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[PRUDENTIAL LOGO] PRUCO LIFE INSURANCE COMPANY
Phoenix, Arizona 85014
A STOCK COMPANY SUBSIDIARY OF
The Prudential Insurance Company of America
ANNUITANT(S) JOHN DOE XX XXX XXX CONTRACT NUMBER
MARY DOE JUNE 4, 1990 CONTRACT DATE
ANNUITY DATE JUNE 4, 2020
AGENCY R-NK 1
This is an annuity contract. Subject to the provisions of this contract, and in
consideration of any purchase payment you make and we accept under the terms of
this contract (see List of Contract Limitations), we will make annuity payments
starting on the annuity date we show above.
Please read this contract with care. If there is ever a question about it, or if
there is a claim, just see one of our representatives or get in touch with one
of our offices.
BENEFITS AND VALUES UNDER THIS CONTRACT MAY BE ADJUSTED UPWARD OR DOWNWARD BY
THE APPLICATION OF A MARKET VALUE ADJUSTMENT FORMULA. SEE MARKET VALUE
ADJUSTMENT FOR A DESCRIPTION OF THE FORMULA, ITS APPLICATION, AND THE BENEFITS
AND VALUES AVAILABLE WITHOUT AN ADJUSTMENT.
RIGHT TO CANCEL CONTRACT.--Not later than ten days after you get this contract,
you may return it to us. All you have to do is take it or mail it to one of our
offices or to the representative who sold it to you. The contract will be
cancelled and we will give back any purchase payment promptly.
Signed for Pruco Life Insurance Company,
an Arizona Corporation.
/s/ DORATHY K. LIGHT /s/ ESTHER H. MILNES
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SECRETARY PRESIDENT
RETIREMENT ANNUITY CONTRACT.--MONTHLY ANNUITY PAYMENTS STARTING ON ANNUITY DATE.
PAYMENT AS STATED UPON DEATH BEFORE ANNUITY DATE. ELIGIBLE FOR ANNUAL DIVIDENDS
AS STATED UNDER PARTICIPATION.
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FAC--G--101--NJ
GUIDE TO CONTENTS
PAGE
----
Contract Data........................................ 3
Basic Contract Data; Interest; List of Contract
Limitations; Adjustments to Purchase Payments;
Adjustments to the Contract Fund; Withdrawal
Charge
Endorsements......................................... 4
Definitions.......................................... 5
Contract Fund........................................ 5
Market Value Adjustment.......................... 6 & 7
Market Value Adjustment Formula
Withdrawals.......................................... 7
Cash Value; Condition for Withdrawal
Death of Annuitant................................... 8
Before the annuity date; After the annuity date
Beneficiary.......................................... 8
Payout Provisions.................................... 9
Choosing an Option; Options Described; Other
Methods of Payments; When No Option
Chosen; Conditions; Interest Rate; Withdrawal
Charges
Annuity Settlement Tables........................... 10
General Provisions............................. 11 & 12
Annual Report; The Contract; Contract
Modifications; Change of Annuity Date;
Removal of an Annuitant; Ownership and
Control; Currency; Misstatement of Age and/or
Sex; Incontestability; Proof of Life or Death;
Assignment; Changes; Requested Transactions;
Minimum Benefits
Dividends........................................... 12
Participation; Dividend Options
FAC--G--101--NJ Page 2
CONTRACT DATA
Annuitant(s) JOHN DOE XX XXX XXX Contract Number
MARY DOE June 4, 1990 Contract Date
Annuity Date June 4, 2020
Agency R-NK I
First Annuitant
Name JOHN DOE
Sex and Issue Age M-35
Co-Annuitant:
Name MARY DOE
Sex and Issue Age F-32
Beneficiary:
CLASS 1 - Robert Doe
Son of Annuitants
CLASS 2 - Barbara Smith
Sister of Co-Annuitant
Purchase Payment Paid on the Contract Date: $10,000.00
INTEREST
o Guaranteed Interest Rate--This is the effective annual interest rate we
will credit for an interest rate period. Your interest rate for the initial
interest rate period is 8.3%. We will tell you the effective annual rate
for each subsequent interest rate period within one month after it begins.
