EX-99.4(A)(1) 3 a20-24944_1ex99d4a1.htm EX-99.4(A)(1)

 

CONTRACT SPECIFICATIONS

 

CONTRACT DATA

 

Contract Number:

 

[VR99999999]

 

Contract Date:

 

[12-01-2020]

 

 

 

 

 

 

 

Contract Type:

 

[Non-Qualified]

 

Maximum Issue Age:

 

[90]

 

 

 

 

 

 

 

Owner(s):

 

[John Doe]
[Jane Doe]

 

Owner’s Age:

 

[35]
[35]

 

 

 

 

 

 

 

Annuitant(s):

 

[John Doe]
[Jane Doe]

 

Annuitant’s Age:

 

[35]
[35]

 

 

 

 

 

 

 

Annuity Date:

 

[01-01-2080]

 

Annuitant’s Sex:

 

[Male]
[Female]

 

PURCHASE PAYMENTS

 

 

 

 

 

Initial Purchase Payment Amount:

 

[$100,000]

 

 

 

Minimum Purchase Payment Amount for Non-Qualified Contracts:

 

[$25,000]

 

 

 

Minimum Subsequent Purchase Payment Amount for Non-Qualified Contracts:

 

[$250]

 

 

 

Minimum Purchase Payment Amount for Qualified Contracts:

 

[$25,000]

 

 

 

Minimum Subsequent Purchase Payment Amount for Qualified Contracts:

 

[$50]

 

 

 

Maximum Aggregate Purchase Payment Amount Without Pacific Life Home Office Approval:

 

[$1,000,000]

 

 

 

Minimum Transfer Amount:

 

[$250]

 

 

 

Transfer Fee for Exceeding Trade Limit:

 

[$25]

 

 

 

Minimum Investment Option Value:

 

[$500]

 

 

 

Interest Rate Used for Misstatement of Age and/or Sex:

 

[1.50%]

 

 

 

Minimum Contract Value to Avoid Contract Termination:

 

[$1,000]

 

 

 

Advisory Fee Cap:

 

[1.50%]

 

Minimum Withdrawal Amounts:

 

·       [$500] for each unscheduled Withdrawal

 

 

·       [$250] for each systematic Withdrawal

 

 

·       [$100] for each systematic Withdrawal paid by electronic funds transfer (EFT)

 

Maximum Annuitization Age:

 

[100]

 

 

 

Minimum Annuitization Amount:

 

[$10,000]

 

 

 

Minimum Annuity Payment Amount:

 

[$240]

 

 

CONTRACT SPECIFICATIONS (continued)

 

FEES AND CHARGES

 

 

 

 

 

Mortality and Expense Risk Charge:

 

[0.15%]

Administrative Fee:

 

[0.15%]

Platform Fee:

 

[0.15%]

 

RIDER(S)

 

Name

 

Current Annual
Charge %

 

Maximum Annual
Charge %

 

[Return of Premium Death Benefit Rider

 

[0.20%]

 

0.20%]

 

 

For a complete description of the charges, fees and deductions shown above and other applicable fees and charges, refer to the Charges, Fees and Deductions Provisions of the Contract or the Annual Charge provision of the Rider(s) shown above, if applicable.

 

3B

 

 

CONTRACT SPECIFICATIONS (continued)

 

INVESTMENT OPTIONS

 

[

 

[

American Funds IS® Bond 1

 

Invesco Oppenheimer VI Mn Strt Sm Cp I

American Funds IS® US Govt/AAA-Rtd Secs1

 

Invesco VI American Value I

BlackRock High Yield V.I. I

 

Janus Henderson VIT Enterprise Instl

BlackRock Total Return V.I. I

 

JPMorgan Insurance Tr Mid Cap Value 1

DFA VA Short-Term Fixed Portfolio

 

MFS® VIT New Discovery Init

Fidelity® VIP Floating Rate Hi Inc Init

 

MFS® VIT Value Init

Pacific Asset Management Floating Rate Income

 

Schwab® S&P 500 Index Portfolio

JPMorgan Insurance Tr Core Bond 1

 

T. Rowe Price Blue Chip Growth Port

PIMCO VIT Long-Term US Govt Instl

 

T. Rowe Price Equity Income Port

PIMCO VIT Low Duration Instl

 

Vanguard VIF Capital Growth

PIMCO VIT Total Return Instl

 

Vanguard VIF Diversified Val

Vanguard VIF High Yield Bond

 

Vanguard VIF Equity Income

Fidelity® VIP Government Money Mkt Init

 

Vanguard VIF Equity Index

Vanguard VIF Short Term Invmt Grade

 

Vanguard VIF Growth

Vanguard VIF Total Bond Mkt Idx

 

