Exhibit 5(c)
THE FRANKLIN LIFE
INSURANCE COMPANY
Springfield, Illinois
A LEGAL RESERVE STOCK COMPANY
Contract Number 1234567
Date of Issue DECEMBER 1, 1970
Name of Annuitant BENJAMIN FRANKLIN 65 Age
Total Purchase Price $10,000.00 $5,000.00 For Fixed Dollar Annuity Payment
$5,000.00 For Separate Account Annuity Units
Amount of Fixed Dollar
Annuity $32.99
Number of Separate Account
Annuity Units 32.994
Frequency of Income Payments MONTHLY
Date of First Income Payment JANUARY 1, 1971
The Franklin Life Insurance Company agrees to pay the Annuitant income
payments with the frequency shown above, the first payment to be made on the
date shown above, if the Annuitant is then living, and to continue such payments
so long as the Annuitant shall live. The dollar amount of each payment shall be
determined as provided in provision 2.
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 Life Annuity. Income is payable for the lifetime of
the Annuitant. The contract is nonparticipating.
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 1172
1. GENERAL 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) "Income Payment" means the sum of the variable annuity payment and the
fixed dollar annuity payment;
(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) "Valuation Date" means the date as of which the Separate Account Net
Investment Rate is determined;
(g) "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;
(h) "Separate Account Annuity Unit" means a unit used to determine the
amount of each variable annuity payment. (See provision 4 dealing
with Separate Account Annuity Unit values.)
(i) "Written Request" means a written request satisfactory to the Company,
filed at its Home Office in Springfield, Illinois.
2. DETERMINATION OF THE AMOUNT OF INCOME PAYMENT-
(a) VARIABLE ANNUITY-The dollar amount of the Variable Annuity Payment is
not predetermined and may change from one payment to the next. The
actual amount of any such payment is determined by multiplying the
number of Separate Account Annuity Units shown on page 1 by the
Separate Account Annuity Unit value, determined as described in
provision 4, for the date on which the payment is due.
The Company guarantees that the dollar amount of each payment shall
not be affected by variations in mortality experience from mortality
assumptions on which the first payment is based.
(b) FIXED DOLLAR ANNUITY-Fixed Dollar Annuity payments remain fixed as to
dollar amount throughout the payment period. The dollar amount is as
stated on page 1.
3. SEPARATE ACCOUNT NET INVESTMENT RATE AND NET INVESTMENT FACTOR-The Separate
Account net investment rate for any Valuation Period is equal to the gross
investment rate 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 assets in the Separate Account at the beginning of the
Valuation Period. The gross investment rate may be positive or negative.
The net investment factor for the Separate Account is 1.00000000 plus the
Separate Account net investment rate for the period.
4. SEPARATE ACCOUNT ANNUITY UNIT VALUE-The value of a Separate Account Annuity
Unit on July 1, 1971 was established 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%.
5. CONSIDERATION-ENTIRE CONTRACT-This contract has been issued in
consideration of the application and of the payment of the Purchase Price.
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.
6. 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.
7. MODIFICATION OF CONTRACT-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.
8. OWNER-The Owner of this contract will be the Annuitant 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.
9. 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.
10. 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 1172 PAGE 2
11. 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.
12. 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
Purchase Price 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 benefits falling due after adjustment, with compound interest
at 5.7% a year in advance.
13. EVIDENCE THAT ANNUITANT IS LIVING-The Company shall as a condition of each
payment to the Annuitant have the right to require satisfactory evidence
that the Annuitant is living on the due date of such income payment.
14. TERMINATION OF CONTRACT-On the death of the Annuitant, this contract shall
immediately cease and become void. The annuity herein provided shall
teminate with the last regular payment preceding said death, and there
shall be no payment due for time elapsed since the due date of the last
regular payment.
15. NONPARTICIPATING-This contract is nonparticipating and will not share in
the surplus earnings of the Company.
16. VOTING RIGHTS-The Owner shall have the right to vote only 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.
17. OWNERSHIP OF ASSETS AND DETERMINATION OF VALUES-The Company shall have
exclusive and absolute ownership and control of its assets, including all
assets in the Separate Account. Determination by the Company of the value
of a Separate Account Annuity Unit by the method described in this contract
will be conclusive upon the Owner and the Annuitant.
FORM 1172 PAGE 3
THE FRANKLIN LIFE INSURANCE COMPANY
A BRIEF DESCRIPTION OF THIS CONTRACT
This is a Single Payment Life Annuity. Income is payable for the lifetime of
the Annuitant. The contract is nonparticipating.
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 1172