Sec Form N3 - Registration Statement Under The Securities Act Of 1933 And/or Registration Statement Under The Investment Company Act Of 1940 Page 7
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54Item 3.
Synopsis or Highlights
(a) Include a table furnishing the following information, using the captions provided, in the format illustrated below:
Contractowner Transaction Expenses
Sales Load Imposed on Purchases (as a percentage of purchase payments
%
Deferred Sales Load (as a percentage of purchase payments or amount surrendered, as applicable)
%
Surrender Fees (as a percentage of amount surrendered, if applicable)
%
Redemption Fee (as a percentage of amount redeemed, if applicable)
%
Exchange Fee
%
[Annual] Account Fee
%
Annual Expenses (as a percentage of average net assets)
Management Fees
%
Mortality and Expenses Risk Fees
%
Other Expenses
%
%
%
%
TotalAnnual Expenses
%
Example
If you surrender your contract at the end of the
1 year
3 years
5 years
10 years
applicable time period, you would pay the following
$ ________
$ ________
$ ________
$ ________
expenses on a $1,000 investment, assuming 5%
annual return on assets:
If you annuitize at the end of the applicable
1 year
3 years
5 years
10 years
time period, you would pay the following ex-
$ ________
$ ________
$ ________
$ ________
penses on a $1,000 investment, assuming 5%
annual return on assets:
If you do not surrender your contract, you
1 year
3 years
5 years
10 years
would pay the following expenses on a $1,000
investment, assuming 5% annual return on
$ ________
$ ________
$ ________
$ ________
assets:
Instructions
1.
General Instructions
(a) Immediately after the table, provide a brief narrative explaining that the purpose of the table is to assist the
contractowner in understanding the various costs and expenses that a contractowner will bear directly or indirectly.
Include, where appropriate, cross-references to the relevant sections of the prospectus for more complete descriptions
of the various costs and expenses. Disclose that premium taxes may be applicable.
(b) Assume that the annuity contract is owned during the accumulation period for purposes of the table (including the
Example). If an annuitant would pay different fees or be subject to different expenses, disclose this in the brief
narrative and provide a cross-reference to those portions of the prospectus describing these fees.
(c). If a particular caption is not applicable to the Registrant, the caption may be omitted from the table.
(d) Round all dollar figures to the nearest dollar and all percentages to the nearest hundredth of one percent.
(e) If the Registrant has sub-accounts, list separately the data for each sub-account.
(f) Provide a separate fee table (or separate column within the table) for each contract form offered by the prospectus
that has different fees. If a Registrant uses one prospectus to offer a contract in both the group and individual variable
annuity contract markets, the Registrant may a) add narrative disclosure following the fee table identifying markets
where certain fees are either inapplicable or waived or lower fees charged to contractowners in group markets, or b)
provide a separate fee table for group and individual contracts.
2
SEC 2124 (5/15)
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