Exhibit 5(b)
THE FRANKLIN LIFE
INSURANCE COMPANY
Springfield, Illinois
A Legal Reserve Stock Company
Single
Stipulated Payment
Contract Number
Name of Annuitant
First Contract Year Begins
Maturity Date
Beneficiary
The Franklin Life Insurance Company agrees to pay a life annuity consisting
of a series of monthly income payments if the Annuitant is living on the
Maturity Date. The first such payment will be made on the Maturity Date and
subsequent payments will be made on the same day of each month thereafter so
long as the Annuitant shall live. The dollar amount of such payments will be
determined as provided in provisions 24, 25, 26 and 28 for the First Settlement
Option.
Upon receipt of due proof of the death of the Annuitant occurring before
the Maturity Date, the Company agrees to pay to the Beneficiary the Cash
Surrender Value at the Valuation Date coincident with or next following the date
on which written notice of death is received by the Company.
The provisions on this and the following pages are part of the Contract.
Signed for the Company at Springfield, Illinois
Secretary President
A BRIEF DESCRIPTION OF THIS CONTRACT
This is a Single Payment Deferred Variable Annuity or Variable and Fixed Annuity
Contract. A death benefit is payable before Maturity Date. Income is payable
for life, first payment at Maturity Date.
ALL INCOME PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT,
WHEN BASED ON INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT,
ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
FORM 1171
POLICY DATA
Date of Issue DECEMBER 1, 1970 MALE 35 Age and Sex
Contract Number 1234567 $10,000.00 Single
Stipulated
Payment
Name of Annuitant BENJAMIN FRANKLIN
First Contract Year Begins DECEMBER 1, 1970
Maturity Date DECEMBER 1, 2000
Beneficiary DEBORAH FRANKLIN, WIFE
STIPULATED PAYMENT
Single Stipulated Payment $ 10,000.00 including the premium for any Additional
Benefits described below.
Account allocation of Single Stipulated Payment excluding premium for Additional
Benefits provided by Supplemental Agreement.
Fixed Dollar Annuity 50.0% Separate Account 50.0%
SCHEDULE OF ADDITIONAL BENEFITS
(as provided by Supplemental Agreement)
Form Single
Number Description of Benefits Premium
- --- NONE ---
FORM 1171 PAGE 2
GENERAL DEFINITIONS
1. DEFINITIONS As used in this contract, the terms:
(a) "Variable Annuity" means an annuity with payments
varying in amount in accordance with the net investment
experience of the Separate Account;
(b) "Fixed Dollar Annuity" means an annuity with payments
which remain fixed as to dollar amount throughout the
payment period;
(c) "Stipulated Payment" means an amount paid to the Company
under this contract as a consideration for the benefits
described herein, and includes the premium for any
additional benefits provided by Supplemental Agreement;
(d) "General Account" means all assets of the Company other
than those in a Separate Account. Reserves for any fixed
dollar benefits shall be maintained in the General Account;
(e) "Separate Account" means those assets of the Company in
a segregated investment account entitled "Franklin Life
Variable Annuity Fund A" established by the Company pursuant
to Illinois law;
(f) "Cash Surrender Value" means the value of the
Accumulation Units credited to this contract determined on
the basis set forth in the Valuation Provisions;
(g) "Valuation Date" means the date as of which the
Accumulation Unit value is determined;
(h) "Valuation Period" means the period, as determined by
the Company, of not more than 7 calendar days beginning on
the day after any Valuation Date and ending on the next
Valuation Date;
(i) "Accumulation Unit" means a unit used to measure the
value of an Owner's fixed dollar annuity or interest in the
Separate Account prior to the date on which annuity payments
commence; (See provision 19 dealing with accumulation unit
values.)
(j) "Annuity Unit" means a unit used to determine the amount
of each annuity payment after the first; (See provision 27
dealing with annuity unit values.)
