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THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

MAXIMUM ANNIVERSARY VALUE OPTIONAL

DEATH BENEFIT ENDORSEMENT

Notwithstanding any provision in the Contract or Certificate (“Contract”) to the contrary, this
Endorsement becomes a part of the Contract to which it is attached. Should any provision in this
Endorsement conflict with the Contract, the provisions of this Endorsement will prevail.
Capitalized terms used in this Endorsement have the same meaning as they have in the Contract.

This Endorsement modifies the “DEATH PROVISIONS” in the Contract as set forth below.

ENDORSEMENT DATA

	 	 	 

	MAXIMUM ANNIVERSARY VALUE OPTIONAL 

DEATH BENEFIT CHARGE:

	 	Annual fee of 0.25% of the average
daily ending value of the assets
attributable to the Accumulation
Units of the Variable Portfolio(s)
to which Your Contract is allocated.
We deduct this charge daily. This
charge is in addition to other
charges, fees and expenses described
in Your Contract.

The “AMOUNT OF DEATH BENEFIT” provisions are modified as follows:

Maximum Anniversary Value Death Benefit

Upon Our receipt of all Required Documentation at Our Annuity Service Center, the Death
Benefit payable upon the death of the Owner will be calculated. The death benefit
calculation is different depending on whether a living benefit or guaranteed minimum
withdrawal benefit has been elected and if the benefit has been terminated.

If You were Age 80 or younger on the Contract Date and did not elect a living benefit or
guaranteed minimum withdrawal benefit, We will calculate the Death Benefit as the greatest
of:

	 	1.	 	The Contract Value for the NYSE business day during which We receive
all Required Documentation at Our Annuity Service Center; or
	 
	 	2.	 	Net Purchase Payment(s) received prior to the Owner’s 86th
birthday; or
	 
	 	3.	 	The Maximum Anniversary Value that is equal to the greatest anniversary
value determined prior to the earlier of the

	 	i)	 	Your 83rd birthday; or
	 
	 	ii)	 	Your date of death;

plus Purchase Payment(s) received since that Contract anniversary, but prior to Your
86th birthday, and this sum is reduced proportionately for any
Withdrawals since that Contract anniversary.

If You were Age 80 or younger on the Contract Date and elected a living benefit or
guaranteed minimum withdrawal benefit, We will calculate the Death Benefit as the greatest
of:

	 	 	 	 	 

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	 	1.	 	The Contract Value for the NYSE business day during which We receive
all Required Documentation at Our Annuity Service Center; or
	 
	 	2.	 	Purchase Payment(s) received prior to Your 86th birthday
reduced by a) or b) as follows:

	 	a)	 	any Withdrawal Adjustments if the benefit has not been
terminated;
	 
	 	b)	 	any Withdrawal Adjustments prior to the date the
benefit is terminated, and reduced proportionately by the amount by which
each Withdrawal reduces the Contract Value on and after the date the
benefit is terminated.

	 	3.	 	The Maximum Anniversary Value that is equal to the greatest anniversary
value determined prior to the earlier of:

	 	i)	 	Your 83rd birthday; or
	 
	 	ii)	 	Your date of death;

plus Purchase Payment(s) received since that Contract anniversary, but prior to
Your 86th birthday, and this sum is reduced by a) or b) as follows:

	 	a)	 	any Withdrawal Adjustments if the benefit has not been
terminated;
	 
	 	b)	 	any Withdrawal Adjustments prior to the date the
benefit is terminated, and reduced proportionately by the amount by which
each Withdrawal reduces the Contract Value on and after the date the
benefit is terminated.

