Form of Specifications Page General

EX-4.B 5 d302995dex4b.htm EX-4.B EX-4.b

Exhibit 4.b

Fidelity & Guaranty Life Insurance Company

SPECIFICATIONS PAGE – GENERAL

 

 

Contract Number: [00000000]      
Tax Status: [Qualified]       [Marketing Name: [Product Name]]
Issue Date: [December 1, 2010]    Issue State: [XX]   
Owner Name(s): [John Doe]    Birth Date: [February 1, 1971]   
                            [Mary Doe]    [Birth Date:] [March 21, 1975]   
Annuitant Name: [John Doe]    Birth Date: [February 1, 1971]    Annuitant Sex: [Male]
[Joint Annuitant Name:] [Mary Doe]    [Birth Date:] [March 21, 1975]    [Joint Annuitant Sex:] [Female]

Maturity Date: [December 1, 2071]

Maturity Date is the Contract Anniversary on or first following [the later of] the Annuitant’s (or oldest Annuitant’s if a Joint Annuitant is named) [100th] birthday [or the [15th] Contract Anniversary].

The information regarding the Owner(s), Annuitant(s), Beneficiary, and Annuity Option is subject to any change submitted and accepted by Us and on record.

Premium: [$100,000.00]

Maximum Aggregate Premium Limit: [$1,000,000.00]

This is a Single Premium Deferred Annuity. Any additional premium received by the Company after the Issue Date will not be accepted.

Minimum Remaining Account Value: [$2,000.00]

Minimum Scheduled Withdrawal Amount: [$100.00] per Withdrawal

Minimum Unscheduled Withdrawal Amount: [$500.00] per Withdrawal

Surrender Charge Schedule

 

Contract
Year 1

   

Contract
Year 2

   

Contract
Year 3

   

Contract
Year 4

   

Contract
Year 5

   

Contract
Year 6

7.00%    7.00%    6.00%    5.00%    4.00%    3.00%

There are no Surrender Charges applicable after the 6th Contract Year.

Underpayment Annual Interest Rate: [X.XX% (not exceeding 6%); Guaranteed Minimum Fixed Interest Rate]

Overpayment Annual Interest Rate: [X.XX% (not exceeding 6%); Guaranteed Minimum Fixed Interest Rate]

Minimum Required Annuitization Amount: [$2,000.00]

Minimum Required Annuity Payment: [$20.00]

 

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SPEC-RILA-6Y-776 (05-22)