EX-99.(4)(D) 6 dex994d.txt FORM OF HIGHEST ANNIVERSARY VALUE DEATH BENEFIT RIDER P-RID-HAV NY Exhibit (4)(d) PRUCO LIFE INSURANCE COMPANY OF NEW JERSEY [213 WASHINGTON STREET NEWARK, NEW JERSEY 07102] HIGHEST ANNIVERSARY VALUE DEATH BENEFIT RIDER This Rider is made part of your Annuity. For purposes of this Rider, certain provisions of your Annuity are amended as described below. If the terms of your Annuity and those of this Rider conflict, the provisions of this Rider shall control. Should this Rider terminate, any amended or replaced Annuity provisions based on this Rider's terms will revert back to the provisions in the Annuity, except as may be provided below. The benefit provided pursuant to the terms of this Rider is a "Highest Anniversary Value Death Benefit." This Rider should be read in conjunction with any other applicable Death Benefit Rider made a part of your Annuity. EFFECTIVE DATE: The Effective Date of this Rider is shown in the Highest Anniversary Value Death Benefit Schedule Supplement. DEFINITIONS: ADJUSTED PURCHASE PAYMENTS: For purposes of calculating the Death Benefit offered under this Rider, "Adjusted Purchase Payments" means the amount of Purchase Payments we receive, less any fees or Tax Charges deducted from the Purchase Payments upon allocation to the Annuity. PURCHASE CREDITS: Amounts we may allocate to your Account Value in relation to Purchase Payments. Refer to your Annuity Schedule to determine if your Annuity makes provision for Purchase Credits. WITHDRAWALS: Withdrawals of any type (including free withdrawals and partial withdrawals) before the application of any applicable Contingent Deferred Sales Charge or other charge applicable upon a Withdrawal. DEATH BENEFIT: If we receive Due Proof of Death within the Due Proof of Death Period shown in the Highest Anniversary Value Death Benefit Schedule Supplement, the Death Benefit of the Annuity equals the greater of (a) and (b), where: (a) is the "Highest Anniversary Value," described below; and (b) is the greater of the Basic Death Benefit described in the "Death Benefit" section of the Annuity and the Death Benefit described in any other Death Benefit Rider made a part of the Annuity. If we do not receive Due Proof of Death within the Due Proof of Death Period, the Death Benefit of the Annuity equals the Basic Death Benefit described in the "Death Benefit" section of the Annuity. We reserve the right to waive or extend, on a non-discriminatory basis, our right to enforce the Due Proof of Death Period. This right will only apply for purposes of determining the amount payable as a Death Benefit, and in no way restricts when a claim may be filed. HIGHEST ANNIVERSARY VALUE: The Highest Anniversary Value is initially equal to the Account Value on the Effective Date. Thereafter, the Highest Anniversary Value is increased by the sum of any additional Adjusted Purchase Payments plus any applicable Purchase Credits allocated to your Account Value in relation to such Purchase Payments, and is reduced by the ratio of each applicable Withdrawal to the Account Value as of the date of the Withdrawal but immediately prior to the Withdrawal. On each Highest Anniversary Value Comparison Date, up to and including the earlier of the decedent's date of death and the Death Benefit Target Date, if applicable, the Highest Anniversary Value is P-RID-HAV(2/10)-NY 1 compared to the Account Value. If the Account Value is greater than the Highest Anniversary Value, the Highest Anniversary Value is increased to equal the Account Value. Highest Anniversary Value Comparison Dates and the Death Benefit Target Date are shown in the Highest Anniversary Value Death Benefit Schedule Supplement. TWO-YEAR SUSPENSION PERIOD: If there is a change of Owner or Annuitant more than 60 days after the Effective Date, resulting in a change in the person upon whose death the Death Benefit is determined, the Highest Anniversary Value Death Benefit is suspended as to that person for a two-year period from the date he or she first became an Owner or Annuitant under the terms of the Annuity. After the suspension period is completed, the Death Benefit is the same as if such person had been an Owner or Annuitant on the Effective Date, although the Death Benefit Target Date may change as described in the Highest Anniversary Value Death Benefit Schedule Supplement. During the Two-Year Suspension Period, the Death Benefit is the Basic Death Benefit described in the "Death Benefit" section of the Annuity. OTHER DEATH BENEFIT PROVISIONS: The provisions applicable to the Death Benefit described in your Annuity regarding eligibility, limits of applicability, methods of payment to Beneficiaries or any