EX-99.4W 8 file009.txt REVISED FORM OF DATA PAGES FOR EQUITABLE [GRAPHIC OF WORD "SPECIMEN"] EQUITABLE ACCUMULATOR SELECT (ROLLOVER) IRA DATA PART A -- THIS PART LISTS YOUR PERSONAL DATA. ------ OWNER: John Doe ANNUITANT: John Doe Age: 44 Sex: Male CONTRACT: GROUP ANNUITY CONTRACT NO. AC 6727 CERTIFICATE NUMBER: 00000 ENDORSEMENTS ATTACHED: Minimum Income Benefit Endorsement Endorsement Applicable to IRA Certificates Endorsement Applicable to Market Value Adjustment Terms Rider to Endorsement Applicable to Market Value Adjustment Terms ISSUE DATE: January 8, 2001 CONTRACT DATE: January 8, 2001 ANNUITY COMMENCEMENT DATE: March 20, 2047 THE MAXIMUM MATURITY AGE IS AGE 90 -- SEE SECTION 7.03. The Annuity Commencement Date may not be later than the Processing Date which follows your 90th birthday. However, if you choose a date later than age 70 1/2, distribution of at least the minimum payments required must commence by April 1 of the calendar year following the calendar year in which you attain age 70 1/2 (see item 2 of the Endorsement Applicable to IRA Certificates). GUARANTEED BENEFITS: Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit (5% Roll Up to Age 80) BENEFICIARY: Jane Doe No. 94ICB Data page 1 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART B -- THIS PART DESCRIBES CERTAIN PROVISIONS OF YOUR CERTIFICATE. ------ INITIAL CONTRIBUTION RECEIVED (SEE SECTION 3.02): $25,000.00 INVESTMENT OPTIONS AVAILABLE (SEE PART II); YOUR ALLOCATION IS ALSO SHOWN. INVESTMENT OPTIONS ALLOCATION (SEE SECTION 3.01) ------------------ ----------------------------- o Alliance Common Stock Fund $25,000.00 o Alliance High Yield Fund o Alliance Money Market Fund o Alliance Small Cap Growth Fund o Capital Guardian International Fund o Capital Guardian Research Fund o Capital Guardian U.S. Equity Fund o EQ Equity 500 Index Fund o EQ International Equity Index Fund o EQ Small Company Index Fund o EQ/Aggressive Stock Fund o EQ/Alliance Premier Growth Fund o EQ/Alliance Technology Fund o EQ/Evergreen Foundation Fund o EQ/Evergreen Fund o EQ/Janus Large Cap Growth Fund o EQ/Putnam Growth & Income Value Fund o EQ/Putnam International Equity Fund o EQ/Putnam Investors Growth Fund o FI Mid Cap Fund o FI Small/Mid Cap Value Fund o JP Morgan Core Bond Fund o Lazard Large Cap Value Fund o Lazard Small Cap Value Fund o Mercury Basic Value Equity Fund o Mercury World Strategy Fund o MFS Emerging Growth Companies Fund o MFS Growth with Income Fund o MFS Research Fund o Morgan Stanley Emerging Markets Equity Fund No. 94ICB Data page 2 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION (SEE SECTION 3.01) ----------------------------- o GUARANTEE PERIODS (CLASS II) EXPIRATION DATE AND GUARANTEED RATE February 15, 2002 February 15, 2003 February 15, 2004 February 15, 2005 February 15, 2006 February 15, 2007 February 15, 2008 February 15, 2009 February 15, 2010 February 15, 2011 ------------------------------ TOTAL: $25,000.00 Investment Options shown are Investment Funds of our Separate Account No. 49 and Guarantee Periods shown are in the Guaranteed Period Account. See Endorsement Applicable to Market Value Adjustment Terms. "TYPES" OF INVESTMENT OPTIONS (SEE SECTION 4.02): Not applicable GUARANTEED INTEREST ACCOUNT (SEE SECTION 2.01): Not available under this Certificate. BUSINESS DAY (SEE SECTION 1.05): A Business Day for this Certificate will mean generally any day on which the New York Stock Exchange is open for trading. PROCESSING DATES (SEE SECTION 1.20): A Processing Date is each Contract Date anniversary. AVAILABILITY OF INVESTMENT OPTIONS (SEE SECTION 2.04): (See Data pages, Part C; Allocation Restrictions) No. 94ICB Data page 2a (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF CONTRIBUTIONS (SEE SECTION 3.01): Your initial and any subsequent Contributions are allocated according to your instructions. Money Market Fund Special Dollar Cost Averaging - You may elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time subject to the Contribution Limits described in the Data Pages of this Certificate. You may elect to make subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program. The minimum subsequent contribution amount that may be made to an existing program is $250. Amounts will be transferred monthly over a twelve month period from the Alliance Money Market Fund to the other Investment Options based on the percentages you selected at the start of the Money Market Fund Special Dollar Cost Averaging program. Subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program will not extend the expiration date of that program. You may have only one Special Dollar Cost Averaging program in effect at any given time. At the expiration of the Money Market Fund Special Dollar Cost Averaging program, you may start a new program. If you elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time after this Certificate has been issued, the minimum contribution to be initially allocated to that program is $2,000. (See Data Pages, Part C; Allocation Restrictions) CONTRIBUTION LIMITS (SEE SECTION 3.02): We will only accept initial Contributions of at least $25,000 in the form of either a rollover Contribution or a direct custodian-to-custodian transfer from other traditional individual retirement arrangements. Subsequent Contributions of at least $1,000 may be made at any time until you attain age 86. Subsequent Contributions may be "regular" IRA Contributions (limited to a maximum of $2,000 a year), rollover Contributions or direct transfers. Rollover Contributions and direct transfers are not subject to the $2,000 annual limit. "Regular" IRA Contributions may not be made for the taxable year in which you attain age 70 1/2 and thereafter. Rollover and direct transfer Contributions may be made at any time until you attain age 79. However, any amount contributed after you attain age 70 1/2 must be net of your minimum distribution for the year in which the rollover or direct transfer Contribution is made (see item 2 Annuity Commencement Date in Endorsement Applicable to IRA Certificates). We may refuse to accept any Contribution if the sum of all Contributions under all accumulation Certificates with the same Annuitant would then total more than $1,500,000. We reserve the right to limit aggregate Contributions made after the first Contract Year to 150% of first year Contributions. We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable Life annuity accumulation certificates/contracts that you own would then total more than $2,500,000. No. 94ICB Sel-SSDCA Data page 3 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) TRANSFER RULES (SEE SECTION 4.02): You may not transfer Annuity Account Value into the Money Market Fund Special Dollar Cost Averaging program. Any request by you to transfer amounts out of the Alliance Money Market Fund, other than your regularly scheduled transfers to the Investment Options as part of the Money Market Fund Special Dollar Cost Averaging program, will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amount remaining in the Alliance Money Market Fund after such a transfer will be transferred to your other Investment Options according to your then current allocation instructions. ALLOCATION OF WITHDRAWALS (SEE SECTION 5.01): Lump Sum Withdrawals - You must provide withdrawal instructions indicating from which Investment Options the Lump Sum Withdrawal will be taken; Minimum Distribution Withdrawals - Unless you specify otherwise, Minimum Distribution Withdrawals will be withdrawn on a pro rata basis from your Annuity Account Value in the Investment Funds. If there is insufficient value or no value in the Investment Funds, any additional amount of the withdrawal required or the total amount of the withdrawal, as applicable, will be withdrawn from the Guarantee Periods in order of the earliest Expiration Date(s) first. Any withdrawal from the Alliance Money Market Fund while participating in the Money Market Fund Special Dollar Cost Averaging program will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amounts remaining in the Alliance Money Market Fund after such a withdrawal will be transferred to your other Investment Options according to your then current allocation instructions. WITHDRAWAL RESTRICTIONS (SEE SECTION 5.01): Minimum Distribution Withdrawals - May be elected in the year in which you attain age 70 1/2 or at a later date. Minimum Distribution Withdrawals will be made annually. MINIMUM WITHDRAWAL AMOUNT (SEE SECTION 5.01): Lump Sum Withdrawals minimum - $1,000; Minimum Distribution Withdrawals minimum - $250. MINIMUM AMOUNT OF ANNUITY ACCOUNT VALUE AFTER A WITHDRAWAL (SEE SECTION 5.02): Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Certificate). We will NOT exercise our rights, described in Sections 5.02(b) and 5.02(c), to terminate the Certificate. DEATH BENEFIT AMOUNT (SEE SECTION 6.01): The death benefit is equal to the Annuity Account Value or, if greater, the Guaranteed Minimum Death Benefit defined below. No. 94ICB Sel-SSDCA Data page 4 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) Guaranteed Minimum Death Benefit 5% Roll Up to Age 80 - On the Contract Date, the Guaranteed Minimum Death Benefit is equal to the initial Contribution. Thereafter, the Guaranteed Minimum Death Benefit is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund and the Guarantee Periods) through your age 80 (or at your death, if earlier), and 0% thereafter. The Guaranteed Minimum Death Benefit interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Death Benefit is also adjusted for any subsequent Contributions and withdrawals. Effect of Withdrawals under Roll Up Option - The current Guaranteed Minimum Death Benefit will be reduced on a dollar-for-dollar basis as long as the sum of your withdrawals in any Contract Year is 5% or less of the beginning of Contract Year Guaranteed Minimum Death Benefit. Once a withdrawal is made that causes cumulative withdrawals in a Contract Year to exceed 5% of the beginning of Contract Year Guaranteed Minimum Death Benefit, that withdrawal and any subsequent withdrawals in that Contract Year will cause a pro rata reduction to occur. If the Successor Owner/Annuitant election is made upon the Annuitant's death, the Annuity Account Value will be increased to the then current Guaranteed Minimum Death Benefit if such amount is greater (including any optional Death Benefit Rider amounts, if applicable). The increase, if any, will be allocated in accordance with the current instructions on file. In determining whether the Guaranteed Minimum Death Benefit is still in effect, we will use the age of the Successor Owner/Annuitant as of the date we receive due proof of death of the original Annuitant. NORMAL FORM OF ANNUITY (SEE SECTION 7.04): The Normal Form of Annuity is Life Annuity 10 Year Period Certain for annuitization ages up to age 79. For annuitization ages 80 and older, the following applies: Annuitization Age Length of Period Certain ----------------- ------------------------ 80 through 81 9 82 through 83 8 84 through 86 7 87 through 89 6 90 5 The maximum annuitization age varies by issue age and is shown on Data page 1. AMOUNT OF ANNUITY BENEFIT (SEE SECTION 7.05): The amount applied to provide the Annuity Benefit will be the Annuity Account Value. INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX (SEE SECTION 7.06): 6% per year No. 94ICB Data page 5 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY (SEE SECTION 7.06): $2,000, as well as minimum of $20 for initial monthly annuity payment. GUARANTEED MINIMUM INCOME BENEFIT (SEE SECTION 7.08): You may apply the Annuity Account Value during the period of time indicated below to purchase a minimum amount of guaranteed lifetime income under either (i) our fixed Life Annuity payout option or (ii) our Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate. Other options may be available at the time of exercise. The Life Annuity payout option provides annuity payments while you are living. Payments end with the last payment made before your death. Our fixed Joint and Survivor Life Annuity payout option is also available. Payments under the Joint and Survivor Life Annuity payout option end with the last payment made before the surviving Annuitant's death. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate provides payments during a period certain with payments continuing for life thereafter. The period certain is based on your age at the time the Income Manager (Life Annuity with a Period Certain) payout annuity is elected. The period certain is 10 years for ages 60 through 75; 9 years for age 76; 8 years for age 77; 7 years for ages 78 through 83; 6 years for age 84; and 5 years for age 85. