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Individual
Annuity
Contract
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This is a deferred annuity contract. It is a legal contract between you, as the
owner, and us, IDS Life Insurance Company. PLEASE READ YOUR CONTRACT CAREFULLY.
If the annuitant is living on the settlement date, we will begin to pay you
monthly annuity payments. Any payments made by us are subject to the terms of
this contract. The owner and beneficiary are as named in the application unless
they are changed as provided for in this contract.
We issue this contract in consideration of your application and payment of the
single purchase payment.
Signed for and issued by IDS Life Insurance Company, Minneapolis, Minnesota, as
of the contract date shown below.
THIS ANNUITY CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA
WHICH MAY RESULT IN BOTH UPWARD AND DOWNWARD ADJUSTMENTS IN CASH
SURRENDER BENEFITS. Surrenders are available without market value adjustment on
the last day of each contract period.
NOTICE OF YOUR RIGHT TO EXAMINE THIS CONTRACT FOR TEN DAYS. If for any reason
you are not satisfied with this contract, return it to us or our agent within
ten days after you receive it. We will then cancel this contract and refund all
purchase payments which you have made. This
contract will then be considered void from the start.
President:
/s/ Richard W. Kling
Richard W. Kling
Secretary:
/s/ William A. Stoltzmann
William A. Stoltzmann
30365D
AMERICAN
EXPRESS
Financial
Advisors
IDS Life Insurance Company
IDS Tower 10
Minneapolis, Minnesota 55440
- - Individual Annuity Contract
- - Purchase payment is payable in a single sum.
- - Annuity payments to begin on the settlement date.
- - This contract is nonparticipating. Dividends are not payable.
ANNUITANT: John Doe
CONTRACT NUMBER: XXX-XXXXXX
CONTRACT DATE: March 18, 1991
CONTRACT SETTLEMENT DATE: March 18, 2021
30365D (3/91)
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Guide to Contract Provisions
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Definitions Important words and meanings/Page 3
The Annuity Contract Entire contract; Incontestability;
Misstatement of birthdate or sex/Page 4
Owner Owner's rights; Change of ownership;
Assignment/Page 4
Beneficiary and Payments to Who is the beneficiary; Change of
Beneficiary beneficiary; Payments to beneficiary/Page
5
Purchase Payment Payment of the purchase payment/Page 5
Accumulation Value, How the accumulation value is determined;
Cash Surrender Value, and Surrender of the contract for the cash
Market Adjusted Value surrender value; How the market adjusted
value is determined; Annual statement of
value/Page 6
Annuity Payment Plans When annuity payments begin; Different
ways to receive annuity payments/Page 8
Table of Settlement Rates Table showing monthly annuity payment
amounts for the various plans/Page 9
30365D
CONTRACT DATA
CONTRACT OWNER: John Doe
PURCHASE PAYMENT: $5,000.00
INITIAL GUARANTEE RATE: 7%
INITIAL GUARANTEE PERIOD: 5 Years
ACCUMULATION VALUE AT END OF INITIAL GUARANTEE PERIOD: $7,012.76
Surrender Charge Percentage
(Applied to Market Adjusted Value Surrendered)
Guarantee Contract Years as measured from the beginning of a
Period Guarantee Period
1 2 3 4 5 6 7 8
1 Year 1%
2 Years 2% 1%
3 Years 3% 2% 1%
4 Years 4% 3% 2% 1%
5 Years 5% 4% 3% 2% 1%
6 Years 6% 5% 4% 3% 2% 1%
7 Years 7% 6% 5% 4% 3% 2% 1%
8 Years 8% 7% 6% 5% 4% 3% 2% 1%
9 Years 8% 7% 6% 5% 4% 3% 2% 1%
10 Years 8% 7% 6% 5% 4% 3% 2% 1%
For renewal guarantee periods, the surrender charge percentages will be based on
the lesser of:
1. The length of the new guarantee period, or
2. The number of years remaining until the eighth contract
anniversary.