o Interest Rate Period--This is the period for which we guarantee an interest
rate. Your initial interest rate period is 3 years, beginning on the
contract date. Each subsequent interest rate period is one year and begins
on the contract anniversary following the end of the immediately preceding
interest rate period.
o The minimum guaranteed interest rate we will declare for any interest rate
period will be at an effective annual rate of 3.0%.
FAC--G--101--NJ Page 3
Contract No. XX XXX XXX
LIST OF CONTRACT LIMITATIONS
o The minimum contract fund after a withdrawal without our prior consent is
$10,000.
o The minimum withdrawal amount is $500. The withdrawal amount is the amount
you receive as a result of the transaction.
o Purchase payments subsequent to the first are not permitted.
ADJUSTMENTS TO PURCHASE PAYMENTS
We will deduct a charge for any applicable state and local premium taxes if
applicable.
The remainder of the purchase payment is the invested purchase payment amount.
ADJUSTMENTS TO THE CONTRACT FUND
On the contract date the contract fund is equal to the invested purchase payment
amount credited on that date. On any day after that date, to the previous days'
contract fund, we will:
o add any Interest
o reduce your contract fund by an amount necessary to produce any amount
withdrawn that day, considering the market value adjustment (see Market
Value Adjustment) and deduction of any withdrawal charge.
o deduct any amount charged against the contract fund for federal or state
income taxes.
o deduct an administration charge of up to $30 on each contract anniversary
and when a full withdrawal is made if the value of your contract fund is
less than $10,000 at either of those times.
FAC--G--101--NJ Page 3A
WITHDRAWAL CHARGE
A withdrawal charge is a charge applied against the amount withdrawn when you
make a full or partial withdrawal. To determine this charge, we first reduce
your withdrawal by any amount not subject to a withdrawal charge. These amounts
are:
- - any charge-free withdrawal amount not previously withdrawn. The charge-free
withdrawal amount that is available in a given contract year is equal to
10% of your contract fund, after any market value adjustment, (see Market
Value Adjustment) as of the first withdrawal in a contract year. These
amounts may not be accumulated from contract year to contract year.
- - earnings not previously withdrawn. Earnings are the excess, if any, of the
contract fund after any market value adjustment, over the total purchase
payment amounts less (1) any prior purchase payments withdrawn, and (2) any
associated withdrawal charges.
- - any amount used to provide income under option 2, Life Income (See Payout
Provisions).
- - any payment withdrawn during the one-month period following the end of an
interest rate period.
The withdrawal charge is found by multiplying the balance of the withdrawal, if
any, by the appropriate charge rate found below. The charge rate depends on the
payment year during which a purchase payment is withdrawn. The withdrawal charge
rates are:
Payment Year of Withdrawal
1 2 3 4 5 6 7 8 and after
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7% 7% 7% 7% 6% 5% 4% 0% (INIT. GUAR. PERIOD OF 7-10 YRS)
7% 7% 6% 5% 4% 3% 1% 0% (6-YEAR INITIAL GUAR. PERIOD)
6% 6% 5% 4% 3% 1% 1% 0% (5-YEAR INITIAL GUAR. PERIOD)
5% 4% 3% 2% 1% 1% 1% 0% (4-YEAR INITIAL GUAR. PERIOD)
4% 3% 2% 1% 1% 1% 1% 0% (3-YEAR INITIAL GUAR. PERIOD)
3% 2% 1% 1% 1% 1% 1% 0% (2-YEAR INITIAL GUAR. PERIOD)
FAC--G--101--NJ Page 3B
CONTRACT NO. XX XXX XXX
ENDORSEMENTS
(only we can endorse this contract.)