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity is also available on a joint and survivor basis. The following paragraphs describe the conditions for exercise of the Guaranteed Minimum Income Benefit. The Guaranteed Minimum Income Benefit is available only if it is exercised within 30 days following the 10th or later Contract Date anniversary under this Certificate. However, it may not be exercised later than your age 85. On the Transaction Date that you exercise the Guaranteed Minimum Income Benefit, the lifetime income that will be provided under the payout option selected will be the greater of (i) your Guaranteed Minimum Income Benefit, and (ii) the amount of income that would be provided by application of the Annuity Account Value as of the Transaction Date at our then current annuity purchase factors. Guaranteed Minimum Income Benefit Benefit Base - The Guaranteed Minimum Income Benefit benefit base is equal to the initial Contribution on the Contract Date. Thereafter, the Guaranteed Minimum Income Benefit benefit base is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund and the Guarantee Periods) through your age 80, and 0% thereafter. The Guaranteed Minimum Income Benefit benefit base interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Income Benefit benefit base is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Income Benefit benefit base is applied to guaranteed minimum annuity purchase factors to determine the Guaranteed Minimum Income Benefit. The guaranteed minimum annuity purchase factors are shown in the attached table. No. 94ICB (10/99) Data page 6 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The Guaranteed Minimum Income Benefit benefit base does not create an Annuity Account Value or a Cash Value and is used solely for purposes of calculating the Guaranteed Minimum Income Benefit. Each withdrawal will cause a reduction in the current Guaranteed Minimum Death Benefit and Guaranteed Minimum Income Benefit benefit base on a pro rata basis. WITHDRAWAL CHARGES (SEE SECTION 8.01): None CHARGES DEDUCTED FROM ANNUITY ACCOUNT VALUE (SEE SECTION 8.02): (a) Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit Charge: For providing the Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit we will deduct annually on each Processing Date an amount equal to 0.30% of the Guaranteed Minimum Income Benefit benefit base (described above) in effect on such Processing Date. 0.30% is the maximum we will charge. (b) Charges for State Premium and Other Applicable Taxes: A charge for applicable taxes, such as state or local premium taxes generally will be deducted from the amount applied to provide an Annuity Benefit under Section 7.02. In certain states, however, we may deduct the charge from Contributions rather than at the Annuity Commencement Date. The above charges will be deducted from the Annuity Account Value in the Investment Funds on a pro rata basis. If there is insufficient value in the Investment Funds, all or a portion of the charges will be deducted from the Annuity Account Value with respect to the Guarantee Periods in order of the earliest Expiration Date(s) first. NUMBER OF FREE TRANSFERS (SEE SECTION 8.03): Unlimited DAILY SEPARATE ACCOUNT CHARGES (SEE SECTION 8.04): Mortality and Expense Risks Charge: Current and Maximum Annual rate of 1.10% (equivalent to a daily rate of 0.003032%). Administration Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000692%). We reserve the right to increase this charge to an annual rate of 0.35%. Distribution Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000695%). No. 94ICB (10/99) Data page 7 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART C -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT APPLICABLE ------ TO MARKET VALUE ADJUSTMENT TERMS (MVA ENDORSEMENT). ALLOCATION RESTRICTIONS (SEE SECTION 3.01): If you are age 76 or older, allocations may be made only to Guarantee Periods with maturities of five years or less; however, in no event may allocations be made to Guarantee Periods with maturities beyond the February 15th immediately following the Annuity Commencement Date. TRANSFERS AT EXPIRATION DATE (SEE ITEM 1 OF MVA ENDORSEMENT): If no election is made with respect to amounts in the Guaranteed Period Account as of the Expiration Date, such amounts will be transferred into the Guarantee Period with the earliest Expiration Date. MARKET VALUE ADJUSTMENT (MVA) ON TRANSFERS AND WITHDRAWALS (SEE ITEM 2 OF MVA ENDORSEMENT): The MVA (positive or negative) resulting from a withdrawal or transfer of a portion of the amount in a Guarantee Period will be a percentage of the MVA that would be applicable upon a withdrawal of all of the Annuity Account Value from a Guarantee Period. This percentage is determined by (i) dividing the amount of the withdrawal or transfer from the Guarantee Period by (ii) the Annuity Account Value in such Guarantee Period prior to the withdrawal or transfer. TRANSFER RULES (SEE SECTION 4.02): Transfers may not be made to a Guarantee Period maturing in the current calendar year. Guarantee Periods to which transfers may be made are limited based on your attained age (see Allocation Restrictions above). MVA FORMULA (SEE ITEM 3 OF MVA ENDORSEMENT): The Guaranteed Rate for new allocations to a Guarantee Period is the rate we have in effect for this purpose even if new allocations to that Guarantee Period would not be accepted at the time. This rate will not be less than 3%. The current rate percentage we use in item (c) of the formula is 0.00%. For purposes of calculating the MVA only, we reserve the right to add up to 0.25% to such current rate percentage. SEPARATE ACCOUNT (SEE ITEM 5 OF MVA ENDORSEMENT): The portion of the assets of Separate Account No. 46 equal to the reserves and other contract liabilities will not be chargeable with liabilities which arise out of any other business we conduct. No. 94ICB Data page 8 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT TABLE OF GUARANTEED MINIMUM ANNUITY PURCHASE FACTORS FOR INITIAL LEVEL ANNUAL INCOME SINGLE LIFE - MALE
PURCHASE FACTORS PURCHASE FACTORS ---------------------------------- ----------------------------------- LIFE ANNUITY WITH LIFE ANNUITY WITH ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ------------ ---------------- ------------ ------------ ---------------- ------------ 35 3.55% 3.56% 60 4.94% 5.15% 36 3.58 3.59 61 5.02 5.26 37 3.62 3.63 62 5.11 5.38 38 3.65 3.67 63 5.20 5.51 39 3.69 3.71 64 5.30 5.64 40 3.74 3.76 65 5.40 5.79 41 3.77 3.80 66 5.50 5.94 42 3.82 3.85 67 5.60 6.10 43 3.87 3.90 68 5.70 6.27 44 3.91 3.95 69 5.81 6.45 45 3.96 4.00 70 5.91 6.64 46 4.02 4.06 71 6.02 6.84 47 4.06 4.11 72 6.12 7.06 48 4.11 4.17 73 6.21 7.28 49 4.17 4.23 74 6.31 7.51 50 4.23 4.30 75 6.40 7.76 51 4.29 4.37 76 6.69 8.03 52 4.35 4.44 77 7.01 8.31 53 4.41 4.51 78 7.38 8.61 54 4.48 4.59 79 7.53 8.93 55 4.55 4.67 80 7.67 9.27 56 4.62 4.76 81 7.81 9.64 57 4.69 4.85 82 7.93 10.02 58 4.77 4.94 83 8.05 10.43 59 4.84 5.04 84 8.60 10.87 85 9.25 11.34
Other forms of annuities may be available. No. 94ICB (10/99) Data page 9 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] EQUITABLE ACCUMULATOR SELECT (ROTH CONVERSION) IRA DATA PART A -- THIS PART LISTS YOUR PERSONAL DATA. ------ OWNER: John Doe ANNUITANT: John Doe Age: 44 Sex: Male CONTRACT: GROUP ANNUITY CONTRACT NO. AC 6727 CERTIFICATE NUMBER: 00000 ENDORSEMENTS ATTACHED: Minimum Income Benefit Endorsement Endorsement Applicable to Roth IRA Certificates Endorsement Applicable to Market Value Adjustment Terms Rider to Endorsement Applicable to Market Value Adjustment Terms ISSUE DATE: January 8, 2001 CONTRACT DATE: January 8, 2001 ANNUITY COMMENCEMENT DATE: March 20, 2047 THE MAXIMUM MATURITY AGE IS AGE 90 -- SEE SECTION 7.03. The Annuity Commencement Date may not be later than the Processing Date which follows your 90th birthday. GUARANTEED BENEFITS: Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit (Annual Ratchet to Age 80) BENEFICIARY: Jane Doe No. 94ICB Data page 1 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART B -- THIS PART DESCRIBES CERTAIN PROVISIONS OF YOUR CERTIFICATE. ------ INITIAL CONTRIBUTION RECEIVED (SEE SECTION 3.02): $25,000.00 INVESTMENT OPTIONS AVAILABLE (SEE PART II); YOUR ALLOCATION IS ALSO SHOWN. INVESTMENT OPTIONS ALLOCATION (SEE SECTION 3.01) ------------------ ----------------------------- o Alliance Common Stock Fund $25,000.00 o Alliance High Yield Fund o Alliance Money Market Fund o Alliance Small Cap Growth Fund o Capital Guardian International Fund o Capital Guardian Research Fund o Capital Guardian U.S. Equity Fund o EQ Equity 500 Index Fund o EQ International Equity Index Fund o EQ Small Company Index Fund o EQ/Aggressive Stock Fund o EQ/Alliance Premier Growth Fund o EQ/Alliance Technology Fund o EQ/Evergreen Foundation Fund o EQ/Evergreen Fund o EQ/Janus Large Cap Growth Fund o EQ/Putnam Growth & Income Value Fund o EQ/Putnam International Equity Fund o EQ/Putnam Investors Growth Fund o FI Mid Cap Fund o FI Small/Mid Cap Value Fund o JP Morgan Core Bond Fund o Lazard Large Cap Value Fund o Lazard Small Cap Value Fund o Mercury Basic Value Equity Fund o Mercury World Strategy Fund o MFS Emerging Growth Companies Fund o MFS Growth with Income Fund o MFS Research Fund o Morgan Stanley Emerging Markets Equity Fund No. 94ICB Data page 2 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION (SEE SECTION 3.01) ----------------------------- o GUARANTEE PERIODS (CLASS II) EXPIRATION DATE AND GUARANTEED RATE February 15, 2002 February 15, 2003 February 15, 2004 February 15, 2005 February 15, 2006 February 15, 2007 February 15, 2008 February 15, 2009 February 15, 2010 February 15, 2011 ------------------------------ TOTAL: $25,000.00 Investment Options shown are Investment Funds of our Separate Account No. 49 and Guarantee Periods shown are in the Guaranteed Period Account. See Endorsement Applicable to Market Value Adjustment Terms. "TYPES" OF INVESTMENT OPTIONS (SEE SECTION 4.02): Not applicable GUARANTEED INTEREST ACCOUNT (SEE SECTION 2.01): Not available under this Certificate. BUSINESS DAY (SEE SECTION 1.05): A Business Day for this Certificate will mean generally any day on which the New York Stock Exchange is open for trading. PROCESSING DATES (SEE SECTION 1.20): A Processing Date is each Contract Date anniversary. AVAILABILITY OF INVESTMENT OPTIONS (SEE SECTION 2.04): (See Data pages, Part C; Allocation Restrictions) No. 94ICB Data page 2a (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF CONTRIBUTIONS (SEE SECTION 3.01): Except as indicated below, your initial and any subsequent Contributions are allocated according to your instructions. Money Market Fund Special Dollar Cost Averaging - You may elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time subject to the Contribution Limits described in the Data Pages of this Certificate. You may elect to make subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program. The minimum subsequent contribution amount that may be made to an existing program is $250. Amounts will be transferred monthly over a twelve month period from the Alliance Money Market Fund to the other Investment Options based on the percentages you selected at the start of the Money Market Fund Special Dollar Cost Averaging program. Subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program will not extend the expiration date of that program. You may have only one Special Dollar Cost Averaging program in effect at any given time. At the expiration of the Money Market Fund Special Dollar Cost Averaging program, you may start a new program. If you elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time after this Certificate has been issued, the minimum contribution to be initially allocated to that program is $2,000. (See Data Pages, Part C; Allocation Restrictions) CONTRIBUTION LIMITS (SEE SECTION 3.02): We will only accept initial Contributions of at least $25,000 in the form of either a rollover Contribution from Traditional IRAs, or Roth IRAs, or direct custodian-to-custodian transfers from other Roth IRAs. Subsequent Contributions of at least $1,000 may be made at any time until you attain age 86. We will not accept "regular" IRA Contributions to Roth IRAs. Rollover Contributions and direct custodian-to-custodian transfers can be made any time during your lifetime provided you meet certain requirements (see item II. Limits on Contributions in Endorsement Applicable to Roth IRA Certificates). We may refuse to accept any Contribution if the sum of all Contributions under all accumulation Certificates with the same Annuitant would then total more than $1,500,000. We reserve the right to limit aggregate Contributions made after the first Contract Year to 150% of first year Contributions. We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable Life annuity accumulation certificates/contracts that you own would then total more than $2,500,000. TRANSFER RULES (SEE SECTION 4.02): You may not transfer Annuity Account Value into the Money Market Fund Special Dollar Cost Averaging program. Any request by you to transfer amounts out of the Alliance Money Market Fund, other than your regularly scheduled transfers to the Investment Options as part of the Money Market Fund Special Dollar Cost Averaging program, will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amount remaining in the Alliance Money Market Fund after such a transfer will be transferred to your other Investment Options according to your then current allocation instructions. No. 94ICB Sel-SSDCA Data page 3 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF WITHDRAWALS (SEE SECTION 5.01): Lump Sum Withdrawals - You must provide withdrawal instructions indicating from which Investment Options the Lump Sum Withdrawal will be taken. Any withdrawal from the Alliance Money Market Fund while participating in the Money Market Fund Special Dollar Cost Averaging program will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amounts remaining in the Alliance Money Market Fund after such a withdrawal will be transferred to your other Investment Options according to your then current allocation instructions. WITHDRAWAL RESTRICTIONS (SEE SECTION 5.01): None. MINIMUM WITHDRAWAL AMOUNT (SEE SECTION 5.01): Lump Sum Withdrawals minimum - $1,000. MINIMUM AMOUNT OF ANNUITY ACCOUNT VALUE AFTER A WITHDRAWAL (SEE SECTION 5.02): Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Certificate). We will NOT exercise our rights, described in Sections 5.02(b) and 5.02(c), to terminate the Certificate. DEATH BENEFIT AMOUNT (SEE SECTION 6.01): The death benefit is equal to the Annuity Account Value or, if greater, the Guaranteed Minimum Death Benefit defined below. Guaranteed Minimum Death Benefit Annual Ratchet to Age 80 - On the Contract Date, the Guaranteed Minimum Death Benefit is equal to the initial Contribution. Thereafter, on each Contract Date anniversary through your age 80, if the Annuity Account Value is greater than the current Guaranteed Minimum Death Benefit, the Guaranteed Minimum Death Benefit is reset to equal the Annuity Account Value. The Guaranteed Minimum Death Benefit is also adjusted for any subsequent Contributions and withdrawals. Each withdrawal will cause a reduction in your current Guaranteed Minimum Death Benefit on a pro rata basis. If the Successor Owner/Annuitant election is made upon the Annuitant's death, the Annuity Account Value will be increased to the then current Guaranteed Minimum Death Benefit if such amount is greater (including any optional Death Benefit Rider amounts, if applicable). The increase, if any, will be allocated in accordance with the current instructions on file. In determining whether the Guaranteed Minimum Death Benefit is still in effect, we will use the age of the Successor Owner/Annuitant as of the date we receive due proof of death of the original Annuitant. No. 94ICB Sel-SSDCA Data page 4 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) NORMAL FORM OF ANNUITY (SEE SECTION 7.04): The Normal Form of Annuity is Life Annuity 10 Year Period Certain for annuitization ages up to age 79. For annuitization ages 80 and older, the following applies: Annuitization Age Length of Period Certain ----------------- ------------------------ 80 through 81 9 82 through 83 8 84 through 86 7 87 through 89 6 90 5 The maximum annuitization age varies by issue age and is shown on Data page 1. AMOUNT OF ANNUITY BENEFIT (SEE SECTION 7.05): The amount applied to provide the Annuity Benefit will be the Annuity Account Value. INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX (SEE SECTION 7.06): 6% per year MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY (SEE SECTION 7.06): $2,000, as well as minimum of $20 for initial monthly annuity payment. GUARANTEED MINIMUM INCOME BENEFIT (SEE SECTION 7.08): You may apply the Annuity Account Value during the period of time indicated below to purchase a minimum amount of guaranteed lifetime income under either (i) our fixed Life Annuity payout option or (ii) our Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate. Other options may be available at the time of exercise. The Life Annuity payout option provides annuity payments while you are living. Payments end with the last payment made before your death. Our fixed Joint and Survivor Life Annuity payout option is also available. Payments under the Joint and Survivor Life Annuity payout option end with the last payment made before the surviving Annuitant's death. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate provides payments during a period certain with payments continuing for life thereafter. The period certain is based on your age at the time the Income Manager (Life Annuity with a Period Certain) payout annuity is elected. The period certain is 10 years for ages 60 through 75; 9 years for age 76; 8 years for age 77; 7 years for ages 78 through 83; 6 years for age 84; and 5 years for age 85. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity is also available on a joint and survivor basis. The following paragraphs describe the conditions for exercise of the Guaranteed Minimum Income Benefit. No. 94ICB (10/99) Data page 5 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The Guaranteed Minimum Income Benefit is available only if it is exercised within 30 days following the 15th or later Contract Date anniversary under this Certificate. However, it may not be exercised later than your age 85. On the Transaction Date that you exercise the Guaranteed Minimum Income Benefit, the lifetime income that will be provided under the payout option selected will be the greater of (i) your Guaranteed Minimum Income Benefit, and (ii) the amount of income that would be provided by application of the Annuity Account Value as of the Transaction Date at our then current annuity purchase factors. Guaranteed Minimum Income Benefit Benefit Base - The Guaranteed Minimum Income Benefit benefit base is equal to the initial Contribution on the Contract Date. Thereafter, the Guaranteed Minimum Income Benefit benefit base is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund and the Guarantee Periods) through your age 80, and 0% thereafter. The Guaranteed Minimum Income Benefit benefit base interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Income Benefit benefit base is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Income Benefit benefit base is applied to guaranteed minimum annuity purchase factors to determine the Guaranteed Minimum Income Benefit. The guaranteed minimum annuity purchase factors are shown in the attached table. The Guaranteed Minimum Income Benefit benefit base does not create an Annuity Account Value or a Cash Value and is used solely for purposes of calculating the Guaranteed Minimum Income Benefit. The current Guaranteed Minimum Income Benefit benefit base will be reduced on a dollar-for-dollar basis as long as the sum of your withdrawals in any Contract Year is 5% or less of the beginning of Contract Year Guaranteed Minimum Death Benefit (described above). Once a withdrawal is made that causes cumulative withdrawals in a Contract Year to exceed 5% of the beginning of Contract Year Guaranteed Minimum Death Benefit, that withdrawal and any subsequent withdrawals in that Contract Year will cause a pro rata reduction to occur. No. 94ICB (10/99) Data page 6 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) WITHDRAWAL CHARGES (SEE SECTION 8.01): None CHARGES DEDUCTED FROM ANNUITY ACCOUNT VALUE (SEE SECTION 8.02): (a) Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit Charge: For providing the Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit we will deduct annually on each Processing Date an amount equal to 0.30% of the Guaranteed Minimum Income Benefit benefit base (described above) in effect on such Processing Date. 0.30% is the maximum we will charge. (b) Charges for State Premium and Other Applicable Taxes: A charge for applicable taxes, such as state or local premium taxes generally will be deducted from the amount applied to provide an Annuity Benefit under Section 7.02. In certain states, however, we may deduct the charge from Contributions rather than at the Annuity Commencement Date. The above charges will be deducted from the Annuity Account Value in the Investment Funds on a pro rata basis. If there is insufficient value in the Investment Funds, all or a portion of the charges will be deducted from the Annuity Account Value with respect to the Guarantee Periods in order of the earliest Expiration Date(s) first. NUMBER OF FREE TRANSFERS (SEE SECTION 8.03): Unlimited DAILY SEPARATE ACCOUNT CHARGES (SEE SECTION 8.04): Mortality and Expense Risks Charge: Current and Maximum Annual rate of 1.10% (equivalent to a daily rate of 0.003032%). Administration Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000692%). We reserve the right to increase this charge to an annual rate of 0.35%. Distribution Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000695%). No. 94ICB Data page 7 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART C -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT APPLICABLE ------ TO MARKET VALUE ADJUSTMENT TERMS (MVA ENDORSEMENT). ALLOCATION RESTRICTIONS (SEE SECTION 3.01): If you are age 76 or older, allocations may be made only to Guarantee Periods with maturities of five years or less; however, in no event may allocations be made to Guarantee Periods with maturities beyond the February 15th immediately following the Annuity Commencement Date. TRANSFERS AT EXPIRATION DATE (SEE ITEM 1 OF MVA ENDORSEMENT): If no election is made with respect to amounts in the Guaranteed Period Account as of the Expiration Date, such amounts will be transferred into the Guarantee Period with the earliest Expiration Date. MARKET VALUE ADJUSTMENT (MVA) ON TRANSFERS AND WITHDRAWALS (SEE ITEM 2 OF MVA ENDORSEMENT): The MVA (positive or negative) resulting from a withdrawal or transfer of a portion of the amount in a Guarantee Period will be a percentage of the MVA that would be applicable upon a withdrawal of all of the Annuity Account Value from a Guarantee Period. This percentage is determined by (i) dividing the amount of the withdrawal or transfer from the Guarantee Period by (ii) the Annuity Account Value in such Guarantee Period prior to the withdrawal or transfer. TRANSFER RULES (SEE SECTION 4.02): Transfers may not be made to a Guarantee Period maturing in the current calendar year. Guarantee Periods to which transfers may be made are limited based on your attained age (see Allocation Restrictions above). MVA FORMULA (SEE ITEM 3 OF MVA ENDORSEMENT): The Guaranteed Rate for new allocations to a Guarantee Period is the rate we have in effect for this purpose even if new allocations to that Guarantee Period would not be accepted at the time. This rate will not be less than 3%. The current rate percentage we use in item (c) of the formula is 0.00%. For purposes of calculating the MVA only, we reserve the right to add up to 0.25% to such current rate percentage. SEPARATE ACCOUNT (SEE ITEM 5 OF MVA ENDORSEMENT): The portion of the assets of Separate Account No. 46 equal to the reserves and other contract liabilities will not be chargeable with liabilities which arise out of any other business we conduct. No. 94ICB Data page 8 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT TABLE OF GUARANTEED MINIMUM ANNUITY PURCHASE FACTORS FOR INITIAL LEVEL ANNUAL INCOME SINGLE LIFE - MALE
PURCHASE FACTORS PURCHASE FACTORS ---------------------------------- ---------------------------------- LIFE ANNUITY WITH LIFE ANNUITY WITH ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ------------ ---------------- ------------ ------------ ---------------- ------------ 35 3.55% 3.56% 60 4.94% 5.15% 36 3.58 3.59 61 5.02 5.26 37 3.62 3.63 62 5.11 5.38 38 3.65 3.67 63 5.20 5.51 39 3.69 3.71 64 5.30 5.64 40 3.74 3.76 65 5.40 5.79 41 3.77 3.80 66 5.50 5.94 42 3.82 3.85 67 5.60 6.10 43 3.87 3.90 68 5.70 6.27 44 3.91 3.95 69 5.81 6.45 45 3.96 4.00 70 5.91 6.64 46 4.02 4.06 71 6.02 6.84 47 4.06 4.11 72 6.12 7.06 48 4.11 4.17 73 6.21 7.28 49 4.17 4.23 74 6.31 7.51 50 4.23 4.30 75 6.40 7.76 51 4.29 4.37 76 6.69 8.03 52 4.35 4.44 77 7.01 8.31 53 4.41 4.51 78 7.38 8.61 54 4.48 4.59 79 7.53 8.93 55 4.55 4.67 80 7.67 9.27 56 4.62 4.76 81 7.81 9.64 57 4.69 4.85 82 7.93 10.02 58 4.77 4.94 83 8.05 10.43 59 4.84 5.04 84 8.60 10.87 85 9.25 11.34
Other forms of annuities may be available. No. 94ICB (10/99) Data page 9 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] EQUITABLE ACCUMULATOR SELECT (NQ) DATA PART A -- THIS PART LISTS YOUR PERSONAL DATA. ------ OWNER: John Doe ANNUITANT: John Doe Age: 61 Sex: Male CONTRACT: GROUP ANNUITY CONTRACT NO. AC 6725 CERTIFICATE NUMBER: 00000 ENDORSEMENTS ATTACHED: Minimum Income Benefit Endorsement Endorsement Applicable to Non-Qualified Certificates Endorsement Applicable to Market Value Adjustment Terms Rider to Endorsement Applicable to Market Value Adjustment Terms Protection Plus Optional Death Benefit Rider ISSUE DATE: January 8, 2001 CONTRACT DATE: January 8, 2001 ANNUITY COMMENCEMENT DATE: March 20, 2025 THE MAXIMUM MATURITY AGE IS AGE 90 -- SEE SECTION 7.03. The Annuity Commencement Date may not be later than the Processing Date which follows the Annuitant's 90th birthday. GUARANTEED BENEFITS: Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit (Annual Ratchet to Age 80) BENEFICIARY: Jane Doe No. 94ICB Data page 1 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART B -- THIS PART DESCRIBES CERTAIN PROVISIONS OF YOUR CERTIFICATE. ------ INITIAL CONTRIBUTION RECEIVED (SEE SECTION 3.02): $25,000.00 INVESTMENT OPTIONS AVAILABLE (SEE PART II); YOUR ALLOCATION IS ALSO SHOWN. INVESTMENT OPTIONS ALLOCATION (SEE SECTION 3.01) ------------------ ----------------------------- o Alliance Common Stock Fund $25,000.00 o Alliance High Yield Fund o Alliance Money Market Fund o Alliance Small Cap Growth Fund o Capital Guardian International Fund o Capital Guardian Research Fund o Capital Guardian U.S. Equity Fund o EQ Equity 500 Index Fund o EQ International Equity Index Fund o EQ Small Company Index Fund o EQ/Aggressive Stock Fund o EQ/Alliance Premier Growth Fund o EQ/Alliance Technology Fund o EQ/Evergreen Foundation Fund o EQ/Evergreen Fund o EQ/Janus Large Cap Growth Fund o EQ/Putnam Growth & Income Value Fund o EQ/Putnam International Equity Fund o EQ/Putnam Investors Growth Fund o FI Mid Cap Fund o FI Small/Mid Cap Value Fund o JP Morgan Core Bond Fund o Lazard Large Cap Value Fund o Lazard Small Cap Value Fund o Mercury Basic Value Equity Fund o Mercury World Strategy Fund o MFS Emerging Growth Companies Fund o MFS Growth with Income Fund o MFS Research Fund o Morgan Stanley Emerging Markets Equity Fund No. 94ICB Data page 2 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION (SEE SECTION 3.01) ----------------------------- o GUARANTEE PERIODS (CLASS II) EXPIRATION DATE AND GUARANTEED RATE February 15, 2002 February 15, 2003 February 15, 2004 February 15, 2005 February 15, 2006 February 15, 2007 February 15, 2008 February 15, 2009 February 15, 2010 February 15, 2011 -------------------------- TOTAL: $25,000.00 Investment Options shown are Investment Funds of our Separate Account No. 49 and Guarantee Periods shown are in the Guaranteed Period Account. See Endorsement Applicable to Market Value Adjustment Terms. "TYPES" OF INVESTMENT OPTIONS (SEE SECTION 4.02): Not applicable GUARANTEED INTEREST ACCOUNT (SEE SECTION 2.01): Not available under this Certificate. BUSINESS DAY (SEE SECTION 1.05): A Business Day for this Certificate will mean generally any day on which the New York Stock Exchange is open for trading. PROCESSING DATES (SEE SECTION 1.20): A Processing Date is each Contract Date anniversary. No. 94ICB Data page 2a (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) AVAILABILITY OF INVESTMENT OPTIONS (SEE SECTION 2.04): (See Data pages, Part C; Allocation Restrictions) ALLOCATION OF CONTRIBUTIONS (SEE SECTION 3.01): Except as indicated below, your initial and any subsequent Contributions are allocated according to your instructions. Money Market Fund Special Dollar Cost Averaging - You may elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time subject to the Contribution Limits described in the Data Pages of this Certificate. You may elect to make subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program. The minimum subsequent contribution amount that may be made to an existing program is $250. Amounts will be transferred monthly over a twelve month period from the Alliance Money Market Fund to the other Investment Options based on the percentages you selected at the start of the Money Market Fund Special Dollar Cost Averaging program. Subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program will not extend the expiration date of that program. You may have only one Special Dollar Cost Averaging program in effect at any given time. At the expiration of the Money Market Fund Special Dollar Cost Averaging program, you may start a new program. If you elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time after this Certificate has been issued, the minimum contribution to be initially allocated to that program is $2,000. (See Data Pages, Part