-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PJ0nTh4J2e10PnmaKkEpu7UOz0jsloUwAa4nAlSgcLrV7yyJ2TXeSJUHgJJBHxLs GkDnKsSTTgTPDsKz+MKSjg== 0000928385-02-003007.txt : 20020905 0000928385-02-003007.hdr.sgml : 20020905 20020905095723 ACCESSION NUMBER: 0000928385-02-003007 CONFORMED SUBMISSION TYPE: 485APOS PUBLIC DOCUMENT COUNT: 7 FILED AS OF DATE: 20020905 FILER: COMPANY DATA: COMPANY CONFORMED NAME: SEPARATE ACCOUNT VA-2L OF TRANSAMERICA OCCIDENTAL LIFE INS C CENTRAL INDEX KEY: 0000890041 IRS NUMBER: 951060502 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 485APOS SEC ACT: 1933 Act SEC FILE NUMBER: 033-49998 FILM NUMBER: 02757046 BUSINESS ADDRESS: STREET 1: 4333 EDGEWOOD ROAD NE CITY: CEDAR RAPIDS STATE: IA ZIP: 52499-0001 BUSINESS PHONE: 3192978121 MAIL ADDRESS: STREET 1: 4333 EDGEWOOD ROAD NE CITY: CEDAR RAPIDS STATE: IA ZIP: 52499-0001 FILER: COMPANY DATA: COMPANY CONFORMED NAME: SEPARATE ACCOUNT VA-2L OF TRANSAMERICA OCCIDENTAL LIFE INS C CENTRAL INDEX KEY: 0000890041 IRS NUMBER: 951060502 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 485APOS SEC ACT: 1940 Act SEC FILE NUMBER: 811-07042 FILM NUMBER: 02757047 BUSINESS ADDRESS: STREET 1: 4333 EDGEWOOD ROAD NE CITY: CEDAR RAPIDS STATE: IA ZIP: 52499-0001 BUSINESS PHONE: 3192978121 MAIL ADDRESS: STREET 1: 4333 EDGEWOOD ROAD NE CITY: CEDAR RAPIDS STATE: IA ZIP: 52499-0001 485APOS 1 d485apos.txt 485APOS As filed with the Securities and Exchange Commission on September 5, 2002 Registration No. 33-49998 811-7042 --------------------------------------- SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 --------------------------------------- FORM N-4 REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 [ ] Pre-Effective Amendment No. __ [ ] Post-Effective Amendment No. 22 [x] -- and REGISTRATION STATEMENT UNDER THE INVESTMENT COMPANY ACT OF 1940 [ ] Amendment No. 23 [x] -- SEPARATE ACCOUNT VA-2L ---------------------- (Exact Name of Registrant) TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY ---------------------------------------------- (Name of Depositor) 4333 Edgewood Road NE, Cedar Rapids, IA 52499 --------------------------------------------- (Address of Depositor's Principal Executive Offices) Depositor's Telephone Number, including Area Code: (319) 297-8121 Name and Address of Agent for Service: Copy to: Frank A. Camp, Esquire Frederick R. Bellamy, Esquire Transamerica Occidental Life Insurance Co. Sutherland, Asbill & Brennan, LLP 4333 Edgewood Road, N.E. 1275 Pennsylvania Avenue, N.W. Cedar Rapids, Iowa 52499-0001 Washington, D.C. 20004-2402 Approximate date of proposed sale to the public: As soon as practicable after effectiveness of the Registration Statement. Title of Securities being registered: Variable Annuity Contracts It is proposed that this filing will become effective: [_] immediately upon filing pursuant to paragraph (b) [_] on ___________ pursuant to paragraph (b) [_] 60 days after filing pursuant to paragraph (a)(i) [X] on November 11, 2002 pursuant to paragraph (a)(1) If appropriate, check the following box: [_] This Post-Effective Amendment designates a new effective date for a previously filed Post-Effective Amendment. The Prospectuses and Statements of Additional Information of Separate Account VA-2L are hereby incorporated by reference to Form N-4 Registration Statement (33-49998 and 811-7042) filed on April 29, 2002. THE DREYFUS/TRANSAMERICA TRIPLE ADVANTAGE(R) VARIABLE ANNUITY Issued by TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY Supplement Dated November 11, 2002 to the Prospectus dated May 1, 2002 An optional "Liquidity Rider" is available for the Dreyfus/Transamerica Triple Advantage(R) Variable Annuity. You can elect this rider which reduces the number of years each purchase payment is subject to surrender charges. You can only elect this rider at the time you purchase your contract. There is an extra charge for this rider. The rights and benefits under the Liquidity Rider are summarized below. A copy of the rider is available upon request from Transamerica Occidental Life Insurance Company. All terms used that are not defined in this supplement shall have the same meanings as the same terms used in the prospectus. The Liquidity Rider may not be available in all states at the date of this supplement. Please contact Transamerica at (877) 717-8861 for additional information regarding the availability of the Liquidity Rider in your state. This Prospectus Supplement must be accompanied by the Prospectus for the Dreufys/Transamerica Triple Advantage(R) Variable Annuity Dated May 1, 2002 The following hereby amends, and to the extent inconsistent replaces, the corresponding Annuity Contract Fee Table in the prospectus. ================================================================================ ANNUITY CONTRACT FEE TABLE* ================================================================================ Contract Owner Transaction Expenses - -------------------------------------------------------------------------------- Sales Load On Purchase Payments .......................................... 0 Maximum Surrender Charge (as a % of purchase payments surrendered)/(1)/ ....................... 7% Annual Service Charge/(2)/ ........................... $0 - $35 Per Contract Transfer Fee/(3)/ ................................................. $0 - $10 Optional Rider Fees: - ------------------- Guaranteed Minimum Income Benefit Rider/(4)/. ......................... 0.45% (as an annual % of the minimum annuitization value on each contract anniversary) Tax Relief Rider/(5)/ ................................................. 0.25% (as an annual % of the account value on each rider anniversary) Variable Account Annual Expenses (as a percentage of average account value) - -------------------------------------------------------------------------------- Mortality and Expense Risk Charges/(6)/ .............................. 1.15% Administrative Charge ................................................ 0.15% ----- TOTAL VARIABLE ACCOUNT ANNUAL EXPENSES .................................................... 1.30% Optional Separate Account Expenses: - ---------------------------------- Double Enhanced Death Benefit/(7)/ ................................... 0.15% ----- Liquidity Rider/(8)/ ................................................. 0.40% ----- TOTAL SEPARATE ACCOUNT ANNUAL EXPENSES WITH HIGHEST OPTIONAL SEPARATE ACCOUNT EXPENSES/(9)/ ..................................... 1.85% - -------------------------------------------------------------------------------- Portfolio Annual Expenses/(10)/ (as a percentage of average net assets and after fee waivers and/or expense reimbursements) - -------------------------------------------------------------------------------- Total Rule Portfolio Management Other 12b-1 Annual Fees Expenses Fees/(11)(12)/ Expenses - -------------------------------------------------------------------------------- Transamerica Equity 0.75% 0.10% - 0.85% Appreciation 0.75% 0.10% 0.25% 1.10% Balanced/(13)/ 0.75% 0.16% 0.09% 1.00% Disciplined Stock/(13)/ 0.75% 0.13% 0.12% 1.00% Growth and Income/(13)/ 0.75% 0.12% 0.14% 1.01% International Equity 0.75% 0.47% 0.25% 1.47% International Value/(13)/ 0.80% 0.60% 0.00% 1.40% Limited Term High Income/(13)/ 0.65% 0.25% 0.01% 0.91% Money Market 0.50% 0.08% - 0.58% Quality Bond 0.65% 0.11% 0.25% 1.01% Small Cap 0.75% 0.11% 0.25% 1.11% Small Company Stock 0.75% 0.39% 0.25% 1.39% Special Value/(13)/ 0.74% 0.24% 0.02% 1.00% Stock Index 0.25% 0.07% 0.25% 0.57% Socially Responsible Growth 0.75% 0.09% 0.25% 1.09% Core Bond/(13)/ 0.43% 0.30% 0.07% 0.80% Core Value/(13)/ 0.73% 0.27% 0.00% 1.00% Emerging Leaders/(13)/ 0.74% 0.65% 0.11% 1.50% Emerging Markets/(13)/ 0.00% 2.00% 0.00% 2.00% European Equity/(13)/ 0.81% 0.44% 0.00% 1.25% Founders Discovery/(13)/ 0.79% 0.62% 0.08% 1.49% Founders Growth/(13)/ 0.65% 0.35% 0.00% 1.00% Founders International Equity/(13)/ 0.28% 1.22% 0.00% 1.50% Founders Passport/(13)/ 0.00% 1.50% 0.00% 1.50% Japan/(13)/ 0.00% 1.50% 0.00% 1.50% MidCap Stock/(13)/ 0.75% 0.17% 0.08% 1.00% Technology Growth 0.75% 0.20% 0.25% 1.20% ================================================================================ *Different contract fees and charges may apply to those contracts purchased prior to May 1, 2002. Check your contract for details. 2 /(1)/ The surrender charge, if any is imposed, applies to each contract, regardless of how account value is allocated among the variable account and the fixed account. The surrender charge is decreased based on the number of years since the purchase payment was made, from 7% in the year in which the purchase payment was made, to 0% in the eighth year after the purchase payment was made (the fifth year if the Liquidity Rider is elected). If applicable a surrender charge will only be applied to surrenders that exceed the amount available under certain listed exceptions. /(2)/ The service charge applies to the fixed account and the variable account, and is assessed on a pro rata basis relative to each account's account value as a percentage of the contract's total account value. The service charge is deducted on each contract anniversary and at the time of surrender. /(3)/ The transfer fee, if any is imposed, applies to each contract, regardless of how account value is allocated among the variable account and the fixed account. There is no fee for the first 18 transfers per year. For additional transfers, Transamerica may charge a fee of $10 per transfer, but currently does not charge for any transfers. /(4)/ The annual Guaranteed Minimum Income Benefit fee is 0.45% of the minimum annuitization value (as defined under "Guaranteed Minimum Income Benefit") and is deducted only during the accumulation phase. If you annuitize under the rider and elect the guaranteed minimum payment option, a guaranteed payment fee is deducted at an annual rate of 1.25%. See Section 5, Expenses. /(5)/ The annual Tax Relief Rider fee is 0.25% of the account value and is deducted only during the accumulation phase. /(6)/ The mortality and expense risk fee shown (1.15%) is for the "Return of Premium Death Benefit." /(7)/ The fee for the "Double Enhanced Death Benefit" is in addition to the mortality and expense risk fee of 1.15%. /(8)/ The fee for the Liquidity Rider is in addition to the mortality and expense risk fee (1.15%). This fee is only charged in the first four contract years. /(9)/ The Double Enhanced Death Benefit fee and the Liquidity Rider fee are included herein. The "Total Separate Account Annual Expenses" shown does not include fees for the Guaranteed Minimum Income Benefit or the Tax Relief Rider. Only mortality and expense risk fee and the administrative charge are applicable during the income phase of the Contract. /(10)/ The fee table information relating to the underlying funds is for the year 2001 (unless otherwise noted) and was provided to Transamerica by the underlying funds, their investment advisers or managers, and Transamerica has not and cannot independently verify the accuracy or completeness of such information. Actual expenses of the portfolios in future years and the current year may be greater or less than those shown in the Table. /(11)/ The Fees shown are for the Service Class Shares, except for the Money Market Portfolio and Transamerica Equity. Contracts purchased before January 22, 2001 generally are invested only in the Initial Class Shares. If you are invested in the Initial Class Shares of each portfolio, the Total Portfolio Annual Expenses would be lower, since the Initial Class Shares are not subject to a Rule 12b-1 Fee. Consult the portfolio prospectuses for more information. /(12)/ The Rule 12b-1 Fees deducted from the Service Class Shares of these portfolios cover certain distribution and shareholder support services provided by Transamerica Occidental Life Insurance Company selling contracts investing in those portfolios. The amount of the Rule 12b-1 Fee is 0.25% per year before any fee waivers and/or expense reimbursements. /(13)/ Total Portfolio Annual Expenses shown are net of any fee waiver and/or expense reimbursement. Without such waivers or reimbursement of expenses, the management fee, other expenses, 12b-1 fee, and Total Portfolio Annual Expenses would be as follows: 0.75%, 0.16%, 0.25%, 1.16% - Balanced; 0.75%, 0.13%, 0.25%, 1.13% - Disciplined Stock; 0.75%, 0.12%, 0.25%, 1.12% - Growth & Income; 1.00%, 0.74%, 0.25%, 1.99% - International Value; 0.65%, 0.25%, 0.25%, 1.15% - Limited Term High Income; 0.75%, 0.24%, 0.25%, 1.24% - Special Value; 0.60%, 0.30%, 0.25%, 1.15% - Core Bond; 0.75%, 0.27%, 0.25%, 1.27% - Core Value; 0.90%, 0.65%, 0.25%, 1.80% - Emerging Leaders; 1.25%, 4.14%, 0.25%, 5.64% - Emerging Markets; 1.00%, 0.52%, 0.25%, 1.77% - European Equity; 0.90%, 0.62%, 0.25%, 1.77% - Founders Discovery; 0.75%, 0.40%, 0.25%, 1.40% - Founders Growth; 1.00%, 1.30%, 0.25%, 2.55% - Founders International Equity; 1.00%, 2.81%, 0.25%, 4.06% - Founders Passport; 1.00%, 3.54%, 0.25%, 4.79% - Japan; and 0.75%, 0.17%, 0.25%, 1.17% - MidCap. 3 The following hereby amends, and to the extent inconsistent replaces, the Annuity Contract Fee Table Examples contained in the prospectus. EXAMPLES - TABLE B You would pay the following expenses on a $1,000 investment, assuming a hypothetical 5% annual return on assets, assuming the entire account value is in the applicable subaccount, assuming the Guaranteed Minimum Income Benefit, the Tax Relief Rider and the Liquidity Rider have all been selected: The expenses reflect different mortality and expense risk fees depending on which death benefit you select: A = Return of Premium Death Benefit B = Double Enhanced Death Benefit If you purchased your contract prior to May 1, 2002, the amount shown may vary.
==================================================================================================================================== If the Contract is annuitized at If the Contract is surrendered the end of the applicable time at the end of the applicable period or if the Contract is simply time period. kept in the accumulation phase. ---------------------------------------------------------------------------- Subaccounts 1 3 5 10 1 3 5 10 Year Years Years Years Year Years Years Years - ------------------------------------------------------------------------------------------------------------------------------------ Transamerica Equity A $102 $154 $171 $346 $33 $103 $171 $346 ---------------------------------------------------------------------------------- B $104 $158 $178 $360 $35 $107 $178 $360 - ------------------------------------------------------------------------------------------------------------------------------------ Appreciation A $105 $161 $183 $370 $36 $110 $183 $370 ---------------------------------------------------------------------------------- B $106 $165 $190 $383 $37 $114 $190 $383 - ------------------------------------------------------------------------------------------------------------------------------------ Balanced A $104 $158 $178 $360 $35 $107 $178 $360 ---------------------------------------------------------------------------------- B $105 $162 $185 $374 $36 $111 $185 $374 - ------------------------------------------------------------------------------------------------------------------------------------ Disciplined Stock A $104 $158 $178 $360 $35 $107 $178 $360 ---------------------------------------------------------------------------------- B $105 $162 $185 $374 $36 $111 $185 $374 - ------------------------------------------------------------------------------------------------------------------------------------ Growth and Income A $104 $158 $178 $361 $35 $107 $178 $361 ---------------------------------------------------------------------------------- B $106 $163 $186 $375 $36 $112 $186 $375 - ------------------------------------------------------------------------------------------------------------------------------------ International Equity A $109 $172 $200 $403 $40 $121 $200 $403 ---------------------------------------------------------------------------------- B $110 $176 $207 $416 $41 $125 $207 $416 - ------------------------------------------------------------------------------------------------------------------------------------ International Value A $108 $170 $197 $397 $39 $119 $197 $397 ---------------------------------------------------------------------------------- B $110 $174 $204 $410 $40 $123 $204 $410 - ------------------------------------------------------------------------------------------------------------------------------------ Limited Term High Income A $103 $155 $174 $352 $34 $104 $174 $352 ---------------------------------------------------------------------------------- B $104 $160 $181 $366 $35 $109 $181 $366 - ------------------------------------------------------------------------------------------------------------------------------------ Money Market A $ 99 $146 $157 $320 $31 $ 95 $157 $320 ---------------------------------------------------------------------------------- B $101 $150 $165 $335 $32 $ 99 $165 $335 - ------------------------------------------------------------------------------------------------------------------------------------ Quality Bond A $104 $158 $178 $361 $35 $107 $178 $361 ---------------------------------------------------------------------------------- B $106 $163 $186 $375 $36 $112 $186 $375 - ------------------------------------------------------------------------------------------------------------------------------------ Small Cap A $105 $161 $183 $370 $36 $110 $183 $370 ---------------------------------------------------------------------------------- B $107 $166 $190 $384 $37 $115 $190 $384 - ------------------------------------------------------------------------------------------------------------------------------------ Small Company Stock A $108 $169 $196 $396 $39 $118 $196 $396 ---------------------------------------------------------------------------------- B $110 $174 $204 $409 $40 $123 $204 $409 - ------------------------------------------------------------------------------------------------------------------------------------ Special Value A $104 $158 $178 $360 $35 $107 $178 $360 ---------------------------------------------------------------------------------- B $105 $162 $185 $374 $36 $111 $185 $374 - ------------------------------------------------------------------------------------------------------------------------------------ Stock Index A $ 99 $145 $157 $319 $31 $ 94 $157 $319 ---------------------------------------------------------------------------------- B $101 $150 $164 $334 $32 $ 99 $164 $334 - ------------------------------------------------------------------------------------------------------------------------------------ Socially Responsible Growth Fund A $105 $161 $182 $369 $36 $110 $182 $369 ---------------------------------------------------------------------------------- B $106 $165 $189 $382 $37 $114 $189 $382 - ------------------------------------------------------------------------------------------------------------------------------------ Core Bond A $102 $152 $168 $341 $33 $101 $168 $341 ---------------------------------------------------------------------------------- B $103 $156 $175 $355 $34 $105 $175 $355 - ------------------------------------------------------------------------------------------------------------------------------------ Core Value A $104 $158 $178 $360 $35 $107 $178 $360 ---------------------------------------------------------------------------------- B $105 $162 $185 $374 $36 $111 $185 $374 ====================================================================================================================================
4 EXAMPLES - TABLE B - continued...
==================================================================================================================================== If the Contract is annuitized at If the Contract is surrendered the end of the applicable time at the end of the applicable period or if the Contract is simply time period. kept in the accumulation phase. ---------------------------------------------------------------------------- Subaccounts 1 3 5 10 1 3 5 10 Year Years Years Years Year Years Years Years - ------------------------------------------------------------------------------------------------------------------------------------ Emerging Leaders A $109 $172 $202 $406 $40 $121 $202 $406 --------------------------------------------------------------------------------- B $111 $177 $209 $419 $41 $126 $209 $419 - ------------------------------------------------------------------------------------------------------------------------------------ Emerging Markets A $114 $187 $225 $449 $45 $136 $225 $449 --------------------------------------------------------------------------------- B $116 $191 $232 $461 $46 $140 $232 $461 - ------------------------------------------------------------------------------------------------------------------------------------ European Equity A $106 $165 $190 $383 $37 $114 $190 $383 --------------------------------------------------------------------------------- B $108 $170 $197 $397 $39 $119 $197 $397 - ------------------------------------------------------------------------------------------------------------------------------------ Founders Discovery A $109 $172 $201 $405 $40 $121 $201 $405 --------------------------------------------------------------------------------- B $111 $177 $208 $418 $41 $126 $208 $418 - ------------------------------------------------------------------------------------------------------------------------------------ Founders Growth A $104 $158 $178 $360 $35 $107 $178 $360 --------------------------------------------------------------------------------- B $105 $162 $185 $374 $36 $111 $185 $374 - ------------------------------------------------------------------------------------------------------------------------------------ Founders International Equity A $109 $172 $202 $406 $40 $121 $202 $406 --------------------------------------------------------------------------------- B $111 $177 $209 $419 $41 $126 $209 $419 - ------------------------------------------------------------------------------------------------------------------------------------ Founders Passport A $109 $172 $202 $406 $40 $121 $202 $406 --------------------------------------------------------------------------------- B $111 $177 $209 $419 $41 $126 $209 $419 - ------------------------------------------------------------------------------------------------------------------------------------ Japan A $109 $172 $202 $406 $40 $121 $202 $406 --------------------------------------------------------------------------------- B $111 $177 $209 $419 $41 $126 $209 $419 - ------------------------------------------------------------------------------------------------------------------------------------ MidCap Stock A $104 $158 $178 $360 $35 $107 $178 $360 --------------------------------------------------------------------------------- B $105 $162 $185 $374 $36 $111 $185 $374 - ------------------------------------------------------------------------------------------------------------------------------------ Technology Growth A $106 $164 $187 $379 $37 $113 $187 $379 --------------------------------------------------------------------------------- B $108 $168 $195 $392 $38 $117 $195 $392 ====================================================================================================================================
Table A and Table B will assist you in understanding the costs and expenses that you will bear, directly or indirectly. These include the year 2001 expenses of the underlying portfolios, including any fee waivers and/or expense reimbursements (said fee waivers and expense reimbursements are assumed to continue throughout the periods shown in the examples). In addition to the expenses listed above, premium taxes may be applicable. These examples should not be considered a representation of past or future expenses, and actual expenses may be greater or less than those shown. The assumed 5% annual return is hypothetical and should not be considered a representation of past or future annual returns, which may be greater or less than the assumed rate. In the examples, the $35 annual service charge is reflected as a charge of 0.0388% based on average account value of $90,209.00 (as of December 31, 2001). 5 Liquidity Rider The optional Liquidity Rider reduces the number of years each purchase payment is subject to surrender charges. You can only elect this rider at the time you purchase the contract. Surrender Schedule. The following schedule shows the surrender charges that - ------------------ apply if the Liquidity Rider is elected: ---------------------------------------------------- Number of Years Since Surrender Charge Purchase Payment Date (as a percentage of purchase payment surrendered) ---------------------------------------------------- 0 - 1 7% 1 - 2 7% 2 - 3 6% 3 - 4 6% 4 or more 0% ---------------------------------------------------- Rider Fee. A rider fee equal to an effective annual rate of 0.40% of the daily - --------- net asset value in the separate account is deducted in calculating the variable accumulation unit values. The rider fee is only charged for the first four contract years. In addition, fixed account crediting rates may be lower than those credited to the policy without the Liquidity Rider. Variable Accumulation Unit Values. After the end of the fourth contract year, - --------------------------------- the 0.40% rider fee will no longer be assessed. We intend to administer the removal of the 0.40% charge by changing to a different class of variable accumulation units. This will result in adjusting the number of variable accumulation units and adjusting the unit value of the subaccounts in which you were invested at the end of the fourth contract year. The elimination of the fee and the adjustment in the number of variable accumulation units and unit values will not affect contract values. Performance Data. The Historical Performance Data in Appendix B to the - ---------------- prospectus and in other marketing material does not reflect the fee for the Liquidity Rider. Performance figures would be lower if the fee were included. Termination. The rider is irrevocable. - ----------- The Liquidity Rider may vary by state and may not be available in all states. 6 DREYFUS/TRANSAMERICA TRIPLE ADVANTAGE(R) VARIABLE ANNUITY Issued by TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY Supplement Dated November 11, 2002 to the Prospectus dated May 1, 2002 An optional "premium accelerator" rider is available at the time you buy your Dreyfus/Transamerica Triple Advantage(R) Variable Annuity. If you elect this rider, each purchase payment will receive a premium accelerator that Transamerica adds to your contract value. We may change the accelerator rate at any time. Under certain circumstances, you might forfeit (or lose) the premium accelerator. There is an extra charge for this rider. Generally, an annuity with a premium accelerator may have higher expenses than a similar annuity without a premium accelerator. Accordingly, you should always consider the expenses along with the features and optional benefits to be sure any annuity meets your financial needs and goals. All terms used that are not defined in this supplement shall have the same meanings as the same terms used in the prospectus. The premium accelerator rider may not be available in all states at the date of this supplement. Please contact Transamerica at (877) 717-8861 for additional information regarding the availability of the premium accelerator rider in your state. ================================================================================ ANNUITY CONTRACT FEE TABLE* ================================================================================ Contract Owner Transaction Expenses - -------------------------------------------------------------------------------- Sales Load On Purchase Payments ........................................... 0 Maximum Surrender Charge (as a % of purchase payments surrendered)/(1)/ ......................... 9% Annual Service Charge/(2)/ ............................. $0 - $35 Per Contract Transfer Fee/(3)/ ................................................... $0 - $10 Optional Rider Fees: - ------------------- Guaranteed Minimum Income Benefit Rider/(4)/ ........................... 0.45% (as an annual % of the minimum annuitization value on each contract anniversary) Tax Relief Rider/(5)/ .................................................. 0.25% (as an annual % of the account value on each rider anniversary) - -------------------------------------------------------------------------------- Variable Account Annual Expenses (as a percentage of average account value) - -------------------------------------------------------------------------------- Mortality and Expense Risk Charges/(6)/ ................................ 1.15% Administrative Charge .................................................. 0.15% ----- TOTAL VARIABLE ACCOUNT ANNUAL EXPENSES ...................................................... 1.30% Optional Separate Account Expenses: - ---------------------------------- Double Enhanced Death Benefit/(7)/ ..................................... 0.15% Premium Accelerator Rider Fee/(8)/ 0.35% ----- TOTAL SEPARATE ACCOUNT ANNUAL EXPENSES WITH HIGHEST OPTIONAL SEPARATE ACCOUNT EXPENSES/(9)/ ......................................... 1.80% - -------------------------------------------------------------------------------- Portfolio Annual Expenses/(10)/ (as a percentage of average net assets and after fee waivers and/or expense reimbursements) - -------------------------------------------------------------------------------- Total Rule Portfolio Management Other 12b-1 Annual Fees Expenses Fees/(11)(12)/ Expenses - -------------------------------------------------------------------------------- Transamerica Equity 0.75% 0.10% - 0.85% Appreciation 0.75% 0.10% 0.25% 1.10% Balanced/(13)/ 0.75% 0.16% 0.09% 1.00% Disciplined Stock/(13)/ 0.75% 0.13% 0.12% 1.00% ================================================================================ 1
=================================================================================================== ANNUITY CONTRACT FEE TABLE* (continued) =================================================================================================== Portfolio Annual Expenses/(10)/ (as a percentage of average net assets and after fee waivers and/or expense reimbursements) - --------------------------------------------------------------------------------------------------- Total Rule Portfolio Management Other 12b-1 Annual Fees Expenses Fees/(11)(12)/ Expenses - --------------------------------------------------------------------------------------------------- Growth and Income/(13)/ 0.75% 0.12% 0.14% 1.01% International Equity 0.75% 0.47% 0.25% 1.47% International Value/(13)/ 0.80% 0.60% 0.00% 1.40% Limited Term High Income/(13)/ 0.65% 0.25% 0.01% 0.91% Money Market 0.50% 0.08% - 0.58% Quality Bond 0.65% 0.11% 0.25% 1.01% Small Cap 0.75% 0.11% 0.25% 1.11% Small Company Stock 0.75% 0.39% 0.25% 1.39% Special Value/(13)/ 0.74% 0.24% 0.02% 1.00% Stock Index 0.25% 0.07% 0.25% 0.57% Socially Responsible Growth 0.75% 0.09% 0.25% 1.09% Core Bond/(13)/ 0.43% 0.30% 0.07% 0.80% Core Value/(13)/ 0.73% 0.27% 0.00% 1.00% Emerging Leaders/(13)/ 0.74% 0.65% 0.11% 1.50% Emerging Markets/(13)/ 0.00% 2.00% 0.00% 2.00% European Equity/(13)/ 0.81% 0.44% 0.00% 1.25% Founders Discovery/(13)/ 0.79% 0.62% 0.08% 1.49% Founders Growth/(13)/ 0.65% 0.35% 0.00% 1.00% Founders International Equity/(13)/ 0.28% 1.22% 0.00% 1.50% Founders Passport/(13)/ 0.00% 1.50% 0.00% 1.50% Japan/(13)/ 0.00% 1.50% 0.00% 1.50% MidCap Stock/(13)/ 0.75% 0.17% 0.08% 1.00% Technology Growth 0.75% 0.20% 0.25% 1.20% ===================================================================================================
*During the income phase the fees may be different than those described in the Fee Table. See Section 5, Expenses. /(1)/ The surrender charge, if any is imposed, applies to each contract, regardless of how account value is allocated among the variable account and the fixed account. The surrender charge is decreased based on the number of years since the purchase payment was made, from 9% in the year in which the purchase payment was made, to 0% in the tenth year after the purchase payment was made if you elect the premium accelerator rider. If applicable a surrender charge will only be applied to surrenders that exceed the amount available under certain listed exceptions. /(2)/ The service charge applies to the fixed account and the variable account, and is assessed on a pro rata basis relative to each account's account value as a percentage of the contract's total account value. The service charge is deducted on each contract anniversary and at the time of surrender. /(3)/ The transfer fee, if any is imposed, applies to each contract, regardless of how account value is allocated among the variable account and the fixed account. There is no fee for the first 18 transfers per year. For additional transfers, Transamerica may charge a fee of $10 per transfer, but currently does not charge for any transfers. /(4)/ The annual Guaranteed Minimum Income Benefit fee is 0.45% of the minimum annuitization value (as defined under "Guaranteed Minimum Income Benefit") and is deducted only during the accumulation phase. If you annuitize under the rider and elect the guaranteed minimum payment option, a guaranteed payment fee is deducted at an annual rate of 1.25%. See Section 5, Expenses. /(5)/ The annual Tax Relief Rider fee is 0.25% of the account value and is deducted only during the accumulation phase. /(6)/ The mortality and expense risk fee shown (1.15%) is for the "Return of Premium Death Benefit". /(7)/ The fee for the "Double Enhanced Death Benefit" is in addition to the mortality and expense risk fee of 1.15%. /(8)/ The fee is only deducted during the first nine contract years. 2 /(9)/ The Double Enhanced Death Benefit fee is included herein. The "Total Separate Account Annual Expenses" shown does not include optional rider fees except for the premium accelerator rider. Since the 0.35% fee for that rider is only deducted during the first nine contract years, the maximum Separate Account Annual Expenses after the first nine years is 1.45%. The mortality and expense risk fee and the administrative charge are applicable during the income phase of the Contract. /(10)/ The fee table information relating to the underlying funds is for the year 2001 (unless otherwise noted) and was provided to Transamerica by the underlying funds, their investment advisers or managers, and Transamerica has not and cannot independently verify the accuracy or completeness of such information. Actual expenses of the portfolios in future years and the current year may be greater or less than those shown in the Table. /(11)/ The Fees shown are for the Service Class Shares, except for the Money Market Portfolio and Transamerica Equity. Contracts purchased before January 22, 2001 generally are invested only in the Initial Class Shares. If you are invested in the Initial Class Shares of each portfolio, the Total Portfolio Annual Expenses would be lower, since the Initial Class Shares are not subject to a Rule 12b-1 Fee. Consult the portfolio prospectuses for more information. /(12)/ The Rule 12b-1 Fees deducted from the Service Class Shares of these portfolios cover certain distribution and shareholder support services provided by Transamerica Occidental Life Insurance Company selling contracts investing in those portfolios. The amount of the Rule 12b-1 Fee is 0.25% per year before any fee waivers and/or expense reimbursements. /(13)/ Total Portfolio Annual Expenses shown are net of any fee waiver and/or expense reimbursement. Without such waivers or reimbursement of expenses, the management fee, other expenses, 12b-1 fee, and Total Portfolio Annual Expenses would be as follows: 0.75%, 0.16%, 0.25%, 1.16% - Balanced; 0.75%, 0.13%, 0.25%, 1.13% - Disciplined Stock; 0.75%, 0.12%, 0.25%, 1.12% - Growth & Income; 1.00%, 0.74%, 0.25%, 1.99% - International Value; 0.65%, 0.25%, 0.25%, 1.15% - Limited Term High Income; 0.75%, 0.24%, 0.25%, 1.24% - Special Value; 0.60%, 0.30%, 0.25%, 1.15% - Core Bond; 0.75%, 0.27%, 0.25%, 1.27% - Core Value; 0.90%, 0.65%, 0.25%, 1.80% - Emerging Leaders; 1.25%, 4.14%, 0.25%, 5.64% - Emerging Markets; 1.00%, 0.52%, 0.25%, 1.77% - European Equity; 0.90%, 0.62%, 0.25%, 1.77% - Founders Discovery; 0.75%, 0.40%, 0.25%, 1.40% - Founders Growth; 1.00%, 1.30%, 0.25%, 2.55% - Founders International Equity; 1.00%, 2.81%, 0.25%, 4.06% - Founders Passport; 1.00%, 3.54%, 0.25%, 4.79% - Japan; and 0.75%, 0.17%, 0.25%, 1.17% - MidCap. 3 EXAMPLES - TABLE B You would pay the following expenses on a $1,000 investment, assuming a hypothetical 5% annual return on assets, assuming the entire account value is in the applicable subaccount, and assuming that the Guaranteed Minimum Income Benefit, the Tax Relief Rider, and the Premium Accelerator Rider have all been selected: The expenses reflect different mortality and expense risk fees depending on which death benefit you select: A = Return of Premium Death Benefit B = Double Enhanced Death Benefit
==================================================================================================================================== If the Contract is annuitized at If the Contract is surrendered the end of the applicable time at the end of the applicable period or if the Contract is simply time period. kept in the accumulation phase. ---------------------------------------------------------------------------- Subaccounts 1 3 5 10 1 3 5 10 Year Years Years Years Year Years Years Years - ------------------------------------------------------------------------------------------------------------------------------------ Transamerica Equity A $121 $161 $215 $362 $33 $101 $172 $362 ---------------------------------------------------------------------------------- B $123 $165 $222 $376 $34 $105 $180 $376 - ------------------------------------------------------------------------------------------------------------------------------------ Appreciation A $124 $168 $227 $385 $35 $108 $184 $385 ---------------------------------------------------------------------------------- B $126 $172 $234 $399 $37 $113 $192 $399 - ------------------------------------------------------------------------------------------------------------------------------------ Balanced A $123 $165 $222 $376 $34 $105 $180 $376 ---------------------------------------------------------------------------------- B $125 $169 $229 $390 $36 $110 $187 $390 - ------------------------------------------------------------------------------------------------------------------------------------ Disciplined Stock A $123 $165 $222 $376 $34 $105 $180 $376 ---------------------------------------------------------------------------------- B $125 $169 $229 $390 $36 $110 $187 $390 - ------------------------------------------------------------------------------------------------------------------------------------ Growth and Income A $123 $165 $223 $377 $35 $106 $180 $377 ---------------------------------------------------------------------------------- B $125 $170 $230 $391 $36 $110 $187 $391 - ------------------------------------------------------------------------------------------------------------------------------------ International Equity A $128 $179 $245 $418 $39 $119 $202 $418 ---------------------------------------------------------------------------------- B $130 $183 $252 $431 $41 $123 $209 $431 - ------------------------------------------------------------------------------------------------------------------------------------ International Value A $127 $177 $241 $412 $38 $117 $199 $412 ---------------------------------------------------------------------------------- B $129 $181 $248 $425 $40 $121 $206 $425 - ------------------------------------------------------------------------------------------------------------------------------------ Limited Term High Income A $122 $162 $218 $368 $34 $103 $175 $368 ---------------------------------------------------------------------------------- B $124 $167 $225 $382 $34 $107 $183 $382 - ------------------------------------------------------------------------------------------------------------------------------------ Money Market A $118 $153 $202 $337 $30 $ 93 $159 $337 ---------------------------------------------------------------------------------- B $120 $157 $209 $351 $32 $ 97 $167 $351 - ------------------------------------------------------------------------------------------------------------------------------------ Quality Bond A $123 $165 $223 $377 $35 $106 $180 $377 ---------------------------------------------------------------------------------- B $125 $170 $230 $391 $36 $110 $187 $391 - ------------------------------------------------------------------------------------------------------------------------------------ Small Cap A $124 $168 $227 $386 $35 $109 $185 $386 ---------------------------------------------------------------------------------- B $126 $173 $235 $400 $37 $113 $192 $400 - ------------------------------------------------------------------------------------------------------------------------------------ Small Company Stock A $127 $176 $241 $411 $38 $117 $198 $411 ---------------------------------------------------------------------------------- B $129 $181 $248 $424 $40 $121 $205 $424 - ------------------------------------------------------------------------------------------------------------------------------------ Special Value A $123 $165 $222 $376 $34 $105 $180 $376 ---------------------------------------------------------------------------------- B $125 $169 $229 $390 $36 $110 $187 $390 - ------------------------------------------------------------------------------------------------------------------------------------ Stock Index A $118 $152 $201 $336 $30 $ 93 $159 $336 ---------------------------------------------------------------------------------- B $120 $157 $209 $350 $32 $ 97 $166 $350 - ------------------------------------------------------------------------------------------------------------------------------------ Socially Responsible Growth Fund A $124 $168 $227 $384 $35 $108 $184 $384 ---------------------------------------------------------------------------------- B $126 $172 $234 $398 $37 $112 $191 $398 - ----------------------------------------------------------------------------------------------------------------------------------- Core Bond A $121 $159 $213 $358 $32 $100 $170 $358 ---------------------------------------------------------------------------------- B $122 $163 $220 $372 $34 $104 $177 $372 - ------------------------------------------------------------------------------------------------------------------------------------ Core Value A $123 $165 $222 $376 $34 $105 $180 $376 ---------------------------------------------------------------------------------- B $125 $169 $229 $390 $36 $110 $187 $390 - ------------------------------------------------------------------------------------------------------------------------------------ Emerging Leaders A $128 $180 $246 $421 $39 $120 $203 $421 ---------------------------------------------------------------------------------- B $130 $184 $253 $434 $41 $124 $210 $434 - ------------------------------------------------------------------------------------------------------------------------------------ Emerging Markets A $134 $194 $269 $463 $44 $134 $227 $463 ---------------------------------------------------------------------------------- B $135 $198 $276 $475 $46 $139 $233 $475 ====================================================================================================================================