FAC--G--101--NJ Page 4
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DEFINITIONS
We define here some of the words and phrases used in
this contract. We explain others, not defined here, in
other parts of the text.
We, Our and Us.--The company issuing this contract.
You and Your.--The owner of the contract.
Annuitant(s).--The person or persons named on the first
page. If two persons are named, one of the two is named
on page 3 as First Annuitant, the other as Co-Annuitant.
In that case, the beneficiary provisions of the contract
will be based on the death of the last survivor of the
persons so named.
Payee.--A beneficiary who has a right to receive a
settlement under this contract.
Annuity Date.--The date the first annuity payment is
due. We show the annuity date on page 3.
Attained Age.--An Annuitant's attained age at any time
is his or her issue age plus the length of time since
the contract date. You will find the issue age(s) on
page 3.
Contract Date.--The date we receive the initial purchase
payment at our Home Office. We show the contract date on
page 3.
Contract Anniversary.--The same day and month as the
contract date in each later year.
Contract Year.--A. year which starts on the contract
date or on a contract anniversary.
Payment Date.--The payment date for a given purchase
payment is the date we receive that payment at our Home
Office.
Payment Anniversary.--The payment anniversary for a
given purchase payment is the same day and month as the
Payment Date in each later year.
Payment Year.--The payment year for a given purchase
payment is a year which starts on the Payment Date or on
a Payment Anniversary.
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CONTRACT FUND
When you make your purchase payment, the invested
purchase payment amount becomes your contract fund.
Amounts are added to and subtracted from the contract
fund as described in the contract data pages. The value
of your contract fund, adjusted as described below, is
used to determine the amount you may withdraw, the
amount we pay upon the death of the sole or last
surviving Annuitant prior to the annuity date, and the
amount of any payment under an option (See Payout
Provisions).
FAC--G--101--NJ Page 5
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MARKET VALUE ADJUSTMENT
The market value adjustment is made when you request a
withdrawal at any time other than the one month period
that follows the end of a guaranteed interest rate
period.
In order to do a market value adjustment we work with
four different numbers.
They are:
1. The value of your contract fund.
2. The interest rate we guaranteed you.
3. The interest rate we would guarantee you today (if
you bought this same contract for the number of
whole years, plus one additional year, that you
now have left in your interest rate period).
4. The number of whole months (but not less than one
month) you now have left in your interest rate
period.
Here is how we do it.
First, we divide the number of months you now have left
in your 4 interest rate period by 12.
Second, we subtract the interest rate we would guarantee
today, on the same type of contract for the number of
years you have left, plus one additional year, from the
interest rate we guaranteed you. This answer could be
negative.
Now we multiply the results of the first two
calculations. Again, the result could be negative. If
the answer is less than -.40 we will use -.40. If the
answer is more than .40 we will use .40.
Next, we multiply the result of the last calculation by
the value of your contract fund.
Finally, we add the result to the contract fund. If the
amount we add is more than 1, your contract fund will go
up in value. If it is less than 1 (a negative number),
your contract fund will go down in value.
It is always true that if the interest rate we would
offer today is more than the guaranteed rate on your
contract, the value of your contract fund will go down.
And, if that newer rate is less then the guaranteed rate
on your contract, the value of your contract fund will
go up.
EXAMPLE: IF YOU ASK FOR A WITHDRAWAL, AND THIS IS NOT
DURING THE 30 DAYS FOLLOWING AN INTEREST RATE
PERIOD--AND
1. You have 30 months left in your interest rate
period, and,
2. Your guaranteed interest rate is 10% (.10),
3. Today we would guarantee an interest rate of 8%
(.08) on the same type of contract if you bought
it for 3 years (the number of whole years you have
left plus 1), then:
4. The value of your contract fund is $ 20,000,
We would divide 30 by 12 for a result of 2.5. Next, we
would subtract .08 from .10 for a result of .02. Next,
we would multiply 2.5 by .02 for a result of .05. Now we
multiply .05 by $20,000 for a result of $ 1,000.00. We
add $1,000 to $20,000 and your market value adjusted
contract fund is $21,000.
