<PAGE>
EXHIBIT (4)(a)
MONY Life Insurance Company of America
Signed for MONY Life Insurance Company of
America on the
Date of Issue.
Administrative Office
1740 Broadway,
New York, NY 10019
Operations Center
One MONY Plaza, PO Box 4830,
Syracuse, NY 13221,
1(800)487-6669
Home Office
2999 North 44th Street, Suite 250,
Phoenix, AZ 85018
/s/ Michael I. Roth
-------------------------
MICHAEL I. ROTH, Chairman
/s/ Samuel J. Foti
--------------------------
SAMUEL J. FOTI, President
/s/ David S. Waldman
----------------------------
DAVID S. WALDMAN, Secretary
If you have a complaint about this
Contract, see Page 2. See page 3 for
information regarding any taxes applicable
to Purchase Payments.
MONY Life Insurance Company of America will
pay the benefits provided in this
Contract, subject to all the contract
provisions.
Annuitant:
John Doe
Age of Annuitant at 35
Issue:
Contract Number:
BGP0000800
Effective Date:
01/01/2003
Date of Issue:
01/01/2003
Annuity Starting Date: 01/01/2063
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Important Notice(s)
This Contract is a legal contract between
the Owner and the Company. READ YOUR
CONTRACT CAREFULLY.
ALL ANNUITY PAYMENTS AND VALUES PROVIDED BY
THIS CONTRACT, WHERE BASED ON THE
INVESTMENT EXPERIENCE OF THE VARIABLE
ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT. PAYMENTS
AND VALUES MAY INCREASE OR DECREASE
ACCORDING TO THE EXPERIENCE OF THE VARIABLE
ACCOUNT. SEE THE VARIABLE ACCOUNT
AND FUND VALUE SECTIONS.
THIS IS A LONG TERM CONTRACT; A SURRENDER
CHARGE MAY BE APPLIED TO ANY SURRENDER
MADE WITHIN THE FIRST 8 YEARS. A POSITIVE
OR NEGATIVE MARKET VALUE ADJUSTMENT
MAY ALSO BE APPLIED TO SURRENDERS OR
TRANSFERS FROM THE GUARANTEED INTEREST
ACCOUNT.
Right to Return Contract - This Contract
may be returned to us within ten days
from the date you receive it by delivering
or mailing it to our Administrative
Office, a local office of ours, or to any
Agent of ours. We will then refund the
Fund Value of the Contract (before
deduction of any surrender charge) plus any
taxes applicable to annuity purchase
payments. The Contract will be considered
never to have been issued. If you return by
mail, the cancellation will be
effective on the date it is postmarked (if
properly addressed with postage
prepaid).
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Brief Description
This is a FLEXIBLE PAYMENT VARIABLE ANNUITY
CONTRACT. Payments to the Payee
begin on the Annuity Starting Date. If the
Annuitant dies before that Date a
Death Benefit is payable. No dividends are
payable.
FLEXIBLE PAYMENT VARIABLE ANNUITY
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PAGE 1
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Table of Contents
<TABLE>
<CAPTION>
Section
Page
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----
<S>
<C>
1. SCHEDULE OF PAYMENTS AND
CHARGES.....................................................
3
Contract Description
And Specifications.
2. VARIABLE ACCOUNT, THE FUNDS AND
SUB-ACCOUNTS......................................... 4
Listing Of
Sub-Accounts And Funds.
3. ABOUT THIS
CONTRACT..................................................................
5
An Overview Of Basic
Contract Provisions.
4. WE WILL
PAY..........................................................................
6
Annuity Payments;
Changing The Date Annuity Payments Start; Death Benefit;
Interest On Death
Proceeds.
5. PURCHASE PAYMENTS YOU
MAKE...........................................................
7
Initial Purchase
Payment; Limits On Payments; Automatic And Non-Automatic
Payments; Net Purchase
Payment; Purchase Payment Allocations.
6. FUND
VALUE...........................................................................
8
How Fund Value Is
Determined.
7.
TRANSFERS............................................................................
9
Types Of Transfers;
Allocation Rules.
8. FULL OR PARTIAL
SURRENDERS...........................................................
10
Full And Partial
Surrenders; Allocation Rules; Surrender Charge; Free Partial
Surrender Amount.
9. RIGHTS OF
OWNER......................................................................
12
Owner Of The Contract;
Owner's Rights; Successor Owner.
10. DEATH OF
OWNER.......................................................................
12
Death Of Owner Before
The Annuity Starting Date.
11.
BENEFICIARY..........................................................................
12
Beneficiary Of The
Contract; Changing The Beneficiary; Successor Beneficiary.
12. SECONDARY
ANNUITANT..................................................................
13
Secondary Annuitant;
Naming Or Deleting A Secondary Annuitant.
