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Individual Fixed Premium Deferred Variable Annuity Contract ...

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Date: 9/28/07As adopted by the IIPRCINDIVIDUAL FIXED PREMIUM DEFERRED VARIABLEANNUITY CONTRACT STANDARDS(WITH SEPARATE AND GENERAL ACCOUNTS)Scope: These standards apply to an individual deferred variable annuity contract that provides for fixedpremium payments as specified and provides for funds to be held in separate and general accounts. Thestandards do not apply to an individual deferred variable annuity contract that provides for indexing,bonuses, guaranteed death benefits, guaranteed living benefits or other guarantees for the separateaccount funds.Although references to “age” or “annuitant” are being made in these standards, it does not preclude thecontract from having more than one annuitant.As used in these standards the following definitions apply:“Account value” is the total amount of premium paid, reduced by specified charges and expenses, at noless than the guaranteed minimum interest rate.“Cash surrender value” is the cash value reduced by indebtedness.“Cash value” is the account value less any surrender charges.Drafting Notes:Other terms may be used in the contract provided they are consistent.Although references to “age” or “annuitant” are being made in these standards, such references do notpreclude the contract from having more than one annuitant.The references to “contract” do not preclude Fraternal Benefit Societies from substituting “certificate” intheir forms.§1. ADDITIONAL SUBMISSION REQUIREMENTSThe following additional filing submission requirements shall apply:(1) All forms filed for approval shall be included with the filing. Changes to a previously approvedform shall be highlighted. The specifications page of a contract shall be completed withhypothetical data that is realistic and consistent with the other contents of the contract and anyrequired actuarial memorandum in support of nonforfeiture values.(2) If a filing is being submitted on behalf of a company, a letter or other document authorizing thefirm to file on behalf of the company shall be included with the filing.(3) If the filing contains an insert page, an explanation of when the insert page will be used shouldbe included in the filing.© IIPRC 2

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