|
Owner:
|
[John Doe]
|
Contract Number:
|
[687456]
|
|
Owner’s Date of Birth:
|
[January 15, 1977]
|
Issue Date:
|
[04/15/26]
|
|
Owner’s Gender:
|
[Male]
|
Annuitant:
|
[John Doe]
|
|
[Joint Owner:
|
[Jane Doe]]
|
Annuitant’s Date of Birth:
|
[January 15, 1977]
|
|
[Joint Owner’s Date of Birth:
|
[January 15, 1977]]
|
Annuitant’s Gender:
|
[Male]
|
|
[Joint Owner’s Gender:
|
[Female]]
|
||
|
Eligible Person(s):
|
[John Doe]
|
||
|
[Jane Doe]
|
|
Eligible Person’s* Age
|
Income Percentage
|
Income Percentage Increase **
|
|||
|
Level Income
|
Increasing Income
|
||||
|
Single Income Payments
|
Joint Income Payments
|
Single Income Payments
|
Joint Income Payments
|
||
|
[0-50
|
5.10%
|
4.60%
|
3.60%
|
3.10%
|
0.25%]
|
|
[51
|
5.20%
|
4.70%
|
3.70%
|
3.20%
|
0.25%]
|
|
[52
|
5.30%
|
4.80%
|
3.80%
|
3.30%
|
0.25%]
|
|
[53
|
5.40%
|
4.90%
|
3.90%
|
3.40%
|
0.25%]
|
|
[54
|
5.50%
|
5.00%
|
4.00%
|
3.50%
|
0.25%]
|
|
[55
|
5.60%
|
5.10%
|
4.10%
|
3.60%
|
0.30%]
|
|
[56
|
5.70%
|
5.20%
|
4.20%
|
3.70%
|
0.30%]
|
|
[57
|
5.80%
|
5.30%
|
4.30%
|
3.80%
|
0.30%]
|
|
[58
|
5.90%
|
5.40%
|
4.40%
|
3.90%
|
0.30%]
|
|
[59
|
6.00%
|
5.50%
|
4.50%
|
4.00%
|
0.30%]
|
|
[60
|
6.10%
|
5.60%
|
4.60%
|
4.10%
|
0.35%]
|
|
[61
|
6.20%
|
5.70%
|
4.70%
|
4.20%
|
0.35%]
|
|
[62
|
6.30%
|
5.80%
|
4.80%
|
4.30%
|
0.35%]
|
|
[63
|
6.40%
|
5.90%
|
4.90%
|
4.40%
|
0.35%]
|
|
[64
|
6.50%
|
6.00%
|
5.00%
|
4.50%
|
0.35%]
|
|
[65
|
6.60%
|
6.10%
|
5.10%
|
4.60%
|
0.40%]
|
|
[66
|
6.70%
|
6.20%
|
5.20%
|
4.70%
|
0.40%]
|
|
[67
|
6.80%
|
6.30%
|
5.30%
|
4.80%
|
0.40%]
|
|
[68
|
6.90%
|
6.40%
|
5.40%
|
4.90%
|
0.40%]
|
|
[69
|
7.00%
|
6.50%
|
5.50%
|
5.00%
|
0.40%]
|
|
[70
|
7.10%
|
6.60%
|
5.60%
|
5.10%
|
0.45%]
|
|
[71
|
7.20%
|
6.70%
|
5.70%
|
5.20%
|
0.45%]
|
|
[72
|
7.30%
|
6.80%
|
5.80%
|
5.30%
|
0.45%]
|
|
[73
|
7.40%
|
6.90%
|
5.90%
|
5.40%
|
0.45%]
|
|
[74
|
7.50%
|
7.00%
|
6.00%
|
5.50%
|
0.45%]
|
|
[75
|
7.60%
|
7.10%
|
6.10%
|
5.60%
|
0.50%]
|
|
[76
|
7.70%
|
7.20%
|
6.20%
|
5.70%
|
0.50%]
|
|
[77
|
7.80%
|
7.30%
|
6.30%
|
5.80%
|
0.50%]
|
|
[78
|
7.90%
|
7.40%
|
6.40%
|
5.90%
|
0.50%]
|
|
[79
|
8.00%
|
7.50%
|
6.50%
|
6.00%
|
0.50%]
|
|
[80+
|
8.10%
|
7.60%
|
6.60%
|
6.10%
|
0.55%]
|
|
[Covered Person’s* Age
|
Level Income Guarantee Payment
Percentage
|
|
50
|
2.23%
|
|
51
|
2.28%
|
|
52
|
2.33%
|
|
53
|
2.39%
|
|
54
|
2.44%
|
|
55
|
2.50%
|
|
56
|
2.57%
|
|
57
|
2.64%
|
|
58
|
2.71%
|
|
59
|
2.78%
|
|
60
|
2.86%
|
|
61
|
2.95%
|
|
62
|
3.04%
|
|
63
|
3.13%
|
|
64
|
3.23%
|
|
65
|
3.34%
|
|
66
|
3.45%
|
|
67
|
3.58%
|
|
68
|
3.71%
|
|
69
|
3.85%
|
|
70
|
4.00%
|
|
71
|
4.17%
|
|
72
|
4.35%
|
|
73
|
4.55%
|
|
74
|
4.77%
|
|
75
|
5.00%
|
|
76
|
5.27%
|
|
77
|
5.56%
|
|
78
|
5.89%
|
|
79
|
6.25%
|
|
80
|
6.67%
|
|
81+
|
0.00%]
|