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MAXIMUM ANNIVERSARY VALUE OPTIONAL

DEATH BENEFIT ENDORSEMENT

Notwithstanding any provision in the 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.

This Endorsement modifies the “AMOUNT OF DEATH BENEFIT” provision under the section titled “DEATH
OF OWNER BEFORE THE ANNUITY DATE” in the Contract.

If on the Contract Date the Maximum Anniversary Value Death Benefit was elected, the following
provisions apply:

Maximum Anniversary Value Optional Death Benefit Charge

On an annual basis, this charge equals 0.20% of Your average daily ending value of the assets
attributable to the Accumulation Units of the Subaccount(s) or Variable Portfolio(s) to which the
Contract is allocated. We deduct this charge daily. This charge is in addition to other charges
in Your Contract.

Maximum Anniversary Value Death Benefit

If the Owner was age 82 or younger on the Contract Date, and death occurs prior to age 90 upon Our
receipt of all Required Documentation at Our Annuity Service Center, We will calculate the Death
Benefit and it will be the greatest of:

	 	(1)	 	The Contract Value as of the later of (a) the date of death of the Owner and (b) 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 earlier of the Owner’s 86th
birthday or date of death; or
	 
	 	(3)	 	The Maximum Anniversary Value that occurs prior to the Owner’s 83rd
birthday. The Maximum Anniversary Value is equal to the greatest anniversary value
attained from the following:
	 
	 	 	 	As of the date of receipt at our Annuity Service Center of all Required Documentation,
anniversary value is equal to the Contract Value on a Contract anniversary; and a Death
Benefit Adjustment for Purchase Payment(s) transacted since that Contract anniversary
but prior to the Owner’s 86th birthday and/or Withdrawals transacted since
that Contract anniversary.

	 	 	NOTE: In declining market environments, the death benefit payable may be less than the Net
Purchase Payments received.

If the Owner was at age 90 or older at the time of death, the Death Benefit will be the Contract
Value as of the later of (a) the date of death of the Owner and (b) the NYSE business day during
which We receive all Required Documentation at Our Annuity Service Center.

Spousal Beneficiary Continuation

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If the Spousal Beneficiary continues the Contract on the Continuation Date the death benefit
payable upon the death of the Spousal Beneficiary will be as follows:

	 	 	If the Spousal Beneficiary was age 82 or younger on the Continuation Date and their death occurs
prior to age 90, upon Our receipt of all Required Documentation at Our Annuity Service Center,
We will calculate the Death Benefit and it will be the greatest of:

	 	(1)	 	The Contract Value as of the later of (a) the date of death of the Spousal
Beneficiary and (b) 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, and a Death Benefit Adjustment for
Purchase Payment(s) transacted after the Continuation Date but prior to the Spousal
Beneficiary’s 86th birthday and/or Withdrawals transacted after the
Continuation Date; or
	 
	 	(3)	 	The Maximum Anniversary Value after the Continuation Date and preceding the
date of death that occurs prior to the Spousal Beneficiary’s 83rd birthday.
The Maximum Anniversary Value is equal to the greatest anniversary value attained from
the following:
	 
	 	 	 	As of the date of receipt at our Annuity Service Center of all Required
Documentation, anniversary value is equal to the Contract Value on a Contract
anniversary and a Death Benefit Adjustment for Purchase Payment(s) transacted
after that Contract anniversary but prior to the Spousal Beneficiary’s
86th birthday and/or Withdrawals transacted since that Contract
anniversary.

	 	 	If the Spousal Beneficiary was age 86 or older on the Continuation Date and/or their death
occurs at age 90 or older, the Death Benefit will be the Contract Value as of the later of (a)
the date of death of the Spousal Beneficiary and (b) the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center. The Optional Maximum
Anniversary Value Optional Death Benefit Charge will no longer be deducted if the Spousal
Beneficiary is age 86 or older on the Continuation Date.

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.

FIRST SUNAMERICA LIFE INSURANCE COMPANY

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RIDER

Notwithstanding any provision in the Contract to the contrary, this Rider becomes a part of the
Contract to which it is attached. Should any provision in this Rider conflict with the Contract,
the provisions of this Rider will prevail.