(k) "Attained Age" of the Annuitant on any date after the
Date of Issue means the age of the Annuitant at issue as
shown on page 2 plus the number of years, including
fractions, elapsed from the Date of Issue to such date;
(l) "Written Request" means a written request satisfactory
to the Company, filed at its Home Office in Springfield,
Illinois.
GENERAL PROVISIONS
2. THE CONTRACT CONSIDERATION-ENTIRE CONTRACT: This contract has been issued
in consideration of the application and of the payment of
the stipulated payment as provided. This contract and the
application, a copy of which is attached to and made a part
of this contract, constitute the entire contract and shall
be construed according to the laws of the jurisdiction where
it is made.
STATEMENTS IN APPLICATION: All statements made in the
application shall, in the absence of fraud, be deemed
representations and not warranties. No statement shall be
used in defense to a claim under this contract unless it is
contained in the application and unless a copy of the
application is attached to this contract when issued.
MODIFICATION: Any change in this contract will be valid only
when it is approved in writing by the President or Secretary
of the Company, and the approval is endorsed on the contract
or otherwise recorded as the Company may require. No agent
or person other than the above has the authority to change,
modify or waive any provision of this contract or to extend
the time for paying the stipulated payment.
3. INCONTESTABILITY This contract will be incontestable after it has been in
force during the lifetime of the Annuitant for 2 years from
its date of issue, and except as to the terms of any
provision for accidental death benefits.
4. SUICIDE If within 2 years from date of issue the Annuitant (whether
sane or insane) shall die by suicide, this contract shall
automatically terminate and the amount payable in lieu of
all other benefits shall be limited to the Cash Surrender
Value at the date of death plus the sum of the additional
premiums paid prior to death for any Supplemental Agreement
attached to this contract.
5. AGE AND SEX If the age or sex of the Annuitant has been misstated, the
amounts payable and any benefits accruing hereunder shall be
such as the stipulated payment paid would have purchased at
the correct age and sex of the Annuitant. Any underpayments
already made by the Company shall be made up immediately and
any overpayments made by the Company shall be charged
against the benefit falling due after adjustment, with
compound interest at 5.7% a year in advance.
6. OWNERSHIP AND OWNER: The Owner of this contract will be the Annuitant
ASSIGNMENT unless otherwise designated in the application for this
contract or otherwise provided by endorsement at date of
issue or unless subsequently changed as provided below.
The relationship of the Owner is the relationship to the
Annuitant, unless otherwise stated.
During the Annuitant's lifetime, all rights under this
contract belong exclusively to the Owner unless the Owner
provides otherwise by written request. Such rights include
the right to assign or surrender this contract and to
exercise, receive and enjoy every other right, option and
privilege conferred by this contract or allowed by the
Company.
CHANGE OF OWNERSHIP: The Owner may designate a new Owner and
may designate or change a Contingent Owner at any time
during the Annuitant's lifetime by filing a written request
at the Home Office of the Company. Such designation or
change will take effect only when endorsed upon this
contract or otherwise recorded as the Company may require
but upon endorsement or recording the change will relate
back to, and take effect as of, the date said written
request was signed whether or not the Annuitant be living at
the time of such endorsement or recording subject to the
rights of any Assignee of record with the Company and
subject to any payment made or action taken by the Company
before the written request for designation or change was
received at the Home Office.
At the death of the Owner during the Annuitant's lifetime,
the Contingent Owner, if any, will become the Owner, but if
no Contingent Owner is then living, ownership will pass to
the estate of the Owner.
ASSIGNMENT: No assignment of this contract will be binding
on the Company unless the assignment is in writing and filed
at the Home Office. The Company is not responsible for the
validity of any assignment.
FORM 1171 PAGE 3
7. BENEFICIARY DETERMINATION OF BENEFICIARY: The Beneficiary to receive
any death benefit will be designated on page 2 of this
contract, unless otherwise provided by endorsement at date
of issue or unless subsequently changed as provided below.
The relationship of the Beneficiary is the relationship to
the Annuitant, unless otherwise stated.
