FPVLI(8/98)-01
AMERICAN SKANDIA LIFE ASSURANCE CORPORATION
ONE CORPORATE DRIVE, P. O. BOX 883
SHELTON, CONNECTICUT 06484
(A Stock Company)
We pay the Death Proceeds to the Beneficiary upon receipt at our Office of due
proof of the death of the Insured while this Policy is in force and subject to
the terms and conditions on the following pages.
This Policy is issued in consideration of any Application, a copy of which may
be attached to and made a part of this Policy, and receipt at our Office of good
funds as payment of the Initial Premium. This Policy is subject to the laws of
the jurisdiction where it is delivered.
RIGHT TO CANCEL
You may return this Policy to our Office or to the representative who solicited
its purchase within ten days after you receive it for a refund. The amount of
the refund will be the greater of (a) and (b), less any Debt, where: (a) is the
Premium paid; and (b) is the Account Value as of the date we receive the
cancellation request In Writing plus any charges and fees deducted from the
Account Value.
Any portion of the Initial Premium you choose to allocate to the variable
investment options is first allocated to the Automatic Sub-account shown in the
Schedule after deduction of any applicable tax charge. As of the Reallocation
Date shown in the Schedule, we reallocate such Account Value to the Sub-accounts
you select in the proportions you indicate in your most recent allocation
instructions to us. Should you notify us that you intend to cancel this Policy
prior to the Reallocation Date, any amount then maintained in the Automatic
Sub-account will remain in that Sub-account until cancellation of this Policy.
Any portion of Premium you choose to allocate directly to the Fixed Allocation,
after deduction of any applicable tax charge, will be allocated as of the Issue
Date and will not be allocated to the Automatic Sub-account.
Signed for American Skandia Life Assurance Corporation:
President
FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE.
NON-PARTICIPATING.
VARIABLE INVESTMENT OPTIONS AND A FIXED ALLOCATION.
DEATH BENEFIT PAYABLE UPON DEATH OF THE INSURED WHILE THIS POLICY IS IN FORCE.
ANY BENEFITS AND VALUES, INCLUDING THE DEATH BENEFIT, BASED ON THE ACCOUNT
VALUE IN THE VARIABLE INVESTMENT OPTIONS, DEPEND ON INVESTMENT PERFORMANCE,
MAY INCREASE OR DECREASE, AND ARE THEREFORE NOT GUARANTEED. PLEASE REFER TO
THE SECTIONS ENTITLED "ACCOUNT VALUE IN THE SUB-ACCOUNTS" AND "DEATH
BENEFIT" FOR A MORE COMPLETE EXPLANATION. ANY ACCELERATED DEATH BENEFIT
PAYMENT MAY REDUCE YOUR POLICY BENEFITS.
THERE IS NO MINIMUM GUARANTEED CASH VALUE.
LESS THAN 100% OF THE CASH VALUE IS AVAILABLE FOR A LOAN.
FPVLI(8/98)-02
TABLE OF CONTENTS
DEFINITIONS...................................................................................................... 8
DEATH BENEFIT....................................................................................................10
ACCELERATED DEATH BENEFIT........................................................................................12
INVESTMENT OF ACCOUNT VALUE......................................................................................13
OPERATIONS OF THE SEPARATE ACCOUNT...............................................................................13
GENERAL ACCOUNT..................................................................................................14
CHARGES ..................................................................................................14
PREMIUM PAYMENT..................................................................................................15
ALLOCATION RULES.................................................................................................16
ACCOUNT VALUE AND CASH VALUE.....................................................................................16
CASH VALUE CREDIT................................................................................................18
TRANSFERS........................................................................................................18
SURRENDER AND PARTIAL WITHDRAWAL.................................................................................19
POLICY LOANS.....................................................................................................19
GUARANTEED CONTINUATION PROVISION................................................................................20
GRACE PERIOD AND REINSTATEMENT...................................................................................20
YOUR RIGHTS, OWNERSHIP AND DESIGNATIONS..........................................................................21
GENERAL PROVISIONS...............................................................................................21
POLICY PAYMENT OPTIONS...........................................................................................23
PAYMENT OPTION TABLES............................................................................................24
Copies of any Application and any riders and endorsements are attached.
FPVLI(8/98)-03
SCHEDULE
POLICY NUMBER: [001-00001] SPECIFIED AMOUNT AS OF THE POLICY DATE: $[100,000]
MINIMUM SPECIFIED AMOUNT: $[50,000]
MINIMUM AMOUNT BY WHICH YOU MAY CHANGE THE SPECIFIED AMOUNT: $[5,000]
DEATH BENEFIT OPTION AS OF THE POLICY DATE: [LEVEL DEATH BENEFIT]
ISSUE DATE: [JUNE 1, 1998] POLICY DATE: [JUNE 1, 1998]
REALLOCATION DATE: [JUNE 16, 1998]
OWNER: [JOHN DOE]
OWNER: [MARY DOE]
INSURED: [JOHN DOE]
INSURED'S DATE OF BIRTH: [APRIL 1,1963] INSURED'S GENDER: [MALE]
INSURED'S RISK CLASS: [NON-TOBACCO]
TYPE OF BUSINESS: [NON-QUALIFIED]
INITIAL PREMIUM: $[3,743.00]
PARTIAL WITHDRAWALS: AMOUNTS EQUAL TO TIER 2 PREMIUMS MAY BE WITHDRAWN AT ANY
TIME. A PARTIAL WITHDRAWAL OF OTHER POLICY CASH VALUE MAY BE MADE ON OR AFTER
THE TENTH POLICY ANNIVERSARY. ALL PARTIAL WITHDRAWALS ARE SUBJECT TO THE PARTIAL
WITHDRAWAL FEE.
PARTIAL WITHDRAWAL FEE: $25.00
MINIMUM PARTIAL WITHDRAWAL AMOUNT: $1,000.00
MINIMUM CASH VALUE AFTER A PARTIAL WITHDRAWAL: $1,000.00
MAXIMUM PARTIAL WITHDRAWAL AMOUNT: 90% OF THE CASH VALUE
MINIMUM AMOUNT REQUIRED TO BE IN AN INVESTMENT OPTION IMMEDIATELY AFTER A
TRANSFER OR PARTIAL WITHDRAWAL: $500
CASH VALUE CREDIT PERCENTAGE: 0.50%
CASH VALUE TRIGGER: 200% OF PREMIUMS PAID
OPTIONAL BENEFIT RIDER: [NOT APPLICABLE]
4
FPVLI(8/98)-04
SCHEDULE (CONTINUED)
MAXIMUM ANNUAL TIER 1 PREMIUM AS OF THE POLICY DATE: $[3,743.00]
TIER 1 PREMIUM GUARANTEED ACCEPTANCE PERIOD: 7 YEARS
CONTINGENT DEFERRED SALES CHARGE:
- ----------------------- ---------------------
PERCENTAGE OF TIER
1 PREMIUMS PAID
POLICY YEAR
- ----------------------- ---------------------
- ----------------------- ---------------------
1 10%
- ----------------------- ---------------------
- ----------------------- ---------------------
2 9%
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- ----------------------- ---------------------
3 8%
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4 7%
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5 6%
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6 5%
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7 4%
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8 3%
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9 2%
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10 1%
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- ----------------------- ---------------------
11 and higher -0-
- ----------------------- ---------------------
AUTOMATIC SUB-ACCOUNT: AST MONEY MARKET
TARGET DATE: THE POLICY ANNIVERSARY ON OR IMMEDIATELY AFTER WHICH THE INSURED
ATTAINS AGE 75
PREMIUM CUT-OFF AGE: INSURED'S AGE 100
TRANSFER FEE: $10 PER TRANSFER AFTER THE TWELFTH IN EACH POLICY YEAR
MORTALITY AND EXPENSE RISK CHARGE: 0.90% OF VARIABLE ACCOUNT VALUE PER POLICY
YEAR
ADMINISTRATION CHARGE: 0.25% OF VARIABLE ACCOUNT VALUE PER POLICY YEAR
TAX CHARGE: [X.XX%] AS OF THE POLICY DATE ON EACH PREMIUM AS PAID, AND ON ANY
LOAN TRANSFERRED FROM ANOTHER POLICY AS THE RESULT OF AN EXCHANGE
FPVLI(8/98)-05
SCHEDULE (CONTINUED)
SALES CHARGE: 0.40% OF ACCOUNT VALUE PER POLICY YEAR DURING THE FIRST 10 POLICY
YEARS.