4 EXAMPLES - TABLE B - continued...
==================================================================================================================================== If the Contract is annuitized at If the Contract is surrendered the end of the applicable time at the end of the applicable period or if the Contract is simply time period. kept in the accumulation phase. ---------------------------------------------------------------------------- Subaccounts 1 3 5 10 1 3 5 10 Year Years Years Years Year Years Years Years - ------------------------------------------------------------------------------------------------------------------------------------ European Equity A $126 $172 $234 $399 $37 $113 $192 $399 ---------------------------------------------------------------------------------- B $127 $177 $241 $412 $38 $117 $199 $412 - ------------------------------------------------------------------------------------------------------------------------------------ Founders Discovery A $128 $179 $245 $420 $39 $120 $203 $420 ---------------------------------------------------------------------------------- B $130 $184 $252 $433 $41 $124 $210 $433 - ------------------------------------------------------------------------------------------------------------------------------------ Founders Growth A $123 $165 $222 $376 $34 $105 $180 $376 ---------------------------------------------------------------------------------- B $125 $169 $229 $390 $36 $110 $187 $390 - ------------------------------------------------------------------------------------------------------------------------------------ Founders International Equity A $128 $180 $246 $421 $39 $120 $203 $421 ---------------------------------------------------------------------------------- B $130 $184 $253 $434 $41 $124 $210 $434 - ------------------------------------------------------------------------------------------------------------------------------------ Founders Passport A $128 $180 $246 $421 $39 $120 $203 $421 ---------------------------------------------------------------------------------- B $130 $184 $253 $434 $41 $124 $210 $434 - ------------------------------------------------------------------------------------------------------------------------------------ Japan A $128 $180 $246 $421 $39 $120 $203 $421 ---------------------------------------------------------------------------------- B $130 $184 $253 $434 $41 $124 $210 $434 - ------------------------------------------------------------------------------------------------------------------------------------ MidCap Stock A $123 $165 $222 $376 $34 $105 $180 $376 ---------------------------------------------------------------------------------- B $125 $169 $229 $390 $36 $110 $187 $390 - ------------------------------------------------------------------------------------------------------------------------------------ Technology Growth A $125 $171 $232 $394 $36 $111 $189 $394 ---------------------------------------------------------------------------------- B $127 $175 $239 $408 $38 $116 $196 $408 ====================================================================================================================================
Table A and Table B will assist you in understanding the costs and expenses that you will bear, directly or indirectly. These include the year 2001 expenses of the underlying portfolios, including any fee waivers and/or expense reimbursements (said fee waivers and expense reimbursements are assumed to continue throughout the periods shown in the examples). In addition to the expenses listed above, premium taxes may be applicable. These examples should not be considered a representation of past or future expenses, and actual expenses may be greater or less than those shown. The assumed 5% annual return is hypothetical and should not be considered a representation of past or future annual returns, which may be greater or less than the assumed rate. In the examples, the $35 annual service charge is reflected as a charge of 0.0388% based on average account value of $90,209.00 (as of December 31, 2001). 5 Premium Accelerator Rider You may only elect the premium accelerator rider at the time you buy your contract. If you elect the premium accelerator rider at issue, the initial purchase payment and each subsequent purchase payment will receive a premium accelerator which is added to the account value. The premium accelerator is currently 3.00%; however, we may change the accelerator rate at any time. The amount of the premium accelerator is not considered a purchase payment and therefore may not be included in the calculation of certain contract features. No premium accelerator will apply if the contract is canceled pursuant to the right to cancel provision. Transamerica may take back or "recapture" the full dollar amount of any premium accelerator upon the occurrence of any of the following events: .. exercise of the right to cancel option; .. exercise of the Nursing Care and Terminal Condition Withdrawal Option or the Unemployment Waiver within one year from the time we apply the premium accelerator; .. a death benefit is payable within one year from the time we apply the premium accelerator; or .. annuitization within one year from the time we apply the premium accelerator. In certain unusual circumstances, you might be worse off because of the premium accelerator. This could happen if we recapture the dollar amount of the premium accelerator and the overall investment performance of your contract is negative (if the overall investment performance of your contract is positive you would be better off). This could also happen if the market does not perform well enough to offset the additional costs associated with the premium accelerator. Rider Fee. There is a daily charge for the premium accelerator at an annual rate - --------- of 0.35% of the assets in each subaccount, but this fee is only deducted for the first nine contract years. Also, fixed account crediting rates may be lower than those credited to the contract without the premium accelerator rider. In addition to this fee, the surrender charge is higher and lasts longer if you elect the rider. In addition to the Rider Fee, Transamerica may use a portion of the mortality and expense risk fee, administrative charge and/or the surrender charge to pay the premium accelerator. See Sections 5, EXPENSES and Section 6, ACCESS TO YOUR MONEY in the prospectus. The following schedule shows the surrender charges that apply during the nine years following payment of each purchase payment if you elect the premium accelerator rider: - ---------------------------------------------------------------- Surrender Charge Number of Years (as a percentage of Since Purchase purchase payment Payment Date surrendered) - ---------------------------------------------------------------- 0-1 9% 1-2 8% 2-3 7% 3-4 6% 4-5 5% 5-6 4% 6-7 3% 7-8 2% 8-9 1% 9 or more 0 - --------------------------------- ------------------------------ Other. You cannot elect both the Liquidity Share rider and the premium - ----- accelerator rider. Termination. The rider is irrevocable. - ----------- The premium accelerator rider may vary for certain contracts and may not be available for all contracts. 6 PART C Other Information Item 24. Financial Statements and Exhibits (a) Financial Statements All required financial statements are included in Parts A and B of this Registration Statement. (b) Exhibits (1) Resolution of the Board of Directors of Transamerica Occidental Life Insurance Company ("Transamerica") authorizing establishment of the Variable Account. (1) (2) Not Applicable. (3) (a) Master Agreement among Transamerica Occidental Life Insurance Company, First Transamerica Life Insurance, Transamerica Financial Resources, Inc., Dreyfus Service Corporation, and Dreyfus Service Organization, Inc. (4) (b) Principal Agency Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Service Organization, Inc. (4) (c) Distribution Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Service Corporation. (4) (d) Form of Sales Agreement among Dreyfus Service Corporation, Dreyfus Service Organization, Inc., and Broker-Dealers. (4) (e) Amendment Dated as of August 31, 1993, to Master Agreement among Transamerica Occidental Life Insurance Company, First Transamerica Life Insurance Company, Transamerica Financial Resources, Inc., Dreyfus Service Corporation and Dreyfus Service Organization, Inc. (6) (f) Amendment Dated as of August 31, 1993 to Principal Agency Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Service Organization, Inc. (6) (g) Amendment Dated as of August 31, 1993 to Distribution Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Service Corporation. (6) (h) Distribution Agreement between Transamerica Occidental Life Insurance Company and Transamerica Insurance Securities Sales Corporation, dated as of August 24, 1994. (8) (i) Sales Agreement among Transamerica Insurance Securities Sales Corporation, Transamerica Occidental Life Insurance Company, First Transamerica Life Insurance Company, Dreyfus Service Corporation, and Dreyfus Service Organization, Inc., dated as of August 24, 1994. (8) (j) Services Agreement among Transamerica Occidental Life Insurance Company, First Transamerica Life Insurance Company, Transamerica Insurance Securities Sales Corporation, Dreyfus Service Corporation, and Dreyfus Service Organization, Inc., dated as of August 24, 1994. (8) (k) Services Agreement among Transamerica Occidental Life Insurance Company, First Transamerica Life Insurance Company, Transamerica Insurance Securities Sales Corporation, Dreyfus Service Corporation, and Dreyfus Service Organization, Inc., dated as of August 24, 1994. (8) (l) Form of Sales Agreement between Transamerica Occidental Life Insurance Company, Transamerica Life Insurance and Annuity Company, First Transamerica Life Insurance Company and Transamerica Securities Sales Corporation. (10) (m) Principal Underwriting Agreement by and between Transamerica Occidental Life Insurance Company, on its own behalf and on the behalf of Mutual Fund Account, and AFSG Securities Corporation. (18) (n) Form of Amendment to Principal Underwriting Agreement. (25) (4) Group Contract Form, Certificate Form, Individual Contract Form and Endorsements. (a) Contract form and Endorsements. (5) (i) Form of Flexible Purchase Payment Multi-Funded Deferred Master Group Annuity Contract. (5) (ii) Form of Automatic Payout Option Endorsement to Group Contract. (5) (iii) Form of Dollar Cost Averaging Option Endorsement to Group Contract. (5) (iv) Form of Systematic Withdrawal Option Endorsement to Group Contract. (5) (v) Form of Guaranteed Minimum Death Benefit Endorsement to Group Contract. (5) (vi) Form of Fixed Account Rider to Group Contract. (7) (vii) Form of Tax Relief Rider. (21) (b) Certificate of Participation Form and Endorsements. (5) (i) Form of Certificate of Participation. (5) (ii) Form of IRA Endorsement to Certificate. (5) (iii) Form of Dollar Cost Averaging Option Endorsement to Certificate. (5) (iv) Form of Systematic Withdrawal Option Endorsement to Certificate. (5) (v) Form of Automatic Payout Option Endorsement to Certificate. (5) (vi) Form of Benefit Distribution Endorsement to Certificate. (5) (vii) Form of Death Benefit Endorsement to Group Contract. (14) (viii) Form of Individual Purchase Payment Endorsement. (14) (ix) Form of Guaranteed Minimum Income Builder Rider. (14) (x) Form of Tax Relief Rider.(21) (c) Individual Contract Form and Endorsements. (6) (i) Form of Flexible Purchase Payment Multi-Funded Deferred Individual Annuity Contract. (6) (ii) Form of IRA Endorsement to Individual Contract. (6) (iii) Form of Benefit Distribution Endorsement. (6) (iv) Form of Dollar Cost Averaging Option Endorsement to Individual Contract. (6) (v) Form of Systematic Withdrawal Option Endorsement to Individual Contract. (6) (vi) Form of Automatic Payout Option Endorsement to Individual Contract. (6) (vii) Form of Guaranteed Minimum Death Benefit Endorsement to Individual Contract. (6) (viii) Form of Fixed Account Rider to Individual Contract. (7) (x) Form of Death Benefit Endorsement. (14) (xi) Form of Initial Purchase Payment Endoresment. (14) (xii) Form of Guaranteed Minimum Income Benefit Rider. (14) (xiii) Form of Tax Relief Rider.(21) (d) Form of Individual Contract and Endorsements. (26) (d) (1) Form of Liquidity Rider. (26) (d) (2) Form of Premium Enhancement Rider. (27) (5) (a) Form of Application for and Acceptance of Group Annuity Contract. (5) (b) Form of Application for Enrollment under Group Annuity Contract. (5) (c) Form of Application for Individual Annuity Contract. (6) (d) Form of Application for Individual Contract. (26) (6) (a) Restated Articles of Incorporation of Transamerica. (1) (a)(1) Articles of Redomestication and Reincorporation of Transamerica Occidental Life Insurance Company. (16) (b) Restated By-Laws of Transamerica. (1) (b)(1) Amended and Restated By-Laws of Transamerica Occidental Life Insurance Company. (16) (7) Not Applicable. (8) (a) Participation Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Variable Investment Fund. (4) (b) Participation Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Life and Annuity Index Fund, Inc. (4) (c) Participation Agreement between Transamerica Occidental Life Insurance Company and The Dreyfus Socially Responsible Growth Fund, Inc. (6) (d) Administrative Services Agreement between Transamerica Occidental Life Insurance Company and Vantage Computer Systems, Inc. (4) (e) Amendment Dated as of August 31, 1993 to Participation Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Variable Investment Fund. (6) (f) Amendment Dated as of August 31, 1993 to Participation Agreement between Transamerica Occidental Life Insurance Company and Dreyfus Life and Annuity Index Fund, Inc. (6) (g) Amendment Dated as of August 24, 1994 to Participation Agreement Dated as of March 3, 1993, As Amended, between Transamerica Occidental Life Insurance Company and Dreyfus Variable Investment Fund. (8) (g)(1) Fund Participation Agreement (Dreyfus). (19) (2) Amendment to Fund Participation Agreement. (19) (h) Amendment Dated as of August 24, 1994 to Participation Agreement Dated as of August 31, 1993 between Transamerica Occidental Life Insurance Company and Dreyfus Socially Responsible Growth Fund, Inc. (8) (i) Amendment Dated as of August 24, 1994 to Participation Agreement Dated as of March 3, 1993, As Amended, between Transamerica Occidental Life Insurance Company and Dreyfus Stock Index Fund. (8) (j) Form of Participation Agreement (Transamerica). (20) (8) (k) Participation Agreement among WRL Series Fund, Inc., Western Reserve Life Assurance co. of Ohio, and PFL Life Insurance Company. Note 22 (8) (k) (1) Amendment No. 16 to Participation Agreement among WRL Series fund, Inc., PFL Life Insurance company, AUSA Life Insurance Company, Inc., Peoples Benefit Life Insurance Company and Transamerica Occidental Life Insurance Company. Note 23 (8) (k) (2) Amendment No. 17 to Participation Agreement among WRL Series Fund, Inc., Transamerica Life Insurance Company, AUSA Life Insurance Company, Inc., Peoples Benefit Life Insurance Company and Transamerica Occidental Life Insurance Company. Note 24 (8) (k) (3) Amendment No. 20 to Participation Agreement among AEGON/Transamerica Series Fund, Inc., Transamerica Life Insurance Company, AUSA Life Insurance Company, Inc., Peoples Benefit Life Insurance Company, Transamerica Occidental Life Insurance Company and Transamerica Life Insurance and Annuity Company. Note 26 (9) (a) Opinion and Consent of Counsel. (9) (b) Consent of Counsel. (11) (10) (a) Consent of Independent Auditors. (25) (b) Opinion and Consent of Actuary. (26) (11) No financial statements are omitted from item 23. (12) Not applicable. (13) Performance Data Calculations. (6) (14) Not applicable. (15) Powers of Attorney. Frank Beardsley (12) Richard N. Latzer (15) Thomas J. Cusak (11) Karen MacDonald (15) James W. Dederer (15) Gary U. Rolle' (15) Paul E. Rutledge III (15) T. Desmond Sugrue (11) George A. Foegele (15) Nooruddin S. Veerjee (15) David E. Gooding (15) Robert A. Watson (11) Edgar H. Grubb (11) Frank C. Herringer (11) Patrick S. Baird (15) Brenda K. Clancy (15) Douglas C. Kolsrud (15) Craig D. Vermie (15) Ron F. Wagley (17) Bruce Clark (17) Christopher H. Garrett (26) Diane Meiners (26) (1) Filed with initial filing of this form N-4 Registration Statement, File No. 33-49998 (July 24, 1992). (2) Incorporated by reference to Exhibit 7(c) of Post-Effective Amendment No.1 to the Registration Statement of Transamerica Occidental Life Insurance Company's Separate Account VL on Form S-6, File No. 33-28107 (April 30, 1990) (3) Incorporated by reference to Exhibit 7(d) of Post-Effective Amendment No. 2 to the Registration Statement of Transamerica Occidental Life Insurance Company's Separate Account VL on Form S-6, File No. 33-28107 (April 30, 1991) (4) Filed with Post-Effective Amendment No. 1 to this Form N-4 Registration Statement, File No. 33-49998 (April 30, 1993). (5) Filed with Post-Effective Amendment No. 3 to this Form N-4 Registration Statement, File No. 33-49998 (March 8, 1994). (6) Filed with Post-Effective Amendment No. 4 to this Form N-4 Registration Statement, File No. 33-49998 (April 29, 1994). (7) Filed with Post-Effective Amendment No. 5 to this Form N-4 Registration Statement, File No. 33-49998 (March 1, 1995). (8) Filed with Post-Effective Amendment No. 6 to this Form N-4 Registration Statement File No. 33-49998 (April 28, 1995). (9) Filed with Post-Effective Amendment No. 7 to this Form N-4 Registration Statement File No. 33-49998 (April 26, 1996). (10) Filed with Post-Effective Amendment No. 8 to this Form N-4 Registration Statement File No. 33-49998 (April 28, 1997). (11) Filed with Post-Effective Amendment No. 9 to this Form N-4 Registration Statement file No. 33-49998 (April 28, 1998). (12) Filed with Post-Effective Amendment No. 10 to this Form N-4 Registration Statement file No. 33-49998 (February 26, 1999). (13) Filed with Post-Effective Amendment No. 11 to this Form N-4 Registration Statement file No. 33-49998 (April 28, 1999). (14) Filed with Post-Effective Amendment No. 13 to this Form N-4 Registration Statement file No. 33-49998 (December 6, 1999). (15) Filed with Post-Effective Amendment No. 14 to this Form N-4 Registration Statement file No 33-49998 (April 28, 2000) (16) Filed with Post-Effective Amendment No 16 to this Form N-4 Registration Statement file No. 33-49998 (February 9, 2001) (17) Filed with Post-Effective Amendment No. 17 to this Form N-4 Registration Statement file No. 33-49998 (April 27, 2001) (18) Incorporated by reference to the Initial Filing of Form S-6 Registration Statement (File No. 333-91851) filed on November 30, 1999. (19) Incorporated by reference to Pre-Effective Amendment No. 1 to N-4 Registration Statement (File No. 333-63086) filed on September 13, 2001. (20) Incorporated by reference to Post-Effective Amendment No. 26 to N-4 Registration Statement (file No. 33-33085) filed on October 2, 2001. (21) Filed with Post-Effective Amendment No. 18 to this Form N-4 Registration Statement (File No. 33-49998) filed on January 18, 2002. (22) Incorporated herein by reference to Post-Effective Amendment No. 1 to form N-4 Registration Statement (File No. 333-7509) on April 29, 1998. (23) Incorporated herein by reference to Initial Filing to form N-4 Registration Statement (File No. 333-62738) on June 11, 2001. (24) Incorporated herein by reference to Post-Effective Amendment No. 25 to Form N-4 Registration Statement (file No. 33-33085) on April 27, 2001. (25) Filed with Post Effective Amendment No. 21 to this Form N-4 Registration Statement (File No. 33-49998) filed on April 29, 2002. (26) Filed herewith. (27) To be filed by Amendment. Item 25. List of Directors and Officers of the Depositor Principal Positions and Name Offices with Depositor - ---- ---------------------- Christopher H. Garrett Director Ron F. Wagley Director, President Brenda K. Clancy Director, Senior Vice President, Corporate Diane Meiners Director, Vice President and Treasurer Craig D. Vermie Director, Vice President and Counsel, Corporate Bruce Clark Chief Financial Officer and Senior Vice President Frank A. Camp Vice President and Financial Markets Division General Counsel Item 26. Persons Controlled by or under Common Control With the Depositor or Registrant.
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business AEGON USA, Inc. Iowa AEGON U.S. Holding Corporation, Holding company AEGON U.S. Corporation RCC North America, L.L.C. Delaware 100% AEGON USA, Inc. Real estate Transamerica Holding Company, L.L.C. Delaware 100% AEGON USA, Inc. Holding Company AEGON Funding Corp. Delaware 100% Transamerica Holding Company, Issue debt L.L.C. securities-net proceeds used to make loans to affiliates First AUSA Life Insurance Company Maryland 100% Transamerica Holding Company, Insurance holding L.L.C. company AUSA Life Insurance Company, Inc. New York 100% First AUSA Life Insurance Insurance Company Life Investors Insurance Company of Iowa 100% First AUSA Life Ins. Co. Insurance America Apple Partners of Iowa, L.L.C. Iowa 100% LICCA Apple production, packing, storage and sales Life Investors Alliance, LLC Delaware 100% LIICA Purchase, own, and hold the equity interest of other entities Transamerica Life Insurance Company Iowa 100% First AUSA Life Ins. Co. Insurance AEGON Financial Services Group, Inc. Minnesota 100% Transamerica Life Insurance Marketing Co. AEGON Assignment Corporation of Kentucky 100% AEGON Financial Services Administrator of Kentucky Group, Inc. structured settlements AEGON Assignment Corporation Illinois 100% AEGON Financial Services Administrator of Group, Inc. structured settlements Transamerica Financial Minnesota 100% AEGON Financial Services Life insurance and Institutions, Inc. Group, Inc. underwriting services Southwest Equity Life Ins. Co. Arizona 100% of Common Voting Stock First Insurance AUSA Life Ins. Co.
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Iowa Fidelity Life Insurance Co. Arizona 100% of Common Voting Stock First Insurance AUSA Life Ins. Co. Western Reserve Life Assurance Co. Ohio 100% First AUSA Life Ins. Co. Insurance of Ohio WRL Insurance Agency, Inc. California 100% Western Reserve Life Insurance Agency Assurance Co. of Ohio WRL Insurance Agency of Alabama, Alabama 100% WRL Insurance Agency, Inc. Insurance Agency Inc. WRL Insurance Agency of Massachusetts 100% WRL Insurance Agency, Inc. Insurance Agency Massachusetts, Inc. WRL Insurance Agency of Nevada, Inc. Nevada 100% WRL Insurance Agency, Inc. Insurance Agency WRL Insurance Agency of Texas, Inc. Texas Record shareholder Daniel DeMarco Insurance Agency WRL Insurance Agency of Wyoming Wyoming 100% WRL Insurance Agency, Inc. Insurance Agency AEGON/Transamerica Series Fund, Inc. Maryland Various Mutual fund AEGON/Transamerica Fund Services, Florida 100% Western Reserve Life Provides administration Inc. Assurance Co. of Ohio for affiliated mutual fund AEGON/Transamerica Fund Advisors, Florida 100% Western Reserve Life Registered investment Inc. Assurance Co. of Ohio advisor World Financial Group Insurance California 100% Western Reserve Life Insurance agency Agency, Inc. Assurance Co. of Ohio World Financial Group Insurance Alabama 100% World Financial Group Insurance Agency Agency of Alabama, Inc. Insurance Agency, Inc. World Financial Group Insurance Ohio 100% World Financial Group Insurance agency Agency of Ohio, Inc. Insurance Agency, Inc. World Financial Group Insurance Massachusetts 100% World Financial Group Insurance Agency Agency of Massachusetts, Inc. Insurance Agency, Inc. WFG Insurance Agency of Texas, Inc. Texas Record Shareholder Jack Linder Insurance Agency World Financial Group Insurance Hawaii 100% World Financial Group Insurance Agency Agency of Hawaii, Inc. Insurance Agency, Inc.
