EXHIBIT LIST
The following exhibits are filed herewith:
Exhibit No. Description
4 Form of Single Premium Deferred Annuity Certificate and Application
24(b) Powers of Attorney for Casey J. Sylla and Danny L. Hale
Page 1
LU10214 (5/1/03)
Allstate Life
Insurance Company
A Stock Company
Home Office: 3100 Sanders Road, Northbrook, Illinois 60062-7154
Single Premium Deferred Annuity Certificate
This Certificate is issued to the Owner in consideration of the initial purchase
payment. Allstate Life Insurance Company ("Allstate Life") will pay the benefits
of this Certificate, subject to its terms and conditions.
Throughout this Certificate, "you" and "your" refer to the Owner(s) of this
Certificate. "We", "us" and "our" refer to Allstate Life Insurance Company.
Contract Summary
This single premium deferred annuity provides a cash withdrawal benefit and a
death benefit during the Accumulation Phase and periodic income payments
beginning on the Payout Start Date during the Payout Phase.
The withdrawal benefit may be subject to a Market Value Adjustment which may
result in an upward or downward adjustment of the amount distributed.
This Certificate does not pay dividends.
The tax status of this Certificate as it applies to the Owner should be reviewed
each year.
The amount of interest credited to the policy is linked to the performance of
the S & P 500 Index. While the value may be affected by an external index, the
Certificate does not participate in any stock or equity investments.
PLEASE READ YOUR CERTIFICATE CAREFULLY.
This is a legal Certificate between the Owner(s) of this Certificate and
Allstate Life Insurance Company.
Trial Examination Period
Upon written request we will provide you with factual information regarding the
benefits and provisions contained in this Certificate. If you are not satisfied
with this Certificate for any reason, you may cancel it by written notification
within 20 days after you receive it. We will refund purchase payments less any
withdrawals to you.
[GRAPHIC OMITTED][GRAPHIC OMITTED] [GRAPHIC OMITTED][GRAPHIC OMITTED]
Single Premium Deferred Annuity
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TABLE OF CONTENTS
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THE PERSONS INVOLVED...................................................3
ACCUMULATION PHASE.....................................................4
PAYOUT PHASE...........................................................8
INCOME PAYMENT TABLES.................................................10
GENERAL PROVISIONS....................................................11
Page 3
LU10214 (5/1/03)
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THE PERSONS INVOLVED
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Owner The person named at the time of application is the Owner of this
Certificate unless subsequently changed. As Owner, you will receive any periodic
income payments, unless you have directed us to pay them to someone else. This
Certificate cannot be jointly owned by both a non-living person and a living
person. If the Owner is a trust, the Owner will be considered a non-living
person.
You may exercise all the rights stated in this Certificate, subject to the
rights of any irrevocable Beneficiary.
You may change the Owner at any time by written request in a form satisfactory
to us. Each change is subject to any payment we make or other action we take
before we accept it. If we accept a change, the change will take effect as of
the date you signed the request.
You may not assign an interest in this Certificate as collateral or security for
a loan. However, you may assign periodic income payments under this Certificate
before to the Payout Start Date. We are bound by an assignment only if it is
signed by you and filed with us. We are not responsible for the validity of an
assignment.
If more than one person is designated as Owner:
o Owner as used in this Certificate refers to all people named as Owners,
unless otherwise indicated;
o any request to exercise ownership rights must be signed by all Owners;
o on the death of any person who is an Owner, the surviving person(s)
named as Owner(s) will continue as Owner(s), as described in the Death
of Owner provision; and,
o if any Owner is a non-living person, on the death of the Annuitant,
the Death of Annuitant provision will apply.
Annuitant The Annuitant is the person(s) named on the Annuity Data Page. The
Annuitant must be a living person. If the Owner is a living person, the Owner
may change the Annuitant before the Payout Start Date by written notice in a
form satisfactory to us. Once we accept a change, it takes effect as of the date
you signed the request. Each change is subject to any payment we make or other
action we take before we accept it.
Beneficiary The two classes of Beneficiaries are Primary Beneficiaries and
Contingent Beneficiaries. Primary Beneficiaries and Contingent Beneficiaries are
individually and collectively referred to herein as "Beneficiaries".
The Primary Beneficiary is the person(s) named on the Annuity Data Page unless
later changed by the Owner. The Primary Beneficiary is the Beneficiary(ies) who
is first entitled to receive benefits under this Certificate upon the death of
the sole surviving Owner.
The Contingent Beneficiary is the person(s) named on the Annuity Data Page
unless later changed by the Owner. The Contingent Beneficiary is entitled to
receive benefits under the Certificate upon the death of the sole surviving
Owner, when all Primary Beneficiary(ies) predecease the sole surviving Owner.
