See All of This Company's Exhibits
EX-99.D.1
2
c66903exv99wdw1.txt
COPY OF FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
RIVERSOURCE LIFE INSURANCE CO. OF NEW YORK
20 Madison Avenue Extension [LOGO]
Box 5144
Albany, New York 12205
1-800-541-2251
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
POLICY CONTINUES UNTIL DEATH, SURRENDER, OR LAPSE.
DEATH BENEFIT PAYABLE AT INSURED'S DEATH.
FLEXIBLE PREMIUMS PAYABLE AS PROVIDED HEREIN. BENEFITS, VALUES AND PERIODS
OF COVERAGE ARE BASED ON ACTUAL PREMIUMS PAID, INTEREST CREDITED,
INVESTMENT PERFORMANCE OF THE SUBACCOUNTS AND CHARGES. INTEREST RATES AND
CHARGES ARE SUBJECT TO CHANGE BY US AS DESCRIBED HEREIN.
NO-LAPSE GUARANTEES AS DESCRIBED HEREIN.
THIS POLICY IS NONPARTICIPATING. DIVIDENDS ARE NOT PAYABLE.
INSURED: John Doe
POLICY DATE: July 15, 2012
INITIAL SPECIFIED AMOUNT: $1,000,000
This is a life insurance policy. It is a legal contract between You, as the
owner, and Us, RiverSource Life insurance Co. of New York, A Stock Company,
Albany, New York.
PLEASE READ YOUR POLICY CAREFULLY.
In consideration of Your application and payment of the initial premium We issue
this policy and We promise to pay the death benefit less Indebtedness described
in this policy to the beneficiary if We receive proof satisfactory to Us that
the Insured died while this policy was In Force. (See "Death Benefits" on page
13.)
The owner and the beneficiary are as named in the application unless they are
changed as provided for in this policy.
THE AMOUNT AND DURATION OF THE DEATH BENEFIT OF THIS POLICY MAY INCREASE OR
DECREASE AS DESCRIBED HEREIN DEPENDING ON THE INVESTMENT EXPERIENCE OF THE
SUBACCOUNTS.
THE POLICY VALUE OF THIS POLICY MAY INCREASE OR DECREASE DAILY DEPENDING ON THE
INVESTMENT EXPERIENCE OF THE SUBACCOUNTS. THERE IS NO GUARANTEED MINIMUM POLICY
VALUE.
POLICY NUMBER: 9790-1234567
ISSUE AGE: 35
INITIAL DEATH BENEFIT OPTION: Option 1
NOTICE OF YOUR RIGHT TO EXAMINE THIS POLICY
If for any reason You are not satisfied with this policy, return it to Us or Our
representative within 10 days after You receive it. If this policy is intended
to replace an existing policy, Your right to examine is extended to 60 days. We
will then cancel this policy and refund all premiums, less Indebtedness, which
You have paid. This policy will then be considered void from its start.
Signed for and issued by RiverSource Life Insurance Co. of New York in Albany,
New York, as of the Policy Date shown above.
PRESIDENT:
[SIGNATURE]
SECRETARY:
[SIGNATURE]
GUIDE TO POLICY PROVISIONS
POLICY DATA Premium Information; Interest and Loan Information; Fees and Deductions; Table of Surrender Charges;
Policy Value Credit; Life Insurance Qualification Test; Schedule of Benefits and Riders; Investment
Options; Initial Premium Allocations; Payment of Policy Proceeds Option Tables; CSO Mortality Table
/ Page 3
DEFINITIONS Important words and meanings / Page 4
THE INSURANCE CONTRACT Entire Contract; Policy Incontestability; Suicide Exclusion; Misstatement of Insured's Age or Sex;
Voting Rights; Policy Termination; Tax Treatment of this Policy; Exchange of this Policy / Page 6
OWNER AND BENEFICIARY Your Rights as Owner of this Policy; Successor Owner; Changing Ownership of this Policy; Proceeds
Paid to the Beneficiary upon Death of the Insured; Charitable Gift Amount Beneficiary; Change of
Beneficiary by Owner; Change of Charitable Gift Amount Beneficiary; Assigning this Policy as
Collateral / Page 8
PREMIUMS Premium Payments; Initial Premium; Scheduled Premium; Unscheduled
Premium Payments; Restrictions of Premium Payments; Premium
Processing; Grace Period; Minimum Initial Premium Guarantee; No-Lapse
Guarantee; Reinstatement / Page 10
DEATH BENEFITS Death Benefit Prior to or on the Insured's Attained Insurance Age 120 Anniversary; Death Benefit
Options; Death Benefit After the Insured's Attained Insurance Age 120 Anniversary; Proceeds Payable
at Insured's Death; Life Insurance Qualification Test; Disclosure / Page 14
POLICY CHANGE Request to Change Benefits; Rules for Changing the Specified Amount; Decreases of the Specified
Amount; Increases of the Specified Amount; Changes to the Death Benefit Option / Page 16
POLICY VALUES Policy Value; Fixed Account Value; Variable Account Value; Monthly Deduction; Policy Fee;
Administrative Charge; Cost of Insurance; Mortality and Expense Risk Charge; Basis Used for Policy
Values; Policy Value Credit; Receiving Information About the Values of this Policy; Paid-Up Option /
Page 17
POLICY SURRENDER Policy Surrender; Partial Surrender; Rules for a Partial Surrender; Payment of a Surrender / Page 21
POLICY LOANS Borrowing Money on this Policy; Maximum Loan Value of this Policy; Interest Rate for a Policy Loan;
Loan Repayment; Failure to Repay a Loan; Payment of a Loan / Page 22
SUBACCOUNTS Investments of the Subaccounts; Subaccount Value; Subaccount Accumulation Units; Subaccount
Accumulation Unit Value; Determination of Net Investment Factor; Change of Investments of the
Subaccounts; Transfers Among the Subaccounts and the Fixed Account; Subaccount Transfer at the
Insured's Attained Insurance Age 120 Anniversary / Page 23
PAYMENT OF POLICY Payment of Proceeds upon Death of the Insured; Payment Options Other Than a Single Sum; Option A -
PROCEEDS Interest Payments; Option B - Payments for a Specified Period; Option C - Lifetime Income;
Beneficiary Request of Payment Option / Page 25
2
POLICY DATA
Insured: John Doe Issue Age: 35
Risk Classification: Male Standard Nontobacco
Policy Number: 9790- 1234567 Policy Date: July 15, 2012
Type of Policy: Flexible Premium Variable Monthly Date: 01
Adjustable Life
RiverSource VUL 5 Initial Specified Amount: $ 1,000,000
Estate Series
Minimum Specified Policy Year 1: $ 100,000 Initial Death
Amount Allowed: Years 2 - 5: 75,000 Benefit Option: Option 1
Years 6 - 10: 50,000
Years 11 - 15: 25,000 Life Insurance Cash Value
Thereafter: 1,000 Qualification Test: Accumulation Test
NY STATE INSURANCE DEPARTMENT TELEPHONE NUMBER: 1-800-342-3736
PREMIUM INFORMATION
Initial Premium: $ 45.84 Scheduled Premium: $1,100.00 per year
payable annually
Minimum Initial No-lapse Guarantee
Premium: $45.84 per month Premium: $86.34 per month
Minimum Initial No-lapse Guarantee
Premium Period: 1 Years Period: 40 Years
Coverage will expire prior to death if no premiums are paid following payment of
the initial premium, or subsequent premiums are insufficient to continue
coverage. Coverage will expire when the policy values are insufficient to pay
the charges assessed on a monthly anniversary. The period for which the policy
and coverage will continue In Force will depend on; 1) the amount, timing and
frequency of premium payments; 2) changes in the specified amount and death
benefit option; 3) changes in the interest rates credited to the Fixed Account
and in the investment performance of the Subaccounts; 4) changes in the monthly
cost of insurance deductions from the Policy Value for this policy and any
riders attached to this policy; 5) changes in the premium expense charge,
administrative charge, mortality and expense risk rate and policy fee; and 6)
loan and partial surrender activity. The payment of scheduled premiums or
unscheduled premiums in any amount or frequency will not guarantee that the
policy will remain In Force unless the premiums needed to keep the minimum
initial premium or the no-lapse guarantee in effect have been paid. At the end
of the minimum initial premium period or the no-lapse guarantee period, the Cash
Surrender Value may not be sufficient to keep this policy In Force without
payment of additional premium. THE PREMIUM REQUIRED TO KEEP THIS POLICY IN FORCE
MAY BE HIGHER THAN THE PREMIUMS REQUIRED FOR THE MINIMUM INITIAL PREMIUM OR THE
NO-LAPSE GUARANTEE. AN ADDITIONAL LUMP SUM PREMIUM MAY BE REQUIRED TO KEEP THE
POLICY IN FORCE AT THE TERMINATION OF THE NO-LAPSE GUARANTEE PERIOD. YOU MAY
CONTACT US FOR ADDITIONAL INFORMATION.
Page 3
Important Information
Cost of insurance rates may be changed based on Our expectations of mortality,
reinsurance costs, future investment earnings, persistency, expenses, and/or
federal and state tax assumptions. Any change will apply to all individuals of
the same risk classification as the Insured. The cost of insurance rates will
never exceed the Guaranteed Maximum Monthly Cost of Insurance Rates as shown in
this policy.
Additional amounts credited to the policy value are not guaranteed and We have
the right to change interest rates, the premium expense charge, cost of
insurance rates, the administrative charge, the mortality and expense risk rate
and the policy fee. Interest rates will never be less than the Guaranteed
Interest Rate shown in this policy. The premium expense charge will never exceed
the Guaranteed Premium Expense Charge shown in this policy. The administrative
charge will never exceed the Guaranteed Administrative Charge shown in this
policy. The policy fee will never exceed the Guaranteed Policy Fee shown in this
policy. The mortality and expense risk rate will never exceed the Guaranteed
Mortality and Expense Risk Rate shown in this policy.
Any changes in interest rates, the premium expense charge, cost of insurance
rates, the administrative charge, the mortality and expense risk rate and the
policy fee may require more premiums to be paid than was illustrate or the
policy values may be less than those illustrated.
Page 3A
INTEREST AND LOAN INFORMATION
Fixed Account
Guaranteed Interest Rate: 2% per year
Guaranteed Interest Rate Factor 1.0016515813
Guaranteed Loan
Interest Rate
All Policy Years: 4 %
The interest rate applied to the portion of the policy value which equals any
Indebtedness due Us will be the Fixed Account Guaranteed Interest Rate.
FEES AND DEDUCTIONS
Maximum Guaranteed Premium Expense Charge
All Policy Years: 4%
Maximum Guaranteed Administrative Charge
Policy Years 1-20: $ 13.70 per month
Policy Years 21+: $ 13.70 per month
Maximum Guaranteed Mortality and Expense Risk Rate:
All policy years: 0.60% per year
Maximum Guaranteed Policy Fee
All Policy Years: $15.00 per month
Partial Surrender Fee:
$25 or 2% of amount
surrendered, whichever
is less
TABLE OF SURRENDER CHARGES
Policy Year Beginning of Year
-------------------------- -----------------
1 $ 2,095.63
2 2,019.23
3 1,942.83
4 1,866.43
5 1,790.03
6 1,691.33
7 1,347.33
8 1,003.33
9 659.33
10 315.33
This table applies to the initial Specified Amount for the first 10 policy
years. Surrender charges decrease evenly at each Monthly Date between Policy
Anniversaries. Additional surrender charges will apply to each increase in
specified amount for the amount of the increase for 10 years after the effective
date of increase.