Spousal Beneficiary Continuation

If the Spousal Beneficiary continues the Contract on the Continuation Date and upon Our
receipt of all Required Documentation at Our Annuity Service Center, the Death Benefit
payable upon the death of the Spousal Beneficiary will be as follows:

If the Spousal Beneficiary was age 80 or younger on the Continuation Date, and if the Owner
did not elect a living benefit or guaranteed minimum withdrawal benefit, We will calculate
the Death Benefit as the greatest of:

	 	1.	 	The Contract Value for the NYSE business day during which We receive
all Required Documentation at Our Annuity Service Center; or
	 
	 	2.	 	The Contract Value on the Continuation Date, plus Purchase Payment(s)
received after the Continuation Date and prior to the Spousal Beneficiary’s
86th birthday and this sum is reduced proportionately for any
Withdrawals after the Continuation Date; or
	 
	 	3.	 	The Maximum Anniversary Value after the Continuation Date that is equal
to the greatest anniversary value determined prior to the earlier of:

	 	i)	 	The Spousal Beneficiary’s 83rd birthday; or
	 
	 	ii)	 	The Spousal Beneficiary’s date of death;

plus Purchase Payment(s) received after the Continuation Date and since that
Contract anniversary, and prior to the Spousal Beneficiary’s 86th
birthday and this sum is reduced proportionately for any Withdrawals since that
Contract anniversary.

	 	 	 	 	 

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If the Spousal Beneficiary was age 80 or younger on the Continuation Date, and if the Owner
elected a living benefit or guaranteed minimum withdrawal benefit, We will calculate the
Death Benefit as the greatest of:

	 	1.	 	The Contract Value for the NYSE business day during which We receive
all Required Documentation at Our Annuity Service Center; or
	 
	 	2.	 	The Contract Value on the Continuation Date, plus Purchase Payment(s)
received after the Continuation Date and prior to the Spousal Beneficiary’s
86th birthday and this sum is reduced by a) or b) as follows:

	 	a)	 	any Withdrawal Adjustments if the benefit has not been
terminated;
	 
	 	b)	 	any Withdrawal Adjustments prior to the date the
benefit is terminated, and reduced proportionately for any Withdrawals on
and after the date the benefit is terminated; or

	 	3.	 	The Maximum Anniversary Value after the Continuation Date that is equal
to the greatest anniversary value determined prior to the earlier of:

	 	i)	 	The Spousal Beneficiary’s 83rd birthday; or
	 
	 	ii)	 	The Spousal Beneficiary’s date of death;

plus Purchase Payment(s) received after the Continuation Date and since that
Contract anniversary, and prior to the Spousal Beneficiary’s 86th
birthday and this sum is reduced by a) or b) as follows:

	 	a)	 	any Withdrawal Adjustments since that anniversary if
the benefit has not been terminated;
	 
	 	b)	 	any Withdrawal Adjustments since that anniversary but
prior to the date the benefit is terminated, and reduced proportionately
for any Withdrawals since that anniversary that occur on and after the date
the benefit is terminated.

If the Spousal Beneficiary was at least age 81 but younger than age 86 on the Continuation
Date, and if the Owner did not elect a living benefit or guaranteed minimum withdrawal
benefit, We will calculate the Death Benefit as the greater of:

	 	1.	 	The Contract Value for the NYSE business day during which We receive
all Required Documentation at Our Annuity Service Center; or
	 
	 	2.	 	The Contract Value on the Continuation Date, plus Purchase Payment(s)
received after the Continuation Date, and prior to the Spousal Beneficiary’s
86th birthday, and this sum is reduced proportionately for any
Withdrawals after the Continuation Date.

If the Spousal Beneficiary was at least age 81 but younger than age 86 on the Continuation
Date, and if the Owner elected a living benefit or guaranteed minimum withdrawal benefit, We
will calculate the Death Benefit as the greater of:

	 	1.	 	The Contract Value for the NYSE business day during which We receive
all Required Documentation at Our Annuity Service Center; or
	 
	 	2.	 	The Contract Value on the Continuation Date, plus Purchase Payment(s)
received after the Continuation Date and prior to the Spousal Beneficiary’s
86th birthday and this sum is reduced by:

	 	 	 	 	 

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	 	a)	 	any Withdrawal Adjustments after the Continuation Date
if the benefit has not been terminated; or
	 
	 	b)	 	any Withdrawal Adjustments after the Continuation Date
and prior to the date the benefit is terminated, and reduced
proportionately for any Withdrawals after the Continuation Date that occur
on and after the date the benefit is terminated.