You may change or add Beneficiaries at any time by written request in a form
satisfactory to us, unless you have designated an irrevocable Beneficiary. Once
we accept a request, the change will take effect as of the date you signed the
request. Any change is subject to any payment we make or other action we take
before we accept the change.
If no named Beneficiary is living when the sole surviving Owner dies, or if a
Beneficiary has not been named, the new Beneficiary will be:
1. your spouse, or if he or she is no longer living,
ii. your surviving children equally, or if you have no surviving children,
iii. your estate.
For purposes of this Certificate, children are natural children and adopted
children.
Unless you have provided written directions to the contrary, in a form
satisfactory to us, the Beneficiaries will take equal shares. If there is more
than one Beneficiary in a class and one of the Beneficiaries predeceases the
Owner, the deceased Beneficiary's entire share will be divided among the
remaining Beneficiaries in that class in proportion to the remaining
Beneficiaries' original shares.
Survivor Clause
For purposes of this Certificate, in determining whether a living person,
including an Owner, Primary Beneficiary, Contingent Beneficiary, or Annuitant
("Living Person A") has survived another living person, including an Owner,
Primary Beneficiary, Contingent Beneficiary, or Annuitant ("Living Person B"),
Living Person A must survive Living Person B by at least 24 hours. Otherwise,
Living Person A will be conclusively deemed to have predeceased Living Person B.
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ACCUMULATION PHASE
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Accumulation Phase The "Accumulation Phase" is the first of the two phases of
this Certificate. The Accumulation Phase begins on the Issue Date stated on the
Annuity Data Page. This phase will continue until the Payout Start Date unless
this Certificate is terminated before this date.
Certificate Year A "Certificate Year" is the 365 day period (366 days for a leap
year) beginning on the Issue Date and on each anniversary of the Issue Date
("Certificate Anniversary").
Purchase Payment The amount of the Purchase Payment is shown on the Annuity Data
Page. We reserve the right to limit the amount of the Purchase Payment we will
accept to a minimum of $10,000 and a maximum of $1,000,000, without prior
approval.
Certificate Value Your "Certificate Value" is equal to your Purchase Payment
plus credited interest less withdrawals and any applicable Withdrawal Charges,
Market Value Adjustment and taxes imposed for such withdrawals.
Credited Interest Rate The Certificate offers two credited interest rates
declared by us on your Certificate Issue Date. The credited interest rate will
be guaranteed for one year. At the end of a Certificate Year, we will send you a
renewal notice stating the Renewal Maximum Credited Interest Rate for the new
Certificate Year. As explained in detail below, the credited interest rate you
will receive for a particular Certificate Year will depend on whether the Index
increases or decreases during the Certificate Year. Any applicable interest will
be compounded and credited to your Certificate at the end of the Certificate
Year. For each Certificate Year, we will credit interest for that Certificate
Year based upon the Minimum and Maximum Credited Interest determined by us at
the beginning of each Certificate Year. The initial Maximum credited interest
rate is shown on your Annuity Data Page. Interest rates may vary based on your
Certificate Value on each Certificate Anniversary. Maximum Credited Interest
Rates applicable to new Certificate Years are referred to as "renewal rates."
At the end of each Certificate Year, your Maximum Credited Interest Rate for the
following Certificate Year will depend on the crediting option you chose when
you completed your application. The crediting options available are shown below.
Once you choose your crediting option, it will be irrevocable. Your choice of
crediting option appears on your Annuity Data Page.
o If the Index on a Certificate Anniversary is equal to or greater than the
Index on the previous Certificate Anniversary, you will receive the Maximum
Credited Interest Rate established for the crediting option you have
chosen; Crediting Option A or Crediting Option B.
o If the Index on a Certificate Anniversary is lower than the Index on the
previous Certificate Anniversary, you will receive the Minimum Guaranteed
Credited Interest Rate as follows:
o For Crediting Option A - your credited interest rate will be 0% for
that Certificate Year, and
o For Crediting Option B - your credited interest rate will be 2% for
that Certificate Year.
The Minimum Guaranteed Credited Interest Rate will not change.
Window Period The "Window Period" is the 45 day period following the end of a
Certificate Year.
Bail Out Rate During the Certificate Years in which a Withdrawal Charge will
apply, if the renewal Maximum Credited Interest Rate is less than the "Bail Out
Rate" you may withdraw all or a portion of your policy during the 45 day Window
Period without incurring a Withdrawal Charge or any Market Value Adjustment. We
must receive your request in writing during the Window Period, in a form
satisfactory to us.
Index The Index for this Certificate is shown on the Annuity Data Page. The
accumulated value of this Certificate is calculated using the Index which is
guaranteed to apply while the Certificate is in force unless publication of the
Index is discontinued, or the calculation of the Index is changed substantially.