FAC--G--101--NJ Page 6
EXAMPLE: IF YOU ASK FOR A WITHDRAWAL, AND THIS IS NOT
DURING THE 30 DAYS FOLLOWING AN INTEREST RATE
PERIOD--AND
1. You have 30 months left in your interest rate
period, and
2. Your guaranteed interest rate is 10%,
3. Today we would guarantee an interest rate of 12%
(.12) on the same type of contract if you bought
it for 3 years (the number of whole years you have
left plus 1), then:
4. The value of your contract fund is $20,000
We would divide 30 by 12 for a result of 2.5. Next, we
would subtract .12 from .10 for a result of -.02. Next,
we would 3 multiply 2.5 by -.02 for a result of -.05.
Now we multiply -.05 by $20,000 for a result of
-$1,000.00. We add -$1,000 to $20,000 and your market
value adjusted contract fund is $ 19,000.
MARKET VALUE Stated as a formula, the market value adjustment is
ADJUSTMENT FORMULA equal to: (M/12)x(R-C), where:
M is the number of whole months (but not less than one
month) left in the initial or subsequent guaranteed
interest period.
R is the contract's initial or renewal interest rate, in
decimals, and
C is the current initial interest rate, in decimals, we
offer on newly-issued contracts like this one for the
number of whole years, plus one, remaining in the
present initial or subsequent interest rate period as of
the date we receive your request for a withdrawal. If we
no longer offer these contracts, we will use a rate
equal to the most recent Moody's Corporate Bond Yield
Average--Monthly Average Corporates, for that duration,
as published by Moody's Investment Services, Inc. or any
successor to that service. If that average is no longer
published, we will use a substantially similar average,
established by the insurance regulator where this
contract is delivered.
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WITHDRAWALS
Before the annuity date, you may be able to make full or
partial withdrawals of your cash value.
The withdrawal amount is any amount you receive as a
result of this transaction.
CASH VALUE The cash value at any time is the contract fund after
any market value adjustment, minus any withdrawal
charge. The withdrawal charge rate(s), how they are
applied, and a description of any withdrawal amounts
excluded from these charges are described in the
contract data pages. Any paid-up annuity, cash surrender
value or death benefits are not less than the minimum
required by statute. Where required, we have given the
insurance regulator a detailed statement of how we
compute values and benefits.
We reserve the right to postpone paying any withdrawal
for up to six months. If we do so for more than 10 days,
we will pay interest at the rate of at least 3% a year.
CONDITION FOR You may make a full withdrawal at any time. You may make
WITHDRAWAL a partial withdrawal if it is at least equal to the
minimum withdrawal amount and the remaining contract
fund is at least equal to the minimum contract fund
amount after withdrawal. Both amounts are shown under
the List of Contract Limitations.
FAC--G--101--NJ Page 7
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DEATH OF ANNUITANT
BEFORE THE ANNUITY If a sole or last surviving Annuitant dies before the
DATE annuity date, we will pay the beneficiary the greater of
(a) the contract fund, after any market value
adjustment, and (b) minimum proceeds, both determined as
of the date we receive due proof of death. The minimum
proceeds is the total invested purchase payment amount,
minus any withdrawals and withdrawal charges,
accumulated at the minimum guaranteed interest rate(s)
shown in the contract data pages.
If two Annuitants are named in the contract and both
have died and there is not sufficient evidence that they
have died otherwise than simultaneously, the proceeds of
the contract will be distributed as if the First
Annuitant had survived the Co-Annuitant.
AFTER THE ANNUITY If the Annuitant dies on or after the annuity date, the
DATE settlement then in effect will govern whether and to
whom we will make any payment(s).
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BENEFICIARY
You may designate or change a beneficiary. Your request
must be in writing and in a form which meets our needs.
