certain charges by the Company
affect the Accumulation Unit value for each subaccount.
Section 4. Separate Account Charges
The American National Variable Annuity Separate Account is subject to certain
charges:
1. Administrative Charges. An administrative asset fee at an annual rate of
0.10% is assessed daily against the separate account.
2. Mortality and Expense Risk Fee. A mortality and expense risk fee at an
annual rate of 1.15% will be assessed daily against the separate account.
3. Charges for Taxes. None at present. The Company may, however, make a
charge in the future if income or gains within the separate account incur
federal, state, or local taxes or if the Company's tax treatment changes.
Charges for such taxes, if any, would be deducted from the separate account.
Each subaccount is also subject to the various fees and expenses associated with
the Eligible Portfolio's.
Each Contract is also subject to surrender charges. (See Article V, Section 2.)
ARTICLE IV
BENEFIT PAYMENTS
Section 1. Benefit Purchases
When a Participant or beneficiary is eligible for a benefit as provided by the
Plan, you shall direct in writing that a portion of the Accumulation Value be
applied:
1. to purchase from the Company for such Participant or beneficiary or for a
person designated by you for the exclusive benefit of such Participant or
beneficiary, one of the forms of monthly benefits enumerated in Section 2 of
this ARTICLE. Any such purchase will be made either at the applicable rate in
the appropriate attached rate table; or
<PAGE>
2. to pay a lump sum cash distribution to you. The lump sum cash distribution
is for the exclusive benefit of a Participant or beneficiary.
For any individual upon whose life income payments depend, proof of date of
birth of such individual must accompany the written direction furnished
following this Section.
No amount used for such benefit purchase, payment, or combination thereof shall
exceed the amount of the Accumulation Value, determined as of the date of
benefit purchase or payment.
The Company reserves the right to defer the benefit payment of any amount
payable on behalf of a Participant or beneficiary, other than a monthly benefit,
for a period not exceeding seven days.
Section 2. Forms of Benefits
Annuity payments will be made as provided by the annuity option elected.
Subject to the provisions of the preceding paragraph, the first payment is due
within 30 days following the receipt by the Company of a written direction in
compliance with Section 1 of this ARTICLE. You can apply all or part of the
Accumulation Value to any of the annuity options described below. Such
Accumulation Value will be transferred to the General Account and annuity
payments will be based upon the annuity option selected. You must designate
such payments for the exclusive benefit of a Participant or beneficiary or for a
person designated by you for the exclusive benefit of such Participant or
beneficiary.
The following annuity options are available to you. The Plan will specify which
of these annuity options are available to individual Plan Participants.
Option 1 - Life Annuity -- monthly payments during the lifetime of an
individual, ceasing with the last annuity payment due before the individual's
death. This option offers the maximum level of monthly annuity payments since
there is no provision for a minimum number of annuity payments or a death
benefit for beneficiaries. It would be possible under this option for an
individual to receive only one annuity payment if death occurred before the due
date of the second annuity payment, two if death occurred before the third
annuity payment date, etc.
Option 2 - Life Annuity With Ten or Twenty Years Certain -- monthly payments
during the lifetime of an individual with payments made for a period certain of
not less than ten or twenty years, as elected. The annuity payments will be
continued to a designated beneficiary until the end of the period certain.
Option 3 - Joint and Survivor Annuity -- monthly payments during the joint
lifetime of two named individuals and thereafter during the lifetime of the
survivor, ceasing with the last annuity payment due before the survivor's death.
It would be possible under this option for only one annuity payment to be made
if both individuals under the option died before the second annuity payment
date, or only two annuity payments if both died before the third annuity payment
date, etc.
Option 4 - Installment Payments, Fixed Period --monthly payments for specified
number of years of at least five, but not exceeding thirty. Payments will
include interest at the effective rate of 2.5% per year.
Option 5 - Equal Installment Payments, Fixed Amount -- monthly installments (not
less than $6.25 per $1,000 applied) until the amount applied, plus interest at
an effective rate of 2.5% per year, is exhausted. The final annuity payment
will be the remaining sum left with the Company. It may be more or less than
the other payments.
Other annuity forms -- may be agreed upon.