There are no surrender charges on the last day of a guarantee period. There will
never be surrender charges beyond the eighth contract anniversary.
30365D
ANNUITANT: John Doe
CONTRACT NUMBER: XXXX-XXXXXXX
CONTRACT DATE: March 18, 1991
CONTRACT SETTLEMENT DATE: March 18, 2021
30365D
Definitions
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The following words are used often in this contract. When we use these words,
this is what we mean:
the annuitant
The person on whose life monthly annuity payments depend.
you, your, owner
The owner of this contract. The owner may be someone other than the annuitant.
The owner is shown in the application unless the owner has been changed as
provided in this contract.
we, our, us
IDS Life Insurance Company.
contract date
It is the date from which contract anniversaries, contract years, and contract
months are determined. Your contract date is shown under contract data.
contract anniversary
The same day and month as the contract date each year that the contract remains
in force.
initial guarantee period
The period during which the initial guarantee rate will be credited. It is shown
under contract data.
initial guarantee rate
The rate of interest credited to the purchase payment as described in the
accumulation value section. It is shown under contract data.
renewal guarantee period
A renewal guarantee period will begin at the end of each guarantee period. It is
determined in accordance with the terms of the contract.
renewal guarantee rate
The rate of interest credited to the renewal value as described in the
accumulation value section.
30365D
renewal date
The first day of a renewal guarantee period. It will always be on a contract
anniversary.
current rate
The applicable interest rate contained in a schedule of rates established by us
from time to time for various guarantee periods.
accumulation value
The value of the purchase payment plus interest credited, adjusted for any
surrenders.
market adjusted value
The accumulation value adjusted by the market adjusted value formula.
market value adjustment
The market adjusted value minus the accumulation value.
renewal value
The accumulation value at the end of the guarantee period.
cash surrender value
The market adjusted value less any applicable surrender charge.
written request
A request in writing signed by you and delivered to us at our home office.
settlement
The application of the market adjusted value of the contract to provide annuity
payments.
settlement date
The date on which annuity payments are to begin. This date may be changed as
provided in this contract.
30365D
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The Annuity Contract
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What is the entire contract?
This contract form and the copy of the application attached to it are the entire
contract between you and us.
No one except one of our corporate officers (President, Vice President,
Secretary, or Assistant Secretary) can change or waive any of our rights or
requirements under the contract. That person must do so in writing. None of our
agents or other persons has the authority to change or waive any of our rights
or requirements under the contract.
In issuing this contract, we have relied upon the application. The statements
contained in the application are considered representations and not warranties.
No statements made in connection with the application will be used by us to void
the contract or to deny a claim unless that statement is part of the
application.
When will this contract become incontestable?
This contract is incontestable from its date of issue.
What if the annuitant's birthdate or sex has been misstated?
If the annuitant's birthdate or sex has been misstated, payments under this
contract will be based on what would have been provided at the correct birthdate
and sex. Any underpayments made by us will be made up immediately. Any
overpayments made by us will be subtracted from the future payments.
What laws govern this contract?
This contract is governed by the law of the state in which it is delivered. The
values and benefits of this contract are at least equal to those required by
such state.
===========================================================================Owner
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What are your rights as owner of this contract?
30365D
As long as the annuitant is living and unless otherwise provided in this
contract, you may exercise all rights and privileges in this contract or allowed
by us.
How can you change ownership for this contract?
You can change the ownership of this contract by written request on a form
approved by us. The change must be made while the annuitant is living. Once the
change is recorded by us, it will take effect as of the date of your request,
subject to any action taken or payment made by us before the recording.
Can you assign this contract as collateral?
Yes. While the annuitant is living, you can assign this contract or any interest
in it. Your interest and the interest of any beneficiary is subject to the
interest of the assignee. An assignment is not a change of ownership and an
assignee is not an owner as these terms are used in the contract. Any amounts
payable to the assignee will be paid in a single sum.