POLICY VALUE CREDIT
POLICY VALUE CREDIT REQUIREMENTS
To receive any available credit the following conditions must be met:
1. the policy has been In Force for at least 10 years; and
2. the sum of the premiums paid, minus partial surrenders and partial
surrender fees, minus outstanding Indebtedness equals or exceeds
$500,000.
Page 3B
LIFE INSURANCE QUALIFICATION TEST: CASH VALUE ACCUMULATION TEST
DEATH BENEFIT PERCENTAGE TABLE
Insured's Insured's Insured's
Attained Death Attained Death Attained Death Insured's Death
Insurance Benefit Insurance Benefit Insurance Benefit Attained Benefit
Age Percentage Age Percentage Age Percentage Insurance Age Percentage
------------ ----------- --------- ---------- --------- ----------- ------------- -----------
0 16.26 25 6.91 50 2.94 75 1.47
1 15.87 26 6.68 51 2.84 76 1.44
2 15.38 27 6.46 52 2.75 77 1.41
3 14.87 28 6.25 53 2.66 78 1.38
4 14.35 29 6.04 54 2.58 79 1.35
5 13.84 30 5.83 55 2.50 80 1.33
6 13.34 31 5.64 56 2.42 81 1.31
7 12.86 32 5.45 57 2.35 82 1.28
8 12.39 33 5.26 58 2.28 83 1.26
9 11.95 34 5.08 59 2.21 84 1.25
10 11.51 35 4.90 60 2.15 85 1.23
11 11.09 36 4.73 61 2.08 86 1.21
12 10.70 37 4.57 62 2.02 87 1.20
13 10.32 38 4.41 63 1.97 88 1.18
14 9.96 39 4.26 64 1.92 89 1.17
15 9.61 40 4.12 65 1.86 90 1.16
16 9.29 41 3.98 66 1.82 91 1.15
17 8.98 42 3.84 67 1.77 92 1.14
18 8.70 43 3.71 68 1.73 93 1.13
19 8.42 44 3.59 69 1.68 94 1.12
20 8.15 45 3.47 70 1.64 95 1.10
21 7.89 46 3.35 71 1.60 96 1.09
22 7.63 47 3.24 72 1.57 97 1.08
23 7.38 48 3.14 73 1.53 98 1.06
24 7.14 49 3.03 74 1.50 99 1.04
100-119 1.01
Page 3C
SCHEDULE OF BENEFITS AND RIDERS
Monthly
Effective Date Expiration Date Cost of Insurance
--------------- --------------------- -----------------
Flexible Premium Variable May 1, 2012 See policy form See policy form
Adjustable Life
Waiver of Specified Premium See Policy Data Supplemental Page for information on this rider
and/or Waiver of Monthly
Deduction Rider for Total
Disability
Automatic Increase July 15, 2012 July 15, 2042 See rider form
Benefit Rider:
Increase Percentage: 5%
Maximum Increase Amount $ 25,000
Total Increase Limit: $ 100,000
Children Level Term July 15, 2012 July 15, 2042 $.58 per unit
Insurance Rider - 10 Units
with Waiver of Monthly
Deduction
(1 Unit = $1,000)
Accidental Death Benefit July 15, 2012 July 15, 2047 $3.50
Rider - $50,000
Accelerated Benefit Rider July 15, 2012 See rider form See rider form
for Terminal Illness
Overloan Protection
Benefit* July 15, 2012 See benefit form Not applicable
Minimum Age: 75
Maximum Age 95
Minimum Policy Duration 15 Years
Indebtedness Percentage: 95%
Maximum Exercise Charge 3%
* When exercised, a one time charge will be assessed, not to exceed the
Maximum Exercise Charge shown above.
Page 3D
INVESTMENT OPTIONS INITIAL PREMIUM ALLOCATIONS
---------------------------------------------------------------------------------- ------------------------------
RiverSource Life Insurance Co. of New York Fixed Account 20%
INVESTMENTS OF THE SUBACCOUNTS:
AllianceBernstein VPS Large Cap Growth Portfolio (Class B) 0%
American Century VP Value, Class II 0%
BlackRock Global Allocation V.I. Fund (Class III) 0%
Columbia Variable Portfolio - Balanced Fund (Class 3) 0%
Columbia Variable Portfolio - Cash Management Fund (Class 2) 0%
Columbia Variable Portfolio - Diversified Bond Fund (Class 2) 0%
Columbia Variable Portfolio - Diversified Equity Income Fund (Class 2) 0%
Columbia Variable Portfolio - Dynamic Equity Fund (Class 2) 0%
Columbia Variable Portfolio - Emerging Markets Opportunity Fund (Class 2) 0%
Columbia Variable Portfolio - Global Bond Fund (Class 2) 0%
Columbia Variable Portfolio - Global Inflation Protected Securities Fund (Class 2) 0%
Columbia Variable Portfolio - High Income Fund, Class 2 0%
Columbia Variable Portfolio - High Yield Bond Fund (Class 2) 10%
Columbia Variable Portfolio - Income Opportunities Fund (Class 2) 50%
Columbia Variable Portfolio - International Opportunity Fund (Class 2) 20%
Columbia Variable Portfolio - Large Cap Growth Fund (Class 2) 0%
Columbia Variable Portfolio - Limited Duration Credit Fund (Class 2) 0%
Columbia Variable Portfolio - Marsico International Opportunities Fund, Class 2 0%
Columbia Variable Portfolio - Mid Cap Growth Opportunity Fund (Class 2) 0%
Columbia Variable Portfolio - Mid Cap Value Opportunity Fund (Class 2) 0%
Columbia Variable Portfolio - S&P 500 Index Fund (Class 3) 0%
Columbia Variable Portfolio - Select Large-Cap Value Fund (Class 2) 0%
Columbia Variable Portfolio - Select Smaller-Cap Value Fund (Class 2) 0%
Columbia Variable Portfolio - Short Duration U.S. Government Fund (Class 2) 0%
Columbia Variable Portfolio - Strategic Income Fund, Class 2 0%
DWS Alternative Asset Allocation VIP, Class B 0%
Fidelity(R) VIP Contrafund(R) Portfolio Service Class 2 0%
Fidelity(R) VIP Mid Cap Portfolio Service Class 2 0%
FTVIPT Franklin Small Cap Value Securities Fund - Class 2 0%
FTVIPT Mutual Shares Securities Fund - Class 2 0%
Janus Aspen Series Janus Portfolio: Service Shares 0%
Janus Aspen Series Moderate Allocation Portfolio: Service Shares 0%
MFS(R) Utilities Series - Service Class 0%
Morgan Stanley UIF Mid Cap Growth Portfolio, Class II Shares 0%
Neuberger Berman Advisers Management Trust Socially Responsive Portfolio (Class S) 0%
Oppenheimer Global Securities Fund/VA, Service Shares 0%
Oppenheimer Main Street Small- & Mid-Cap Fund(R)/VA, Service Shares 0%
PIMCO VIT All Asset Portfolio, Advisor Share Class 0%
PIMCO VIT Global Multi-Asset Portfolio, Advisor Share Class 0%
Variable Portfolio - Aggressive Portfolio (Class 2) 0%
Variable Portfolio - American Century Diversified Bond Fund (Class 2) 0%
Page 3E
INVESTMENT OPTIONS INITIAL PREMIUM ALLOCATIONS
---------------------------------------------------------------------------------- ------------------------------
INVESTMENTS OF THE SUBACCOUNTS:
Variable Portfolio - American Century Growth Fund (Class 2) 0%
Variable Portfolio - Columbia Wanger International Equities Fund (Class 2) 0%
Variable Portfolio - Columbia Wanger U.S. Equities Fund (Class 2) 0%
Variable Portfolio - Conservative Portfolio (Class 2) 0%
Variable Portfolio - Davis New York Venture Fund (Class 2) 0%
Variable Portfolio - DFA International Value Fund (Class 2) 0%
Variable Portfolio - Eaton Vance Floating-Rate Income Fund (Class 2) 0%
Variable Portfolio - Goldman Sachs Mid Cap Value Fund (Class 2) 0%
Variable Portfolio - Invesco International Growth Fund (Class 2) 0%
Variable Portfolio - J.P. Morgan Core Bond Fund (Class 2) 0%
Variable Portfolio - Jennison Mid Cap Growth Fund (Class 2) 0%
Variable Portfolio - Marsico Growth Fund (Class 2) 0%
Variable Portfolio - MFS Value Fund (Class 2) 0%
Variable Portfolio - Moderate Portfolio (Class 2) 0%
Variable Portfolio - Moderately Aggressive Portfolio (Class 2) 0%
Variable Portfolio - Moderately Conservative Portfolio (Class 2) 0%
Variable Portfolio - Morgan Stanley Global Real Estate Fund (Class 2) 0%
Variable Portfolio - NFJ Dividend Value Fund (Class 2) 0%
Variable Portfolio - Nuveen Winslow Large Cap Growth Fund (Class 2) 0%
Variable Portfolio - Partners Small Cap Growth Fund (Class 2) 0%
Variable Portfolio - Partners Small Cap Value Fund (Class 2) 0%
Variable Portfolio - PIMCO Mortgage-Backed Securities Fund (Class 2) 0%
Variable Portfolio - Pyramis(R) International Equity Fund (Class 2) 0%
Variable Portfolio - Wells Fargo Short Duration Government Fund (Class 2) 0%
Wells Fargo Advantage VT Opportunity Fund - Class 2 0%
Wells Fargo Advantage VT Small Cap Growth Fund - Class 2 0%
Page 3E
PAYMENT OF POLICY PROCEEDS OPTION TABLES
OPTION A INTEREST RATE
Option A Interest Rate 1%
Interest in excess of the Option A Interest Rate may be applied by Us. Excess
interest will be determined by Us based on Our expectations of future investment
earnings.
OPTION B TABLE
Number Monthly
of Years Payment/$1000
----------------------------- -------------
10 9.18
15 6.42
20 5.04
25 4.22
30 3.68
The table above is based on an interest rate of 2.00%
OPTION C TABLE
M = MALE F = FEMALE
LIFE INCOME PER $1,000 WITH
PAYMENTS GUARANTEED FOR
Settlement 5 Years 10 Years 15 Years
Age Beginning ------------------ ------------------ ------------------
Payee In Year M F M F M F
---------- ---------- ------- ------ ------ -------- --------- -------
65 2015 4.54 4.10 4.46 4.06 4.31 3.99
2025 4.39 3.97 4.32 3.94 4.19 3.88
2035 4.25 3.86 4.19 3.84 4.08 3.79
75 2015 6.41 5.77 5.99 5.53 5.39 5.14
2025 6.13 5.52 5.78 5.33 5.27 5.01
2035 5.88 5.30 5.59 5.15 5.16 4.88
85 2015 9.63 9.02 7.85 7.61 6.22 6.16
2025 9.20 8.56 7.68 7.40 6.18 6.10
2035 8.81 8.16 7.50 7.20 6.14 6.05
The table above is based on the "Annuity 2000 Mortality Table" with 100%
Projection Scale G at a 2.00% annual effective interest rate. Mortality
improvements are projected, for each applicable mortality rate, from calendar
year 2000 to the calendar year in which each mortality rate is applicable.
