TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER t: SEPARATE ACCOUNTS
PART 1551 VARIABLE CONTRACTS
SECTION 1551.APPENDIX A VARIABLE ANNUITIES ONLY


 

Section 1551.APPENDIX A  Variable Annuities Only

 

[Name of Company]

 

Hypothetical Illustration of Benefits

From An Immediate Variable Annuity

 

Prepared for

John Doe

Age & Sex

65 Male

Annuity Form

Life Annuity with 120

 

Months Certain

Single Purchase Payment

$15,000

 

Annuity payments will vary as described in the prospectus, and in accordance with the actual investment results.

 

An interest rate of 3½% is used in calculating the initial payment. If the investment result after charges and taxes, as described in the prospectus, is equal to the interest rate assumed for the annuity, the annuity payment for that period will be unchanged.  If the investment result is greater, the annuity payment will increase; if less, the payment will decrease.

 

The table below illustrates the effect of three hypothetical annual rates of investment return.  The hypothetical rates of investment return shown are after provision for any taxes chargeable to the account, but before deduction of other charges.

 

 

MONTHLY ANNUITY PAYMENT

 

AT AGE

Hypothetical Investment Result

 

First

Payment

 

70

 

75

 

80

 

85

8%

 

$92.64

 

$109.40

 

$129.19

 

$152.56

 

$180.16

4%

 

92.64

 

90.42

 

88.26

 

86.15

 

84.09

0%

 

92.64

 

74.18

 

59.39

 

47.56

 

38.08

 

The investment results bear no relationship to past or future investment results.  Actual investment results will vary from month to month and actual payments may be more or less than shown above.

 

Use of this material is prohibited unless preceded or accompanied by a current prospectus which sets forth the sales expenses and other material information.