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business World Financial Group Insurance Nevada 100% World Financial Group Insurance Agency Agency of Nevada, Inc. Insurance Agency, Inc. World Financial Group Insurance New Mexico 100% World Financial Group Insurance Agency Agency of New Mexico, Inc. Insurance Agency, Inc. World Financial Group Insurance Wyoming 100% World Financial Group Insurance Agency Agency of Wyoming Insurance Agency, Inc. AEGON Equity Group, Inc. Florida 100% Western Reserve Life Insurance Agency Assurance Co. of Ohio Monumental General Casualty Co. Maryland 100% First AUSA Life Ins. Co. Insurance United Financial Services, Inc. Maryland 100% First AUSA Life Ins. Co. General agency Bankers Financial Life Ins. Co. Arizona 100% First AUSA Life Ins. Co. Insurance The Whitestone Corporation Maryland 100% First AUSA Life Ins. Co. Insurance agency Cadet Holding Corp. Iowa 100% First AUSA Life Insurance Holding company Company Monumental General Life Insurance Puerto Rico 51% First AUSA Life Insurance Insurance Company of Puerto Rico Company 49% Baldrich & Associates of Puerto Rico AUSA Holding Company Maryland 100% Transamerica Holding Company Holding company Monumental General Insurance Group, Maryland 100% AUSA Holding Co. Holding company Inc. Trip Mate Insurance Agency, Inc. Kansas 100% Monumental General Insurance Sale/admin. of travel Group, Inc. insurance Monumental General Administrators, Maryland 100% Monumental General Insurance Provides management Inc. Group, Inc. srvcs. to unaffiliated third party administrator National Association Management And Maryland 100% Monumental General Provides actuarial Consultant Services, Inc. Administrators, Inc. consulting services Monumental General Mass Marketing, Maryland 100% Monumental General Insurance Marketing arm for sale Inc. Group, Inc. of mass marketed insurance coverages Transamerica Capital, Inc. California 100% AUSA Holding Co. Broker/Dealer
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Universal Benefits Corporation Iowa 100% AUSA Holding Co. Third party administrator Investors Warranty of America, Inc. Iowa 100% AUSA Holding Co. Provider of automobile extended maintenance contracts Massachusetts Fidelity Trust Co. Iowa 100% AUSA Holding Co. Trust company Money Services, Inc. Delaware 100% AUSA Holding Co. Provides financial counseling for employees and agents of affiliated companies ADB Corporation, L.L.C. Delaware 100% Money Services, Inc. Special purpose limited Liability company ORBA Insurance Services, Inc. California 26.91% Money Services, Inc. Insurance agency Great Companies L.L.C. Iowa 30% Money Services, Inc. Markets & sells mutual funds & individually managed accounts AEGON USA Travel and Conference Iowa 100% Money Services Travel and Conference Services, L.L.C. Services Roundit, Inc. Maryland 50% AUSA Holding Co. Financial services Zahorik Company, Inc. California 100% AUSA Holding Co. Broker-Dealer ZCI, Inc. Alabama 100% Zahorik Company, Inc. Insurance agency Zahorik Texas, Inc. Texas 100% Zahorik Company, Inc. Insurance agency Long, Miller & Associates, L.L.C. California 33-1/3% AUSA Holding Co. Insurance agency AEGON Asset Management Services, Delaware 100% AUSA Holding Co. Registered investment Inc. advisor World Group Securities, Inc. Delaware 100% AEGON Asset Management Broker-Dealer Services, Inc. World Financial Group, Inc. Delaware 100% AEGON Asset Management Marketing Services, Inc. Intersecurities, Inc. Delaware 100% AUSA Holding Co. Broker-Dealer Associated Mariner Financial Group, Michigan 100% Intersecurities, Inc. Holding co./management Inc. services
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Associated Mariner Ins. Agency of Massachusetts 100% Associated Mariner Agency, Insurance agency Massachusetts, Inc. Inc. Associated Mariner Agency Ohio, Inc. Ohio 100% Associated Mariner Agency, Insurance agency Inc. Associated Mariner Agency Texas, Texas 100% Associated Mariner Agency, Insurance agency Inc. Inc. PIA General Partner, Inc. Delaware 100% AUSA Holding Company General Partner to PIA 2001-A, L.P. PIA 2001-A, L.P. Delaware PIA General, Inc. is the General Private placement Partner investment limited partnership Idex Investor Services, Inc. Florida 100% AUSA Holding Co. Shareholder services Idex Management, Inc. Delaware 100% AUSA Holding Co. Investment advisor IDEX Mutual Funds Massachusetts Various Mutual fund Diversified Investment Advisors, Delaware 100% AUSA Holding Co. Registered investment Inc. advisor Diversified Investors Securities Delaware 100% Diversified Investment Broker-Dealer Corp. Advisors, Inc. George Beram & Company, Inc. Massachusetts 100% Diversified Investment Employee benefit and Advisors, Inc. actuarial consulting Creditor Resources, Inc. Michigan 100% AUSA Holding Co. Credit insurance CRC Creditor Resources Canadian Canada 100% Creditor Resources, Inc. Insurance agency Dealer Network Inc. Premier Solutions Group, Inc. Maryland 100% Creditor Resources, Inc. Insurance agency AEGON USA Investment Management, Iowa 100% Transamerica Holding Company, Investment advisor LLC. L.L.C. AEGON USA Realty Advisors, Inc. Iowa 100% AUSA Holding Co. Provides real estate administrative and real estate investment services AEGON USA Real Estate Services, Inc. Delaware 100% AEGON USA Realty Advisors, Real estate and Inc. mortgage holding company
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business QSC Holding, Inc. Delaware 100% AEGON USA Realty Advisors, Real estate and Inc. financial software production and sales Realty Information Systems, Inc. Iowa 100% AEGON USA Realty Advisors, Inc Information Systems for real estate investment management USP Real Estate Investment Trust Iowa 12.89% First AUSA Life Ins. Co. Real estate investment 13.11% PFL Life Ins. Co. trust 4.86% Bankers United Life Assurance Co. RCC Properties Limited Partnership Iowa AEGON USA Realty Advisors, Inc. is Limited Partnership General Partner and 5% owner Commonwealth General Corporation Delaware 100% AEGON U.S. Corporation Holding company ("CGC") AFSG Securities Corporation Pennsylvania 100% CGC Broker-Dealer Benefit Plans, Inc. Delaware 100% CGC TPA for Peoples Security Life Insurance Company AEGON Alliances, Inc. Virginia 100% Benefit Plans, Inc. General agent Capital 200 Block Corporation Delaware 100% CGC Real estate holdings AEGON Structured Settlements, Inc. Kentucky 100% CGC Administrator of structured settlements AEGON Institutional Markets, Inc. Delaware 100% CGC Provider of investment, marketing and admin. Services to ins. cos. Ampac Insurance Agency, Inc. Pennsylvania 100% CGC Provider of management (EIN 23-1720755) support services Compass Rose Development Corporation Pennsylvania 100% Ampac Insurance Agency, Inc. Special-purpose subsidiary Financial Planning Services, Inc. Dist. Columbia 100% Ampac Insurance Agency, Inc. Special-purpose subsidiary Frazer Association Consultants, Inc. Illinois 100% Ampac Insurance Agency, Inc. TPA license-holder
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business National Home Life Corporation Pennsylvania 100% Ampac Insurance Agency, Inc. Special-purpose subsidiary Valley Forge Associates, Inc. Pennsylvania 100% Ampac Insurance Agency, Inc. Furniture & equipment lessor Veterans Benefits Plans, Inc. Pennsylvania 100% Ampac Insurance Agency, Inc. Administrator of group insurance programs Veterans Insurance Services, Inc. Delaware 100% Ampac Insurance Agency, Inc. Special-purpose subsidiary Academy Insurance Group, Inc. Delaware 100% CGC Holding company Academy Life Insurance Co. Missouri 100% Academy Insurance Group, Inc. Insurance company Pension Life Insurance Company of New Jersey 100% Academy Life Insurance Company Insurance company America FED Financial, Inc. Delaware 100% Academy Insurance Group, Inc. Special-purpose subsidiary Ammest Massachusetts Insurance Massachusetts 100% Academy Insurance Group, Inc. Special-purpose Agency, Inc. subsidiary Ammest Realty, Inc. Pennsylvania 100% Academy Insurance Group, Inc. Special-purpose subsidiary Ampac, Inc. Texas 100% Academy Insurance Group, Inc. Managing general agent Ampac Insurance Agency, Inc. Pennsylvania 100% Academy Insurance Group, Inc. Special-purpose (EIN 23-2364438) subsidiary Force Financial Group, Inc. Delaware 100% Academy Insurance Group, Inc. Special-purpose subsidiary Force Financial Services, Inc. Massachusetts 100% Force Fin. Group, Inc. Special-purpose subsidiary Military Associates, Inc. Pennsylvania 100% Academy Insurance Group, Inc. Special-purpose subsidiary NCOAA Management Company Texas 100% Academy Insurance Group, Inc. Special-purpose subsidiary NCOA Motor Club, Inc. Georgia 100% Academy Insurance Group, Inc. Automobile club Unicom Administrative Services, Inc. Pennsylvania 100% Academy Insurance Group, Inc. Provider of admin. services
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Unicom Administrative Services, GmbH Germany 100%Unicom Administrative Provider of admin. Services, Inc. services Capital General Development Delaware 100% CGC Holding company Corporation Monumental Life Insurance Company Maryland 73.23% Capital General Development Insurance company Company 26.77% First AUSA Life Insurance Company Exchange Management Services, Inc. Missouri 100% Monumental Life Insurance Management company Company AEGON Direct Marketing Services, Maryland 100% Monumental Life Insurance Marketing company Inc. Company Peoples Benefit Life Insurance Iowa 3.7% CGC Insurance company Company 20.0% Capital Liberty, L.P. 76.3% Monumental Life Insurance Company Veterans Life Insurance Co. Illinois 100% Transamerica Holding Company, Insurance company L.L.C. Peoples Benefit Services, Inc. Pennsylvania 100% Veterans Life Ins. Co. Special-purpose subsidiary Coverna Direct Insurance Insurance Maryland 100% Peoples Benefit Life Insurance agency Agency, Inc. Insurance Company Ammest Realty Corporation Texas 100% Monumental Life Insurance Special purpose Company subsidiary JMH Operating Company, Inc. Mississippi 100% Peoples Benefit Life Real estate holdings Insurance Company Capital Liberty, L.P. Delaware 99.0% Monumental Life Insurance Holding Company Company 1.0% CGC Consumer Membership Services, Inc. Delaware 100% Commonwealth General Credit Card Protection Corporation Global Premier Reinsurance Company, British Virgin 100% Commonwealth General Insurance and LTD. Islands Corporation Reinsurance company Health Benefits Services, Inc. Delaware 100% Commonwealth General Health discount plan Corporation Quest Membership Services, Inc. Delaware 100% Commonwealth General Travel discount plan Corporation
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Stonebridge Group, Inc. Delaware 100% Commonwealth General General purpose Corporation corporation J.C. Penney Life Insurance Vermont 100% Commonwealth General Insurance Corporation Corporation Stonebridge Insurance Company Wisconsin 100% J.C. Penney Life Insurance Insurance Company Insurance Consultants, Inc. Nebraska 100% Commonwealth General Brokerage Corporation ICON Partners Limited United Kingdom 100% Insurance Consultants, Inc. Marketing company J.C. Penney Casualty Insurance Ohio 100% Commonwealth General Insurance Company Corporation AEGON N.V. Netherlands 51.27% of Vereniging Holding Company AEGON Netherlands Membership Association Groninger Financieringen B.V. Netherlands Held through AEGON Nevak Holding Holding Company B.V. AEGON Nederland N.V. Netherlands 100% AEGON N.V. Holding Company AEGON Nevak Holding B.V. Netherlands 100% AEGON N.V. Holding Company AEGON Derivatives Netherlands 100% AEGON N.V. Holding Company AEGON International N.V. Netherlands 100% AEGON N.V. Holding Company AEGON Trust Advisory Board Members: Delaware 100% AEGON International N.V. Manage assets of AEGON K.J.Storm U.S. Holding Corporation Donald J. Shepard Joseph Streppel Dennis Hersch AEGON U.S. Holding Corporation Delaware 100% AEGON Trust Holding company AEGON DMS Holding B.V. Netherlands 100% AEGON International N.V. Holding company JCPenney Financial & Marketing Korea 100% AEGON DMS Holding B.V. Marketing Services Group LTD JCPenney Direct Marketing Services Japan 100% AEGON DMS Holding B.V. Marketing Japan K.K. Canadian Premier Holdings LTD Canada 100% AEGON DMS Holding B.V. Holding company
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Canadian Premier Life Insurance Canada 100% Canadian Premier Holdings LTD Holding company Company Legacy General Insurance Company Canada 100% Canadian Premier Life Insurance Insurance Company Cornerstone International Holdings United Kingdom 100% AEGON DMS Holding B.V. Holding company LTD Cornerstone International Marketing United Kingdom 100% Cornerstone International Marketing company LTD Holdings, LTD Stonebridge International Insurance United Kingdom 100% Cornerstone International Insurance company LTD Marketing, LTD JCPenney Direct Asia Pacific Pty LTD Australia 100% AEGON DMS Holding B.V. Holding company JCPenney Direct Service Asia Australia 100% JCPenney Direct Asia Pacific Operations company Pacific Pty LTD Pty LTD JCPenney Insurance Marketing Asia Australia 100% JcPenney Direct Asia Pacific Marketing company Pacific Pty LTD Pty LTD Short Hills Management Company New Jersey 100% AEGON U.S. Holding Corporation Insurance Agent COPRA Reinsurance Company New York 100% AEGON U.S. Reinsurance Holding Corporation AEGON Management Company Indiana 100% AEGON U.S. Insurance holding Holding Corporation company AEGON U.S. Corporation Iowa 100% AEGON U.S. Holding Corporation Holding company Transamerica Corporation ("TAC") Delaware 100% AEGON NV Major interest in insurance and finance AEGON Funding Corp. II Delaware 100% TAC Commercial paper insurance Transamerica Pacific Insurance Hawaii 100% TAC Life insurance Company, Ltd. TREIC Enterprises, Inc. Delaware 100% TFC Investments Terrapoint, LLC Delaware 50% TREIC Enterprises, Inc. Data Processing ARC Reinsurance Corporation Hawaii 100% Transamerica Corp. Property & Casualty Insurance Inter-America Corporation California 100% Transamerica Corp. Insurance Broker
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Pyramid Insurance Company, Ltd. Hawaii 100% Transamerica Corp. Property & Casualty Insurance Transamerica Business Tech Corp. Delaware 100% Transamerica Corp. Telecommunications and data processing Transamerica CBO I, Inc. Delaware 100% Transamerica Corp. Owns and manages a pool of high-yield bonds Transamerica Corporation (Oregon) Oregon 100% Transamerica Corp. Name holding only - Inactive Transamerica Finance Corp. Delaware 100% Transamerica Corp. Commercial & Consumer Lending & equipment leasing Transamerica Public Finance, LLC Delaware 70% TCFCI, 30% TFC Finance TFC Properties, Inc. Delaware 100% Transamerica Finance Corp. Holding Company Transamerica Retirement Delaware 100% TFC Properties, Inc. Own property Communities, S.F., Inc. Transamerica Retirement Delaware 100% TFC Properties, Inc. Own property Communities, S.J., Inc. TA Leasing Holding Co., Inc. Delaware 100% Transamerica Finance Corp. Holding company Trans Ocean Ltd. Delaware 100% TA Leasing Holding Co. Inc. Holding company Trans Ocean Container Corp. ("TOCC") Delaware 100% Trans Ocean Ltd. Intermodal leasing SpaceWise Inc. Delaware 100% TOCC Intermodal leasing Trans Ocean Container Finance Corp. Delaware 100% TOL Intermodal leasing Trans Ocean Leasing Deutschland GmbH Germany 100% TOCC Intermodal leasing Trans Ocean Leasing PTY Ltd. Austria 100% TOCC Intermodal leasing Trans Ocean Management S.A. Switzerland 100% TOCC Intermodal leasing Trans Ocean Regional Corporate California 100% TOCC Holding company Holdings Trans Ocean Tank Services Corp. Delaware 100% TOCC Intermodal leasing
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Leasing Inc. Delaware 100% TA Leasing Holding Co. Leases & Services intermodal equipment Transamerica Leasing Holdings Inc. Delaware 100% Transamerica Leasing Inc. Holding company ("TLHI") Greybox Logistics Services Inc. Delaware 100% TLHI Intermodal leasing Greybox L.L.C. ("G") Delaware 100% TLHI Intermodal freight container interchange facilitation service Transamerica Trailer Leasing S.N.C. France 100% Greybox L.L.C. Leasing Greybox Services Limited U.K. 100% TLHI Intermodal leasing Intermodal Equipment, Inc. Delaware 100% TLHI Intermodal leasing Transamerica Leasing N.V. Belg. 100% Intermodal Equipment Inc. Leasing Transamerica Leasing SRL Italy 100% Intermodal Equipment Inc. Leasing Transamerica Distribution Services, Delaware 100% TLHI Dormant Inc. Transamerica Leasing Coordination Belg. 100% TLHI Leasing Center Transamerica Leasing do Brasil Ltda. Braz. 100% TLHI Container Leasing Transamerica Leasing GmbH Germany 100% TLHI Leasing Transamerica Trailer Leasing Sp. Poland 100% TLHI Leasing z.o.o Transamerica Leasing Limited U.K. 100% TLHI Leasing ICS Terminals (UK) Limited U.K. 100% Transamerica Leasing Limited Leasing Transamerica Leasing Pty. Ltd. Australia 100% TLHI Leasing Transamerica Leasing (Canada) Inc. Canada 100% TLHI Leasing Transamerica Leasing (HK) Ltd. H.K. 100% TLHI Leasing Transamerica Leasing (Proprietary) S. Africa 100% TLHI In Liquidation - Limited Intermodal leasing Transamerica Trailer Holdings I Inc. Delaware 100% TLHI Holding company
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Trailer Holdings II Delaware 100% TLHI Holding company Inc. Transamerica Trailer Holdings III Delaware 100% TLHI Holding company Inc. Transamerica Trailer Leasing AB Swed. 100% TLHI Leasing Transamerica Trailer Leasing AG Switzerland 100% TLHI Leasing Transamerica Trailer Leasing A/S + Denmark 100% TLHI Leasing C66 Transamerica Trailer Leasing GmbH Germany 100% TLHI Leasing Transamerica Trailer Leasing Belgium 100% TLHI Leasing (Belgium) N.V. Transamerica Trailer Leasing Netherlands 100% TLHI Leasing (Netherlands) B.V. Transamerica Alquiler de Trailer Spain 100% TLHI Leasing Spain S.L. Transamerica Transport Inc. New Jersey 100% TLHI Dormant Transamerica Commercial Finance Delaware 100% Transamerica Finance Corp. Holding company Corporation, I ("TCFCI") Transamerica Equipment Financial Delaware 100% TCFCI Investment in Various Services Corporation equipment leases and loans BWAC Credit Corporation Delaware 100% TCFCI Inactive BWAC International Corporation Delaware 100% TCFCI Retail Appliance and furniture stores BWAC Twelve, Inc. Delaware 100% TCFCI Holding company TIFCO Lending Corporation Illinois 100% BWAC Twelve, Inc. General financing Transamerica Insurance Finance Maryland 100% BWAC Twelve, Inc. Insurance premium Corporation ("TIFC") financing Transamerica Insurance Finance California 100% TIFC Insurance premium Corporation, California Transamerica Insurance Finance Maryland 100% TIFC Insurance premium Company (Europe) Transamerica Insurance Finance Ontario 100% TIFC Insurance premium Corporation, Canada financing
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business T Holdings, Inc. DE 100% TCFCI Holding Company M Credit, Inc. Delaware 100% TCFCI Commercial lending Transamerica Mezzanine Financing, Delaware 100% T Holdings, Inc. Holding company Inc. Bay Capital Corporation Delaware 100% M Credit, Inc. Special purpose corporation Coast Funding Corporation Delaware 100% M Credit, Inc. Special purpose corporation Transamerica Small Business Delaware 100% M Credit, Inc. Holding company Capital, Inc. ("TSBC") Emergent Business Capital Holdings, Delaware 100% TSBC Dormant Inc. Gulf Capital Corporation Delaware 100% M Credit, Inc. Special purpose corporation Direct Capital Equity Investment, Delaware 100% M Credit, Inc. Small business loans Inc. TA Air East, Corp. Delaware 100% TEFSC Special purpose corporation TA Air I, Corp. Delaware 100% TEFS Special purpose corporation TA Air II, Corp. Delaware 100% TEFS Special purpose corporation TA Air III, Corp. Delaware 100% TEFS Special purpose corporation TA Air IV, Corp. Delaware 100% TEFS Special purpose corporation TA Air V, Corp. Delaware 100% TEFS Special purpose corporation TA Air VI, Corp. Delaware 100% TEFS Special purpose corporation TA Air VII, Corp. Delaware 100% TEFS Special purpose corporation TA Air VIII, Corp. Delaware 100% TEFS Special purpose corporation
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business TA Air IX, Corp. Delaware 100% TEFS Special purpose corporation TA Air X, Corp. Delaware 100% TEFS Special purpose corporation TA Air XI, Corp. Delaware 100% TEFS Special purpose corporation TA Air XII, Corp. Delaware 100% TEFS Special purpose corporation TA Air XIII, Corp. Delaware 100% TEFS Special purpose corporation TA Air XIV, Corp. Delaware 100% TEFS Special purpose corporation TA Air XV, Corp. Delaware 100% TEFS Special purpose corporation TA Air XVI, Corp. Delaware 100% TEFS Special purpose corporation TA Air XVII, Corp. Delaware 100% TEFS Special purpose corporation TA Air XVIII, Corp. Delaware 100% TEFS Special purpose corporation TA Air XIX, Corp. Delaware 100% TEFS Special purpose corporation Transamerica Aviation 803 Corp. Delaware 100% TEFS Special purpose corporation Transamerica Aviation 400 Corp. Delaware 100% TEFS Special purpose corporation Transamerica Aviation 429/448 Corp. Delaware 100% TEFS Special purpose corporation Transamerica Aviation 630 Corp. Delaware 100% TEFS Special purpose corporation TA Steel I, LLC Delaware 100% TEFS Special purpose corporation Transamerica Aviation 24245/24246 Delaware 100% TEFS Special purpose Corp. corporation TA Heli I, Inc. Delaware 100% TEFS Special purpose corporation
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business TA Marine I, Inc. Delaware 100% TEFS Special purpose corporation TA Marine II, Inc. Delaware 100% TEFS Special purpose corporation TA Marine IV, Inc. Delaware 100% TEFS Special purpose corporation TA Marine VI, Inc. Delaware 100% TEFS Special purpose corporation TA Marine V, Inc. Delaware 100% TEFS Special purpose corporation TA Marine III, Corp. Delaware 100% TEFS Special purpose corporation TA Public Finance Air I, Corp. Delaware 100% TEFS Special purpose corporation TBC I, Inc. Delaware 100% T Holdings, Inc. Special purpose corporation Facta, LLP Delaware 100% TBC I, Inc. Commercial finance TBC III, Inc. Delaware 100% T Holdings, Inc. Special purpose corporation Transcap Trade Finance Delaware 100% TBC III, Inc. Commercial finance TBC IV, Inc. Delaware 100% T Holdings, Inc. Special purpose corporation Transamerica Commercial Real Estate Delaware 100% T Holdings, Inc. Bridge financing Finance, LLC TBC V, Inc. Delaware 100% T Holdings, Inc. Special purpose corporation Breakthrough Funding LLP Delaware 100% TBC V, Inc. Commercial finance TBC Tax I, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax II, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax III, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax IV, Inc. Delaware 100% M Credit, Inc. Special purpose corporation
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business TBC Tax V, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax VI, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax VII, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax VIII, Inc. Delaware 100% M Credit, Inc. Special purpose corporation TBC Tax IX, Inc. Delaware 100% M Credit, Inc. Special purpose corporation The Plain Company Delaware 100% TEFS Special purpose corporation Transamerica Distribution Finance Delaware 100% TCFCI Holding company Corporation ("TDFC") Transamerica Accounts Holding Corp. Delaware 100% TDFC Holding company ARS Funding Corporation Delaware 100% Transamerica Accounts Holding Dormant Corporation Transamerica Commercial Finance Delaware 100% TIFC Finance company Corporation ("TCFC") Transamerica Acquisition Canada 100% TCFCC Holding company Corporation, Canada Transamerica Distribution Finance Delaware 100% TCFC Commercial Finance Corporation - Overseas, Inc. ("TDFOI") TDF Mauritius Limited Mauritius 100% TDFOI Mauritius holding company Transamerica Apple Distribution India 69.94% TDF-Mauritius, Limited Transamerica Finance Public Limited Distribution Finance Joint Venture Inventory Funding Trust Delaware 100% TCFC Delaware Business Trust Inventory Funding Company, LLC Delaware 100% Inventory Funding Trust Holding company TCF Asset Management Corporation Colorado 100% TCFC A depository for foreclosed real and personal property
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Distribution Finance Illinois 100% TCFC Special purpose Insurance Services, Inc. corporation Transamerica Distribution Finance Mexico 99% TCFC Inactive Factorje S.A. DE C.V. Transamerica Joint Ventures, Inc. Delaware 100% TCFC Holding company Amana Finance Illinois 50% Transamerica Joint Ventures, Commercial finance Inc. American Standard Financial Services Illinois 50% Transamerica Joint Ventures, Finance Inc. Penske Financial Services LLC Delaware 50% Transamerica Joint Ventures, Commercial finance Inc. Polaris Acceptance Illinois 50% Transamerica Joint Ventures, Commercial finance Inc. Transamerica Inventory Finance Delaware 100% TDFC Holding company Corporation ("TIFC") Transamerica GmbH, Inc. Delaware 100% TIFC Holding company Transamerica Netherlands 100% Trans. GmbH, Inc. Commercial lending in Fincieringsmaatschappij B.V. Europe BWAC Seventeen, Inc. Delaware 100% TIFC Holding company Transamerica Commercial Finance Ontario 100% BWAC Seventeen, Inc. Dormant Canada, Limited Transamerica Commercial Finance Canada 100% BWAC Seventeen, Inc. Commercial finance Corporation, Canada Cantrex Group Inc. Quebec 76% TACC Buying group and retail merchant services 2953-9087 Quebec Inc. Quebec 100% Cantrex Group, Inc. Dormant Corbeil Electrique, Inc. Quebec 100% Cantrex Group, Inc. Dormant Prestex Marketing, Inc. Quebec 100% Cantrex Group, Inc. Dormant BWAC Twenty-One, Inc. Delaware 100% TIFC Holding company ODBH Ltd/Harley Davidson Acceptance United Kingdom 100% BWAC Twenty-One, Inc. Finance Transamerica Technology Services United Kingdom 100% TCFL Inactive Limited
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Commercial Finance U.K. 100% Transamerica Commercial Commercial lending Limited ("TCFL") Holdings Limited TDF Credit Insurance Services U.K. 100% TCFL Credit insurance Limited brokerage Whirlpool Financial Corporation Poland 100% TCFL Inactive - commercial Polska Spozoo finance Transamerica Commercial Holdings U.K. 33% BWAC Twenty-One Inc. Holding company Limited Transamerica Trailer Leasing Limited New York 100% Transamerica Commercial Special purpose Holdings Limited corporation Transamerica Distribution Capital Spain 100% Transamerica Commercial Inactive Services, Iberica Holdings Limited Transamerica Commercial Finance France 100% TIFC Factoring company France S.A. Transamerica GmbH Frankfurt, Germany 100% GmbH Commercial lending in Germany Transamerica Retail Financial Delaware 100% TDFC Provides retail Services Corporation ("TRFSC") financing Transamerica Bank, NA Delaware 100% TRFSC Bank Transamerica Consumer Finance Delaware 100% TRFSC Consumer finance Holding Company ("TCFHC") holding company Transamerica Mortgage Company Delaware 100% TCFHC Consumer mortgages Transamerica Consumer Mortgage Delaware 100% TCFHC Securitization company Receivables Company Metropolitan Mortgage Company Florida 100% TCFHC Consumer mortgages First Florida Appraisal Services, Florida 100% Metropolitan Mtg. Co. Appraisal and Inc. inspection services First Georgia Appraisal Services, Georgia 100% First FL App. Srvc, Inc. Appraisal services Inc. Freedom Tax Services, Inc. Florida 100%. Metropolitan Mtg. Co. Property tax information services J.J. & W. Advertising, Inc. Florida 100% Metropolitan Mtg. Co. Advertising and marketing services J.J. & W. Realty Services, Inc. Florida 100% Metropolitan Mtg. Co. To hold problem REO properties
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Liberty Mortgage Company of Ft. Florida 100% Metropolitan Mtg. Co. No active business/Name Myers, Inc. holding only Metropolis Mortgage Company Florida 100% Metropolitan Mtg. Co. No active business/Name holding only Perfect Mortgage Company Florida 100% Metropolitan Mtg. Co. No active business/Name holding only Transamerica Vendor Financial Delaware 100% TDFC Provides commercial Service Corporation leasing Transamerica Distribution Finance Mexico 99% TCFC Holding company in Corporation de Mexico S. de R.L. Mexican subsidiaries de C.V. TDF de Mexico S. de R.L. de C.V. Mexico 99% TDFC Mex Service company for Whirlpool receivables Transamerica Corporate Services De Mexico 99% TDFC Mex Holds employees Mexico S. de R.L. de CV Transamerica Distribution Finance Mexico 99% TCFC Finance company Factorje S.A. de C.V. Transamerica Distribution Finance Illinois 100% TCFC Finance company Insurance Services, Inc. Transamerica Flood Hazard Delaware 100% TFC Flood Zone Certification, Inc. certification service Transamerica Home Loan California 100% TFC Consumer mortgages Transamerica Lending Company Delaware 100% TFC In liquidation - lending Transamerica Public Finance, LLC Delaware 70% TFC Financial Services Transamerica Financial Products, California 100% Transamerica Corp. Investments Inc. Transamerica Insurance Corporation Iowa 100% TIHI Holding company ("TIC") Plaza Insurance Sales Inc. California 100% TIC Casualty insurance placement Transamerica Advisors, Inc. California 100% TIC Retail sale of investment advisory services
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Annuity Services Corp. New Mexico 100% TIC Performs services required for structured settlements Transamerica Financial Advisors, Delaware 100% TIC Retail sale of Inc. securities products Financial Resources Insurance Texas 100% Transamerica Fin. Adv. Retail sale of Agency of Texas securities products TBK Insurance Agency of Ohio, Inc. Ohio 100% Transamerica Fin Adv. Variable insurance contract sales in state of Ohio Transamerica Financial Resources Alabama 100% Transamerica Fin. Adv. Insurance agent & broker Agency of Alabama, Inc. Transamerica Financial Resources Massachusetts 100% Transamerica Fin. Adv. Insurance agent & broker Ins. Agency of Massachusetts, Inc. Transamerica International Delaware 100% TIC Holding & administering Insurance Services, Inc. ("TIISI") foreign operations AEGON Canada Inc. ("ACI") Canada 100% TIHI Holding company Transamerica Life Canada Canada 100% ACI Life insurance company Home Loans and Finance Ltd. U.K. 100% TIISI Inactive Transamerica Occidental Life Iowa 100% TIC Life insurance Insurance Company ("TOLIC") NEF Investment Company California 100% TOLIC Real estate development Transamerica China Investments Hong Kong 99% TOLIC Holding company Holdings Limited Transamerica Life Insurance and N. Carolina 100% TOLIC Life insurance Annuity Company ("TALIAC") Transamerica Assurance Company Missouri 100% TALIAC Life and disability insurance Gemini Investments, Inc. Delaware 100% TALIAC Investment subsidiary Transamerica Life Insurance Company New York 100% TOLIC Insurance sales of New York Transamerica South Park Resources, Delaware 100% TOLIC Market analysis Inc.
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Variable Insurance Fund Maryland 100% TOLIC Mutual Fund USA Administration Services, Inc. Kansas 100% TOLIC Third party administrator Transamerica Products, Inc. ("TPI") California 100% TIC Holding company Transamerica Products I, Inc. California 100% TPI Co-general partner Transamerica Securities Sales Corp. Maryland 100% TIC Life insurance sales Transamerica Service Company Delaware 100% TIC Passive loss tax service Transamerica International RE Bermuda 100% TAC Reinsurance (Bermuda) Ltd. Transamerica Intellitech, Inc. Delaware 100% TFC Real estate information and technology services Transamerica International Delaware 100% TAC Holding company Holdings, Inc. ("TIHI") Transamerica Investment Services, Delaware 100% TAC Investment adviser Inc. ("TISI") Transamerica Income Shares, Inc. Maryland 100% TISI Mutual fund Transamerica Real Estate Tax Delaware 100% TFC Real estate tax Service, Inc. reporting and processing services Transamerica Realty Services, Inc. Delaware 100% TAC Real estate investments ("TRS") Bankers Mortgage Company of CA California 100% TRS Investment management Pyramid Investment Corporation Delaware 100% TRS Real estate company The Gilwell Company California 100% TRS Ground lessee of 517 Washington Street, San Francisco Transamerica Affordable Housing, California 100% TRS General partner LHTC Inc. Partnership Transamerica Minerals Company California 100% TRS Owner and lessor of oil and gas properties
Name Jurisdiction of Percent of Voting Securities Incorporation Owned Business Transamerica Oakmont Corporation California 100% TRS General partner retirement properties Auto Funding Services, LLC Delaware 100% TBCC Commercial lending TBCC Funding II, L.L.C. Delaware 100% TBCC Funding Trust II Special purpose corporation Private Label Funding LLC Delaware 100% TBCC Funding Trust II Special purpose corporation TBCC Funding Trust II Delaware 100% TCFCI Trust TBCC Funding I, L.L.C. Delaware 100% TBCC Funding I, LLC Special purpose corporation TBCC Funding Trust I Delaware 100% TCFCI Trust Direct Capital Partners, LLC Delaware Various members Investment banking Inland Water Transportation LLC Delaware 100% Direct Capital Partners, L.P. Finance barges Direct Capital Partners, L.P. Delaware 100% Direct Capital Partners, LLC Investment banking Transamerica Business Capital Delaware 100% TCFCI Commercial lending Corporation Transamerica Technology Finance Delaware 100% TCFCI Commercial lending Corporation
Item 27. Number of Certificate Owners As of December 31, 2001 there were 29,369 Owners of Contracts. Item 28. Indemnification The Iowa Code (Sections 490.850 et. seq.) provides for permissive indemnification in certain situations, mandatory indemnification in other situations, and prohibits indemnification in certain situations. The code also specifies procedures for determining when indemnification payments can be made. Insofar as indemnification for liabilities arising under the Securities Act of 1933 may be permitted to directors, officers and controlling persons of the Depositor pursuant to the foregoing provisions, or otherwise, the Depositor has been advised that in the opinion of the Securities and Exchange Commission such indemnification is against public policy as expressed in the Act and is, therefore, unenforceable. In the event a claim for indemnification against such liabilities (other than the payment by the Depositor of expenses incurred or paid by a director, officer or controlling person in connection with the securities being registered), the Depositor will, unless in the opinion of its counsel the matter has been settled by controlling precedent, submit to a court of appropriate jurisdiction the question whether such indemnification by it is against public policy as expressed in the Act and will be goverened by the final adjudication of such issue. Item 29. Principal Underwriter AFSG Securities Corporation 4333 Edgewood Road N.E. Cedar Rapids, IA 52499-0001 The directors and officers of AFSG Securities Corporation are as follows/(5)/: Larry N. Norman Anne Spaes Director and President Director and Vice President Lisa Wachanedorf Darin Smith Director, Vice President and Vice President and Chief Compliance Officer Assistant Secretary Thomas R. Moriarty Emily Bates Vice President Assistant Treasurer Priscilla Hechler Clifton Flenniken Assistant Vice President and Assistant Treasurer Assistant Secretary Teresa Stolba Assistant Compliance Officer /(5)/ The principal business address of each person listed is AFSG Securities Corporation, 4333 Edgewood Road, N.E., Cedar Rapids, IA 52499-0001. Prior to May 1, 2002, Transamerica Securities Sales Corporation ("TSSC") and Transamerica Financial Resources ("TFR") were co-principal underwriters of the contracts. TSSC and TFR received $15,913,242.07, $40,610,303.26 and $17,147,205.77 from the Registrant for the years ending December 31, 2001, December 31, 2000 and December 31, 1999 respectively, for its services in distributing the policies. No other commission or compensation was received by TSSC or TFR, directly or indirectly, from the Registrant during the fiscal year. As of May 1, 2002, AFSG Securities Corporation, an affiliate of Transamerica, is the principal underwriter of the contracts and may enter into agreements with broker-dealers for the distribution of the contracts. AFSG Securities Corporation serves as the principal underwriter for Separate Account VA B, the Retirement Builder Variable Annuity Account, Separate Account VA A, Separate Account VA C, Separate Account VA D, Separate Account VA E, Separate Account VA F, Separate Account VA I, Separate Account VA J, Separate Account VA K, Separate Account VA L, Separate Account VL A and Legacy Builder Variable Life Separate Account. These accounts are separate accounts of Transamerica Life Insurance Company. AFSG Securities Corporation serves as principal underwriter for Separate Account VA BNY, Separate Account C, AUSA Series Life Account, AUSA Series Annuity Account and AUSA Series Annuity Account B. These accounts are separate accounts of AUSA Life Insurance Company, Inc. AFSG Securities Corporation serves as principal underwriter for Separate Account I, Separate Account II and Separate Account V. These accounts are separate accounts of Peoples Benefit Life Insurance Company. AFSG Securities Corporation serves as principal underwriter for WRL Series Life Account, WRL Series Annuity Account and WRL Series Annuity Account B. These accounts are separate accounts of Western Reserve Life Assurance Company of Ohio. AFSG Securities Corporation also serves as principal underwriter for Separate Account VA G, Separate Account VA H, Separate Account VA-2L and Transamerica Occidental Life Separate Account VUL-3. These accounts are separate accounts of Transamerica Occidental Life Insurance Company. AFSG Securities Corporation also serves as principal underwriter for Separate Account VA-2LNY. This account is a separate account of Transamerica Life Insurance Company of New York. Item 30. Location and Accounts and Records All accounts and records required to be maintained by Section 31(a) of the 1940 Act and the rules under it are maintained by Transamerica or the Service Office at their administrative offices. Item 31. Management Services All management contracts are discussed in Parts A or B. Items 32. Undertakings (a) Registrant undertakes that it will file a post-effective amendment to this registration statement as frequently as necessary to ensure that the audited financial statements in the registration statement are never more than 16 months old for so long as payments under the variable annuity contracts may be accepted. (b) Registrant undertakes that it will include either (1) as part of any application to purchase a Certificate or an Individual Contract offered by the Prospectus, a space that an applicant can check to request a Statement of Additional Information, or (2) a post card or similar written communication affixed to or included in the Prospectus that the applicant can remove to send for a Statement of Additional Information. (c) Registrant undertakes to deliver any Statement of Additional Information and any financial statements required to be made available under this Form promptly upon written or oral request to Transamerica at the address or phone number listed in the Prospectus. (d) Registrant represents that it is relying on a no-action letter dated November 28, 1988, to the American Council of Life Insurance (Ref. No. IP-6-88) regarding Sections 22(e), 27(c)(i) and 27(d) of the Investment Company Act of 1940, in connection with redeemability restrictions on Section 403(b) policies, and that paragraphs numbered (1) through (4) of that letter will be complied with. (e) Transamerica hereby represents that the fees and the charges deducted under the Contracts, in the aggregate, are reasonable in relation to the services rendered, the expenses expected to be incurred, and the risks assumed by Transamerica. SIGNATURES As required by the Securities Act of 1933 and the Investment Company Act of 1940, the Registrant has caused this Registration Statement to be signed on its behalf, in the City of Cedar Rapids and State of Iowa, on this 3rd day of September, 2002. SEPARATE ACCOUNT VA-2L TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY (DEPOSITOR) /s/ Frank A. Camp --------------------------- Frank A. Camp Vice President As required by the Securities Act of 1933, this Registration Statement has been signed by the following persons in the capacities and on the date indicated.
Signatures Titles Date - ---------- ------ ---- * Director ____________, 2002 - -------------------------------------- Christopher H. Garrett * Director ____________, 2002 - -------------------------------------- Brenda K. Clancy * Director ____________, 2002 - -------------------------------------- Diane Meiners * Director ____________, 2002 - -------------------------------------- Craig D. Vermie * Director and President ____________, 2002 - -------------------------------------- Ron F. Wagley * Chief Financial Officer and ____________, 2002 - -------------------------------------- Bruce Clark Senior Vice President /s/ Frank A. Camp Attorney -in-Fact pursuant to powers of September 3, 2002 - -------------------------------------- *By: Frank A. Camp attorney filed herewith, and in his own capacity as Vice President.