Settlement rates for any year, age, or any combination of year, age and sex not
shown above, will be calculated on the same basis as those rates shown in the
table above. We will furnish such rates upon request.
Page 3G
IMPORTANT INFORMATION
Cost of insurance rates may be changed based on Our expectations of mortality,
reinsurance costs, future investment earnings, persistency, expenses, and/or
federal and state tax assumptions. Any change will apply to all individuals of
the same risk classification as the Insured. The cost of insurance rates will
never exceed the Guaranteed Maximum Monthly Cost of Insurance Rates as shown in
this policy.
Additional amounts credited to the policy value are not guaranteed and We have
the right to change interest rates, the premium expense charge, cost of
insurance rates, the administrative charge and the policy fee. Interest rates
will never be less than the Guaranteed Interest Rate shown in this policy. The
premium expense charge will never exceed the Guaranteed Premium Expense Charge
shown in this policy. The administrative charge will never exceed the Guaranteed
Administrative Charge shown in this policy. The policy fee will never exceed the
Guaranteed Policy Fee shown in this policy.
Any changes in interest rates, the premium expense charge, cost of insurance
rates, the administrative charge and the policy fee may require more premiums to
be paid than was illustrated or the policy values may be less than those
illustrated.
CSO MORTALITY TABLES
2001 Commissioner's Standard Ordinary (CSO) Mortality Table; Smoker or
Nonsmoker; Male or Female; Age Nearest
Birthday
Ages 17 and Under
2001 Commissioner's Standard Ordinary Mortality Table; Male or Female; Age
Nearest Birthday
MALE RATE TABLE
GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1,000 FOR
MALE INSURED'S WITH A STANDARD NON-TOBACCO RISK CLASSIFICATION*
Attained Standard Attained Standard Attained Standard Attained Standard
Age Non-Tobacco Age Non-Tobacco Age Non-Tobacco Age Non-Tobacco
-------- ----------------- ---------- -------------- --------- -------------- -------- ------------
0 $ 0.0800 30 $ 0.0850 60 $ 0.7450 90 $ 16.9075
1 0.0450 31 0.0825 61 0.8300 91 18.4150
2 0.0325 32 0.0825 62 0.9325 92 20.0150
3 0.0225 33 0.0850 63 1.0475 93 21.7325
4 0.0175 34 0.0875 64 1.1675 94 23.5850
5 0.0175 35 0.0900 65 1.2975 95 25.5725
6 0.0175 36 0.0950 66 1.4275 96 27.4300
7 0.0175 37 0.1000 67 1.5600 97 29.4575
8 0.0175 38 0.1075 68 1.7025 98 31.6725
9 0.0175 39 0.1125 69 1.8500 99 34.0975
10 0.0175 40 0.1200 70 2.0300 100 36.7700
11 0.0225 41 0.1300 71 2.2300 101 38.9500
12 0.0275 42 0.1425 72 2.4950 102 41.3350
13 0.0325 43 0.1575 73 2.7775 103 43.9450
14 0.0375 44 0.1750 74 3.0725 104 46.8125
15 0.0500 45 0.1925 75 3.3975 105 49.9250
16 0.0600 46 0.2125 76 3.7525 106 53.3625
17 0.0700 47 0.2325 77 4.1675 107 57.1725
18 0.0750 48 0.2425 78 4.6525 108 61.4175
19 0.0775 49 0.2575 79 5.2175 109 66.1725
20 0.0775 50 0.2750 80 5.8375 110 71.5275
21 0.0775 51 0.2975 81 6.5500 111 77.6150
22 0.0775 52 0.3300 82 7.2975 112 83.3325
23 0.0800 53 0.3625 83 8.1075 113 83.3325
24 0.0800 54 0.4050 84 9.0150 114 83.3325
25 0.0800 55 0.4575 85 10.0400 115 83.3325
26 0.0850 56 0.5125 86 11.1900 116 83.3325
27 0.0875 57 0.5700 87 12.4650 117 83.3325
28 0.0875 58 0.6200 88 13.8475 118 83.3325
29 0.0850 59 0.6775 89 15.3325 119 83.3325
Page 3H
MALE RATE TABLE
GUARANTEED MAXIMUM MONTHLY COST OF INSURANCE RATES PER $1,000 FOR
MALE INSURED'S WITH A STANDARD TOBACCO RISK CLASSIFICATION*
Attained Standard Attained Standard Attained Standard Attained Standard
Age Tobacco Age Tobacco Age Tobacco Age Tobacco
-------- ----------------- ---------- -------------- --------- -------------- -------- -----------
30 $ 0.1500 60 $ 1.3675 90 $ 19.8800
31 0.1500 61 1.5050 91 21.3775
32 0.1500 62 1.6750 92 22.9325
33 0.1550 63 1.8625 93 24.5700
34 0.1600 64 2.0550 94 26.3000
35 0.1650 65 2.2450 95 28.2550
36 0.1750 66 2.4300 96 30.0200
37 0.1850 67 2.6075 97 31.9175
38 0.2000 68 2.7975 98 33.9650
39 0.2125 69 2.9850 99 36.1825
40 0.2300 70 3.2125 100 38.5875
41 0.2525 71 3.4625 101 40.4550
42 0.2775 72 3.8025 102 42.4650
43 0.3075 73 4.1475 103 44.6300
44 0.3425 74 4.4950 104 46.9650
45 0.3800 75 4.9025 105 50.0725
46 0.4150 76 5.3375 106 53.5050
47 0.4550 77 5.8450 107 57.3150
18 $ 0.0925 48 0.4775 78 6.4325 108 61.5525
19 0.1000 49 0.5025 79 7.1075 109 66.3050
20 0.1050 50 0.5375 80 7.8325 110 71.6575
21 0.1100 51 0.5800 81 8.6525 111 77.7400
22 0.1150 52 0.6400 82 9.4875 112 83.3325
23 0.1200 53 0.7050 83 10.3725 113 83.3325
24 0.1275 54 0.7900 84 11.3425 114 83.3325
25 0.1350 55 0.8825 85 12.4975 115 83.3325
26 0.1425 56 0.9800 86 13.7800 116 83.3325
27 0.1500 57 1.0800 87 15.1775 117 83.3325
28 0.1500 58 1.1600 88 16.6725 118 83.3325
29 0.1500 59 1.2550 89 18.2450 119 83.3325
* For Insureds with a super preferred or preferred risk classification, the
corresponding standard non-tobacco or standard tobacco guaranteed maximum
monthly cost of insurance rates will apply.
* For Insureds with other than a super preferred, preferred or standard risk
classification, the guaranteed monthly cost of insurance rates are
calculated by multiplying the monthly rates by the Substandard Class Risk
Factor shown under Policy Data.
You may apply for a change in risk classification for Insureds who are at least
Attained Insurance Age 18, and no more than Attained Insurance Age 119, subject
to Our underwriting rules and requirements at the time the change is requested.
There are no cost of insurance charges on or after Attained Insurance Age 120.
Page 3I
DEFINITIONS
The following words are often used in this policy. When We use these words, this
is what We mean:
ACCUMULATION UNIT
An accounting unit used to calculate the Variable Account Value. It is a measure
of the net investment results of each of the Subaccounts.
AGE ANNIVERSARY
An Age Anniversary is the Policy Anniversary on which the Insured becomes a
certain Attained Insurance Age.
ATTAINED INSURANCE AGE
The Insured's Insurance Age plus the number of Policy Anniversaries since the
Policy Date. Attained Insurance Age changes only on a Policy Anniversary.
CASH SURRENDER VALUE
The policy Proceeds if the policy is surrendered in full. It is the Policy Value
minus any Indebtedness, minus surrender charges shown under Policy Data.
CHARITABLE GIFT AMOUNT
The Charitable Gift Amount is equal to 1% of the policy's Proceeds payable, upon
death of the Insured. The maximum Charitable Gift Amount is $100,000. The
Charitable Gift Amount is only payable to the Charitable Gift Amount
beneficiary. The Charitable Gift Amount is determined as of the date of death of
the Insured. The Charitable Gift Amount is payable by Us and is not deducted
from Your policy's proceeds.
FIXED ACCOUNT
Our general investment account. It is made up of Our assets other than those
held in any segregated asset account. Fixed Account Value
The portion of the Policy Value that is allocated to the Fixed Account including
Indebtedness Indebtedness All existing loans on this policy plus policy loan
interest which has either been accrued or added to the policy loan.
IN FORCE
The Insured's life remains insured under the terms of this policy.
INSURANCE AGE
The Insurance Age of the Insured on the Policy Date is the issue age shown under
Policy Data. It is the age We determine from the date of birth listed on the
application, and is the age on the birthday nearest to the application date.
INSURED
The person whose life is insured by this policy.
MONTHLY DATE
It is the same day each month as the Policy Date. If there is no Monthly Date in
a calendar month, the Monthly Date will be the first day of the next calendar
month.
NET PREMIUM
The portion of a premium paid that is credited to the policy as described in the
Policy Values section. It is the premium paid minus the premium expense charge.
We reserve the right to change the current premium expense charge based on Our
expectations of future investment earnings, persistency, expenses, and/or
federal and state tax assumptions. However, it will never exceed the guaranteed
premium expense charge shown under Policy Data.
POLICY ANNIVERSARY
The same day and month as the Policy Date each year that the policy remains In
Force.
POLICY DATE
It is the date from which Policy Anniversaries, policy years and policy months
are determined. Your Policy Date is shown under Policy Data.
POLICY VALUE
The Fixed Account Value plus the Variable Account Value.
Page 4
PROCEEDS
Proceeds means the amount payable under this policy as follows:
1. upon death of the Insured, Proceeds will be the death benefit minus any
Indebtedness, as of the date of the Insured's death;
2. upon surrender of the policy, the Proceeds will be the Cash Surrender
Value.
PRO-RATA BASIS
Method for allocating amounts to the Fixed Account and to each of the
Subaccounts. It is proportionate to the value (minus any Indebtedness in the
Fixed Account) that each bears to the total Policy Value, minus Indebtedness.
SPECIFIED AMOUNT
An amount used to determine the death benefit and the Proceeds payable upon
death of the Insured. The initial Specified Amount is shown under Policy Data.
SUBACCOUNTS
Each Subaccount is a separate investment division of the Variable Account and
invests in a particular portfolio or fund as shown under Policy Data.
TERMINATE
This policy is no longer In Force. All insurance coverage under this policy has
stopped.
VALUATION DATE
Any day on which the New York Stock Exchange is open for trading, or any other
day on which there is a sufficient degree of trading in the investments of the
Subaccounts such that the current value might be materially affected.
VALUATION PERIOD
The interval of time commencing at the close of business on each Valuation Date
and ending at the close of business on the next Valuation Date. Variable Account
Value
The sum of the values of the Subaccounts under this policy.
VARIABLE ACCOUNT
RiverSource of New York Account 8 established under New York law as a segregated
asset account of Ours. We have allocated to the Variable Account a part of Our
assets for this and certain other policies. Such assets remain Our property.
They cannot be charged, however, with liabilities from any other business in
which We may take part.
WE, OUR, US
RiverSource Life Insurance Co. of New York
WRITTEN REQUEST
A request in writing signed by You, and acceptable to Us.
YOU, YOUR
The owner of this policy. The owner may be someone other than the Insured. The
owner is shown in the application unless the owner has been changed as provided
in this policy.