C; Allocation Restrictions) CONTRIBUTION LIMITS (SEE SECTION 3.02): Initial Contribution minimum: $25,000. Subsequent Contribution minimum: $1,000. Subsequent Contributions can be made at any time up until the Annuitant attains age 86. We may refuse to accept any Contribution if the sum of all Contributions under all accumulation Certificateswith the same Annuitant would then total more than $1,500,000. We reserve the right to limit aggregate Contributions made after the first Contract Year to 150% of first year Contributions. We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable Life annuity accumulation certificates/contracts that you own would then total more than $2,500,000. TRANSFER RULES (SEE SECTION 4.02): You may not transfer Annuity Account Value into the Money Market Fund Special Dollar Cost Averaging program. Any request by you to transfer amounts out of the Alliance Money Market Fund, other than your regularly scheduled transfers to the Investment Options as part of the Money Market Fund Special Dollar Cost Averaging program, will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amount remaining in the Alliance Money Market Fund after such a transfer will be transferred to your other Investment Options according to your then current allocation instructions. No. 94ICB Sel-SSDCA Data page 3 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF WITHDRAWALS (SEE SECTION 5.01): Lump Sum Withdrawals - You must provide withdrawal instructions indicating from which Investment Options the Lump Sum Withdrawal will be taken; Systematic Withdrawals - Unless you specify otherwise, Systematic Withdrawals will be withdrawn on a pro rata basis from your Annuity Account Value in the Investment Funds. If there is insufficient value or no value in the Investment Funds, any additional amount required or the total amount of the withdrawal, as applicable, will be withdrawn from the Guarantee Periods in order of the earliest Expiration Date(s) first. Any withdrawal from the Alliance Money Market Fund while participating in the Money Market Fund Special Dollar Cost Averaging program will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amounts remaining in the Alliance Money Market Fund after such a withdrawal will be transferred to your other Investment Options according to your then current allocation instructions. WITHDRAWAL RESTRICTIONS (SEE SECTION 5.01): Systematic Withdrawals - May not start sooner than 28 days after issue of this Certificate. You may elect to receive Systematic Withdrawals on a monthly, quarterly or annual basis subject to a maximum of 1.2% monthly, 3.6% quarterly and 15.0% annually of the Annuity Account Value as of the Transaction Date. MINIMUM WITHDRAWAL AMOUNT (SEE SECTION 5.01): Lump Sum Withdrawals minimum - $1,000; Systematic Withdrawals minimum - $250. MINIMUM AMOUNT OF ANNUITY ACCOUNT VALUE AFTER A WITHDRAWAL (SEE SECTION 5.02): Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Certificate). We will NOT exercise our rights, described in Sections 5.02(b) and 5.02(c), to terminate the Certificate. DEATH BENEFIT AMOUNT (SEE SECTION 6.01): The death benefit is equal to the Annuity Account Value or, if greater, the Guaranteed Minimum Death Benefit defined below. Guaranteed Minimum Death Benefit Annual Ratchet to Age 80 - On the Contract Date, the Guaranteed Minimum Death Benefit is equal to the initial Contribution. Thereafter, on each Contract Date anniversary through the Annuitant's age 80, if the Annuity Account Value is greater than the current Guaranteed Minimum Death Benefit, the Guaranteed Minimum Death Benefit is reset to equal the Annuity Account Value. The Guaranteed Minimum Death Benefit is also adjusted for any subsequent Contributions and withdrawals. Each withdrawal will cause a reduction in your current Guaranteed Minimum Death Benefit on a pro rata basis. No. 94ICB Sel-SSDCA Data page 4 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) Upon the death of the Owner who is also the Annuitant, any death benefit applied as an annuity benefit will be paid out over the life of the Beneficiary or for a period not extending beyond the Beneficiary's life expectancy and payments must begin within one year after such Owner's death. If the Successor Owner/Annuitant election is made upon the Annuitant's death, the Annuity Account Value will be increased to the then current Guaranteed Minimum Death Benefit if such amount is greater (including any optional Death Benefit Rider amounts, if applicable). The increase, if any, will be allocated in accordance with the current instructions on file. In determining whether the Guaranteed Minimum Death Benefit is still in effect, we will use the age of the Successor Owner/Annuitant as of the date we receive due proof of death of the original Annuitant. NORMAL FORM OF ANNUITY (SEE SECTION 7.04): The Normal Form of Annuity is Life Annuity 10 Year Period Certain for annuitization ages up to age 79. For annuitization ages 80 and older, the following applies: Annuitization Age Length of Period Certain ----------------- ------------------------ 80 through 81 9 82 through 83 8 84 through 86 7 87 through 89 6 90 5 The maximum annuitization age varies by issue age and is shown on Data page 1. AMOUNT OF ANNUITY BENEFIT (SEE SECTION 7.05): The amount applied to provide the Annuity Benefit will be the Annuity Account Value. INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX (SEE SECTION 7.06): 6% per year MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY (SEE SECTION 7.06): $2,000, as well as minimum of $20 for initial monthly annuity payment. No. 94ICB Data page 5 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT (SEE SECTION 7.08): You may apply the Annuity Account Value during the period of time indicated below to purchase a minimum amount of guaranteed lifetime income under either (i) our fixed Life Annuity payout option or (ii) our Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate. Other options may be available at the time of exercise. The Life Annuity payout option provides annuity payments while the Annuitant is living. Payments end with the last payment made before the Annuitant's death. Our fixed Joint and Survivor Life Annuity payout option is also available. Payments under the Joint and Survivor Life Annuity payout option end with the last payment made before the surviving Annuitant's death. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate provides payments during a period certain with payments continuing for life thereafter. The period certain is based on the Annuitant's age at the time the Income Manager (Life Annuity with a Period Certain) payout annuity is elected. The period certain is 10 years for ages 60 through 75; 9 years for age 76; 8 years for age 77; 7 years for ages 78 through 83; 6 years for age 84; and 5 years for age 85. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity is also available on a joint and survivor basis. The following paragraphs describe the conditions for exercise of the Guaranteed Minimum Income Benefit. The Guaranteed Minimum Income Benefit is available only if it is exercised within 30 days following the 10th or later Contract Date anniversary under this Certificate. However, it may not be exercised later than the Annuitant's age 85. On the Transaction Date that you exercise the Guaranteed Minimum Income Benefit, the lifetime income that will be provided under the payout option selected will be the greater of (i) your Guaranteed Minimum Income Benefit, and (ii) the amount of income that would be provided by application of the Annuity Account Value as of the Transaction Date at our then current annuity purchase factors. Guaranteed Minimum Income Benefit Benefit Base - The Guaranteed Minimum Income Benefit benefit base is equal to the initial Contribution on the Contract Date. Thereafter, the Guaranteed Minimum Income Benefit benefit base is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund and the Guarantee Periods) through the Annuitant's age 80, and 0% thereafter. The Guaranteed Minimum Income Benefit benefit base interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Income Benefit benefit base is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Income Benefit benefit base is applied to guaranteed minimum annuity purchase factors to determine the Guaranteed Minimum Income Benefit. The guaranteed minimum annuity purchase factors are shown in the attached table. No. 94ICB (10/99) Data page 6 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The Guaranteed Minimum Income Benefit benefit base does not create an Annuity Account Value or a Cash Value and is used solely for purposes of calculating the Guaranteed Minimum Income Benefit. The current Guaranteed Minimum Income Benefit benefit base will be reduced on a dollar-for-dollar basis as long as the sum of your withdrawals in any Contract Year is 5% or less of the beginning of Contract Year Guaranteed Minimum Death Benefit (described above). Once a withdrawal is made that causes cumulative withdrawals in a Contract Year to exceed 5% of the beginning of Contract Year Guaranteed Minimum Death Benefit, that withdrawal and any subsequent withdrawals in that Contract Year will cause a pro rata reduction to occur. WITHDRAWAL CHARGES (SEE SECTION 8.01): None CHARGES DEDUCTED FROM ANNUITY ACCOUNT VALUE (SEE SECTION 8.02): (a) Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit Charge: For providing the Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit we will deduct annually on each Processing Date an amount equal to 0.30% of the Guaranteed Minimum Income Benefit benefit base (described above) in effect on such Processing Date. 0.30% is the maximum we will charge. (b) For providing the Protection Plus Death Benefit, we will deduct annually on each Processing Date an amount equal to 0.20% of the Annuity Account Value in effect on such Processing Date. (c) Charges for State Premium and Other Applicable Taxes: A charge for applicable taxes, such as state or local premium taxes generally will be deducted from the amount applied to provide an Annuity Benefit under Section 7.02. In certain states, however, we may deduct the charge from Contributions rather than at the Annuity Commencement Date. The above charges will be deducted from the Annuity Account Value in the Investment Funds on a pro rata basis. If there is insufficient value in the Investment Funds, all or a portion of the charges will be deducted from the Annuity Account Value with respect to the Guarantee Periods in order of the earliest Expiration Date(s) first. NUMBER OF FREE TRANSFERS (SEE SECTION 8.03): Unlimited No. 94ICB (Rev 9/00) Data page 7 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) DAILY SEPARATE ACCOUNT CHARGES (SEE SECTION 8.04): Mortality and Expense Risks Charge: Current and Maximum Annual rate of 1.10% (equivalent to a daily rate of 0.003032%). Administration Charge: Current and Maximum Annual rate of 0.25%(equivalent to a daily rate of 0.000692%). We reserve the right to increase this charge to an annual rate of 0.35%. Distribution Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000695%). No. 94ICB Data page 8 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART C -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT ------ APPLICABLE TO MARKET VALUE ADJUSTMENT TERMS (MVA ENDORSEMENT). ALLOCATION RESTRICTIONS (SEE SECTION 3.01): If the Annuitant is age 76 or older, allocations may be made only to Guarantee Periods with maturities of five years or less; however, in no event may allocations be made to Guarantee Periods with maturities beyond the February 15th immediately following the Annuity Commencement Date. TRANSFERS AT EXPIRATION DATE (SEE ITEM 1 OF MVA ENDORSEMENT): If no election is made with respect to amounts in the Guaranteed Period Account as of the Expiration Date, such amounts will be transferred into the Guarantee Period with the earliest Expiration Date. MARKET VALUE ADJUSTMENT (MVA) ON TRANSFERS AND WITHDRAWALS (SEE ITEM 2 OF MVA ENDORSEMENT): The MVA (positive or negative) resulting from a withdrawal or transfer of a portion of the amount in a Guarantee Period will be a percentage of the MVA that would be applicable upon a withdrawal of all of the Annuity Account Value from a Guarantee Period. This percentage is determined by (i) dividing the amount of the withdrawal or transfer from the Guarantee Period by (ii) the Annuity Account Value in such Guarantee Period prior to the withdrawal or transfer. TRANSFER RULES (SEE SECTION 4.02): Transfers may not be made to a Guarantee Period maturing in the current calendar year. Guarantee Periods to which transfers may be made are limited based on the attained age of the Annuitant (see Allocation Restrictions above). MVA FORMULA (SEE ITEM 3 OF MVA ENDORSEMENT): The Guaranteed Rate for new allocations to a Guarantee Period is the rate we have in effect for this purpose even if new allocations to that Guarantee Period would not be accepted at the time. This rate will not be less than 3%. The current rate percentage we use in item (c) of the formula is 0.00%. For purposes of calculating the MVA only, we reserve the right to add up to 0.25% to such current rate percentage. SEPARATE ACCOUNT (SEE ITEM 5 OF MVA ENDORSEMENT): The portion of the assets of Separate Account No. 46 equal to the reserves and other contract liabilities will not be chargeable with liabilities which arise out of any other business we conduct. No. 94ICBMVA Data page 9 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT TABLE OF GUARANTEED MINIMUM ANNUITY PURCHASE FACTORS FOR INITIAL LEVEL ANNUAL INCOME SINGLE LIFE - MALE PURCHASE FACTORS ---------------------------------- LIFE ANNUITY WITH ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ------------ ---------------- ------------ 60 4.93% 5.15% 61 5.02 5.26 62 5.11 5.38 63 5.20 5.51 64 5.30 5.64 65 5.40 5.79 66 5.50 5.94 67 5.60 6.10 68 5.71 6.27 69 5.81 6.45 70 5.91 6.64 71 6.02 6.84 72 6.12 7.06 73 6.21 7.28 74 6.31 7.51 75 6.41 7.76 76 6.50 8.03 77 6.59 8.31 78 6.67 8.61 79 6.74 8.93 80 6.81 9.27 81 7.16 9.64 82 7.57 10.02 83 8.05 10.43 84 8.60 10.87 85 9.25 11.34 Other forms of annuities may be available. No. 94ICB (10/99) Data page 10 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] EQUITABLE ACCUMULATOR SELECT (QP - DEFINED CONTRIBUTION) DATA