When any benefit becomes due by reason of the Annuitant's
death, the benefit will be paid equally to the Beneficiaries
then living in the following order (unless otherwise
provided):
(1) the primary Beneficiaries;
(2) the first contingent Beneficiaries, if any, provided
none of the primary Benefiaries are living;
(3) the second contingent Beneficiaries, if any, provided
none of the primary and first contingent Beneficiaries are
living.
If no Beneficiary be living at death of the Annuitant, the
death benefit will be paid to the Owner or the executors or
administrators of the Owner.
CHANGE OF BENEFICIARY: Any Beneficiary may be changed by the
Owner at any time during the Annuitant's lifetime by filing
a written request at the Home Office of the Company. Such
change will take effect only when endorsed upon this
contract or otherwise recorded as the Company may require,
but upon endorsement or recording the change will relate
back to, and take effect as of, the date said written
request was signed whether or not the Annuitant be living at
the time of such endorsement or recording, subject to the
rights of any Assignee of record with the Company and
subject to any payment made or action taken by the Company
before the written request for change was received at the
Home Office.
CLAIM OF CREDITORS: Any amount due any Beneficiary under
this contract will be exempt from the claims of creditors of
such Beneficiary to the extent permitted by law and may not
be assigned or withdrawn before becoming payable unless
otherwise agreed to by the Company.
8. SETTLEMENT Any death benefit becoming due is payable immediately upon
receipt at the Home Office of the Company of due proof of
death. If any settlement is not made by payment of a single
sum, a Supplementary Contract will be issued by the Company
which shall set forth the terms and conditions of payment.
In any settlement of this contract, by reason of death,
surrender or otherwise, the Company may require return of
this contract.
9. CASH SURRENDER The Owner may surrender this contract for its Cash
VALUE Surrender Value by written request at any time before the
commencement of annuity payments. The portion of the
contract in either Account may be surrendered, provided that
portion of the total Stipulated Payment allocated to the
other Account on the date of surrender was at least equal to
the minimum amount required by the Company under its usual
underwriting practices on that date.
The Cash Surrender Value will be computed on the Valuation
Date coincident with or next following the date written
request for surrender is received by the Company at the Home
Office, and any cash payment will be made within 7 days
thereafter except as the Company may be permitted to defer
such payment under the Investment Company Act of 1940, as in
effect at the time such request is received.
10. NONQUALIFICA- In the event that this contract fails to qualify as a
TION OF CONTRACT "qualified pension, profit sharing or annuity contract",
the Franklin shall have the right, upon receiving notice of
such fact, to transfer as of the date of receipt of such
notice, the portion of this contract in the Separate Account
to the General Account less a deduction for the appropriate
part attributable to this contract of any Federal income tax
payable by Franklin which would not have been payable if
this contract had been at all times a "qualified pension,
profit sharing or annuity contract." Thereafter, only fixed
dollar annuity or fixed dollar instalment benefits will be
available under any Settlement Option. The Franklin
reserves the right to require proof of this contract's
qualification under the Internal Revenue Code prior to
commencement of any variable annuity or variable instalment
benefit. "Qualified pension, profit sharing, or annuity
contract" means any contract in this form which implements
a plan or agreement which meets the requirements for
qualification under Sections 401 or 403(a) of said Code or
is being purchased under Section 403(b) for an employee by
an organization described in Section 501 (c) (3) and exempt
from taxation under Section 501 (a), or is being purchased
under Section 403 (b) for an employee by a public school
described in Sections 403 (b) (1) (A) (ii) and 151 (e) (4).
As used in this contract, all references to sections of the
Internal Revenue Code mean said sections as now or hereafter
amended, or any corresponding provisions of prior or
subsequent United States Revenue laws.
11. PROOF OF The Company shall have the right to require evidence of the
SURVIVAL survival of any payee at the time any payment to such Payee
is due.
12. NONPARTICI- This contract is nonparticipating and will not share in the
PATING surplus earnings of the Company.