Registration No. 33-49998 SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ___________________ EXHIBITS TO FORM N-4 REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 FOR DREYFUS/TRANSAMERICA TRIPLE ADVANTAGE ___________________ EXHIBIT INDEX
Exhibit No. Description of Exhibit Page No.* - ---------------------------------- --------- (4)(d) Form of Individual Contract and Endorsements (4)(d)(1) Form of Liquidity Rider (5)(d) Form of Application for Individual Contract (8)(k)(3) Amendment No. 20 to Participation Agreement among AEGON/Transamerica Series Fund, Inc., Transamerica Life Insurance Company, AUSA Life Insurance Company, Inc., Peoples Benefit Life Insurance Company, Transamerica Occidental Life Insurance Company and Transamerica Life Insurance and Annuity Company (10)(b) Opinion and Consent of Actuary (15) Powers of Attorney
___________ * Page numbers included only in manually executed original. EX-4.D 3 dex4d.txt EXHIBIT-4.D EXHIBIT (4)(d) FORM OF INDIVIDUAL CONTRACT FORM AND ENDORSEMENTS Home Office: Transamerica Occidental Life 4333 Edgewood Road NE Insurance Company [LOGO] Transamerica Cedar Rapids, IA 52499 OCCIDENTAL LIFE A Stock Company ANNUITANT: [John Doe] OWNER(S): [John Doe] CONTRACT NUMBER: [07 - 12345] CONTRACT DATE: [December 4, 2001] WE AGREE .. To provide annuity payments as set forth in Section 10 of this contract, .. Or to pay Withdrawal benefits in accordance with Section 5 of this contract, .. Or to pay death proceeds in accordance with Section 9 of this contract. Withdrawals may be subject to an Excess Interest Adjustment reflecting changes in interest rates in accordance with Section 5 of this contract. Transfers and amounts applied to a Payment Option may also be subject to an Excess Interest Adjustment in accordance with Sections 8 and 10, respectively, of this contract. These agreements are subject to the provisions of this contract. This contract is issued in consideration of the payment of the initial premium. This contract may be applied for and issued to qualify as a tax-qualified annuity under the applicable sections of the Internal Revenue Code. 20 DAY RIGHT TO CANCEL You may cancel this contract by delivering or mailing a written notice or sending a telegram to us. You must return the contract before midnight of the twentieth day after the day You receive it. Notice given by mail and return of the contract by mail are effective on being postmarked, properly addressed and postage prepaid. We will pay You an amount equal to the sum of: .. the premiums paid; .. less partial withdrawals; and .. the accumulated gains or losses, if any, in the Separate Account on the date of cancellation; unless otherwise required by law. Signed for us at our home office. /s/ James W. Dederer /s/ Ron F. Wagley SECRETARY PRESIDENT This contract is a legal contract between the contract owner and the Company. READ YOUR CONTRACT CAREFULLY Flexible Premium Deferred Variable Annuity Income Payable At Annuity Commencement Date Benefits Based On The Performance Of The Separate Account Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C) Non-Participating AV696 101 145 901 SECTION 1 - DEFINITIONS ACCOUNT VALUE - Amount defined in Section 4, that can be used to fund one of the Payment Options. ADJUSTED ACCOUNT VALUE - The Account Value increased or decreased by any Excess Interest Adjustment. ANNUITANT - The person whose life annuity payments will be based on. ANNUITY COMMENCEMENT DATE - The Date the Annuitant will begin receiving payments from this contract, which may not be later than the last day of the contract month starting after the Annuitant attains age 85, except as expressly allowed by us (within state restrictions), but in no event later than the last day of the month in which the Annuitant attains age 95. CASH VALUE - Amount, defined in Section 5 that is available for partial or full Surrenders. CONTRACT ANNIVERSARY - The anniversary of the Contract Date for each year the contract remains in force. CONTRACT DATE - The date shown on the Contract Data page of this contract and the date on which this contract becomes effective. CONTRACT YEAR - The 12-month period following the Contract Date shown on the Contract Data page. The first Contract Year starts on the Contract Date. Each subsequent year starts on the anniversary of the Contract Date. CUMULATIVE EARNINGS - An amount equal to the Account Value at the time a lump sum payout or systematic payout option payout is made, minus the sum of all premium payments reduced by all prior partial Withdrawals deemed to have been from premium, if any. CUSTODIAL CARE - Care designed essentially to help a person with the activities of daily living which does not require the continuous attention of trained medical or paramedical personnel. DISTRIBUTION - A Withdrawal or disbursement of funds from the Account Value or Cash Value. Account Value and Cash Value will be reduced by any Distribution. GAINS - Cumulative Earnings, if any, in the Account Value. HOSPITAL - An institution which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or under the supervision of registered graduate professional nurses, 4) is supervised by a staff of one or more licensed Physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. INVESTMENT OPTIONS - Any of the Guaranteed Period Options of the Fixed Account, the Dollar Cost Averaging Fixed Account Option, and any of the Subaccounts of the Separate Account. MONTHLY ANNIVERSARY - The same date each month as the Contract Date. If there is no day in the calendar month, which coincides with the Contract Date, the Monthly Anniversary will be the first day of the next calendar month. NURSING CARE - Care prescribed by a Physician and performed or supervised by a registered graduate nurse. Such care includes nursing and rehabilitation services available 24 hours. NURSING FACILITY - A facility which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) provides Nursing Care or Custodial Care, 3) primarily provides Nursing Care under the direction of a licensed Physician, registered graduate professional nurse, or licensed vocational nurse, except when receiving Custodial Care, and 4) is not other than incidentally a Hospital, a home for the aged, a retirement home, a rest home, a community living center or a place mainly for the treatment of alcoholism, mental illness or drug abuse. PAYEE - The person to whom annuity payments will be made. PAYMENT OPTIONS - Options through which the distribution of the Adjusted Account Value can be directed. PHYSICIAN - Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of the license. SEPARATE ACCOUNT - The separate investment account(s) established by us, as described in Section 6. SUBACCOUNT - A division of the Separate Account, as described in Section 6. SURRENDER - A partial or full withdrawal of funds from the Account Value or Cash Value. TERMINAL CONDITION - A condition resulting from an accident or illness which, as determined by a Physician, has reduced life expectancy to not more than 12 months, despite appropriate medical care. WITHDRAWAL - A distribution of funds from the Account Value or Cash Value. YOU, YOUR - The owner of this contract. Unless otherwise specified on the Contract Data page, the Annuitant and the owner shall be one and the same person. AVB696 Page 2 SECTION 2 - CONTRACT DATA CONTRACT NUMBER: [07 - 12345] ANNUITANT: [John Doe] INITIAL PREMIUM PAYMENT: [$5,000.00] ISSUE AGE/SEX: [35 / Male] CONTRACT DATE: [December 4, 2001] OWNER(S): [John Doe] ANNUITY COMMENCEMENT GUARANTEED DATE: [March 8, 2050] MINIMUM DEATH BENEFIT OPTION: [N] BENEFICIARY: [Jane Doe] Fixed Account Guaranteed Minimum Effective Annual Interest Rate: [3%] Before the Annuity Commencement Date: Death Benefit Option P - Return of Premium Mortality and Expense Risk Fee and Administrative Charge: 1.30% Death Benefit Option N - 6% / Monthly Double Enhanced Mortality and Expense Risk Fee and Administrative Charge: 1.45% After the Annuity Commencement Date: Mortality and Expense Risk Fee and Administrative Charge: 1.25% AV696 101 145 901SP Page 3 SECTION 3 - PREMIUM PAYMENTS PAYMENT OF PREMIUMS Premium payments may be made any time while this contract is in force before the Annuity Commencement Date. You may start or stop, increase or decrease, or skip any Premium Payments. MAXIMUM AND MINIMUM PREMIUM PAYMENT The premium payments may not be more than the amount permitted by law if this is a tax-qualified annuity. The minimum initial premium payment is $5,000. If this contract is being used as a tax-qualified annuity, the minimum initial premium is $1,000, except that no minimum initial premium payment will be required for 403(b) annuities. The minimum subsequent premium payment we will accept is $50. The maximum total premium payments which we will accept without prior Company approval is $1,000,000. PREMIUM PAYMENT DATE The premium payment date is the date on which the premium payment is credited to the contract. The initial premium payment less any applicable premium taxes will be credited to the contract within two business days of receipt of the premium payment and the information needed. Subsequent additional premium payments will be credited to the contract as of the business day the premium payment and required information are received. A business day is any day that the New York Stock Exchange is open for trading. ALLOCATION OF PREMIUM PAYMENTS Premium payments may be applied to various Investment Options, which we make available. For each premium payment, You must indicate what percentage to allocate to various Investment Options. Each percent may be either zero or any whole number; however, the allocation among all accounts must total 100%. CHANGE OF ALLOCATION You may change the allocation of premium payments to various Investment Options by providing us notice containing the facts that we need. Premium payments received after the date on which we receive Your notice will be applied on the basis of the new allocation. PREMIUM TAXES Your state may impose a premium tax. It may be imposed either when a premium payment is made, on the Annuity Commencement Date, on the date of death or on the date of full Surrender. When permitted by state law, we will not deduct the premium tax until the Annuity Commencement Date, date of death, or date of full Surrender. SECTION 4 - ACCOUNT VALUE ACCOUNT VALUE On or before the Annuity Commencement Date, the Account Value is equal to Your: (a) premium payments; minus (b) Gross Partial Withdrawals (as defined in Section 5); plus (c) interest credited to the Fixed Account (see Section 7); plus (d) accumulated gains in the Separate Account (see Section 6); minus (e) accumulated losses in the Separate Account (see Section 6); minus (f) service charges, premium taxes, rider fees and transfer fees, if any. ADJUSTED ACCOUNT VALUE The Adjusted Account Value is the Account Value increased or decreased by any Excess Interest Adjustment. You may use the Adjusted Account Value on the Annuity Commencement Date to provide lifetime income or income for a period of no less than 60 months under the Payment Options in Section 10. SERVICE CHARGE On each Contract Anniversary and at the time of full Surrender during any Contract Year before the Annuity Commencement Date, we reserve the right to assess a service charge up to $35 for contract administration expenses. The Service Charge will be deducted from each Investment Option in proportion to the portion of Account Value (prior to such charge) in each Investment Option. In no event will the Service Charge exceed 2% of the Account Value on the Contract Anniversary or at the time of full Surrender. The Service Charge will not be deducted on a Contract Anniversary or at the time of full Surrender if, at either of these times, (1) the sum of all premium payments less the sum of all Withdrawals taken equals or exceeds $50,000; or (2) the Account Value equals or exceeds $50,000. M1259 Page 4 SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS CASH VALUE On or before the Annuity Commencement Date, the Cash Value is equal to the Adjusted Account Value less any Surrender Charges. Information on the current amount of Your contract's Cash Value is available upon request. The Cash Value may be partially withdrawn or will be paid in the event of a full Surrender of the contract. We must receive Your written partial Withdrawal or Surrender request before the Annuity Commencement Date. There is no Cash Value once an Annuity Payment Option has been selected. EXCESS INTEREST ADJUSTMENT Full Surrenders, partial Withdrawals, transfers, and amounts applied to a Payment Option (prior to the end of any Guaranteed Payment Option) from Guaranteed Period Options of the Fixed Account described in Section 7 will be subject to an Excess Interest Adjustment except as provided for in the partial Withdrawals provision below. An Excess Interest Adjustment applies in the following situations: 1) When You withdraw all or any portion of Your Cash Value, 2) When You exercise Annuity Payment Options, 3) When death proceeds are calculated. However, death proceeds will not be reduced if the Excess Interest Adjustment is negative. The Excess Interest Adjustment is only applied to transactions affecting the Guaranteed Period Options of the Fixed Account (see Section 7) and is based on any change in interest rates from the time the affected Guaranteed Period(s) started until the time the Excess Interest Adjustment occurs. The Excess Interest Adjustment is applied as follows: 1) The Excess Interest Adjustment is only applied when the transactions occur prior to the end of any Guaranteed Period Option; 2) Transfers to the Guaranteed Period Options of the Fixed Account are considered Premium Payments for purposes of determining the Excess Interest Adjustment; 3) The Excess Interest Adjustment is distinct from, and is applied prior to, the surrender charge; 4) The Excess Interest Adjustment may affect the death proceeds defined in Section 9; 5) If interest rates have decreased from the time the affected Guaranteed Period (s) started until the time the transaction occurs, the Excess Interest Adjustment will result in additional funds available to You; 6) If interest rates have increased from the time the affected Guaranteed Period (s) started until the time the transaction occurs, the Excess Interest Adjustment will result in a decrease in the funds available to You; 7) Certain amounts are not subject to the Excess Interest Adjustment as provided in Sections 5, 7 and 8. The formula for determining the amount of the Excess Interest Adjustment is as follows: Excess Interest Adjustment = S x (G-C) x (M/12) where: S is the amount (before surrender charges and premium taxes, if any) being Surrendered, partially withdrawn, transferred, or applied to a Payment Option that is subject to the Excess Interest Adjustment. G is the guaranteed interest rate for the Guaranteed Period applicable to "S". C is the current guaranteed interest rate then being offered on new Premium Payments for the next longer Guaranteed Period than "M". If this contract form or such a Guaranteed Period Option is no longer offered, "C" will be the U.S. Treasury rate for the next longer maturity (in whole years) than "M" on the 25th day of the previous calendar month, plus up to 2%. M is the number of months remaining in the Guaranteed Period for "S", rounded up to the next higher whole number of months. Upon full Surrender, the Excess Interest Adjustment (EIA) for each Guaranteed Period Option will not reduce the Adjusted Account Value for that Guaranteed Period Option below the amount paid into, less any prior Withdrawals and transfers from, that Guaranteed Period Option, plus interest at the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. U1259 Page 5 SECTION 5 - CONTINUED PARTIAL WITHDRAWALS We will pay You a portion of the Cash Value as a Partial Withdrawal provided we receive Your written request while the contract is in effect and before the Annuity Commencement Date. When You request a Partial Withdrawal You must tell us how it is to be allocated from among the Investment Options. If no selection is made, the Partial Withdrawal will be taken prorata from Your Investment Option. If Your request for a Partial Withdrawal from any Investment Option is less than or equal to the Cash Value in that option, we will pay the amount of Your request. However, if Your request for a Partial Withdrawal from any Investment Option is greater than the Cash Value in that option, we will pay You the Cash Value of that Investment Option. The Gross Partial Withdrawal is the total amount which will be deducted from Your Account Value as a result of each Partial Withdrawal. The Gross Partial Withdrawal may be more or less than Your requested Partial Withdrawal amount, depending on whether surrender charges and/or Excess Interest Adjustments apply at the time You request the Partial Withdrawal. The Excess Partial Withdrawal amount is the portion of the requested Partial Withdrawal that is subject to surrender charge (that is, the portion which is in excess of the surrender charge-free portion). For example, if the requested withdrawal amount is $1,000, and the surrender charge-free amount is $200, then the Excess Partial Withdrawal would be $800. Excess Partial Withdrawals will reduce the Account Value by an amount equal to (X-Y+Z) where: X = Excess Partial Withdrawal A = Amount of Partial Withdrawal subject to Excess Interest Adjustment Y = Excess Interest Adjustment = (A) x (G-C) x (M/12) where G, C and M are defined in the Excess Interest Adjustment provision above, with "A" substituted for "S" in the definitions of G and M. Z = surrender charge on X minus Y. The formula for determining the Gross Partial Withdrawal is as follows: Gross Partial Withdrawal = R - E + SC, where: R is the requested Partial Withdrawal; E is the Excess Interest Adjustment; and SC is the surrender charge on (EPW - E); where EPW is the Excess Partial Withdrawal Amount (the portion of the requested Partial Withdrawal that is subject to surrender charge). If any Partial Withdrawal reduces the Cash Value below $500, we reserve the right to pay the full Cash Value and terminate the contract. We may delay payment of the Cash Value from the Fixed Account for up to 6 months after we receive the request. If the owner dies after we receive the request, but before the request is processed, the request will be processed before the death proceeds are determined. Each Partial Withdrawal consists of a portion that is subject to a surrender charge (that is, the Excess Partial Withdrawal) and a remaining portion that is free from surrender charge (that is, the surrender charge-free amount). Either portion may be zero (0) depending on the Partial Withdrawal requested and prior amounts withdrawn. Partial Withdrawals in the amount of the cumulative interest in the Guaranteed Period Option(s) of the Fixed Account at the time of Withdrawal may be withdrawn from the GPO(s) of the Fixed Account free of any Excess Interest Adjustment. Amounts withdrawn under one of these options may reduce the amount available free of surrender charges under another option. Surrender charges and/or Excess Interest Adjustment may be waived as described below: LUMP SUM Beginning in the second Contract Year, You may withdraw, free from surrender charges, a lump sum amount equal to the maximum of A or B where: A is the Cumulative Earnings, if any, in the Account Value and B is an amount equal to 10% of the premium payments immediately prior to the partial Withdrawal reduced by all prior partial Withdrawals deemed to have been from premium, if any. The minimum partial Withdrawal under this option is $500. This partial Withdrawal option is available once per Contract Year. P1246 Page 6 SECTION 5 - CONTINUED SYSTEMATIC PAYOUT OPTION Beginning in the first Contract Year, a Systematic Payout Option (SPO) is available on a monthly, quarterly, semi-annual or annual basis. At the time a SPO payout is made, such payout must be at least $50 and may not exceed the maximum of A and B, divided by the number of payouts made per year (e.g. 12 for monthly). A is the Cumulative Earnings, if any, in the Account Value and B is an amount equal to 10% of the premium payments immediately prior to the partial Withdrawal reduced by all prior partial Withdrawals deemed to have been from premium, if any. No surrender charges or Excess Interest Adjustment will apply to the SPO payout. Monthly and quarterly payouts must be sent through electronic funds transfer directly to a checking or savings account. You may start or stop SPO payouts at any time; however, 30 days' written notice is required to stop SPO payouts. Once You have elected a SPO, You must wait a minimum time before the first SPO payment: 1 month for monthly, 3 months for quarterly, 6 months for semi-annual, or 12 months for annual. MINIMUM REQUIRED DISTRIBUTION For tax-qualified plans, partial Withdrawals taken to satisfy minimum distribution requirements under Section 401(a)(9) of the Internal Revenue Code (IRC) are available with no surrender charges and no Excess Interest Adjustments. The amount available from this contract with respect to the minimum distribution requirement is based solely on this contract. The owner must be at least 70 1/2 years old in the calendar year of distribution, must submit a written request to us and must take the distribution before year-end. If the owner attains age 70 1/2 in the calendar year of distribution, a written request, which is postmarked no later than the end of the current calendar year, must be submitted to us. Systematic minimum distributions must be at least $50 or a lump sum distribution is available if minimum required distributions are less than $50. Any amount requested in excess of the IRC minimum required distribution will have the appropriate surrender charges and Excess Interest Adjustments applied, unless the excess Distribution qualifies as surrender charge-free or Excess Interest Adjustment-free under any additional options provided. NURSING CARE AND TERMINAL CONDITION WITHDRAWAL OPTION Beginning in the first Contract Year, if the owner or owner's spouse (Annuitant or Annuitant's spouse if the owner is not a natural person) has been 1) confined in a Hospital or Nursing Facility for 30 consecutive days or 2) diagnosed as having a Terminal Condition, You may elect to withdraw all or a portion of the Account Value without surrender charges and without an Excess Interest Adjustment. The minimum Withdrawal under this option is $1000. This option is available even during the contract years other partial Withdrawal options were exercised prior to Nursing Care. For Nursing Care, we must receive each Withdrawal request and proof of eligibility with each request no later than 90 days following the date that confinement has ceased, unless it can be shown that it was not reasonably possible to provide the notice and proof within the above time period and that the notice and proof were given as soon as reasonably possible. However, in no event, except the absence of legal capacity, shall the notice and proof be provided later than one year following the date that confinement has ceased. Proof of confinement may be a Physician's statement or a statement from a Hospital or Nursing Facility administrator. For a Terminal Condition, we must receive each Withdrawal request and the applicable proof of eligibility no later than one year following diagnosis of the Terminal Condition. Proof of a Terminal Condition is required only with the initial Withdrawal request and must be furnished by the owner's, owner's spouse's, Annuitant's, or Annuitant's spouse's Physician. UNEMPLOYMENT WAIVER Beginning in the first Contract Year, You may withdraw all or a portion of the Account Value free of any surrender charges and free of any Excess Interest Adjustment if the owner or owner's spouse (Annuitant or Annuitant's spouse, if the owner is not a natural person) becomes unemployed. In order to qualify, You 1) must have been employed full-time for at least two years prior to Your becoming unemployed, 2) must have been employed full-time on Your Contract Date, 3) must have been unemployed for at least 60 consecutive days at the time of Withdrawal and 4) must have a minimum Cash Value at the time of Withdrawal of $5000. Proof of unemployment will consist of providing us with a determination letter from the applicable State's Department of Labor, which verifies that You qualify for and are receiving unemployment benefits at the time of Withdrawal. The determination letter must be received by us no later than 15 days following the date of the Withdrawal request. PB1246 Page 7 SECTION 5 - CONTINUED SURRENDER CHARGES Amounts withdrawn in excess of the surrender charge-free amount specified in the Withdrawal provisions above are subject to a surrender charge. The amount of this charge, if any, will be a percentage, as shown in the table below, of the amount of premium withdrawn: Number of Years Percentage of Since Premium Premium Withdrawn Payment Date 0-1 7% 1-2 7% 2-3 6% 3-4 6% 4-5 5% 5-6 4% 6-7 3% 7 or more 0% For surrender charge purposes, all earnings are considered to be withdrawn first. After all earnings are withdrawn then the oldest premium payment is the first premium payment considered to be withdrawn. If the amount withdrawn exceeds this, the next oldest premium payment is considered to be withdrawn, and so on until the most recent premium payments are deemed to be withdrawn (the procedure being applied to Withdrawals of premium is a "First-In, First-Out" or FIFO procedure). GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS Upon full Surrender of the contract, You will always receive at least the premium payments made to, less prior Withdrawals and transfers from, the Fixed Account. MINIMUM VALUES Benefits available under this contract, including any paid up annuity or death benefits that may be available, are not less than those required by any statute of the state in which the contract is delivered. SECTION 6 - SEPARATE ACCOUNT SEPARATE ACCOUNT We have established and will maintain one or more Separate Account(s), under the laws of the state of Iowa. Any realized or unrealized income, net gains and losses from the assets of the Separate Account are credited to or charged against it without regard to our other income, gains or losses. Assets are put in the Separate Account for this contract, as well as for other variable annuity contracts. Any Separate Account may invest assets in shares of one or more mutual fund portfolio, or in the case of a managed Separate Account, direct investments in stocks or other securities as permitted by law. Fund shares refer to shares of underlying mutual funds or prorata ownership of the assets held in a Subaccount of a managed Separate Account. Fund shares are purchased, redeemed and valued on behalf of the Separate Account. The Separate Account is divided into Subaccounts. Each Subaccount invests exclusively in shares of one of the portfolios of an underlying fund. We reserve the right to add or remove any Subaccount of the Separate Account. The assets of the Separate Account are our property. These assets will equal or exceed the reserves and other contract liabilities of the Separate Account. These assets will not be chargeable with liabilities arising out of any other business we conduct. We reserve the right, subject to regulations governing the Separate Account, to transfer assets of a Subaccount, in excess of the reserves and other contract liabilities with respect to that Subaccount, to another Subaccount or to our General Account. We will determine the fair market value of the assets of the Separate Account in accordance with a method of valuation, which we establish in good faith. Valuation Period means the period of time from one determination of the value of each Subaccount to the next. Such determinations are made when the value of the assets and liabilities of each Subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. We also reserve the right to transfer assets of the Separate Account, which we determine to be associated with the class of contracts to which this contract belongs, to another Separate Account. If this type of transfer is made, the term "Separate Account", as used in the contract, shall then mean the Separate Account to which the assets were transferred. We also reserve the right, when permitted by law to: (a) deregister the Separate Account under the Investment Company Act of 1940; (b) manage the Separate Account under the direction of a committee at any time; (c) restrict or eliminate any voting rights of contract owners or other persons who have voting rights as to the Separate Account; (d) combine the Separate Account with one or more other Separate Accounts; (e) create new Separate Accounts; (f) add new Subaccounts to or remove existing Subaccounts from the Separate Account, or combine Subaccounts; and (g) add new underlying mutual funds, remove existing mutual funds, or substitute a new fund for an existing fund. V1266 Page 8 SECTION 6 - CONTINUED The Net Asset Value of a fund share is the per-share value calculated by the mutual fund or, in the case of a managed Separate Account, by the Company. The Net Asset Value is computed by adding the value of the Subaccount's investments, cash and other assets, subtracting its liabilities, and then dividing by the number of shares outstanding. Net Asset Values of fund shares reflect investment advisory fees and other expenses incurred in managing a mutual fund or a managed Separate Account. CHANGE IN INVESTMENT OBJECTIVE OR POLICY OF A MUTUAL FUND If required by law or regulation, an investment policy of the Separate Account will only be changed if approved by the appropriate insurance official of the state of Iowa or deemed approved in accordance with such law or regulation. If so required, the process for obtaining such approval is filed with the insurance official of the state or district in which this contract is delivered. CHARGES AND DEDUCTIONS The Mortality and Expense Risk Fee and the Administrative Charge are each deducted both before and after the Annuity Commencement Date to compensate for changes in mortality and expenses not anticipated by the mortality and administration charges guaranteed in the contract. The service charge is deducted prior to the Annuity Commencement Date only. If the Mortality and Expense Risk Fee is more than sufficient, the Company will retain the balance as profit or may reduce this fee in the future. ACCUMULATION UNITS The Account Value in the Separate Account before the Annuity Commencement Date is represented by accumulation units. The dollar value of accumulation units for each Subaccount will change from business day to business day reflecting the investment experience of the Subaccount. Premium payments allocated to and any amounts transferred to the Subaccounts will be applied to provide accumulation units in those Subaccounts. The number of accumulation units purchased in a Subaccount will be determined by dividing the amount allocated to or transferred to that Subaccount, by the value of an accumulation unit for that Subaccount on the premium payment or transfer date. The number of accumulation units withdrawn or transferred from the Subaccounts will be determined by dividing the amount withdrawn or transferred by the value of an accumulation unit for that Subaccount on the Withdrawal or transfer date. The value of an accumulation unit on any business day is determined by multiplying the value of that unit at the end of the immediately preceding valuation period by the net investment factor for the valuation period. The net investment factor used to calculate the value of an accumulation unit in each Subaccount for the Valuation Period is determined by dividing (a) by (b) and subtracting (c) from the result, where: (a) is the result of: (1) the net asset value of a fund share held in that Subaccount determined as of the end of the current valuation period; plus (2) the per share amount of any dividend or capital gain Distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the valuation period; plus or minus (3) a per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount. (b) is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding valuation period. (c) is a factor representing the Mortality and Expense Risk Fee and Administrative Charge before the Annuity Commencement Date. This factor is less than or equal to, on an annual basis, the percentage shown on the Contract Data Page of the daily net asset value of a fund share held in that Subaccount. Since the net investment factor may be greater or less than one, the accumulation unit value may increase or decrease. VB1266 Page 9 SECTION 7 - FIXED ACCOUNT FIXED ACCOUNT Premium payments applied to and any amounts transferred to the Fixed Account will reflect a fixed interest rate. The interest rates we set will be credited for increments of at least one year measured from each premium payment or transfer date. These rates will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. Upon full Surrender of the Contract, the minimum Cash Value provided by the Fixed Account portion of the Account Value will be at least 90% of the premium payments made to the Fixed Account, less prior Withdrawals and transfers from the Fixed Account, plus interest credited using an Effective Annual Interest Rate of 3%. GUARANTEED PERIODS We may offer optional Guaranteed Period Options, into which premium payments may be paid or amounts transferred. The current interest rate we set for funds entering each Guaranteed Period Option (GPO) is guaranteed until the end of that option's Guaranteed Period. At that time, the premium payment made or amount transferred into the GPO, less any Withdrawals or transfers from that GPO, plus accrued interest, will be rolled into a new GPO or may be transferred to any Subaccount(s) within the Separate Account(s). You may choose the Investment Option(s) You want the funds rolled into by giving us a written notice within 30 days before the end of the expiring option's Guaranteed Period. However, any Guaranteed Period elected may not extend beyond the maximum Annuity Commencement Date defined in Section 11. In the absence of such election, the funds will be rolled into a new GPO which is the same as the expiring GPO unless that GPO is no longer offered, in which case, the next shorter GPO offered will be used. You will be mailed a notice of completion of the rollover with the new interest rate applicable. The new GPO will be deemed as accepted if we do not receive a written rejection within 30 days from the postmark date of the completion notice. We reserve the right for new premium payments, transfers, or rollovers to offer or not to offer any GPO, except that we will always offer at least a one-year GPO. When funds are withdrawn or transferred from a GPO, the Account Value associated with the oldest premium payment or rollover is considered to be withdrawn/transferred first. If the amount withdrawn/transferred exceeds the Account Value associated with the oldest premium, the Account Value associated with the next oldest premium payment or rollover is considered to be withdrawn/transferred next, and so on until the Account Value associated with the most recent premium payment or rollover is considered to be withdrawn/transferred (this is a "First-In, First-Out" or FIFO basis). Partial Withdrawals, Surrenders, transfers, and amounts applied to a Payment Option from the Guaranteed Period Option(s) are subject to an Excess Interest Adjustment as described in Section 5. DOLLAR COST AVERAGING FIXED ACCOUNT OPTION We may offer a Dollar Cost Averaging (DCA) Fixed Account Option separate from the Guaranteed Period Options. This option will have a one-year interest rate guarantee. The current interest rate we set for the DCA Fixed Account may differ from the rates credited on the one-year GPO in the Fixed Account. In addition, the current interest rate we credit may vary on different portions of the DCA Fixed Account. The credited interest rate will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. The DCA Fixed Account Option will only be available under a Dollar Cost Averaging program as described in Section 8. SECTION 8 - TRANSFERS A. TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE Prior to the Annuity Commencement Date, You may transfer the value of the accumulation units from one Investment Option to another by providing us notice containing the facts that we need. Transfers of Account Value from the Guaranteed Period Options (GPO) of the Fixed Account prior to the end of that GPO are subject to an Excess Interest Adjustment. If the Excess Interest Adjustment at the time of such Account Value transfer is a negative adjustment, then the maximum Account Value transfer is 25% of that GPO's Account Value, less Account Values previously transferred out of that GPO during the current Contract Year. If the Excess Interest Adjustment at the time of such Account Value transfer is a positive adjustment, no maximum will apply to such Account Values transferred from the GPO. No Excess Interest Adjustment will apply to Account Value transfers at the end of a Guaranteed Period. Transfers of interest credited in the GPOs to other Investment Options are allowed on a "First-In, First-Out" basis. Such transfers may be made monthly, quarterly, semi-annually, or annually. Each such transfer must be at least $50 and will not be subject to an Excess Interest Adjustment. Transfers of Account Value from the Separate Account are subject to a minimum of $500 or the entire Subaccount Account Value, if less. However, if the remaining Subaccount Account Value is less than $500, we reserve the right to include that amount as part of the transfer. You may choose which GPO to transfer to or from, however, any GPO elected may not extend beyond the maximum Annuity Commencement Date defined in Section 11. L999 Page 10 SECTION 8 - CONTINUED We reserve the right to limit transfers to no more than 18 in any one Contract Year. Any transfers in excess of 18 per Contract Year may be charged a $10 per transfer fee. Transfers among multiple Investment Options will be treated as one transfer in determining the number of transfers that have occurred. We also reserve the right to prohibit transfers to the Fixed Account if we are crediting an interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. The contract was not designed for professional market timing organizations or other persons that use programmed, large, or frequent transfers. The use of such transfers may be disruptive to an underlying portfolio. We reserve the right to reject any transfer request from any person in the interest of overall fund management or, if, in our judgment, an underlying fund would be unable to invest effectively in accordance with its investment objectives and policies or would otherwise be potentially adversely affected or if an underlying fund would reject our purchase order. We also reserve the right to revoke Your telephone, fax, and electronic transfer privileges at any time without revoking all owner's telephone, fax and electronic transfer privileges. DOLLAR COST AVERAGING OPTION Prior to the Annuity Commencement Date, You may instruct us to automatically transfer a specified amount from the Money Market Subaccount or the Dollar Cost Averaging (DCA) Fixed Account Option to any other Subaccount(s) of the Separate Account. The automatic transfers can occur monthly or quarterly. Transfers will continue until the elected Subaccount or DCA Fixed Account value is depleted. The amount transferred each time must be at least $250. All transfers from the DCA account will be the same amount as the initial transfer. Changes to the Subaccounts to which these transfers are allocated are not restricted. Transfers must be scheduled for at least 6, but not more than 24 months or for at least 4, but not more than 8 quarters each time the Dollar Cost Averaging program is started or restarted following termination of the program for any reason. Dollar Cost Averaging results in the purchase of more accumulation units when the value of the accumulation unit is low, and fewer accumulation units when the value of the accumulation unit is high. However, there is no guarantee that the Dollar Cost Averaging program will result in higher Account Values or will otherwise be successful. Dollar Cost Averaging may be discontinued by providing notice to us. While Dollar Cost Averaging is in effect, Asset Rebalancing is not available. ASSET REBALANCING Prior to the Annuity Commencement Date, You may instruct us to automatically transfer amounts among the Subaccounts of the Separate Account on a regular basis to maintain a desired allocation of the Account Value among the various Subaccounts offered. Rebalancing will occur on a monthly, quarterly, semi-annual or annual basis, beginning on a date selected by You. You must select the percentage of the Account Value desired in each of the various Subaccounts offered (totaling 100%). Any amounts in the Fixed Account are ignored for the purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at any time. Asset Rebalancing is not available while Dollar Cost Averaging is in effect. Rebalancing will cease as soon as we receive a request for any other transfer. B. TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE After the Annuity Commencement Date, You may transfer the value of the variable annuity units from one Subaccount to another within the Separate Account or to the Fixed Account. If You want to transfer the value of the variable annuity units, You must provide a signed notice, containing the facts that we need. We reserve the right to limit transfers between the Subaccounts or to the Fixed Accounts to once per Contract Year. The minimum amount which may be transferred is the lesser of $10 monthly income or the entire monthly income of the variable annuity units in the Subaccount from which the transfer is being made. If the monthly income of the remaining units in a Subaccount is less than $10, we have the right to include the value of those variable annuity units as part of the transfer. After the Annuity Commencement Date, no transfers may be made from the Fixed Account to any other Investment Options. LB999 Page 11 SECTION 9 - DEATH PROCEEDS A. DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE The amount of death proceeds will be the greatest of (a), (b) or (c) where: (a) is the Account Value on the date we receive due proof of death and an election of a method of settlement; (b) is the Cash Value on the date we receive due proof of death and an election of a method of settlement, and; (c) is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any additional premium payments received, less any Gross Partial Withdrawals from the date of death to the date of payment of death proceeds. If You have not selected a payment option by the date of death, the beneficiary may make such election within one year of the date we receive due proof of the owner's or Annuitant's death as described in C below. The beneficiary may elect to receive the death proceeds as a lump sum payment or may use the death proceeds to provide any of the annuity Payment Options described in Section 10. Interest on death proceeds will be paid as required by law. B. GUARANTEED MINIMUM DEATH BENEFIT The amount of the Guaranteed Minimum Death Benefit (GMDB) is based on the death benefit option shown on the Contract Data Page. You may not change the GMDB option after the contract is issued. Option N: 6%/ Monthly Double Enhanced Death Benefit This GMDB is equal to the greater of (1) and (2) where: (1) is a 6% Annually Compounding through age 80 Death Benefit, equal to: a) the total premium payments; minus Adjusted Partial Withdrawals, (as described below); plus b) Interest accumulated at 6% per annum from the payment or Withdrawal date to the earlier of; I) the date of death or the Annuitant's 81/st/ birthday, or II) the date the sum of all premium payments less the sum of all Adjusted Partial Withdrawals and any applicable Premium Taxes has grown to two times it's original amount as a result of the 6% interest accumulation. (2) is a Monthly Step-Up through age 80 Death Benefit, equal to: a) the largest Account Value on the Contract Date or on the Monthly Anniversary prior to the earlier of the date of death or the Annuitant's 81st birthday; plus b) any premium payments subsequent to the date of the Monthly Anniversary with the largest Account Value; minus c) any Adjusted Partial Withdrawals (as described below), subsequent to the date of the Monthly Anniversary with the largest Account Value. Option P: Return of Premium Death Benefit This GMDB is equal to the total premiums paid for this contract, less any Adjusted Partial Withdrawals (as described below), as of the date of death. A partial Withdrawal taken as provided in Section 5 will reduce the Guaranteed Minimum Death Benefit by an amount referred to as the "Adjusted Partial Withdrawal". The Adjusted Partial Withdrawal may be a different amount than the Gross Partial Withdrawal described in Section 5. The Adjusted Partial Withdrawal is the total amount deducted from the GMDB as a result of a partial Withdrawal as used in the GMDB provision. It is equal to the Gross Partial Withdrawal described in Section 5, multiplied by an Adjustment Factor. The Adjustment Factor is equal to the amount of the death proceeds prior to the partial Withdrawal divided by the Account Value prior to the partial Withdrawal. D422 Page 12 SECTION 9 - CONTINUED C. DEATH PRIOR TO ANNUITY COMMENCEMENT DATE Death proceeds are payable contingent upon the relationships between the owner, Annuitant, and beneficiary as outlined below. The contract must be surrendered upon settlement or on proof of death. If there is a surviving owner(s), the surviving owner(s) automatically takes the place of any beneficiary designation. I. Annuitant Death When we have due proof that the Annuitant died before the Annuity Commencement Date, we will provide the death proceeds to the beneficiary. If no beneficiary is designated, the owner or owner's estate will become the beneficiary. a) Beneficiary is the deceased Annuitant's surviving spouse. The beneficiary may elect to continue this contract as owner and Annuitant rather than receiving the death proceeds. If the contract is continued, an amount equal to the excess, if any, of the Guaranteed Minimum Death Benefit over the Account Value will then be added to the Account Value. This is a one-time only Account Value adjustment applied at the time the contract is continued, and the Guaranteed Minimum Death Benefit will continue on as applicable. If the contract is continued, all current surrender charges will be waived. If this beneficiary elects to have the death proceeds paid, the death proceeds must be distributed: (1) by the end of 5 years after the date of the deceased Annuitant's death, or (2) payments must begin no later than one year after the deceased Annuitant's death and must be made for a period certain or for this beneficiary's lifetime, so long as any period certain does not exceed this beneficiary's life expectancy. In 1035 exchanges where there are joint Annuitants, the death proceeds will only be payable upon the death of the surviving Annuitant. II. Owner or Joint Owner dies. If an owner or joint owner who is also an Annuitant dies, death proceeds will be payable according to section I above. If an owner or joint owner who is not an Annuitant dies prior to the Annuity Commencement Date and before the entire interest in the contract is distributed, the Annuitant will become the new owner. DB422 Page 13 SECTION 9 - CONTINUED If the new owner is the deceased owner's surviving spouse, the new owner may elect to continue this contract rather than receiving the Adjusted Account Value. If the contract is continued, all current surrender charges will be waived. If the new owner is a natural person but is not the sole surviving spouse, OR if the new owner is the sole surviving spouse but elects to have the Adjusted Account Value paid, the Adjusted Account Value must be distributed by either a) or b) below: (a) by the end of 5 years after the date of the deceased owner's death, or (b) payments must begin no later than one year after the deceased owner's death and must be made for a period certain or for the new owner's lifetime, so long as any period certain does not exceed the new owner's life expectancy. D. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE The death proceeds on or after the Annuity Commencement Date depend on the payment option selected. If any owner dies on or after the Annuity Commencement Date, but before the entire interest in the contract is distributed, the remaining portion of such interest in the contract will be distributed to the owner's beneficiary at least as rapidly as under the method of distribution being used as of the date of that owner's death. E. AN OWNER IS NOT AN INDIVIDUAL In the case of a non tax-qualified annuity, if any owner or beneficial owner is not an individual, then for purposes of the federal income tax mandatory distribution provisions in subsection C or D above, (1) the primary Annuitant will be treated as the owner of the contract, and (2) if there is any change in the primary Annuitant, such a change will be treated as the death of the owner. SECTION 10 - ANNUITY PAYMENTS A. GENERAL PAYMENT PROVISIONS Payment If this contract is in force on the Annuity Commencement Date, we will use the Fixed Account portion and/or the Separate Account portion of the Adjusted Account Value to make annuity payments to the Payee under Option 3 and/or 3-V, respectively, with 10 years certain, or if elected, under one or more of the other options described in this section. However, the option(s) elected must provide for lifetime income or income for a period of at least 60 months. You will become the Annuitant at the Annuity Commencement Date. Payments will be made at 1, 3, 6 or 12-month intervals. We reserve the right to change the frequency of payments to avoid making payments of less than $50.00. Before the Annuity Commencement Date, if the death proceeds become payable or if You Surrender this contract, we will pay any proceeds in one sum, or if elected, all or part of these proceeds may be placed under one or more of the options described in this section. If we agree, the proceeds may be placed under some other method of payment instead. Adjusted Age Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V are determined based on the adjusted age of the Annuitant. The adjusted age is the Annuitant's actual age on the Annuitant's nearest birthday, at the Annuity Commencement Date, adjusted as follows: Annuity Commencement Date Adjusted Age - ----------------- ------------ Before 2010 Actual Age 2010 - 2019 Actual Age minus 1 2020 - 2026 Actual Age minus 2 2027 - 2033 Actual Age minus 3 2034 - 2040 Actual Age minus 4 After 2040 Determined by us S1095 Page 14 SECTION 10 - CONTINUED Election of Optional Method of Payment Before the Annuity Commencement Date You can elect or change a payment option. You may elect, in a notice You sign which gives us the facts that we need, annuity payments that may be either variable, fixed, or a combination of both. If You elect a combination, You must also tell us what part of the contract proceeds on the Annuity Commencement Date are to be applied to provide each type of payment. (You must also specify which Subaccounts.) The amount of a combined payment will be the sum of the variable and fixed payments. Payments under a variable payment option will reflect the investment performance of the selected Subaccount of the Separate Account. Payee Unless You specify otherwise, the Payee shall be the Annuitant, or the beneficiary as defined in the Beneficiary provision in Section 11. Proof of Age We may require proof of the age of any person who has an annuity purchased under Options 3, 3-V, 5 and 5 -V of this section before we make the first payment. Minimum Proceeds If the proceeds are less than $2,000, we reserve the right to pay them out as a lump sum instead of applying them to a payment option. Premium Tax We may be required by law to pay premium tax on the amount applied to a payment option. If so, we will deduct the premium tax before applying the proceeds. Supplementary Contract Once proceeds become payable and a payment option has been selected, we will issue a supplementary contract to reflect the terms of the selected option. The contract will name the Payee(s) and will describe the payment schedule. B. FIXED ACCOUNT PAYMENTS Guaranteed Payment Options The fixed account payment is determined by multiplying each $1,000 of contract proceeds allocated to a fixed payment option by the amounts shown on page 18 for the option You select. Options 1, 2 and 4 are based on a guaranteed interest rate of 3%. Options 3 and 5 are based on a guaranteed interest rate of 3% and the "Annuity 2000" (male, female, and unisex if required by law) mortality table projected for improvement using projection scale G. The "Annuity 2000" mortality rates are adjusted based on improvements in mortality since 2000 to more appropriately reflect increased longevity. This is accomplished using a set of improvement factors referred to as projection scale G. Option 1 - Interest Payments We will pay the interest on the amount we use to provide annuity payments in equal payments or this amount may be left to accumulate for a period of time we and You agree to. We and You will agree on Withdrawal rights when You elect this option. The interest rate we declare for this option may be different than the interest rate(s) credited prior to the Annuity Commencement Date. Option 2 - Income for a Specified Period We will make level payments only for the fixed period You choose. In the event of the death of the person receiving payments prior to the end of the fixed period elected, payments will be continued to that person's beneficiary or their present value may be paid in a single sum. No funds will remain at the end. Option 3 - Life Income - You may choose between: 1. No Period Certain - We will make level payments only during the Annuitant's lifetime. 2. 10 Years Certain - We will make level payments for the longer of the Annuitant's lifetime or ten years. 3. Guaranteed Return of Contract Proceeds - We will make level payments for the longer of the Annuitant's lifetime or until the total dollar amount of payments we made to You equals the amount applied to this option. 4. Life with Emergency Cash - We will make level payments during the Annuitant's lifetime, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the payment where that multiple reduces over time to zero at age 101. A surrender charge will be applied. Should the Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Option 4 - Income of a Specified Amount Payments are made for any specified amount until the amount applied to this option, with interest, is exhausted. This will be a series of level payments followed by a smaller final payment. In the event of the death of the person receiving payments prior to the time proceeds with interest are exhausted, payments will be continued to that person's beneficiary or their present value may be paid in a single sum. SB1095 Page 15 SECTION 10 - CONTINUED Option 5 - Joint and Survivor Annuity - You may choose between: 1. No Period Certain - Payments are made during the joint lifetime of the Payee and a joint Payee of Your selection. Payments will be made as long as either person is living. 2. Life with Emergency Cash - Level payments will be made during the joint lifetime of the Payee and a joint Payee of Your selection. Payments will be made as long as either person is living, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the payment, where that multiple reduces over time to zero at age 101 of the younger Annuitant. A surrender charge will be applied. Should the last surviving Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Current Payment Options The amounts shown in the tables on page 18 are the guaranteed amounts. Current amounts offered to individuals of the same class may be obtained from us. C. VARIABLE ACCOUNT PAYMENT OPTIONS Variable Annuity Units The contract proceeds You tell us to apply to a variable payment option will be used to purchase variable annuity units in Your chosen Subaccounts. The dollar value of variable annuity units in Your chosen Subaccounts will increase or decrease reflecting the investment experience of Your chosen Subaccounts. The value of a variable annuity unit in a particular Subaccount on any business day is equal to (a) multiplied by (b) multiplied by (c), where: (a) is the variable annuity unit value for that Subaccount on the immediately preceding business day; (b) is the net investment factor for that Subaccount for the Valuation Period; and (c) is the Assumed Investment Return adjustment factor for the Valuation Period. The Assumed Investment Return adjustment factor for the valuation period is the product of discount factors of .99986634 per day to recognize the 5.0% effective annual Assumed Investment Return. The net investment factor used to calculate the value of a variable annuity unit in each Subaccount for the Valuation Period is determined by dividing (a) by (b) and subtracting (c) from the result, where: (a) is the net result of: (1) the net asset value of a fund share held in that Subaccount determined as of the end of the current valuation period; plus (2) the per share amount of any dividend or capital gain Distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the Valuation Period; plus or minus (3) a per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of the Subaccount. (b) is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period. (c) is a factor representing the Mortality and Expense Risk Fee and Administrative Charge applicable after the Annuity Commencement Date. This factor is less than or equal to, on an annual basis, the percentage shown on the Contract Data Page of the daily net asset value of a fund share held in the Separate Account for that Subaccount. Determination of the First Variable Payment The amount of the first variable payment is determined by multiplying each $1,000 of contract proceeds allocated to a variable payment option by the amounts shown on page 20 for the variable option You select. The tables are based on a 5% effective annual Assumed Investment Return and the "Annuity 2000" (male, female, and unisex if required by law) mortality table projected for improvement using projection scale G. The "Annuity 2000" mortality rates are adjusted based on improvements in mortality since 2000 to more appropriately reflect increased longevity. This is accomplished using a set of improvement factors referred to as projection scale G. C853 Page 16 SECTION 10 - CONTINUED Option 3-V - Life Income - You may choose between: 1. No Period Certain - Payments will be made during the lifetime of the Annuitant. 2. 10 Years Certain - Payments will be made for the longer of the Annuitant's lifetime or ten years. In the event of the death of the person receiving payments prior to the end of the guarantee period for which the election was made, payments will be continued to that person's beneficiary or their present value may be paid in a single sum. 3. Life with Emergency Cash - We will make payments during the Annuitant's lifetime, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the Supportable Payment (see definition below), where that multiple reduces over time to zero at age 101. A surrender charge will be applied. Should the Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Option 5-V - Joint and Survivor Annuity - You may choose between: 1. No Period Certain - Payments are made as long as either the Annuitant or the joint Annuitant is living. 2. Life with Emergency Cash - Payments will be made during the joint lifetime of the Payee and a joint Payee of Your selection. Payments will be made as long as either person is living, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the Supportable Payment (see definition below), where that multiple reduces over time to zero at age 101 of the younger Annuitant. A surrender charge will be applied. Should the last surviving Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Optional Initial Payment Guarantee Upon annuitization, You may elect an option that guarantees Your variable annuity payments will never be less than a percentage of the initial variable annuity payment. You cannot terminate the payment guarantee after You have selected the option. The percentage applicable to the initial payment and the fee for the option will be those currently applicable at the time of annuitization. Supportable Payment The Supportable Payment is the sum of each selected subaccount's variable annuity unit value times the number of variable annuity units. The variable annuity units are adjusted to reflect the year-to-date difference between the stabilized payment and the payment had they not been stabilized. Supportable Payments are used to determine surrender values, death benefits and transfers. Determination of Subsequent Variable Payments The amount of each variable annuity payment after the first will increase or decrease according to the value of the variable annuity units which reflect the investment experience of the selected Subaccounts. Each variable annuity payment after the first will be equal to the number of variable annuity units in the selected Subaccounts multiplied by the variable annuity unit value on the date the payment is made. The number of variable annuity units in each selected Subaccount is determined by dividing the first variable annuity payment allocated to the Subaccount by the variable annuity unit value of that Subaccount on the Annuity Commencement Date. If "Life with Emergency Cash" is chosen (Option 3-V(3) or 5-V(2)), or if the Optional Initial Payment Guarantee is chosen, payments would be "stabilized" (would change only once per year) but "value adjustments" would be made to ensure full value would be received. Page 17 CB853 GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS The amounts shown in these tables are the guaranteed amounts for each 1,000 of the proceeds. Higher current amounts may be available at the time of settlement.