FIXED OPTION INTEREST RATE MINIMUM: 3.0% PER POLICY YEAR, COMPOUNDED YEARLY
NET AMOUNT AT RISK DISCOUNT RATE: 4.0% PER YEAR
POLICY LOANS:
POLICY LOAN INTEREST RATE: 6.0% PER POLICY YEAR, COMPOUNDED YEARLY IN
ARREARS
INTEREST RATE CREDITED TO COLLATERAL FOR POLICY LOANS: NOT LESS THAN 5.5%
PER POLICY YEAR, COMPOUNDED YEARLY
MAXIMUM LOAN VALUE PERCENTAGE: 90.0%
MINIMUM LOAN AMOUNT: $1,000.00
VARIABLE SEPARATE ACCOUNT:
AMERICAN SKANDIA LIFE ASSURANCE CORPORATION SEPARATE ACCOUNT F
OFFICE: [AMERICAN SKANDIA LIFE ASSURANCE CORPORATION
P.O. BOX 290698
WETHERSFIELD, CONNECTICUT 06129-0698
Telephone: 1-888-554-3348]
FPVLI(8/98)-06
SCHEDULE (CONTINUED)
TABLE OF GUARANTEED MONTHLY COST OF INSURANCE CHARGES
PER $1,000 NET AMOUNT AT RISK
This table shows the guaranteed monthly cost of insurance charges applicable to
this Policy. Rates actually used cannot exceed these rates. These rates are per
$1,000 Net Amount at Risk. They are based on the Age of the Insured, and on the
gender and risk class shown in the Schedule. The rates shown below are for the
Policy Date and subsequent Policy Anniversaries. The rates are level within each
Policy Year. No cost of insurance charge is assessed on or after the Premium Cut
Off Age.
We may change the cost of insurance rates actually used, but they can never
exceed the rates shown in this table. Any change in the cost of insurance rates
will apply uniformly to all members of the same class.
[
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
Policy Year Rate Policy Year Rate Policy Year Rate
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
1 .14428 36 3.08860
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ -----------------
2 .15179 37 3.42980
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
3 .16181 38 3.82530
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
4 .17266 39 4.27493
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
5 .18435 40 4.77159
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
6 .19855 41 5.30544
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
7 .21358 42 5.87269
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
8 .22946 43 6.46947
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
9 .24700 44 7.09996
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
10 .26622 45 7.78482
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
11 .28796 46 8.54724
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
12 .31137 47 9.40951
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
13 .33646 48 10.39222
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
14 .36406 49 11.49455
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
15 .39419 50 12.69876
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
16 .42851 51 13.98063
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
17 .46787 52 15.32651
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
18 .51311 53 16.71801
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
19 .56509 54 18.15089
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
20 .62296 55 19.64755
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
21 .68759 56 21.23308
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
22 .75815 57 22.94951
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
23 .83297 58 24.87000
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
24 .91627 59 27.20133
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
25 1.00976 60 30.42888
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
26 1.11430 61 35.49222
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
27 1.23080 62 44.51508
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
28 1.36520 63 62.83141
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
29 1.51760 64 107.67365
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
30 1.68724 65 1000.00000
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
31 1.87335
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
32 2.07519
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
33 2.29201
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
34 2.52819
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
35 2.79077
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
]
See the Charges Section of this Policy for a description of the calculation
of monthly cost of insurance.
FPVLI(8/98)-07
SCHEDULE (CONTINUED)
TABLE OF INSURANCE FACTORS
The following Insurance Factors are based on the Age of the Insured and on the
gender and risk class of the Insured as shown in the Schedule. The Insurance
Factors shown below are for the Policy Date and subsequent Policy Anniversaries.
These Factors change each month and are determined from the values shown below.
[
----------------- ----------------- ---------------- ----------------- ----------------- ----------------
Policy Year Insurance Factor Policy Year Insurance Factor Policy Year Insurance
Factor
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
1 4.22534993 36 1.49969011
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ -----------------
2 4.08504317 37 1.46801616
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
3 3.94952591 38 1.43803091
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
4 3.81890134 39 1.40980091
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
5 3.69300143 40 1.38334411
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
6 3.57165473 41 1.35859892
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
7 3.45486271 42 1.33542913
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
8 3.34242165 43 1.31367439
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
9 3.23413313 44 1.29315435
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
10 3.12987326 45 1.27370715
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
11 3.02950710 46 1.25525118
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
12 2.93295027 47 1.23777421
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
13 2.84004437 48 1.22131344
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
14 2.75062932 49 1.20594036
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
15 2.66459086 50 1.19169255
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
16 2.58180443 51 1.17853769
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
17 2.50221597 52 1.16637180
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
18 2.42578270 53 1.15505458
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
19 2.35246662 54 1.14439615
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
20 2.28222980 55 1.13417786
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
21 2.21497502 56 1.12418512
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
22 2.15061366 57 1.11418084
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
23 2.08901423 58 1.10389096
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
24 2.02999311 59 1.09298609
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
25 1.97347261 60 1.08115594
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
26 1.91939308 61 1.06823488
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
27 1.86768854 62 1.05422768
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
28 1.81828662 63 1.03933992
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
29 1.77119553 64 1.02362116
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
30 1.72638418 65 1.00327374
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
31 1.68377853
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
32 1.64327249
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
33 1.60473626
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
34 1.56802269
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
35 1.53302514
------------------ ----------------- ---------------- ----------------- ----------------- ----------------
]
FPVLI(8/98)-08
DEFINITIONS
The following are key terms used in this Policy. Other terms are defined as they
occur.
Account Value: The value of each allocation to any Sub-account and any Fixed
Allocation, plus any earnings and less any losses, distributions and charges
thereon, plus the value of amounts transferred to the Loan Account, plus any
earnings less any distributions and charges thereon, all before assessment of
any contingent deferred sales charge or any Debt. Account Value is determined
separately for each Sub-account and each Fixed Allocation, as well as for any
amounts in the Loan Account, and then totaled to determine Account Value for the
entire Policy.
Age: Initially, and for the first Policy Year, the Insured's age last birthday
on the Policy Date. In each following Policy Year, it is the age last birthday
of the Insured as of the preceding Policy Anniversary.
Anniversary Value: The Account Value on any previous Policy Anniversary less any
partial withdrawals since that Anniversary.
Application: The form or combination of forms we require you to submit when you
are applying for issue or reinstatement of this Policy, or for any change in the
Specified Amount or any form or combination of forms we may require when adding
an optional benefit.
Beneficiary: The person or entity you designate on whose behalf any Death
Proceeds are payable. Unless otherwise specified, Beneficiary refers to all
persons or entities so designated.
Cash Value: The Account Value less any contingent deferred sales charge and less
any unpaid charges and Debt.
Cash Value Credit: The amount we credit to your Account Value if your Cash Value
on a Policy Anniversary equals or exceeds the Cash Value trigger as shown in the
Schedule.
Code: The Internal Revenue Code of 1986, as amended from time to time, and the
regulations thereunder.
Death Benefit: The amount payable as a result of the Insured's death, before any
applicable reduction for any Debt and for any unpaid charges, and before the
addition of any interest due pursuant to law.
Death Proceeds: The amount payable as a result of the Insured's death, after any
applicable reduction for Debt and for any unpaid charges, and after the addition
of any interest due pursuant to law.
Debt: The total of all Policy loans and accrued loan interest.
Fixed Allocation: An allocation of Account Value that is to be credited a fixed
rate of interest.
Guaranteed Minimum Death Benefit: The minimum amount we guarantee is due as a
result of the Insured's death, prior to any reduction for Debt.
In Writing: In a written form, in a manner we accept, that is satisfactory to us
and filed at our Office. We retain the right to specifically agree in advance to
accept communication regarding a specific matter by telephone or by some other
form of electronic transmission, in a manner we prescribe.
Initial Premium: Premium paid on or before the Issue Date. The Initial Premium
is shown in the Schedule.
Insurance Factor: The amount by which the Account Value is multiplied to
determine the Minimum Required Death Benefit.
FPVLI(8/98)-09
Insured: The person named in the Schedule upon whose life coverage is issued and
upon whose death the Death Proceeds are payable.
Issue Date: The date we issue this Policy. The Issue Date is shown in the
Schedule.
Loan Account: That portion of the Account Value that is used as collateral for a
loan from us.
Minimum Required Death Benefit: The minimum amount due as a result of the
Insured's death pursuant to the applicable test we apply in accordance with the
Code, prior to any reduction for Debt.
Monthly Processing Date: The Valuation Day each month we deduct charges taken
from the Account Value. The first Monthly Processing Date is the Policy Date.
After that, the Monthly Processing Dates generally occur on the same day of the
month as the Policy Date. In any month that date is not a Valuation Day, the
Monthly Processing Date that month will be the next following Valuation Day.
Net Amount at Risk: As of the date for which this amount is calculated, the
Death Benefit then in effect, (discounted for one month at the Net Amount at
Risk Discount Rate shown in the Schedule) minus the then current Account Value.