Page 5
THE INSURANCE CONTRACT
ENTIRE CONTRACT
The entire contract between You and Us is as stated in this policy, Your
attached application, and any attached supplemental applications, endorsements
and riders.
No one except one of Our corporate officers (President, Vice President,
Secretary or Assistant Secretary) can change or waive any of Our rights or
requirements under this policy. That person must do so in writing. None of Our
representatives or other persons has the authority to change or waive any of Our
rights or requirements under this policy.
In issuing this policy, We have relied upon the application. The statements made
in the application are considered representations and not warranties. No
material misrepresentations made in connection with the application will be used
by Us to void the policy or to deny a claim unless that material
misrepresentation is part of the application.
After the Policy Date, applications for an increase of the Specified Amount will
be attached to and made a part of this policy and will form part of the entire
contract.
Any statement concerning tobacco status will be attached to and made a part of
this policy and will form part of the entire contract.
POLICY INCONTESTABILITY
After this policy has been In Force during the Insured's lifetime for two years
from the Policy Date, We cannot contest the policy except for nonpayment of
premiums.
While this policy is contestable, We, on the basis of a material
misrepresentation made in the application, may rescind or reform this policy and
We may deny a claim.
Any increase in Specified Amount which requires proof of insurability will be
incontestable only after such amount has been In Force during the Insured's
lifetime for two years from the effective date of such amount.
If within two years from the effective date of the Insured's reclassification as
nontobacco We find that the Insured's tobacco status has been misstated, and it
is discovered on or after the death of the Insured, the Proceeds payable upon
death will be:
1. the Policy Value on the date of death; plus
2. the amount of insurance that the cost of insurance on the Insured, which
was deducted from the Policy Value for the policy month during which such
death occurred, would have purchased using the cost of insurance rates for
the correct tobacco status; minus
3. any Indebtedness on the date of death.
If within two years from the effective date of the Insured's reclassification as
nontobacco We find that the Insured's tobacco status has been misstated, and it
is discovered before the death of the Insured:
1. the Specified Amount will be adjusted to the amount it would have been had
the cost of insurance, on the Monthly Date immediately preceding the date
the misstatement is discovered, been based on the Insured's correct tobacco
status. The adjustment will take effect on the Monthly Date on or next
following the date such misstatement is discovered; and
2. the monthly deduction will then be based on the Insured's correct tobacco
status beginning on the Monthly Date on or next following the date such
misstatement is discovered.
SUICIDE EXCLUSION
Suicide by the Insured within two years from the Policy Date is not covered by
this policy. In this event the only amount payable by Us to the beneficiary will
be the premiums which You have paid, minus any Indebtedness and partial
surrenders.
If the Insured commits suicide whether sane or insane within two years from the
effective date of:
1. any increase in Specified Amount which requires proof of insurability; or
2. any rider attached to this policy;
then the amount payable by Us with respect to the increased coverage or rider
benefit will be limited to the monthly deductions for such additional Specified
Amount or rider on the life of the Insured.
Page 6
MISSTATEMENT OF INSURED'S AGE OR SEX
If the Insured's age or sex has been misstated, and it is discovered on or after
the death of the Insured, the Proceeds payable upon death will be:
1. the Policy Value on the date of death; plus
2. the amount of insurance that the cost of the insurance on the Insured,
which was deducted from the Policy Value for the policy month during which
such death occurred, would have purchased had the cost of the insurance
been calculated using the cost of insurance rates for the correct age and
sex; minus
3. any Indebtedness on the date of death.
If the Insured's age or sex has been misstated and it is discovered before the
death of the Insured:
1. the Specified Amount will be adjusted to the amount it would have been had
the cost of insurance, on the Monthly Date immediately preceding the date
the misstatement is discovered, been based on the Insured's correct age and
sex. The adjustment will take effect beginning on the Monthly Date on or
next following the date such misstatement is discovered; and
2. the monthly deduction will then be based on the Insured's correct age and sex
beginning on the Monthly Date on or next following the date such misstatement is
discovered.
VOTING RIGHTS
All policy owners with Variable Account Values will have voting rights. So long
as federal law requires, You may have the right to vote at shareholder meetings.
If You have voting rights, We will send You a notice of the time and place of
any such meetings. The notice will explain matters to be voted upon and how many
votes You will have.
POLICY TERMINATION
This policy will Terminate on the earliest of the following:
1. the date You request, by Written Request or other requests acceptable to Us,
that coverage ends; or
2. the date You surrender the policy in full; or
3. the end of the grace period; or
4. the date of death of the Insured.
Your Written Request to Terminate coverage will be effective as of the date We
receive Your Written Request, or a later date if specified in Your request. If
We accept a request for Termination by other than Written Request, it will be
effective as of the date We receive Your request, or a later date if specified
in Your request.
TAX TREATMENT OF THIS POLICY
This policy is intended to qualify for treatment as a life insurance policy
under Sections 72, 101, 7702, and other relevant sections of the Internal
Revenue Code as they now exist or may later be amended. We reserve the right to
endorse this policy to comply with:
1. future changes in the Internal Revenue Code;
2. any regulations or rulings issued under the Internal Revenue Code; and
3. any other requirements imposed by the Internal Revenue Service;
with respect to remaining qualified for treatment as a life insurance policy
under these Internal Revenue Code sections.
If endorsed, We will provide the owner with a copy of any such endorsement upon
approval of the insurance regulator of the state in which this policy is
delivered.
We reserve the right to decline any change that would cause this policy to lose
its ability to be tested for federal income tax purposes under the CSO mortality
tables shown under Policy Data.
EXCHANGE OF THIS POLICY
Once during the first 18 months after the Policy date, if it has not lapsed or
been surrendered in full, You have the right to exchange this policy for a
flexible premium adjustable life policy that provides for benefits that do not
vary with the investment return of the Subaccounts. This is done by
transferring, without charge, the entire Policy Value to the Fixed Account.
You also have the right to exchange this policy for a flexible premium
adjustable life policy that provides for benefits that do not vary with the
investment return of the Subaccounts in the event of a material change in the
investments of the Subaccounts. The option is exchange is exercisable within 60
days after (a) the effective date of such change in the investments, or (b) the
receipt of the notice of the change in investments, whichever is later. The
exchange is done by transferring, without charge, the entire Policy Value to the
Fixed Account.
A transfer for these purposes will not count against the five transfers per
policy year limit described in the Transfers Among the Subaccounts and the Fixed
Account provision of the Subaccounts section of this policy. Also, we will waive
the restrictions on transfers from the Subaccounts into the Fixed Account
described in the Transfers Among the Subaccounts and the Fixed Account provision
of the Subaccounts section of this policy.
Page 7
OWNER AND BENEFICIARY
YOUR RIGHTS AS OWNER OF THIS POLICY
As long as the Insured is living and unless otherwise provided in this policy,
You may exercise all rights and privileges provided in this policy or allowed by
Us.
SUCCESSOR OWNER
A successor owner becomes the new owner of this policy if You die during the
lifetime of the Insured. If no successor owner is living at the time of Your
death, ownership will pass to Your estate. The successor owner, if any, is shown
in the application unless changed as provided below.
CHANGING OWNERSHIP OF THIS POLICY
You can change the ownership of this policy by Written Request on a form
satisfactory to Us. A successor owner may also be changed in this same way. The
change must be made while the Insured is living. Once the change is received by
Us, it will take effect as of the date Your request was signed, or a later date
if specified in Your request, subject to any action taken or payment made by Us
before We received the change.
PROCEEDS PAID TO BENEFICIARY UPON DEATH OF THE INSURED
We will pay the Proceeds to the beneficiary or beneficiaries which You have
named in the application unless You have since changed the beneficiary as
provided below. If the beneficiary has been changed, We will pay the Proceeds in
accordance with Your last change of beneficiary request. Only those
beneficiaries who are living at the Insured's death may share in the Proceeds.
If no beneficiary survives the Insured, We will pay the Proceeds to You, if
living; otherwise, to Your estate.
CHARITABLE GIFT AMOUNT BENEFICIARY
The Charitable Gift Amount beneficiary may be any organization that is listed
under Section 170(c) of the Internal Revenue Code, as it now exists or may later
be amended, as an authorized recipient of charitable contributions. Generally,
these organizations are considered exempt from federal taxation under Section
504(c)(3) of the Internal Revenue Code, as it now exists or may be amended.
In addition, if We are prohibited from providing the payable Charitable Gift
Amount to the Charitable Gift Amount beneficiary by State or Federal law, such
as the USA Patriot Act as it now exists or may later be amended, no amount will
be payable by Us to that Charitable GiftAmount beneficiary.
You may designate the Charitable Gift Amount beneficiary at any time. If the
Charitable Gift Amount beneficiary You have designated is not in existence at
the time the Charitable Gift Amount is payable, or is no longer qualified as
described in the previous two paragraphs, You (or Your estate representative, if
You are the Insured) may name a new Charitable Gift Amount beneficiary to whom
the Charitable Gift Amount will be payable.
Only one organization may be designated as the Charitable Gift Amount
beneficiary at any time.
Page 8
CHANGE OF BENEFICIARY BY OWNER
You may change the beneficiary anytime while the Insured is living by Written
Request on a form satisfactory to Us. Once the change is received by Us, it will
take effect as of the date Your request was signed, or a later date if specified
in Your request, subject to any action taken or payment made by Us before We
received the change.
If an irrevocable beneficiary is on record, such beneficiary cannot be changed
without the written consent of the irrevocable beneficiary.
CHANGE OF CHARITABLE GIFT AMOUNT BENEFICIARY
You may change the Charitable Gift Amount beneficiary once each year, while the
Insured is living by Written Request on a form satisfactory to Us. The change
will take effect on the next monthly date following the date We approve the
request.
ASSIGNING THIS POLICY AS COLLATERAL
While the Insured is living, You can assign this policy or any interest in it,
other than the Charitable Gift Amount, by Written Request on a form satisfactory
to Us. Your interest and the interest of any beneficiary is subject to the
interest of the assignee. An assignment is not a change of ownership and an
assignee is not an owner as these terms are used in this policy. Any policy
Proceeds payable to the assignee will be paid in a single sum.
A copy of any assignment must be submitted to Us. Any assignment, unless
otherwise specified by You, shall take effect as of the date the assignment was
signed, subject to any action taken or payment made by Us before We received the
assignment. We are not responsible for the validity of any assignment.
To terminate the assignment, the collateral assignee must release his or her
interest in the policy.
Page 9
PREMIUMS
PREMIUM PAYMENTS
There are three types of premium payments that apply to this policy:
1. the initial premium;
2. scheduled premiums; and
3. unscheduled premiums.
Premiums must be paid or mailed to Us at Our home office or to an authorized
agent. We will give You a receipt if You request one. A check or draft given for
all or part of a premium, unless paid upon its presentation to the bank or
person drawn on, shall not be considered payment.
We reserve the right to require evidence of insurability or limit the amount of
any premium payment that would result in more than a dollar for dollar increase
in the death benefit.
INITIAL PREMIUM
The initial premium is the premium due on or before the Policy Date. The initial
premium payment must be received by Us before the policy can become effective,
and no insurance will take effect until this amount is paid.
SCHEDULED PREMIUM
The scheduled premium is the premium shown under Policy Data. It is payable at
the stated interval which You selected in the application. However, no scheduled
premium may be paid on or after the Insured's Attained Insurance Age 120
Anniversary except amounts required to keep the policy In Force under the grace
period provision.
