Symetra Trek Plus Non-Qualified Annuity Contract Data Page – John Doe and Jane Doe
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Summary
This contract is between Symetra Life Insurance Company and John Doe (with Jane Doe as joint owner and annuitant) for a non-qualified annuity product called Symetra Trek Plus. The contract was issued on December 1, 2020, with a $25,000 purchase payment. It sets out key terms such as maximum issue and annuitization ages, surrender charges for early withdrawals, free withdrawal limits, and minimum withdrawal amounts. The contract is governed by the laws of the state where delivered and outlines the process for annuity payments and withdrawals.
EX-4.II 4 ex4iicontractdatapage.htm EX-4.II Document
CONTRACT DATA PAGE
Product Name Product Type | [Symetra Trek Plus [Non-Qualified Annuity | ||||||||||
| Contract Date | [12/01/2020] | ||||||||||
| Allocation Date | [12/07/2020] | ||||||||||
| Contract Number | [000000000] | ||||||||||
| Purchase Payment | [$25,000] | ||||||||||
| Separate Account | [Symetra Separate Account RI | ||||||||||
| Owner: | [John Doe | ||||||||||
| [Date of Birth: [12/12/195 | Age at issue: [ | Sex: [Male] | |||||||||
| [Joint Owner | [Jane Doe | ||||||||||
| Date of Birth: [11/12/195 | Age at issue: [ | Sex: [Female]] | |||||||||
| Annuitant: | [John Doe | ||||||||||
| Date of Birth: [12/12/195 | Age at issue: [ | Sex: [Male | |||||||||
| [Joint Annuitant | [Jane Doe Date of Birth: [11/12/195 | ||||||||||
| Age at issue: [ | Sex: [Female]] | ||||||||||
Maximum Issue Age: [80]. The Contract Date must be prior to the Owner's and Annuitant's [81st]
birthday(s).
Maximum Annuitization Age: [95]. Annuity Payments must begin prior to the Annuitant's [96]th birthday(s).
This is not later than [12/13/2084].
Delivered in the State of: [Any State] and governed by its laws.
Surrender Charge Schedule: Contract Year Charge
[1 9% of amount withdrawn
2 8% of amount withdrawn
3 7% of amount withdrawn
4 6% of amount withdrawn
5 5% of amount withdrawn
6 4% of amount withdrawn
After 6 0% of amount withdrawn]
Please see the "Charges and Taxes" section for a complete explanation of charges.
Free Withdrawal Percentage: [15%]
Minimum Withdrawal Amount: [$500]
Transfer Notice Deadline: [2 business days]
Annuity Payments Table: [Annuity Reserve 2012 mortality table with mortality improvement scale G2,
with age setback of five years], and an interest rate of [1%].
[Premium Taxes: [0.00%]
ANNUITY SERVICE OFFICE:
Home Office:
Symetra Life Insurance Company [777 108th Ave. NE, Suite 1200
Bellevue, Washington 98004]
Telephone: [1 ###-###-####]
Mailing Address:
Symetra Life Insurance Company [PO Box 674420
Houston, Texas ###-###-####]
Fax: [1 ###-###-####]