Office: Our administrative office. The location is shown in the Schedule where
all requests regarding this Policy are to be sent.
Owner: The person(s) or entity(ies) who may exercise the ownership rights
provided by this Policy. The Owner is shown in the Schedule unless later
changed.
Policy: The insurance contract we issue as evidence of our commitment to pay the
Death Proceeds upon the death of the Insured.
Policy Anniversary: The yearly anniversary of the Policy Date.
Policy Date: The date as of which coverage under this Policy begins.
Policy Years: The continuous 12-month periods that begin on the Policy Date and
each Policy Anniversary thereafter.
Portfolio: An underlying mutual fund or a portfolio of an underlying mutual
fund.
Premium: The cash consideration you give to us for the rights, privileges and
benefits provided by this Policy. This includes the Initial Premium and any
additional consideration we agree to accept.
Premium Cut-off Age: The age at which we will no longer accept Premium payments.
The Premium Cut-off Age is shown in the Schedule.
Reallocation Date: The date on which we reallocate Account Value from the
Automatic Sub-account to the Sub-accounts you select in the proportions you have
indicated in your most recent allocation instructions to us.
Separate Account: The variable separate account, shown in the Schedule, to which
we allocate assets in relation to our obligations for benefits based on the
variable investment options.
Specified Amount: An amount, shown in the Schedule, that is one of the measures
used to calculate the Death Benefit under this Policy.
Sub-account: A division of the Separate Account shown in the Schedule.
FPVLI(8/98)-10
Target Date: The last Policy Anniversary, as shown in the Schedule, that the
Guaranteed Minimum Death Benefit may increase.
Tier 1 Premiums: Tier 1 Premiums are subject to a contingent deferred sales
charge upon surrender.
Tier 2 Premiums: Tier 2 Premiums are not subject to a contingent deferred sales
charge at any time.
Unit: A measure used to calculate Account Value in a Sub-account.
Unit Price: The Unit Price is used for calculating: (a) the number of Units
allocated to a Sub-account; and (b) the value of transactions into or out of a
Sub-account or benefits based on Account Value in a Sub-account. Each
Sub-account has its own Unit Price, which will vary with each Valuation Period
reflecting the investment experience of that Sub-account.
Valuation Day/Date: Every day the New York Stock Exchange is open for trading or
any other day that the Securities and Exchange Commission requires mutual funds
or unit investment trusts to be valued.
Valuation Period: The period of time between the close of business of the New
York Stock Exchange on successive Valuation Days.
"we", "us", "our" means American Skandia Life Assurance Corporation.
"you" or "your" means the Owner(s) shown in the Schedule.
DEATH BENEFIT
Death Benefit: If the Insured is younger than the Premium Cut-off Age, the Death
Benefit under this Policy, as of the date Death Proceeds are payable, is equal
to the greatest of the Basic Death Benefit, the Minimum Required Death Benefit
and the Guaranteed Minimum Death Benefit. On or after the Policy Anniversary
when the Insured attains the Premium Cut-off Age, the Death Benefit is the
Account Value as of the date Death Proceeds are payable.
Basic Death Benefit: If the Death Benefit option shown in the Schedule is the
level Death Benefit option, the Basic Death Benefit is the Specified Amount. If
the Death Benefit option is the variable Death Benefit option, the Basic Death
Benefit is the Specified Amount plus the Account Value.
Minimum Required Death Benefit: The Minimum Required Death Benefit is determined
by multiplying the Account Value as of the date the Death Proceeds become
payable by the applicable Insurance Factor shown in the Schedule.
Guaranteed Minimum Death Benefit: The Guaranteed Minimum Death Benefit is
determined as follows:
a) On the Policy Date: The Guaranteed Minimum Death Benefit equals the Initial
Premium.
b) After the Policy Date and before the first Policy Anniversary: The
Guaranteed Minimum Death Benefit equals total Premiums paid less any
partial withdrawals.
c) After the first Policy Anniversary but before the Target Date shown in the
Schedule: The Guaranteed Minimum Death Benefit is the greater of (1) and
(2), where:
(1) is total Premiums paid less any partial withdrawals; and (2) is the
highest Anniversary Value.
FPVLI(8/98)-11
d) On or after the Target Date shown in the Schedule: The Guaranteed
Minimum Death Benefit is the greater of (1) and (2), where:
(1) is total Premiums paid less any partial withdrawals; and
(2) is the highest Anniversary Value as of the Target Date, less any
partial withdrawals since the Target Date.
Changes after Issue: After the first Policy Year, and while the Insured is
alive, you may request In Writing a change, subject to our approval, in the
Death Benefit option and/or Specified Amount. The effective date of any change
in the Death Benefit option and/or Specified Amount is the Monthly Processing
Date coinciding with or next following the date we approve your request In
Writing. Any change in the Death Benefit option and/or Specified Amount is
subject to the following conditions:
a) A change in Death Benefit option or an increase in Specified Amount is
subject to evidence of insurability satisfactory to us and is not
allowed if the Insured does not meet our then current underwriting
rules or such a change is not permitted pursuant to any applicable law
or regulation.
b) If the Death Benefit option is changed, the Specified Amount will be
recalculated, if necessary, so that the Death Benefit immediately after
the change equals the Death Benefit immediately before the change.
c) One change in Death Benefit option is allowed each Policy Year.
d) We will not approve a request to reduce the Specified Amount during the
first seven Policy Years or thereafter within five years of an increase
to the Specified Amount.
e) The minimum amount by which you may change the Specified Amount is
shown in the Schedule. f) A change in Specified Amount or Death
Benefit option is not allowed if it reduces the Specified Amount below
the minimum Specified Amount shown in the Schedule. g) On any change
in Specified Amount, including one resulting from a Death Benefit
option change, the Maximum Annual Assessable Premium will be increased
or decreased by the same percentage as the Specified Amount. This
change in the Maximum Annual Assessable Premium may affect the
calculation of future contingent deferred sales charges
Death Proceeds: The Death Proceeds become payable to the Beneficiary as of our
receipt, at our Office, of all of the following: (1) due proof satisfactory to
us that the Insured died while this Policy was in force; (2) all representations
we require or which are mandated by applicable law or regulation in relation to
the death claim and the payment of Death Proceeds; and (3) any applicable
election of the mode of payment, if not previously elected by you. The Death
Proceeds payable are equal to:
a) the Death Benefit as of the date we receive all items listed above;
plus
b) any Death Benefit provided by additional benefit riders under this
Policy; minus
c) any Debt; minus d) any due and unpaid monthly deductions, including
those charges that would be required to keep this Policy from lapsing,
if the Insured dies during any grace period; plus, e) any interest
required by law.
The Death Proceeds may be paid in a lump sum or applied under one of the payment
options described in this Policy. They may also be applied under any other
payment option selected by the Beneficiary and agreed to by us, if not elected
by you before we receive due proof of the Insured's death.
Due Proof of Death: Due proof of death consists of any of the following: (1) a
certified copy of a death certificate; (2) a certified copy of a decree of a
court of competent jurisdiction as to the finding of death; and (3) any other
proof satisfactory to us.
FPVLI(8/98)-12
ACCELERATED DEATH BENEFIT
General: The accelerated Death Benefit is pre-payment to you, not to the Insured
or to a Beneficiary, of a portion of the Death Proceeds. Only one such payment
is permitted. Payment may be made as described in the Payment Options section of
this Policy.
Amount of the Accelerated Death Benefit: The amount of the accelerated Death
Benefit payment is subject to a maximum, but you may request that less than the
maximum be paid. The maximum amount payable before any reductions is the lesser
of $250,000 and 50% of the Death Benefit as of the Valuation Date we approve
such payment. The actual amount payable will be reduced by the following:
a) 12 months of interest on that amount. The applicable interest rate equals
the loan interest rate shown in the Schedule; and
b) A pro-rata portion of any outstanding Debt, based on the ratio by which the
Death Benefit is reduced as a result of the accelerated Death Benefit
payment.
Requirements for Payment of the Accelerated Death Benefit: The accelerated Death
Benefit is payable only when all our requirements are met. The requirements are:
a) You and any person or entity with a vested interest in this Policy,
including, but not limited to, an irrevocable Beneficiary or an assignee,
must make the request that we make such a payment. We will not agree to
such a payment based on a request from the Insured unless you are the
Insured.
b) Such a request must be In Writing.
c) We receive In Writing proof satisfactory to us that the Insured became
terminally ill, as defined below, at least 30 days after the Issue Date or
became terminally ill as a result of an accident that occurred after the
Issue Date. d) We receive all information required to meet our obligations
for tax or other regulatory reporting.