13. VOTING RIGHTS The Owner shall have the right to vote at the meetings of
the Separate Account Contract Owners. Ownership of this
contract shall not entitle any person to vote at any meeting
of shareholders of the Company. Votes attributable to the
contract shall be cast in conformity with the provisions of
the Rules and Regulations of the Separate Account.
14. OWNERSHIP OF The Company shall have exclusive and absolute ownership
ASSETS AND and control of its assets, including all assets in the
DETERMINATION Separate Account. Determination by the Company of the
OF VALUES value of an Accumulation Unit and an Annuity Unit by
the method described in this contract will be conclusive
upon the Owner, the Annuitant, and any Beneficiary.
15. STIPULATED The Stipulated Payment is due on the date of issue and is
PAYMENT payable in advance.
16. NET STIPULATED The Net Stipulated Payment is equal to (a) 95% of the amount
PAYMENT obtained by deducting from the Stipulated Payment any
premium for additional benefits provided by Supplemental
Agreement attached to this contract, less (b) any premium
taxes on such Stipulated Payment and a contract service
charge of $100.
FORM 1171 PAGE 4
VALUATION PROVISIONS
17. ADDITIONAL Each month during the first 5 contract years, the Company
FIXED DOLLAR will increase the number of Fixed Dollar Annuity
ANNUITY Accumulation Units in the General Account by a number
ACCUMULATION which is equivalent to a 1% a year additional net
UNITS investment rate. Each month during the 6th to 10th contract
years, inclusive, the Company will increase the number
of Fixed Dollar Annuity Accumulation Units in the General
Account by a number which is equivalent to a 1/2% a year
additional net investment rate. By action of its Directors,
the Company may credit additional Fixed Dollar Annuity
Accumulation Units at any time.
18. NET INVESTMENT (a) The net investment rate for any Valuation Period
RATE AND NET for the General Account is guaranteed, and is
INVESTMENT equivalent to an investment rate of 3 1/2% compounded
FACTOR annually, except that, for benefits provided by the Fifth,
Sixth and Seventh Settlement Options it shall be 3%
compounded annually.
(b) The net investment rate for any Valuation Period for the
Separate Account is equal to the gross investment rate for
that Account for the period expressed in decimal form to 8
places less a deduction of .00003945 for each day of such
Valuation Period. Such gross investment rate is equal to
(i) the investment income for the Valuation Period, plus
capital gains and minus capital losses for the period,
whether realized or unrealized, on the assets of the
Separate Account less a deduction for any applicable taxes
arising from such income and realized and unrealized capital
gains attributable to the assets of the Separate Account,
divided by (ii) the value of the assets in the Separate
Account at the beginning of the Valuation Period. The gross
investment rate may be positive or negative.
(c) The net investment factor for each Account is the sum of
1.00000000 plus the net investment rate for the Account.
19. ACCUMULATION The value of both the Fixed Dollar Annuity Accumulation
UNIT VALUE Unit and the Separate Account Accumulation Unit was
established at $10.00 as of July 1, 1971. The value, of an
Accumulation Unit of either type on the last day of any
subsequent Valuation Period is determined by multiplying
such value on the last day of the immediately preceding
Valuation Period by the net investment factor for the
current Valuation Period. The value of an Accumulation Unit
as of any date other than a Valuation Date is equal to its
value as of the immediately following Valuation Date.
20. REPORTS TO The Company will send the Owner at least once in each
THE OWNER contract year after the first (a) a statement which
reflects the investment results for the preceding year, and
(b) a statement which reflects the value of the Accumulation
Units credited to the contract in all cases where the
contract provides for Cash Surrender Value.
SETTLEMENT PROVISIONS
21. GENERAL Subject to these provisions, the whole or any part (but in
CONDITIONS OF no case less than $2,000) of the proceeds due the Payee
SETTLEMENT in settlement of this contract may be made payable in
accordance with one of the following options, or in any
other manner that may be agreed upon with the Company.