It will take effect only when we file it at our Home
Office; this will be after you send the contract to us
to be endorsed, if we ask you to do so. Then any
previous beneficiary's interest will end as of the date
of the request. It will end then even if no Annuitant is
living when we file the request. Unless otherwise
stated, we will make payment to the beneficiary only if
the last surviving or sole Annuitant dies before the
annuity date. Any beneficiary's interest is subject to
the rights of any assignee we know of.
When a beneficiary is designated, any relationship shown
is to the Annuitant (First Annuitant if two Annuitants
are named on page 3) unless otherwise stated.
To show priority, we may use numbered classes, so that
the class with first priority is called class 1, the
class with next priority is called class 2, and so on.
When we use numbered classes, these statements apply to
beneficiaries unless the form states otherwise: (In
these provisions and in the Example, the term
"Annuitant" refers, where two Annuitants are named, to
the last surviving Annuitant.)
1. One who survives the Annuitant will have the right
to be paid only if no one in a prior class
survives the Annuitant.
2. One who has the right to be paid will be the only
one paid if no one else in the same class survives
the Annuitant.
3. Two or more in the same class who have the right
to be paid will be paid in equal shares.
4. If none survives the Annuitant, we will pay in one
sum to the Annuitant's estate.
EXAMPLE: SUPPOSE THE CLASS 1 BENEFICIARY IS JANE AND THE
CLASS 2 BENEFICIARIES ARE PAUL AND JOHN. IF THE
ANNUITANT DIES BEFORE THE ANNUITY DATE, WE OWE JANE THE
PROCEEDS IF SHE IS LIVING AT THE ANNUITANT'S DEATH. WE
OWE PAUL AND JOHN THE PROCEEDS IF THEY ARE LIVING THEN
BUT JANE IS NOT. BUT IF ONLY ONE OF THEM IS LIVING, WE
OWE HIM THE PROCEEDS. IF NONE OF THEM IS LIVING, WE OWE
THE ANNUITANT'S ESTATE.
Before we make a payment, we have the right to decide
what proof we need of the identity, age or any other
facts about any persons designated as beneficiaries. If
beneficiaries are not designated by name and we make
payment(s) based on that proof, we will not have to make
the payment(s) again.
FAC--G--101--NJ Page 8
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PAYOUT PROVISIONS
CHOOSING AN OPTION You may use the contract fund after any market value
adjustment, as of the annuity date to provide an income
to the Annuitant(s) under one or more of the options we
describe below. But, for any annuity option, we will
first deduct from this amount any charge for state and
local premium taxes, and any withdrawal charges
described below. We offer the same annuity options to
the payee that we offer to an Annuitant. And we
determine monthly payments for the payee in the same way
we do for an Annuitant.
Your choice of an option will take effect on the annuity
date but only if: (1) the person on whose life the
annuity is to be based is living on that date; (2) the
first payment under the option will be at least $50; and
(3) you do not void the choice by making a later choice
before the annuity date.
If two Annuitants are named in the Contract and both are
living, settlement will be made on the life of the First
Annuitant, as named on page 3.
OPTIONS DESCRIBED When we use the word Annuitant in the following
paragraphs we mean the Annuitant for whom the annuity
described was chosen and who is to receive settlement
under the annuity.
For an Annuitant, the first payment under these options
is due on the annuity date.
For a payee, unless a later date is requested, the first
payment will be due on the first day of the earliest
calendar month on or after the day the Home Office has
received the request for the settlement and due proof of
the Annuitant's death and such claim forms and other
evidence as may be satisfactory to us.
Here are the options we offer. We may also consent to
other arrangements.
OPTION 1 We will make equal payments for up to 25 years. The
(INSTALLMENTS FOR A Option 1 Table shows the minimum amounts we will pay.
FIXED PERIOD)
OPTION 2 (LIFE INCOME) We will make monthly payments for as long as the person
on whose life the settlement is based lives, with
payments certain for 120 months. The Option 2 Table
shows the minimum amounts we will pay.