Terminally ill, for purposes of this provision, means a condition diagnosed by a
physician, as defined below, which is expected to result in death within 12
months for 80% of the diagnosed cases. Physician, for purposes of this
provision, is a person other than you, the Insured, or a member of either your
or the Insured's family, who meets the definition of physician as defined in the
Code. We may change the definition of terminally ill or physician to the extent
needed to make any payment pursuant to this provision exempt from federal or
state income taxation.
Consequences to the Policy of an Accelerated Death Benefit Payment: An
accelerated Death Benefit payment reduces the Specified Amount, Account Value,
Guaranteed Minimum Death Benefit, Minimum Required Death Benefit, and any Debt
in the same ratio as the Death Benefit is reduced as of the Valuation Period
such a payment is made.
Please consult your tax advisor regarding any tax issues with respect to
exercising any provisions under this Policy. This is not a Long Term Care
policy.
FPVLI(8/98)-13
INVESTMENT OF ACCOUNT VALUE
General: We offer a range of variable investment options and a Fixed Allocation
as ways to invest your Account Value. You may maintain Account Value in multiple
investment options, subject to the limits set forth in the Allocation Rules
section of this Policy. You may transfer Account Value between investment
options, subject to the requirements set forth in the Transfers section of this
Policy. Transfers may be subject to a fee, as shown in the Schedule.
Variable Investment Options: We offer a number of Sub-accounts as variable
investment options. These are all Sub-accounts of the Separate Account shown in
the Schedule.
The investment policy of the Separate Account will not be changed without the
approval of the Insurance Commissioner of the State of Connecticut. Any such
approval will be on file with the Commissioner.
Fixed Allocation: We credit interest to Fixed Allocations. From time to time we
declare interest rates applicable to new Fixed Allocations. If you make a Fixed
Allocation, we credit the rate then in effect to that Fixed Allocation until the
next Policy Anniversary. Once that Policy Anniversary is reached, we credit, for
the next Policy Year, the then current rate applicable to new Fixed Allocations.
This applies to all your Fixed Allocations then in effect. During each
subsequent Policy Year, the rate we credit for each Policy Year is the one in
effect for new Fixed Allocations at the beginning of the Policy Year. The
interest rates we credit are determined by us and are subject to a minimum. The
minimum is shown in the Schedule.
You may allocate part or all of the Premium to the Fixed Allocation. You may
transfer all or part of the Account Value attributable to the variable
investment options into the Fixed Allocation. Transfers from the Fixed
Allocations are subject to the limitations discussed in the Transfers section of
this policy.
OPERATIONS OF THE SEPARATE ACCOUNT
General: The assets supporting our obligations under this Policy may be held in
various accounts, depending on the obligation being supported. Assets supporting
obligations based on the Account Value allocated to the variable investment
options are maintained in the Separate Account shown in the Schedule. This
Separate Account consists of multiple Sub-accounts. This Separate Account was
established by us pursuant to Connecticut law. This Separate Account also holds
assets of other policies issued by us with values and benefits that vary
according to the investment performance of this Separate Account. The assets of
the Separate Account will be valued at least monthly.
We are the legal owner of assets in the Separate Account. Income, gains and
losses, whether or not realized, from assets allocated to the Separate Account,
are credited to, or charged against, the Separate Account in accordance with the
terms of the policies supported by such assets without regard to our other
income, gains or losses or to the income, gains or losses in any other of our
separate accounts. We will maintain assets in the Separate Account with a total
market value at least equal to the reserve and other liabilities we must
maintain in relation to the policy obligations supported by such assets. These
assets may only be charged with liabilities which arise from such policies.
Values and benefits based on allocations to the Sub-accounts will vary with the
investment performance of the Portfolios, as applicable. We reserve the right to
transfer assets of the Separate Account, which we determine to be associated
with the class of policies to which this Policy belongs, to another Separate
Account. If this type of transfer is made, the term "Separate Account" as used
in this Policy will mean the Separate Account to which the assets were
transferred.
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The assets of the Separate Account will be available to cover the liabilities of
our general account only to the extent that the assets of the Separate Account
exceed the liabilities of the Separate Account arising under the policies
supported by the Separate Account.
The Separate Account is registered with the Securities and Exchange Commission
(the "SEC") under the Investment Company Act of 1940 as a unit investment trust,
which is a type of investment company. This does not involve any supervision by
the SEC of the investment policies, management or practices of the Separate
Account or of us.
GENERAL ACCOUNT
We maintain assets in our general account to support our obligations: (1) for
that portion of the Account Value allocated to any Fixed Allocation; (2) equal
to the Account Value in the Loan Account; (3) for that portion of the Death
Proceeds greater than the Account Value; (4) for any settlement option; and (5)
for any other obligation we may have in relation to a Policy for which assets
are not maintained in the Separate Account.
CHARGES
General: There are certain charges assessable against your Policy. There are
also certain charges that are assessed against the Sub-accounts of the Separate
Account, as noted below.
The charges which are or may be assessed against your Policy are: (1) the cost
of insurance charge; (2) the sales charge; (3) the tax charge; (4) the
contingent deferred sales charge; (5) any fee for any partial withdrawal; (6)
any transfer fee; and (7) any charge for optional benefits.
The charges assessed against the Sub-accounts of the Separate Account are: (1)
the administration charge; and (2) the mortality and expense risk charge. A
charge for taxes also may be assessed against the Sub-accounts.
Cost of Insurance Charge: The cost of insurance charge is deducted as of each
Monthly Processing Date. It is deducted on a pro-rata basis from your variable
investment options and any Fixed Allocations. It is determined by applying a
monthly cost of insurance rate to the Net Amount at Risk as of the Monthly
Processing Date and adding a cost of insurance fee. The monthly cost of
insurance rate depends on the Age, gender and risk class of the Insured as show
in the Schedule and on the Insured's underwriting method. Subject to any
requirement for prior approval of the applicable jurisdiction, we have the right
to change the current cost of insurance rates. However, the cost of insurance
will not exceed the guaranteed monthly cost of insurance charge, shown in the
Schedule, multiplied by the Net Amount at Risk.
Any change in the cost of insurance rates or cost of insurance fee will be based
on changes in our future expectations as to mortality, expenses, persistency,
investment earnings and any taxes. Changes in cost of insurance rates or fee
will not be made because of a deterioration in the Insured's health, nor will
they be made to recoup any prior losses. The changes will be determined only
prospectively and will comply with the procedures and standards on file with the
insurance department for the jurisdiction where this Policy is delivered. Any
change will apply uniformly to all members of the same class.
Sales Charge: The sales charge is deducted on each Monthly Processing Date. It
is deducted on a pro-rata basis from your variable investment options and any
Fixed Allocations. It is a percentage of your Account Value on the Monthly
Processing Date. The equivalent annual percentage and the period during which
the sales charge applies are shown in the Schedule.
Tax Charge: The tax charge is deducted from each Premium paid. The percentage
rate applicable as of the Policy Date is shown in the Schedule. We also assess
the charge as a percentage of the amount of any loans established as the result
of an exchange. The charge is deducted from that Premium amount received as the
proceeds of such exchange.
FPVLI(8/98)-15
Contingent Deferred Sales Charge: The contingent deferred sales charge may be
deducted from amounts receivable upon surrender or partial withdrawal. It is a
percentage of Tier 1 Premiums paid prior to surrender. The applicable percentage
varies by Policy Year, as shown in the Schedule. No contingent deferred sales
charge is applied to any Tier 2 Premiums.
Partial Withdrawal Fee: We charge a fee to process a partial withdrawal. The fee
is deducted from the fixed and variable allocations in the same proportions as
the partial withdrawal, and is shown in the Schedule. This fee applies to all
partial withdrawals.
Transfer Fee: The transfer fee may be deducted at the time of a transfer. This
includes transfers into the Fixed Allocation and any transfers from a Fixed
Allocation. For this purpose, all transfers occurring during the same Valuation
Period are considered one transfer. We deduct the charge from the amounts
transferred pro-rata in the same ratio as Account Value is being transferred.
The maximum amount of this charge and the circumstances under which it applies
are shown in the Schedule. The following transfers are not taken into
consideration in determining whether any transfer fee applies: (a) a transfer
from a Fixed Allocation on a Policy Anniversary; (b) transfers to or from the
Loan Account in relation to loans and loan repayments.
Administration Charge: We charge for administering each Sub-account. We assess
this charge each day at the daily equivalent of the annual rate shown in the
Schedule against the assets in each Sub-account. We deduct the charge each
Valuation Period.
Mortality and Expense Risk Charges: We charge for bearing certain mortality and
expense risks related to the investment performance of the Sub-accounts. We
assess this charge each day at the daily equivalent of the annual rate shown in
the Schedule against the assets in each Sub-account. We deduct the charge each
Valuation Period.