If the publication of the Index is discontinued, or the calculation of the Index
is changed substantially, we will substitute a suitable index and notify you.
The Index value for a particular day is the value, calculated to the nearest
1/100 of a point, published at the end of that day. If the Index is not
published that day, the first preceding Index value published will apply.
Withdrawal You have the right, subject to the restrictions and charges described
in this Certificate, to withdraw part or all of your Certificate Value at any
time during the Accumulation Phase. A withdrawal must be at least $250. If any
withdrawal reduces the Certificate Value to less than $10,000, we may treat the
request as a withdrawal of the entire Certificate Value. If you withdraw the
entire Certificate Value, this Certificate will terminate.
When you make a withdrawal, your Certificate Value will be reduced by the amount
paid to you and any applicable Withdrawal Charge and taxes, and adjusted for any
applicable Market Value Adjustment.
Free Withdrawal Amount The Free Withdrawal Amount available in a Certificate
Year is equal to 10% of the Certificate Value as of the beginning of that
Certificate Year.
During each Certificate Year you may withdraw the Free Withdrawal Amount without
incurring a Withdrawal Charge or Market Value Adjustment; however, the amount
withdrawn may be subject to any applicable taxes. If you do not withdraw the
entire Free Withdrawal Amount during a Certificate Year, any remainder is not
carried forward to increase the Free Withdrawal Amount in a subsequent
Certificate Year. The Free Withdrawal Amount is only available during the
Accumulation Phase of the Certificate.
Withdrawal Charge A Withdrawal Charge may be assessed on certain withdrawals.
Withdrawals during the Accumulation Phase in excess of the Free Withdrawal
Amount will be subject to a Withdrawal Charge as follows:
Certificate Year: 1 2 3 4 5 6 7 8 and Later
Percentage: 7% 7% 7% 6% 6% 5% 5% 0%
The Withdrawal Charge is determined by multiplying the withdrawal charge
percentage corresponding to the Certificate Year in the table above by the
amount withdrawn that is in excess of the Free Withdrawal Amount.
Any Withdrawal Charge or Market Value Adjustment will be waived on withdrawals
taken to satisfy IRS minimum distribution rules; however, the amount of the
withdrawal will reduce the Free Withdrawal Amount, as described in the provision
above, available in a Certificate Year. This waiver is permitted only for
withdrawals that satisfy required distributions resulting solely from this
Certificate.
Taxes Any premium tax relating to this Certificate may be deducted from purchase
payments or the Certificate Value when the tax is incurred or at a later time.
Market Value Adjustment Period The Market Value Adjustment Period is seven years
in length. The first Market Value Adjustment Period begins on the Issue Date,
and a new Market Value Adjustment Period begins immediately at the end of the
prior Market Value Adjustment Period.
Market Value Adjustment Withdrawals will be subject to a Market Value Adjustment
as set forth below.
A Market Value Adjustment is an increase or decrease in the amount withdrawn
reflecting changes in the level of interest rates since the Market Value
Adjustment Period began. As used in this Certificate, the Treasury Rate is the
U. S. Treasury Constant Maturity 10 Year yield as most recently reported in
Federal Reserve Bulletin Release H.15. If the publication of the U. S. Treasury
Constant Maturity 10 Year yield is discontinued, or if the calculation of the
yield is changed substantially, we will substitute a suitable interest rate and
notify you in writing.
The Market Value Adjustment is based on the following:
I = the Treasury Rate for the week preceding the establishment of the
Market Value Adjustment Period;
J = the Treasury Rate for the week preceding our receipt of your
withdrawal request;
N = the number of whole and partial years from the date we receive your
request until the end of the Market Value Adjustment Period.
An adjustment factor is determined from the following formula:
.9 x {I - (J + .0025)} x N
The amount subject to a Market Value Adjustment is multiplied by the adjustment
factor to determine the amount of the Market Value Adjustment.
Any Market Value Adjustment will be waived on withdrawals taken during the 45
day Window Period following the end of the 7th Certificate Anniversary and
subsequent Certificate Anniversaries that are multiples of 7: for example the
14th and 21st Certificate Anniversaries. Any Market Value Adjustment will be
waived on withdrawals taken to satisfy IRS minimum distribution rules. This
waiver is permitted only for withdrawals which satisfy distributions resulting
from this Certificate.
Death of Owner If you die before the Payout Start Date, the new Owner will be
the surviving Owner. If there is no surviving Owner, the new Owner will be the
Beneficiary(ies) as described in the Beneficiary provision.