PART A -- THIS PART LISTS YOUR PERSONAL DATA. ------ OWNER: Richard Roe As Trustee for the XYZ Qualified Plan ANNUITANT: John Doe Age: 61 Sex: Male CONTRACT: GROUP ANNUITY CONTRACT NO. AC 6725 CERTIFICATE NUMBER: 00000 ENDORSEMENTS ATTACHED: Minimum Income Benefit Endorsement Endorsement Applicable to Qualified Plan Certificates Endorsement Applicable to Market Value Adjustment Terms Rider to Endorsement Applicable to Market Value Adjustment Terms ISSUE DATE: January 8, 2001 CONTRACT DATE: January 8, 2001 ANNUITY COMMENCEMENT DATE: March 20, 2025 THE MAXIMUM MATURITY AGE IS AGE 90 -- SEE SECTION 7.03. The Annuity Commencement Date may not be later than the Processing Date which follows the Annuitant's 90th birthday. However, any distribution option under this Certificate must meet any minimum distribution requirements under Section 401(a)(9) of the Code which apply after the "Required Beginning Date" which is April 1st following the calendar year which is generally the later of the year in which the Annuitant (i) attains age 70 1/2 or (ii) retires from service of the employer sponsoring the Plan. GUARANTEED BENEFITS: Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit (Annual Ratchet to Age 80) BENEFICIARY: Richard Roe As Trustee for the XYZ Qualified Plan No. 94ICB Data page 1 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART B -- THIS PART DESCRIBES CERTAIN PROVISIONS OF YOUR CERTIFICATE. ------ INITIAL CONTRIBUTION RECEIVED (SEE SECTION 3.02): $25,000.00 INVESTMENT OPTIONS AVAILABLE (SEE PART II); YOUR ALLOCATION IS ALSO SHOWN. INVESTMENT OPTIONS ALLOCATION (SEE SECTION 3.01) ------------------ ----------------------------- o Alliance Common Stock Fund $25,000.00 o Alliance High Yield Fund o Alliance Money Market Fund o Alliance Small Cap Growth Fund o Capital Guardian International Fund o Capital Guardian Research Fund o Capital Guardian U.S. Equity Fund o EQ Equity 500 Index Fund o EQ International Equity Index Fund o EQ Small Company Index Fund o EQ/Aggressive Stock Fund o EQ/Alliance Premier Growth Fund o EQ/Alliance Technology Fund o EQ/Evergreen Foundation Fund o EQ/Evergreen Fund o EQ/Janus Large Cap Growth Fund o EQ/Putnam Growth & Income Value Fund o EQ/Putnam International Equity Fund o EQ/Putnam Investors Growth Fund o FI Mid Cap Fund o FI Small/Mid Cap Value Fund o JP Morgan Core Bond Fund o Lazard Large Cap Value Fund o Lazard Small Cap Value Fund o Mercury Basic Value Equity Fund o Mercury World Strategy Fund o MFS Emerging Growth Companies Fund o MFS Growth with Income Fund o MFS Research Fund o Morgan Stanley Emerging Markets Equity Fund No. 94ICB Data page 2 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION (SEE SECTION 3.01) ----------------------------- o GUARANTEE PERIODS (CLASS II) EXPIRATION DATE AND GUARANTEED RATE February 15, 2002 February 15, 2003 February 15, 2004 February 15, 2005 February 15, 2006 February 15, 2007 February 15, 2008 February 15, 2009 February 15, 2010 February 15, 2011 -------------------------- TOTAL: $25,000.00 Investment Options shown are Investment Funds of our Separate Account No. 49 and Guarantee Periods shown are in the Guaranteed Period Account. See Endorsement Applicable to Market Value Adjustment Terms. "TYPES" OF INVESTMENT OPTIONS (SEE SECTION 4.02): Not applicable GUARANTEED INTEREST ACCOUNT (SEE SECTION 2.01): Not available under this Certificate. BUSINESS DAY (SEE SECTION 1.05): A Business Day for this Certificate will mean generally any day on which the New York Stock Exchange is open for trading. PROCESSING DATES (SEE SECTION 1.20): A Processing Date is each Contract Date anniversary. No. 94ICB Data page 2a (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) AVAILABILITY OF INVESTMENT OPTIONS (SEE SECTION 2.04): (See Data pages, Part C; Allocation Restrictions) ALLOCATION OF CONTRIBUTIONS (SEE SECTION 3.01): Except as indicated below, your initial and any subsequent Contributions are allocated according to your instructions. Money Market Fund Special Dollar Cost Averaging - You may elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time subject to the Contribution Limits described in the Data Pages of this Certificate. You may elect to make subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program. The minimum subsequent contribution amount that may be made to an existing program is $250. Amounts will be transferred monthly over a twelve month period from the Alliance Money Market Fund to the other Investment Options based on the percentages you selected at the start of the Money Market Fund Special Dollar Cost Averaging program. Subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program will not extend the expiration date of that program. You may have only one Special Dollar Cost Averaging program in effect at any given time. At the expiration of the Money Market Fund Special Dollar Cost Averaging program, you may start a new program. If you elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time after this Certificate has been issued, the minimum contribution to be initially allocated to that program is $2,000. (See Data Pages, Part C; Allocation Restrictions) CONTRIBUTION LIMITS (SEE SECTION 3.02): Initial Contribution minimum: $25,000. Subsequent Contribution minimum: $1,000. Subsequent Contributions can be made at any time up until the Annuitant attains age 76. We may refuse to accept any Contribution if the sum of all Contributions under all accumulation Certificates with the same Annuitant would then total more than $1,500,000. We reserve the right to limit aggregate Contributions made after the first Contract Year to 150% of first year Contributions. We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable Life annuity accumulation certificates/contracts that you own would then total more than $2,500,000. TRANSFER RULES (SEE SECTION 4.02): You may not transfer Annuity Account Value into the Money Market Fund Special Dollar Cost Averaging program. Any request by you to transfer amounts out of the Alliance Money Market Fund, other than your regularly scheduled transfers to the Investment Options as part of the Money Market Fund Special Dollar Cost Averaging program, will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amount remaining in the Alliance Money Market Fund after such a transfer will be transferred to your other Investment Options according to your then current allocation instructions. No. 94ICB Sel-SSDCA Data page 3 DATA PAGES (CONT'D) [GRAPHIC OF WORD "SPECIMEN"] ALLOCATION OF WITHDRAWALS (SEE SECTION 5.01): Lump Sum Withdrawals - You must provide withdrawal instructions indicating from which Investment Options the Lump Sum Withdrawal will be taken; Minimum Distribution Withdrawals - Unless you specify otherwise, Minimum Distribution Withdrawals will be withdrawn on a pro rata basis from your Annuity Account Value in the Investment Funds. If there is insufficient value or no value in the Investment Funds, any additional amount of the withdrawal required or the total amount of the withdrawal, as applicable, will be withdrawn from the Guarantee Periods in order of the earliest Expiration Date(s) first. Any withdrawal from the Alliance Money Market Fund while participating in the Money Market Fund Special Dollar Cost Averaging program will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amounts remaining in the Alliance Money Market Fund after such a withdrawal will be transferred to your other Investment Options according to your then current allocation instructions. WITHDRAWAL RESTRICTIONS (SEE SECTION 5.01): Minimum Distribution Withdrawals - May be elected in the year in which you attain age 70 1/2 or at a later date. Minimum Distribution Withdrawals will be made annually. MINIMUM WITHDRAWAL AMOUNT (SEE SECTION 5.01): Lump Sum Withdrawals minimum - $1,000; Minimum Distribution Withdrawals minimum - $250. MINIMUM AMOUNT OF ANNUITY ACCOUNT VALUE AFTER A WITHDRAWAL (SEE SECTION 5.02): Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Certificate). We will NOT exercise our rights, described in Sections 5.02(b) and 5.02(c), to terminate the Certificate. DEATH BENEFIT AMOUNT (SEE SECTION 6.01): The death benefit is equal to the Annuity Account Value or, if greater, the Guaranteed Minimum Death Benefit defined below. Guaranteed Minimum Death Benefit Annual Ratchet to Age 80 - On the Contract Date, the Guaranteed Minimum Death Benefit is equal to the initial Contribution. Thereafter, on each Contract Date anniversary through the Annuitant's age 80, if the Annuity Account Value is greater than the current Guaranteed Minimum Death Benefit, the Guaranteed Minimum Death Benefit is reset to equal the Annuity Account Value. The Guaranteed Minimum Death Benefit is also adjusted for any subsequent Contributions and withdrawals. Each withdrawal will cause a reduction in your current Guaranteed Minimum Death Benefit on a pro rata basis. No. 94ICB Sel-SSDCA Data page 4 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) NORMAL FORM OF ANNUITY (SEE SECTION 7.04): The Normal Form of Annuity is Life Annuity 10 Year Period Certain or Joint and Survivor Life Annuity 10 Year Period Certain for annuitization ages up to age 79. For annuitization ages 80 and older, the following applies: Annuitization Age Length of Period Certain ----------------- ------------------------ 80 through 81 9 82 through 83 8 84 through 86 7 87 through 89 6 90 5 The maximum annuitization age varies by issue age and is shown on Data page 1. AMOUNT OF ANNUITY BENEFIT (SEE SECTION 7.05): The amount applied to provide the Annuity Benefit will be the Annuity Account Value. INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX (SEE SECTION 7.06): 6% per year MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY (SEE SECTION 7.06): $2,000, as well as minimum of $20 for initial monthly annuity payment. GUARANTEED MINIMUM INCOME BENEFIT (SEE SECTION 7.08): If the Annuitant has converted the Certificate to a traditional IRA certificate, the Annuitant may apply the Annuity Account Value during the period of time indicated below to purchase a minimum amount of guaranteed lifetime income under either (i) our fixed Life Annuity payout option or (ii) our Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate. Other options may be available at the time of exercise. The Life Annuity payout option provides annuity payments while the Annuitant is living. Payments end with the last payment made before the Annuitant's death. Our fixed Joint and Survivor Life Annuity payout option is also available. Payments under the Joint and Survivor Life Annuity payout option end with the last payment made before the surviving Annuitant's death. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate provides payments during a period certain with payments continuing for life thereafter. The period certain is based on the Annuitant's age at the time the Income Manager (Life Annuity with a Period Certain) payout annuity is elected. The period certain is 10 years for ages 60 through 75; 9 years for age 76; 8 years for age 77; 7 years for ages 78 through 83; 6 years for age 84; and 5 years for age 85. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity is also available on a joint and survivor basis. The following paragraphs describe the conditions for exercise of the Guaranteed Minimum Income Benefit. No. 94ICB (10/99) Data page 5 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The Guaranteed Minimum Income Benefit is available only if it is exercised within 30 days following the 10th or later Contract Date anniversary under this Certificate. However, it may not be exercised later than the Annuitant's age 85. On the Transaction Date that the Annuitant exercises the Guaranteed Minimum Income Benefit, the lifetime income that will be provided under the payout option selected will be the greater of (i) the Guaranteed Minimum Income Benefit, and (ii) the amount of income that would be provided by application of the Annuity Account Value as of the Transaction Date at our then current annuity purchase factors. Guaranteed Minimum Income Benefit Benefit Base - The Guaranteed Minimum Income Benefit benefit base is equal to the initial Contribution on the Contract Date. Thereafter, the Guaranteed Minimum Income Benefit benefit base is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund and the Guarantee Periods) through the Annuitant's age 80, and 0% thereafter. The Guaranteed Minimum Income Benefit benefit base interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Income Benefit benefit base is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Income Benefit benefit base is applied to guaranteed minimum annuity purchase factors to determine the Guaranteed Minimum Income Benefit. The guaranteed minimum annuity purchase factors are shown in the attached table. The Guaranteed Minimum Income Benefit benefit base does not create an Annuity Account Value or a Cash Value and is used solely for purposes of calculating the Guaranteed Minimum Income Benefit. The current Guaranteed Minimum Income Benefit benefit base will be reduced on a dollar-for-dollar basis as long as the sum of the withdrawals in any Contract Year is 5% or less of the beginning of Contract Year Guaranteed Minimum Death Benefit (described above). Once a withdrawal is made that causes cumulative withdrawals in a Contract Year to exceed 5% of the beginning of Contract Year Guaranteed Minimum Death Benefit, that withdrawal and any subsequent withdrawals in that Contract Year will cause a pro rata reduction to occur. WITHDRAWAL CHARGES (SEE SECTION 8.01): None No. 94ICB (10/99) Data page 6 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) CHARGES DEDUCTED FROM ANNUITY ACCOUNT VALUE (SEE SECTION 8.02): (a) Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit Charge: For providing the Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit we will deduct annually on each Processing Date an amount equal to 0.30% of the Guaranteed Minimum Income Benefit benefit base (described above) in effect on such Processing Date. 0.30% is the maximum we will charge. (b) Charges for State Premium and Other Applicable Taxes: A charge for applicable taxes, such as state or local premium taxes generally will be deducted from the amount applied to provide an Annuity Benefit under Section 7.02. In certain states, however, we