PREMIUM PAYMENT
Premium: The amount of Initial Premium is shown in the Schedule. Additional
Premiums may be paid while this Policy is in force and before the Insured
attains the Premium Cut-off Age, subject to the limitations described below.
Allocation of Premium, after reduction for any applicable charges shown in the
Schedule, is subject to our allocation rules (see "Allocation Rules").
Additional Premiums: Any Premium payment that would increase the Net Amount at
Risk under this Policy is subject to evidence of insurability satisfactory to
us, unless all of the following conditions are met:
1) The Policy is within the Tier 1 Premium Guaranteed Acceptance Period shown in
the Schedule; 2) No Tier 2 Premium has been paid; and, 3) No portion of such
Premium payment would be classified as Tier 2 Premium.
We reserve the right to reject any portion of a Premium payment that would
change the tax status of this Policy under the Code, without your specific
acknowledgement and authorization in Writing.
Tier 1 and Tier 2 Premiums: Tier 1 Premiums are used to calculate the amount of
contingent deferred sales charge that applies on surrender of this Policy. Tier
1 Premiums are subject to a cumulative limit that varies by Policy Year. The
limit is equal to (1) multiplied by (2), where:
(1) Is the Maximum Annual Tier 1 Premium shown in the Schedule, and; (2) Is the
Policy Year of the payment.
The Tier 1 portion of any Premium payment is that portion, if any, which will
not cause total Tier 1 Premiums to exceed this limit. The Tier 2 portion of any
Premium payment is any balance of the payment.
FPVLI(8/98)-16
ALLOCATION RULES
You may allocate your Account Value among the investment options we make
available. We may limit the number of investment options to which Account Value
may be allocated at one time. This limit will not be less than 10 investment
options.
Until the Reallocation Date shown in the Schedule, that portion of your Initial
Premium you designated to be allocated to variable investment options will be
allocated to the Automatic Sub-account, after deduction of any applicable tax
charge. As of the Reallocation Date, the Account Value of the Automatic
Sub-account will be allocated per your most recent instruction to us. If the
Reallocation Date is not a Valuation Day, the reallocation will occur on the
Valuation Day immediately following. Any portion of the Premium you designated
to be allocated to the Fixed Allocation will be allocated directly to the Fixed
Allocation, after deduction of any applicable tax charge, and will not be
allocated to the Automatic Sub-account.
Withdrawals of any type are taken pro-rata from the investment options based on
the then current Account Values in such investment options unless we receive
other instructions from you prior to such withdrawal. If there are multiple
Fixed Allocations as of the date of such partial withdrawal, amounts are taken
from the Fixed Allocations on a last in, first out basis.
Deductions for charges and fees are as noted above in the section entitled
"Charges." If there are multiple Fixed Allocations as of the applicable Monthly
Processing Date, amounts deducted from the investment options are deducted from
the Fixed Allocations on a last in, first out basis.
Should you request a transaction that would leave less than any minimum amount
we then require in an investment option, we reserve the right, to the extent
permitted by law, to add the balance of your Account Value in the applicable
Sub-account or Fixed Allocation to the transaction and close out your balance in
that investment option.
ACCOUNT VALUE AND CASH VALUE
General: Your Policy has an Account Value and a Cash Value. Your Account Value
is the sum of values in: (1) any Sub-account; (2) each Fixed Allocation, if any;
and (3) the Loan Account, if any. The Cash Value is the Account Value less any
Debt and less any applicable contingent deferred sales charge.
Account Value in the Sub-accounts: We determine your Account Value separately
for each Sub-account. To determine the Account Value in each Sub-account, we
multiply the Unit Price as of the Valuation Period for which the calculation is
being made by the number of Units attributable to your Account Value in that
Sub-account as of that Valuation Period.
Units: The number of Units attributable to this Policy in a Sub-account is the
number of Units purchased for you as a result of allocations to that Sub-account
less the number of Units transferred or withdrawn. We determine the number of
Units involved in any transaction specified in dollars by dividing the dollar
value of the transaction by the Unit Price of the affected Sub-account as of the
Valuation Period applicable to such transaction
Unit Price: For each Sub-account the initial Unit Price was $10.00. The Unit
Price for each subsequent period is the net investment factor for that period,
multiplied by the Unit Price for the immediately preceding Valuation Period. The
Unit Price for a Valuation Period applies to each day in the period.
FPVLI(8/98)-17
Net Investment Factor: Each Sub-account has a net investment factor. The net
investment factor is an index that measures the investment performance of and
charges assessed against a Sub-account from one Valuation Period to the next.
The net investment factor for a Valuation Period is (a) divided by (b), less
(c); where:
(a) is the net result of :
1) the net asset value per share of the Portfolio shares at the end
of the current Valuation Period plus the per share amount of any
dividend or capital gain distribution declared and unpaid
(accrued) by the Portfolio; plus or minus
2) any per share charge or credit during the Valuation Period as a
provision for taxes attributable to the operation or maintenance
of the Sub-account.
(b) is the net result of:
1) the net asset value per share of the Portfolio shares at the end
of the preceding Valuation Period plus the per share amount of any
dividend or capital gain distribution declared and unpaid
(accrued) by the Portfolio; plus or minus
2) any per share charge or credit during the preceding Valuation
Period as a provision for taxes attributable to the operation or
maintenance of the Sub-account;
(c) is the mortality and expense risk charge and the administration charge.
We value the assets in the Sub-accounts at their fair market value in accordance
with accepted accounting practices and applicable laws and regulations. The net
investment factor may be greater than, equal to, or less than one.
Account Value For Fixed Allocations: We determine the Account Value separately
for each Fixed Allocation, other than a Fixed Allocation made on a Policy
Anniversary, from the date of such Fixed Allocation to the subsequent Policy
Anniversary. All amounts to be allocated to the fixed investment option as of
the same day are treated as one Fixed Allocation, irrespective of the source of
the Account Value being allocated to the fixed option. As of each Policy
Anniversary, all prior Fixed Allocations are combined and treated as a single
new Fixed Allocation.
The Account Value in each Fixed Allocation equals:
(a) The Account Value initially allocated to a Fixed Allocation; less (b)
Charges and fees deducted from that Fixed Allocation; less (c) Transfers from
that Fixed Allocation; less (d) Distributions from that Fixed Allocation, for
any reason; plus (e) Interest credited to that Fixed Allocation.
Interest is credited daily on each Fixed Allocation. On any day, interest is
credited to the Account Value in a Fixed Allocation after any deductions made as
of that day and after any transfers or distributions from that Fixed Allocation
as of that day.
Account Value in the Loan Account: The Account Value in the Loan Account equals:
(a) The amounts transferred to the Loan Account; less
(b) Reductions in the Loan Account due to loan repayments or any other
reason; plus
(c) Interest credited to the Loan Account.
Interest is credited daily to the Account Value in the Loan Account after any
deductions and after any transfers as of that day. The Policy Loan Interest Rate
is shown in the Schedule.
FPVLI(8/98)-18
When you take a policy loan, we transfer Account Value equal to the amount of
the policy loan from the investment options to the Loan Account. Unless you give
us different instructions before the transfer, we transfer Account Value from
the investment options pro-rata based on the Account Value in the investment
options as of the Valuation Day of such transfer.
Account Value maintained in the Loan Account remains in the Loan Account until
the loan is repaid. Amounts in the Loan Account earn interest from the Valuation
Day of the transfer at the annual interest rate shown in the Schedule.
Monthly Deduction: Account Value is reduced by monthly deductions. On each
Monthly Processing Date, until the Insured attains the Premium Cut-off Age, we
will take the monthly deduction. The monthly deduction consists of the then
applicable amounts for the following charges and fees:
(a) the cost of insurance charge;
(b) any applicable sales charge;
(c) any applicable charge for benefits provided by rider.
CASH VALUE CREDIT
We add a Cash Value Credit to your Account Value on each Policy Anniversary that
the Cash Value of your Policy equals or exceeds the Cash Value trigger shown in
the Schedule. Eligibility for the Cash Value Credit at one Policy Anniversary
does not mean you will qualify on any other Policy Anniversary.
The Cash Value Credit is equal to (a) multiplied by (b); where (a) is the Cash
Value on the applicable Policy Anniversary; and (b) is the Cash Value Credit
percentage shown in the Schedule.
The Cash Value Credit, if any, due on the applicable Policy Anniversary is
applied pro-rata based on the Account Value in the investment options.
TRANSFERS
General: You may transfer Account Value between investment options, subject to
the allocation rules herein and any applicable transfer fee. The amount of such
fee and when it applies are shown in the Schedule. Your transfer request must be
In Writing unless we receive a prior written authorization from you permitting
transfers based on instructions we receive over the phone or through electronic
means. The minimum amount required to be in any investment option after a
transfer is shown in the Schedule. No transfers are permitted during the grace
period.