If there is more than one new Owner taking a share of the Death Proceeds,
described in the Death Proceeds provision, each new Owner will be treated as a
separate and independent Owner of his or her respective share of the Death
Proceeds. Each new Owner will exercise all rights related to his or her share of
the Death Proceeds, including the sole right to elect one of the Option(s) below
for his or her respective share. Each new Owner may designate a Beneficiary(ies)
for his or her respective share, but that designated Beneficiary(ies) will be
restricted to the Option chosen by the original new Owner.
The Options available to the new Owner will be determined by the applicable
following Category in which the new Owner is defined. An Option will be deemed
to have been chosen on the day we receive written notification in a form
satisfactory to us.
Category 1. If your spouse is the sole new Owner of the entire
Certificate, the Certificate will continue in the Accumulation
Phase, unless your spouse chooses from Options A, B, or C,
described below. If you were also the Annuitant, then your
spouse will be the new Annuitant, unless he or she names a new
Annuitant, as described in the Annuitant provision.
Your spouse may make a single withdrawal of any amount within
one year of the date of your death without incurring a
Withdrawal Charge; however, the amount withdrawn may be
subject to a Market Value Adjustment.
Category 2. If the new Owner is a living person who is not your spouse,
or if there are multiple living new Owners, the new Owner(s)
must each choose from Options A, B or C, described below. If a
new Owner does not choose one of these Options, Option A will
apply for such new Owner.
Category 3. If the new Owner is a corporation, trust or other
non-living person, the new Owner must choose between Options A
or C, described below. If the new Owner does not choose either
of these Options, Option A will apply.
The following Death of Owner Options are available, as applicable:
Option A. The new Owner may receive the Certificate Value payable
within 5 years of the date of your death. Withdrawal Charges
will be waived for any withdrawals made during this 5 year
period; however the amount withdrawn may be subject to a
Market Value Adjustment.
If the new Owner dies before the end of the 5 year period and
before the complete liquidation of the Certificate Value, then
the new Owner's Beneficiary(ies) will receive the remaining
Certificate Value. This amount must be fully withdrawn within
5 years of the date of your death.
Option B. The new Owner may elect, within 11 months of the date of
your death, to receive the Death Proceeds paid out under one
of the Income Plans described in the Payout Phase section,
subject to the following conditions:
Income payments must begin within one year of your date of
death. Income payments must be payable:
i. over the life of the new Owner; or
ii. for a guaranteed payment period of at least
5 years, but not to exceed the life
expectancy of the new Owner; or
iii. over the life of the new Owner with a
guaranteed payment period of at least 5
years, but not to exceed the life expectancy
of the new Owner.
Option C. The new Owner may elect to receive the Death Proceeds in a lump sum.
All ownership rights subject to the conditions stated in this provision or any
restrictions previously placed upon the Beneficiary, are available to the new
Owner from the date of your death until the date on which the Death Proceeds are
paid.
We reserve the right to offer additional Death of Owner Options.
If the Owner dies after the Payout Start Date, refer to the Payout Phase section
of this Certificate.
Death of Annuitant If the Annuitant who is also the Owner dies before the Payout
Start Date, the Death of Owner provision above applies.
If the Annuitant who is not also the Owner dies before the Payout Start Date,
the Options available to the Owner will be determined by the applicable
following Category in which the Owner is defined.
Category 1. If the Owner is a living person, the Certificate will
continue in the Accumulation Phase with a new Annuitant.
The new Annuitant will be:
o a person you name by written request subject to the
conditions described in the Annuitant provision of this
Certificate; otherwise,
o the youngest Owner; otherwise,
o the youngest Beneficiary.
Category 2. If the Owner is a corporation, trust or other non-living
person, the Owner must receive the Certificate Value payable
within 5 years of the Annuitant's death.
Withdrawal Charges will be waived for any withdrawals made
during this 5 year period; however the amount withdrawn may be
subject to a Market Value Adjustment.
All ownership rights, subject to the conditions stated in this
provision, are available to the Owner from the date of the
Annuitant's death until the date on which the Death Proceeds
are paid.
We reserve the right to offer additional Death of Annuitant Options.
If the Annuitant dies after the Payout Start Date, refer to the Payout Phase
section of this Certificate.
Death Proceeds Before the Payout Start Date, the Death Proceeds are equal to the
Certificate Value. The value of the Death Proceeds is calculated as of the day
we receive the first complete request for settlement from any Owner. A complete
request must include due proof of death.
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PAYOUT PHASE
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Payout Phase The "Payout Phase" is the second of the two phases of this
Certificate. The Payout Phase begins on the Payout Start Date. It continues
until we make the last payment as provided by the Income Plan(s) chosen.
Payout Start Date The "Payout Start Date" is the date the Certificate Value less
any applicable taxes is applied to an Income Plan. The anticipated Payout Start
Date is shown on the Annuity Data Page. You may change the Payout Start Date by
writing to us at least 30 days before the new Payout Start date.