The scheduled premium will serve only as an indication of Your preference as to
the probable future amount and frequency of payments. You may change the amount
or frequency at any time by Written Request or other requests acceptable to Us.
SCHEDULED PREMIUMS MAY BE PAID ANNUALLY, SEMI-ANNUALLY, OR QUARTERLY. PAYMENT AT
ANY OTHER INTERVAL MUST BE APPROVED BY US. ANY SCHEDULED PREMIUM PAYMENT MUST BE
AT LEAST $25.
UNSCHEDULED PREMIUM PAYMENTS
You can make additional premium payments of at least $25 at any time prior to
the Insured's Attained Insurance Age 120 Anniversary. After that, We will only
accept amounts required to keep the policy In Force under the grace period
provision.
RESTRICTIONS OF PREMIUM PAYMENTS
This policy is intended to qualify for treatment as a life insurance policy
under Sections 72, 101, 7702, and other relevant sections of the Internal
Revenue Code as they now exist or may later be amended.
We reserve the right to refuse premiums and return them with interest, unless
the premium is neccessary to continue coverage, if such premiums would
disqualify this policy from:
1. treatment as a life insurance policy under Internal Revenue Code Sections
72, 101, and 7702; or
2. favorable tax treatment under Internal Revenue Code Sections 72 and 101.
PREMIUM PROCESSING
The Net Premium is allocated to the Fixed Account and the Subaccounts according
to Your premium allocation percentages in effect. You may choose any whole
percentage for the Fixed Account and each Subaccount from 0% to 100%. The sum of
Your premium allocation percentages must equal 100%. You may change the premium
allocation percentages at any time by Written Request or other requests
acceptable to Us.
Net Premiums received before the Policy Date will initially be allocated to the
Fixed Account. On the Policy Date, the Policy Value will be transferred to the
Subaccounts or remain in the Fixed Account in accordance with Your premium
allocation percentages. For any premium received on or after the Policy Date,
the Net Premium will be allocated in accordance with Your premium allocation
percentages in effect.
Page 10
GRACE PERIOD
If on a Monthly Date the Cash Surrender Value is less than the monthly deduction
for the policy month following such Monthly Date, and neither the no-lapse
guarantee nor the minimum initial premium guarantee is in effect, a grace period
of 61 days will begin.
The grace period will give You time to make a premium payment or loan repayment
sufficient to continue Your coverage. Within 30 days following the Monthly Date,
We will mail to Your last known address, a notice as to the payment needed.
The premium payment or loan repayment needed will be the lesser of:
1. an amount so that the Cash Surrender Value is sufficient to pay any overdue
monthly deductions, plus the next three monthly deductions; or
2. the amount needed to keep the minimum initial premium guarantee in effect,
if it is eligible to be kept in effect, during the grace period and for
three months after the end of the grace period; or
3. the amount needed to keep the no-lapse guarantee in effect, if it is
eligible to be kept in effect, during the grace period and for three months
after the end of the grace period.
If the premium payment or loan repayment is not paid within the grace period,
all coverage under this policy will Terminate without value at the end of the 61
day grace period. This type of Termination is known as lapse. The end of the
grace period is the date of lapse.
Any payment sent by U.S. mail must be postmarked within the grace period to keep
the policy In Force.
If the Insured's death occurs during the grace period and benefits become
payable under the policy, the lesser of the following will be deducted from the
Proceeds:
1. any overdue monthly deductions; or
2. the premium required to keep the minimum initial premium guarantee in
effect, if it is eligible to be kept in effect; or
3. the premium required to keep the no-lapse guarantee in effect, if it is
eligible to be kept in effect.
If either the minimum initial premium guarantee or no-lapse guarantee is in
effect as described in the next two provisions, the policy will not enter the
grace period.
MINIMUM INITIAL PREMIUM GUARANTEE
To allow You the opportunity to increase Your Policy Value gradually so that the
Cash Surrender Value is sufficient to pay the monthly deduction, a minimum
initial premium guarantee will be in effect during the minimum initial premium
period shown under Policy Data if:
1. on a Monthly Date, the Policy Value minus Indebtedness equals or
exceeds the monthly deduction for the policy month following such
Monthly Date; and
2. the sum of all premiums paid, minus any partial surrenders, and minus
Indebtedness equals or exceeds the minimum initial premium shown under
Policy Data times the number of months since the Policy Date,
including the current month.
To keep the minimum initial premium guarantee in effect, premiums may be paid at
any interval as long as the sum of premiums paid at all times is at least equal
to the total required minimum initial premium.
If on a Monthly Date sufficient premiums have not been paid to maintain the
minimum initial premium guarantee, the minimum initial premium guarantee will no
longer be in effect. Therefore, Your policy will enter the grace period if the
no-lapse guarantee is not in effect and the Cash Surrender Value is insufficient
to pay the monthly deduction on a Monthly Date.
If on a Monthly Date sufficient premiums have not been paid to maintain the
minimum initial premium guarantee, You will have 61 days to pay a premium
sufficient to maintain the minimum initial premium guarantee. Within 30 days
following the Monthly Date, We will mail to Your last known address, a notice as
to the payment needed. If You do not pay such a premium within the 61 day
period, the minimum initial premium guarantee will no longer be in effect and it
cannot be reinstated.
The minimum initial premium will change if:
1. the Specified Amount is increased or decreased;
2. the death benefit option is changed; or
3. riders are added, changed or terminated.
The new minimum initial premium will apply from the date of the change.
Although Your policy will remain In Force, if You pay only the premium needed to
keep the minimum initial premium guarantee in effect,
Page 11
You may be foregoing the advantage of building up Policy Value.
If the minimum initial premium guarantee terminates before the end of the
no-lapse guarantee period, and the no-lapse guarantee is not in effect, the Cash
Surrender Value may not be sufficient to keep this policy In Force without
payment of an additional premium.
At the end of the minimum initial premium period, if the no-lapse guarantee is
not in effect, the Cash Surrender Value may not be sufficient to keep this
policy In Force without payment of additional premium. The premium required to
keep this policy In Force may be higher than the premiums required for the
minimum initial premium guarantee.
NO-LAPSE GUARANTEE
The no-lapse guarantee provides that during the no-lapse guarantee period shown
under Policy Data, this policy will not Terminate even if the Cash Surrender
Value is insufficient to pay the monthly deduction on a Monthly Date. Sufficient
premium as described below must be paid to keep the no-lapse guarantee in
effect.
The no-lapse guarantee will remain in effect if, on each Monthly Date:
(a) equals or exceeds (b)
where:
(a) is the sum of all premiums paid, minus any partial surrenders and partial
surrender fees, and minus any Indebtedness; and
(b) is the no-lapse guarantee premium, shown under Policy Data, times the
number of months since the Policy Date, including the current month.
To keep the no-lapse guarantee in effect, premiums may be paid at any interval
as long as the sum of premiums paid at all times is at least equal to the total
required no-lapse guarantee premiums.
While this policy is kept In Force by the no-lapse guarantee, any monthly
deduction amounts that exceed the Policy Value, minus any Indebtedness, will be
waived.
If on a Monthly Date sufficient premiums have not been paid to maintain the
no-lapse guarantee, the no-lapse guarantee provision will no longer be in
effect. Therefore, Your policy will enter the grace period if the minimum
initial premium guarantee is not in effect and the Cash Surrender Value is
insufficient to pay the monthly deduction on a Monthly Date.
Within 60 days following the Monthly Date where sufficient premiums have not
been paid to maintain the no-lapse guarantee, We will mail to Your last known
address, a notice as to the payment needed within the next 60 days to continue
the no-lapse guarantee. If the premium is not paid within this period, the
no-lapse guarantee will no longer be in effect.
The no-lapse guarantee, however, can be reinstated within two years from the
date it was last in effect. The amount needed to reinstate the no-lapse
guarantee is an amount equal to:
(a) + (b) + (c) - (d)
where:
(a) is the sum of premiums required for the no-lapse guarantee to the date of
reinstatement assuming a no-lapse guarantee was always in effect since the
Policy Date;
(b) is any partial surrenders and partial surrender fees that have been taken
to the date of reinstatement;
(c) is any Indebtedness on the date of reinstatement;
(d) is the total of all premiums paid to the date of reinstatement.
The no-lapse guarantee premium will change if:
1. the Specified Amount is increased or decreased;
2. the death benefit option is changed; or
3. riders are added, changed or terminated.
The new no-lapse guarantee premium will apply from the date of the change.
Although Your policy will remain In Force, if You pay only the premium needed to
keep the no-lapse guarantee in effect, You may be foregoing the advantage of
building up Policy Value.
If the no-lapse guarantee terminates before the end of the no-lapse guarantee
period and the minimum initial premium guarantee is not in effect, the Cash
Surrender Value may not be sufficient to keep this policy In Force without
payment of an additional premium.
At the end of the no-lapse guarantee period, if the minimum initial premium
guarantee is not in effect, the Cash Surrender Value may not be sufficient to
keep this policy In Force without payment of additional premium. The premium
required to keep this policy In Force may be higher than the premiums required
for the no-lapse guarantee.
Page 12
REINSTATEMENT
This policy may be reinstated within three years after the end of the grace
period, unless it was surrendered for cash. To do this, We will require all of
the following:
1. your Written Request on a form satisfactory to Us to reinstate the policy;
2. evidence of insurability of the Insured satisfactory to Us;
3. payment of the required reinstatement premium or loan repayment amount;
4. payment or reinstatement of any Indebtedness.
If the policy is within the no-lapse guarantee period, and the no-lapse
guarantee is no longer in effect but it can be reinstated, the required
repayment amount to reinstate the policy is an amount equal to the lesser of:
1. An amount equal to (a) + (b) + (c) - (d) - (e)
where:
(a) is the sum of required premiums for the no-lapse guarantee to the date of
reinstatement assuming a no-lapse guarantee was always in effect since the
Policy Date;
(b) is any partial surrenders and partial surrender fees that have been taken
to the date of reinstatement;
(c) is any Indebtedness on the policy at the end of the grace period;
(d) is any Indebtedness repaid on the date of the reinstatement; and
(e) is the total of all premiums paid to the date of reinstatement; or
2. An amount equal to (a) + (b) + (c) + (d) - (e) - (f)
Where:
(a) is the surrender charge which will be reinstated;
(b) is an amount equal to the monthly deductions not taken during the grace
period;
(c) is an amount equal to the next 3 monthly deductions that will be taken
after reinstatement;
(d) is any Indebtedness on the policy at the end of the grace period;
(e) is any Indebtedness repaid on the date of the reinstatement; and
(f) is the Policy Value as of the last day of the grace period.
If the policy is within the no-lapse guarantee period, but the no-lapse
guarantee is no longer in effect and it cannot be reinstated or the policy is
beyond the No-Lapse Guarantee Period, the required repayment amount to reinstate
the policy is an amount equal to;
(a) + (b) + (c) + (d) - (e) - (f)
where:
(a) is the surrender charge which will be reinstated;
(b) is an amount equal to the monthly deductions not taken during the grace
period;
(c) is an amount equal to the next 3 monthly deductions that will be taken
after reinstatement;
(d) is any Indebtedness on the policy at the end of the grace period;
(e) is any Indebtedness repaid on the date of the reinstatement; and
(f) is the Policy Value as of the last day of the grace period.