Where permitted by law, we may accept your authorization of a third party to
transfer Account Values on your behalf. We may suspend or cancel such acceptance
at any time. We give you prior notification of any such suspension or
cancellation. We may restrict the investment options that will be available to
you for transfers during any period in which you authorize such third party to
act on your behalf. We give the third party you authorize prior notification of
any such restrictions. However, we will not enforce such a restriction if we are
provided evidence satisfactory to us that: (a) such third party has been
appointed by a court of competent jurisdiction to act on your behalf; or (b)
such third party has been appointed by you to act on your behalf for all your
financial affairs.
We reserve the right to limit the number of transfers in any Policy Year for all
Owners. We also reserve the right to limit the number of transfers in any Policy
Year or to refuse any transfer request for an Owner or certain Owners if we
believe that: (a) excessive trading by such Owner or Owners or a specific
transfer request or group of transfer requests may have a detrimental effect on
Unit Values or the share prices of the Portfolios; or (b) we are informed by one
or more of the Portfolios that the purchase or redemption of
FPVLI(8/98)-19
shares is to be restricted because of excessive trading or a specific transfer
or group of transfers is deemed to have a detrimental effect on share prices of
affected Portfolios, or (c) we believe there may be adverse consequences to
other Owners as a result of excess transfers.
We allow at least twelve transfers in each Policy Year. Unless we limit the
number of transfers in any Policy Year, there is no limit on the number of
transfers that only involve variable investment options, or the number of
transfers from variable investment options to make Fixed Allocations. However,
we limit each transfer from Fixed Allocations that are to be effective on any
day other than a Policy Anniversary to the greater of 25% of the Account Value
in your Fixed Allocations or $1,000. If you make such a transfer from your Fixed
Allocations, you cannot make another such transfer until either 90 days have
passed or the next Policy Anniversary, if earlier.
SURRENDER AND PARTIAL WITHDRAWAL
Surrender: You may surrender your Policy for its Cash Value at any time while
the Insured is alive. You must send your Policy and surrender request In Writing
to our Office.
Partial Withdrawals: You may withdraw an amount equal to Tier 2 Premiums paid,
reduced by any Tier 2 Premiums previously withdrawn, after the Right to Cancel
period has expired. You may withdraw other Policy values at any time the
contingent deferred sales charge is zero. The minimum partial withdrawal amount
is shown in the Schedule. The Cash Value that must remain in the Policy as of
the Valuation Day of a partial withdrawal is also shown in the Schedule. If the
amount of the partial withdrawal request exceeds the maximum amount available,
we reserve the right to treat your request as one for a full surrender. We
charge a fee, shown in the Schedule, to process any partial withdrawal.
Effect of a Partial Withdrawal: Each partial withdrawal reduces the Account
Value, Cash Value and Guaranteed Minimum Death Benefit by the amount of
withdrawal plus the amount of the fee. As a result, the Minimum Required Death
Benefit is reduced as of the Valuation Day of the partial withdrawal. If the
Death Benefit option is the level Death Benefit option, the Specified Amount is
reduced by the lesser of:
1. The amount of the partial withdrawal, including the amount of the transaction
fee; and, 2. The amount such that the Specified Amount equals the higher of the
recalculated Minimum Required Death
Benefit and the recalculated Guaranteed Minimum Death Benefit.
An amount taken as a partial withdrawal cannot be repaid.
POLICY LOANS
General: You may borrow against your Policy. The Policy is the only collateral
we require for the loan. If you request a loan equal to the amount of loan in
effect under any policy exchanged for this Policy, such a loan takes effect as
of the Issue Date or, if later, the date we apply the surrender proceeds of such
exchanged policy as Premium. A loan may be taken, or an existing loan repaid, at
any time while the Insured is alive and this Policy is in force, except during
the period in which you have the Right to Cancel. The Debt resulting from a loan
affects the Death Proceeds, Cash Value and the maximum amount of accelerated
Death Benefit.
Maximum Loan Value: The maximum loan value is the maximum amount of Account
Value you may borrow. It is equal to the Account Value less the contingent
deferred sales charge, multiplied by the maximum loan value percentage shown in
the Schedule. The amount available for a loan at any time is equal to the then
maximum loan value minus any Debt. The minimum loan amount is shown in the
Schedule.
Loan Interest: Loan interest accrues daily at an effective annual interest rate
shown in the Schedule. It is payable on each Policy Anniversary. Interest not
paid when due will be added to the Debt and will be charged interest at the same
rate. If you do not pay the interest when due, we transfer Account Value from
the investment options to the Loan Account.
FPVLI(8/98)-20
This Account Value is taken pro-rata from the investment options based on the
Account Value in the investment options as of the Valuation Day of the transfer.
If there is inadequate Account Value in the investment options to make such a
transfer, we reserve the right to transfer the deficiency to the Loan Account as
of any subsequent Valuation Date such an amount equal to the deficiency is
available in the investment options.
Loan Repayment: Debt may be repaid in whole or in part at any time while the
Insured is living and this Policy is in force. If the Policy is reinstated, then
payment of Debt is required.
As of the Valuation Day of the repayment:
(a) we reduce the loan principal and outstanding loan interest
proportionately based on the ratio between loan principal and loan
interest as of that Valuation Day;
(b) we reduce the Account Value in the Loan Account by an amount equal to
the lesser of the amount of the loan repayment and the total Account
Value in the Loan Account as of that Valuation Day; and
(c) we allocate the reduction in the Loan Account to the investment options
pro-rata based on the Account Value in the investment options as of
that Valuation Day. Any amount then allocated to the Fixed Allocation
will be treated as a separate Fixed Allocation.
GUARANTEED CONTINUATION PROVISION
If the Cash Value on any Monthly Processing Date is less than the charges then
due, we will pay the net amount due, and this Policy will continue in force
through the tenth Policy Anniversary, provided that:
(a) this Policy has not reached its tenth Policy Anniversary; and,
(b) there is no Debt; and,
(c) total Premiums paid equal or exceed one-half the total Tier 1 Premiums
that could have been paid, pro-rated for the number of completed months
elapsed since the Policy Date.
GRACE PERIOD AND REINSTATEMENT
Grace Period: If the Guaranteed Continuation Provision is not in effect, we will
keep this Policy in force during a 61 day grace period that begins on the
Monthly Processing Date on which it is determined that the Cash Value is
insufficient to pay charges then due.
We will send you and any assignee of record a notice 61 days prior to lapse
indicating a recommended payment required to keep the Policy from lapsing. The
recommended payment equals the amount of any Debt plus an amount equal to three
months' charges based on: (a) the Net Amount at Risk as of the beginning of the
grace period; and (b) the guaranteed monthly cost of insurance rate as shown in
the Schedule for the Policy Year at the beginning of the grace period. The
Policy will remain in force during the grace period, and will lapse without
value at the end of the 61st day if the Cash Value is insufficient to pay
charges then due.
The Death Benefit payable during the grace period will equal the Death Benefit
in effect immediately prior to such grace period minus the lesser of three
months charges, as detailed above, and the charges due for the period between
the beginning of the grace period and the date we receive due proof of death.
Reinstatement: If the Policy lapses, we may reinstate the Policy at any time
within a five-year period after the end of the grace period provided we receive
the following:
(a) Written Application to reinstate;
(b) Evidence of insurability satisfactory to us;
(c) Payment of an amount equal to the Debt at the beginning of the grace
period preceding lapse plus an amount equal to three months' charges,
based on: (i) the Net Amount at Risk as of the
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beginning of the grace period preceding lapse; and (ii) the guaranteed
monthly cost of insurance rate per thousand as shown in the Schedule
for the Policy Year as of the date of reinstatement.
After any reinstatement, the period during which certain charges apply may be
extended. If the lapse occurred while the sales charge or contingent deferred
sales charge was in effect, or while charges for certain optional benefits were
in effect, application of these charges under the reinstated policy may be
extended by the period between the date of the lapse and the date of
reinstatement.
YOUR RIGHTS, OWNERSHIP, AND DESIGNATIONS
Ownership Rights and Beneficiary Designations: You may exercise the rights,
options and privileges granted in this Policy or permitted by us. Your rights
are subject to the rights of any assignee recorded by us and of any irrevocably
designated Beneficiary.
If more than one Owner is named, the Owners will own this Policy as joint
tenants with rights of survivorship unless otherwise stated. We require the
consent In Writing of all joint Owners for any transaction for which we require
the written consent of an Owner.