A copy of any assignment must be submitted to us at our home office. Any
assignment is subject to any action taken or payment made by us before the
assignment was recorded at our home office. We are not responsible for the
validity of any assignment.
30365D
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Beneficiary and Payments
to Beneficiary
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What death benefits are paid if the annuitant or owner dies before settlement?
If the annuitant or owner dies before settlement while this contract is in
force, we will pay the beneficiary the accumulation value.
The accumulation value will be determined as of the date on which due proof of
death is received at our home office.
The above described payment will also be made upon the first to die if ownership
is in a joint tenancy except where spouses are joint owners with right of
survivorship and the surviving spousal joint owner elects to continue this
contract.
Unless you have provided otherwise during the lifetime of the annuitant, the
beneficiary may elect by written request to have the amount payable applied
under the terms of the annuity payment plans section of this contract provided:
1. the beneficiary elects the plan within 60 days after we receive due
proof of death; and
2. payments begin no later than one year after we receive due proof of
death; and
3. the plan provides equal or substantially equal payments over a period
which does not exceed the life of the beneficiary or the life expectancy
of the beneficiary.
In this event, the references to "annuitant" in the annuity payment plans
section of this contract will apply to the beneficiary.
To whom are the death benefits payable?
Benefits will be paid equally to all primary beneficiaries surviving the
annuitant. If none survive, proceeds will be paid equally to all contingent
beneficiaries surviving the annuitant. If no beneficiary survives the annuitant,
we will pay the benefits to you, if living, otherwise to your estate.
30365D
Who is the beneficiary?
The beneficiary or beneficiaries are as named in the application unless you have
since changed the beneficiary as provided below. If the beneficiary has been
changed, we will pay any benefits in accordance with your last change of
beneficiary request.
How do you change the beneficiary?
You may change the beneficiary any time while the annuitant is living by
satisfactory written request to us. Once the change is recorded by us, it will
take effect as of the date of your request, subject to any action taken or
payment made by us before the recording.
What is the spouse's option to continue this contract?
If the owner's death occurs prior to the settlement date, the owner's spouse, if
designated as sole beneficiary, may elect in writing to forego receipt of the
death benefit and instead continue this contract in force as its owner. The
election by the spouse must be made within 60 days after we receive due proof of
death.
What if the annuitant dies after settlement?
If the annuitant dies after settlement, the amount payable, if any, will be as
provided in the annuity plan then in effect.
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Purchase Payment
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What is the purchase payment for this contract?
The purchase payment for this contract is shown under contract data. It is
payable to us on or before the date we deliver this contract. It must be paid or
mailed to us at our home office or to an authorized agent.
30365D
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Accumulation Value,
Cash Surrender Value,
Market Adjusted Value
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How is the accumulation value determined?
On the contract date, the accumulation value of this contract is the purchase
payment. Thereafter, interest accrues from day to day for the guarantee period
at the rate shown under contract data. This rate represents an effective annual
yield. At no time while the contract is in force shall interest accrue at a rate
less than 3% compounded annually. The accumulation value will be adjusted for
any amounts surrendered.
Are there premium tax charges?
We reserve the right to deduct an amount from the accumulation value of this
contract at the time that any applicable premium taxes not previously deducted
are payable.
If a tax is payable at the time of your purchase payment and we choose to not
deduct it at that time, we further reserve the right to deduct it at a later
date.
How are renewal guarantee periods determined?
At the end of any guarantee period, a renewal guarantee period will begin. We
will notify you in writing 45 days before the renewal guarantee period. Each
renewal guarantee period will be one year unless you elect a different length
from those offered at the time. We must receive your written request at least 15
days before the renewal date. The renewal guarantee period may never extend
beyond the settlement date.
The accumulation value on the renewal date will be equal to the accumulation
value at the end of the guarantee period just ending. This value will earn
interest at the renewal guarantee rate. Upon written request, within 45 days of
the renewal guarantee period, we will notify you of the renewal guarantee rate
then in effect for contracts renewing at that time. The actual renewal guarantee
rate will be determined on the renewal date.