The Payout Start Date must be at least 30 days after the Issue Date, and occur
on or before the later of:
o the Annuitant's 90th birthday; or
o the 10th Certificate Anniversary.
Income Plans An "Income Plan" is a series of payments to be made on a scheduled
basis to you or to another person designated by you. You may choose only one
Income Plan. The Certificate Value on the Payout Start Date less any applicable
taxes, will be applied to your Income Plan choice from the following list.
The "Guaranteed Payment Period" is the period of time over which income payments
are guaranteed to be paid.
Income Plan 1 - Life Income with Guaranteed Payment Period We will make payments
for as long as the Annuitant lives, or until the end of the Guaranteed Payment
Period, if longer. The Guaranteed Payment Period may range from 0 to 360 months.
If the Annuitant is age 90 or older on the Payout Start Date, the Guaranteed
Payment Period may range from 60 to 360 months.
Income Plan 2 - Joint and Survivor Life Income with Guaranteed Payment Period We
will make payments for as long as either the Annuitant or joint Annuitant, named
at the time of Income Plan selection, lives, or until the end of the Guaranteed
Payment Period, if longer. The Guaranteed Payment Period may range from 0 to 360
months. If either the Annuitant or joint Annuitant is age 90 or older on the
Payout Start Date, the Guaranteed Payment Period may range from 60 to 360
months.
Income Plan 3 - Guaranteed Payment Period We will make payments for a Guaranteed
Payment Period. These payments do not depend on the Annuitant's life. The
minimum Guaranteed Payment Period is 60 months (120 months if the Payout Start
Date occurs before the third anniversary of the Issue Date). The maximum
Guaranteed Payment Period is 360 months or the number of full months between the
Payout Start Date and the date that the Annuitant reaches age 100, if greater.
In no event may the Guaranteed Payment Period exceed 600 months.
We reserve the right to make other Income Plans available.
Payout Terms and Conditions The income payments are subject to the following
terms and conditions:
o If the Certificate Value is less than $2,000 when it is applied to the
Income Plan(s) you choose, or if the Certificate Value is not enough to
provide an initial payment of at least $20 when it is applied to the Income
Plan(s) you choose, we reserve the right to:
o change the payment frequency to make the payment at least $20; or
o terminate the Certificate and pay you the Certificate Value in a lump
sum.
o If we do not receive a written selection of an Income Plan from you at
least 30 days before the Payout Start Date, the Income Plan will be deemed
to be Life Income with a Guaranteed Payment Period of 120 months.
o If you choose an Income Plan which depends on any person's life, we may
require:
o proof of age and sex before income payments begin; and
o proof that the Annuitant or joint Annuitant is still alive before we
make each payment.
o After the Payout Start Date:,
o a new Income Plan may not be selected nor may amounts be
reallocated to a different Income Plan;
o the Income Plan cannot be changed and withdrawals cannot be made;
and
o the Annuitant may not be changed.
o If any Owner dies during the Payout Phase, the new Owner will be the
surviving Owner. If there is no surviving Owner, the new Owner will be the
Beneficiary(ies) as described in the Beneficiary provision. Any remaining
income payments will be paid to the new Owner as scheduled.
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INCOME PAYMENT TABLES
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The Income Payment Tables shown below contain monthly income payment factors per
$1,000 applied, which were calculated using the Annuity 2000 Mortality Tables
and an annualized effective interest rate of 3%. For ages, Guaranteed Payment
Periods, combinations of sex, payment frequencies, and annualized effective
interest rates not shown in these examples, income payment factors will be
calculated on a basis consistent with the factors shown. The adjusted age of the
Annuitant is used to determine the appropriate monthly income payment factor to
apply for the selected Income Plan. The adjusted age is the actual age of the
Annuitant(s) on the Payout Start Date, reduced by one year for each six full
calendar years between January 1, 2000 and the Payout Start Date.