Vanguard VIF Mid-Cap Index

Western Asset Core Plus VIT I

 

Vanguard VIF Total Stock Mkt Idx

American Funds IS® Captial World Bond Fund 1

 

American Funds IS® Capital Inc Builder®1

DFA VA Global Bond

 

American Funds IS® Global Growth 1

Franklin Strategic Income VIP 1

 

American Funds IS® Global Growth & Inc 1

PIMCO VIT Emerging Markets Bond Instl

 

American Funds IS® International 1

Templeton Global Bond VIP 1

 

American Funds IS® Intl Gr And Inc 1

Vanguard VIF Global Bond Index

 

American Funds IS® New World 1

American Funds IS® Blue Chip Inc&Gr 1

 

BlackRock Global Allocation V.I. I

American Funds IS® Growth 1

 

DFA VA Equity Allocation Portfolio Instl

American Funds IS® Growth-Income 1

 

DFA VA Global Moderate Allocation Instl

American Century VP Mid Cap Value I

 

DFA VA International Small Portfolio

BlackRock S&P 500 Index V.I. I

 

DFA VA International Value Portfolio

BlackRock Small Cap Index V.I. I

 

Fidelity® VIP Emerging Markets Initial

BlackRock Equity Dividend V.I. I

 

Goldman Sachs VIT Glbl Trds Alloc Instl

DFA VA US Large Value

 

Invesco Oppenheimer VI Intl Gr I

DFA VA US Targeted Value

 

Invesco VI Balanced-Risk Allocation I

Fidelity® VIP Contrafund Initial

 

Invesco VI International Growth I

Fidelity® VIP Extended Mkt Idx Initial

 

MFS® VIT II International Growth Init

Fidelity® VIP Growth Opportunities Init

 

Templeton Foreign VIP 1

Fidelity® VIP Index 500 Initial

 

Vanguard VIF International

Fidelity® VIP Value Strategies Initial

 

Vanguard VIF Total Intl Stk Mkt Idx

Franklin Rising Dividends VIP 1

 

American Funds IS® Mgd Risk Asset AllcP1

Franklin Small Cap Value VIP 1

 

American Funds IS® Asset Allocation 1

Franklin Small Mid Cap Growth VIP 1

 

BlackRock 60/40 Trgr Allc ETF VI I

Goldman Sachs VIT Large Cap Value Instl

 

DFA Balanced Allocation Portfolio

Goldman Sachs VIT Mid Cap Value Instl

 

Franklin Income VIP 1

Goldman Sachs VIT Strategic Growth Instl

 

Franklin Mutual Shares VIP 1

Invesco Oppenheimer VI Discv Md Cp Gr I]

 

Janus Henderson VIT Balanced Instl]

 

3C

 

 

CONTRACT SPECIFICATIONS (continued)

 

INVESTMENT OPTIONS (continued)

 

[

 

 

PLFA Pacific Dynamix Conservative-Growth

 

 

PLFA Pacific Dynamix Growth

 

 

PLFA Pacific Dynamix Moderate-Growth

 

 

TOPS® Aggressive Growth ETF 1

 

 

TOPS® Balanced ETF 1

 

 

TOPS® Conservative ETF 1

 

 

TOPS® Growth ETF 1

 

 

TOPS® Managed Risk Balanced ETF 1

 

 

TOPS® Managed Risk Growth ETF 1

 

 

TOPS® Managed Risk Moderate Gr ETF 1

 

 

TOPS® Moderate Growth ETF 1

 

 

Vanguard VIF Balanced

 

 

Vanguard VIF Conservative Allocation

 

 

Vanguard VIF Moderate Allocation

 

 

Invesco VI Technology I

 

 

T. Rowe Price Health Sciences Port

 

 

Vanguard VIF Real Estate Index

 

 

MFS® VIT Utilities Series Initial

 

 

Fidelity® VIP Consumer Disctnry Init

 

 

Fidelity® VIP Energy Initial

 

 

]

 

 

 

3D

 

 

CONTRACT SPECIFICATIONS (continued)

 

SERVICE CENTER

 

Send Forms and written requests to:

 

Send Payments to:

[Pacific Life Insurance Company

 

[Pacific Life Insurance Company

P.O. Box 2378

 

P.O. Box 2290

Omaha, Nebraska 68103-2378]

 

Omaha, Nebraska 68103-2290]

 

Hours: [Between 6:00 am and 5:00 pm, Pacific Standard Time.]

Toll-Free Number for Contract Owners:  [1-800-722-4448]

Toll-Free Number for Financial Professionals:  [1-800-722-2333]

Website: [www.PacificLife.com]

 

Please use our toll-free telephone number for questions about your annuity contract and benefit riders, or you may call your state insurance department at [1-xxx-xxx-xxxx.]

 

3E