may deduct the charge from Contributions rather than at the Annuity Commencement Date. The above charges will be deducted from the Annuity Account Value in the Investment Funds on a pro rata basis. If there is insufficient value in the Investment Funds, all or a portion of the charges will be deducted from the Annuity Account Value with respect to the Guarantee Periods in order of the earliest Expiration Date(s) first. NUMBER OF FREE TRANSFERS (SEE SECTION 8.03): Unlimited DAILY SEPARATE ACCOUNT CHARGES (SEE SECTION 8.04): Mortality and Expense Risks Charge: Current and Maximum Annual rate of 1.10% (equivalent to a daily rate of 0.003032%). Administration Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000692%). We reserve the right to increase this charge to an annual rate of 0.35%. Distribution Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000695%). No. 94ICB Data page 7 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART C -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT APPLICABLE ------ TO MARKET VALUE ADJUSTMENT TERMS (MVA ENDORSEMENT). ALLOCATION RESTRICTIONS (SEE SECTION 3.01): If the Annuitant is age 76 or older, allocations may be made only to Guarantee Periods with maturities of five years or less; however, in no event may allocations be made to Guarantee Periods with maturities beyond the February 15th immediately following the Annuity Commencement Date. TRANSFERS AT EXPIRATION DATE (SEE ITEM 1 OF MVA ENDORSEMENT): If no election is made with respect to amounts in the Guaranteed Period Account as of the Expiration Date, such amounts will be transferred into the Guarantee Period with the earliest Expiration Date. MARKET VALUE ADJUSTMENT (MVA) ON TRANSFERS AND WITHDRAWALS (SEE ITEM 2 OF MVA ENDORSEMENT): The MVA (positive or negative) resulting from a withdrawal or transfer of a portion of the amount in a Guarantee Period will be a percentage of the MVA that would be applicable upon a withdrawal of all of the Annuity Account Value from a Guarantee Period. This percentage is determined by (i) dividing the amount of the withdrawal or transfer from the Guarantee Period by (ii) the Annuity Account Value in such Guarantee Period prior to the withdrawal or transfer. TRANSFER RULES (SEE SECTION 4.02): Transfers may not be made to a Guarantee Period maturing in the current calendar year. Guarantee Periods to which transfers may be made are limited based on the attained age of the Annuitant (see Allocation Restrictions above). MVA FORMULA (SEE ITEM 3 OF MVA ENDORSEMENT): The Guaranteed Rate for new allocations to a Guarantee Period is the rate we have in effect for this purpose even if new allocations to that Guarantee Period would not be accepted at the time. This rate will not be less than 3%. The current rate percentage we use in item (c) of the formula is 0.00%. For purposes of calculating the MVA only, we reserve the right to add up to 0.25% to such current rate percentage. SEPARATE ACCOUNT (SEE ITEM 5 OF MVA ENDORSEMENT): The portion of the assets of Separate Account No. 46 equal to the reserves and other contract liabilities will not be chargeable with liabilities which arise out of any other business we conduct. No. 94ICBMVA Data page 8 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT TABLE OF GUARANTEED MINIMUM ANNUITY PURCHASE FACTORS FOR A TRADITIONAL IRA CERTIFICATE FOR INITIAL LEVEL ANNUAL INCOME SINGLE LIFE - MALE PURCHASE FACTORS ---------------------------------- LIFE ANNUITY WITH ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ------------ ---------------- ------------ 60 4.93% 5.15% 61 5.02 5.26 62 5.11 5.38 63 5.20 5.51 64 5.30 5.64 65 5.40 5.79 66 5.50 5.94 67 5.60 6.10 68 5.71 6.27 69 5.81 6.45 70 5.91 6.64 71 6.02 6.84 72 6.12 7.06 73 6.21 7.28 74 6.31 7.51 75 6.41 7.76 76 6.69 8.03 77 7.02 8.31 78 7.38 8.61 79 7.53 8.93 80 7.67 9.27 81 7.81 9.64 82 7.94 10.02 83 8.05 10.43 84 8.60 10.87 85 9.25 11.34 Other forms of annuities may be available. No. 94ICB (10/99) Data page 9 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] EQUITABLE ACCUMULATOR SELECT (QP - DEFINED BENEFIT) DATA PART A -- THIS PART LISTS YOUR PERSONAL DATA. ------ OWNER: Richard Roe As Trustee for the XYZ Qualified Plan ANNUITANT: John Doe Age: 61 Sex: Male CONTRACT: GROUP ANNUITY CONTRACT NO. AC 6725 CERTIFICATE NUMBER: 00000 ENDORSEMENTS ATTACHED: Minimum Income Benefit Endorsement Endorsement Applicable to Defined Benefit Qualified Plan Certificates Endorsement Applicable to Market Value Adjustment Terms Rider to Endorsement Applicable to Market Value Adjustment Terms ISSUE DATE: January 8, 2001 CONTRACT DATE: January 8, 2001 ANNUITY COMMENCEMENT DATE: March 20, 2025 THE MAXIMUM MATURITY AGE IS AGE 90 -- SEE SECTION 7.03. The Annuity Commencement Date may not be later than the Processing Date which follows the Annuitant's 90th birthday. GUARANTEED BENEFITS: Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit (Annual Ratchet to Age 80) BENEFICIARY: Richard Roe As Trustee for the XYZ Qualified Plan No. 94ICB Data page 1 (5/99) DATA PAGES (CONT'D) PART B -- THIS PART DESCRIBES CERTAIN PROVISIONS OF YOUR CERTIFICATE. ------ INITIAL CONTRIBUTION RECEIVED (SEE SECTION 3.02): $25,000.00 INVESTMENT OPTIONS AVAILABLE (SEE PART II); YOUR ALLOCATION IS ALSO SHOWN. INVESTMENT OPTIONS ALLOCATION (SEE SECTION 3.01) ------------------ ----------------------------- o Alliance Common Stock Fund $25,000.00 o Alliance High Yield Fund o Alliance Money Market Fund o Alliance Small Cap Growth Fund o Capital Guardian International Fund o Capital Guardian Research Fund o Capital Guardian U.S. Equity Fund o EQ Equity 500 Index Fund o EQ International Equity Index Fund o EQ Small Company Index Fund o EQ/Aggressive Stock Fund o EQ/Alliance Premier Growth Fund o EQ/Alliance Technology Fund o EQ/Evergreen Foundation Fund o EQ/Evergreen Fund o EQ/Janus Large Cap Growth Fund o EQ/Putnam Growth & Income Value Fund o EQ/Putnam International Equity Fund o EQ/Putnam Investors Growth Fund o FI Mid Cap Fund o FI Small/Mid Cap Value Fund o JP Morgan Core Bond Fund o Lazard Large Cap Value Fund o Lazard Small Cap Value Fund o Mercury Basic Value Equity Fund o Mercury World Strategy Fund o MFS Emerging Growth Companies Fund o MFS Growth with Income Fund o MFS Research Fund o Morgan Stanley Emerging Markets Equity Fund No. 94ICB Data page 2 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION (SEE SECTION 3.01) ----------------------------- o GUARANTEE PERIODS (CLASS II) EXPIRATION DATE AND GUARANTEED RATE February 15, 2002 February 15, 2003 February 15, 2004 February 15, 2005 February 15, 2006 February 15, 2007 February 15, 2008 February 15, 2009 February 15, 2010 February 15, 2011 ------------------------- TOTAL: $25,000.00 Investment Options shown are Investment Funds of our Separate Account No. 49 and Guarantee Periods shown are in the Guaranteed Period Account. See Endorsement Applicable to Market Value Adjustment Terms. "TYPES" OF INVESTMENT OPTIONS (SEE SECTION 4.02): Not applicable GUARANTEED INTEREST ACCOUNT (SEE SECTION 2.01): Not available under this Certificate. BUSINESS DAY (SEE SECTION 1.05): A Business Day for this Certificate will mean generally any day on which the New York Stock Exchange is open for trading. PROCESSING DATES (SEE SECTION 1.20): A Processing Date is each Contract Date anniversary. No. 94ICB Data page 2a (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) AVAILABILITY OF INVESTMENT OPTIONS (SEE SECTION 2.04): (See Data pages, Part C; Allocation Restrictions) ALLOCATION OF CONTRIBUTIONS (SEE SECTION 3.01): Except as indicated below, your initial and any subsequent Contributions are allocated according to your instructions. Money Market Fund Special Dollar Cost Averaging - You may elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time subject to the Contribution Limits described in the Data Pages of this Certificate. You may elect to make subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program. The minimum subsequent contribution amount that may be made to an existing program is $250. Amounts will be transferred monthly over a twelve month period from the Alliance Money Market Fund to the other Investment Options based on the percentages you selected at the start of the Money Market Fund Special Dollar Cost Averaging program. Subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program will not extend the expiration date of that program. You may have only one Special Dollar Cost Averaging program in effect at any given time. At the expiration of the Money Market Fund Special Dollar Cost Averaging program, you may start a new program. If you elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time after this Certificate has been issued, the minimum contribution to be initially allocated to that program is $2,000. (See Data Pages, Part C; Allocation Restrictions) CONTRIBUTION LIMITS (SEE SECTION 3.02): We will only accept transfers from a defined benefit plan or a change of investment vehicles in the plan. Initial Contribution minimum: $25,000. Subsequent Contribution minimum: $1,000. Subsequent Contributions can be made at any time up until the Annuitant attains age 76. We may refuse to accept any Contribution if the sum of all Contributions under all accumulation Certificates with the same Annuitant would then total more than $1,500,000. We reserve the right to limit aggregate Contributions made after the first Contract Year to 150% of first year Contributions. We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable Life annuity accumulation certificates/contracts that you own would then total more than $2,500,000. TRANSFER RULES (SEE SECTION 4.02): You may not transfer Annuity Account Value into the Money Market Fund Special Dollar Cost Averaging program. Any request by you to transfer amounts out of the Alliance Money Market Fund, other than your regularly scheduled transfers to the Investment Options as part of the Money Market Fund Special Dollar Cost Averaging program, will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amount remaining in the Alliance Money Market Fund after such a transfer will be transferred to your other Investment Options according to your then current allocation instructions. No. 94ICB Sel-SSDCA Data page 3 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF WITHDRAWALS (SEE SECTION 5.01): Lump Sum Withdrawals - You must provide withdrawal instructions indicating from which Investment Options the Lump Sum Withdrawal will be taken; Minimum Distribution Withdrawals - Unless you specify otherwise, Minimum Distribution Withdrawals will be withdrawn on a pro rata basis from your Annuity Account Value in the Investment Funds. If there is insufficient value or no value in the Investment Funds, any additional amount of the withdrawal required or the total amount of the withdrawal, as applicable, will be withdrawn from the Guarantee Periods in order of the earliest Expiration Date(s) first. Any withdrawal from the Alliance Money Market Fund while participating in the Money Market Fund Special Dollar Cost Averaging program will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amounts remaining in the Alliance Money Market Fund after such a withdrawal will be transferred to your other Investment Options according to your then current allocation instructions. WITHDRAWAL RESTRICTIONS (SEE SECTION 5.01): Minimum Distribution Withdrawals - May be elected in the year in which you attain age 70 1/2 or at a later date. Minimum Distribution Withdrawals will be made annually. MINIMUM WITHDRAWAL AMOUNT (SEE SECTION 5.01): Lump Sum Withdrawals minimum - $1,000; Minimum Distribution Withdrawals minimum - $250. MINIMUM AMOUNT OF ANNUITY ACCOUNT VALUE AFTER A WITHDRAWAL (SEE SECTION 5.02): Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Certificate). We will NOT exercise our rights, described in Sections 5.02(b) and 5.02(c), to terminate the Certificate. DEATH BENEFIT AMOUNT (SEE SECTION 6.01): The death benefit is equal to the Annuity Account Value or, if greater, the Guaranteed Minimum Death Benefit defined below. Guaranteed Minimum Death Benefit Annual Ratchet to Age 80 - On the Contract Date, the Guaranteed Minimum Death Benefit is equal to the initial Contribution. Thereafter, on each Contract Date anniversary through the Annuitant's age 80, if the Annuity Account Value is greater than the current Guaranteed Minimum Death Benefit, the Guaranteed Minimum Death Benefit is reset to equal the Annuity Account Value. The Guaranteed Minimum Death Benefit is also adjusted for any subsequent Contributions and withdrawals. Each withdrawal will cause a reduction in your current Guaranteed Minimum Death Benefit on a pro rata basis. No. 94ICB Sel-SSDCA Data page 4 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) NORMAL FORM OF ANNUITY (SEE SECTION 7.04): The Normal Form of Annuity is Life Annuity 10 Year Period Certain or Joint and Survivor Life Annuity 10 Year Period Certain for annuitization ages up to age 79. For annuitization ages 80 and older, the following applies: Annuitization Age Length of Period Certain ----------------- ------------------------ 80 through 81 9 82 through 83 8 84 through 86 7 87 through 89 6 90 5 The maximum annuitization age varies by issue age and is shown on Data page 1. AMOUNT OF ANNUITY BENEFIT (SEE SECTION 7.05): The amount applied to provide the Annuity Benefit will be the Annuity Account Value. INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX (SEE SECTION 7.06): 6% per year MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY (SEE SECTION 7.06): $2,000, as well as minimum of $20 for initial monthly annuity payment. GUARANTEED MINIMUM INCOME BENEFIT (SEE SECTION 7.08): If the Annuitant has converted the Certificate to a traditional IRA certificate, the Annuitant may apply the Annuity Account Value during the period of time indicated below to purchase a minimum amount of guaranteed lifetime income under either (i) our fixed Life Annuity payout option or (ii) our Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate. Other options may be available at the time of exercise. The Life Annuity payout option provides annuity payments while the Annuitant is living. Payments end with the last payment made before the Annuitant's death. Our fixed Joint and Survivor Life Annuity payout option is also available. Payments under the Joint and Survivor Life Annuity payout option end with the last payment made before the surviving Annuitant's death. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate provides payments during a period certain with payments continuing for life thereafter. The period certain is based on the Annuitant's age at the time the Income Manager (Life Annuity with a Period Certain) payout annuity is elected. The period certain is 10 years for ages 60 through 75; 9 years for age 76; 8 years for age 77; 7 years for ages 78 through 83; 6 years for age 84; and 5 years for age 85. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity is also available on a joint and survivor basis. The following paragraphs describe the conditions for exercise of the Guaranteed Minimum Income Benefit. No. 94ICB (10/99) Data page 5 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The Guaranteed Minimum Income Benefit is available only if it is exercised within 30 days following the 10th or later Contract Date anniversary under this Certificate. However, it may not be exercised later than the Annuitant's age 85. On the Transaction Date that the Annuitant exercises the Guaranteed Minimum Income Benefit, the lifetime income that will be provided under the payout option selected will be the greater of (i) the Guaranteed Minimum Income Benefit, and (ii) the amount of income that would be provided by application of the Annuity Account Value as of the Transaction Date at our then current annuity purchase factors. Guaranteed Minimum Income Benefit Benefit Base - The Guaranteed Minimum Income Benefit benefit base is equal to the initial Contribution on the Contract Date. Thereafter, the Guaranteed Minimum Income Benefit benefit base is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund and the Guarantee Periods) through the Annuitant's age 80, and 0% thereafter. The Guaranteed Minimum Income Benefit benefit base interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Income Benefit benefit base is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Income Benefit benefit base is applied to guaranteed minimum annuity purchase factors to determine the Guaranteed Minimum Income Benefit. The guaranteed minimum annuity purchase factors are shown in the attached table. The Guaranteed Minimum Income Benefit benefit base does not create an Annuity Account Value or a Cash Value and is used solely for purposes of calculating the Guaranteed Minimum Income Benefit. The current Guaranteed Minimum Income Benefit benefit base will be reduced on a dollar-for-dollar basis as long as the sum of the withdrawals in any Contract Year is 5% or less of the beginning of Contract Year Guaranteed Minimum Death Benefit (described above). Once a withdrawal is made that causes cumulative withdrawals in a Contract Year to exceed 5% of the beginning of Contract Year Guaranteed Minimum Death Benefit, that withdrawal and any subsequent withdrawals in that Contract Year will cause a pro rata reduction to occur. WITHDRAWAL CHARGES (SEE SECTION 8.01): None No. 94ICB (10/99) Data page 6 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) CHARGES DEDUCTED FROM ANNUITY ACCOUNT VALUE (SEE SECTION 8.02): (a) Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit Charge: For providing the Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit we will deduct annually on each Processing Date an amount equal to 0.30% of the Guaranteed Minimum Income Benefit benefit base (described above) in effect on such Processing Date. 0.30% is the maximum we will charge. (b) Charges for State Premium and Other Applicable Taxes: A charge for applicable taxes, such as state or local premium taxes generally will be deducted from the amount applied to provide an Annuity Benefit under Section 7.02. In certain states, however, we may deduct the charge from Contributions rather than at the Annuity Commencement Date. The above charges will be deducted from the Annuity Account Value in the Investment Funds on a pro rata basis. If there is insufficient value in the Investment Funds, all or a portion of the charges will be deducted from the Annuity Account Value with respect to the Guarantee Periods in order of the earliest Expiration Date(s) first. NUMBER OF FREE TRANSFERS (SEE SECTION 8.03): Unlimited DAILY SEPARATE ACCOUNT CHARGES (SEE SECTION 8.04): Mortality and Expense Risks Charge: Current and Maximum Annual rate of 1.10% (equivalent to a daily rate of 0.003032%). Administration Charge: Current and Maximum Annual rate of 0.25%(equivalent to a daily rate of 0.000692%). We reserve the right to increase this charge to an annual rate of 0.35%. Distribution Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000695%). No. 94ICB Data page 7 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART C -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT APPLICABLE ------ TO MARKET VALUE ADJUSTMENT TERMS (MVA ENDORSEMENT). ALLOCATION RESTRICTIONS (SEE SECTION 3.01): If the Annuitant is age 76 or older, allocations may be made only to Guarantee Periods with maturities of five years or less; however, in no event may allocations be made to Guarantee Periods with maturities beyond the February 15th immediately following the Annuity Commencement Date. TRANSFERS AT EXPIRATION DATE (SEE ITEM 1 OF MVA ENDORSEMENT): If no election is made with respect to amounts in the Guaranteed Period Account as of the Expiration Date, such amounts will be transferred into the Guarantee Period with the earliest Expiration Date. MARKET VALUE ADJUSTMENT (MVA) ON TRANSFERS AND WITHDRAWALS (SEE ITEM 2 OF MVA ENDORSEMENT): The MVA (positive or negative) resulting from a withdrawal or transfer of a portion of the amount in a Guarantee Period will be a percentage of the MVA that would be applicable upon a withdrawal of all of the Annuity Account Value from a Guarantee Period. This percentage is determined by (i) dividing the amount of the withdrawal or transfer from the Guarantee Period by (ii) the Annuity Account Value in such Guarantee Period prior to the withdrawal or transfer. TRANSFER RULES (SEE SECTION 4.02): Transfers may not be made to a Guarantee Period maturing in the current calendar year. Guarantee Periods to which transfers may be made are limited based on the attained age of the Annuitant (see Allocation Restrictions above). MVA FORMULA (SEE ITEM 3 OF MVA ENDORSEMENT): The Guaranteed Rate for new allocations to a Guarantee Period is the rate we have in effect for this purpose even if new allocations to that Guarantee Period would not be accepted at the time. This rate will not be less than 3%. The current rate percentage we use in item (c) of the formula is 0.00%. For purposes of calculating the MVA only, we reserve the right to add up to 0.25% to such current rate percentage. SEPARATE ACCOUNT (SEE ITEM 5 OF MVA ENDORSEMENT): The portion of the assets of Separate Account No. 46 equal to the reserves and other contract liabilities will not be chargeable with liabilities which arise out of any other business we conduct. No. 94ICBMVA Data page 8 (5/99) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT TABLE OF GUARANTEED MINIMUM ANNUITY PURCHASE FACTORS FOR A TRADITIONAL IRA CERTIFICATE FOR INITIAL LEVEL ANNUAL INCOME SINGLE LIFE - MALE PURCHASE FACTORS -------------------------------------- LIFE ANNUITY WITH ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ------------ ---------------- ------------ 60 4.93% 5.15% 61 5.02 5.26 62 5.11 5.38 63 5.20 5.51 64 5.30 5.64 65 5.40 5.79 66 5.50 5.94 67 5.60 6.10 68 5.71 6.27 69 5.81 6.45 70 5.91 6.64 71 6.02 6.84 72 6.12 7.06 73 6.21 7.28 74 6.31 7.51 75 6.41 7.76 76 6.69 8.03 77 7.02 8.31 78 7.38 8.61 79 7.53 8.93 80 7.67 9.27 81 7.81 9.64 82 7.94 10.02 83 8.05 10.43 84 8.60 10.87 85 9.25 11.34 Other forms of annuities may be available. No. 94ICB (10/99) Data page 9 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] EQUITABLE ACCUMULATOR SELECT TSA DATA PART A -- THIS PART LISTS YOUR PERSONAL DATA. ------ OWNER: John Doe ANNUITANT: John Doe Age: 61 Sex: Male CONTRACT: GROUP ANNUITY CONTRACT NO. AC 6727 CERTIFICATE NUMBER: 00000 ENDORSEMENTS ATTACHED: Minimum Income Benefit Endorsement Endorsement Applicable to TSA Certificates Endorsement Applicable to Market Value Adjustment Terms Rider to Endorsement Applicable to Market Value Adjustment Terms ISSUE DATE: January 8, 2001 CONTRACT DATE: January 8, 2001 ANNUITY COMMENCEMENT DATE: March 20, 2025 THE MAXIMUM MATURITY AGE IS AGE 90 -- SEE SECTION 7.03. The Annuity Commencement Date may not be later than the Processing Date which follows the Annuitant's 90th birthday. However, if you choose a date later than age 70 1/2, distribution of at least the minimum payments required must commence by April 1 of the calendar year following the calendar year in which you attain age 70 1/2 (except as otherwise indicated in item 8 of the Endorsement Applicable to TSA Certificates). GUARANTEED BENEFITS: Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit (Annual Ratchet to Age 80) BENEFICIARY: Jane Doe No. 94ICB-TSA1 Data page 1 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART B -- THIS PART DESCRIBES CERTAIN PROVISIONS OF YOUR CERTIFICATE. ------ INITIAL CONTRIBUTION RECEIVED (SEE SECTION 3.02): $25,000.00 INVESTMENT OPTIONS AVAILABLE (SEE PART II); YOUR ALLOCATION IS ALSO SHOWN. INVESTMENT OPTIONS ALLOCATION (SEE SECTION 3.01) ------------------ ----------------------------- o Alliance Common Stock Fund $25,000.00 o Alliance High Yield Fund o Alliance Money Market Fund o Alliance Small Cap Growth Fund o Capital Guardian International Fund o Capital Guardian Research Fund o Capital Guardian U.S. Equity Fund o EQ Equity 500 Index Fund o EQ International Equity Index Fund o EQ Small Company Index Fund o EQ/Aggressive Stock Fund o EQ/Alliance Premier Growth Fund o EQ/Alliance Technology Fund o EQ/Evergreen Foundation Fund o EQ/Evergreen Fund o EQ/Janus Large Cap Growth Fund o EQ/Putnam Growth & Income Value Fund o EQ/Putnam International Equity Fund o EQ/Putnam Investors Growth Fund o FI Mid Cap Fund o FI Small/Mid Cap Value Fund o JP Morgan Core Bond Fund o Lazard Large Cap Value Fund o Lazard Small Cap Value Fund o Mercury Basic Value Equity Fund o Mercury World Strategy Fund o MFS Emerging Growth Companies Fund o MFS Growth with Income Fund o MFS Research Fund o Morgan Stanley Emerging Markets Equity Fund No. 94ICB-TSA1 Data page 2 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION (SEE SECTION 3.01) ----------------------------- o GUARANTEE PERIODS (CLASS II) EXPIRATION DATE AND GUARANTEED RATE February 15, 2002 February 15, 2003 February 15, 2004 February 15, 2005 February 15, 2006 February 15, 2007 February 15, 2008 February 15, 2009 February 15, 2010 February 15, 2011 ------------------------------ TOTAL: $25,000.00 Investment Options shown are Investment Funds of our Separate Account No. 49 and Guarantee Periods shown are in the Guaranteed Period Account. See Endorsement Applicable to Market Value Adjustment Terms. "TYPES" OF INVESTMENT OPTIONS (SEE SECTION 4.02): Not applicable GUARANTEED INTEREST ACCOUNT (SEE SECTION 2.01): Not available under this Certificate. ANNUITY ACCOUNT VALUE (SEE SECTION 1.02): If a loan is outstanding, Annuity Account Value means the sum of the amounts in the Investment Options, plus any amount in the Loan Reserve Account. BUSINESS DAY (SEE SECTION 1.05): A Business Day for this Certificate will mean generally any day on which the New York Stock Exchange is open for trading. PROCESSING DATES (SEE SECTION 1.20): A Processing Date is each Contract Date anniversary. No. 94ICB-TSA1 Data page 2a [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF CONTRIBUTIONS (SEE SECTION 3.01): Except as indicated below, your initial and any subsequent Contributions are allocated according to your instructions. Money Market Fund Special Dollar Cost Averaging - You may elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time subject to the Contribution Limits described in the Data Pages of this Certificate. You may elect to make subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program. The minimum subsequent contribution amount that may be made to an existing program is $250. Amounts will be transferred monthly over a twelve month period from the Alliance Money Market Fund to the other Investment Options based on the percentages you selected at the start of the Money Market Fund Special Dollar Cost Averaging program. Subsequent Contributions to an existing Money Market Fund Special Dollar Cost Averaging program will not extend the expiration date of that program. You may have only one Special Dollar Cost Averaging program in effect at any given time. At the expiration of the Money Market Fund Special Dollar Cost Averaging program, you may start a new program. If you elect to participate in the Money Market Fund Special Dollar Cost Averaging program at any time after this Certificate has been issued, the minimum contribution to be initially allocated to that program is $2,000. (See Data Pages, Part C; Allocation Restrictions) CONTRIBUTION LIMITS (SEE SECTION 3.02): The only Contributions we will accept are rollover and direct transfer Contributions described in the second sentence of item 5 in the Endorsement Applicable to TSA Certificates. We will not accept Contributions from employers. The second paragraph of item 5 in the Endorsement does not apply. Your initial Contribution must be at least $25,000. Subsequent rollover or direct transfer Contributions may be made in an amount of at least $1,000. Rollover and direct transfer Contributions may be made at any time until you attain age . However, any amount contributed after you attain age 70 1/2 must be net of your required minimum distribution for the year in which the rollover or direct transfer Contribution is made (see item 8 Required Minimum Distributions in Endorsement Applicable to TSA Certificates). We may refuse to accept any Contribution if the sum of all Contributions under all accumulation Certificates with the same Annuitant would then total more than $1,500,000. We reserve the right to limit aggregate Contributions made after the first Contract Year to 150% of first year Contributions. We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable annuity accumulation certificates/contracts that you own would then total more than $2,500,000. TRANSFER RULES (SEE SECTION 4.02): You may not transfer Annuity Account Value into the Money Market Fund Special Dollar Cost Averaging program. Any request by you to transfer amounts out of the Alliance Money Market Fund, other than your regularly scheduled transfers to the Investment Options as part of the Money Market Fund Special Dollar Cost Averaging program, will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amount remaining in the Alliance Money Market Fund after such a transfer will be transferred to your other Investment Options according to your then current allocation instructions. No. 94ICB Sel-SSDCA Data page 3 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) ALLOCATION OF WITHDRAWALS (SEE SECTION 5.01): Lump Sum Withdrawals - You must provide withdrawal instructions indicating from which Investment Options the Lump Sum Withdrawal will be taken; Minimum Distribution Withdrawals - Unless you specify otherwise, Minimum Distribution Withdrawals will be withdrawn on a pro rata basis from your Annuity Account Value in the Investment Funds. If there is insufficient value or no value in the Investment Funds, any additional amount of the withdrawal required or the total amount of the withdrawal, as applicable, will be withdrawn from the Guarantee Periods in order of the earliest Expiration Date(s) first. Any withdrawal from the Alliance Money Market Fund while participating in the Money Market Fund Special Dollar Cost Averaging program will terminate that Money Market Fund Special Dollar Cost Averaging program. Any amounts remaining in the Alliance Money Market Fund after such a withdrawal will be transferred to your other Investment Options according to your then current allocation instructions. WITHDRAWAL RESTRICTIONS (SEE SECTION 5.01): Minimum Distribution Withdrawals - May be elected in the year in which you attain age 70 1/2 or at a later date. Minimum Distribution Withdrawals will be made annually. MINIMUM WITHDRAWAL AMOUNT (SEE SECTION 5.01): Lump Sum Withdrawals minimum - $1,000; Minimum Distribution Withdrawals minimum - $250. MINIMUM AMOUNT OF ANNUITY ACCOUNT VALUE AFTER A WITHDRAWAL (SEE SECTION 5.02): Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Certificate). If there is a loan outstanding, the amount withdrawn will be limited such that the Cash Value remaining after a withdrawal is equal to at least 10% of the outstanding loan amount. We will NOT exercise our rights, described in Sections 5.02(b) and 5.02(c), to terminate the Certificate. DEATH BENEFIT AMOUNT (SEE SECTION 6.01): The death benefit is equal to the Annuity Account Value or, if greater, the Guaranteed Minimum Death Benefit defined below. Guaranteed Minimum Death Benefit Annual Ratchet to Age 80 - On the Contract Date, the Guaranteed Minimum Death Benefit is equal to the initial Contribution. Thereafter, on each Contract Date anniversary through your age 80, if the Annuity Account Value is greater than the current Guaranteed Minimum Death Benefit, the Guaranteed Minimum Death Benefit is reset to equal the Annuity Account Value. The Guaranteed Minimum Death Benefit is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Death Benefit will be reduced by any outstanding loan balance and accrued interest. No. 94ICB Sel-SSDCA Data page 4 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) Each withdrawal will cause a reduction in your current Guaranteed Minimum Death Benefit on a pro rata basis. NORMAL FORM OF ANNUITY (SEE SECTION 7.04): The Normal Form of Annuity is Life Annuity 10 Year Period Certain or Joint and Survivor Life Annuity 10 Year Period Certain for annuitization ages up to age 79. For annuitization ages 80 and older, the following applies: Annuitization Age Length of Period Certain ----------------- ------------------------ 80 through 81 9 82 through 83 8 84 through 86 7 87 through 89 6 90 5 The maximum annuitization age varies by issue age and is shown on Data page 1. AMOUNT OF ANNUITY BENEFIT (SEE SECTION 7.05): The amount applied to provide the Annuity Benefit will be the Annuity Account Value. INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX (SEE SECTION 7.06): 6% per year MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY (SEE SECTION 7.06): $2,000, as well as minimum of $20 for initial monthly annuity payment. GUARANTEED MINIMUM INCOME BENEFIT (SEE SECTION 7.08): If the Annuitant has converted the Certificate to a traditional IRA certificate, the Annuitant may apply the Annuity Account Value during the period of time indicated below to purchase a minimum amount of guaranteed lifetime income under either (i) our fixed Life Annuity payout option or (ii) our Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate. Other options may be available at the time of exercise. The Life Annuity payout option provides annuity payments while the Annuitant is living. Payments end with the last payment made before the Annuitant's death. Our fixed Joint and Survivor Life Annuity payout option is also available. Payments under the Joint and Survivor Life Annuity payout option end with the last payment made before the surviving Annuitant's death. No. 94ICB-TSA1 (10/99) Data page 5 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The Income Manager (Life Annuity with a Period Certain) level payment payout annuity Certificate provides payments during a period certain with payments continuing for life thereafter. The period certain is based on the Annuitant's age at the time the Income Manager (Life Annuity with a Period Certain) payout annuity is elected. The period certain is 10 years for ages 60 through 75; 9 years for age 76; 8 years for age 77; 7 years for ages 78 through 83; 6 years for age 84; and 5 years for age 85. The Income Manager (Life Annuity with a Period Certain) level payment payout annuity is also available on a joint and survivor basis. The following paragraphs describe the conditions for exercise of the Guaranteed Minimum Income Benefit. The Guaranteed Minimum Income Benefit is available only if it is exercised within 30 days following the 10th or later Contract Date anniversary under this Certificate. However, it may not be exercised later than the Annuitant's age 85. On the Transaction Date that the Annuitant exercises the Guaranteed Minimum Income Benefit, the lifetime income that will be provided under the payout option selected will be the greater of (i) the Guaranteed Minimum Income Benefit, and (ii) the amount of income that would be provided by application of the Annuity Account Value as of the Transaction Date at our then current annuity purchase factors. Guaranteed Minimum Income Benefit Benefit Base - The Guaranteed Minimum Income Benefit benefit base is equal to the initial Contribution on the Contract Date. Thereafter, the Guaranteed Minimum Income Benefit benefit base is credited each day with interest at an annual effective rate of 5% (3% for amounts in the Alliance Money Market Fund, the Guarantee Periods and the Loan Reserve Account) through the Annuitant's age 80, and 0% thereafter. The Guaranteed Minimum Income Benefit benefit base interest applicable to amounts in the Alliance Money Market Fund under the Special Dollar Cost Averaging program, if applicable, will be 5%. The Guaranteed Minimum Income Benefit benefit base is also adjusted for any subsequent Contributions and withdrawals. The Guaranteed Minimum Income Benefit benefit base will also be reduced by any outstanding loan balance remaining on the Transaction Date that the Annuitant exercises the Guaranteed Minimum Income Benefit. The Guaranteed Minimum Income Benefit benefit base is applied to guaranteed minimum annuity purchase factors to determine the Guaranteed Minimum Income Benefit. The guaranteed minimum annuity purchase factors are shown in the attached table. The Guaranteed Minimum Income Benefit benefit base does not create an Annuity Account Value or a Cash Value and is used solely for purposes of calculating the Guaranteed Minimum Income Benefit. No. 94ICB-TSA1 (10/99) Data page 6 (rev 3/00 bB) [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) The current Guaranteed Minimum Income Benefit benefit base will be reduced on a dollar-for-dollar basis as long as the sum of the withdrawals in any Contract Year is 5% or less of the beginning of Contract Year Guaranteed Minimum Death Benefit (described above). Once a withdrawal is made that causes cumulative withdrawals in a Contract Year to exceed 5% of the beginning of Contract Year Guaranteed Minimum Death Benefit, that withdrawal and any subsequent withdrawals in that Contract Year will cause a pro rata reduction to occur. WITHDRAWAL CHARGES (SEE SECTION 8.01): None CHARGES DEDUCTED FROM ANNUITY ACCOUNT VALUE (SEE SECTION 8.02): (a) Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit Charge: For providing the Combined Guaranteed Minimum Income Benefit and Guaranteed Minimum Death Benefit we will deduct annually on each Processing Date an amount equal to 0.30% of the Guaranteed Minimum Income Benefit benefit base (described above) in effect on such Processing Date. 0.30% is the maximum we will charge. (b) Charges for State Premium and Other Applicable Taxes: A charge for applicable taxes, such as state or local premium taxes generally will be deducted from the amount applied to provide an Annuity Benefit under Section 7.02. In certain states, however, we may deduct the charge from Contributions rather than at the Annuity Commencement Date. The above charges will be deducted from the Annuity Account Value in the Investment Funds on a pro rata basis. If there is insufficient value in the Investment Funds, all or a portion of the charges will be deducted from the Annuity Account Value with respect to the Guarantee Periods in order of the earliest Expiration Date(s) first. NUMBER OF FREE TRANSFERS (SEE SECTION 8.03): Unlimited DAILY SEPARATE ACCOUNT CHARGES (SEE SECTION 8.04): Mortality and Expense Risks Charge: Current and Maximum Annual rate of 1.10% (equivalent to a daily rate of 0.003032%). No. 94ICB-TSA1 Data page 7 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) Administration Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000692%). We reserve the right to increase this charge to an annual rate of 0.35%. Distribution Charge: Current and Maximum Annual rate of 0.25% (equivalent to a daily rate of 0.000695%). No. 94ICB-TSA1 Data page 8 DATA PAGES (CONT'D) PART C -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT APPLICABLE TO ------ MARKET VALUE ADJUSTMENT TERMS (MVA ENDORSEMENT). ALLOCATION RESTRICTIONS (SEE SECTION 3.01): If you are age 76 or older, allocations may be made only to Guarantee Periods with maturities of five years or less; however, in no event may allocations be made to Guarantee Periods with maturities beyond the February 15th immediately following the Annuity Commencement Date. TRANSFERS AT EXPIRATION DATE (SEE ITEM 1 OF MVA ENDORSEMENT): If no election is made with respect to amounts in the Guaranteed Period Account as of the Expiration Date, such amounts will be transferred into the Guarantee Period with the earliest Expiration Date. MARKET VALUE ADJUSTMENT (MVA) ON TRANSFERS AND WITHDRAWALS (SEE ITEM 2 OF MVA ENDORSEMENT): The MVA (positive or negative) resulting from a withdrawal or transfer of a portion of the amount in a Guarantee Period will be a percentage of the MVA that would be applicable upon a withdrawal of all of the Annuity Account Value from a Guarantee Period. This percentage is determined by (i) dividing the amount of the withdrawal or transfer from the Guarantee Period by (ii) the Annuity Account Value in such Guarantee Period prior to the withdrawal or transfer. TRANSFER RULES (SEE SECTION 4.02): Transfers may not be made to a Guarantee Period maturing in the current calendar year. Guarantee Periods to which transfers may be made are limited based on your attained age (see Allocation Restrictions above). MVA FORMULA (SEE ITEM 3 OF MVA ENDORSEMENT): The Guaranteed Rate for new allocations to a Guarantee Period is the rate we have in effect for this purpose even if new allocations to that Guarantee Period would not be accepted at the time. This rate will not be less than 3%. The current rate percentage we use in item (c) of the formula is 0.00%. For purposes of calculating the MVA only, we reserve the right to add up to 0.25% to such current rate percentage. SEPARATE ACCOUNT (SEE ITEM 5 OF MVA ENDORSEMENT): The portion of the assets of Separate Account No. 46 equal to the reserves and other contract liabilities will not be chargeable with liabilities which arise out of any other business we conduct. No. 94ICBMVA-TSA1 Data page 9 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) PART D -- THIS PART LISTS THE TERMS WHICH APPLY TO THE ENDORSEMENT APPLICABLE ------ TO TSA CERTIFICATES (TSA ENDORSEMENT). LOAN RESERVE ACCOUNT (SEE ITEM 10(D) OF TSA ENDORSEMENT): On the Loan Effective Date, we will transfer to the Loan Reserve Account only an amount equal to the amount of the loan (instead of 110% of such amount, as described in the TSA Endorsement). DEFAULT (SEE ITEM 10(G) OF TSA ENDORSEMENT): By each repayment date, if the amount of the loan payment is less than the amount due or the loan payment is not received at our Processing Office, pursuant to our rights described in the TSA Endorsement, we will treat the amount of the unpaid balance of the loan at that time, including interest due but not paid, as a deemed distribution for Federal income tax purposes. No. 94ICB-TSA1 Data page 10 [GRAPHIC OF WORD "SPECIMEN"] DATA PAGES (CONT'D) GUARANTEED MINIMUM INCOME BENEFIT TABLE OF GUARANTEED MINIMUM ANNUITY PURCHASE FACTORS FOR A TRADITIONAL IRA CERTIFICATE FOR INITIAL LEVEL ANNUAL INCOME SINGLE LIFE - MALE
PURCHASE FACTORS --------------------------------------------------- LIFE ANNUITY WITH ELECTION AGE A PERIOD CERTAIN LIFE ANNUITY ------------ ---------------- ------------ 60 4.93% 5.15% 61 5.02 5.26 62 5.11 5.38 63 5.20 5.51 64 5.30 5.64 65 5.40 5.79 66 5.50 5.94 67 5.60 6.10 68 5.71 6.27 69 5.81 6.45 70 5.91 6.64 71 6.02 6.84 72 6.12 7.06 73 6.21 7.28 74 6.31 7.51 75 6.41 7.76 76 6.69 8.03 77 7.02 8.31 78 7.38 8.61 79 7.53 8.93 80 7.67 9.27 81 7.81 9.64 82 7.94 10.02 83 8.05 10.43 84 8.60 10.87 85 9.25 11.34
Other forms of annuities may be available. No. 94ICB-TSA1 (10/99) Data page 11 (rev 3/00 bB)