30365D
What is the market adjusted value and how is it determined?
The market adjusted value is the accumulation value on any date before the end
of the current guarantee period adjusted by a formula. The formula adjustment
reflects the relationship between:
1. the interest rate we are then crediting for new contract sales and
renewals (Form 30365) for the time remaining in your contract's current
guarantee period; and
2. the guaranteed interest rate applicable to your contract's current
guarantee period.
The market adjusted value may be more or less than the accumulation value.
The market adjusted value formula is as follows:
market adjusted value = renewal value
(1 + ic + .0025)(N + t)
where: renewal value = the accumulation value at the end of your
current guarantee period.
N = the number of complete contract years to
the end of your guarantee period.
t = the fraction of the contract year
remaining to the end of your contract year
(for example, if 180 days remain in a 365
day contract year, t would be .493)
ic = the current rate offered for new contract
sales and renewals (Form 30365) for the
number of years left in your guarantee
period (straight line interpolation
between whole year rates). If N is
zero, ic is the rate for one year
guarantee periods.
The market value adjustment is as follows:
market value adjustment = market adjusted value - accumulation value
30365D
There will be no market value adjustment made on the last day of a guarantee
period.
Can you request surrender of any amounts under this contract before settlement?
Yes. By written request to us and subject to the rules below you may:
1. surrender this contract for the total cash surrender value;
2. partially surrender this contract for a part of the cash surrender value.
How is the cash surrender value determined?
The cash surrender value is the market adjusted value less a surrender charge.
The surrender charge is based on the amount surrendered and the contract year in
which the surrender is made. The schedule of surrender charges is shown under
contract data.
After the first contract anniversary, surrender charges will not apply to
surrenders of amounts totaling up to 10% of the contract accumulation value as
of the last contract anniversary.
What are the rules for a surrender or partial surrender?
The amount surrendered and any applicable market value adjustment or surrender
charge will be deducted from the accumulation value of the contract on the date
of surrender. You may surrender all or a portion of the cash surrender value.
However, the accumulation value that remains after a partial surrender must be
at least $2,000. Any partial surrender must be at least $250.
The surrender payment will normally be mailed to you within seven days of the
receipt of your written request.
Upon surrender of this contract for the total cash surrender value, this
contract will terminate. We may require that you return this contract to our
home office before we pay the total cash surrender value.
Can we delay or suspend payment of a partial or full surrender?
We may defer payment of any partial or full surrender for a period not to exceed
6 months from the date we receive your surrender request or the period permitted
by state insurance law, if less. If we defer payment more than 30 days, we will
pay annual interest of at least 3% on the amount deferred.
30365D
Will you receive information about your contract values?
Yes. At least once a year we will send you a statement showing both the
accumulation value and the cash surrender value of this contract. The statement
will specify the surrender charge and market value adjustment used to determine
the cash surrender value. This statement will be based on any laws or
regulations that apply.
We will also notify you 45 days before the end of a guarantee period concerning
renewal periods available and your right to surrender without a market value
adjustment on the last day of your guarantee period.
30365D
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Annuity Payment Plans
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When will annuity payments begin?
The first payment will be made as of the settlement date. Before payments begin,
we will require satisfactory proof that the annuitant is alive. We may also
require that you exchange this contract for a supplemental contract which
provides the annuity payments.
Can you change the settlement date?
Yes. Tell us the new date by written request. However, the settlement date
cannot be later than the later of:
1. the contract anniversary nearest the annuitant's 85th birthday; or
2. the 10th contract anniversary.
Also, if you select a new date, it must be at least 30 days after we receive
your written request at our home office.
What are the annuity payment plans?
There are different ways to receive annuity payments. We call these plans.
Plan A - This provides monthly annuity payments for the lifetime of the
annuitant. No payments will be made after the annuitant dies.