Any election, or change or revocation thereof, must be
filed with the Company at its Home Office before
settlement has been made and shall be effective only when
attached hereto or endorsed hereon or otherwise recorded
as the Company may require. The Change of Beneficiary
provision under this contract shall apply to any election
or change of election of an option prior to settlement
date. If no election is in effect on the settlement
date, the Payee entitled to the proceeds may at that time
make such election. No settlement option will be
available without the consent of the Company if this
contract is assigned, or if the Payee is a corporation,
association, partnership, trustee or estate.
The Payee under a settlement option operative on or after
the death of the Annuitant shall be the Beneficiary during
the lifetime of such Beneficiary. The Payee under a
settlement option operative on or after surrender of this
contract shall be the Annuitant during the lifetime of such
Annuitant.
Any settlement of this contract in accordance with the first
paragraph on the face hereof, or under one of the first four
settlement options in provision 23, shall be subject to the
satisfactory proof of age of any Payee.
22. DATE OF The right to interest will accrue under the Seventh Option
PAYMENT in provision 23, and the first income payment will be
made under any other option as of the date when the proceeds
of this contract would otherwise be payable.
23. SETTLEMENT FIRST OPTION-Life Annuity- An annuity payable monthly
OPTIONS during the lifetime of the Payee, ceasing with the last
payment due prior to the death of the payee.
SECOND OPTION-Life Annuity with 120, 180 or 240 Monthly
Payments Guaranteed-An annuity payable monthly during the
lifetime of the Payee including the guarantee that if, at
the death of the Payee, payments have been made for less
than 120 months, 180 months or 240 months (as selected),
payments shall be continued during the remainder of the
selected period.
THIRD OPTION-Unit Refund Life Annuity-An annuity payable
monthly during the lifetime of the Payee, ceasing with the
last payment due prior to the death of the Payee; provided
that, at the death of the Payee, the Beneficiary will
receive an additional payment of the then dollar value of
the number of Annuity Units equal to the excess, if any, of
(a) over (b) where (a) is the total amount applied under the
option divided by the Annuity Unit value at the effective
date of the first annuity payment and (b) is the number of
Annuity Units represented by each payment multiplied by the
number of payments made.
FOURTH OPTION-Joint and Last Survivor Life Annuity-An
annuity payable monthly during the joint lifetime of the
Payee and a secondary Payee, and thereafter during the
remaining lifetime of the Survivor, ceasing with the last
payment prior to the death of the survivor.
FIFTH OPTION-Payments for a Designated Period-An amount
payable monthly for the number of years selected which may
be from 1 to 30 years.
FORM 1171 PAGE 5
SIXTH OPTION-Payments of a Specified Dollar Amount-The
amount due may be paid in equal annual, semiannual,
quarterly or monthly instalments of a designated dollar
amount (not less than $75. a year per $1,000 of the original
amount due) until the remaining balance is less than the
amount of one instalment. To determine the remaining
balance in either Account at the end of any valuation period
such balance at the end of the previous period is decreased
by the amount of any instalment paid during the period and
the result multiplied by the net investment factor for the
period. If the remaining balance at any time is less than
the amount of one instalment, such balance will be paid and
will be the final payment under the option.
SEVENTH OPTION-Investment Income-The amount due may be left
on deposit with the Company in its General Account and a sum
will be paid annually, semiannually, quarterly or monthly,
as selected, which shall be equal to the net investment rate
for the period multiplied by the amount remaining on
deposit.
24. ALLOCATION At the time election of one of the first 5 settlement
OF ANNUITY options is made, the person electing the option may
further elect to have the Cash Surrender Value (amount due)
applied to provide a variable annuity, a fixed dollar
annuity or a combination of both. Election of the Sixth
Option may specify that the net investment factor for the
Separate Account or the General Account is to apply or the
amount due may be split between the two Accounts. If no
election is made to the contrary, that portion of the amount
due from the Separate Account shall be applied to provide a
variable annuity and that portion of the amount due from the
General Account shall be applied to provide a fixed dollar
annuity. Election of the Seventh Option shall constitute
election of fixed income.