other provision regarding the Death Benefit, other than the method of calculation of the Death Benefit, continue to apply unless specifically indicated otherwise in this Rider. SPOUSAL CONTINUATION: Upon Spousal Continuation, the Account Value is increased, if necessary, to equal the greatest of (1) the Highest Anniversary Value, (2) the Death Benefit described in any other Death Benefit Rider made a part of the Annuity, and (3) the Basic Death Benefit described in the Annuity If the Annuity is surrendered within 12 months of Spousal Continuation, we will deduct from the Surrender Value any Purchase Credits applied during the period beginning 12 months prior to the date of the decedent's death and ending on the date we receive Due Proof of Death. We reserve the right to waive, on a non-discriminatory basis, our right to deduct such Purchase Credits. Any increase to the Account Value resulting from such adjustment will be allocated on a pro-rata basis to the Sub-accounts in which Account Value is then allocated, excluding any Sub-accounts to which you are not permitted to electively allocate or transfer Account Value. If the Account Value in such "elected" Sub-accounts is zero, we will allocate the additional amount to a money market Investment Option. If Spousal Continuation occurs prior to the Death Benefit Target Date, we reset the Highest Anniversary Value to equal the Account Value, including any increase described above, as of the date of Due Proof of Death of the decedent, for purposes of calculating any subsequent Death Benefit. If Spousal Continuation occurs on or after the Death Benefit Target Date, this Rider terminates upon Spousal Continuation. CHARGE FOR THE RIDER: The Insurance Charge shown in the Annuity Schedule is increased to include the Insurance Charge for this Rider, as shown in the Highest Anniversary Value Death Benefit Schedule Supplement. The charge is assessed until we receive Due Proof of Death of the decedent, unless Spousal Continuation occurs, or until the Rider terminates for any of the reasons cited in "Termination of this Rider" below. See the "Account Value" section of the Annuity for a description of how the charge is applied. INVESTMENT LIMITATIONS: While this Rider is in effect, your entire Account Value must be allocated to only those Investment Options we permit. Any limitations are stated in the Application for this benefit. In addition, you may be required to maintain all or a portion of your Account Value in accordance with an asset allocation model. At any time until this Rider is terminated, these investment limitations may be implemented, suspended or changed. This includes changing prohibited Investment Options, changing the extent to which Account Value may be allocated to an Investment Option, and changing required Investment Options. Any P-RID-HAV(2/10)-NY 2 change in the investment limitations will first be approved by the Superintendent of Insurance. Any transfers resulting from our implementing or changing any investment limitation will not be counted in determining the number of free transfers made during an Annuity Year. If, subsequent to your election of this benefit, we change our requirements as to how Account Value must be allocated under the benefit, that new requirement will apply to new elections of the benefit, and we will not compel you to re-allocate your Account Value in accordance with our newly-adopted requirements. However, all transfers and Purchase Payments made after such a change in requirements may be subject to the new investment limitations. TERMINATION OF THIS RIDER: Termination of this Rider is subject to the following rules: A. TERMINATION DUE TO DEATH: This Rider terminates automatically as of the date the Annuity's Death Benefit is determined, unless the Annuity is continued by a Spouse Beneficiary prior to the Death Benefit Target Date. B. TERMINATION DUE TO OWNER(S)/ANNUITANT CHANGE: This Rider terminates automatically if you designate a new Owner(s) or Annuitant such that the new Owner(s) or Annuitant is older than the age for which we would then issue this benefit as of the effective date of such a change or if we do not then consent, on a non-discriminatory basis, to continue the Rider. C. TERMINATION ON THE ANNUITY DATE: This Rider terminates automatically as of the Annuity Date. D. TERMINATION UPON SURRENDER: This Rider terminates upon surrender of the Annuity to which it is made a part. E. TERMINATION IF ACCOUNT VALUE REDUCES TO ZERO: This Rider automatically terminates if your Account Value reduces to zero. PRUCO LIFE INSURANCE COMPANY OF NEW JERSEY /s/ Thomas C. Castano --------------------------------------- Secretary P-RID-HAV(2/10)-NY 3