- ------------------------------------------------------------------------------------------------------------------------------------ Option 2, Table I Option 3, Table II Option 3, Table III Option 3, Table IV Option 3, Table V - ------------------------------------------------------------------------------------------------------------------------------------ Amount of Number of Monthly Monthly Installment For Monthly Installment For Monthly Installment For Monthly Installment for Years Installment Life No Period Certain Life 10 Years Certain Life Guaranteed Return Of Life With Emergency Cash Payable Proceeds - ------------------------------------------------------------------------------------------------------------------------------------ Age* Male Female Unisex Male Female Unisex Male Female Unisex Male Female Unisex - ------------------------------------------------------------------------------------------------------------------------------------ 50 $ 3.82 $ 3.70 $ 3.74 $ 3.80 $ 3.69 $ 3.72 $ 3.70 $ 3.62 $ 3.65 $ 3.57 $ 3.52 $ 3.54 51 3.89 3.76 3.80 3.86 3.74 3.78 3.75 3.67 3.70 3.62 3.56 3.58 52 3.95 3.81 3.86 3.92 3.80 3.84 3.81 3.72 3.75 3.67 3.61 3.63 53 4.02 3.88 3.92 3.99 3.86 3.90 3.87 3.78 3.80 3.72 3.65 3.67 5 17.91 54 4.10 3.94 3.99 4.06 3.92 3.96 3.93 3.83 3.86 3.77 3.70 3.73 6 15.14 55 4.18 4.01 4.06 4.13 3.99 4.03 3.99 3.89 3.92 3.83 3.76 3.78 7 13.16 56 4.26 4.08 4.14 4.21 4.06 4.10 4.06 3.95 3.98 3.89 3.81 3.83 8 11.68 57 4.35 4.16 4.22 4.29 4.13 4.18 4.13 4.02 4.05 3.95 3.87 3.89 9 10.53 58 4.44 4.24 4.30 4.38 4.21 4.26 4.20 4.08 4.12 4.01 3.93 3.96 10 9.61 59 4.54 4.33 4.39 4.47 4.29 4.35 4.27 4.16 4.19 4.08 4.00 4.02 11 8.86 60 4.64 4.42 4.49 4.57 4.38 4.44 4.36 4.23 4.27 4.15 4.06 4.09 12 8.24 61 4.76 4.52 4.59 4.67 4.47 4.53 4.44 4.31 4.35 4.23 4.14 4.16 13 7.71 62 4.88 4.63 4.70 4.78 4.57 4.63 4.53 4.39 4.43 4.31 4.21 4.24 14 7.26 63 5.01 4.74 4.82 4.89 4.67 4.74 4.62 4.48 4.52 4.39 4.29 4.32 15 6.87 64 5.15 4.86 4.94 5.01 4.78 4.85 4.72 4.57 4.62 4.48 4.38 4.41 16 6.53 65 5.30 4.98 5.08 5.14 4.89 4.97 4.83 4.67 4.72 4.57 4.47 4.50 17 6.23 66 5.46 5.12 5.22 5.27 5.02 5.09 4.94 4.78 4.82 4.67 4.56 4.59 18 5.96 67 5.63 5.27 5.37 5.41 5.14 5.22 5.05 4.89 4.94 4.77 4.66 4.69 19 5.73 68 5.81 5.42 5.54 5.55 5.28 5.36 5.17 5.00 5.05 4.88 4.77 4.80 20 5.51 69 6.00 5.59 5.71 5.70 5.42 5.51 5.30 5.13 5.18 4.99 4.88 4.91 70 6.21 5.78 5.90 5.86 5.58 5.66 5.43 5.26 5.31 5.12 5.00 5.03 71 6.43 5.97 6.11 6.02 5.74 5.82 5.58 5.39 5.45 5.24 5.13 5.16 72 6.66 6.19 6.33 6.18 5.90 5.99 5.72 5.54 5.59 5.37 5.26 5.29 73 6.91 6.42 6.56 6.35 6.08 6.16 5.88 5.70 5.75 5.51 5.40 5.43 74 7.18 6.67 6.82 6.53 6.26 6.34 6.05 5.86 5.92 5.65 5.55 5.58 75 7.46 6.94 7.09 6.70 6.45 6.53 6.22 6.04 6.09 5.81 5.70 5.73 76 7.77 7.23 7.39 6.88 6.65 6.72 6.40 6.22 6.27 5.97 5.87 5.90 77 8.10 7.55 7.71 7.07 6.85 6.91 6.60 6.42 6.47 6.14 6.05 6.08 78 8.45 7.89 8.05 7.25 7.05 7.11 6.80 6.63 6.68 6.33 6.24 6.25 79 8.83 8.26 8.43 7.43 7.26 7.31 7.01 6.85 6.90 6.52 6.43 6.45 80 9.23 8.66 8.83 7.61 7.46 7.51 7.24 7.08 7.13 6.71 6.62 6.65 81 9.66 9.10 9.27 7.79 7.66 7.70 7.47 7.33 7.37 6.92 6.84 6.85 82 10.13 9.57 9.74 7.97 7.86 7.89 7.72 7.59 7.63 7.13 7.07 7.08 83 10.62 10.09 10.24 8.13 8.05 8.07 7.98 7.86 7.90 7.34 7.29 7.30 84 11.15 10.64 10.79 8.29 8.23 8.25 8.26 8.15 8.18 7.57 7.55 7.56 85 11.72 11.24 11.38 8.44 8.40 8.41 8.55 8.45 8.48 7.81 7.80 7.80 86 12.32 11.89 12.02 8.59 8.56 8.56 8.85 8.77 8.80 8.10 8.06 8.06 87 12.97 12.59 12.70 8.72 8.70 8.71 9.17 9.11 9.12 8.38 8.37 8.37 88 13.65 13.33 13.42 8.84 8.83 8.83 9.50 9.45 9.47 8.67 8.67 8.67 89 14.38 14.11 14.19 8.95 8.95 8.95 9.85 9.82 9.83 8.99 8.99 8.99 90 15.16 14.94 15.00 9.06 9.05 9.05 10.22 10.19 10.20 9.33 9.33 9.33 91 15.97 15.80 15.85 9.15 9.15 9.15 10.61 10.59 10.59 9.76 9.76 9.76 92 16.84 16.70 16.74 9.23 9.23 9.23 11.01 11.00 11.00 10.18 10.18 10.18 93 17.75 17.63 17.67 9.31 9.31 9.31 11.45 11.42 11.43 10.62 10.61 10.61 94 18.72 18.60 18.64 9.37 9.37 9.37 11.92 11.88 11.89 11.07 11.06 11.07 95 19.77 19.62 19.66 9.43 9.43 9.43 12.42 12.36 12.38 11.57 11.46 11.47 - ------------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A. Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. T890 Page 18 Option 5, Table VI Monthly Installment For Joint and Full Survivor
- ----------------------------------------------------------------------------------------------------------------------------- Age of Age of Female Annuitant* ---------------------------------------------------------------------------------------------------------- Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Annuitant* Male Male Male Male Male Male - ----------------------------------------------------------------------------------------------------------------------------- 50 $3.06 $3.12 $3.19 $3.25 $3.31 $3.38 $3.44 55 3.20 3.27 3.35 3.44 3.52 3.61 3.69 60 3.37 3.47 3.57 3.68 3.79 3.91 4.02 65 3.59 3.72 3.86 4.01 4.16 4.32 4.47 70 3.88 4.06 4.25 4.45 4.67 4.89 5.11 - ----------------------------------------------------------------------------------------------------------------------------- Monthly Installment For Unisex Joint and Full Survivor - ----------------------------------------------------------------------------------------------------------------------------- Age of Age of Joint Annuitant* ---------------------------------------------------------------------------------------------------------- First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than First More Than Annuitant* First First First First First First - ----------------------------------------------------------------------------------------------------------------------------- 50 $3.07 $3.13 $3.19 $3.25 $3.31 $3.37 $3.43 55 3.20 3.28 3.36 3.44 3.52 3.60 3.67 60 3.38 3.48 3.58 3.68 3.79 3.89 4.00 65 3.61 3.73 3.87 4.01 4.16 4.30 4.44 70 3.90 4.07 4.26 4.46 4.66 4.86 5.05 - ----------------------------------------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A. - -----------------------------------------------------------------------------------------------------------------------------
Option 5, Table VII Monthly Installment for Joint & Full Survivor (Life with Emergency Cash)
- ----------------------------------------------------------------------------------------------------------------------------- Age of Male Age of Female Annuitant Annuitant* ----------------------------------------------------------------------------------------------------------- 15 Years 12 Years 9 Years 6 Years 3 Years Same as 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Male Male Male Male Male Male - ----------------------------------------------------------------------------------------------------------------------------- 50 $3.02 $3.08 $3.13 $3.20 $3.26 $3.32 $3.37 55 3.14 3.21 3.29 3.36 3.45 3.53 3.59 60 3.29 3.38 3.48 3.58 3.69 3.80 3.88 65 3.48 3.60 3.72 3.86 4.00 4.15 4.26 70 3.72 3.88 4.05 4.23 4.42 4.62 4.77 - ----------------------------------------------------------------------------------------------------------------------------- Monthly Installment for Unisex Joint & Full Survivor (Life with Emergency Cash) - ----------------------------------------------------------------------------------------------------------------------------- Age of First Age of Joint Annuitant Annuitant* ----------------------------------------------------------------------------------------------------------- 15 Years 12 Years 9 Years 6 Years 3 Years Same as 3 Years Less Than Less Than Less Than Less Than Less Than First More Than First First First First First First - ----------------------------------------------------------------------------------------------------------------------------- 50 $3.02 $3.08 $3.14 $3.20 $3.26 $3.32 $3.36 55 3.14 3.21 3.29 3.37 3.44 3.52 3.58 60 3.30 3.39 3.48 3.58 3.68 3.79 3.86 65 3.49 3.61 3.73 3.86 4.00 4.14 4.24 70 3.74 3.89 4.06 4.24 4.42 4.60 4.74 - ----------------------------------------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A. - -----------------------------------------------------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. TB890 Page 19 VARIABLE PAYMENT OPTIONS BASED ON ASSUMED INVESTMENT RETURN The amounts shown in these tables are the initial payment amounts based on a 5.0% Assumed Investment Return for each $1,000 of the proceeds.
- ----------------------------------------------------------------------------------------------------------------------------------- Option 3-V, Table II Option 3-V, Table III Option 3-V, Table IV - ----------------------------------------------------------------------------------------------------------------------------------- Monthly Installment for Life Monthly Installment for Life Monthly Installment for Life No Period Certain 10 Years Certain With Emergency Cash - ----------------------------------------------------------------------------------------------------------------------------------- Age* Male Female Unisex Male Female Unisex Male Female Unisex 50 $ 5.07 $ 4.93 $ 4.98 $ 5.04 $ 4.92 $ 4.95 $ 4.83 $ 4.76 $ 4.78 51 5.13 4.99 5.03 5.09 4.96 5.00 4.87 4.80 4.82 52 5.19 5.04 5.08 5.15 5.01 5.05 4.92 4.84 4.86 53 5.26 5.10 5.14 5.21 5.07 5.11 4.96 4.88 4.91 54 5.33 5.16 5.21 5.27 5.12 5.17 5.01 4.93 4.95 55 5.40 5.22 5.27 5.34 5.18 5.23 5.06 4.98 5.00 56 5.48 5.29 5.35 5.41 5.25 5.30 5.12 5.03 5.05 57 5.57 5.36 5.42 5.49 5.32 5.37 5.18 5.08 5.11 58 5.66 5.44 5.50 5.57 5.39 5.44 5.24 5.14 5.17 59 5.75 5.52 5.59 5.66 5.47 5.52 5.31 5.20 5.23 60 5.85 5.61 5.68 5.75 5.55 5.61 5.37 5.26 5.29 61 5.97 5.70 5.78 5.85 5.63 5.70 5.45 5.33 5.37 62 6.09 5.81 5.89 5.95 5.72 5.79 5.53 5.40 5.44 63 6.21 5.91 6.00 6.06 5.82 5.89 5.61 5.48 5.52 64 6.35 6.03 6.13 6.17 5.92 6.00 5.70 5.56 5.60 65 6.50 6.16 6.26 6.29 6.03 6.11 5.79 5.65 5.69 66 6.66 6.29 6.40 6.42 6.15 6.23 5.89 5.75 5.79 67 6.83 6.43 6.55 6.55 6.27 6.36 6.00 5.85 5.89 68 7.01 6.59 6.71 6.69 6.40 6.49 6.11 5.96 6.00 69 7.21 6.76 6.89 6.83 6.54 6.63 6.23 6.07 6.12 70 7.41 6.94 7.08 6.98 6.69 6.77 6.36 6.20 6.25 71 7.63 7.14 7.28 7.13 6.84 6.93 6.49 6.33 6.38 72 7.87 7.35 7.50 7.28 7.00 7.09 6.63 6.46 6.52 73 8.12 7.58 7.74 7.45 7.17 7.25 6.78 6.62 6.66 74 8.39 7.83 8.00 7.61 7.34 7.42 6.94 6.78 6.83 75 8.68 8.11 8.28 7.78 7.52 7.60 7.11 6.95 7.00 76 8.99 8.40 8.58 7.95 7.71 7.78 7.29 7.13 7.18 77 9.32 8.72 8.90 8.12 7.90 7.97 7.47 7.33 7.36 78 9.68 9.07 9.25 8.29 8.09 8.16 7.68 7.52 7.57 79 10.06 9.45 9.63 8.47 8.29 8.34 7.88 7.74 7.79 80 10.47 9.85 10.04 8.64 8.48 8.53 8.11 7.98 8.01 81 10.91 10.30 10.48 8.80 8.67 8.71 8.34 8.23 8.26 82 11.38 10.78 10.96 8.97 8.86 8.89 8.60 8.48 8.53 83 11.88 11.30 11.47 9.12 9.04 9.06 8.84 8.75 8.77 84 12.42 11.87 12.03 9.27 9.21 9.23 9.09 9.01 9.05 85 12.99 12.48 12.63 9.41 9.37 9.38 9.35 9.31 9.32 86 13.60 13.13 13.27 9.54 9.51 9.52 9.67 9.60 9.61 87 14.26 13.84 13.96 9.67 9.65 9.65 9.96 9.90 9.91 88 14.95 14.59 14.70 9.78 9.77 9.77 10.28 10.27 10.27 89 15.69 15.39 15.48 9.89 9.88 9.88 10.61 10.61 10.61 90 16.47 16.23 16.30 9.98 9.98 9.98 10.97 10.97 10.97 91 17.29 17.10 17.16 10.07 10.07 10.07 11.36 11.36 11.36 92 18.16 18.01 18.05 10.15 10.15 10.15 11.86 11.85 11.85 93 19.07 18.95 18.98 10.22 10.22 10.22 12.33 12.32 12.32 94 20.05 19.92 19.96 10.28 10.28 10.28 12.94 12.93 12.93 95 21.09 20.94 20.99 10.34 10.33 10.33 13.47 13.45 13.46 - -----------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A. Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. H994 Page 20 Option 5V, Table V Monthly Installment For Joint and Full Survivor
- ------------------------------------------------------------------------------------------- Age of Age of Female Annuitant* ------------------------------------------------------------------------------- Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Annuitant* Male Male Male Male Male Male - ------------------------------------------------------------------------------------------- 50 $4.37 $4.42 $4.46 $4.51 $4.56 $4.62 $4.67 55 4.48 4.54 4.60 4.67 4.74 4.81 4.88 60 4.62 4.70 4.79 4.88 4.98 5.08 5.18 65 4.81 4.92 5.04 5.17 5.31 5.46 5.61 70 5.07 5.23 5.40 5.59 5.79 6.00 6.22 - ------------------------------------------------------------------------------------------- Monthly Installment For Unisex Joint and Full Survivor - ------------------------------------------------------------------------------------------- Age of Age of Joint Annuitant* ------------------------------------------------------------------------------- First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than First More Than Annuitant* First First First First First First - ------------------------------------------------------------------------------------------- 50 $4.38 $4.42 $4.47 $4.51 $4.56 $4.61 $4.66 55 4.48 4.54 4.60 4.67 4.73 4.80 4.87 60 4.63 4.70 4.79 4.88 4.97 5.07 5.16 65 4.82 4.93 5.05 5.17 5.30 5.44 5.57 70 5.09 5.24 5.41 5.59 5.78 5.97 6.16 - ------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A - -------------------------------------------------------------------------------------------
Option 5V, Table VI Monthly Installment For Joint and Full Survivor (Life with Emergency Cash)
- ------------------------------------------------------------------------------------------- Age of Age of Female Annuitant* ------------------------------------------------------------------------------- Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Annuitant* Male Male Male Male Male Male - ------------------------------------------------------------------------------------------- 50 $4.34 $4.38 $4.42 $4.47 $4.51 $4.57 $4.61 55 4.43 4.48 4.54 4.60 4.67 4.74 4.79 60 4.55 4.62 4.70 4.78 4.88 4.97 5.05 65 4.71 4.80 4.91 5.03 5.16 5.30 5.41 70 4.92 5.05 5.21 5.38 5.56 5.76 5.91 - ------------------------------------------------------------------------------------------- Monthly Installment For Unisex Joint and Full Survivor (Life with emergency Cash) - ------------------ ------------------------------------------------------------------------ Age of Age of Joint Annuitant* ------------------------------------------------------------------------------- First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than First More Than Annuitant* First First First First First First 011---------------------------------------------------------------------------------------- 50 $4.34 $4.38 $4.42 $4.47 $4.51 $4.56 $4.60 55 4.43 4.48 4.54 4.60 4.67 4.73 4.78 60 4.55 4.62 4.70 4.78 4.87 4.96 5.03 65 4.71 4.81 4.92 5.03 5.16 5.29 5.38 70 4.93 5.07 5.22 5.38 5.56 5.74 5.87 - ------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A - -------------------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. J994 Page 21 SECTION 11 - GENERAL PROVISIONS THE CONTRACT The entire contract consists of this contract, and endorsements, if any. MODIFICATION OF CONTRACT No change in this contract is valid unless made in writing by us and approved by one of our officers. No Registered Representative has authority to change or waive any provision of Your contract. TAX QUALIFICATION This contract is intended to qualify as an annuity contract for federal income tax purposes. The provisions of this contract are to be interpreted to maintain such qualification, notwithstanding any other provisions to the contrary. To maintain such tax qualification, we reserve the right to amend this contract to reflect any clarifications that may be needed or are appropriate to maintain such tax qualification or to conform this contract to any applicable changes in the tax qualification requirements. We will send You a copy in the event of any such amendment. If You refuse such an amendment it must be by giving us written notice, and Your refusal may result in adverse tax consequences. NON-PARTICIPATING This contract will not share in our surplus earnings. AGE OR SEX CORRECTIONS If the age or sex of the Annuitant has been misstated, the benefits will be those, which the premiums paid, would have purchased for the correct age and sex. If required by law to ignore differences in the sex of the Annuitant, the annuity payments will be determined using the unisex factors in Section 10. Any underpayment made by us will be paid with the next payment. Any overpayment made by us will be deducted from future payments. Any underpayment or overpayment, will include interest at 5% per year, from the date of the wrong payment to the date of the adjustment. INCONTESTABILITY This contract shall be incontestable from the Contract Date. EVIDENCE OF SURVIVAL We have the right to require satisfactory evidence that a person was alive if a payment is based on that person being alive. No payment will be made until we receive the evidence. SETTLEMENT Any payment by us under this contract is payable at our Home Office. RIGHTS OF OWNER The owner may, while the Annuitant is living: 1. Assign this contract. 2. Surrender the contract to us. 3. Amend or modify the contract with our consent. 4. Receive annuity payments or name a Payee to receive the payments. 5. Exercise, receive and enjoy every other right and benefit contained in the contract. The use of these rights may be subject to the consent of any assignee or irrevocable beneficiary; and of the spouse in a community or marital property state. Unless we have been notified of a community or marital property interest in this contract, we will rely on our good faith belief that no such interest exists and will assume no responsibility for inquiry. CHANGE OF OWNERSHIP In the case of a non-tax-qualified annuity, You can change the owner of this contract, from yourself to a new owner, in a notice You sign which gives us the facts that we need. When this change takes effect, all rights of ownership in this contract will pass to the new owner. A change of owner will not be effective until it is recorded in our records. After it has been so recorded, the change will take effect as of the date You signed the notice. However, if the Annuitant dies before the notice has been so recorded, it will not be effective as to those proceeds we have paid before the change was recorded in our records. We may require that the change be endorsed in the contract. Changing the owner does not change the beneficiary or the Annuitant. A change of ownership may result in adverse tax consequences. ANNUITY COMMENCEMENT DATE The Annuity Commencement Date is the date annuity payments begin. This date may not be later than the last day of the contract month starting after the Annuitant attains age 85, except as expressly allowed by us (within state restrictions), but in no event later than the last day of the contract month following the month in which the Annuitant attains age 95. You may change the Annuity Commencement Date at any time before the Annuity Commencement Date by giving us 30 days' written notice. R142 Page 22 SECTION 11 - CONTINUED ASSIGNMENT (a) In the case of a non tax-qualified annuity, this Contract may be assigned. The assignment must be in writing and filed with us. (b) We assume no responsibility for the validity of any assignment. Any claim made under an assignment shall be subject to proof of interest and the extent of the assignment. (c) This contract may be applied for and issued to qualify as a tax-qualified annuity under certain sections of the Internal Revenue Code. Ownership of this contract is then restricted so that it will comply with provisions of the Internal Revenue Code. Assignment of this contract may result in adverse tax consequences. BENEFICIARY Death proceeds, when payable in accordance with Section 9, are payable to the designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and may be changed without consent (unless irrevocably designated or required by law) by notifying us in writing on a form acceptable to us. The change will take effect upon the date You sign it, whether or not You are living when we receive it. The notice must have been postmarked (or show other evidence of delivery that is acceptable to us) on or before the date of death. Your most recent change of beneficiary notice will replace any prior beneficiary designations. No change will apply to any payment we made before the written notice was received. If an irrevocable beneficiary dies, You may designate a new beneficiary. You may direct that the beneficiary shall not have the right to withdraw, assign or commute any sum payable under an option. In the absence of such election or direction, the beneficiary may change the manner of payment or make an election of any option. If any primary or contingent beneficiary dies before the Annuitant, that beneficiary's interest in this contract ends with that beneficiary's death. Only those beneficiaries living at the time of the Annuitant's death will be eligible to receive their share of the death proceeds. In the event no primary or contingent beneficiaries have been named and all primary beneficiaries have died before the death proceeds become payable, the owner(s) will become the beneficiary(ies) unless elected otherwise in accordance with Section 9. If both primary and contingent beneficiaries have been named, payment will be made to the named primary beneficiaries living at the time the death proceeds become payable. If there is more than one beneficiary and You failed to specify their interest, they will share equally. Payment will be made to the named contingent beneficiary(ies) only, if all primary beneficiaries have died before the death proceeds become payable. If any primary beneficiary is alive at the time the death proceeds become payable, but dies before receiving their payment, their share will be paid to their estate. PROTECTION OF PROCEEDS Unless You so direct by filing written notice with us, no beneficiary may assign any payments under this contract before the same are due. To the extent permitted by law, no payments under this contract will be subject to the claims of creditors of any beneficiary. DEFERMENT We will pay any Partial Withdrawals or Surrender proceeds from the Separate Account within 7 days after we receive all requirements that we need. However, it may happen that the New York Stock Exchange is closed for trading (other than the usual weekend or holiday closings), or the Securities and Exchange Commission restricts trading or determines that an emergency exists. If so, it may not be practical for us to determine the investment experience of the Separate Account. In that case, we may defer transfers among the Subaccounts and to the Fixed Account, and determination or payment of Partial Withdrawals or Surrender proceeds. When permitted by law, we may defer paying any Partial Withdrawals or Surrender proceeds from the Fixed Account for up to 6 months from the date we receive Your request. If the owner dies after the request is received, but before the request is processed, the request will be processed before the death proceeds are determined. Interest will be paid on any amount deferred for 30 days or more. This rate will be the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3, unless otherwise required by law. REPORTS TO OWNER We will give You an annual report at least once each Contract Year. This report will show the number and value of the accumulation units held in each of the Subaccounts as well as the value of the Fixed Account. It will also give You the Death Benefit, Cash Value, and any other facts required by law or regulation. R142 Page 23 Home Office: Transamerica Occidental Life Transamerica 4333 Edgewood Road NE +Insurance Company [LOGO] Occicental Life Cedar Rapids, IA 52499 A Stock Company INDEX Page Account Value ................................. 4 Accumulation Units ............................ 9 Age or Sex Corrections ........................ 22 Annuity Commencement Date ..................... 22 Annuity Payments .............................. 14 Adjusted Account Value ........................ 4 Assignment .................................... 23 Beneficiary ................................... 23 Cash Value .................................... 5 Contract ...................................... 22 Contract Data Page ............................ 3 Death Proceeds ................................ 12 Definitions ................................... 2 Dollar Cost Averaging Option .................. 11 Evidence of Survival .......................... 22 Excess Interest Adjustment .................... 5 Fixed Account ................................. 10 Guaranteed Minimum Death Benefit .............. 12 Guaranteed Return of Fixed Account Premium Payments .......................... 8 Guaranteed Periods ............................ 10 Incontestability .............................. 22 Modification of Contract ...................... 22 Non-participating ............................. 22 Option to Change Annuity Commencement Date .... 22 Partial Withdrawals ........................... 6 Payee ......................................... 15 Payment of Premiums ........................... 4 Payment Option Tables ......................... 18, 19, 20, 21 Proof of Age .................................. 5 Protection of Proceeds ........................ 3 Right to Cancel ............................... 1 Rights of Owner ............................... 2 Separate Account .............................. 8 Service Charge ................................ 4 Settlement .................................... 2 Surrender Charges ............................. 8 Transfers ..................................... 10 Flexible Premium Deferred Variable Annuity Income Payable At Annuity Commencement Date Benefits Based On The Performance Of The Separate Account Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C) Non-Participating Y734 EX-4.D.1 4 dex4d1.txt EXHIBIT-4.D.1 EXHIBIT (4)(d)(1) FORM OF LIQUIDITY RIDER Home Office: Transamerica Occidental Life 4333 Edgewood Road NE Insurance Company [LOGO] Transamerica Cedar Rapids, IA 52499 OCCIDENTAL LIFE A Stock Company ANNUITANT: John Doe OWNER(S): John Doe CONTRACT NUMBER: 07 - 12345 CONTRACT DATE: December 4, 2001 WE AGREE .. To provide annuity payments as set forth in Section 10 of this contract, .. Or to pay Withdrawal benefits in accordance with Section 5 of this contract, .. Or to pay death proceeds in accordance with Section 9 of this contract. Withdrawals may be subject to an Excess Interest Adjustment reflecting changes in interest rates in accordance with Section 5 of this contract. Transfers and amounts applied to a Payment Option may also be subject to an Excess Interest Adjustment in accordance with Sections 8 and 10, respectively, of this contract. These agreements are subject to the provisions of this contract. This contract is issued in consideration of the payment of the initial premium. This contract may be applied for and issued to qualify as a tax-qualified annuity under the applicable sections of the Internal Revenue Code. 20 DAY RIGHT TO CANCEL You may cancel this contract by delivering or mailing a written notice or sending a telegram to us. You must return the contract before midnight of the twentieth day after the day You receive it. Notice given by mail and return of the contract by mail are effective on being postmarked, properly addressed and postage prepaid. We will pay You an amount equal to the sum of: .. the premiums paid; .. less partial withdrawals; and .. the accumulated gains or losses, if any, in the Separate Account on the date .. of cancellation; unless otherwise required by law. Signed for us at our home office. /s/ James W. Dederer /s/ Ron F. Wagley SECRETARY PRESIDENT This contract is a legal contract between the contract owner and the Company. READ YOUR CONTRACT CAREFULLY Flexible Premium Deferred Variable Annuity Income Payable At Annuity Commencement Date Benefits Based On The Performance Of The Separate Account Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C) Non-Participating AV696 101 145 901 SECTION 1 - DEFINITIONS ACCOUNT VALUE - Amount defined in Section 4, that can be used to fund one of the Payment Options. ADJUSTED ACCOUNT VALUE - The Account Value increased or decreased by any Excess Interest Adjustment. ANNUITANT - The person whose life annuity payments will be based on. ANNUITY COMMENCEMENT DATE - The Date the Annuitant will begin receiving payments from this contract, which may not be later than the last day of the contract month starting after the Annuitant attains age 85, except as expressly allowed by us (within state restrictions), but in no event later than the last day of the month in which the Annuitant attains age 95. CASH VALUE - Amount, defined in Section 5 that is available for partial or full Surrenders. CONTRACT ANNIVERSARY - The anniversary of the Contract Date for each year the contract remains in force. CONTRACT DATE - The date shown on the Contract Data page of this contract and the date on which this contract becomes effective. CONTRACT YEAR - The 12-month period following the Contract Date shown on the Contract Data page. The first Contract Year starts on the Contract Date. Each subsequent year starts on the anniversary of the Contract Date. CUMULATIVE EARNINGS - An amount equal to the Account Value at the time a lump sum payout or systematic payout option payout is made, minus the sum of all premium payments reduced by all prior partial Withdrawals deemed to have been from premium, if any. CUSTODIAL CARE - Care designed essentially to help a person with the activities of daily living which does not require the continuous attention of trained medical or paramedical personnel. DISTRIBUTION - A Withdrawal or disbursement of funds from the Account Value or Cash Value. Account Value and Cash Value will be reduced by any Distribution. GAINS - Cumulative Earnings, if any, in the Account Value. HOSPITAL - An institution which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or under the supervision of registered graduate professional nurses, 4) is supervised by a staff of one or more licensed Physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. INVESTMENT OPTIONS - Any of the Guaranteed Period Options of the Fixed Account, the Dollar Cost Averaging Fixed Account Option, and any of the Subaccounts of the Separate Account. MONTHLY ANNIVERSARY - The same date each month as the Contract Date. If there is no day in the calendar month, which coincides with the Contract Date, the Monthly Anniversary will be the first day of the next calendar month. NURSING CARE - Care prescribed by a Physician and performed or supervised by a registered graduate nurse. Such care includes nursing and rehabilitation services available 24 hours. NURSING FACILITY - A facility which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) provides Nursing Care or Custodial Care, 3) primarily provides Nursing Care under the direction of a licensed Physician, registered graduate professional nurse, or licensed vocational nurse, except when receiving Custodial Care, and 4) is not other than incidentally a Hospital, a home for the aged, a retirement home, a rest home, a community living center or a place mainly for the treatment of alcoholism, mental illness or drug abuse. PAYEE - The person to whom annuity payments will be made. PAYMENT OPTIONS - Options through which the distribution of the Adjusted Account Value can be directed. PHYSICIAN - Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of the license. SEPARATE ACCOUNT - The separate investment account(s) established by us, as described in Section 6. SUBACCOUNT - A division of the Separate Account, as described in Section 6. SURRENDER - A partial or full withdrawal of funds from the Account Value or Cash Value. TERMINAL CONDITION - A condition resulting from an accident or illness which, as determined by a Physician, has reduced life expectancy to not more than 12 months, despite appropriate medical care. WITHDRAWAL - A distribution of funds from the Account Value or Cash Value. YOU, YOUR - The owner of this contract. Unless otherwise specified on the