25. VARIABLE After the first monthly payment for a variable annuity has
ANNUITY been determined in accordance with provision 28, the
number of Separate Account Annuity Units is determined by
dividing that first monthly payment by the Separate Account
Annuity Unit value at the effective date of the first
annuity payment. Once variable annuity payments have begun,
the number of annuity units remains fixed. The method of
calculating the unit value is described in provision 27.
The dollar amount of the second and subsequent variable
annuity payments is not predetermined and may change from
month to month. The actual amount of each variable annuity
payment after the first is determined by multiplying the
number of Separate Account Annuity Units by the Separate
Account Annuity Unit Value, as described in provision 27,
for the date on which the payment is due.
The Company guarantees that the dollar amount of variable
annuity payments shall not be affected by variation in the
actual mortality experience of Payees from the mortality
assumption as used in determining the first monthly payment.
26. FIXED DOLLAR After the first monthly payment for a fixed dollar
ANNUITY annuity has been determined in accordance with provision
28, the number of Fixed Dollar Annuity Units is determined
by dividing the first monthly payment by the Fixed Dollar
Annuity Unit value. Such value will always equal $1.00.
Once fixed dollar annuity payments have begun, the number of
Annuity Units remain fixed. Although fixed dollar annuity
payments may never be less than the first monthly payment,
each payment certain after the first under the Second or
Fifth Option and the net investment rate applied under the
Sixth and Seventh Options may be increased as a result of
excess credits declared by the Board of Directors of the
Company.
27. ANNUITY UNIT The value of the Fixed Dollar Annuity Unit is fixed at
VALUE $1.00. The value of the Separate Account Annuity Unit for
July 1, 1971 was fixed at $1.00 and for each day thereafter
is determined by multiplying the value of the Separate
Account Annuity Unit on the preceding day by the Annuity
Change Factor for the Valuation Period ending on the 10th
preceding day or by 1.0 if no Valuation Period ended on the
10th preceding day. The Annuity Change Factor is equal to
the amount determined by dividing the net investment factor
for such Valuation Period by an amount equal to one, (1)
plus the interest rate for the number of calendar days in
such Valuation Period at the effective annual rate of
3 1/2%.
28. ANNUITY TABLES The Tables below show the dollar amount of the first
monthly payment for each $1,000 applied under the first 5
settlement options. Under the First, Second or Third
Options, the amount of each payment will depend upon the sex
of the Payee and the Payee's adjusted age at the time the
first payment is due. Under the Fourth Option, the amount
of each payment will depend upon the sex of both Payees and
their adjusted ages at the time the first payment is due.
Adjusted age is determined in accordance with the following
table:
CALENDAR YEAR OF BIRTH ADJUSTED AGE
Before 1900-------------------Actual Age increased by 1
1900-1919---------------------Actual Age
1920-1939---------------------Actual Age decreased by 1
1940-1959---------------------Actual Age decreased by 2
1960-1979---------------------Actual Age decreased by 3
After 1979--------------------Actual Age decreased by 4
Actual age, as used in the table above shall mean age
nearest birthday at the time the first payment is due.
If it would produce greater benefits, the Company agrees
that the first monthly payment to the Annuitant will be 103%
of the first monthly payment produced by a then currently
issued immediate annuity of the same form with a single
Stipulated Payment equal to the Cash Surrender Value which
is being applied under this contract.
29. MINIMUM No election of any settlement option may be made under the
PAYMENTS contract for any Payee unless such election would
produce a first payment of at least $25. to that Payee and
if a combination benefit is elected, no election may be made
unless the first payment from each Account would be $25. to
the Payee. If at any time any payments to be made to any
Payee from either Account are or become less than $25. each
the Company shall have the right to change the frequency of
payments to such interval as will result in the payment of
at least $25. or if any payment would be less than $25. a
year the Company may make such other settlement as may be
equitable to the Payee.