If a beneficiary dies while receiving annuity payments certain under Option 2, 4
or 5 above, the present value of minimum guaranteed payments will be paid in a
lump sum to the estate of the beneficiary.
We determine life contingent annuity payments based on the Annuity 2000
Mortality Table (50% male, 50% female blend) and 2.5% interest. The payee's
attained age at settlement will be adjusted downward by one year for each full
five-year period that has lapsed since January 1, 2000.
<PAGE>
Section 3. Supplementary Contracts
The Company will issue an individual supplementary contract for delivery to each
person for whom benefits are purchased under Section 1.1 of this ARTICLE,
setting forth an agreement as to the benefits to which such person is entitled
under this Contract.
ARTICLE V
PARTIAL WITHDRAWALS, SURRENDER CHARGES, EFFECTIVE DATE OF TERMINATION, AND
TERMINATION OF CONTRACT
Section 1. Partial Withdrawals
Before the effective date of termination, you may request a partial withdrawal
of the Accumulation Value. The request must be made in writing. The amount
requested will be withdrawn by the Company and will be paid to you in one sum.
The Accumulation Value will be reduced by the amount of any partial withdrawal
and applicable surrender charges.
Section 2. Surrender Charges
During the first seven Contract Years, the Company will deduct a surrender
charge from the Accumulation Value for withdrawals of all or a portion of
Accumulation Value according to the following table:
Deferred Sales load ("Surrender Charge")
Contract Year Surrender Charge
Of Withdrawal Percentage
1 7%
2 7%
3 6%
4 5%
5 4%
6 3%
7 2%
8 and thereafter 0
However, no surrender charge will apply to any such withdrawal:
1. if you request a lump sum cash distribution and give the Company proof that
benefits in the amount of the lump sum cash distribution are payable under
the Plan to a Participant or beneficiary under Article IV, Section 1.2; or
2. if you request that such withdrawal be applied to purchase from the Company
any of the annuity options available under the Contract, as described in
Article IV, Section 1.1.
For termination, the surrender charge will be equal to the surrender charge
percentage multiplied by the Accumulation Value. The surrender charge
percentage will be determined by the Contract year in which the termination
occurs.
For withdrawals not exempt from the surrender charge, a surrender charge will be
assessed consistent with that for termination. The surrender charge percentage
will be determined by the Contract year in which the withdrawal occurs.
For partial withdrawals, the surrender charge will be equal to the partial
surrender charge percentage multiplied by the amount of withdrawal that is not
exempt from the surrender charge. The partial surrender charge percentage is
the surrender charge percentage divided by one minus the surrender charge
percentage. The surrender charge percentage will be determined by the Contract
Year in which the partial surrender occurs.
<PAGE>
Section 3. Effective Date of Termination
You may terminate the Contract at any time by giving the Company written notice.
Such notice will specify a date of termination, which may not be earlier than 30
days after receipt at the Company's home office.
The Company may terminate the Contract by giving you written notice, if any one
or more of the following events occurs:
1. the Accumulation Value is less than $1,200; or
2. you failed to provide any information or render any performance required by
the terms of this Contract.
Such termination notice will specify a date of termination, which will not be
earlier than 6 months after the date you received such notice.
Section 4. Termination of Contract
Upon termination, no further Purchase Payments will be accepted, and you shall
designate a party to receive the amounts due on termination. The Company shall
transfer the balance of the Accumulation Value, less any applicable surrender
charge to the designated party. The Company shall have no obligation or duty to
verify that such party has the right to receive such payment, nor that the Plan
is or will continue to be qualified under the Internal Revenue Code, nor that
such payments will be properly applied by the designated party. The Company
reserves the right to defer the payment of such amount for a period not
exceeding seven days from the effective date of termination under Section 3 of
this ARTICLE. Such payment or payments will fully and finally discharge the
Company of all liability under this Contract, except for the payment of benefits
previously purchased under Section 1 of ARTICLE IV. Termination of this
Contract will have no effect upon the payments to be made by the Company to any
person for whom an annuity has been purchased prior to the date of termination.