13. THE VARIABLE
ACCOUNT.................................................................
14
Variable Account;
Sub-Accounts; Changes To The Variable Account.
14. SUB-ACCOUNT UNIT
VALUE...............................................................
15
Unit Value
Determination.
</TABLE>
FOR INFORMATION OR TO MAKE A COMPLAINT
CALL 1-800-487-MONY (1-800-487-6669)
OR WRITE TO US AT OUR OPERATIONS CENTER AT:
ONE MONY PLAZA, PO BOX 4830, SYRACUSE, NEW YORK 13221
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PAGE 2
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<TABLE>
<CAPTION>
Section
Page
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<C>
<C>
15. THE GUARANTEED INTEREST
ACCOUNT......................................................
15
Guaranteed Interest
Account; Interest Rate Applied To The guaranteed Interest
Account, Accumulation
Period, Market Value Adjustment.
16. THE DOLLAR COST AVERAGING PLUS
ACCOUNT............................................... 17
DCA Plus Periods; DCA
Plus Interest; DCA Plus Accounts.
17. ANNUAL CONTRACT
CHARGE...............................................................
18
Annual Contract
Charge.
18. DATES AND CONTRACT
PERIODS...........................................................
18
How Dates Are
Determined; How Periods Are Measured.
19. GENERAL
PROVISIONS...................................................................
18
The Contract;
Statements In Application; Incontestability; Misstatement Of Age
Or
Gender; Assignment;
Postponement Of Payments Or Transfers; Authority;
Relationships;
Reports.
20. SETTLEMENT
OPTIONS...................................................................
20
Election Of Settlement
Options; Settlement (Payout) Options Available; Minimum
Monthly Income
Tables.
ENDORSEMENTS, IF
ANY
RIDERS, IF ANY
APPLICATION
</TABLE>
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PAGE 2A
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1. Schedule of Payments and Charges
Flexible Payment Variable Annuity Contract
BGP0000800
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Initial Purchase Payment
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Guaranteed Interest Account Accumulation
Periods available at issue: [3, 5, 7
and 10yr]
(subject to change, see Guaranteed Interest
Account section)
<TABLE>
<CAPTION>
Accumulation Period(s) Selected at Issue
Guaranteed Rate
for Accumulation Period
----------------------------------------
---------------------------------------
<S>
<C>
1 Year
[1.5%]
</TABLE>
Guaranteed Minimum Interest Rate
[1.5%]
Minimum DCA Plus Account Allocation
[$5,000]
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Number of guaranteed free transfers during
a contract year
12
Charge on excess transfers:
Current
[$0]
(subject to change; see
Transfers section)
Guaranteed Maximum
$25
Daily Mortality/Expense Risk Charge* (see
Sub-Account Unit Value section)
Current
[0.003288% (equal to 1.20% annually)]
Guaranteed Maximum
0.003836% (equal to 1.40% annually)
* Will be reduced by 0.20% annually if the
Purchase Payment(s) made during the
first contract year total $750,000 or more
and either (a) or (b) are applicable
on any contract anniversary:
(a) the Fund Value is $750,000 or
more, or
(b) Fund Value is less than $750,000
and the total withdrawals made during the
prior contract
year do not exceed the greater of: (i) the Free Partial
Surrender Amount
for that year; and (ii) the a amount of any required
minimum
distributions under the Internal Revenue Code of 1986 (Code)
for
that year, if
applicable.
Annual Contract Charge (to be waived on any
contract anniversary on which the
Fund Value is $50,000 or more):
Current
[$30]
Guaranteed Maximum if
Initial Purchase Payment is less than $2,500 $40
Guaranteed Maximum if
Initial Purchase Payment is at least $2,500
$50
Tax Charge - 0% of each payment received
subject to change based upon change in
applicable federal or state tax laws or
cost to the Company.
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PAGE 3
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1. Schedule of Payments and Charges
Surrender charge (see Full and Partial Surrenders section)
SURRENDER CHARGE PERCENTAGE TABLE
# of Contract
Anniversaries since Surrender Charge
Effective Date
Percentage
------------------- ----------------
0
8%
1
8
2
7
3
7
4
6
5
5
6
4
7
3
8(or more)
0
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PAGE 3A
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2. Variable Account, The Funds and
Sub-Accounts
See Variable Account section for further
information
The Variable Account is MONY America
Variable Account A and includes the
Sub-accounts listed below.