Income Plan 1 - Life Income with Guaranteed Payment Period for 120 Months
============================================================================================================================
Monthly Income Payment for each $1,000 Applied to this Income Plan
- ----------------------------------------------------------------------------------------------------------------------------
- ------------------ ----------------------- ---------------- ---------------------- ---------------- ------------------------
Annuitant's Annuitant's Annuitant's
Adjusted Male Female Adjusted Male Female Adjusted Male Female
Age Age
Age
- ------------------ ----------------------- ---------------- ---------------------- ---------------- ------------------------
- ------------------ ----------------------- ---------------- ---------------------- ---------------- ------------------------
35 $3.34 $3.22 49 $3.99 $3.76 63 $5.23 $4.84
36 3.38 3.24 50 4.05 3.81 64 5.35 4.95
37 3.41 3.27 51 4.11 3.87 65 5.49 5.07
38 3.45 3.30 52 4.18 3.93 66 5.62 5.20
39 3.49 3.34 53 4.26 3.99 67 5.77 5.33
40 3.53 3.37 54 4.33 4.06 68 5.92 5.47
41 3.57 3.41 55 4.41 4.13 69 6.07 5.62
42 3.62 3.44 56 4.50 4.20 70 6.23 5.78
43 3.66 3.48 57 4.58 4.28 71 6.39 5.94
44 3.71 3.52 58 4.68 4.36 72 6.56 6.11
45 3.76 3.57 59 4.78 4.45 73 6.73 6.29
46 3.81 3.61 60 4.88 4.54 74 6.90 6.48
47 3.87 3.66 61 4.99 4.63 75 7.08 6.67
48 3.93 3.71 62 5.11 4.73
================== ======================= ================ ====================== ================ ========================
Income Plan 2 - Joint and Survivor Life Income with Guaranteed Payment Period for 120 Months
==============================================================================================================================
Monthly Income Payment for each $1,000 Applied to this Income Plan
- ------------------------------------------------------------------------------------------------------------------------------
- -------------------- ---------------------------------------------------------------------------------------------------------
Female Annuitant's Adjusted Age
- -------------------- ---------------------------------------------------------------------------------------------------------
- -------------------- ---------- ------------ ----------- ---------- ---------- ---------- ---------- --------- ---------------
Male
Annuitant's 35 40 45 50 55 60 65 70 75
Adjusted
Age
- -------------------- ---------- ------------ ----------- ---------- ---------- ---------- ---------- --------- ---------------
- -------------------- ---------- ---------- ---------- ---------- ----------- ---------- ------------ ----------- -------------
35 $3.06 $3.12 $3.17 $3.22 $3.26 $3.28 $3.31 $3.32 $3.33
40 3.10 3.18 3.26 3.32 3.38 3.43 3.46 3.49 3.51
45 3.13 3.23 3.33 3.43 3.52 3.59 3.65 3.69 3.72
50 3.16 3.27 3.40 3.53 3.65 3.76 3.86 3.93 3.98
55 3.18 3.30 3.45 3.61 3.77 3.94 4.08 4.20 4.29
60 3.19 3.33 3.49 3.68 3.88 4.10 4.31 4.51 4.66
65 3.20 3.34 3.52 3.73 3.97 4.24 4.54 4.83 5.08
70 3.21 3.35 3.54 3.76 4.03 4.36 4.73 5.13 5.52
75 3.21 3.36 3.55 3.78 4.07 4.44 4.87 5.38 5.92
==================== ========== ========== ========== ========== =========== ========== ============ =========== =============
Income Plan 3 - Guaranteed Payment Period
================================= ===============================================
Monthly Income Payment for each
Specified Period $1,000 Applied to this Income Plan
- --------------------------------- -----------------------------------------------
- --------------------------------- -----------------------------------------------
10 Years $9.61
11 Years 8.86
12 Years 8.24
13 Years 7.71
14 Years 7.26
15 Years 6.87
16 Years 6.53
17 Years 6.23
18 Years 5.96
19 Years 5.73
20 Years 5.51
================================= ===============================================
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GENERAL PROVISIONS
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The Entire Contract The entire contract consists of this Certificate, the Master
Policy, Policy Application, any written applications, the annuity data page, and
any Certificate endorsements and riders.
All statements made in written applications are representations and not
warranties. No statement will be used by us in defense of a claim or to void the
Certificate unless it is included in a written application. If your Certificate
is voided, you will receive any purchase payments, less any withdrawals,
excluding accrued interest.
Unless otherwise specified, all references in this Certificate to days, months
or years shall mean calendar days, months or years.
Only our officers are authorized to change the Certificate or waive a right or
requirement of the Certificate. No other individual is authorized to do this.
We may not modify this Certificate without your signed consent, except to make
it comply with any changes in the Internal Revenue Code or as required by any
other applicable law or as otherwise permitted by the terms of this Certificate.
Master Policy Amendment or Termination The Master Policy may be amended by us,
terminated by us, or terminated by the Master Policyholder without the consent
of any other person. No termination completed after the issue date of this
Certificate will adversely affect your rights under this Certificate. Nothing in
the Master Policy will invalidate or impair any rights of Certificate owners.
Incontestability Except as provided in the Entire Certificate provision above,
this Certificate will be incontestable after it has been in force during your
lifetime for a period of two years from the Issue Date.
Misstatement of Age or Sex If any age or sex has been misstated, we will pay the
amounts which would have been paid at the correct age and sex.
If we find the misstatement of age or sex after the income payments begin, we
will:
o pay all amounts underpaid including interest calculated at an effective
annual rate of 6%; or
o stop payments until the total income payments made are equal to the total
amounts that would have been made if the correct age and sex had been used.