OPTION 3 We will hold an amount at interest. We will pay the
(INTEREST PAYMENT) interest annually, semi-annually, quarterly, or monthly.
OTHER METHODS OF We may offer other methods of payment. Contact one of
PAYMENT our representatives or get in touch with one of our
offices for information.
WHEN NO OPTION CHOSEN If no choice takes effect on the annuity date,
settlement under the Interest Payment Option will become
effective.
CONDITIONS Your right to choose an option is subject to all these
conditions: (1) You must ask for the option in writing
and in a form which meets our needs. (2) You must send
the contract to us to be endorsed. (3) If we require it,
you must give us proof of the date of birth of the
person on whose life an annuity payment is based. (4) We
must have your request, the contract and any required
proof(s) of the date(s) of birth before the annuity
date.
INTEREST RATE Payments under any of the options will be calculated
assuming an effective interest rate of at least 3 1/2% a
year. We may include more interest.
WITHDRAWAL CHARGES Before we make payments under options 1 or 3, we will
reduce the contract fund after any market value
adjustment, by a withdrawal charge in the same way as we
would if you had made a withdrawal (see Withdrawals). If
you choose any other method of payment not described in
this contract, we will tell you if it is subject to a
withdrawal charge.
FAC--G--101--NJ Page 9
AMOUNTS PAYABLE If the annuity date is a contract anniversary, for
Options 1 and 2 we will use the table below to compute
the amount of the annuity payment.
If the annuity date is not a contract anniversary, we
will adjust the amounts accordingly.
When we computed the amounts we show in the Option 2
table, we adjusted the 1983 Table 2 to an age last
birthday basis, less three years; we used an interest
rate of 3 1/2% a year. If the age is over 80, the rate
for age 80 will be used.
OPTION 1 TABLE
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MINIMUM AMOUNT OF
MONTHLY PAYMENT FOR OPTION 2 TABLE
EACH $1,000, THE FIRST Amount of Annuity Payment for
PAYABLE IMMEDIATELY each $1,000 applied on the Annuity Date
- ------------------------------- ------------------------------------------------------------
Number Monthly
of Years Payment AGE MALE FEMALE AGE MALE FEMALE
- ------------------------------- ------------------------------------------------------------
41 $3.88 $3.67 61 $5.25 $4.79
1 $84.65 42 3.92 3.70 62 5.36 4.89
2 43.05 43 3.97 3.74 63 5.48 4.98
3 29.19 44 4.01 3.78 64 5.60 5.09
4 22.27 45 4.06 3.82 65 5.73 5.20
5 18.12 46 4.12 3.86 66 5.87 5.31
47 4.17 3.90 67 6.01 5.43
6 15.35 48 4.23 3.94 68 6.15 5.56
7 13.38 49 4.28 3.99 69 6.30 5.70
8 11.90 50 4.35 4.04 70 6.46 5.84
9 10.75 51 4.41 4.09 71 6.62 5.99
10 9.83 52 4.48 4.15 72 6.79 6.15
53 4.55 4.21 73 6.96 6.31
11 9.09 54 4.62 4.27 74 7.13 6.49
12 8.46 55 4.70 4.33 75 7.30 6.67
13 7.94 56 4.78 4.40 76 7.48 6.85
14 7.49 57 4.68 4.47 77 7.66 7.04
15 7.10 58 4.95 4.54 78 7.83 7.24
59 5.05 4.62 79 8.00 7.44
16 6.76 60 5.15 4.71 80 8.17 7.64
17 6.47 ------------------------------------------------------------
18 6.20
19 5.97
20 5.75
21 5.56
22 5.39
23 5.24
24 5.09
25 4.96
- ------------------------------
Multiply the monthly amount
by 2.989 for quarterly,
5.952 for semi-annual or
11.804 for annual.