Plan B - This provides monthly annuity payments for the lifetime of the
annuitant with a guarantee by us that payments will be made for a period of at
least five, ten, or fifteen years. You must select the guaranteed period.
Plan C - This provides monthly annuity payments for the lifetime of the
annuitant with a guarantee by us that payments will be made for a certain number
of months. We determine the number of months by dividing the market adjusted
value applied under this plan by the amount of the monthly annuity payment.
30365D
Plan D - We call this a joint and survivor life annuity. Monthly payments will
be paid for the lifetime of the annuitant and a joint annuitant. When either the
annuitant or joint annuitant dies, we will continue to make monthly payments for
the lifetime of the survivor. No payments will be paid after the death of both
the annuitant and joint annuitant.
Plan E - This provides monthly fixed dollar annuity payments for a period of
years. The period of years may be no less than 10 nor more than 30.
What are the requirements for selecting a plan?
By written request to us at least 30 days before the settlement date, you may
select the plan or change to another plan. If at least 30 days before the
settlement date we have not received at our home office your written request to
select a plan, we will make payments according to Plan B with payments
guaranteed for ten years.
If the amount to be applied to a plan is not at least $2,000, or if payments are
to be made to other than a natural person, we have the right to make a lump-sum
payment of the cash surrender value.
How will payments be made?
Payments will be made by us by check. The check must be personally endorsed by
the payee or payees as well as the annuitant (or joint annuitant under Plan D).
If the annuitant or joint annuitant does not endorse the check, other evidence
must be furnished to show that the annuitant or joint annuitant is still alive.
30365D
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Table of Settlement Rates
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What will be the amount of the monthly annuity payments?
The amount of each monthly annuity payment for each $1,000 of market adjusted
value applied under any payment plan will be based on our Table of Settlement
Rates in effect at the time of the first payment. The amounts will not be less
than those shown in the table below.
The amount of such payments under plans A, B, and C will depend on the sex and
the adjusted age of the annuitant on the settlement date. The amount of such
payments under plan D will depend on the sex and the adjusted age of the
annuitant and the joint annuitant on the settlement date.
Adjusted age means the age on the annuitant's nearest birthday minus an
"adjustment" based on the calendar year of the birth of the annuitant as
follows:
Calendar Calendar
Year of Year of
Annuitant's Adjust- Annuitant's Adjust-
Birth ment Birth ment
- ----- ---- ----- ----
Prior to 1920 0 1945 through 1949 6
1920 through 1924 1 1950 through 1959 7
1925 through 1929 2 1960 through 1969 8
1930 through 1934 3 1970 through 1979 9
1935 through 1939 4 1980 through 1989 10
1940 through 1944 5 After 1989 11
30365D
Amount of Each Monthly Annuity Payment Per $1,000 Applied
Plan A Plan B Plan C Plan D - Joint and Survivor
Adjusted Age of Female Joint Annuitant
Life 5 Years 10 Years 15 Years With Adj.