Annual Statement At least once a year, before the Payout Start Date, we will
send a statement to you at the last known address we have in our records
reporting Certificate Values. The effective date of the information in the
annual statement will not be more than two months before the date of the
mailing. We will provide you with Certificate Value information at any time upon
your request. The information presented will comply with any applicable law.
Settlements We must receive due proof of death of the Owner or due proof of
death of the Annuitant before the settlement of a death claim.
Any full withdrawal or payment of death proceeds under this Certificate will not
be less than the minimum benefits required by any statute of the state in which
the Certificate is delivered.
Deferment of Payments We reserve the right to postpone payment of any withdrawal
for up to six months. If we elect to postpone payments for 30 days or more, we
will pay interest as required by applicable law. Any such interest will be
payable from the date the payment request is received by us to the date the
payment is made.
ALLSTATE
APPLICATION FOR THE ALLSTATE MARKETSMART ANNUITY
Issued by: Allstate Life Insurance Company
P.O. Box 94620
Palatine, Illinois 60094-4260
Make check payable to: Allstate Life Insurance Company
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Annuity Number
___________________ Issue Date ___/___/___
Required only for filed issue contracts Required only for field issue contracts
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1. Owner(s)
If the owner is a trust or other non-living entity, it is a surviving owner and
will receive any death benefit due regardless of any beneficiaries designated
on the contract.
Name ___________________________ // M // F Birthdate ___/__/____
Address ________________________ Soc.Sec. No./TIN ____-____-____
City _____________ State _____ Zip ____ Owner(s) Phone ____-____-____
Name ___________________________ // M // F Birthdate ___/__/____
Address ________________________ Soc.Sec. No./TIN ____-____-____
City _____________ State _____ Zip ____ Owner(s) Phone ____-____-____
Are the Owner(s), Annuitant and Beneficiary(ies) U.S. Citizens? // Yes // No If
No, provide name and country of each (use "Special Instructions" below).
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2. Owner Type
// Individual // Non Grantor Trust // Corporate/Association
// Tax Exempt/NonProfit Organization // Minor // Partnership
// Grantor Trust // Qualified Plan // Trust-Type ____________
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3. Annuitant
Leave blank if Annuitant is the same as sole Owner; otherwise complete.
Name ___________________________ // M // F Birthdate ___/__/____
Address ________________________ Soc.Sec. No./TIN ____-____-____
City _____________ State _____ Zip ____
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4. Beneficiary(ies)
Include additional beneficiary information under Special Instructions.
Primary _______________________ Relationship to Owner ______________________
Soc. Sec. No./TIN ____-____-____ Birthdate ____/__/____ _____%
Address ____________________ City ______________ State ______ Zip __________
Contingent _______________________ Relationship to Owner ___________________
Soc. Sec. No./TIN ____-____-____ Birthdate ____/__/____ _____%
Address ____________________ City ______________ State ______ Zip __________
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5. Tax Qualified Plan Type:
// Yes // No (Check one - If Yes, complete the following)
// Traditional IRA // ROTH IRA // SEP-IRA // Employer // Employee _____
// Other ________ // IRA Rollover // IRA Transfer // Contribution $ _____
Contribution Year __
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6. Purchase Payment Crediting Option
Initial Purchase Payment $______________________
(Includes contribution amount plus any rollover/transfer/exchange amount)
(Must select one crediting option)
// Crediting Option A ___% or ___% OR // Crediting Option B __% or __%
S&P 500 Index Linked
// ___________________________
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7. Special Instructions
______________________________________________________________________________
______________________________________________________________________________
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8. Replacement Information
Do you have any existing annuity or life insurance contracts? // Yes // No
Will this annuity replace or change any existing annuity or life insurance? //
Yes // No (If Yes, complete the following.)
Company _____________________________________ Policy No. _____________________
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9. Signature(s) Owner(s) Signature(s) Required
I have read the above statements and represent that they are complete and true
to the best of my knowledge and belief. I have read the applicable fraud warning
for my state on the reverse side. I understand that withdrawals made prior to
the end of a guarantee period for the MVA fixed account may be subject to a
Market Value Adjustment (MVA) which may be positive or negative.
Under penalties of perjury, I certify that: (1) The number shown on this form is
my correct taxpayer identification number (or I am waiting for a number to be
issued to me), and (2) I am not subject to backup withholding because: (a) I am
exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to back up withholding as a result of a
failure to report all interest or dividends, or (c) the (IRS) has notified me
that I am no longer subject to backup withholding, (3) I am a U.S. person
(including U.S. resident alien). The Internal Revenue Service does not require
your consent to any provisions of this document other than the certification
required to avoid backup withholding.