Contract Data page, the Annuitant and the owner shall be one and the same person. AVB696 Page 2 SECTION 2 - CONTRACT DATA CONTRACT NUMBER: [07 - 12345] ANNUITANT: [John Doe] INITIAL PREMIUM PAYMENT: [$5,000.00] ISSUE AGE/SEX: [35 / Male] CONTRACT DATE: [December 4, 2001] OWNER(S): [John Doe] ANNUITY COMMENCEMENT GUARANTEED DATE: [March 8, 2050] MINIMUM DEATH BENEFIT OPTION: [N] BENEFICIARY: [Jane Doe] Fixed Account Guaranteed Minimum Effective Annual Interest Rate: [2%] Before the Annuity Commencement Date: Death Benefit Option P - Return of Premium Mortality and Expense Risk Fee and Administrative Charge: Policy Years 1-4 1.70% Policy Years 5 and later 1.30% Death Benefit Option N - 6% / Monthly Double Enhanced Mortality and Expense Risk Fee and Administrative Charge: Policy Years 1-4 1.85% Policy Years 5 and later 1.45% Current interest rates credited to the Fixed Account may be lower than those credited to the Fixed Account on contracts without the Surrender Charge Modification Rider. However, the credited interest rate will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown above. After the Annuity Commencement Date: Mortality and Expense Risk Fee and Administrative Charge: 1.25% AV696 101 145 901SP (RLS) Page 3 SECTION 3 - PREMIUM PAYMENTS PAYMENT OF PREMIUMS Premium payments may be made any time while this contract is in force before the Annuity Commencement Date. You may start or stop, increase or decrease, or skip any Premium Payments. MAXIMUM AND MINIMUM PREMIUM PAYMENT The premium payments may not be more than the amount permitted by law if this is a tax-qualified annuity. The minimum initial premium payment is $5,000. If this contract is being used as a tax-qualified annuity, the minimum initial premium is $1,000, except that no minimum initial premium payment will be required for 403(b) annuities. The minimum subsequent premium payment we will accept is $50. The maximum total premium payments which we will accept without prior Company approval is $1,000,000. PREMIUM PAYMENT DATE The premium payment date is the date on which the premium payment is credited to the contract. The initial premium payment less any applicable premium taxes will be credited to the contract within two business days of receipt of the premium payment and the information needed. Subsequent additional premium payments will be credited to the contract as of the business day the premium payment and required information are received. A business day is any day that the New York Stock Exchange is open for trading. ALLOCATION OF PREMIUM PAYMENTS Premium payments may be applied to various Investment Options, which we make available. For each premium payment, You must indicate what percentage to allocate to various Investment Options. Each percent may be either zero or any whole number; however, the allocation among all accounts must total 100%. CHANGE OF ALLOCATION You may change the allocation of premium payments to various Investment Options by providing us notice containing the facts that we need. Premium payments received after the date on which we receive Your notice will be applied on the basis of the new allocation. PREMIUM TAXES Your state may impose a premium tax. It may be imposed either when a premium payment is made, on the Annuity Commencement Date, on the date of death or on the date of full Surrender. When permitted by state law, we will not deduct the premium tax until the Annuity Commencement Date, date of death, or date of full Surrender. SECTION 4 - ACCOUNT VALUE ACCOUNT VALUE On or before the Annuity Commencement Date, the Account Value is equal to Your: (a) premium payments; minus (b) Gross Partial Withdrawals (as defined in Section 5); plus (c) interest credited to the Fixed Account (see Section 7); plus (d) accumulated gains in the Separate Account (see Section 6); minus (e) accumulated losses in the Separate Account (see Section 6); minus (f) service charges, premium taxes, rider fees and transfer fees, if any. ADJUSTED ACCOUNT VALUE The Adjusted Account Value is the Account Value increased or decreased by any Excess Interest Adjustment. You may use the Adjusted Account Value on the Annuity Commencement Date to provide lifetime income or income for a period of no less than 60 months under the Payment Options in Section 10. SERVICE CHARGE On each Contract Anniversary and at the time of full Surrender during any Contract Year before the Annuity Commencement Date, we reserve the right to assess a service charge up to $35 for contract administration expenses. The Service Charge will be deducted from each Investment Option in proportion to the portion of Account Value (prior to such charge) in each Investment Option. In no event will the Service Charge exceed 2% of the Account Value on the Contract Anniversary or at the time of full Surrender. The Service Charge will not be deducted on a Contract Anniversary or at the time of full Surrender if, at either of these times, (1) the sum of all premium payments less the sum of all Withdrawals taken equals or exceeds $50,000; or (2) the Account Value equals or exceeds $50,000. M1259 Page 4 SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS CASH VALUE On or before the Annuity Commencement Date, the Cash Value is equal to the Adjusted Account Value less any Surrender Charges. Information on the current amount of Your contract's Cash Value is available upon request. The Cash Value may be partially withdrawn or will be paid in the event of a full Surrender of the contract. We must receive Your written partial Withdrawal or Surrender request before the Annuity Commencement Date. There is no Cash Value once an Annuity Payment Option has been selected. EXCESS INTEREST ADJUSTMENT Full Surrenders, partial Withdrawals, transfers, and amounts applied to a Payment Option (prior to the end of any Guaranteed Payment Option) from Guaranteed Period Options of the Fixed Account described in Section 7 will be subject to an Excess Interest Adjustment except as provided for in the partial Withdrawals provision below. An Excess Interest Adjustment applies in the following situations: 1) When You withdraw all or any portion of Your Cash Value, 2) When You exercise Annuity Payment Options, 3) When death proceeds are calculated. However, death proceeds will not be reduced if the Excess Interest Adjustment is negative. The Excess Interest Adjustment is only applied to transactions affecting the Guaranteed Period Options of the Fixed Account (see Section 7) and is based on any change in interest rates from the time the affected Guaranteed Period(s) started until the time the Excess Interest Adjustment occurs. The Excess Interest Adjustment is applied as follows: 1) The Excess Interest Adjustment is only applied when the transactions occur prior to the end of any Guaranteed Period Option; 2) Transfers to the Guaranteed Period Options of the Fixed Account are considered Premium Payments for purposes of determining the Excess Interest Adjustment; 3) The Excess Interest Adjustment is distinct from, and is applied prior to, the surrender charge; 4) The Excess Interest Adjustment may affect the death proceeds defined in Section 9; 5) If interest rates have decreased from the time the affected Guaranteed Period(s) started until the time the transaction occurs, the Excess Interest Adjustment will result in additional funds available to You; 6) If interest rates have increased from the time the affected Guaranteed Period(s) started until the time the transaction occurs, the Excess Interest Adjustment will result in a decrease in the funds available to You; 7) Certain amounts are not subject to the Excess Interest Adjustment as provided in Sections 5, 7 and 8. The formula for determining the amount of the Excess Interest Adjustment is as follows: Excess Interest Adjustment = S x (G-C) x (M/12) where: S is the amount (before surrender charges and premium taxes, if any) being Surrendered, partially withdrawn, transferred, or applied to a Payment Option that is subject to the Excess Interest Adjustment. G is the guaranteed interest rate for the Guaranteed Period applicable to "S". C is the current guaranteed interest rate then being offered on new Premium Payments for the next longer Guaranteed Period than "M". If this contract form or such a Guaranteed Period Option is no longer offered, "C" will be the U.S. Treasury rate for the next longer maturity (in whole years) than "M" on the 25th day of the previous calendar month, plus up to 2%. M is the number of months remaining in the Guaranteed Period for "S", rounded up to the next higher whole number of months. Upon full Surrender, the Excess Interest Adjustment (EIA) for each Guaranteed Period Option will not reduce the Adjusted Account Value for that Guaranteed Period Option below the amount paid into, less any prior Withdrawals and transfers from, that Guaranteed Period Option, plus interest at the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. U1259 Page 5 SECTION 5 - CONTINUED PARTIAL WITHDRAWALS We will pay You a portion of the Cash Value as a Partial Withdrawal provided we receive Your written request while the contract is in effect and before the Annuity Commencement Date. When You request a Partial Withdrawal You must tell us how it is to be allocated from among the Investment Options. If no selection is made, the Partial Withdrawal will be taken prorata from Your Investment Option. If Your request for a Partial Withdrawal from any Investment Option is less than or equal to the Cash Value in that option, we will pay the amount of Your request. However, if Your request for a Partial Withdrawal from any Investment Option is greater than the Cash Value in that option, we will pay You the Cash Value of that Investment Option. The Gross Partial Withdrawal is the total amount which will be deducted from Your Account Value as a result of each Partial Withdrawal. The Gross Partial Withdrawal may be more or less than Your requested Partial Withdrawal amount, depending on whether surrender charges and/or Excess Interest Adjustments apply at the time You request the Partial Withdrawal. The Excess Partial Withdrawal amount is the portion of the requested Partial Withdrawal that is subject to surrender charge (that is, the portion which is in excess of the surrender charge-free portion). For example, if the requested withdrawal amount is $1,000, and the surrender charge-free amount is $200, then the Excess Partial Withdrawal would be $800. Excess Partial Withdrawals will reduce the Account Value by an amount equal to (X-Y+Z) where: X = Excess Partial Withdrawal A = Amount of Partial Withdrawal subject to Excess Interest Adjustment Y = Excess Interest Adjustment = (A) x (G-C) x (M/12) where G, C and M are defined in the Excess Interest Adjustment provision above, with "A" substituted for "S" in the definitions of G and M. Z = surrender charge on X minus Y. The formula for determining the Gross Partial Withdrawal is as follows: Gross Partial Withdrawal = R - E + SC, where: R is the requested Partial Withdrawal; E is the Excess Interest Adjustment; and SC is the surrender charge on (EPW - E); where EPW is the Excess Partial Withdrawal Amount (the portion of the requested Partial Withdrawal that is subject to surrender charge). If any Partial Withdrawal reduces the Cash Value below $500, we reserve the right to pay the full Cash Value and terminate the contract. We may delay payment of the Cash Value from the Fixed Account for up to 6 months after we receive the request. If the owner dies after we receive the request, but before the request is processed, the request will be processed before the death proceeds are determined. Each Partial Withdrawal consists of a portion that is subject to a surrender charge (that is, the Excess Partial Withdrawal) and a remaining portion that is free from surrender charge (that is, the surrender charge-free amount). Either portion may be zero (0) depending on the Partial Withdrawal requested and prior amounts withdrawn. Partial Withdrawals in the amount of the cumulative interest in the Guaranteed Period Option(s) of the Fixed Account at the time of Withdrawal may be withdrawn from the GPO(s) of the Fixed Account free of any Excess Interest Adjustment. Amounts withdrawn under one of these options may reduce the amount available free of surrender charges under another option. Surrender charges and/or Excess Interest Adjustment may be waived as described below: LUMP SUM Beginning in the second Contract Year, You may withdraw, free from surrender charges, a lump sum amount equal to the maximum of A or B where: A is the Cumulative Earnings, if any, in the Account Value and B is an amount equal to 10% of the premium payments immediately prior to the partial Withdrawal reduced by all prior partial Withdrawals deemed to have been from premium, if any. The minimum partial Withdrawal under this option is $500. This partial Withdrawal option is available once per Contract Year. P1246 Page 6 SECTION 5 - CONTINUED SYSTEMATIC PAYOUT OPTION Beginning in the first Contract Year, a Systematic Payout Option (SPO) is available on a monthly, quarterly, semi-annual or annual basis. At the time a SPO payout is made, such payout must be at least $50 and may not exceed the maximum of A and B, divided by the number of payouts made per year (e.g. 12 for monthly). A is the Cumulative Earnings, if any, in the Account Value and B is an amount equal to 10% of the premium payments immediately prior to the partial Withdrawal reduced by all prior partial Withdrawals deemed to have been from premium, if any. No surrender charges or Excess Interest Adjustment will apply to the SPO payout. Monthly and quarterly payouts must be sent through electronic funds transfer directly to a checking or savings account. You may start or stop SPO payouts at any time; however, 30 days' written notice is required to stop SPO payouts. Once You have elected a SPO, You must wait a minimum time before the first SPO payment: 1 month for monthly, 3 months for quarterly, 6 months for semi-annual, or 12 months for annual. MINIMUM REQUIRED DISTRIBUTION For tax-qualified plans, partial Withdrawals taken to satisfy minimum distribution requirements under Section 401(a)(9) of the Internal Revenue Code (IRC) are available with no surrender charges and no Excess Interest Adjustments. The amount available from this contract with respect to the minimum distribution requirement is based solely on this contract. The owner must be at least 70 1/2 years old in the calendar year of distribution, must submit a written request to us and must take the distribution before year-end. If the owner attains age 70 1/2 in the calendar year of distribution, a written request, which is postmarked no later than the end of the current calendar year, must be submitted to us. Systematic minimum distributions must be at least $50 or a lump sum distribution is available if minimum required distributions are less than $50. Any amount requested in excess of the IRC minimum required distribution will have the appropriate surrender charges and Excess Interest Adjustments applied, unless the excess Distribution qualifies as surrender charge-free or Excess Interest Adjustment-free under any additional options provided. NURSING CARE AND TERMINAL CONDITION WITHDRAWAL OPTION Beginning in the first Contract Year, if the owner or owner's spouse (Annuitant or Annuitant's spouse if the owner is not a natural person) has been 1) confined in a Hospital or Nursing Facility for 30 consecutive days or 2) diagnosed as having a Terminal Condition, You may elect to withdraw all or a portion of the Account Value without surrender charges and without an Excess Interest Adjustment. The minimum Withdrawal under this option is $1000. This option is available even during the contract years other partial Withdrawal options were exercised prior to Nursing Care. For Nursing Care, we must receive each Withdrawal request and proof of eligibility with each request no later than 90 days following the date that confinement has ceased, unless it can be shown that it was not reasonably possible to provide the notice and proof within the above time period and that the notice and proof were given as soon as reasonably possible. However, in no event, except the absence of legal capacity, shall the notice and proof be provided later than one year following the date that confinement has ceased. Proof of confinement may be a Physician's statement or a statement from a Hospital or Nursing Facility administrator. For a Terminal Condition, we must receive each Withdrawal request and the applicable proof of eligibility no later than one year following diagnosis of the Terminal Condition. Proof of a Terminal Condition is required only with the initial Withdrawal request and must be furnished by the owner's, owner's spouse's, Annuitant's, or Annuitant's spouse's Physician. UNEMPLOYMENT WAIVER Beginning in the first Contract Year, You may withdraw all or a portion of the Account Value free of any surrender charges and free of any Excess Interest Adjustment if the owner or owner's spouse (Annuitant or Annuitant's spouse, if the owner is not a natural person) becomes unemployed. In order to qualify, You 1) must have been employed full-time for at least two years prior to Your becoming unemployed, 2) must have been employed full-time on Your Contract Date, 3) must have been unemployed for at least 60 consecutive days at the time of Withdrawal and 4) must have a minimum Cash Value at the time of Withdrawal of $5000. Proof of unemployment will consist of providing us with a determination letter from the applicable State's Department of Labor, which verifies that You qualify for and are receiving unemployment benefits at the time of Withdrawal. The determination letter must be received by us no later than 15 days following the date of the Withdrawal request. PB1246 Page 7 SECTION 5 - CONTINUED SURRENDER CHARGES Amounts withdrawn in excess of the surrender charge-free amount specified in the Withdrawal provisions above are subject to a surrender charge. The amount of this charge, if any, will be a percentage, as shown in the table below, of the amount of premium withdrawn: Number of Years Percentage of Since Premium Premium Withdrawn Payment Date 0-1 7% 1-2 7% 2-3 6% 3-4 6% 4-5 5% 5-6 4% 6-7 3% 7 or more 0% For surrender charge purposes, all earnings are considered to be withdrawn first. After all earnings are withdrawn then the oldest premium payment is the first premium payment considered to be withdrawn. If the amount withdrawn exceeds this, the next oldest premium payment is considered to be withdrawn, and so on until the most recent premium payments are deemed to be withdrawn (the procedure being applied to Withdrawals of premium is a "First-In, First-Out" or FIFO procedure). GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS Upon full Surrender of the contract, You will always receive at least the premium payments made to, less prior Withdrawals and transfers from, the Fixed Account. MINIMUM VALUES Benefits available under this contract, including any paid up annuity or death benefits that may be available, are not less than those required by any statute of the state in which the contract is delivered. SECTION 6 - SEPARATE ACCOUNT SEPARATE ACCOUNT We have established and will maintain one or more Separate Account(s), under the laws of the state of Iowa. Any realized or unrealized income, net gains and losses from the assets of the Separate Account are credited to or charged against it without regard to our other income, gains or losses. Assets are put in the Separate Account for this contract, as well as for other variable annuity contracts. Any Separate Account may invest assets in shares of one or more mutual fund portfolio, or in the case of a managed Separate Account, direct investments in stocks or other securities as permitted by law. Fund shares refer to shares of underlying mutual funds or prorata ownership of the assets held in a Subaccount of a managed Separate Account. Fund shares are purchased, redeemed and valued on behalf of the Separate Account. The Separate Account is divided into Subaccounts. Each Subaccount invests exclusively in shares of one of the portfolios of an underlying fund. We reserve the right to add or remove any Subaccount of the Separate Account. The assets of the Separate Account are our property. These assets will equal or exceed the reserves and other contract liabilities of the Separate Account. These assets will not be chargeable with liabilities arising out of any other business we conduct. We reserve the right, subject to regulations governing the Separate Account, to transfer assets of a Subaccount, in excess of the reserves and other contract liabilities with respect to that Subaccount, to another Subaccount or to our General Account. We will determine the fair market value of the assets of the Separate Account in accordance with a method of valuation, which we establish in good faith. Valuation Period means the period of time from one determination of the value of each Subaccount to the next. Such determinations are made when the value of the assets and liabilities of each Subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. We also reserve the right to transfer assets of the Separate Account, which we determine to be associated with the class of contracts to which this contract belongs, to another Separate Account. If this type of transfer is made, the term "Separate Account", as used in the contract, shall then mean the Separate Account to which the assets were transferred. We also reserve the right, when permitted by law to: (a) deregister the Separate Account under the Investment Company Act of 1940; (b) manage the Separate Account under the direction of a committee at any time; (c) restrict or eliminate any voting rights of contract owners or other persons who have voting rights as to the Separate Account; (d) combine the Separate Account with one or more other Separate Accounts; (e) create new Separate Accounts; (f) add new Subaccounts to or remove existing Subaccounts from the Separate Account, or combine Subaccounts; and (g) add new underlying mutual funds, remove existing mutual funds, or substitute a new fund for an existing fund. V1266 Page 8 SECTION 6 - CONTINUED The Net Asset Value of a fund share is the per-share value calculated by the mutual fund or, in the case of a managed Separate Account, by the Company. The Net Asset Value is computed by adding the value of the Subaccount's investments, cash and other assets, subtracting its liabilities, and then dividing by the number of shares outstanding. Net Asset Values of fund shares reflect investment advisory fees and other expenses incurred in managing a mutual fund or a managed Separate Account. CHANGE IN INVESTMENT OBJECTIVE OR POLICY OF A MUTUAL FUND If required by law or regulation, an investment policy of the Separate Account will only be changed if approved by the appropriate insurance official of the state of Iowa or deemed approved in accordance with such law or regulation. If so required, the process for obtaining such approval is filed with the insurance official of the state or district in which this contract is delivered. CHARGES AND DEDUCTIONS The Mortality and Expense Risk Fee and the Administrative Charge are each deducted both before and after the Annuity Commencement Date to compensate for changes in mortality and expenses not anticipated by the mortality and administration charges guaranteed in the contract. The service charge is deducted prior to the Annuity Commencement Date only. If the Mortality and Expense Risk Fee is more than sufficient, the Company will retain the balance as profit or may reduce this fee in the future. ACCUMULATION UNITS The Account Value in the Separate Account before the Annuity Commencement Date is represented by accumulation units. The dollar value of accumulation units for each Subaccount will change from business day to business day reflecting the investment experience of the Subaccount. Premium payments allocated to and any amounts transferred to the Subaccounts will be applied to provide accumulation units in those Subaccounts. The number of accumulation units purchased in a Subaccount will be determined by dividing the amount allocated to or transferred to that Subaccount, by the value of an accumulation unit for that Subaccount on the premium payment or transfer date. The number of accumulation units withdrawn or transferred from the Subaccounts will be determined by dividing the amount withdrawn or transferred by the value of an accumulation unit for that Subaccount on the Withdrawal or transfer date. The value of an accumulation unit on any business day is determined by multiplying the value of that unit at the end of the immediately preceding valuation period by the net investment factor for the valuation period. The net investment factor used to calculate the value of an accumulation unit in each Subaccount for the Valuation Period is determined by dividing (a) by (b) and subtracting (c) from the result, where: (a) is the result of: (1) the net asset value of a fund share held in that Subaccount determined as of the end of the current valuation period; plus (2) the per share amount of any dividend or capital gain Distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the valuation period; plus or minus (3) a per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount. (b) is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding valuation period. (c) is a factor representing the Mortality and Expense Risk Fee and Administrative Charge before the Annuity Commencement Date. This factor is less than or equal to, on an annual basis, the percentage shown on the Contract Data Page of the daily net asset value of a fund share held in that Subaccount. Since the net investment factor may be greater or less than one, the accumulation unit value may increase or decrease. VB1266 Page 9 SECTION 7 - FIXED ACCOUNT FIXED ACCOUNT Premium payments applied to and any amounts transferred to the Fixed Account will reflect a fixed interest rate. The interest rates we set will be credited for increments of at least one year measured from each premium payment or transfer date. These rates will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. Upon full Surrender of the Contract, the minimum Cash Value provided by the Fixed Account portion of the Account Value will be at least 90% of the premium payments made to the Fixed Account, less prior Withdrawals and transfers from the Fixed Account, plus interest credited using an Effective Annual Interest Rate of 3%. GUARANTEED PERIODS We may offer optional Guaranteed Period Options, into which premium payments may be paid or amounts transferred. The current interest rate we set for funds entering each Guaranteed Period Option (GPO) is guaranteed until the end of that option's Guaranteed Period. At that time, the premium payment made or amount transferred into the GPO, less any Withdrawals or transfers from that GPO, plus accrued interest, will be rolled into a new GPO or may be transferred to any Subaccount(s) within the Separate Account(s). You may choose the Investment Option(s) You want the funds rolled into by giving us a written notice within 30 days before the end of the expiring option's Guaranteed Period. However, any Guaranteed Period elected may not extend beyond the maximum Annuity Commencement Date defined in Section 11. In the absence of such election, the funds will be rolled into a new GPO which is the same as the expiring GPO unless that GPO is no longer offered, in which case, the next shorter GPO offered will be used. You will be mailed a notice of completion of the rollover with the new interest rate applicable. The new GPO will be deemed as accepted if we do not receive a written rejection within 30 days from the postmark date of the completion notice. We reserve the right for new premium payments, transfers, or rollovers to offer or not to offer any GPO, except that we will always offer at least a one-year GPO. When funds are withdrawn or transferred from a GPO, the Account Value associated with the oldest premium payment or rollover is considered to be withdrawn/transferred first. If the amount withdrawn/transferred exceeds the Account Value associated with the oldest premium, the Account Value associated with the next oldest premium payment or rollover is considered to be withdrawn/transferred next, and so on until the Account Value associated with the most recent premium payment or rollover is considered to be withdrawn/transferred (this is a "First-In, First-Out" or FIFO basis). Partial Withdrawals, Surrenders, transfers, and amounts applied to a Payment Option from the Guaranteed Period Option(s) are subject to an Excess Interest Adjustment as described in Section 5. DOLLAR COST AVERAGING FIXED ACCOUNT OPTION We may offer a Dollar Cost Averaging (DCA) Fixed Account Option separate from the Guaranteed Period Options. This option will have a one-year interest rate guarantee. The current interest rate we set for the DCA Fixed Account may differ from the rates credited on the one-year GPO in the Fixed Account. In addition, the current interest rate we credit may vary on different portions of the DCA Fixed Account. The credited interest rate will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. The DCA Fixed Account Option will only be available under a Dollar Cost Averaging program as described in Section 8. SECTION 8 - TRANSFERS A. TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE Prior to the Annuity Commencement Date, You may transfer the value of the accumulation units from one Investment Option to another by providing us notice containing the facts that we need. Transfers of Account Value from the Guaranteed Period Options (GPO) of the Fixed Account prior to the end of that GPO are subject to an Excess Interest Adjustment. If the Excess Interest Adjustment at the time of such Account Value transfer is a negative adjustment, then the maximum Account Value transfer is 25% of that GPO's Account Value, less Account Values previously transferred out of that GPO during the current Contract Year. If the Excess Interest Adjustment at the time of such Account Value transfer is a positive adjustment, no maximum will apply to such Account Values transferred from the GPO. No Excess Interest Adjustment will apply to Account Value transfers at the end of a Guaranteed Period. Transfers of interest credited in the GPOs to other Investment Options are allowed on a "First-In, First-Out" basis. Such transfers may be made monthly, quarterly, semi-annually, or annually. Each such transfer must be at least $50 and will not be subject to an Excess Interest Adjustment. Transfers of Account Value from the Separate Account are subject to a minimum of $500 or the entire Subaccount Account Value, if less. However, if the remaining Subaccount Account Value is less than $500, we reserve the right to include that amount as part of the transfer. You may choose which GPO to transfer to or from, however, any GPO elected may not extend beyond the maximum Annuity Commencement Date defined in Section 11. L999 Page 10 SECTION 8 - CONTINUED We reserve the right to limit transfers to no more than 18 in any one Contract Year. Any transfers in excess of 18 per Contract Year may be charged a $10 per transfer fee. Transfers among multiple Investment Options will be treated as one transfer in determining the number of transfers that have occurred. We also reserve the right to prohibit transfers to the Fixed Account if we are crediting an interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. The contract was not designed for professional market timing organizations or other persons that use programmed, large, or frequent transfers. The use of such transfers