Adj. Income Certain Certain Certain Refund Male 10 Years 5 Years Same 5 Years 10 Years
Age* M F M F M F M F M F Age* Younger Younger Age Older Older
- -----------------------------------------------------------------------------------------------------------------------------------
55 5.29 4.84 5.26 4.83 5.20 4.80 5.09 4.74 5.05 4.71 55 4.11 4.27 4.45 4.62 4.79
56 5.39 4.92 5.36 4.91 5.29 4.87 5.17 4.81 5.13 4.77 56 4.15 4.32 4.51 4.70 4.88
57 5.49 5.00 5.47 4.99 5.38 4.95 5.25 4.88 5.21 4.85 57 4.19 4.37 4.57 4.77 4.96
58 5.61 5.09 5.58 5.08 5.48 5.03 5.33 4.96 5.30 4.92 58 4.24 4.43 4.64 4.85 5.06
59 5.73 5.19 5.70 5.17 5.59 5.12 5.42 5.04 5.40 5.00 59 4.28 4.49 4.71 4.94 5.16
60 5.86 5.29 5.82 5.27 5.70 5.22 5.51 5.12 5.50 5.09 60 4.34 4.55 4.79 5.03 5.27
61 6.00 5.40 5.96 5.38 5.82 5.32 5.60 5.21 5.60 5.18 61 4.39 4.62 4.87 5.13 5.38
62 6.16 5.52 6.10 5.50 5.95 5.42 5.69 5.30 5.72 5.27 62 4.45 4.69 4.96 5.24 5.50
63 6.32 5.65 6.26 5.62 6.08 5.53 5.79 5.39 5.83 5.37 63 4.51 4.77 5.06 5.35 5.64
64 6.49 5.78 6.42 5.75 6.21 5.65 5.89 5.49 5.96 5.48 64 4.57 4.85 5.16 5.48 5.78
65 6.68 5.92 6.60 5.89 6.35 5.77 5.98 5.58 6.09 5.59 65 4.64 4.94 5.27 5.61 5.93
66 6.88 6.08 6.78 6.03 6.50 5.90 6.08 5.69 6.23 5.71 66 4.71 5.03 5.38 5.75 6.09
67 7.09 6.24 6.98 6.19 6.65 6.04 6.18 5.79 6.38 5.83 67 4.79 5.13 5.51 5.90 6.27
68 7.31 6.42 7.18 6.36 6.81 6.19 6.28 5.90 6.53 5.97 68 4.87 5.24 5.64 6.06 6.46
69 7.56 6.61 7.40 6.54 6.97 6.34 6.37 6.01 6.69 6.11 69 4.96 5.35 5.78 6.24 6.66
70 7.82 6.81 7.64 6.74 7.14 6.50 6.47 6.12 6.86 6.26 70 5.06 5.47 5.94 6.43 6.87
71 8.09 7.04 7.88 6.95 7.31 6.67 6.55 6.22 7.04 6.42 71 5.16 5.60 6.10 6.63 7.11
72 8.39 7.28 8.14 7.17 7.48 6.84 6.64 6.33 7.23 6.59 72 5.26 5.74 6.28 6.84 7.36
73 8.71 7.54 8.41 7.41 7.65 7.02 6.72 6.44 7.43 6.77 73 5.38 5.89 6.47 7.08 7.62
74 9.05 7.83 8.70 7.67 7.83 7.21 6.80 6.54 7.64 6.97 74 5.50 6.05 6.68 7.33 7.91
75 9.41 8.14 9.00 7.95 8.00 7.40 6.87 6.64 7.86 7.17 75 5.63 6.22 6.90 7.60 8.22
*Adjusted age of annuitant. M = Male F = Female
The table above is based on the "1983 Individual Annuitant Mortality Table A"
assuming an interest rate of 4% per year compounded annually. Settlement rates
for any age, or any combination of age and sex not shown above, will be
calculated on the same basis as those rates shown in the table above. Such rates
will be furnished by us upon request. Amounts shown in the table below are based
on an assumed interest rate of 4% per year compounded annually.
Plan E - Dollar Amount of Each Monthly Fixed Dollar Annuity Payment Per $1,000 Applied
Years Monthly Years Monthly Years Monthly
Payable Payment Payable Payment Payable Payment
------- ------- ------- ------- ------- -------
10 $10.06 17 $6.71 24 $5.35
11 9.31 18 6.44 25 5.22
12 8.69 19 6.21 26 5.10
13 8.17 20 6.00 27 5.00
14 7.72 21 5.81 28 4.90
15 7.34 22 5.64 29 4.80
16 7.00 23 5.49 30 4.72
30365D
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Individual Annuity Contract
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- - Individual Annuity Contract.
- - Purchase payment is payable in a single sum.
- - Annuity payments to begin on the settlement date.
- - This contract is nonparticipating. Dividends are not payable.
AMERICAN
EXPRESS
Financial
Advisors
IDS Life Insurance Company
IDS Tower 10
Minneapolis, Minnesota 55440
30365D