The Policy Value on the date of reinstatement will be equal to:
1. the Policy Value as of the last day of the grace period; plus
2. the required reinstatement premium; plus
3. any premium in excess of the required reinstatement premium; minus
4. the monthly deductions not collected during the 61 day grace period.
Surrender charges will return to what they would have been if the policy had not
lapsed. Any Indebtedness on the policy at the end of the grace period will be
reinstated unless it is repaid prior to the reinstatement.
The incontestability period will also start over from the effective date of
reinstatement and we may contest the truth of statements or representations made
in the reinstatement application.
Page 13
DEATH BENEFITS
DEATH BENEFIT PRIOR TO OR ON INSURED'S ATTAINED INSURANCE AGE 120 ANNIVERSARY
The death benefit upon death of the Insured prior to or on the Insured's
Attained Insurance Age 120 Anniversary will be the greater of:
1. the amount based on the death benefit option in effect as of the date of
the Insured's death; or
2. the Policy Value multiplied by the death benefit percentage found in the
death benefit percentage table shown under Policy Data.
DEATH BENEFIT OPTIONS
The initial death benefit option is shown under Policy Data. While this policy
is In Force, You may change the option as explained in the Policy Change
section, or as limited by any attached riders or endorsements.
OPTION 1
The amount under this option will be the Specified Amount.
OPTION 2
The amount under this option will be the Specified Amount plus the Policy
Value of this policy.
The initial Specified Amount is shown under Policy Data. Such amount may be
changed as explained in the Policy Change section.
DEATH BENEFIT AFTER THE INSURED'S ATTAINED INSURANCE AGE 120 ANNIVERSARY
The death benefit upon death of the Insured after the Insured's Attained
Insurance Age 120 Anniversary will be the greater of:
1. the death benefit on the Insured's Attained Insurance Age 120 Anniversary,
minus any partial surrenders and partial surrender fees occurring after the
Insured's Attained Insurance Age 120 Anniversary; or
2. the Policy Value on the date of death.
When the policy is continued after the Insured's Attained Insurance Age 120
Anniversary, the following will occur:
1. interest and/or investment earnings will continue to be credited to the
policy value;
2. premium payments will no longer be accepted;
3. monthly deductions will no longer be taken;
4. requests may not be made to change the Specified Amount or make a change to
the death benefit option;
5. policy loans, loan repayments, and full and partial surrenders will
continue to be available under the terms of the policy; and
6. any riders that are a part of this policy will Terminate.
Termination of this continuation occurs on the earliest of: (1) the date of Your
Written Request for this continuation to end; (2) Your Written request to
surrender this policy; or (3) the death of the Insured.
PROCEEDS PAYABLE AT INSURED'S DEATH
The Proceeds payable upon death will be:
1. the death benefit provided by this policy; minus
2. the amount required to continue coverage to the date of death without the
policy entering the grace period (if death occurs during the grace period);
minus
3. any Indebtedness as of the date of death.
DEATH BENEFIT PAYABLE UNDER CHARITABLE GIFT AMOUNT
If the policy's Proceeds become payable upon the death of the Insured, while the
policy and this benefit are In Force, We will pay the Charitable Gift Amount to
the Charitable Gift Amount beneficiary.
The policy's Proceeds payable upon death of the Insured is defined under the
Proceeds definition. The policy's Proceeds payable upon death does not include
any benefits provided by any riders attached to the policy.
If You have (1) never designated a Charitable Gift Amount beneficiary; or (2) a
Charitable Gift Amount has been withdrawn and no subsequent designation
provided, no amount will be payable under the Charitable Gift Amount.
There is no cost for the Charitable Gift amount. There may be estate tax
implications. As with all tax matters, You should consult a personal tax advisor
to assess the impact of this benefit.
If the paid-up option is elected, the Charitable Gift Amount will no longer be
In Force.
Page 14
LIFE INSURANCE QUALIFICATION TEST
The life insurance qualification test is used to determine if a policy will
qualify as life insurance under applicable tax laws. The life insurance
qualification test and death benefit percentage table for this test is shown
under Policy Data. The test may not be changed after the Policy Date.
DISCLOSURE
Under current federal tax law in effect as of the Policy Date, keeping the
policy In Force on or after the Insured's Attained Insurance Age 100 Anniversary
raises certain tax issues to which there are currently no clear answers. They
include, but are not limited to, the following:
1. the policy may no longer qualify as life insurance for federal income tax
purposes; and
2. if the Internal Revenue Service takes the position that the policy does not
qualify for life insurance for federal income tax purposes on or after the
Insured's Attained Insurance Age 100 Anniversary, You could be taxed on any
gain in the policy on or after the Insured's Attained Insurance Age 100
Anniversary.
We strongly urge You to consult with Your own tax advisor about the income tax
consequences on or after the Insured's Attained Insurance Age 100 Anniversary.
Page 15
POLICY CHANGE
REQUEST TO CHANGE BENEFITS
While this policy is In Force, You may request to decrease or increase the
Specified Amount. You may also request certain changes to the death benefit
option. Such changes are subject to the rules below.
RULES FOR CHANGING THE SPECIFIED AMOUNT
You may change the Specified Amount once per year by Written Request. Decreases
may only be made after the first policy year. The rules are as follows:
DECREASES OF THE SPECIFIED AMOUNT
1. Any decrease will be effective on the Monthly Date on or next following Our
receipt of Your Written Request. Any such decrease will be applied in the
following order:
(a) against the initial Specified Amount shown under Policy Data; then
(b) against the increases successively following the initial Specified
Amount.
2. The Specified Amount that remains In Force after a requested decrease may
not be less than the minimum Specified Amount allowed as shown under Policy
Data.
3. We reserve the right to decline to make any Specified Amount decrease that
We determine would cause this policy to fail to qualify as life insurance
under applicable tax laws.
INCREASES OF THE SPECIFIED AMOUNT
The following rules apply to any increase in Specified Amount other than that
resulting solely from a change in death benefit option:
1. You must apply for an increase by Written Request on a form satisfactory to
Us prior to the Insured's Attained Insurance Age 86 Anniversary.
2. You must furnish satisfactory evidence of insurability of the Insured.
3. Any increase will be subject to Our issue rules and limits at the time of
increase.
4. The minimum increase in the Specified Amount is $10,000.
5. Any increase will be effective on the Monthly Date on or next following the
date Your application is approved.
6. An additional administrative charge will apply to the amount of any
increase in the Specified Amount.
7. A new schedule of surrender charges will apply to the amount of any
increase in the Specified Amount.
CHANGES TO THE DEATH BENEFIT OPTION
Prior to the Insured's Attained Insurance Age 120 Anniversary, You may change
the death benefit option once per year by Written Request. The change in option
will be effective on the Monthly Date on or next following the date We approve
Your request.
If the death benefit option is 2, it may be changed to option 1. The new
Specified Amount will be the option 2 death benefit as of the effective date of
the change.
If the death benefit option is 1, it may be changed to option 2. The new
Specified Amount will be the option 1 death benefit minus the Policy Value as of
the effective date of the change.
The death benefit after a change may not be less than the minimum Specified
Amount allowed as shown under Policy Data.
We reserve the right to decline to make any death benefit option change that We
determine would cause this policy to fail to qualify as life insurance under
applicable tax laws.
Page 16
POLICY VALUES
POLICY VALUE
On a given date the Policy Value equals the Fixed Account Value plus the
Variable Account Value.
FIXED ACCOUNT VALUE
On the Policy Date, the Fixed Account value equals:
1. the portion of the initial Net Premiums allocated to the Fixed Account,
plus any interest credited on such portion before the Policy Date; minus
2. the portion of the monthly deduction taken from the Fixed Account for the
first policy month.
On any subsequent date, the Fixed Account value will be calculated as:
(a) + (b) + (c) + (d) - (e) - (f) - (g)
where:
(a) is the Fixed Account value on the preceding Monthly Date plus interest from
the preceding Monthly Date to the date of calculation;
(b) is the portion of Net Premiums allocated to the Fixed Account and received
since the preceding Monthly Date, plus interest from the date such Net
Premiums were received to the date of calculation;
(c) the amount of any transfers from the Subaccounts to the Fixed Account,
including transfers due to loans taken or interest charged on Indebtedness,
since the preceding Monthly Date, plus interest from the effective dates of
such transfers to the date of calculation;
(d) is any applicable policy value credit allocated to the Fixed Account since
the preceding Monthly Date, plus interest from the effective dates of such
credits to the date of calculation;
(e) is the amount of any transfers from the Fixed Account, including loan
repayment transfers, to the Subaccounts since the preceding Monthly Date,
plus interest from the effective dates of such transfers to the date of
calculation;
(f) is the amount of any partial surrender and partial surrender fees taken
from the Fixed Account since the preceding Monthly Date, plus interest from
the effective dates of such partial surrenders to the date of calculation;
And
(g) if the date of calculation is a Monthly Date, the portion of the monthly
deduction taken from the Fixed Account.
The interest rate applied in the calculation of the Fixed Account Value is the
Fixed Account guaranteed interest rate shown under Policy Data. Interest in
excess of the Fixed Account guaranteed rate may be applied in the calculation of
the Fixed Account Value. Any change in excess interest rates will be determined
by Us based on Our expectations as to future investment earnings, mortality,
persistency and expenses.
Interest in excess of the Fixed Account guaranteed interest rate shown under
Policy Data will not be applied to the portion of the Policy Value which equals
any Indebtedness due Us. Interest in excess of the Fixed Account guaranteed
interest rate is nonforfeitable, except indirectly due to any applicable
surrender charge.
VARIABLE ACCOUNT VALUE
The Variable Account Value is the sum of the values of the Subaccounts.
On the Policy Date, the value of each Subaccount equals:
1. the portion of the initial Net Premiums allocated to the Subaccount, plus
any fixed interest credited on such portion before the Policy Date; minus
2. the portion of the monthly deduction taken from the Subaccount for the
first policy month.
On any subsequent date, the value of each Subaccount is calculated as:
(a) + (b) + (c) + (d) - (e) - (f) - (g)
where:
(a) is the value of the Subaccount on the preceding Valuation Date, multiplied
by the net investment factor for the current Valuation Period;
(b) is the portion of Net Premiums allocated to the Subaccount and received
during the current Valuation Period;
(c) is the amount of any transfers from other Subaccounts or the Fixed Account,
including loan repayment transfers, to the Subaccount during the current
Valuation Period;
(d) is any applicable policy value credit allocated to the Subaccount during
the current Valuation Period;
(e) is the amount of any transfers from the Subaccount to other Subaccounts or
the Fixed Account, including transfers due to loans taken or interest
charged on Indebtedness, during the current Valuation Period;
Page 17
(f) is the amount of any partial surrender and partial surrender fees taken
from the Subaccount during the current Valuation Period; and
(g) is the portion of any monthly deduction during the current Valuation Period
allocated to the Subaccount for the policy month following the Monthly
Date.
MONTHLY DEDUCTION
A monthly deduction is made on each Monthly Date prior to the Insured's Attained
Insurance Age 120 Anniversary for the policy fee, administrative charge, cost of
insurance, mortality and expense risk charge, and cost of any riders for the
policy month following such Monthly Date.