may be disruptive to an underlying portfolio. We reserve the right to reject any transfer request from any person in the interest of overall fund management or, if, in our judgment, an underlying fund would be unable to invest effectively in accordance with its investment objectives and policies or would otherwise be potentially adversely affected or if an underlying fund would reject our purchase order. We also reserve the right to revoke Your telephone, fax, and electronic transfer privileges at any time without revoking all owner's telephone, fax and electronic transfer privileges. DOLLAR COST AVERAGING OPTION Prior to the Annuity Commencement Date, You may instruct us to automatically transfer a specified amount from the Money Market Subaccount or the Dollar Cost Averaging (DCA) Fixed Account Option to any other Subaccount(s) of the Separate Account. The automatic transfers can occur monthly or quarterly. Transfers will continue until the elected Subaccount or DCA Fixed Account value is depleted. The amount transferred each time must be at least $250. All transfers from the DCA account will be the same amount as the initial transfer. Changes to the Subaccounts to which these transfers are allocated are not restricted. Transfers must be scheduled for at least 6, but not more than 24 months or for at least 4, but not more than 8 quarters each time the Dollar Cost Averaging program is started or restarted following termination of the program for any reason. Dollar Cost Averaging results in the purchase of more accumulation units when the value of the accumulation unit is low, and fewer accumulation units when the value of the accumulation unit is high. However, there is no guarantee that the Dollar Cost Averaging program will result in higher Account Values or will otherwise be successful. Dollar Cost Averaging may be discontinued by providing notice to us. While Dollar Cost Averaging is in effect, Asset Rebalancing is not available. ASSET REBALANCING Prior to the Annuity Commencement Date, You may instruct us to automatically transfer amounts among the Subaccounts of the Separate Account on a regular basis to maintain a desired allocation of the Account Value among the various Subaccounts offered. Rebalancing will occur on a monthly, quarterly, semi-annual or annual basis, beginning on a date selected by You. You must select the percentage of the Account Value desired in each of the various Subaccounts offered (totaling 100%). Any amounts in the Fixed Account are ignored for the purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at any time. Asset Rebalancing is not available while Dollar Cost Averaging is in effect. Rebalancing will cease as soon as we receive a request for any other transfer. B. TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE After the Annuity Commencement Date, You may transfer the value of the variable annuity units from one Subaccount to another within the Separate Account or to the Fixed Account. If You want to transfer the value of the variable annuity units, You must provide a signed notice, containing the facts that we need. We reserve the right to limit transfers between the Subaccounts or to the Fixed Accounts to once per Contract Year. The minimum amount which may be transferred is the lesser of $10 monthly income or the entire monthly income of the variable annuity units in the Subaccount from which the transfer is being made. If the monthly income of the remaining units in a Subaccount is less than $10, we have the right to include the value of those variable annuity units as part of the transfer. After the Annuity Commencement Date, no transfers may be made from the Fixed Account to any other Investment Options. LB999 Page 11 SECTION 9 - DEATH PROCEEDS A. DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE The amount of death proceeds will be the greatest of (a), (b) or (c) where: (a) is the Account Value on the date we receive due proof of death and an election of a method of settlement; (b) is the Cash Value on the date we receive due proof of death and an election of a method of settlement, and; (c) is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any additional premium payments received, less any Gross Partial Withdrawals from the date of death to the date of payment of death proceeds. If You have not selected a payment option by the date of death, the beneficiary may make such election within one year of the date we receive due proof of the owner's or Annuitant's death as described in C below. The beneficiary may elect to receive the death proceeds as a lump sum payment or may use the death proceeds to provide any of the annuity Payment Options described in Section 10. Interest on death proceeds will be paid as required by law. B. GUARANTEED MINIMUM DEATH BENEFIT The amount of the Guaranteed Minimum Death Benefit (GMDB) is based on the death benefit option shown on the Contract Data Page. You may not change the GMDB option after the contract is issued. Option N: 6%/ Monthly Double Enhanced Death Benefit This GMDB is equal to the greater of (1) and (2) where: (1) is a 6% Annually Compounding through age 80 Death Benefit, equal to: a) the total premium payments; minus Adjusted Partial Withdrawals, (as described below); plus b) Interest accumulated at 6% per annum from the payment or Withdrawal date to the earlier of; I) the date of death or the Annuitant's 81/st/ birthday, or II) the date the sum of all premium payments less the sum of all Adjusted Partial Withdrawals and any applicable Premium Taxes has grown to two times it's original amount as a result of the 6% interest accumulation. (2) is a Monthly Step-Up through age 80 Death Benefit, equal to: a) the largest Account Value on the Contract Date or on the Monthly Anniversary prior to the earlier of the date of death or the Annuitant's 81st birthday; plus b) any premium payments subsequent to the date of the Monthly Anniversary with the largest Account Value; minus c) any Adjusted Partial Withdrawals (as described below), subsequent to the date of the Monthly Anniversary with the largest Account Value. Option P: Return of Premium Death Benefit This GMDB is equal to the total premiums paid for this contract, less any Adjusted Partial Withdrawals (as described below), as of the date of death. A partial Withdrawal taken as provided in Section 5 will reduce the Guaranteed Minimum Death Benefit by an amount referred to as the "Adjusted Partial Withdrawal". The Adjusted Partial Withdrawal may be a different amount than the Gross Partial Withdrawal described in Section 5. The Adjusted Partial Withdrawal is the total amount deducted from the GMDB as a result of a partial Withdrawal as used in the GMDB provision. It is equal to the Gross Partial Withdrawal described in Section 5, multiplied by an Adjustment Factor. The Adjustment Factor is equal to the amount of the death proceeds prior to the partial Withdrawal divided by the Account Value prior to the partial Withdrawal. D422 Page 12 SECTION 9 - CONTINUED C. DEATH PRIOR TO ANNUITY COMMENCEMENT DATE Death proceeds are payable contingent upon the relationships between the owner, Annuitant, and beneficiary as outlined below. The contract must be surrendered upon settlement or on proof of death. If there is a surviving owner(s), the surviving owner(s) automatically takes the place of any beneficiary designation. I. Annuitant Death When we have due proof that the Annuitant died before the Annuity Commencement Date, we will provide the death proceeds to the beneficiary. If no beneficiary is designated, the owner or owner's estate will become the beneficiary. a) Beneficiary is the deceased Annuitant's surviving spouse. The beneficiary may elect to continue this contract as owner and Annuitant rather than receiving the death proceeds. If the contract is continued, an amount equal to the excess, if any, of the Guaranteed Minimum Death Benefit over the Account Value will then be added to the Account Value. This is a one-time only Account Value adjustment applied at the time the contract is continued, and the Guaranteed Minimum Death Benefit will continue on as applicable. If the contract is continued, all current surrender charges will be waived. If this beneficiary elects to have the death proceeds paid, the death proceeds must be distributed: (1) by the end of 5 years after the date of the deceased Annuitant's death, or (2) payments must begin no later than one year after the deceased Annuitant's death and must be made for a period certain or for this beneficiary's lifetime, so long as any period certain does not exceed this beneficiary's life expectancy. In 1035 exchanges where there are joint Annuitants, the death proceeds will only be payable upon the death of the surviving Annuitant. II. Owner or Joint Owner dies. If an owner or joint owner who is also an Annuitant dies, death proceeds will be payable according to section I above. If an owner or joint owner who is not an Annuitant dies prior to the Annuity Commencement Date and before the entire interest in the contract is distributed, the Annuitant will become the new owner. DB422 Page 13 SECTION 9 - CONTINUED If the new owner is the deceased owner's surviving spouse, the new owner may elect to continue this contract rather than receiving the Adjusted Account Value. If the contract is continued, all current surrender charges will be waived. If the new owner is a natural person but is not the sole surviving spouse, OR if the new owner is the sole surviving spouse but elects to have the Adjusted Account Value paid, the Adjusted Account Value must be distributed by either a) or b) below: (a) by the end of 5 years after the date of the deceased owner's death, or (b) payments must begin no later than one year after the deceased owner's death and must be made for a period certain or for the new owner's lifetime, so long as any period certain does not exceed the new owner's life expectancy. D. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE The death proceeds on or after the Annuity Commencement Date depend on the payment option selected. If any owner dies on or after the Annuity Commencement Date, but before the entire interest in the contract is distributed, the remaining portion of such interest in the contract will be distributed to the owner's beneficiary at least as rapidly as under the method of distribution being used as of the date of that owner's death. E. AN OWNER IS NOT AN INDIVIDUAL In the case of a non tax-qualified annuity, if any owner or beneficial owner is not an individual, then for purposes of the federal income tax mandatory distribution provisions in subsection C or D above, (1) the primary Annuitant will be treated as the owner of the contract, and (2) if there is any change in the primary Annuitant, such a change will be treated as the death of the owner. SECTION 10 - ANNUITY PAYMENTS A. GENERAL PAYMENT PROVISIONS Payment If this contract is in force on the Annuity Commencement Date, we will use the Fixed Account portion and/or the Separate Account portion of the Adjusted Account Value to make annuity payments to the Payee under Option 3 and/or 3-V, respectively, with 10 years certain, or if elected, under one or more of the other options described in this section. However, the option(s) elected must provide for lifetime income or income for a period of at least 60 months. You will become the Annuitant at the Annuity Commencement Date. Payments will be made at 1, 3, 6 or 12-month intervals. We reserve the right to change the frequency of payments to avoid making payments of less than $50.00. Before the Annuity Commencement Date, if the death proceeds become payable or if You Surrender this contract, we will pay any proceeds in one sum, or if elected, all or part of these proceeds may be placed under one or more of the options described in this section. If we agree, the proceeds may be placed under some other method of payment instead. Adjusted Age Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V are determined based on the adjusted age of the Annuitant. The adjusted age is the Annuitant's actual age on the Annuitant's nearest birthday, at the Annuity Commencement Date, adjusted as follows: Annuity Commencement Date Adjusted Age - ----------------- ------------ Before 2010 Actual Age 2010 - 2019 Actual Age minus 1 2020 - 2026 Actual Age minus 2 2027 - 2033 Actual Age minus 3 2034 - 2040 Actual Age minus 4 After 2040 Determined by us S1095 Page 14 SECTION 10 - CONTINUED Election of Optional Method of Payment Before the Annuity Commencement Date You can elect or change a payment option. You may elect, in a notice You sign which gives us the facts that we need, annuity payments that may be either variable, fixed, or a combination of both. If You elect a combination, You must also tell us what part of the contract proceeds on the Annuity Commencement Date are to be applied to provide each type of payment. (You must also specify which Subaccounts.) The amount of a combined payment will be the sum of the variable and fixed payments. Payments under a variable payment option will reflect the investment performance of the selected Subaccount of the Separate Account. Payee Unless You specify otherwise, the Payee shall be the Annuitant, or the beneficiary as defined in the Beneficiary provision in Section 11. Proof of Age We may require proof of the age of any person who has an annuity purchased under Options 3, 3-V, 5 and 5 -V of this section before we make the first payment. Minimum Proceeds If the proceeds are less than $2,000, we reserve the right to pay them out as a lump sum instead of applying them to a payment option. Premium Tax We may be required by law to pay premium tax on the amount applied to a payment option. If so, we will deduct the premium tax before applying the proceeds. Supplementary Contract Once proceeds become payable and a payment option has been selected, we will issue a supplementary contract to reflect the terms of the selected option. The contract will name the Payee(s) and will describe the payment schedule. B. FIXED ACCOUNT PAYMENTS Guaranteed Payment Options The fixed account payment is determined by multiplying each $1,000 of contract proceeds allocated to a fixed payment option by the amounts shown on page 18 for the option You select. Options 1, 2 and 4 are based on a guaranteed interest rate of 3%. Options 3 and 5 are based on a guaranteed interest rate of 3% and the "Annuity 2000" (male, female, and unisex if required by law) mortality table projected for improvement using projection scale G. The "Annuity 2000" mortality rates are adjusted based on improvements in mortality since 2000 to more appropriately reflect increased longevity. This is accomplished using a set of improvement factors referred to as projection scale G. Option 1 - Interest Payments We will pay the interest on the amount we use to provide annuity payments in equal payments or this amount may be left to accumulate for a period of time we and You agree to. We and You will agree on Withdrawal rights when You elect this option. The interest rate we declare for this option may be different than the interest rate(s) credited prior to the Annuity Commencement Date. Option 2 - Income for a Specified Period We will make level payments only for the fixed period You choose. In the event of the death of the person receiving payments prior to the end of the fixed period elected, payments will be continued to that person's beneficiary or their present value may be paid in a single sum. No funds will remain at the end. Option 3 - Life Income - You may choose between: 1. No Period Certain - We will make level payments only during the Annuitant's lifetime. 2. 10 Years Certain - We will make level payments for the longer of the Annuitant's lifetime or ten years. 3. Guaranteed Return of Contract Proceeds - We will make level payments for the longer of the Annuitant's lifetime or until the total dollar amount of payments we made to You equals the amount applied to this option. 4. Life with Emergency Cash - We will make level payments during the Annuitant's lifetime, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the payment where that multiple reduces over time to zero at age 101. A surrender charge will be applied. Should the Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Option 4 - Income of a Specified Amount Payments are made for any specified amount until the amount applied to this option, with interest, is exhausted. This will be a series of level payments followed by a smaller final payment. In the event of the death of the person receiving payments prior to the time proceeds with interest are exhausted, payments will be continued to that person's beneficiary or their present value may be paid in a single sum. SB1095 Page 15 SECTION 10 - CONTINUED Option 5 - Joint and Survivor Annuity - You may choose between: 1. No Period Certain - Payments are made during the joint lifetime of the Payee and a joint Payee of Your selection. Payments will be made as long as either person is living. 2. Life with Emergency Cash - Level payments will be made during the joint lifetime of the Payee and a joint Payee of Your selection. Payments will be made as long as either person is living, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the payment, where that multiple reduces over time to zero at age 101 of the younger Annuitant. A surrender charge will be applied. Should the last surviving Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Current Payment Options The amounts shown in the tables on page 18 are the guaranteed amounts. Current amounts offered to individuals of the same class may be obtained from us. C. VARIABLE ACCOUNT PAYMENT OPTIONS Variable Annuity Units The contract proceeds You tell us to apply to a variable payment option will be used to purchase variable annuity units in Your chosen Subaccounts. The dollar value of variable annuity units in Your chosen Subaccounts will increase or decrease reflecting the investment experience of Your chosen Subaccounts. The value of a variable annuity unit in a particular Subaccount on any business day is equal to (a) multiplied by (b) multiplied by (c), where: (a) is the variable annuity unit value for that Subaccount on the immediately preceding business day; (b) is the net investment factor for that Subaccount for the Valuation Period; and (c) is the Assumed Investment Return adjustment factor for the Valuation Period. The Assumed Investment Return adjustment factor for the valuation period is the product of discount factors of .99986634 per day to recognize the 5.0% effective annual Assumed Investment Return. The net investment factor used to calculate the value of a variable annuity unit in each Subaccount for the Valuation Period is determined by dividing (a) by (b) and subtracting (c) from the result, where: (a) is the net result of: (1) the net asset value of a fund share held in that Subaccount determined as of the end of the current valuation period; plus (2) the per share amount of any dividend or capital gain Distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the Valuation Period; plus or minus (3) a per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of the Subaccount. (b) is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period. (c) is a factor representing the Mortality and Expense Risk Fee and Administrative Charge applicable after the Annuity Commencement Date. This factor is less than or equal to, on an annual basis, the percentage shown on the Contract Data Page of the daily net asset value of a fund share held in the Separate Account for that Subaccount. Determination of the First Variable Payment The amount of the first variable payment is determined by multiplying each $1,000 of contract proceeds allocated to a variable payment option by the amounts shown on page 20 for the variable option You select. The tables are based on a 5% effective annual Assumed Investment Return and the "Annuity 2000" (male, female, and unisex if required by law) mortality table projected for improvement using projection scale G. The "Annuity 2000" mortality rates are adjusted based on improvements in mortality since 2000 to more appropriately reflect increased longevity. This is accomplished using a set of improvement factors referred to as projection scale G. C853 Page 16 SECTION 10 - CONTINUED Option 3-V - Life Income - You may choose between: 1. No Period Certain - Payments will be made during the lifetime of the Annuitant. 2. 10 Years Certain - Payments will be made for the longer of the Annuitant's lifetime or ten years. In the event of the death of the person receiving payments prior to the end of the guarantee period for which the election was made, payments will be continued to that person's beneficiary or their present value may be paid in a single sum. 3. Life with Emergency Cash - We will make payments during the Annuitant's lifetime, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the Supportable Payment (see definition below), where that multiple reduces over time to zero at age 101. A surrender charge will be applied. Should the Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Option 5-V - Joint and Survivor Annuity - You may choose between: 1. No Period Certain - Payments are made as long as either the Annuitant or the joint Annuitant is living. 2. Life with Emergency Cash - Payments will be made during the joint lifetime of the Payee and a joint Payee of Your selection. Payments will be made as long as either person is living, but the annuity may be surrendered (in full or part). The Cash Value is equal to a multiple of the Supportable Payment (see definition below), where that multiple reduces over time to zero at age 101 of the younger Annuitant. A surrender charge will be applied. Should the last surviving Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified), the same Cash Value would be payable, but without the surrender charge. Optional Initial Payment Guarantee Upon annuitization, You may elect an option that guarantees Your variable annuity payments will never be less than a percentage of the initial variable annuity payment. You cannot terminate the payment guarantee after You have selected the option. The percentage applicable to the initial payment and the fee for the option will be those currently applicable at the time of annuitization. Supportable Payment The Supportable Payment is the sum of each selected subaccount's variable annuity unit value times the number of variable annuity units. The variable annuity units are adjusted to reflect the year-to-date difference between the stabilized payment and the payment had they not been stabilized. Supportable Payments are used to determine surrender values, death benefits and transfers. Determination of Subsequent Variable Payments The amount of each variable annuity payment after the first will increase or decrease according to the value of the variable annuity units which reflect the investment experience of the selected Subaccounts. Each variable annuity payment after the first will be equal to the number of variable annuity units in the selected Subaccounts multiplied by the variable annuity unit value on the date the payment is made. The number of variable annuity units in each selected Subaccount is determined by dividing the first variable annuity payment allocated to the Subaccount by the variable annuity unit value of that Subaccount on the Annuity Commencement Date. If "Life with Emergency Cash" is chosen (Option 3-V(3) or 5-V(2)), or if the Optional Initial Payment Guarantee is chosen, payments would be "stabilized" (would change only once per year) but "value adjustments" would be made to ensure full value would be received. Page 17 CB853 GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS The amounts shown in these tables are the guaranteed amounts for each 1,000 of the proceeds. Higher current amounts may be available at the time of settlement.
------------------------------------------------------------------------------------------------------------------------------- Option 2, Table I Option 3, Table II Option 3, Table III Option 3, Table IV Option 3, Table V ------------------------------------------------------------------------------------------------------------------------------- Number of Amount of Years Monthly Monthly Installment For Monthly Installment For Monthly Installment For Monthly Installment Payable Installment Life No Period Certain Life Life Guaranteed Return Of for Life 10 Years Certain Proceeds With Emergency Cash ------------------------------------------------------------------------------------------------------------------------------- Age* Male Female Unisex Male Female Unisex Male Female Unisex Male Female Unisex ------------------------------------------------------------------------------------------------------------------------------- 50 $3.82 $3.70 $3.74 $3.80 $3.69 $3.72 $3.70 $3.62 $3.65 $3.57 $3.52 $3.54 51 3.89 3.76 3.80 3.86 3.74 3.78 3.75 3.67 3.70 3.62 3.56 3.58 52 3.95 3.81 3.86 3.92 3.80 3.84 3.81 3.72 3.75 3.67 3.61 3.63 53 4.02 3.88 3.92 3.99 3.86 3.90 3.87 3.78 3.80 3.72 3.65 3.67 5 17.91 54 4.10 3.94 3.99 4.06 3.92 3.96 3.93 3.83 3.86 3.77 3.70 3.73 6 15.14 55 4.18 4.01 4.06 4.13 3.99 4.03 3.99 3.89 3.92 3.83 3.76 3.78 7 13.16 56 4.26 4.08 4.14 4.21 4.06 4.10 4.06 3.95 3.98 3.89 3.81 3.83 8 11.68 57 4.35 4.16 4.22 4.29 4.13 4.18 4.13 4.02 4.05 3.95 3.87 3.89 9 10.53 58 4.44 4.24 4.30 4.38 4.21 4.26 4.20 4.08 4.12 4.01 3.93 3.96 10 9.61 59 4.54 4.33 4.39 4.47 4.29 4.35 4.27 4.16 4.19 4.08 4.00 4.02 11 8.86 60 4.64 4.42 4.49 4.57 4.38 4.44 4.36 4.23 4.27 4.15 4.06 4.09 12 8.24 61 4.76 4.52 4.59 4.67 4.47 4.53 4.44 4.31 4.35 4.23 4.14 4.16 13 7.71 62 4.88 4.63 4.70 4.78 4.57 4.63 4.53 4.39 4.43 4.31 4.21 4.24 14 7.26 63 5.01 4.74 4.82 4.89 4.67 4.74 4.62 4.48 4.52 4.39 4.29 4.32 15 6.87 64 5.15 4.86 4.94 5.01 4.78 4.85 4.72 4.57 4.62 4.48 4.38 4.41 16 6.53 65 5.30 4.98 5.08 5.14 4.89 4.97 4.83 4.67 4.72 4.57 4.47 4.50 17 6.23 66 5.46 5.12 5.22 5.27 5.02 5.09 4.94 4.78 4.82 4.67 4.56 4.59 18 5.96 67 5.63 5.27 5.37 5.41 5.14 5.22 5.05 4.89 4.94 4.77 4.66 4.69 19 5.73 68 5.81 5.42 5.54 5.55 5.28 5.36 5.17 5.00 5.05 4.88 4.77 4.80 20 5.51 69 6.00 5.59 5.71 5.70 5.42 5.51 5.30 5.13 5.18 4.99 4.88 4.91 70 6.21 5.78 5.90 5.86 5.58 5.66 5.43 5.26 5.31 5.12 5.00 5.03 71 6.43 5.97 6.11 6.02 5.74 5.82 5.58 5.39 5.45 5.24 5.13 5.16 72 6.66 6.19 6.33 6.18 5.90 5.99 5.72 5.54 5.59 5.37 5.26 5.29 73 6.91 6.42 6.56 6.35 6.08 6.16 5.88 5.70 5.75 5.51 5.40 5.43 74 7.18 6.67 6.82 6.53 6.26 6.34 6.05 5.86 5.92 5.65 5.55 5.58 75 7.46 6.94 7.09 6.70 6.45 6.53 6.22 6.04 6.09 5.81 5.70 5.73 76 7.77 7.23 7.39 6.88 6.65 6.72 6.40 6.22 6.27 5.97 5.87 5.90 77 8.10 7.55 7.71 7.07 6.85 6.91 6.60 6.42 6.47 6.14 6.05 6.08 78 8.45 7.89 8.05 7.25 7.05 7.11 6.80 6.63 6.68 6.33 6.24 6.25 79 8.83 8.26 8.43 7.43 7.26 7.31 7.01 6.85 6.90 6.52 6.43 6.45 80 9.23 8.66 8.83 7.61 7.46 7.51 7.24 7.08 7.13 6.71 6.62 6.65 81 9.66 9.10 9.27 7.79 7.66 7.70 7.47 7.33 7.37 6.92 6.84 6.85 82 10.13 9.57 9.74 7.97 7.86 7.89 7.72 7.59 7.63 7.13 7.07 7.08 83 10.62 10.09 10.24 8.13 8.05 8.07 7.98 7.86 7.90 7.34 7.29 7.30 84 11.15 10.64 10.79 8.29 8.23 8.25 8.26 8.15 8.18 7.57 7.55 7.56 85 11.72 11.24 11.38 8.44 8.40 8.41 8.55 8.45 8.48 7.81 7.80 7.80 86 12.32 11.89 12.02 8.59 8.56 8.56 8.85 8.77 8.80 8.10 8.06 8.06 87 12.97 12.59 12.70 8.72 8.70 8.71 9.17 9.11 9.12 8.38 8.37 8.37 88 13.65 13.33 13.42 8.84 8.83 8.83 9.50 9.45 9.47 8.67 8.67 8.67 89 14.38 14.11 14.19 8.95 8.95 8.95 9.85 9.82 9.83 8.99 8.99 8.99 90 15.16 14.94 15.00 9.06 9.05 9.05 10.22 10.19 10.20 9.33 9.33 9.33 91 15.97 15.80 15.85 9.15 9.15 9.15 10.61 10.59 10.59 9.76 9.76 9.76 92 16.84 16.70 16.74 9.23 9.23 9.23 11.01 11.00 11.00 10.18 10.18 10.18 93 17.75 17.63 17.67 9.31 9.31 9.31 11.45 11.42 11.43 10.62 10.61 10.61 94 18.72 18.60 18.64 9.37 9.37 9.37 11.92 11.88 11.89 11.07 11.06 11.07 95 19.77 19.62 19.66 9.43 9.43 9.43 12.42 12.36 12.38 11.57 11.46 11.47 -------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A. Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. T890 Page 18 Option 5, Table VI Monthly Installment For Joint and Full Survivor
- ------------------------------------------------------------------------------------------------------- Age of Age of Female Annuitant* --------------------------------------------------------------------------------------- Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Annuitant* Male Male Male Male Male Male - ------------------------------------------------------------------------------------------------------- 50 $ 3.06 $ 3.12 $ 3.19 $ 3.25 $ 3.31 $ 3.38 $ 3.44 55 3.20 3.27 3.35 3.44 3.52 3.61 3.69 60 3.37 3.47 3.57 3.68 3.79 3.91 4.02 65 3.59 3.72 3.86 4.01 4.16 4.32 4.47 70 3.88 4.06 4.25 4.45 4.67 4.89 5.11 - ------------------------------------------------------------------------------------------------------- Monthly Installment For Unisex Joint and Full Survivor - ------------------------------------------------------------------------------------------------------- Age of Age of Joint Annuitant* --------------------------------------------------------------------------------------- First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than First More Than Annuitant* First First First First First First - ------------------------------------------------------------------------------------------------------- 50 $ 3.07 $ 3.13 $ 3.19 $ 3.25 $ 3.31 $ 3.37 $ 3.43 55 3.20 3.28 3.36 3.44 3.52 3.60 3.67 60 3.38 3.48 3.58 3.68 3.79 3.89 4.00 65 3.61 3.73 3.87 4.01 4.16 4.30 4.44 70 3.90 4.07 4.26 4.46 4.66 4.86 5.05 - ------------------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A. - -------------------------------------------------------------------------------------------------------
Option 5, Table VII Monthly Installment for Joint & Full Survivor (Life with Emergency Cash) - ------------------------------------------------------------------------------------------------------- Age of Male Age of Female Annuitant Annuitant* --------------------------------------------------------------------------------------- 15 Years 12 Years 9 Years 6 Years 3 Years Same as 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Male Male Male Male Male Male - ------------------------------------------------------------------------------------------------------- 50 $ 3.02 $ 3.08 $ 3.13 $ 3.20 $ 3.26 $ 3.32 $ 3.37 55 3.14 3.21 3.29 3.36 3.45 3.53 3.59 60 3.29 3.38 3.48 3.58 3.69 3.80 3.88 65 3.48 3.60 3.72 3.86 4.00 4.15 4.26 70 3.72 3.88 4.05 4.23 4.42 4.62 4.77 - ------------------------------------------------------------------------------------------------------- Monthly Installment for Unisex Joint & Full Survivor (Life with Emergency Cash) - ------------------------------------------------------------------------------------------------------- Age of First Age of Joint Annuitant Annuitant* --------------------------------------------------------------------------------------- 15 Years 12 Years 9 Years 6 Years 3 Years Same as 3 Years Less Than Less Than Less Than Less Than Less Than First More Than First First First First First First - ------------------------------------------------------------------------------------------------------- 50 $ 3.02 $ 3.08 $ 3.14 $ 3.20 $ 3.26 $ 3.32 $ 3.36 55 3.14 3.21 3.29 3.37 3.44 3.52 3.58 60 3.30 3.39 3.48 3.58 3.68 3.79 3.86 65 3.49 3.61 3.73 3.86 4.00 4.14 4.24 70 3.74 3.89 4.06 4.24 4.42 4.60 4.74 - ------------------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A. - -------------------------------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. TB890 Page 19 VARIABLE PAYMENT OPTIONS BASED ON ASSUMED INVESTMENT RETURN The amounts shown in these tables are the initial payment amounts based on a 5.0% Assumed Investment Return for each $1,000 of the proceeds.