You may name a contingent Owner. You must do so In Writing. The contingent Owner
will become the Owner on your death. If there is more than one Owner, the
contingent Owner will become the Owner on the death of the last surviving Owner
unless otherwise stated In Writing. If you do not name a contingent Owner, the
estate of the last surviving Owner will own the Policy upon the last surviving
Owner's death.
Death Proceeds are payable to the Beneficiary. You may designate more than one
primary or contingent Beneficiary. If you make such a designation, the proceeds
are payable in equal shares to the survivors in the appropriate Beneficiary
class, unless you request otherwise In Writing.
If the primary Beneficiary dies before Death Proceeds become payable, the
proceeds will become payable to the contingent Beneficiary. If no Beneficiary is
alive when Death Proceeds become payable, or in the absence of any Beneficiary
designation, the proceeds will vest in you or your estate.
Changing Revocable Designations: Unless you indicated that a prior choice was
irrevocable or your Policy has been endorsed to limit certain changes, you may
request to change Owner and Beneficiary designations by sending a request In
Writing.
Common Disaster: If any Beneficiary dies with the Insured in a common disaster,
it must be proved to our satisfaction that the Insured died first. Unless
information provided and satisfactory to us indicates otherwise, the Policy is
treated as though the Beneficiary died first.
GENERAL PROVISIONS
Entire Contract: This Policy, any attached riders or endorsements, and the
attached copy of any Application constitutes the entire contract. All statements
made in any Application are deemed to be representations and not warranties.
Only our President, a Vice President or Secretary may change or waive any
provisions of this Policy. Any change or waiver must be In Writing. We are not
bound by any promises or representations made by or to any other person.
Misstatement of Age or Sex: If there has been a misstatement of the age or
gender of the Insured, we will recalculate all Policy values, including the
Death Benefit, based on the correct age and gender. As to payments under any
payment options: (a) any underpayments by us will be remedied on the next
payment following correction; and (b) any overpayments by us will be charged
against future amounts payable by us under this Policy.
FPVLI(8/98)-22
Incontestability: This Policy will be incontestable after it has been in force
during the Insured's lifetime for two years, or less if required by law, from
its Issue Date. Any increase in coverage under this Policy will be incontestable
after a period of two years, or less if required by law, from the effective date
of such increase. If the Policy is reinstated, the Policy will be incontestable
after it has been in force for a period of two years, or less if required by
law, from the date of the reinstatement. The contestable period for any
additional benefit provided by a rider attached to this Policy is stated in the
rider.
Suicide: If the Insured as shown in the Schedule dies by suicide, while sane or
insane, within two years from the Issue Date and while the Policy is in force,
the Policy will terminate. The Death Benefit will be limited to the greater of
(a) and (b) where: (a) is the Premium paid less any outstanding Debt and less
any partial withdrawals as of the date Death Proceeds would otherwise have
become payable; and (b) is the Cash Value as of the date Death Proceeds would
otherwise become payable.
Transfers, Assignments or Pledges: Generally, your rights in this Policy may be
transferred, assigned or pledged for loans at any time. You may transfer, assign
or pledge your rights to another person at any time, prior to the Insured's
death. You must request a transfer or provide us with a copy of the assignment
In Writing. A transfer or assignment is subject to our acceptance. We will not
be deemed to know of or be obligated under any assignment prior to our receipt
and acceptance thereof. We assume no responsibility for the validity or
sufficiency of any assignment. A transfer, assignment or pledge may have adverse
tax consequences for you.
Nonparticipation: The Policy does not share in our profits or surplus earnings.
Deferral of Transactions: We may defer any payment that is not distributed form
a variable investment option for a period not to exceed the lesser of 6 months
and the period permitted by law. If we defer a distribution or transfer from a
Fixed Allocation or any payment under a fixed settlement option for more than
thirty days, or less where required by law, we will credit interest of at least
3% per year, or the rate required by law, to the amount deferred. We may defer
any distribution from any Sub-account or any transfer from a Sub-account for a
period not to exceed 7 calendar days from the date the transaction is effected.
Any other deferral period begins on the date such distribution or transfer would
otherwise have been transacted.
All transactions into, out of or based on any Sub-account may be postponed
whenever (1) the New York Stock Exchange is closed (other than customary
holidays or weekends) or trading on the New York Stock Exchange is restricted as
determined by the SEC; (2) the SEC permits postponement and so orders; or (3)
the SEC determines that an emergency exists which may make valuation or disposal
of securities not reasonably practical.
Elections, Designations, Changes and Requests: All elections, designations,
changes and requests must be In Writing and are effective only after they have
been approved by us, subject to any transactions made by us before receipt of
such notices. We inform you of any changes that materially affect your rights.
We reserve the right to require that this Policy be returned to our Office for
endorsement of any change.
Claims of Creditors: To the extent permitted by law, no payment under this
Policy is subject to the claims of the creditors of any Owner, Insured or
Beneficiary.
Tax Reporting: We intend to make all required regulatory reports regarding
taxable events in relation to this Policy. Such events may include, but are not
limited to: (a) loans; (b) payment of death benefits; (c) surrender of value
from the Policy; and (d) assignments.
FPVLI(8/98)-23
Facility of Payment: We reserve the right, in settlement of full liability, to
make payments to a guardian, relative or other person if a payee is legally
incompetent.
Participation and Termination of Certain Programs We May Offer: To elect to
participate or to terminate participation in any program we may offer, we may
require receipt at our Office of a request In Writing on a form satisfactory to
us.
Reports to You: We provide reports to you while this Policy is in force. We
provide you with reports at least once each quarter that you maintain Account
Values in the Sub-accounts. We provide you with reports once a year if you
maintain Account Value only in the Fixed Allocation. You may request additional
reports. We reserve the right to charge up to $50 for each such additional
report.
Reserved Rights: In addition to rights specifically reserved elsewhere in this
Policy, we reserve the right to any or all of the following: (a) combine a
Sub-account with other Sub-accounts; (b) combine the Separate Account shown in
the Schedule with other separate accounts; (c) deregister the Separate Account
shown in the Schedule under the Investment Company Act of 1940; (d) operate the
Separate Account shown in the Schedule as a management investment company under
the Investment Company Act of 1940 or in any other form permitted by law; (e)
make changes required by any change in the Securities Act of 1933, the Exchange
Act of 1934 or the Investment Company Act of 1940; (f) make changes that are
necessary to maintain the tax status of your Policy under the Code; and (g) make
changes required by any change in other federal or state laws relating to life
insurance policies.
We may eliminate Sub-accounts, or substitute one or more Portfolios for the one
in which a Sub-account is invested. Substitutions may be necessary if we believe
a Portfolio no longer suits the purpose of the Policy. This may happen due to a
change in laws or regulations, or a change in the investment objectives or
restrictions of a Portfolio, or because the Portfolio is no longer available for
investment, or for some other reason. We would obtain prior approval from the
insurance department of our state of domicile, if so required by law, before
making such a substitution, combination, deletion or addition. We also would
obtain prior approval from the SEC as required by law, and any other required
approvals before making such a substitution, combination, deletion or addition.
POLICY PAYMENT OPTIONS
Payment Options: Partial withdrawals, surrender amounts, Death Proceeds and any
accelerated Death Benefit payment may be paid as a lump sum or pursuant to any
other payment option we offer. If you choose any of our payment options, you
must request your choice In Writing. Payment options can be guaranteed for life,
for a certain period, for joint lives or for a certain period and life as
described below. We make available fixed payments. We reserve the right to
require that the payments be payable on the first or the fifteenth day of a
calendar month. Except for lump sum payments, we will only make payments
directly to an account with a financial institution in the United States of
America.
In the absence of an election In Writing prior to Death Proceeds becoming due,
the Beneficiary may elect to receive the Death Proceeds under one of the payment
options described below. However, if you made an election, the Beneficiary may
not alter such election.
For purposes of the payment options described below, the term "key life" means
the person or persons upon whose life any payments dependent upon the
continuation of life are based.
(a) Option 1 - Payments for Life: Under this option, income is payable
periodically prior to the death of the key life, terminating with the last
payment due prior to such death.
FPVLI(8/98)-24
(b) Option 2 - Payments for Life with 10, 15, or 20 Years Certain: Under this
option, income is payable periodically for 10, 15, or 20 years, as
selected, and thereafter until the death of the key life. Should the death
of the key life occur before the end of the period selected, the remaining
payments are paid to the Beneficiary to the end of such period.
(c) Option 3 - Payments Based on Joint Lives: Under this option, income is
payable periodically during the joint lifetime of two key lives, and
thereafter during the remaining lifetime of the survivor, ceasing with the
last payment prior to the survivor's death
(d) Option 4 - Payments for a Certain Period: Under this option, income is
payable periodically for a specified number of years. The number of years
is subject to our then current rules. Should the payee die before the end
of the specified number of years, the remaining payments are paid to the
Beneficiary to the end of such period.
