Individual Fixed Premium Deferred Variable Annuity Contract ...
Individual Fixed Premium Deferred Variable Annuity Contract ...
Individual Fixed Premium Deferred Variable Annuity Contract ...
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Date: 9/28/07As adopted by the IIPRC<strong>Contract</strong> Form SpecificationsAPPENDIX A-1<strong>Fixed</strong> <strong>Premium</strong> <strong>Deferred</strong> Non-<strong>Variable</strong> and General Account of <strong>Fixed</strong> <strong>Deferred</strong> <strong>Variable</strong> <strong>Annuity</strong>Demonstration of Nonforfeiture Law Compliance – Retrospective TestIssue Age: 60 Minimum Nonforfeiture Interest Rate: 3.00%Minimum <strong>Contract</strong> Guaranteed Interest Rate(s): 4.00%Surrender Charge Type:% <strong>Contract</strong> Measure Surrender Charges From:Issue DateValue% <strong>Premium</strong> <strong>Premium</strong> Payment DateNoneFree Withdrawal Type: <strong>Contract</strong> Value Free Withdrawal %: 10.00%Accumulated Interest<strong>Premium</strong>s Paid<strong>Contract</strong> Loads—-> % <strong>Premium</strong>: 5.00% Per <strong>Contract</strong>: $30.00 Per Payment: $2.50<strong>Contract</strong>Year1••••<strong>Contract</strong> Year<strong>Premium</strong>Guaranteed<strong>Contract</strong>Value EOYSurrenderChargePercentSurrenderCharge(A)GuaranteedCashValue EOY(B)NF LawMinimumCash Value EOYExcess(A)-(B)<strong>Contract</strong>Year1••••<strong>Contract</strong> Year<strong>Premium</strong>Guaranteed<strong>Contract</strong>Value EOYSurrenderChargePercentSurrenderCharge(A)GuaranteedCashValue EOY(B)NF LawMinimumCash Value EOYExcess(A)-(B)© IIPRC 22
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