ARTICLE VI
GENERAL PROVISIONS
Section 1. Waiver or Modification
No agent or other person, except the president, a vice president, or the
secretary of the Company, has power on behalf of the Company to modify this
Contract. These officers may extend any due date, waive any proof required by
this Contract, or bind the Company by making any promise or representation or by
giving or receiving any information. No waiver, modification, or extension
shall be binding on the Company unless it is in writing signed by one of such
officers.
Section 2. Amendments
The Company reserves the right to amend this Contract for the following
purposes:
1. to maintain this Contract in compliance with applicable local, state or
federal laws or regulations; or
2. to change the distribution method(s) contained in ARTICLE IV, Section 2.
In order for such amendment to become effective, the Company must give you
written notice of the Company's intent to amend no less than 30 days prior to
the date the amendment is to take effect. The notice is effective upon mailing
to you at the last address provided to the Company. If you do not consent to
such amendment, you may, upon providing written notice to the Company within
such 30 days, withdraw from the Contract. Notice to the Company is effective
upon receipt by the Company at its home office. In such event, the Accumulation
Value will be paid to you within 30 days following receipt by the Company of
your written request to withdraw.
No such amendment shall apply to monthly benefits purchased prior to the
effective date of amendment, nor will any maximum established by such amendment
serve to limit the amount of monthly benefit which may be purchased for a
Participant prior to the date such amendment becomes effective.
This Contract may also be amended at any time as to any of its provisions,
including those in regard to coverage, benefits,
<PAGE>
and participation privileges, by written agreement between you and the Company.
The Contract amendments following this Section may be made without the consent
of any employer, Participant, or beneficiary, and any such amendment shall be
binding and conclusive upon each employer, Participant, or beneficiary. No
amendment will affect the terms of any annuity that has already been purchased,
except by written agreement between you and the Company.
Section 3. Assignment
The Contract may not be assigned.
Section 4. Misstatements
If the age of any person, or any other fact affecting the amount or date of any
payment by or to the Company is misstated, an appropriate adjustment may be
made. Any adjustment of terms or amounts of payments made in accordance with
the preceding statement shall be conclusive upon any Participant or beneficiary
affected thereby.
If an adjustment is made pursuant to the preceding paragraph:
1. the amount of annuity payable by the Company shall be that provided by the
amounts applied to the purchase of such annuity, determined as of the date of
purchase established by the misstated information but on the basis of the
correct age and other facts;
2. any overpayments by the Company resulting from any misstatement shall first
be deducted from amounts otherwise payable to the Participant or beneficiary
before any additional amounts are paid to the Participant or beneficiary; any
remainder of such overpayments after the date as of which no further payments
are due to the Participant or beneficiary shall be charged against the Purchase
Payments next received; and
3. any underpayment by the Company resulting from any misstatement shall be
paid in full with the next payment due the Participant or beneficiary.
Section 5. Information, Proofs and Determination of Facts
You shall furnish to the Company records, data, proofs, and all other
information, which, in the opinion of the Company, are necessary for the
administration of this Contract.
For the purposes of this Contract, the Company shall be entitled to conclusively
rely on all factual representations made to the Company by you, including but
not limited to:
1. the age of any person;
2. the commencement date and duration of employment for any Participant;
3. the fact that a Participant's employment has been terminated and the date of
such termination;
4. any classification of employment and the date of any change in the
classification of employment;
5. compensation of any Participant and the date of any change in such
compensation;
6. the eligibility of any Participant or beneficiary for benefits;
7. the amount and type of benefit to which any Participant or beneficiary is
entitled;
8. the existence and genuineness of any domestic relations, probate or judicial
order and the appropriate payee thereunder.
<PAGE>
SETTLEMENT OPTION TABLES
OPTION 1 AND OPTION 2
MONTHLY PAYMENT FOR LIFE FOR EACH $1,000.00 OF THE NET SUM PAYABLE
Age in years means age of named individual on birthday prior to the due date of
the first payment. Amounts for payments other than monthly are available on
request.
