Document:

p-ridxrilaxixrop10x21

P-RID-RILA-I-ROP(10/21) 1  PRUCO LIFE INSURANCE COMPANY, PHOENIX, ARIZONA      RETURN OF PURCHASE PAYMENTS DEATH BENEFIT RIDER    ANNUITY NUMBER: [001-00001]    EFFECTIVE DATE: [Contract Issue Date]    This Rider is made part of your Annuity.  For purposes of this Rider, certain provisions of your Annuity are  amended as described below.  If the terms of your Annuity and those of this Rider conflict, the provisions  of this Rider shall control.  Should this Rider terminate, any amended or replaced Annuity provisions  based on this Rider’s terms will revert to the provisions in the Annuity, except as may be provided below.    This Rider will terminate upon assignment or a change in ownership of your Annuity unless the  new assignee or Owner meets the qualifications specified in the Termination provision. This Rider  may not be re-elected after it terminates. The benefit provided pursuant to the terms of this Rider is a  “Return of Purchase Payments Death Benefit."  This Rider should be read in conjunction with any other  Rider or Endorsement made a part of your Annuity.     Definitions:      Advisory Fees:  Deductions permitted to be taken from your Annuity to pay your investment advisor for  investment advice related to the Annuity up to the Standard Advisory Fee Percentage of [1.50%]. Advisory  Fees will not reduce the Return of Purchase Payment Amount. Advisory Fees reduce your Account Value by  the amount of the Advisory Fee and, unless we receive instructions from you prior to the Advisory Fee  deduction, we will take the Advisory Fee first from the Variable Sub-Accounts in which your Account Value is  allocated on a pro-rata basis. Once the Account Value in all Variable Sub-Accounts has been depleted, we  will deduct any remaining Advisory Fee from the Index Strategy(ies) in which you have Account Value  allocated on a pro-rata basis.  The Index Strategy Base is reduced for any Advisory Fees that occur between  the Index Strategy Start Date and the Index Strategy End Date in the same proportion that the total Advisory  Fee amount reduces the Interim Value.      Purchase Payment(s):  A cash consideration in the currency of the United States of America given to us  in exchange for the rights, privileges and benefits outlined in this Annuity reduced for any applicable fees,  charges or Tax Charges.    Withdrawals:  Withdrawals of any type (including Partial Withdrawals but not including Advisory Fees)  before the application of any Contingent Deferred Sales Charge or other charge applicable upon a  Withdrawal.    Death Benefit: If we receive Due Proof of Death within a period of [1 year], beginning on the decedent’s  date of death, the Death Benefit of the Annuity equals the greater of (a) and (b), where:    (a) is the “Return of Purchase Payments Amount” described below; and    (b) is the Account Value as described in the “Death Benefit” section of the Annuity.    If we do not receive Due Proof of Death within a period of [1 year], beginning on the decedent’s date of  death, the Death Benefit of the Annuity equals (b) above.  We reserve the right to waive or extend, on a  non-discriminatory basis, our right to enforce the Due Proof of Death period.  This right will only apply for  purposes of determining the amount payable as a Death Benefit, and in no way restricts when a claim  may be filed.    Return of Purchase Payments Amount:  Initially, this is an amount equal to the initial Purchase  Payment on the Effective Date of this Rider.  Thereafter, on each Valuation Day, up to and including the  date we receive Due Proof of Death, the Return of Purchase Payments Amount is increased by the  amount of any additional Purchase Payments allocated to the Annuity on that day and reduced for any  Withdrawal(s) by the ratio of the Withdrawal amount to the Account Value immediately prior to the  Withdrawal.     

 

P-RID-RILA-I-ROP(10/21) 2  Other Death Benefit Provisions:  The provisions applicable to the Death Benefit described in your  Annuity regarding eligibility, limits of applicability, methods of payment to Beneficiaries or any other  provision regarding the Death Benefit, other than the method of calculation of the Death Benefit, continue  to apply unless specifically indicated otherwise in this Rider.    Spousal Continuation:  If the Annuity is eligible for Spousal Continuation and Spousal Continuation  occurs, upon Spousal Continuation the Account Value is increased, if necessary, to equal the greater of  the (1) Return of  Purchase Payments Amount and (2) the Death Benefit described in the Annuity. Any  increase to the Account Value resulting from such adjustment will be allocated to the Variable Sub- Accounts pro-rata or to the Holding Account if there is no Account Value in the Variable Sub-Accounts.   The spouse who continues the Annuity may transfer available Account Value to any of the Variable Sub- Accounts at any time or to a new Index Strategy on the next Index Anniversary Date.   Following Spousal Continuation, any subsequent Death Benefit will be equal to the Account Value,  including any increase described above.    Termination of this Rider and its Benefits:  Benefits pursuant to this Rider will terminate upon the first  to occur of the following events:    1) the date the Annuity’s Death Benefit is determined, unless the Annuity is eligible for Spousal  Continuation and Spousal Continuation is elected;    2) we process a request to change the Owner(s) (or Annuitant if entity owned) more than 60 days  after the Effective Date, resulting in a change in the person(s) upon whose death a Death Benefit  is determined, other than when the Annuity is jointly owned and one of the Owners remains the  Owner;    3) we process an assignment of the Annuity to which this Rider is made a part;    4) if there is then any Account Value on the Annuity Date, or if earlier, the date we transfer all  Account Value in order to begin annuity payments;    5) the date we receive your request for full surrender;     6) if your Account Value reduces to zero;        PRUCO LIFE INSURANCE COMPANY                  [ ]   Secretaryp-endxrilaxmrs10x21