The monthly deduction for a policy month will be calculated as:
(a) + (b) + (c) + (d) + (e)
where:
(a) is the policy fee;
(b) is the administrative charge;
(c) is the cost of insurance for the policy month;
(d) is the mortality and expense risk charge; and
(e) is the cost of any policy riders for the policy month.
The monthly deduction will be taken from the Fixed Account and the Subaccounts
according to the monthly deduction allocation percentages specified in Your
application for this policy. You may choose any whole percentages for the Fixed
Account and each Subaccount from 0% to 100%. By Written Request or other
requests acceptable to Us You may change the percentages. Any change will be
effective for monthly deductions taken thereafter.
The monthly deductions will be taken from the Fixed Account and the Subaccounts
on a Pro-Rata Basis if: 1) the value in the Fixed Account or in any Subaccount
is insufficient to pay the portion of the monthly deduction so allocated; or 2)
You do not specify the monthly deduction allocation percentages for the Fixed
Account and each Subaccount.
POLICY FEE
There is a monthly policy fee deducted each month prior to the Insured's
Attained Insurance Age 120 Anniversary. We reserve the right to change the
policy fee based on Our expectations of future investment earnings, persistency,
expenses, and/or federal and state tax assumptions. However, it will never
exceed the guaranteed policy fee shown under Policy Data.
ADMINISTRATIVE CHARGE
There is a monthly administrative charge deducted each month prior to the
Insured's Attained Insurance Age 120 Anniversary. We reserve the right to change
the administrative charge based on Our expectations of future investment
earnings, persistency, expenses, and/or federal and state tax assumptions.
However, it will never exceed the guaranteed administrative charge shown under
Policy Data.
COST OF INSURANCE
The cost of insurance for the policy month is calculated as:
(a + d) x (b - c)
-------------------
1000
where:
(a) is the monthly cost of insurance rate described below;
(b) is the death benefit divided by the Guaranteed Interest Rate Factor shown
under Policy Data;
(c) is the Policy Value at the beginning of the policy month. At this point,
the Policy Value has been reduced by the monthly deduction except for the
part of the monthly deduction that pays for the cost of insurance; and
(d) is the flat extra rate, shown under Policy Data.
If there have been increases in the Specified Amount, the Policy Value is
allocated on a proportional basis to the initial Specified Amount and each
subsequent increase.
See the Decreases of the Specified Amount provision of the Policy Change section
for how decreases impact the initial Specified Amount and each subsequent
increase.
Page 18
COST OF INSURANCE RATE
The cost of insurance rate used in the cost of insurance calculation is based on
the sex, Insurance Age, years since issue, and risk classification of the
Insured.
The cost of insurance rate used in the cost of insurance calculation for any
increase in Specified Amount is based on the sex, Attained Insurance Age at the
time of increase, years since increase, and risk classification of the Insured
at the time of increase.
We may change cost of insurance rates from time to time. Any change in the cost
of insurance rate will apply to all individuals of the same risk classification
as the Insured. Cost of insurance rates will be determined by Us based on Our
expectations of mortality, reinsurance costs, future investment earnings,
persistency, expenses, and/or federal and state tax assumptions.
The cost of insurance rates will not exceed the guaranteed Maximum Monthly Cost
of Insurance Rates shown under Policy Data and are based on the CSO Mortality
Tables shown under Policy Data.
MORTALITY AND EXPENSE RISK CHARGE
The mortality and expense risk charge compensates us for assuming the mortality
and expense risks under the policy. It is equal to
(a) x (b) where:
---------
12
(a) is the Variable Account Value; and
(b) is the guaranteed mortality and expense risk rate shown under Policy Data.
At this point, the Variable Account Value has not been reduced by any part of
the monthly deduction.
We reserve the right to change the mortality and expense risk rate based on Our
expectations of mortality, reinsurance costs, future investment earnings,
persistency, expenses, and/or federal and state tax assumptions. However, it
will never exceed the guaranteed mortality and expense risk rate shown under
Policy Data.
BASIS USED FOR POLICY VALUES
Values and reserves are equal to or greater than those required by law. Where
required, a detailed statement of the method of computation of values and
reserves has been filed with the insurance regulator of the state in which this
policy is delivered.
POLICY VALUE CREDIT
We may periodically apply a policy value credit to Your Policy Value. The
requirements that must be met to receive any policy value credit are shown under
Policy Data.
The amount of the policy value credit is determined by multiplying the policy
value credit percentage times the Policy Value minus any Indebtedness at the
time the calculation is made.
We reserve the right to calculate and apply any policy value credit annually,
quarterly or monthly.
Any policy value credit will be allocated according to Your premium allocation
percentages in effect. Any policy value credit is nonforfeitable, except
indirectly due to any applicable surrender charge.
We reserve the right to change the policy value credit percentage based on Our
expectations of future investment earnings, persistency, expenses, and/or
federal and state tax assumptions. However, it will never be less than zero.
Page 19
RECEIVING INFORMATION ABOUT THE VALUES OF THIS POLICY
At least once a year, without charge, We will send to Your last known address a
report that shows:
1. the Policy Value at the end of the previous and current report periods;
2. the current death benefit;
3. the premiums paid;
4. all charges since the last report;
5. Indebtedness on this policy;
6. the current Cash Surrender Value;
7. a notice if the policy's Cash Surrender Value will not maintain the
insurance In Force for the next year unless further premium payments are
made; and
8. any other information required by the state in which this policy is
delivered.
At any time and without charge, We will provide a projection of future death
benefits and Policy Values upon Written Request by You.
PAID-UP OPTION
By Written Request, the Cash Surrender Value of this policy can be used to
purchase an amount of paid-up insurance. The request may be made in the 30 days
before any Policy Anniversary prior to the Insured's Attained Insurance Age 120.
If You request this option, You will be forfeiting all rights to make future
premium payments. Any riders will terminate. The Charitable Gift Amount will no
longer be In Force. The paid-up insurance policy will be effective as of the
Policy Anniversary after Your Written request.
The insurance amount and cash surrender value of the paid-up insurance will be
based on the cost of insurance rates guaranteed in this policy, with interest at
the Fixed Account guaranteed interest rate shown under Policy Data. This
policy's death benefit and policy value, both as of the date of the paid-up
policy's purchase, will also be used to compute the paid-up policy's insurance
amount. The paid-up policy's insurance amount, minus its cash surrender value,
cannot be greater than this policy's death benefit, minus its policy value. The
amount purchased will remain level and mature on the Insured's Attained
Insurance Age 120. Any Cash Surrender Value of this policy that is not used to
purchase the paid-up insurance amount will be paid to You. The amount of paid-up
insurance will not be less than that required by law.
At any time before the Insured's death, You may surrender the paid-up insurance
for its cash surrender value.
Page 20
POLICY SURRENDER
POLICY SURRENDER
You may surrender this policy for its Cash Surrender Value at any time by
Written Request, or other requests acceptable to Us. Upon surrender for the full
Cash Surrender Value, this policy will Terminate.
The Cash Surrender Value of this policy is:
1. the Policy Value at the time of surrender; minus
2. any Indebtedness on this policy; minus
3. any applicable surrender charges shown under Policy Data.
PARTIAL SURRENDER
Subject to the rules below, You may partially surrender this policy by Written
Request, or other requests acceptable to Us for an amount less than the Cash
Surrender Value. A partial surrender fee will be applied as shown under Policy
Data.
If death benefit option 1 is in effect, both the Specified Amount and the Policy
Value will be reduced by the amount of the partial surrender and partial
surrender fee. If death benefit option 2 is in effect, the Policy Value will be
reduced by the amount of the partial surrender and partial surrender fee.
Various provisions of this policy may be affected by partial surrenders,
including the minimum initial premium guarantee and the no-lapse guarantee as
described in the Premiums section.
RULES FOR A PARTIAL SURRENDER
The following rules shall apply to any partial surrender:
1. partial surrenders may not be made in the first policy year;
2. the minimum amount that may be surrendered is $500;
3. the partial surrender amount cannot exceed 90% of the full cash surrender
value;
4. partial surrenders may not be made if the death benefit that remains In
Force is less than the minimum Specified Amount allowed as shown under
Policy Data.
We reserve the right to decline a request for a partial surrender that We
determine would cause this policy to fail to qualify as life insurance under
applicable tax laws.
If you do not specify the percentages for allocation of the partial surrender
from the Fixed Account and each Subaccount, the surrender will be made from the
Fixed Account and the Subaccounts on a Pro-Rata Basis.
PAYMENT OF A SURRENDER
We will normally pay the portion of any surrendered amount from the Subaccounts
within 7 days after We receive Your Written Request. We reserve the right,
however, to suspend or delay the date of any surrender payment from the
Subaccounts for any period:
1. when the New York Stock Exchange is closed; or
2. when trading on the New York Stock Exchange is restricted; or
3. when an emergency exists, and as a result:
(a) disposal of securities held in the Subaccounts is impractical; or
(b) it is impractical to fairly determine the value of the assets of the
Subaccounts; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of security holders.
Rules and regulations of the Securities and Exchange Commission will govern as
to whether the conditions set forth in the above items 2 and 3 exist.
For any surrender request from the Fixed Account, We reserve the right to
postpone the payment for up to 6 months.
If we postpone payment more than 10 days after we receive the documentation
necessary to complete the surrender, we will also pay you interest for the
period of postponement for the amount surrendered. The interest paid will
be at the rate of interest currently in effect for the provision entitled
Option A - Interest Payments in the Payment of Policy Proceeds section on
of this policy. However, no interest will be paid if the amount of interest
is less than $25 or if payment is postponed as required under applicable laws
of the state in which this policy is delivered.
Page 21
POLICY LOANS
BORROWING MONEY ON THIS POLICY
By Written Request or other requests acceptable to Us, You may obtain a loan
from Us whenever this policy has a Cash Surrender Value. This policy is the only
security required for Your loan. We will pay interest on the Policy Value loaned
at the guaranteed interest rate shown under Policy Data.
Various provisions of this policy may be affected by loans, including the
minimum initial premium guarantee and the no-lapse guarantee as described in the
Premiums section.
If You do not specify the percentages for allocation of the loan from the Fixed
Account and each Subaccount, the loan will be made from the Fixed Account and
the Subaccounts on a Pro- Rata Basis. The amount of any loan and loan interest
from the Subaccounts will be transferred from the Subaccounts to the Fixed
Account.
MAXIMUM LOAN VALUE OF THIS POLICY
You can borrow an amount up to 90% of the available loan value. The maximum loan
value is the Policy Value minus surrender charges, minus any existing
Indebtedness. We calculate the Policy Value as of the date of the loan. In
determining the maximum loan value, We reserve the right to subtract monthly
deductions and loan interest for three months.
INTEREST RATE FOR A POLICY LOAN
Loan interest is charged daily and payable at the end of the policy year. If
interest is not paid when it is due, it will be added to Your Indebtedness and
charged the same interest rate as Your loan. The additional loan interest will
be taken from the Fixed Account and Subaccounts on a Pro-Rata Basis.
We reserve the right to change the loan interest rate based on Our expectations
of future investment earnings, persistency, expenses, and/or federal and state
tax assumptions. However, it will never exceed the guaranteed loan interest rate
shown under Policy Data. Any change in the loan interest rate will apply to all
policies of the same class and duration.
LOAN REPAYMENT
Your loan can be repaid in full or in part at any time before the Insured's
death and while this policy is In Force. A loan that exists at the end of the
grace period may not be repaid unless this policy is reinstated.
