Contract Schedule
Contract Number: [12345]
Contract Date: [01/01/2008] Maturity Date: [01/01/2058]
Contract Owner: [John Doe]
[Joint Contract Owner:] [Jane Doe]
Covered Person: [John Doe] Covered Person’s DOB: [01/01/1958]
[Joint Covered Person:] [Jane Doe] [Joint Covered Person’s DOB:] [01/01/1958]
Annuitant: [John Doe] Annuitant’s DOB: [01/01/1958]
Maximum Issue Age: [80]
Minimum Annuity Payment Amount: $[100] per month
Maximum Birthday: [91st] birthday
Program Sponsor: [XYZ Trust/Broker-Dealer]
Designated Account
Account Number: [8675309]
Maximum Coverage Amount: [$1,000,000.00]
Program Rule(s): [0 to 100% PIMCO Global Multi-Asset Fund]
[0 to 100% PIMCO Total Return Fund]
[0 to 100% PIMCO Money Market Fund]
Required Reallocation Period: | [30 days from the date of the written notice or the next Business Day if the 30th day is not a Business Day. ] |
Allocation Correction Period: | [10 days from the date of the written notice or the next Business Day if the 10th day is not a Business Day.] |
Addition Reversal Period: | [60 days from the date of the written notice or the next Business Day if the 60th day is not a Business Day.] |
Minimum Value: [$5,000]
Benefit Grace Period: | [10 days from the date of the written notice or the next Business Day if the 10th day is not a Business Day] |
Benefit Base
Initial Investment: [$75,000]
Withdrawals
Withdrawal Reversal Period: | [10 days from the date of withdrawal or the next Business Day if the 10th day is not a Business Day] |
Exercise Ages: On the Withdrawal Start Date, all Covered Persons must be atleast age [65].
Withdrawal Percentage Table
Current Ten-year U.S. Constant Maturity Treasury rate | Payment percentage |
[Less than 3.50% | 4%] |
[3.50% to 4.99% | 5%] |
[5.00% to 6.49% | 6%] |
[6.50% and above | 7%] |
CS1000 3
Contract Schedule continued from the previous page
Total Contract Charges
Grace Period: [30] days
Due Dates: [Contract Date and the first Business Day in January, April, July and October]
[Contract Date and each quarterly anniversary of the Contract Date or the next BusinessDay if such day is not a Business Day]
Contract Maintenance
Charge Due Date: [First Business Day in January]
[Contract Anniversary]
Insurance Charge
[Initial Annual Insurance Charge Rate for a Sole Covered Person]
Allocation 1: [PIMCO Global Multi-Asset Fund] [1.05%]
Allocation 2: [PIMCO Total Return Fund] [1.05%]
Allocation 3: [PIMCO Money Market Fund ] [1.05%]
[Initial Annual Insurance Charge Rate for Joint Covered Persons]
Allocation 1: [PIMCO Global Multi-Asset Fund] [1.05%]
Allocation 2: [PIMCO Total Return Fund] [1.05%]
Allocation 3: [PIMCO Money Market Fund ] [1.05%]
Maximum Annual Insurance Charge Rate: [1.75]%
Administrative Charge
The Annual Administrative Charge Rate is [0.20]%.
Contract Maintenance Charge
The Annual Contract Maintenance Charge is $[75.00].
The Designated Amount is $[100,000].
Reinstatement and Reapplication
Reinstatement Period: | [90 days or the next Business Day if the 90th day is not a Business Day] after Contract Termination |
Reapplication Wait Period: [24 months] after Contract Termination
[Optional Riders:]
CS1000 [3A]
Contract Schedule continued from the previous page
Guaranteed Purchase Rate Tables are based on [1]% interest and the [Annuity 2000 Mortality Tables]. Values for ages not shown will be furnished upon request.
TABLE 1, LIFE ONLY ANNUITY Monthly Installments, per $1,000, payable during the lifetime of the Annuitant. | ||
Age on Annuity Date | Male Female Annuitant 60; Annuitant | |
[50 | 3.02 | 2.78 |
51 | 3.09 | 2.84 |
52 | 3.17 | 2.90 |
53 | 3.25 | 2.97 |
54 | 3.33 | 3.04 |
55 | 3.42 | 3.12 |
56 | 3.51 | 3.20 |
57 | 3.61 | 3.29 |
58 | 3.72 | 3.38 |
59 | 3.83 | 3.47 |
60 | 3.95 | 3.57 |
61 | 4.07 | 3.68 |
62 | 4.21 | 3.79 |
63 | 4.35 | 3.91 |
64 | 4.50 | 4.04 |
65 | 4.67 | 4.18 |
66 | 4.84 | 4.33 |
67 | 5.03 | 4.48 |
68 | 5.22 | 4.65 |
69 | 5.43 | 4.83 |
70 | 5.66 | 5.03 |
71 | 5.90 | 5.24 |
72 | 6.15 | 5.47 |
73 | 6.42 | 5.71 |
74 | 6.71 | 5.98 |
75 | 7.02 | 6.26 |
76 | 7.36 | 6.57 |
77 | 7.71 | 6.91 |
78 | 8.09 | 7.27 |
79 | 8.50 | 7.66 |
80 | 8.93 | 8.09] |
TABLE 2, JOINT AND SURVIVOR ANNUITY Monthly installment per $1,000, payable as long as either Annuitant is living. | |||||||
Age of Male on | Age of Female on Annuity Date | ||||||
Annuity Date | 50 | 55 | 60 | 65 | 70 | 75 | 80 |
[50 | 2.49 | 2.63 | 2.74 | 2.84 | 2.90 | 2.95 | 2.98 |
55 | 2.58 | 2.76 | 2.94 | 3.09 | 3.21 | 3.29 | 3.35 |
60 | 2.65 | 2.88 | 3.12 | 3.34 | 3.54 | 3.69 | 3.80 |
65 | 2.70 | 2.97 | 3.27 | 3.58 | 3.89 | 4.15 | 4.36 |
70 | 2.73 | 3.03 | 3.38 | 3.78 | 4.22 | 4.64 | 5.00 |
75 | 2.75 | 3.06 | 3.46 | 3.93 | 4.49 | 5.11 | 5.70 |
80 | 2.76 | 3.09 | 3.51 | 4.04 | 4.70 | 5.50 | 6.37] |
CS1000 [3A]