Individual Fixed Premium Deferred Variable Annuity Contract ...

Date: 9/28/07As adopted by the IIPRCM. MATURITY DATE(1) The contract may provide the owner with the right to change the maturity date. If the contractincludes such a right and is intended to be tax qualified, the provision shall contain sufficientlatitude to allow the contract to continue to be tax qualified.(2) The latest maturity date, if any, shall be defined in the contract.N. MISSTATEMENT OF AGE OR SEX(1) The contract shall contain a misstatement of age provision or, if the contract is written on a sexdistinct basis a misstatement of age or sex provision, providing that the amount payable shall besuch as the premium payments to the company would have purchased at the correct age or thecorrect age and sex.(2) Any overpayments/underpayments by the company on account of misstatement of age or sexshall, with interest at a rate specified in the contract but not exceeding 6%, be charged/creditedagainst the current or next succeeding payments to be made by the company.(3) If there is more than one annuitant, the misstatement provision may provide that the amountpayable may be adjusted due to the misstatement in the age or the age or sex, as appropriate, ofany annuitant.O. NONFORFEITURE VALUES(1) If the contract contains a general account, the contract shall contain provisions applicable to thegeneral account at least as favorable to the owner as the following:(a)(b)(c)(d)(e)A provision that upon cessation of payment of considerations under the contract, thecompany will grant a paid-up annuity benefit as specified in the contract.If the contract provides for a lump sum settlement at maturity or at any other time, aprovision that upon surrender of the contract at or prior to the commencement of anyannuity payments, the company will pay in lieu of a paid-up annuity benefits a cashsurrender benefit.A statement of the mortality table, if any, and interest rates used in calculating anyminimum paid-up annuity, cash surrender or death benefits that are guaranteed under thecontract, together with sufficient information to determine the amounts of such benefits.The sufficient information includes all expense, partial withdrawal and surrender charges.A statement that any paid-up annuity, cash surrender or death benefits that may beavailable under the contract are not less than the minimum benefits required by Section 7of the Model Variable Annuity Regulation, model #250.An explanation of the manner in which the paid-up annuity, cash surrender or deathbenefits are altered by the existence of any additional amounts credited by the company© IIPRC 13