Repayments should be clearly marked as "loan repayments"; otherwise, they will
be credited to this policy as premiums.
Loan repayments will be allocated according to Your premium allocation
percentages in effect.
FAILURE TO REPAY A LOAN
Failure to repay a loan or to pay loan interest will not Terminate this policy
unless the Cash Surrender Value is insufficient to cover the monthly deduction
as provided in the Grace Period provision. This would happen if Indebtedness
exceeded the Policy Value minus surrender charges.
PAYMENT OF A LOAN
We will normally pay the portion of any loan amount from the Subaccounts within
7 days after We receive Your Written Request. We reserve the right, however, to
suspend or delay the date of any loan from the Subaccounts for any period:
1. when the New York Stock Exchange is closed; or
2. when trading on the New York Stock Exchange is restricted; or
3. when an emergency exists, and as a result:
(a) disposal of securities held in the Subaccounts is impractical; or
(b) it is impractical to fairly determine the value of the assets of the
Subaccounts; or
4. during any other period when the Securities and Exchange Commission, by
order, so permits for the protection of security holders.
Rules and regulations of the Securities and Exchange Commission will govern as
to whether the conditions set forth in the above items 2 and 3 exist.
For any loan from the Fixed Account, We reserve the right to postpone the
payment for up to 6 months unless the loan is used to pay premiums on any
policies You have with Us.
If we postpone payment more than 10 days after we receive the documentation
necessary to complete the loan, we will also pay you interest for the period of
postponement for the amount of the loan. The interest paid will be at the rate
of interest currently in effect for the provision entitled Option A - Interest
Payments in the Payment Of Policy Proceeds section on of this policy. However,
no interest will be paid if the amount of interest is less than $25 or if
payment is postponed as required under applicable laws of the state in which
this policy is delivered.
Page 22
SUBACCOUNTS
INVESTMENTS OF THE SUBACCOUNTS
Net Premiums and transfers will be allocated as You specify. Each Subaccount
will buy the investment shown under Policy Data or as later added or changed.
SUBACCOUNT VALUE
The Subaccount value is determined by multiplying the number of Accumulation
Units credited to the Subaccount by the appropriate accumulation unit value.
SUBACCOUNT ACCUMULATION UNITS
The number of Accumulation Units for each of the Subaccounts is found by
dividing: (1) the amount allocated to the Subaccount; by (2) the Subaccount's
accumulation unit value for the Valuation Period in which We received the
premium payment, transfer request, or partial surrender request.
SUBACCOUNT ACCUMULATION UNIT VALUE
The value of an Accumulation Unit for each of the Subaccounts was arbitrarily
set at $1 when the first investments were bought. The value for any later
Valuation Period is found as follows: The accumulation unit value for a
Subaccount for the last prior Valuation Period is multiplied by such
Subaccount's net investment factor for the following Valuation Period. The
result is the accumulation unit value. The value of an Accumulation Unit may
increase or decrease from one Valuation Period to the next.
DETERMINATION OF NET INVESTMENT FACTOR
The net investment factor is an index applied to measure the investment
performance of a Subaccount from one Valuation Period to the next. The net
investment factor value of an Accumulation Unit may increase or decrease from
one Valuation Period to the next.
To find the net investment factor of any such Subaccount for a Valuation Period,
we divide (1) by (2), where:
(1) is the net result of:
a. the net asset value per share of the portfolio or fund held in the
Subaccount determined at the end of the current Valuation Period; plus
b. the per-share amount of any dividend or capital gain distributions
made by the investment held in the Subaccount, if the "ex-dividend"
date occurs during the current Valuation Period; plus or minus
c. a per-share charge or credit for any taxes reserved for the current
Valuation Period that We determine to have resulted from the
investment operations of the Subaccount; and
(2) is the net result of:
a. the net asset value per share of the portfolio or fund held in the
Subaccount, determined at the end of the last prior Valuation Period;
plus or minus
b. the per-share charge or credit for any taxes reserved for the last
prior Valuation Period.
CHANGE OF INVESTMENTS OF THE SUBACCOUNTS
The investments of the Subaccounts would be changed only if laws or regulations
change, the investment became unavailable, or in Our judgment, the investments
were no longer suitable for the Subaccounts. If any of these situations
occurred, We would have the right to substitute investments other than those
shown under Policy Data. When required, We would first seek the approval of the
Securities and Exchange Commission and the insurance regulator of the state in
which this policy is delivered.
Page 23
TRANSFERS AMONG THE SUBACCOUNTS AND THE FIXED ACCOUNT
By Written Request or other request acceptable to Us, You may transfer all or
part of the value of a Subaccount to one or more of the other Subaccounts or to
the Fixed Account. The amount transferred, however, must be at least: (1) $250;
or (2) the total value of the Subaccount, if less. We reserve the right to limit
such transfers to five per policy year. We may suspend or modify this transfer
privilege at any time with the necessary approval of the Securities and Exchange
Commission and the insurance regulator of the state in which this policy is
delivered.
You may also transfer from the Fixed Account to the Subaccounts once a year, but
only on the Policy Anniversary or within 30 days after such Policy Anniversary.
If You make this transfer, You cannot transfer from the Subaccounts back into
the Fixed Account until the next Policy Anniversary. If We receive Your Written
Request within 30 days before the Policy Anniversary date, the transfer from the
Fixed Account to the Subaccounts will be effective on the Policy Anniversary
date. If We receive Your Written Request within 30 days after the Policy
Anniversary date, the transfer from the Fixed Account to the Subaccounts will be
effective on the date We receive the request. The minimum transfer amount is
$250 or the Fixed Account value minus Indebtedness, if less. The maximum
transfer amount is the Fixed Account Value, minus Indebtedness. We may suspend
or modify this transfer privilege at any time with the necessary approval of the
Securities and Exchange Commission and the insurance regulator of the state in
which this policy is delivered.
Automated transfers are also allowed. By an automated transfers arrangement, You
may transfer: (1) all or part of the value of a Subaccount to one or more of the
other Subaccounts or to the Fixed Account; or (2) all or part of the Fixed
Account Value, minus Indebtedness, to one or more of the Subaccounts. Only one
automated transfer arrangement can be in effect at any time. Policy values may
be transferred to one or more of the Subaccounts or to the Fixed Account, but
can only be transferred from only one account. The minimum transfer amount is
$50. Twelve automated transfers from the Fixed Account may not exceed an amount
that, if continued, would deplete the Fixed Account Value, minus Indebtedness,
within twelve months.
SUBACCOUNT TRANSFER AT THE INSURED'S ATTAINED INSURANCE AGE 120 ANNIVERSARY
On the Insured's Attained Insurance Age 120 Anniversary any policy value in the
Subaccounts will be transferred to the Fixed Account. Transfers from the Fixed
Account to the Subaccounts are not permitted after the Insured's Attained
Insurance Age 120 Anniversary.
Page 24
PAYMENT OF POLICY PROCEEDS
PAYMENT OF PROCEEDS UPON DEATH OF THE INSURED
Upon death of the Insured, the Proceeds will be paid in a single sum unless a
payment option has been selected. The date on which the Proceeds are paid in a
lump sum or first placed under a payment option is the settlement date. The
Proceeds will be paid upon Our receipt of the following:
1. due proof of death; and
2. information sufficient to determine Our liability and the appropriate
payee legally entitled to the Proceeds; and
3. if Proceeds depend on the action of parties other than Us, the date
that legal impediments to payment are resolved and sufficient evidence
is provided to Us.
Proceeds shall accrue interest at the Option A Interest Rate per year, shown
under Policy Data in the Payment of Policy Proceeds Option Tables, from the date
of death to the settlement date
PAYMENT OPTIONS OTHER THAN A SINGLE SUM
During the Insured's lifetime, You may request in writing that We pay the
Proceeds upon death of the Insured or upon surrender of the policy under one or
more of the payment options shown below or You may change a prior election. You
may elect other payment options not shown if We agree.
However, unless We agree otherwise, a payment option may be selected only if
the payments are to be made to a natural person in that person's own right.
Also, the amount of Proceeds placed under a payment option must be at
least $5,000.
OPTION A - INTEREST PAYMENTS
This option provides for payment of interest on the Proceeds placed under this
option at the Option A Interest Rate, shown under Policy Data in the Payment of
Policy Proceeds Option Tables, per year compounded annually. We will make
regular interest payments at intervals and for a period that is agreeable to
both You and Us. At the end of any payment interval, a withdrawal of Proceeds
may be made in amounts of at least $100. At any time, all of the Proceeds that
remain may be withdrawn or placed under a different payment option approved by
Us.
OPTION B - PAYMENTS FOR A SPECIFIED PERIOD
This option provides for monthly payments for a specified number of years. The
amount of each monthly payment for each $1,000 placed under this option is shown
in the Option B Table under Policy Data in the Payment of Policy Proceeds Option
Tables. The monthly payments will not be less than that which would be provided
if a single payment immediate annuity contract then offered by Us to annuitants
in the same class were to be purchased for amounts of either:
1. upon surrender of the policy, the Cash Surrender Value; or
2. upon death of the Insured, the death benefit minus any Indebtedness, as of
the date of the Insured's death.
Monthly payments for years not shown will be furnished upon request.
OPTION C - LIFETIME INCOME
This option provides for monthly payments for the life of the person (the payee)
who is to receive the income. Payments will be guaranteed for either 5, 10, or
15 years. The amount of each monthly payment for each $1,000 placed under this
option will be based on Our Table of Settlement rates in effect at the time of
the first payment. The amounts will not be less than those in the Option C
Table, shown under Policy Data in the Payment of Policy Proceeds Option Tables,
for the sex and age of the payee on the due date of the first payment. The
monthly payments will not be less than that which would be provided if a single
payment immediate annuity contract then offered by Us to annuitants in the same
class were to be purchased for amounts of either:
1. upon surrender of the policy, the Cash Surrender Value; or
2. upon death of the Insured, the death benefit minus any Indebtedness, as of
the date of the Insured's death.
Monthly income amounts for any age not shown in the Option C Table will be
furnished upon request.
BENEFICIARY REQUEST OF PAYMENT OPTION
After the Insured's death but before any Proceeds are paid, the beneficiary may
select a payment option by Written Request on a form satisfactory to Us.
However, You may provide that the beneficiary will not be permitted to change
the payment option You have selected.
Page 25
FLEXIBLE PREMIUM VARIABLE
LIFE INSURANCE POLICY
POLICY CONTINUES UNTIL DEATH, SURRENDER, OR LAPSE.
DEATH BENEFIT PAYABLE AT INSURED'S DEATH.
FLEXIBLE PREMIUMS PAYABLE AS PROVIDED HEREIN. BENEFITS, VALUES AND PERIODS
OF COVERAGE ARE BASED ON ACTUAL PREMIUMS PAID, INTEREST CREDITED,
INVESTMENT PERFORMANCE OF THE SUBACCOUNTS AND CHARGES. INTEREST RATES AND
CHARGES ARE SUBJECT TO CHANGE BY US AS DESCRIBED HEREIN.
NO-LAPSE GUARANTEES AS DESCRIBED HEREIN.
THIS POLICY IS NONPARTICIPATING. DIVIDENDS ARE NOT PAYABLE.
RIVERSOURCE LIFE INSURANCE CO. OF NEW YORK
20 Madison Avenue Extension
Box 5144
Albany, New York 12205