EX-4 7 e150734_ex4vi.htm FORM OF GUARANTEED LIFETIME WITHDRAWAL BENEFIT (GLWB) DATA PAGE
Ex. 4(vi)

 
Rider Section 1.   RIDER DATA PAGE   CONTRACT NUMBER:    [123456789]
 

GUARANTEED LIFETIME WITHDRAWAL BENEFIT (GLWB)

1.01   GENERAL INFORMATION    
         
    Covered Person   Issue Age
    [John Doe]   [50]
         
  [ Joint Covered Person   Issue Age
    [Jane Doe]   [50]]
         
    Owner(s)   Contract Issue Date
    [John Doe]   [October 1, 2018]

1.02   GLWB PAYMENT INFORMATION          
    Earliest GLWB Payment Start Date:         [Contract Anniversary following the 50th birthday of the
              younger Covered Person or the first Contract Anniversary,
              whichever is later]
1.03   ANNUAL INCREASE PERIOD          
    Maximum Annual Increase Period: [10 Years]
               
1.04   GLWB RIDER FEE          
               
    GLWB Rider Fee:   [0.XX]% multiplied by the average daily GLWB Benefit Base for
the prior Contract Year as described in Rider Section 9.01.
               
1.05   WITHDRAWAL PERCENTAGE TABLE          

[ Age of Covered Person* as
of the Contract Issue Date
Base Withdrawal Percentage Annual Increase Percentage
Single Life Joint Life Single Life Joint Life
<55 2.00% 1.50% 0.40% 0.40%
55 - 59 3.00% 2.50% 0.40% 0.40%
60 - 64 4.00% 3.50% 0.40% 0.40%
65 - 74 5.00% 4.50% 0.40% 0.40%
75 - 79 6.00% 5.50% 0.40% 0.40%
80+ 7.00% 6.50% 0.40% 0.40%

  *If there are two Covered Persons, we will use the age of the younger Covered Person as of the Contract Issue Date.]

2018-RILA-GLWBDP