FORM 1171 PAGE 6
30. DESCRIPTION The tables for the First, Second, Third and Fourth
OF TABLES Options in provision 23 are based on the Progressive
Annuity Table assuming births in the year 1900 and a net
investment rate of 3 1/2% a year. The tables for the Fifth
Option are based on a net investment rate of 3% for the
General Account and 3 1/2% for the Separate Account.
31. PAYMENT OF If any Payee dies while receiving payments under a
GUARANTEED settlement option, the present values at the current
MONTHLY dollar amount, on the date of death, of any remaining
PAYMENTS guaranteed number of payments or any then remaining balance
of proceeds under the Sixth or Seventh Options, will be paid
in one sum to the executor or administrators of the Payee
unless other provision shall have been previously made and
approved by the Company. Calculations for such present
value of guaranteed payments remaining will assume a net
investment rate of 3%; a year in the General Account for the
Fifth Option and 3 1/2% a year for all other General Account
and all Separate Account options.
32. OPTION TO Upon written request by the Owner and any assignee and
BEGIN MONTHLY irrevocable beneficiary, the commencement of monthly
INCOME AT income may be deferred and this contract continued
LATER DATE until any contract anniversary after the Maturity Date
but not beyond the contract anniversary on which the
attained age of the Annuitant is 75. In the event of the
death of the Annuitant during the period during which
monthly income is deferred, the Company will, upon receipt
of due proof of such death, pay to the Beneficiary the Cash
Surrender Value on the Valuation Date coincident with or
next following the date written notice of death is received
by the Company.
33. SURRENDER When the income provided on page 1 hereof becomes payable,
CONTRACT FOR or when a settlement option shall become operative, this
SUPPLEMENTARY contract must be surrendered to the Company in exchange for
CONTRACT a supplementary contract which shall set forth the terms
and conditions of payment of such income or under such
settlement option.
FORM 1171 PAGE 7
AMOUNT OF FIRST MONTHLY PAYMENT
FOR EACH $1,000 OF NET TERMINATION VALUE
FIRST, SECOND AND THIRD OPTIONS - SINGLE LIFE ANNUITIES WITH:
Monthly
Payments Monthly Payments Monthly Payments
Adjusted Guaranteed Adjusted Guaranteed Adjusted Guaranteed
Age of Payee ----------- Age of Payee --------------------------- Unit Age of Payee --------------------------- Unit
Male Female 120 240 Male Female None 120 180 240 Refund Male Female None 120 180 240 Refund
20 24 $3.38 $3.37 40 44 $4.03 $3.98 60 64 $6.01 $5.79 $5.53 $5.13 $5.44
21 25 3.40 3.39 41 45 4.08 4.03 61 65 6.18 5.94 5.63 5.24 5.56
22 26 3.42 3.41 42 46 4.14 4.08 62 66 6.37 6.08 5.74 5.30 5.69
23 27 3.44 3.43 43 47 4.20 4.13 63 67 6.57 6.24 5.84 5.36 5.82
24 28 3.46 3.45 44 48 4.26 4.18 64 68 6.79 6.40 5.95 5.41 5.96
25 29 3.49 3.48 45 49 $4.34 4.32 $4.28 4.23 $4.21 65 69 7.02 6.57 6.05 5.46 6.11