P-END-RILA-MRS(10/21)  1  PRUCO LIFE INSURANCE COMPANY, PHOENIX ARIZONA    MEDICALLY RELATED SURRENDER ENDORSEMENT    ANNUITY NUMBER: [001-00001]    EFFECTIVE DATE: [Contract Issue Date]    This Endorsement is made a part of your Annuity.  If the terms of your Annuity and those of this  Endorsement conflict, the provisions of this Endorsement shall control.  The benefit provided pursuant to the  terms of this Endorsement is a “Medically Related Surrender Benefit.”  There is no charge for the Medically  Related Surrender Benefit.    Definitions:    Contingency Event:  A “Contingency Event” occurs if an Owner (an Annuitant, if the Annuity is owned by  an entity) is:    a) first confined in a Medical Care Facility after the Issue Date and while this Annuity is in force,  remains confined for at least 90 consecutive days, and remains confined on the date we receive  the Medically Related Surrender Request in Good Order at our Service Office; or    b) first diagnosed as having a Fatal Illness after the Issue Date and while this Annuity is in force.   We may require a second or third medical opinion regarding such diagnosis, at our expense, by a  Physician(s) chosen by us.  We may request the third medical opinion if the second opinion  received conflicts with the first opinion.    Fatal Illness:  A condition:  a) diagnosed by a Physician; and  b) expected to result in death within 24 months after the diagnosis in 80% of the cases diagnosed  with this condition.    Licensed Practical Nurse:  A person who is:  a) A professional nurse legally designated “LPN” who, where licensing is required, holds a valid  license according to the laws of the United States jurisdiction in which the nursing service is  performed and is acting within the scope of that license; and  b) not you, the Annuitant, or member of either your or the Annuitant’s family.    The term licensed practical nurse (LPN) shall include a licensed vocational nurse (LVN) and any  other similarly designated nurse in those jurisdictions in which a professional nurse is designated as  other than an LPN and for whom licensing is required.    Medical Care Facility:  A facility operated and licensed pursuant to laws of any United States jurisdiction  providing medically necessary in-patient care, which is:  a) prescribed by a Physician in writing;  b)    recognized as a general hospital or long-term care facility by the proper authority of the United  States jurisdiction in which it is located;  c) recognized as a general hospital by the Joint Commission on the Accreditation of Hospitals; and  d) certified as a hospital or long-term care facility; or   e) a nursing home licensed by the United States jurisdiction in which it is located and offers the services  of a Registered Nurse (RN) or Licensed Practical Nurse (LPN) 24 hours a day that maintains control of  all prescribed medications dispensed and daily medical records.    Physician:  A person who is:  a) a professional physician who holds a valid license according to the laws of the United States  jurisdiction in which the medical service is performed and is acting within the scope of that  license; and  b) not you, the Annuitant ,or member of either your or the Annuitant’s family.    Registered Nurse:  A person who is:  a) a professional nurse legally designated “RN” who, where licensing is required, holds a valid  license according to the laws of the United States jurisdiction in which the nursing service is  performed and is acting within the scope of that license; and    b) not you, the Annuitant, or member of either your or the Annuitant’s family.  

 

P-END-RILA-MRS(10/21)  2    MEDICALLY RELATED SURRENDER    Upon the occurrence of a Contingency Event prior to the Annuity Date, you may submit a request to our  Service Office in Good Order to surrender all or part of your Annuity without application of any Contingent  Deferred Sales Charge.      If, as a result of your request for a partial withdrawal, the Surrender Value of your Annuity would be less  than the Minimum Surrender Value after a Partial Withdrawal shown in the Annuity Schedule, we reserve  the right to treat your request as a request for a full surrender.      All Owners (the Annuitant, if your Annuity is owned by an entity) must be alive as of the date we pay the  proceeds of such surrender request.  This benefit is available only if we agree to, and accept, your  designation of the Owner (the Annuitant, if the Annuity is owned by an entity) prior to the occurrence of a  Contingency Event.    This benefit is not available:   (i) if the Annuity has been assigned, or   (ii) on the portion, if any, of the amount of the Medically Related Surrender which, when added to the  aggregate amount of Medically Related Surrenders you have previously taken under this Annuity  and all other annuities issued to you by us or one of our affiliates, would exceed the Maximum  Medically Related Surrender Amount shown below.  We reserve the right to waive, on a non- discriminatory basis, our right to enforce the Maximum Medically Related Surrender Amount.    Additional Purchase Payments may not be made after a Medically Related Surrender has been approved.      Distributions under this Endorsement are subject to all reporting and withholding rules applicable to  annuity distributions.    When we receive your completed Medically Related Surrender Request form, in Good Order, we will process  it.  If we disapprove your request, we will notify you.    Maximum Medically Related Surrender Amount:  [$500,000]    Termination of this Endorsement:  Termination of this Endorsement is subject to the following rules:    A. Termination due to Death:  This Endorsement terminates automatically as of the date the  Annuity’s Death Benefit is determined, unless the Annuity is eligible for Spousal Continuation and  Spousal Continuation occurs.    B.  Termination on the Annuity Date:  This Endorsement terminates automatically as of the Annuity  Date.    C. Termination upon Surrender:  This Endorsement terminates upon surrender of the Annuity to  which it is made a part.    PRUCO LIFE INSURANCE COMPANY      [                     Secretary                   ]

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