Withdrawal Adjustments

If a living benefit or guaranteed minimum withdrawal benefit is elected and the benefit has not
been terminated, the amount of the Death Benefit will be adjusted for Withdrawals as follows:

	 	1.	 	If cumulative Withdrawals in any Contract are taken prior to your
81st birthday and are less than or equal to the Maximum Annual
Withdrawal Amount, the amount of adjustment will be the amount of each Withdrawal;
or
	 
	 	2.	 	If cumulative Withdrawals in any Contract Year are taken prior to your
81st birthday and are in excess of the Maximum Annual Withdrawal Amount, the
Contract Value and Death Benefit are first reduced by the Withdrawal amount equal
to the Maximum Annual Withdrawal Amount; then the Death Benefit is further reduced
proportionately by the amount by which the Excess Withdrawal reduced the resulting
Contract Value.
	 
	 	3.	 	If Withdrawals are taken on or after your 81st birthday, the
Death Benefit is reduced proportionately by the amount by which each Withdrawal
reduces the Contract Value.

If the Spousal Beneficiary was age 86 or older on the Continuation Date, the Death Benefit will be
the Contract Value for the NYSE business day during which We receive all Required Documentation at
Our Annuity Service Center.

The Death Benefit payable will accrue interest at Our current rate from the date of death to the
date the Death Benefit is distributed.

Signed for the Company to be effective on the Contract Date.

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

	 	 	 	 	 
	 
	 		 	 
	 
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	 	4exv4ws

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

ENDORSEMENT

Notwithstanding any provision in the Contract or Certificate (“Contract”) to the contrary, this
Endorsement becomes a part of the Contract to which it is attached. Should any provision in this
Endorsement conflict with the Contract, the provisions of this Endorsement will prevail.

Subject to the terms and conditions set forth herein this Endorsement provides additional
information to the Owner if the Contract was purchased in connection with the Premium Plus Program.

	1.	 	For purposes of this Endorsement, the following definitions apply. Terms not defined in this
Endorsement shall have the same meaning as defined in the Contract.

ELIGIBLE PERSON

Individuals named as Participants or Owners (“Owners”) of the Contract who are: (1)
employees of the Company or Our affiliates; (2) appointed agents, registered
representatives and employees of broker-dealers that sell Our variable annuity
contracts or the variable annuity contracts of Our affiliates; (3) trustees of mutual
funds offered in Our or Our affiliate’s variable annuity contracts; and (4) the
immediate family members of set forth in (1), (2) and (3).

IMMEDIATE FAMILY MEMBERS

The spouse, child, parent, parent-in-law, brother, brother-in-law, sister or
sister-in-law of an individual identified in items (1), (2) and (3) of the definition
of Eligible Person, or such other family member as We may approve.

YOU, YOUR

The Eligible Person(s) under this Endorsement.

	2.	 	The following paragraph is added to the PURCHASE PAYMENT PROVISIONS of the Contract:

We will credit an additional amount to Contracts sold to an Eligible Person. The
additional amount credited to a Contract sold to one of the above individuals will
generally equal the commission payable on the Initial Purchase Payment of the
Contract. If any subsequent Purchase Payments are received under the Contract, an
additional amount generally equal to the commission payable on any subsequent
Purchase Payments received will be credited to the Contract.

					
	 	 	 	 	 
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If, after purchasing the Contract to which this Endorsement is part, You choose to
exercise Your Right to Examine shown on page 1 of the Contract, the amount refunded
to You will not include the additional amount credited as the result of this program.

This Endorsement is signed by the Company to be effective on the later of the Contract Effective
Date or [ DATE ]¬1.

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

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