EX-4.F ENDORSEMENTS 6 ipvadatapage2006.txt DATA PAGE SF 749-2 3- 1 SF 749-2 3 DATA PAGE -------------------------------------------------------------------------- Flexible Premium Deferred Variable Annuity --------------------------------------------------------------------- CONTRACT DATA Contract Number: [Sample] Annuitant/Age: [John Doe/35] Owner: [Jane Doe] Joint Annuitant/Age: [Jane Doe/35] Joint Owner: [John Doe] Contract Date: [November 1, 2004] Maximum Annuitization Date: [October 31, 2054] Initial Premium: [$10,000.00] BENEFITS Fixed Account Guaranteed Minimum Interest Rate: [1.00%-3.00%] Fixed Account Interest Rate for premium payments received on the Contract Date: [3.50%] The Fixed Account Interest Rate may be lower for the Premium Payment Credit Rider. Fixed Dollar Cost Averaging (DCA) Account Guaranteed Minimum Interest Rate: [1.00%-3.00%] Fixed DCA Account 6-Month DCA Term Interest Rate for premium payments received on the Contract Date: [4.50%] Fixed DCA Account 12-Month DCA Term Interest Rate for premium payments received on the Contract Date: [5.50%] CONTRACT CHARGES AND LIMITS
Separate Account Administration Charge: Currently [ 0.00% ], not to exceed 0.15% annually Mortality & Expense Risks Charge: 1.25% annually Annual Fee: Lesser of $30.00 or 2.00% of accumulated value Transaction Fee: [Currently $00.00 ], or, for unscheduled Division transfers after the first, such larger amount as is required by law or by the underlying mutual fund of the Division. Minimum Additional Premium: $500.00 Maximum Total Premium Contributions: $2,000,000.00 Minimum Unscheduled Partial Surrender: $100.00 Minimum Accumulated Value After A Partial Surrender: $5,000.00 Minimum Accumulated Value To Initiate A Scheduled Partial Surrender: $5,000.00 Minimum Transfer Amount: $100.00 Free Surrender Amount: The greater of (A.) and (B.) where: (A.) is 10% of premium payments decreased by any partial surrenders made since the last Contract Anniversary; and (B.) is the accumulated value minus remaining premium payments as of the surrender date. [ Minimum Fixed DCA Account Premium Payment: $1,000.00 ]
------- ----- SURRENDER CHARGES Completed Contract Years Since Each Premium Payment Was Made Surrender Charge Percentage 0 6.00% 1 6.00% 2 6.00% 3 5.00% 4 4.00% 5 3.00% 6 2.00% 7 and after 0.00% ------- ----- ------- ----- SURRENDER CHARGES Completed Contract Years Since Each Premium Payment Was Made Surrender Charge Percentage 0 8.00% 1 8.00% 2 7.00% 3 6.00% 4 5.00% 5 4.00% 6 3.00% 7 2.00% 8 1.00% 9 and after 0.00% ------- ----- ------------------------------------- RIDER DATA
Enhanced Death Benefit Rider Effective Date: [ September 1, 2004 ] Quarterly Rider Charge: Currently [ 0.0625% ] of average quarterly accumulated value, not to exceed 0.0750%. Guaranteed Minimum Withdrawal Benefit Rider Effective Date: [ September 1, 2004 ] Quarterly Rider Charge: Currently [ 0.1500% ] of average quarterly Investment Back Remaining Withdrawal Benefit Base, not to exceed 0.2125%. Premium Payment Credit Rider Effective Date: [ September 1, 2004 ] Annual Rider Charge: 0.60% of the Division Value for the first eight Contract Years. [ Also, the Fixed Account Initial Interest Rate may reflect an adjustment for this rider. ]