EFFECTIVE DATE: [date]

Prior to the Annuity Date, We will waive the Contingent Deferred Sales Charge or Withdrawal
Charge upon the Owner’s request for full or partial surrender of the Contract Value. Such benefit
shall be available if:

	1.	 	The Owner is confined to a Nursing Home and/or Hospital for at least 60 consecutive days
while the Contract is in force;
	 
	2.	 	A surrender or partial withdrawal request and adequate proof of confinement are received by
Us either while the Owner is confined or within 90 days of the Owner’s discharge from the
Nursing Home or Hospital; and
	 
	3.	 	Confinement in a Nursing Home and/or Hospital is prescribed by a Physician and is Medically
Necessary.

A Market Value Adjustment (MVA), if any, shall not be applied to amounts withdrawn from the Fixed
Account whether such application results in a gain or a loss in the Contract Value.

This Rider may not be exercised before the expiration of 90 days from the Contract Date.

A new 60 day confinement period must be satisfied each time the Owner becomes newly confined
(whether for the same or unrelated causes), if services by a Nursing Home and/or Hospital have not
been provided for a period of at least six months. If services for related causes were provided
less than six months from current receipt of services, a new 60 day confinement need not be
satisfied.

If the Owner’s request for waiver of Contingent Deferred Sales Charges or Withdrawal Charges is
denied, the surrender proceeds will not be dispersed until the Owner is notified by Us of the
denial and provided with the opportunity to reapply for the surrender proceeds or reject the
surrender proceeds.

DEFINITIONS

For purposes of this Rider, the following definitions apply. Terms not defined in this Rider shall
have the same meaning given to them in the Contract.

“Nursing Home” means a Skilled Nursing Facility, an Intermediate Care Facility, or a Residential
Care facility. Nursing Home does not mean:

 

 

	1.	 	A home for the aged, a community living center, or a place that primarily provides
domiciliary, residency or retirement care; or
	 
	2.	 	A place owned or operated by a member of the Owner’s immediate family. Immediate family
members include the Owner’s spouse, children, parents, grandparents, grandchildren, siblings,
and in-laws.

“Skilled Nursing Facility” is a facility which:

	1.	 	Is located in the United States or its territories;
	 
	2.	 	Is licensed and operated as a Skilled Nursing Facility according to the laws of the
jurisdiction in which it is located;
	 
	3.	 	Provides skilled nursing care under the supervision of a licensed physician;
	 
	4.	 	Provides continuous 24 hours a day nursing services by or under the supervision of a
registered graduate professional nurse (R.N.); and
	 
	5.	 	Maintains a daily medical record of each patient.

“Intermediate Care Facility” is a facility which:

	1.	 	Is located in the United States or its territories;
	 
	2.	 	Is licensed and operated as an Intermediate Care Facility according to the laws of the
jurisdiction in which it is located;
	 
	3.	 	Provides continuous 24 hours a day nursing service by or under the supervision of a
registered graduate professional nurse (R.N.), or a licensed practical nurse (L.P.N.); and
	 
	4.	 	Maintains a daily medical record of each patient.

“Residential Care Facility” is a facility which:

	1.	 	Is located in the United States or its territories;
	 
	2.	 	Is licensed and operated as an Residential Care Facility according to the laws of the
jurisdiction in which it is located; and
	 
	3.	 	Provides nursing care under the supervision of a registered graduate professional nurse
(R.N.).

“Hospital” is a facility which:

	1.	 	Is located in the United States or its territories;
	 
	2.	 	Is licensed as a Hospital by the jurisdiction in which it is located;
	 
	3.	 	Is supervised by a staff of licensed physicians;
	 
	4.	 	Provides nursing services 24 hours a day by, or under the supervision of, a registered nurse
(R.N.);
	 
	5.	 	Operates primarily for the care and treatment of sick and injured persons as inpatients for a
charge; and
	 
	6.	 	Has access to medical and diagnostic facilities.

“Physician” is any person duly licensed and legally qualified to diagnose and treat sickness and
injuries. He or she must be providing services within the scope of his or her license. Physicians
do not include members of the Owner’s immediate family.

 

 

“Medically Necessary” means appropriate and consistent with the diagnosis in accord with accepted
standards of practice and which could not have been omitted without adversely affecting the
individual’s condition.

This Rider shall take effect on the Contract Date. This Rider shall terminate on the date a life
contingent annuity option is elected, since Contract Value will cease to be available on that date.

FIRST SUNAMERICA LIFE INSURANCE COMPANY

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