Signed at ___________________________________ Date ____/___/____
City State
Owner(s) Signature(s) ____________________ Owner(s) Signature(s)______________
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10. Representative Use Only
To the best of my knowledge the insured has an existing annuity or life
insurance contract. // Yes // No
Do you have any reason to beleive that the annuity applied for is to replace or
change any existing annuity or life insurance // Yes // No
Rep Name (Please Print) _________________ Phone No. ( ) __-____
Rep Signature ______________________ Soc. Sec. No./Rep No. _______________
E-Mail Address __________@_________ FAX No. ( ) ___-____
FL License No. _______________________ Institution _______________________
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IMPORTANT INFORMATION
For applicants in Arizona: Upon you written request we will provide you, within
a reasonable period of time, reasonable factual information concerning the
benefits and provisions of the annuity contract to you. If for any reason you
are not satisfied with the contract, you may return it within 20 days after it
is delivered and receive a full refund of the monies paid.
For applicants in Arkansas, Kentucky, Maine, New Mexico, Ohio, and Pennsylvania:
Any person who knowingly and with intent to defraud any insurance company or
other person files an application for insurance or statement of claim containing
any materially false information or conceals, for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance
act, which is a crime and subjects such person to criminal and civil penalties.
For applicants in Colorado: It is unlawful to knowingly provide false,
incomplete, or misleading facts or information to an insurance company for the
purpose of defrauding or attempting to defraud the company. Penalties may
include imprisonment, fines, denial of insurance, and civil damages. Any
insurance company or agent of an insurance company who knowingly provides false,
incomplete, or misleading facts or information to a policy holder or claimant
for the purpose of defrauding or attempting to defraud the policy holder or
claimant with regard to a settlement or award payable from insurance proceeds
shall be reported to the Colorado Division of Insurance within the Department of
Regulatory Agencies.
For applicants in the District of Columbia and Tennessee: Warning: It is a crime
to provide false or misleading information to an insurer for the purpose of
defrauding the insurer or any other person. Penalties include imprisonment
and/or fined. In addition, an insurer may deny insurance benefits if false
information materially related to a claim was provided by the applicant.
For applicants in Florida: Any person who knowingly and with intent to injure,
defraud, or deceive any insurer files a statement of claim or an application
containing any false, incomplete, or misleading information is guilty of a
felony of the third degree.
For applicants in Georgia: Any person who knowingly and with intent to injure,
defraud, or deceive any insurer files a statement of claim, or an application
containing any false, incomplete or misleading information may be guilty of a
felony of the third degree.
For applicants in Louisiana and Oregon: Any person who knowingly presents a
false or fraudulent claim for payment of a loss or benefit or knowingly presents
false information in an application for insurance is guilty of a crime and may
be subject to fines and confinement in prison.
For applicants in New Jersey: Any person who includes any false or misleading
information on an application for an insurance policy is subject to criminal and
civil penalties.
FICCP11 (03/03)
Exhibit 24(b)
POWER OF ATTORNEY
WITH RESPECT TO
ALLSTATE LIFE INSURANCE COMPANY
(REGISTRANT)
Know all men by these presents that the undersigned director of Allstate Life
Insurance Company constitutes and appoints Casey J. Sylla, and Michael J.
Velotta, and each of them (with full power to each of them to act alone) as his
true and lawful attorney-in-fact and agent, with full power of substitution, for
him in any and all capacities, to sign any registration statements of Allstate
Life Insurance Company and any amendments thereto, and to file the same, with
exhibits and other documents in connection therewith, with the Securities and
Exchange Commission or any other regulatory authority as may be necessary or
desirable, hereby ratifying and confirming all that each of said
attorney-in-fact and agent, or his substitute or substitutes, may lawfully do or
cause to be done by virtue hereof.
February 4, 2003
/s/ DANNY L. HALE
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Danny L. Hale
Director
POWER OF ATTORNEY
WITH RESPECT TO
ALLSTATE LIFE INSURANCE COMPANY
(REGISTRANT)
Know all men by these presents that the undersigned director of Allstate Life
Insurance Company constitutes and appoints Michael J. Velotta, as his true and
lawful attorney-in-fact and agent, with full power of substitution, for him in
any and all capacities, to sign any registration statements of Allstate Life
Insurance Company and any amendments thereto, and to file the same, with
exhibits and other documents in connection therewith, with the Securities and
Exchange Commission or any other regulatory authority as may be necessary or
desirable, hereby ratifying and confirming all that each of said
attorney-in-fact and agent, or his substitute or substitutes, may lawfully do or
cause to be done by virtue hereof.
February 4, 2003
/s/ CASEY J. SYLLA
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Casey J. Sylla
Director, Chairman of the Board and President