- ----------------------------------------------------------------------------------------------------------------------------------- Option 3-V, Table II Option 3-V, Table III Option 3-V, Table IV - ----------------------------------------------------------------------------------------------------------------------------------- Monthly Installment for Life Monthly Installment for Life Monthly Installment for Life No Period Certain 10 Years Certain With Emergency Cash - ----------------------------------------------------------------------------------------------------------------------------------- Age* Male Female Unisex Male Female Unisex Male Female Unisex 50 $5.07 $4.93 $4.98 $5.04 $4.92 $4.95 $4.83 $4.76 $4.78 51 5.13 4.99 5.03 5.09 4.96 5.00 4.87 4.80 4.82 52 5.19 5.04 5.08 5.15 5.01 5.05 4.92 4.84 4.86 53 5.26 5.10 5.14 5.21 5.07 5.11 4.96 4.88 4.91 54 5.33 5.16 5.21 5.27 5.12 5.17 5.01 4.93 4.95 55 5.40 5.22 5.27 5.34 5.18 5.23 5.06 4.98 5.00 56 5.48 5.29 5.35 5.41 5.25 5.30 5.12 5.03 5.05 57 5.57 5.36 5.42 5.49 5.32 5.37 5.18 5.08 5.11 58 5.66 5.44 5.50 5.57 5.39 5.44 5.24 5.14 5.17 59 5.75 5.52 5.59 5.66 5.47 5.52 5.31 5.20 5.23 60 5.85 5.61 5.68 5.75 5.55 5.61 5.37 5.26 5.29 61 5.97 5.70 5.78 5.85 5.63 5.70 5.45 5.33 5.37 62 6.09 5.81 5.89 5.95 5.72 5.79 5.53 5.40 5.44 63 6.21 5.91 6.00 6.06 5.82 5.89 5.61 5.48 5.52 64 6.35 6.03 6.13 6.17 5.92 6.00 5.70 5.56 5.60 65 6.50 6.16 6.26 6.29 6.03 6.11 5.79 5.65 5.69 66 6.66 6.29 6.40 6.42 6.15 6.23 5.89 5.75 5.79 67 6.83 6.43 6.55 6.55 6.27 6.36 6.00 5.85 5.89 68 7.01 6.59 6.71 6.69 6.40 6.49 6.11 5.96 6.00 69 7.21 6.76 6.89 6.83 6.54 6.63 6.23 6.07 6.12 70 7.41 6.94 7.08 6.98 6.69 6.77 6.36 6.20 6.25 71 7.63 7.14 7.28 7.13 6.84 6.93 6.49 6.33 6.38 72 7.87 7.35 7.50 7.28 7.00 7.09 6.63 6.46 6.52 73 8.12 7.58 7.74 7.45 7.17 7.25 6.78 6.62 6.66 74 8.39 7.83 8.00 7.61 7.34 7.42 6.94 6.78 6.83 75 8.68 8.11 8.28 7.78 7.52 7.60 7.11 6.95 7.00 76 8.99 8.40 8.58 7.95 7.71 7.78 7.29 7.13 7.18 77 9.32 8.72 8.90 8.12 7.90 7.97 7.47 7.33 7.36 78 9.68 9.07 9.25 8.29 8.09 8.16 7.68 7.52 7.57 79 10.06 9.45 9.63 8.47 8.29 8.34 7.88 7.74 7.79 80 10.47 9.85 10.04 8.64 8.48 8.53 8.11 7.98 8.01 81 10.91 10.30 10.48 8.80 8.67 8.71 8.34 8.23 8.26 82 11.38 10.78 10.96 8.97 8.86 8.89 8.60 8.48 8.53 83 11.88 11.30 11.47 9.12 9.04 9.06 8.84 8.75 8.77 84 12.42 11.87 12.03 9.27 9.21 9.23 9.09 9.01 9.05 85 12.99 12.48 12.63 9.41 9.37 9.38 9.35 9.31 9.32 86 13.60 13.13 13.27 9.54 9.51 9.52 9.67 9.60 9.61 87 14.26 13.84 13.96 9.67 9.65 9.65 9.96 9.90 9.91 88 14.95 14.59 14.70 9.78 9.77 9.77 10.28 10.27 10.27 89 15.69 15.39 15.48 9.89 9.88 9.88 10.61 10.61 10.61 90 16.47 16.23 16.30 9.98 9.98 9.98 10.97 10.97 10.97 91 17.29 17.10 17.16 10.07 10.07 10.07 11.36 11.36 11.36 92 18.16 18.01 18.05 10.15 10.15 10.15 11.86 11.85 11.85 93 19.07 18.95 18.98 10.22 10.22 10.22 12.33 12.32 12.32 94 20.05 19.92 19.96 10.28 10.28 10.28 12.94 12.93 12.93 95 21.09 20.94 20.99 10.34 10.33 10.33 13.47 13.45 13.46 - -----------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A. Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. H994 Page 20 Option 5V, Table V Monthly Installment For Joint and Full Survivor
- --------------------------------------------------------------------------------------------------------------------------------- Age of Age of Female Annuitant* ---------------------------------------------------------------------------------------------------------------- Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Annuitant* Male Male Male Male Male Male - --------------------------------------------------------------------------------------------------------------------------------- 50 $4.37 $4.42 $4.46 $4.51 $4.56 $4.62 $4.67 55 4.48 4.54 4.60 4.67 4.74 4.81 4.88 60 4.62 4.70 4.79 4.88 4.98 5.08 5.18 65 4.81 4.92 5.04 5.17 5.31 5.46 5.61 70 5.07 5.23 5.40 5.59 5.79 6.00 6.22 - --------------------------------------------------------------------------------------------------------------------------------- Monthly Installment For Unisex Joint and Full Survivor - --------------------------------------------------------------------------------------------------------------------------------- Age of Age of Joint Annuitant* ---------------------------------------------------------------------------------------------------------------- First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than First More Than Annuitant* First First First First First Male - --------------------------------------------------------------------------------------------------------------------------------- 50 $4.38 $4.42 $4.47 $4.51 $4.56 $4.61 $4.66 55 4.48 4.54 4.60 4.67 4.73 4.80 4.87 60 4.63 4.70 4.79 4.88 4.97 5.07 5.16 65 4.82 4.93 5.05 5.17 5.30 5.44 5.57 70 5.09 5.24 5.41 5.59 5.78 5.97 6.16 - --------------------------------------------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A - ---------------------------------------------------------------------------------------------------------------------------------
Option 5V, Table VI Monthly Installment For Joint and Full Survivor (Life with Emergency Cash)
- --------------------------------------------------------------------------------------------------------------------------------- Age of Age of Female Annuitant* ---------------------------------------------------------------------------------------------------------------- Male 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than Male More Than Annuitant* Male Male Male Male Male Male - --------------------------------------------------------------------------------------------------------------------------------- 50 $4.34 $4.38 $4.42 $4.47 $4.51 $4.57 $4.61 55 4.43 4.48 4.54 4.60 4.67 4.74 4.79 60 4.55 4.62 4.70 4.78 4.88 4.97 5.05 65 4.71 4.80 4.91 5.03 5.16 5.30 5.41 70 4.92 5.05 5.21 5.38 5.56 5.76 5.91 - --------------------------------------------------------------------------------------------------------------------------------- Monthly Installment For Unisex Joint and Full Survivor (Life with emergency Cash) - --------------------------------------------------------------------------------------------------------------------------------- Age of Age of Joint Annuitant* ---------------------------------------------------------------------------------------------------------------- First 15 Years 12 Years 9 Years 6 Years 3 Years Same As 3 Years Less Than Less Than Less Than Less Than Less Than First More Than Annuitant* First First First First First First - --------------------------------------------------------------------------------------------------------------------------------- 50 $4.34 $4.38 $4.42 $4.47 $4.51 $4.56 $4.60 55 4.43 4.48 4.54 4.60 4.67 4.73 4.78 60 4.55 4.62 4.70 4.78 4.87 4.96 5.03 65 4.71 4.81 4.92 5.03 5.16 5.29 5.38 70 4.93 5.07 5.22 5.38 5.56 5.74 5.87 - --------------------------------------------------------------------------------------------------------------------------------- *Adjusted Age as defined in Section 10.A - ---------------------------------------------------------------------------------------------------------------------------------
Dollar amounts of monthly, quarterly, semi-annual, and annual installments not shown in the above tables will be calculated on the same basis as those shown and may be obtained from the Company. Page 21 J994 SECTION 11 - GENERAL PROVISIONS THE CONTRACT The entire contract consists of this contract, and endorsements, if any. MODIFICATION OF CONTRACT No change in this contract is valid unless made in writing by us and approved by one of our officers. No Registered Representative has authority to change or waive any provision of Your contract. TAX QUALIFICATION This contract is intended to qualify as an annuity contract for federal income tax purposes. The provisions of this contract are to be interpreted to maintain such qualification, notwithstanding any other provisions to the contrary. To maintain such tax qualification, we reserve the right to amend this contract to reflect any clarifications that may be needed or are appropriate to maintain such tax qualification or to conform this contract to any applicable changes in the tax qualification requirements. We will send You a copy in the event of any such amendment. If You refuse such an amendment it must be by giving us written notice, and Your refusal may result in adverse tax consequences. NON-PARTICIPATING This contract will not share in our surplus earnings. AGE OR SEX CORRECTIONS If the age or sex of the Annuitant has been misstated, the benefits will be those, which the premiums paid, would have purchased for the correct age and sex. If required by law to ignore differences in the sex of the Annuitant, the annuity payments will be determined using the unisex factors in Section 10. Any underpayment made by us will be paid with the next payment. Any overpayment made by us will be deducted from future payments. Any underpayment or overpayment, will include interest at 5% per year, from the date of the wrong payment to the date of the adjustment. INCONTESTABILITY This contract shall be incontestable from the Contract Date. EVIDENCE OF SURVIVAL We have the right to require satisfactory evidence that a person was alive if a payment is based on that person being alive. No payment will be made until we receive the evidence. SETTLEMENT Any payment by us under this contract is payable at our Home Office. RIGHTS OF OWNER The owner may, while the Annuitant is living: 1. Assign this contract. 2. Surrender the contract to us. 3. Amend or modify the contract with our consent. 4. Receive annuity payments or name a Payee to receive the payments. 5. Exercise, receive and enjoy every other right and benefit contained in the contract. The use of these rights may be subject to the consent of any assignee or irrevocable beneficiary; and of the spouse in a community or marital property state. Unless we have been notified of a community or marital property interest in this contract, we will rely on our good faith belief that no such interest exists and will assume no responsibility for inquiry. CHANGE OF OWNERSHIP In the case of a non-tax-qualified annuity, You can change the owner of this contract, from yourself to a new owner, in a notice You sign which gives us the facts that we need. When this change takes effect, all rights of ownership in this contract will pass to the new owner. A change of owner will not be effective until it is recorded in our records. After it has been so recorded, the change will take effect as of the date You signed the notice. However, if the Annuitant dies before the notice has been so recorded, it will not be effective as to those proceeds we have paid before the change was recorded in our records. We may require that the change be endorsed in the contract. Changing the owner does not change the beneficiary or the Annuitant. A change of ownership may result in adverse tax consequences. ANNUITY COMMENCEMENT DATE The Annuity Commencement Date is the date annuity payments begin. This date may not be later than the last day of the contract month starting after the Annuitant attains age 85, except as expressly allowed by us (within state restrictions), but in no event later than the last day of the contract month following the month in which the Annuitant attains age 95. You may change the Annuity Commencement Date at any time before the Annuity Commencement Date by giving us 30 days' written notice. R142 Page 22 SECTION 11 - CONTINUED ASSIGNMENT (a) In the case of a non tax-qualified annuity, this Contract may be assigned. The assignment must be in writing and filed with us. (b) We assume no responsibility for the validity of any assignment. Any claim made under an assignment shall be subject to proof of interest and the extent of the assignment. (c) This contract may be applied for and issued to qualify as a tax-qualified annuity under certain sections of the Internal Revenue Code. Ownership of this contract is then restricted so that it will comply with provisions of the Internal Revenue Code. Assignment of this contract may result in adverse tax consequences. BENEFICIARY Death proceeds, when payable in accordance with Section 9, are payable to the designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and may be changed without consent (unless irrevocably designated or required by law) by notifying us in writing on a form acceptable to us. The change will take effect upon the date You sign it, whether or not You are living when we receive it. The notice must have been postmarked (or show other evidence of delivery that is acceptable to us) on or before the date of death. Your most recent change of beneficiary notice will replace any prior beneficiary designations. No change will apply to any payment we made before the written notice was received. If an irrevocable beneficiary dies, You may designate a new beneficiary. You may direct that the beneficiary shall not have the right to withdraw, assign or commute any sum payable under an option. In the absence of such election or direction, the beneficiary may change the manner of payment or make an election of any option. If any primary or contingent beneficiary dies before the Annuitant, that beneficiary's interest in this contract ends with that beneficiary's death. Only those beneficiaries living at the time of the Annuitant's death will be eligible to receive their share of the death proceeds. In the event no primary or contingent beneficiaries have been named and all primary beneficiaries have died before the death proceeds become payable, the owner(s) will become the beneficiary(ies) unless elected otherwise in accordance with Section 9. If both primary and contingent beneficiaries have been named, payment will be made to the named primary beneficiaries living at the time the death proceeds become payable. If there is more than one beneficiary and You failed to specify their interest, they will share equally. Payment will be made to the named contingent beneficiary(ies) only, if all primary beneficiaries have died before the death proceeds become payable. If any primary beneficiary is alive at the time the death proceeds become payable, but dies before receiving their payment, their share will be paid to their estate. PROTECTION OF PROCEEDS Unless You so direct by filing written notice with us, no beneficiary may assign any payments under this contract before the same are due. To the extent permitted by law, no payments under this contract will be subject to the claims of creditors of any beneficiary. DEFERMENT We will pay any Partial Withdrawals or Surrender proceeds from the Separate Account within 7 days after we receive all requirements that we need. However, it may happen that the New York Stock Exchange is closed for trading (other than the usual weekend or holiday closings), or the Securities and Exchange Commission restricts trading or determines that an emergency exists. If so, it may not be practical for us to determine the investment experience of the Separate Account. In that case, we may defer transfers among the Subaccounts and to the Fixed Account, and determination or payment of Partial Withdrawals or Surrender proceeds. When permitted by law, we may defer paying any Partial Withdrawals or Surrender proceeds from the Fixed Account for up to 6 months from the date we receive Your request. If the owner dies after the request is received, but before the request is processed, the request will be processed before the death proceeds are determined. Interest will be paid on any amount deferred for 30 days or more. This rate will be the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3, unless otherwise required by law. REPORTS TO OWNER We will give You an annual report at least once each Contract Year. This report will show the number and value of the accumulation units held in each of the Subaccounts as well as the value of the Fixed Account. It will also give You the Death Benefit, Cash Value, and any other facts required by law or regulation. RB142 Page 23 Home Office: Transamerica Occidental Life 4333 Edgewood Road NE Insurance Company [LOGO] Transamerica Cedar Rapids, IA 52499 OCCIDENTAL LIFE A Stock Company SURRENDER CHARGE MODIFICATION RIDER We issued this rider as a part of the contract to which it is attached. The following language replaces the Surrender Charge Provision in Section 5 of Your contract. SURRENDER CHARGES Amounts withdrawn in excess of the Surrender Charge free amount specified in the withdrawal provisions above are subject to a Surrender Charge. The amount of this charge, if any, will be a percentage, as shown in the table below, of the amount of premium withdrawn: Number of Years Percentage of Since Premium Premium Withdrawn Payment Date 0-1 7% 1-2 7% 2-3 6% 3-4 6% 4 or more 0% For Surrender Charge purposes, all earnings are considered to be withdrawn first. After all earnings are withdrawn then the oldest premium payment is the first premium payment considered to be withdrawn. If the amount withdrawn exceeds this, the next oldest premium payment is considered to be withdrawn, and so on until the most recent premium payments are deemed to be withdrawn (the procedure being applied to Withdrawals of premium is a "First-In, First-Out" or FIFO procedure). Signed for Us at our Home Office. /s/ James W. Dederer /s/ Ron F. Wagley SECRETARY PRESIDENT RLS 3 502 Home Office: Transamerica Occidental Life 4333 Edgewood Road NE Insurance Company [LOGO] Transamerica Cedar Rapids, IA 52499 OCCIDENTAL LIFE A Stock Company INDEX
Page Account Value ................................................. 4 Accumulation Units ............................................ 9 Age or Sex Corrections ........................................ 22 Annuity Commencement Date ..................................... 22 Annuity Payments .............................................. 14 Adjusted Account Value ........................................ 4 Assignment .................................................... 23 Beneficiary ................................................... 23 Cash Value .................................................... 5 Contract ...................................................... 22 Contract Data Page ............................................ 3 Death Proceeds ................................................ 12 Definitions ................................................... 2 Dollar Cost Averaging Option .................................. 11 Evidence of Survival .......................................... 22 Excess Interest Adjustment .................................... 5 Fixed Account ................................................. 10 Guaranteed Minimum Death Benefit .............................. 12 Guaranteed Return of Fixed Account Premium Payments ........... 8 Guaranteed Periods ............................................ 10 Incontestability .............................................. 22 Modification of Contract ...................................... 22 Non-participating ............................................. 22 Option to Change Annuity Commencement Date .................... 22 Partial Withdrawals ........................................... 6 Payee ......................................................... 15 Payment of Premiums ........................................... 4 Payment Option Tables ......................................... 18, 19, 20, 21 Proof of Age .................................................. 15 Protection of Proceeds ........................................ 23 Right to Cancel ............................................... 1 Rights of Owner ............................................... 22 Separate Account .............................................. 8 Service Charge ................................................ 4 Settlement .................................................... 22 Surrender Charges ............................................. 8 Transfers ..................................................... 10
Flexible Premium Deferred Variable Annuity Income Payable At Annuity Commencement Date Benefits Based On The Performance Of The Separate Account Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C) Non-Participating Y734 EX-5.D 5 dex5d.txt EXHIBIT-5.D EXHIBIT (5)(d) FORM OF APPLICATION FOR INDIVIDUAL CONTRACT - -------------------------------------------------------------------------------------------------------------- Mail the application and a check to: Product Name: TRIPLE ADVANTAGE Transamerica Occidental Transamerica Occidental Life Insurance Company ----------------- Attn: Variable Annuity Dept. Variable Annuity Life Insurance Company 4333 Edgewood Road N.E. Application [LOGO] Cedar Rapids, IA 52499-0001 - ---------------------------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------- 1. OWNER INFORMATION (If no Annuitant is specified in #2, - --------------------- the Owner will be the Annuitant.) In the event the owner and/or beneficiary is a trust, MUST COMPLETE and SUBMIT the "Trustee Certification of Trust" form. First Name:_____________________________________________________________________ Last Name:______________________________________________________________________ Address:________________________________________________________________________ City, State:____________________________________________________________________ Zip:___________________ Telephone:______________________________________________ Date of Birth:______________________________________________ Sex: [_] Female SS#/TIN:____________________________________________________ [_] Male - -------------------------------------------------------------------------------- 1b. JOINT OWNER(S) - ------------------ First Name:_____________________________________________________________________ Last Name:______________________________________________________________________ Address:________________________________________________________________________ City, State:____________________________________________________________________ Zip:___________________ Telephone:______________________________________________ Date of Birth:______________________________________________ Sex: [_] Female SS#/TIN:____________________________________________________ [_] Male - -------------------------------------------------------------------------------- 2. ANNUITANT Complete only if different from Owner. - ------------- First Name:_____________________________________________________________________ Last Name:______________________________________________________________________ Address:________________________________________________________________________ City, State:____________________________________________________________________ Zip: __________________ Telephone:______________________________________________ Date of Birth:______________________________________________ SS#/TIN:____________________________________________________ - -------------------------------------------------------------------------------- 3. BENEFICIARY(IES) DESIGNATION - -------------------------------- Primary Contingent Name Relationship [_] [_] _______________________________________________________________% [_] [_] _______________________________________________________________% [_] [_] _______________________________________________________________% - -------------------------------------------------------------------------------- 4. TYPE OF ANNUITY - ------------------- [_] Non-qualified Qualified Types: [_] IRA [_] Roth IRA [_] SEP/IRA [_] 403(b) [_] Keogh [_] Roth Conversion [_] Other________________________________ IRA / SEP / ROTH IRA $_______________ Contribution for tax year__________________________ $_______________ Trustee to Trustee Transfer $_______________ Rollover from [_] IRA [_] 403(b) [_] Pension [_] Other ROTH IRA Rollover _______________________ Date first established or date of conversion $______________________ Portion previously taxed - -------------------------------------------------------------------------------- 5. GUARANTEED MINIMUM DEATH BENEFITS - ------------------------------------ Your selection cannot be changed after the policy has been issued. If no option is specified, the Return of Premium Death Benefit will apply. [_] Double Enhanced Death Benefit, available for issue through age 80. Daily M&E Risk Fee and Administrative Charge is 1.45% annually. [_] Return of Premium Death Benefit, available for issue through age 90. Daily M&E Risk Fee and Administrative Charge is 1.30% annually. - -------------------------------------------------------------------------------- 6. GUARANTEED MINIMUM INCOME BENEFIT RIDER - ------------------------------------------ Must complete this section. If no selection is made, the GMIB option will not apply. (Available at an additional cost. Please see prospectus for information on the terms of the Rider.) [_] I/We elect Guaranteed Minimum Income Benefit Rider - -------------------------------------------------------------------------------- 7. TAX RELIEF RIDER - ------------------- (Available at an additional cost. Please see prospectus for information on the terms of the Rider.) [_] I/We wish to elect the Tax Relief Rider - -------------------------------------------------------------------------------- 8. TELEPHONE TRANSFER AUTHORIZATION - ----------------------------------- Please complete this section to authorize you and/or your Registered Representative to make transfer requests via our recorded telephone line. (check one selection only): [_] Owner(s) only, or [_] Owner(s) and Owner's Registered Representative - -------------------------------------------------------------------------------- 9. REBALANCING - -------------- [_] Quarterly [_] Semi-Annually [_] Annually I elect to rebalance the variable subaccounts according to my Allocation of Purchase Payments using the frequency indicated above (Not available with DCA). If you would like to rebalance to a mix other than the indicated Allocation of Purchase Payments, please complete the Optional Programs Form. DVA-APP 1201 813-A-0502 Triple Advantage 5/02 8132132 5/02 - -------------------------------------------------------------------------------- 10. ALLOCATION OF PURCHASE PAYMENTS - ----------------------------------- The invested amount will be allocated as indicated below. If Dollar Cost Averaging, Section 11 must be completed in order to begin the Dollar Cost Averaging Program. Initial Purchase Payments $___________ Make check payable to Transamerica Occidental Life Insurance Company. DOLLAR COST AVERAGING ACCOUNT ________ .0% (Must also complete Section 11 Dollar Cost Averaging Program) SUBACCOUNTS: Dreyfus Appreciation Portfolio - Service Class _______ .0% Dreyfus Balanced Portfolio - Service Class _______ .0% Dreyfus Core Bond Portfolio - Service Class _______ .0% Dreyfus Core Value Portfolio - Service Class _______ .0% Dreyfus Disciplined Stock Portfolio - Service Class _______ .0% Dreyfus Emerging Leaders Portfolio - Service Class _______ .0% Dreyfus Emerging Markets Portfolio - Service Class _______ .0% Dreyfus European Equity Portfolio - Service Class _______ .0% Dreyfus Founders Discovery Portfolio - Service Class _______ .0% Dreyfus Founders Growth Portfolio- Service Class _______ .0% Dreyfus Founders International Equity Portfolio - Service Class _______ .0% Dreyfus Founders Passport Portfolio - Service Class _______ .0% Dreyfus Growth and Income Portfolio - Service Class _______ .0% Dreyfus International Equity Portfolio - Service Class _______ .0% Dreyfus International Value Portfolio - Service Class _______ .0% Dreyfus Japan Portfolio - Service Class _______ .0% Dreyfus Limited Term High Income Portfolio - Service Class _______ .0% Dreyfus MidCap Stock Portfolio - Service Class _______ .0% Dreyfus Money Market Portfolio _______ .0% Dreyfus Quality Bond Portfolio - Service Class _______ .0% Dreyfus Small Cap Portfolio - Service Class _______ .0% Dreyfus Small Company Stock Portfolio - Service Class _______ .0% Dreyfus Socially Responsible Growth Fund, Inc. - Service Class _______ .0% Dreyfus Special Value Portfolio - Service Class _______ .0% Dreyfus Stock Index Fund - Service Class _______ .0% Dreyfus Technology Growth Portfolio - Service Class _______ .0% Transamerica Equity _______ .0% _________________________________________________ _______ .0% _________________________________________________ _______ .0% _________________________________________________ _______ .0% _________________________________________________ _______ .0% FIXED ACCOUNTS: 1 Year Fixed _______ .0% 3 Year Fixed _______ .0% 5 Year Fixed _______ .0% 7 Year Fixed _______ .0% TOTAL VARIABLE AND FIXED 100% - -------------------------------------------------------------------------------- 11. DOLLAR COST AVERAGING PROGRAM - --------------------------------- If DCA is selected as an initial purchase payments allocation option under Section 10, please complete the following information to provide allocations in order to start the Dollar Cost Averaging Program. SPECIAL DCA FIXED ACCOUNTS: [_] Special 6-month DCA Fixed Account (when available) [_] Special 12-month DCA Fixed Account (when available) DCA FIXED ACCOUNTS: Specify fixed account and frequency of transfer. Minimum transfer $250; monthly (6-60); quarterly (4-20). [_] Money Market __Monthly __Quarterly ___#Transfers [_] 1 Year Fixed Account __Monthly __Quarterly ___#Transfers [_] Quality Bond __Monthly __Quarterly ___#Transfers [_] Limited Term High Income __Monthly __Quarterly ___#Transfers TRANSFER TO SUBACCOUNTS: Dreyfus Appreciation Portfolio - Service Class ________ .0% Dreyfus Balanced Portfolio - Service Class ________ .0% Dreyfus Core Bond Portfolio - Service Class ________ .0% Dreyfus Core Value Portfolio - Service Class ________ .0% Dreyfus Disciplined Stock Portfolio - Service Class ________ .0% Dreyfus Emerging Leaders Portfolio - Service Class ________ .0% Dreyfus Emerging Markets Portfolio - Service Class ________ .0% Dreyfus European Equity Portfolio - Service Class ________ .0% Dreyfus Founders Discovery Portfolio - Service Class ________ .0% Dreyfus Founders Growth Portfolio- Service Class ________ .0% Dreyfus Founders International Equity Portfolio - Service Class ________ .0% Dreyfus Founders Passport Portfolio - Service Class ________ .0% Dreyfus Growth and Income Portfolio - Service Class ________ .0% Dreyfus International Equity Portfolio - Service Class ________ .0% Dreyfus International Value Portfolio - Service Class ________ .0% Dreyfus Japan Portfolio - Service Class ________ .0% Dreyfus Limited Term High Income Portfolio - Service Class ________ .0% Dreyfus MidCap Stock Portfolio - Service Class ________ .0% Dreyfus Money Market Portfolio ________ .0% Dreyfus Quality Bond Portfolio - Service Class ________ .0% Dreyfus Small Cap Portfolio - Service Class ________ .0% Dreyfus Small Company Stock Portfolio - Service Class ________ .0% Dreyfus Socially Responsible Growth Fund, Inc. - Service Class ________ .0% Dreyfus Special Value Portfolio - Service Class ________ .0% Dreyfus Stock Index Fund - Service Class ________ .0% Dreyfus Technology Growth Portfolio - Service Class ________ .0% Transamerica Equity ________ .0% __________________________________________________ ________ .0% __________________________________________________ ________ .0% __________________________________________________ ________ .0% TOTAL MUST = 100% DVA-APP 1201 (2) - -------------------------------------------------------------------------------- 12. SIGNATURE(S) OF AUTHORIZATION ACCEPTANCE - -------------------------------------------- .. Unless I have notified the Company of a community or marital property interest in this contract, the Company will rely on good faith belief that no such interest exists and will assume no responsibility for inquiry. .. To the best of my knowledge and belief, my answers to the questions on this application are correct and true, and I agree that this application becomes a part of the annuity contract when issued to me. .. I am in receipt of a current prospectus for this variable annuity. .. This application is subject to acceptance by Transamerica Occidental Life Insurance Company. If this application is rejected for any reason, Transamerica Occidental Life Insurance Company will be liable only for return of purchase payments paid. [_] Check here if you want a copy of "Statement of Additional Information" sent to you. Will this annuity replace or change any existing annuity or life insurance? [_] No [_] Yes (If yes, complete the following) Company: _______________________________________________________________________ Policy No.: ____________________________________________________________________ I HAVE REVIEWED MY EXISTING ANNUITY COVERAGE AND FIND THIS COVERAGE SUITABLE FOR MY NEEDS. - -------------------------------------------------------------------------------- For applicants in all state except Connecticut, New Jersey, Pennsylvania, and Washington. When funds are allocated in Fixed Options Guarantee periods, account values under contract may increase or decrease in accordance with Excess Interest Adjustment prior to the end of Guaranteed Period. - -------------------------------------------------------------------------------- Account values when allocated to any of the Variable Options are not guaranteed as to fixed dollar amount. Signed at: _____________________________________________________________________ City State Date Owner(s) Signature: ____________________________________________________________ Joint Owner(s) Signature: ______________________________________________________ Annuitant Signature: (if not Owner) ____________________________________________ - -------------------------------------------------------------------------------- 13. AGENT INFORMATION - --------------------- Do you have any reason to believe the annuity applied for will replace or change any existing annuity or life insurance? [_] No [_] Yes I HAVE REVIEWED THE APPLICANT'S EXISTING ANNUITY COVERAGE AND FIND THIS COVERAGE IS SUITABLE FOR HIS/HER NEEDS. Registered Rep/Licensed Agent Name: Please print First Name: _______________________________________________________ Please print Last Name: ________________________________________________________ Signature:______________________________________________________________________ Rep Phone #: ___________________________________________________________________ SS # / TIN: ____________________________________________________________________ Rep. License #: ________________________________________________________________ Firm Name: _____________________________________________________________________ Firm Address: __________________________________________________________________ For Registered Representative Use Only - Contact your home office for program information. [_] Option A [_] Option B [_] Option C [_] Option D (Once selected program cannot be changed) - -------------------------------------------------------------------------------- For applicants in the following states LA, MT or NH: Do you have any existing policies or contracts? [_] No [_] Yes (If yes, you must complete and submit with the application the "Important Notice Replacement of Life Insurance or Annuities".) Did the agent/registered representative present and leave the applicant insurer-approved sales material? [_] No [_] Yes - -------------------------------------------------------------------------------- DVA-APP 1201 (3) For applicants in Florida - -------------------------------------------------------------------------------- Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. For applicants in Louisiana - -------------------------------------------------------------------------------- Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. For applicants in New Jersey - -------------------------------------------------------------------------------- Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. For applicants in Pennsylvania - -------------------------------------------------------------------------------- Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. EX-8.K.3 6 dex8k3.txt EXHIBIT-8.K.3 EXHIBIT (8)(k)(3) AMENDMENT NO. 20 TO PARTICIPATION AGREEMENT (AEGON/TRANSAMERICA) AMENDMENT NO. 20 TO PARTICIPATION AGREEMENT AMONG AEGON/TRANSAMERICA SERIES FUND, INC., TRANSAMERICA LIFE INSURANCE COMPANY, AUSA LIFE INSURANCE COMPANY, INC., PEOPLES BENEFIT LIFE INSURANCE COMPANY, TRANSAMERICA OCCIDENTAL LIFE INSURANCE COMPANY AND TRANSAMERICA LIFE INSURANCE AND ANNUITY COMPANY Amendment No. 20 to the Participation Agreement among AEGON/Transamerica Series Fund, Inc., (the "Fund"), Transamerica Life Insurance Company ("Transamerica"), AUSA Life Insurance Company, Inc. ("AUSA Life"), Peoples Benefit Life Insurance Company ("Peoples"), Transamerica Occidental Life Insurance Company ("TOLIC") and Transamerica Life Insurance and Annuity Company ("TALIAC") dated July 1, 1992, as amended ("Participation Agreement"). WHEREAS, Transamerica, has registered or will register certain variable annuity contracts (the "Contracts") and certain variable life insurance policies (the "Policy") under the Securities Act of 1933; and WHEREAS, Transamerica Life Insurance Company of New York ("TONY"), an affiliate of Transamerica, AUSA Life, Peoples, TOLIC and TALIAC has registered or will register certain variable annuity contracts and/or variable life insurance policies (both the contracts and policies, collectively, "Policies") under the Securities Act of 1933; and WHEREAS, Transamerica has, by resolution of its Board of Directors, duly organized and established the Separate Account VA K, Separate Account VA H, Separate Account VA G, Separate Account VA-2L and Separate Account VL A and TONY has, by resolution of its Board of Directors, duly organized and established the Separate Account VA-2LNY (the "Accounts") as segregated asset accounts to receive, set aside and invest assets attributable to net premiums and payments received under the Contracts and Policy and such variable annuity contracts and variable life insurance policy will be partly funded by the Fund; and WHEREAS, Transamerica and TONY has registered or will register the Accounts as unit investment trusts under the Investment Company Act of 1940, as amended; and WHEREAS, to the extent permitted by applicable insurance law and regulation, Transamerica and TONY intend to purchase shares in one or more of the portfolios of the Fund to fund their respective Contracts and Policy on behalf of the Accounts, as specified in Schedule A attached to this Amendment, as such Schedule A is amended by this Amendment No. 20, and as Schedule A may be amended from time to time; and WHEREAS, each of the current parties is desirous of adding Transamerica New York as a party, subject to the same terms and conditions, to the Agreement. NOW, THEREFORE, IT IS HEREBY AGREED that Transamerica, through its separate accounts, Separate Account VA K, Separate Account VA H, Separate Account VA G, Separate Account VA-2L and Separate Account VL A and TONY, through its separate account, Separate Account VA-2LNY, will purchase and redeem shares issued by the Fund, subject to the terms and conditions of the Participation Agreement. It is also agreed that Schedule A to the Participation Agreement is hereby amended to add the Separate Account VA K, Separate Account VA H, Separate Account VA G, Separate Account VA-2L, Separate Account VL A and Separate Account VA-2LNY, as additional "Accounts;" to add the Retirement Income Builder Variable Annuity, Retirement Income Builder III Variable Annuity, Dreyfus Advisor Advantage Variable Annuity, Dreyfus Access Advantage Variable Annuity, Dreyfus/Transamerica Triple Advantage(R) Variable Annuity contracts and the Transamerica Variable Life policy issued by Transamerica and the Dreyfus/Transamerica Triple Advantage(R) Variable Annuity (NY) contract issued by TONY, to the list of "Policies;" and to delete reference to the Transamerica Landmark ML Variable Annuity contract from the list of "Policies;" and to add the Van Kampen Money Market Portfolio, the Van Kampen Asset Allocation Portfolio, the Van Kampen Active International Allocation Portfolio, the Transamerica U.S. Government Securities Portfolio, the Transamerica Growth Opportunities Portfolio, the Transamerica Equity Portfolio, Transamerica Convertible Securities Portfolio, the T. Rowe Price Growth Stock Portfolio, the T. Rowe Price Equity Income Portfolio, the Protected Principal Stock Portfolio, the PIMCO Total Return Portfolio, the Moderately Aggressive Asset Allocation Portfolio, the Moderate Asset Allocation Portfolio, the MFS High Yield Portfolio, the Jennison Growth Portfolio, the Janus Growth II Portfolio, the Janus Balanced Portfolio the J.P. Morgan Enhanced Index Portfolio, the Dreyfus Small Cap Value Portfolio, the Conservative Asset Allocation Portfolio, the Capital Guardian Value Portfolio, the Capital Guardian U.S. Equity Portfolio, the Capital Guardian Global Portfolio, and the Aggressive Asset Allocation Portfolio to the list of "Portfolios", to delete reference to the C.A.S.E. Growth Portfolio and to delete reference to the AEGON Balanced Portfolio, to change the name of the J.P. Morgan Real Estate Securities Portfolio to Clarion Real Estate Securities Portfolio, to change the name of the NWQ Value Equity Portfolio to PBHG/NWQ Value Select Portfolio, to change Pilgrim Baxter Mid Cap Growth to PBHG to Mid Cap Growth and to change the name of the J.P. Morgan Money Market Portfolio to Transamerica Money Market Portfolio of the AEGON/Transamerica Series Fund, Inc. IN WITNESS WHEREOF, each of the parties has caused this Amendment to be executed in its name and on its behalf by its duly authorized representative as of May 1, 2002. TRANSAMERICA LIFE INSURANCE AEGON/TRANSAMERICA SERIES COMPANY FUND, INC. By its authorized officer By its authorized officer By: /s/ Larry N. Norman By: /s/ John K. Carter -------------------------------- -------------------------------- Larry N. Norman John K. Carter Title: President Title: Vice President, Secretary and General Counsel AUSA LIFE INSURANCE PEOPLES BENEFIT LIFE COMPANY, INC. INSURANCE COMPANY By its authorized officer By its authorized officer By: /s/Larry N. Norman By: /s/ Larry N. Norman ------------------------------- -------------------------------- Larry N. Norman Larry N. Norman Title: Vice President Title: Executive Vice President TRANSAMERICA OCCIDENTAL LIFE TRANSAMERICA LIFE INSURANCE INSURANCE COMPANY AND ANNUITY COMPANY By its authorized officer By its authorized officer By: /s/ Priscilla I. Hechler By: /s/ Priscilla I. Hechler ---------------------------------------- -------------------------- Priscilla I. Hechler Priscilla I. Hechler Title: Assistant Vice President and Title: Assistant Vice President Assistant Secretary and Assistant Secretary AMENDED SCHEDULE A Effective May 1, 2002 Account(s), Policy(ies) and Portfolio(s) Subject to the Participation Agreement Accounts: Separate Account VA B Separate Account VA BNY Mutual Fund Account Separate Account VA A Separate Account VA C Separate Account VA D Retirement Builder Variable Annuity Account AUSA Life Insurance Company, Inc. Separate Account C Peoples Benefit Life Insurance Company Separate Account V Legacy Builder Variable Life Separate Account AUSA Series Life Account AUSA Series Annuity Account Transamerica Occidental Life Separate Account VUL-3 Separate Account VA E Separate Account VA F Transamerica Occidental Life Separate Account VUL-4 Transamerica Occidental Life Separate Account VUL-5 Transamerica Life Insurance and Annuity Company on behalf of its Separate Account VA-8 Separate Account VA J Transamerica Occidental Life Separate Account VUL-6 TA PPVUL 1 Separate Account K Separate Account H Separate Account G Separate Account VA-2LNY Separate Account VA-2L Separate Account VL A Policies: Transamerica Landmark Variable Annuity AUSA Landmark Variable Annuity The Atlas Portfolio Builder Variable Annuity Transamerica EXTRA Variable Annuity Transamerica Access Variable Annuity Retirement Income Builder II Variable Annuity AUSA & Peoples - Advisor's Edge Variable Annuity Peoples - Advisor's Edge Select Variable Annuity Legacy Builder Plus AUSA Financial Freedom Builder Transamerica Elite Privilege Select Variable Annuity Estate Enhancer Variable Life AMENDED SCHEDULE A (continued) Policies (continued): TransSurvivor Life Variable Universal Life TransMark Optimum Choice Variable Annuity TransUltra(R) Variable Universal Life AUSA Freedom Elite Builder AUSA Premier Variable Annuity Immediate Income Builder II Premier Asset Builder Variable Annuity TransAccumulator VUL cv AUSA Freedom Wealth Protector Advantage V Retirement Income Builder Variable Annuity Retirement Income Builder III Variable Annuity Dreyfus Advisor Advantage Variable Annuity Dreyfus Access Advantage Variable Annuity Dreyfus/Transamerica Triple Advantage(R) Variable Annuity (NY) Dreyfus/Transamerica Triple Advantage(R) Variable Annuity Transamerica Variable Life Portfolios: AEGON/Transamerica Series Fund, Inc. Janus Growth AEGON Bond Transamerica Money Market Janus Global LKCM Strategic Total Return Van Kampen Emerging Growth Alger Aggressive Growth Federated Growth & Income PBHG/NWQ Value Select GE U.S. Equity Clarion Real Estate Securities T. Rowe Price Dividend Growth T. Rowe Price Small Cap Goldman Sachs Growth PBHG Mid Cap Growth Salomon All Cap Dreyfus Mid Cap Third Avenue Value Transamerica Value Balanced Great Companies - America(SM) Great Companies - Technology(SM) Value Line Aggressive Growth AMENDED SCHEDULE A (continued) Portfolios: AEGON/Transamerica Series Fund, Inc. (continued) Gabelli Global Growth Great Companies - Global/2/ LKCM Capital Growth American Century International American Century Income & Growth Munder Net50 BlackRock Large Cap Value BlackRock Mid Cap Growth BlackRock Global Science & Technology Aggressive Asset Allocation Capital Guardian Global Capital Guardian U.S. Equity Capital Guardian Value Conservative Asset Allocation Dreyfus Small Cap Value J.P. Morgan Enhanced Index Janus Balanced Janus Growth II Jennison Growth MFS High Yield Moderate Asset Allocation Moderately Aggressive Asset Allocation PIMCO Total Return Protected Principal Stock T. Rowe Price Equity Income T. Rowe Price Growth Stock Transamerica Equity Transamerica Convertible Securities Transamerica Growth Opportunities Transamerica U.S. Government Securities Van Kampen Active International Allocation Van Kampen Asset Allocation Van Kampen Money Market EX-10.B 7 dex10b.txt EXHIBIT-10.B EXHIBIT (10)(b) OPINION AND CONSENT OF ACTUARY [Transamerica Occidental Life Insurance Company Letterhead] August 15, 2002 Transamerica Occidental Life Insurance Company 4333 Edgewood Road NE Cedar Rapids, Iowa 52499-0001 Re: Separate Account VA-2L Registration on Form N-4 SEC File No. 33-49998 Dear Sir/Madam: With regard to the above registration statement, I have examined such documents and made such inquiries as I have deemed necessary and appropriate, and on the basis of such examination, have the following opinions: Fees and charges deducted under the Dreyfus/Transamerica Triple Advantage Variable Annuity policies are those deemed necessary to appropriately reflect: (1) the expenses incurred in the acquisition and distribution of the Policies, (2) the expenses associated with the development and servicing of the policies, (3) the assumption of certain risks arising from the operation and management of the policies and/or riders to the policy and that provides for a reasonable margin of profit. Fees and charges assessed against the policy values in the variable account include: (i) Service Charge and Administrative Charge (ii) Surrender Charge (iii) Mortality and Expense Risk Fee (M&E) (iv) Taxes (including premium and other taxes if applicable) (v) Any applicable rider fees or charges The magnitude of each of the individual charges listed above in (i) through (v) is established in the pricing of the Dreyfus/Transamerica Triple Advantage Variable Annuity, to achieve a reasonable Return on Investment (ROI), which is within the range of industry practice with respect to comparable variable annuity products. Transamerica Occidental Life Insurance Company August 15, 2002 Page 2 Except by coincidence, it is not expected that actual charges assessed in a given year would exactly offset actual expenses incurred. Acquisition expenses (as well as major product and/or systems development expenses) are incurred "up front" and recovered, with a reasonable profit margin, through future years' charges. In addition, the company cannot increase certain charges under the Policies in the pricing process. Therefore, in my opinion, the fees and charges deducted under the Policies, in the aggregate, are reasonable in relation to the services rendered, the expenses expected to be incurred, and the risks assumed by the company. I hereby consent to the use of this opinion, which is included as an Exhibit to the Registration Statement. /s/ Tim Bennett - ---------------------------------------------- Tim Bennett, ASA, MAAA Assistant Actuary Transamerica Occidental Life Insurance Company EX-15 8 dex15.txt EXHIBIT-15 EXHIBIT (15) POWERS OF ATTORNEY POWER OF ATTORNEY WITH RESPECT TO SEPARATE ACCOUNT VA-2L Know all men by these presents that Christopher H. Garrett, whose signature appears below, constitutes and appoints Frank A. Camp and Brenda K. Clancy, and each of them, his attorneys-in-fact, each with the power of substitution, for him in any and all capacities, to sign any registration statements and amendments thereto for the Separate Account VA-2L, and to file the same, with exhibits thereto and other documents in connection therewith, with the Securities and Exchange Commission, hereby ratifying and confirming all that each of said attorneys-in-fact, or their substitute, may do or cause to be done by virtue hereof. /s/ Christopher H. Garrett ------------------------------------- Christopher H. Garrett Director Transamerica Occidental Life Insurance Company August 15, 2002 - ---------------------- Date POWER OF ATTORNEY WITH RESPECT TO SEPARATE ACCOUNT VA-2L Know all men by these presents that Diane Meiners, whose signature appears below, constitutes and appoints Frank A. Camp and Brenda K. Clancy, and each of them, her attorneys-in-fact, each with the power of substitution, for her in any and all capacities, to sign any registration statements and amendments thereto for the Separate Account VA-2L, and to file the same, with exhibits thereto and other documents in connection therewith, with the Securities and Exchange Commission, hereby ratifying and confirming all that each of said attorneys-in-fact, or their substitute, may do or cause to be done by virtue hereof. /s/ Diane Meiners ------------------------------------ Diane Meiners Vice President Transamerica Occidental Life Insurance Company August 15, 2002 - ----------------------- Date -----END PRIVACY-ENHANCED MESSAGE-----