<TABLE>
<CAPTION>
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AGE Guaranteed Guaranteed Life Only AGE Guaranteed Guaranteed Life Only
IN Period: Period: IN Period: Period:
YEARS 10 Years 20 Years YEARS 10 Years 20 Years
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Amount Amount Amount Amount Amount Amount
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<S> <C> <C> <C> <C> <C> <C> <C>
11 $2.50 $2.50 $2.50 46 $3.43 $3.38 $3.44
12 2.51 2.51 2.51 47 3.48 3.43 3.49
13 2.53 2.52 2.53 48 3.53 3.48 3.55
14 2.54 2.54 2.54 49 3.59 3.53 3.61
15 2.55 2.55 2.55 50 3.65 3.58 3.67
16 2.57 2.56 2.57 51 3.71 3.63 3.73
17 2.58 2.58 2.58 52 3.78 3.69 3.80
18 2.60 2.60 2.60 53 3.84 3.75 3.87
19 2.62 2.61 2.62 54 3.92 3.80 3.95
20 2.63 2.63 2.63 55 3.99 3.87 4.03
21 2.65 2.65 2.65 56 4.07 3.93 4.11
22 2.67 2.66 2.67 57 4.16 3.99 4.20
23 2.69 2.68 2.69 58 4.24 4.06 4.30
24 2.71 2.70 2.71 59 4.34 4.13 4.40
25 2.73 2.72 2.73 60 4.44 4.20 4.50
26 2.75 2.74 2.75 61 4.54 4.26 4.62
27 2.77 2.76 2.77 62 4.65 4.34 4.74
28 2.79 2.79 2.80 63 4.76 4.41 4.87
29 2.82 2.81 2.82 64 4.88 4.48 5.00
30 2.84 2.83 2.84 65 5.01 4.55 5.15
31 2.87 2.86 2.87 66 5.14 4.61 5.31
32 2.89 2.89 2.90 67 5.28 4.68 5.48
33 2.92 2.91 2.93 68 5.43 4.74 5.65
34 2.95 2.94 2.96 69 5.58 4.81 5.85
35 2.98 2.97 2.99 70 5.74 4.86 6.05
36 3.02 3.00 3.02 71 5.91 4.92 6.27
37 3.05 3.03 3.05 72 6.08 4.97 6.51
38 3.08 3.07 3.09 73 6.25 5.02 6.76
39 3.12 3.10 3.13 74 6.44 5.06 7.03
40 3.16 3.14 3.16 75 6.62 5.09 7.33
41 3.20 3.17 3.20 76 6.81 5.13 7.64
42 3.24 3.21 3.25 77 7.00 5.15 7.98
43 3.28 3.25 3.29 78 7.19 5.18 8.35
44 3.33 3.29 3.34 79 7.38 5.20 8.74
45 3.38 3.34 3.39 80** 7.56 5.22 9.16
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</TABLE>
** and over
<PAGE>
OPTION 3
JOINT AND SURVIVOR MONTHLY PAYMENT FOR EACH $1,000.00 OF NET SUM PAYABLE
Age in years means age of named individual on the birthday prior to the due date
of the first payment. Monthly payment amount during the joint lifetime of two
named individuals with payment during the lifetime of the surviving individual
based on the elected Specified Amount Payment.
<TABLE>
<CAPTION>
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Specified
AGE Specified Specified Amount Specified AGE Specified Amount Specified
IN Amount One-Half Two-Thirds Amount Full IN Amount One-Half Two-Thirds Amount Full
YEARS Payment Payment Payment YEARS Payment Payment Payment
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<S> <C> <C> <C> <C> <C> <C> <C>
55 $4.02 $3.83 $3.50 63 $4.86 $4.57 $4.09
56 4.10 3.91 3.56 64 4.99 4.69 4.18
57 4.19 3.98 3.62 65 5.14 4.82 4.28
58 4.29 4.07 3.69 66 5.30 4.95 4.39
59 4.39 4.16 3.76 67 5.46 5.10 4.50
60 4.49 4.25 3.83 68 5.64 5.26 4.62
61 4.61 4.35 3.91 69 5.83 5.42 4.76
62 4.73 4.46 4.00 70 6.04 5.60 4.89
=============================================================================================================================
</TABLE>
Amounts shown apply if both named individuals are the same age. Amounts for
payment other than monthly and for other ages are available on request.