- ------------------------------
FAC--G--101--NJ Page 10
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GENERAL PROVISIONS
ANNUAL REPORT Starting on the first contract anniversary we will send
you a report each year until the annuity date. It will
show the contract fund, the cash value, interest and any
other credits applied during the year; and charges and
withdrawals during the year. The report will include any
other data that may be currently required where this
contract is delivered. You may ask for a report like
this at any time. But, except for the report we send you
once a year, we have the right to charge a fee for each
report.
THE CONTRACT This document forms the whole contract.
CONTRACT MODIFICATIONS Only one of our officers at the rank of
vice president or above may agree to modify this
contract, and then only in writing.
CHANGE OF ANNUITY You may be able to change your annuity date. But
any change may be DATE made only if we consent, and will
be subject to conditions that are then determined.
REMOVAL OF AN If a First Annuitant and a Co-Annuitant are named, we
ANNUITANT will remove one from the contract upon: (1) receipt of
your written request to remove that Annuitant; or (2)
receipt of due proof that the Annuitant has died.
OWNERSHIP AND CONTROL Unless we endorse this contract to say otherwise: (1 )
the owner of the contract is the Annuitant (the First
Annuitant, if two are named); (2) while any Annuitant is
living the owner alone is entitled to (a) any contract
benefit and value, and (b) the exercise of any right and
privilege granted by the contract or by us; and (3) if
two Annuitants are named and the First Annuitant, dies
while the Co-Annuitant is living, the Co-Annuitant will
become the Owner.
CURRENCY Any money we pay, or which is paid to us, must be in
United States currency. Any amount we owe will be
payable at our Home Office.
MISSTATEMENT OF AGE If any Annuitant's stated sex or date of birth or both
AND/OR SEX are not correct, we will change each benefit and the
amount of each annuity payment to that which the total
purchase payment amounts would have bought for the
correct sex and/or date of birth. Also, we will adjust
the amount of any payments we have already made. Here is
how we will do it: (1) We will deduct any overpayments,
with interest at 5% a year, from any payment(s) due then
or later. (2) We will add any underpayments, with
interest at 5% a year, to the next payment we make after
we receive proof of the correct sex and date of birth.
INCONTESTABILITY We will not contest this contract unless the purchase
payment due on the contract date is not paid.
FAC--G--101--NJ Page 11
PROOF OF LIFE OR DEATH Before we make a payment, we have the right to require
proof of the life or death of any person whose life or
death determines whether or to whom we must make the
payment.
ASSIGNMENT [CANCELED]
CHANGES We reserve the right, upon 90 days notice to you to:
1. change any or all terms and provisions of the
Annuity Settlement Table, but only with respect to
any portion of an annuity settlement deriving from
purchase payments, if any, made on or after the
effective date of the change and earnings on those
purchase payments; and
2. make any changes required by law.
REQUESTED TRANSACTIONS On any requested transaction, we have the right to
require that your request be in writing. We may also ask
for your contract to endorse it.
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DIVIDENDS
PARTICIPATION This contract is eligible to participate in our
divisible surplus. We do not expect that any dividends
will be payable on or before the annuity date. While any
annuity settlement is in effect, the contract will share
in our surplus to the extent and in the way we decide.
DIVIDEND OPTIONS If you ask us in writing at our Home Office and
in a form which meets our needs, you may choose one of
these uses for any dividend we declare:
1. we will pay it to you in cash;
2. we will credit it to the contract fund.
If you have not made a choice by 31 days after we credit
a dividend, we will apply it as we state in 2 above.
FAC--G--101--NJ Page 12
[Intentionally blank]
FAC--G--101--NJ Page 13
RETIREMENT ANNUITY CONTRACT.--MONTHLY ANNUITY PAYMENTS STARTING ON ANNUITY DATE.
PAYMENT AS STATED UPON DEATH BEFORE ANNUITY DATE. ELIGIBLE FOR ANNUAL DIVIDENDS
AS STATED UNDER PARTICIPATION.
FAC--G--101--NJ Page 14