The periodic payment amount is determined by multiplying the amount applied to
purchase payment options (expressed in thousands of dollars) by the amount of
the periodic payment per $1,000 obtained from our then current payment rates for
that type of payment option and for the frequency of payment selected. These
rates will not be less than those shown in the Payment Option Tables shown
herein.
We reserve the right to require submission prior to commencement of any payment
option of evidence satisfactory to us of the age and gender of any key life upon
whose life payment amounts are calculated.
Proof of Survival: Any payment is subject to evidence satisfactory to us that
the payee is alive on the date such payment is otherwise due.
PAYMENT OPTION TABLES
The attached tables show the minimum dollar amount of each monthly payment for
each $1,000 applied under the options. The amounts payable when payments
commence may be higher, based on our then current assumptions as to interest,
expenses and mortality, but will not be lower.
Under options one and two, the amount of each payment depends on the age and
gender, if applicable, of the payee at the time the first payment is due. Under
option three, the amount of each payment depends on the age and gender, if
applicable, of both payees at the time the first payment is due. No election can
be changed once payments begin.
The tables shown are based on interest at 3% per year compounded annually and
the 1983a Individual Annuity Mortality Table set back one year for males and two
years for females, or the appropriate variation of such table with
gender-neutral rates if necessary to meet state or Federal requirements.
The payee's settlement age is the payee's age, on the date of the first payment,
minus an age adjustment. The age adjustments are shown below. They are based on
the date of the first payment. The age adjustment does not exceed the age of the
payee.
- --------------------------------------------------------------------------------------------------------------------
Calendar Year of First Payment Age Adjustment
- --------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------
2000 to 2009 1 Year
- --------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------
2010 to 2019 2 Years
- --------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------
2020 and later 3 Years
- --------------------------------------------------------------------------------------------------------------------
FPVLI(8/98)-25
Amount of Monthly Payment For Each $1,000 Applied
(Based on 3% Annual Interest Rate)
- --------------------------------------------------------------------------------------------------------------------
Options 1 and 2 --- Single Life Annuities
- --------------------------------------------------------------------------------------------------------------------
- --------- ----------------------------------------------------- ----------------------------------------------------
Male Payee Female Payee
- --------- ----------------------------------------------------- ----------------------------------------------------
- --------- ----------------------------------------------------- ----------------------------------------------------
Monthly Payments Guaranteed Monthly Payments Guaranteed
- --------- ----------------------------------------------------- ----------------------------------------------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
Age None 120 180 240 None 120 180 240
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
50 4.19 4.15 4.10 4.03 3.79 3.78 3.76 3.73
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
55 4.61 4.54 4.45 4.32 4.10 4.08 4.04 3.99
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
60 5.15 5.03 4.87 4.65 4.52 4.47 4.40 4.30
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
65 5.91 5.67 5.36 4.97 5.08 4.98 4.85 4.65
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
70 6.98 6.44 5.87 5.23 5.85 5.65 5.38 5.00
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
75 8.46 7.32 6.31 5.40 6.98 6.50 5.94 5.28
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
80 10.57 8.18 6.62 5.48 8.66 7.50 6.41 5.43
- --------- ------------- ------------ ------------ ------------- ------------ ------------- ------------ ------------
PAYMENT OPTION TABLES
Amount of Monthly Payment For Each $1,000 Applied
(Based on 3% Annual Interest Rate)
- --------------------------------------------------------------------------------------------------------------------
Option 3 - Joint and Last Survivor Annuity
- --------------------------------------------------------------------------------------------------------------------
- ---------------------------- ---------------------------------------------------------------------------------------
Age of Female Payee
- ---------------------------- ---------------------------------------------------------------------------------------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
Age of Male Payee 35 40 45 50 55 60 65 70 75 80
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
50 3.15 3.27 3.39 3.53 3.67 3.79 3.91 4.00 4.07 4.12
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
55 3.17 3.29 3.44 3.60 3.78 3.96 4.13 4.27 4.39 4.47
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
60 3.18 3.31 3.47 3.66 3.88 4.11 4.35 4.57 4.76 4.91
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
65 3.19 3.33 3.50 3.70 3.95 4.23 4.55 4.87 5.18 5.44
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
70 3.19 3.34 3.52 3.74 4.01 4.33 4.72 5.16 5.62 6.05
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
75 3.20 3.34 3.53 3.76 4.04 4.40 4.85 5.39 6.02 6.68
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
80 3.20 3.35 3.53 3.77 4.07 4.45 4.94 5.57 6.35 7.26
- ---------------------------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
- ----------------------------------------------------------------------------
Option 4 - Payments for a Designated Period
- ----------------------------------------------------------------------------
- --------------- ---------------- ------------ ------------- ----------------
Monthly Payment Monthly Payment
Years Years
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
10 9.61 21 5.32
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
11 8.86 22 5.15
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
12 8.24 23 4.99
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
13 7.71 24 4.84
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
14 7.26 25 4.71
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
15 6.87 26 4.59
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
16 6.53 27 4.47
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
17 6.23 28 4.37
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
18 5.96 29 4.27
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
19 5.73 30 4.18
- --------------- ---------------- ------------ ------------- ----------------
- --------------- ---------------- ------------ ------------- ----------------
20 5.51
- --------------- ---------------- ------------ ------------- ----------------
FPVLI(8/98)-26
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FPVLI(8/98)-27
(THIS PAGE IS INTENTIONALLY LEFT BLANK)
FPVLI(8/98)-28
AMERICAN SKANDIA LIFE ASSURANCE CORPORATION
Shelton, Connecticut
(A Stock Company)
FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE.
NON-PARTICIPATING.
VARIABLE INVESTMENT OPTIONS AND A FIXED ALLOCATION.
DEATH BENEFIT PAYABLE UPON DEATH OF THE INSURED WHILE THIS POLICY IS IN FORCE.
ANY BENEFITS AND VALUES, INCLUDING THE DEATH BENEFIT, BASED ON THE ACCOUNT
VALUE IN THE VARIABLE INVESTMENT OPTIONS, DEPEND ON INVESTMENT PERFORMANCE,
MAY INCREASE OR DECREASE, AND ARE THEREFORE NOT GUARANTEED. PLEASE REFER TO
THE SECTIONS ENTITLED "ACCOUNT VALUE IN THE SUB-ACCOUNTS" AND "DEATH
BENEFIT" FOR A MORE COMPLETE EXPLANATION. ANY ACCELERATED DEATH BENEFIT
PAYMENT MAY REDUCE YOUR POLICY BENEFITS.
THERE IS NO MINIMUM GUARANTEED CASH VALUE.
LESS THAN 100% OF THE CASH VALUE IS AVAILABLE FOR A LOAN.
VLI-MWR (11/97)
ENDORSEMENT
MEDICALLY-RELATED WAIVER BENEFIT
This Endorsement is made part of the Policy to which it is attached. It is
effective on the date such Policy is effective.
General: You may request a medically-related waiver of the contingent deferred
sales charge and the contingent deferred tax charge that would otherwise apply
to a partial withdrawal or surrender. Eligibility for this waiver depends on the
health of an Insured and on the conditions and requirements provided below. We
delay processing any partial withdrawal or surrender for which you have
requested a medically-related waiver until we receive all our requirements for
the medically-related waiver or until we determine that the transaction is not
eligible for such waiver. A partial withdrawal to which a medically-related
surrender applies results in the same consequences with respect to the benefits
and charges of this Policy as a partial withdrawal that is not eligible for such
waiver.
Maximum Benefit: This waiver is subject to a maximum. The maximum amount is
based on all insurance policies and annuities with us for which a named Insured
for this Policy is named as an insured or annuitant. The maximum amount on which
we will waive charges due on a partial withdrawal or surrender is a combined
$500,000 from all such insurance policies and annuities, whether taken
simultaneously or sequentially.
Requirements of the Medically-Related Waiver Benefit: The requirements for the
medically-related waiver benefit are:
(a) You must make the request for the medically related waiver.
(b) Such a request must be In Writing.
(c) We receive In Writing proof satisfactory to us that an Insured
was first confined to a "Medical Care Facility", as defined below,
while this Policy is in force and remains confined for at least 90
consecutive days after the Issue Date.
"Medical Care Facility", for purposes of this provision, means a facility
operated pursuant to law or any state licensed facility providing medical
necessary in-patient care which is: (a) prescribed by a licensed Physician In
Writing; and (b) is based on physical limitations which prohibit daily living in
a non-institutional setting. "Physician" means a person other than you, an
Insured or a member of either your or an Insured's family who is state licensed
to give medical care or treatment.
American Skandia Life Assurance Corporation
--------------------------------------
President