26 30 3.51 3.50 46 50 4.42 4.39 4.35 4.28 4.27 66 70 7.27 6.74 6.15 5.51 6.27
27 31 3.54 3.53 47 51 4.49 4.46 4.41 4.34 4.33 67 71 7.54 6.91 6.26 5.55 6.43
28 32 3.57 3.55 48 52 4.57 4.53 4.48 4.40 4.39 68 72 7.83 7.10 6.35 5.59 6.60
29 33 3.60 3.58 49 53 4.65 4.61 4.55 4.46 4.46 69 73 8.14 7.28 6.45 5.62 6.80
30 34 3.63 3.61 50 54 4.74 4.69 4.62 4.52 4.53 70 74 8.48 7.47 6.54 5.65 6.98
31 35 3.66 3.64 51 55 4.84 4.78 4.70 4.58 4.60 71 75 8.84 7.66 6.62 5.68 7.20
32 36 3.69 3.67 52 56 4.94 4.87 4.78 4.65 4.67 72 76 9.23 7.85 6.70 5.70 7.43
33 37 3.73 3.71 53 57 5.04 4.97 4.87 4.71 4.76 73 77 9.65 8.04 6.77 5.71 7.65
34 38 3.77 3.74 54 58 5.16 5.07 4.95 4.78 4.84 74 78 10.11 8.23 6.83 5.72 7.90
35 39 3.80 3.78 55 59 5.28 5.18 5.04 4.85 4.93 75 79 10.61 8.41 6.88 5.72 8.18
36 40 3.84 3.82 56 60 5.40 5.29 5.13 4.91 5.02 76 80 8.58 5.72
37 41 3.89 3.85 57 61 5.54 5.41 5.23 4.98 5.12
38 42 3.93 3.90 58 62 5.69 5.53 5.33 5.05 5.22
39 43 3.98 3.94 59 63 5.84 5.66 5.43 5.11 5.33
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
Adjusted Age of Payee
Adjusted Age of -----------------------------------------------------------------------------------------------
Secondary Payee Male 45 Male 50 Male 55 Male 60 Male 65 Male 70
Male Female Female 49 Female 54 Female 59 Female 64 Female 69 Female 74 Male 75
36 40 $3.68 $3.73 $3.77 $3.80 $3.82 $3.83 $3.84
41 45 3.81 3.89 3.95 4.00 4.04 4.06 4.08
46 50 3.93 4.05 4.15 4.24 4.30 4.35 4.38
51 55 4.03 4.21 4.37 4.51 4.62 4.70 4.76
56 60 4.13 4.35 4.58 4.80 4.99 5.14 5.25
61 65 4.20 4.47 4.78 5.09 5.39 5.65 5.86
66 70 4.25 4.57 4.94 5.36 5.81 6.23 6.60
71 75 4.29 4.64 5.07 5.59 6.19 6.83 7.45
76 80 --- 4.68 5.15 5.75 6.50 7.37 8.33
81 85 --- 4.71 5.21 5.87 6.72 7.81 9.13
The monthly payment for any combination of ages not shown will be quoted upon
request.
FIFTH OPTION - PAYMENTS FOR A DESIGNATED PERIOD
Amount of Amount of Amount of
Years of Monthly Payment Years of Monthly Payment Years of Monthly Payment
Payment Gen. Acct. Sep. Acct. Payment Gen. Acct. Sep. Acct. Payment Gen. Acct. Sep. Acct.
1 $84.47 $84.65 11 $8.86 $9.09 21 $5.32 $5.56
2 42.86 43.05 12 8.24 8.46 22 5.15 5.39
3 28.99 29.19 13 7.71 7.94 23 4.99 5.24
4 22.06 22.27 14 7.26 7.49 24 4.84 5.09
5 17.91 18.12 15 6.87 7.10 25 4.71 4.96
6 15.14 15.35 16 6.53 6.76 26 4.59 4.84
7 13.16 13.38 17 6.23 6.47 27 4.47 4.73
8 11.68 11.90 18 5.96 6.20 28 4.37 4.63
9 10.53 10.75 19 5.73 5.97 29 4.27 4.53
10 9.61 9.83 20 5.51 5.75 30 4.18 4.45
FORM 1170-1171 PAGE 8
THE FRANKLIN LIFE INSURANCE COMPANY
A Brief Description of This Contract
This is a Single Payment Deferred Variable Annuity or Variable and Fixed Annuity
Contract. A death benefit is payable before Maturity Date. Income is payable
for life, first payment at Maturity Date. Income is payable for life, first
payment at Maturity Date.
ALL INCOME PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT,
WHEN BASED ON INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT,
ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
FORM 1171