The Sub-accounts available for investment
purposes, and the corresponding
portfolios of the applicable funds are:
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<TABLE>
<CAPTION>
Sub-Accounts
Applicable Fund
------------
---------------
<S>
<C>
[AIM V.I. Basic Value
AIM Variable Insurance Funds
AIM V.I. Mid Cap Core Equity
AIM Variable Insurance Funds
Alger American Balanced
The Alger American Fund
Alger American MidCap Growth
The Alger American Fund
Dreyfus I. P. Small Cap Stock Index
Dreyfus Investment Portfolio
Enterprise Deep Value
Enterprise Accumulation Trust
Enterprise Equity Income
Enterprise Accumulation Trust
Enterprise Growth
Enterprise Accumulation Trust
Enterprise Growth and Income
Enterprise Accumulation Trust
Enterprise Global Socially Responsive
Enterprise Accumulation Trust
Enterprise Managed
Enterprise Accumulation Trust
Enterprise Mergers and Acquisitions
Enterprise Accumulation Trust
Enterprise Multi-Cap Growth
Enterprise Accumulation Trust
Enterprise Short Duration Bond
Enterprise Accumulation Trust
Enterprise Small Company Growth
Enterprise Accumulation Trust
Enterprise Small Company Value
Enterprise Accumulation Trust
Enterprise Total Return
Enterprise Accumulation Trust
Franklin Income Securities
Franklin Templeton Variable Insurance Product Trust
Franklin Rising Dividends Securities
Franklin
Templeton Variable Insurance Product Trust
Franklin Zero Coupon 2010
Franklin Templeton Variable Insurance Product Trust
INVESCO VIF - Financial Services
INVESCO Variable Investment Funds, Inc
INVESCO VIF - Health Sciences
INVESCO Variable Investment Funds, Inc
INVESCO VIF - Telecommunications
INVESCO Variable Investment Funds, Inc
Janus Aspen Series Capital Appreciation
Janus Aspen
Series
Janus Aspen Series Flexible Income
Janus Aspen Series
Janus Aspen Series International Growth
Janus Aspen
Series
Lord Abbett Bond-Debenture
Lord Abbett Series Fund
Lord Abbett Growth and Income
Lord Abbett Series Fund
Lord Abbett Mid-Cap Value
Lord Abbett Series Fund
MFS Mid Cap Growth
MFS. Variable Insurance Trust(SM)
MFS New Discovery
MFS. Variable Insurance Trust(SM)
MFS Total Return
MFS. Variable Insurance Trust(SM)
MFS Utilities
MFS. Variable Insurance Trust(SM)
MONY Government Securities
MONY Series Fund, Inc.
MONY Long Term Bond
MONY Series Fund, Inc.
MONY Money Market
MONY Series Fund, Inc.
Oppenheimer Main Street
Oppenheimer Variable Account Funds
Oppenheimer Global Securities
Oppenheimer Variable Account Funds
PBHG Mid-Cap
PBHG Insurance Series Fund
PBHG Select Value
PBHG Insurance Series Fund
PIMCO Global Bond
PIMCO Variable Insurance Trust
PIMCO Real Return
PIMCO Variable Insurance Trust
PIMCO StocksPLUS Growth and Income
PIMCO Variable Insurance Trust
ProFund VP Bear
The ProFunds VP
ProFund VP UltraBull
The ProFunds VP
ProFund VP Rising Rates Opportunity
The
ProFunds VP
Van Kampen UIF Emerging Markets Equity
The
Universal Institutional Funds, Inc
Van Kampen UIF Global Value Equity
The Universal Institutional Funds, Inc
Van Kampen UIF U.S. Real Estate
The Universal Institutional Funds, Inc ]
</TABLE>
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PAGE 4
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2. Variable Account, The Funds and
Sub-Accounts
See Variable Account section for further
information
The Variable Account is MONY America
Variable Account A and includes the
Sub-accounts listed below.
The Sub-accounts available for investment
purposes, and the corresponding
portfolios of the applicable funds are:
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[AIM Variable Insurance Funds, Janus Aspen
Series, PBHG Insurance Series Fund,
PIMCO Variable Insurance Trust and The
ProFunds VP are organized under the laws
of Delaware. INVESCO Variable Investment
Funds, Inc., Lord Abbett Series Fund,
MONY Series Fund, Inc., and The Universal
Institutional Funds, Inc. are
organized under the laws of Maryland. The
Alger American Fund, Dreyfus
Investment Portfolio, Enterprise
Accumulation Trust, Franklin Templeton Variable
Insurance Product Trust, MFS Variable
Insurance Trust and Oppenheimer Variable
Account Funds are organized under the laws
of Massachusetts. The Alger American
Fund, Enterprise Accumulation Trust,
Franklin Templeton Variable Insurance
Product Trust, Janus Aspen Series, INVESCO
Variable Investment Funds, Inc., Lord
Abbett Series Fund, MFS Variable Insurance
Trust, MONY Series Fund, Inc.,
Oppenheimer Variable Account Funds, PBHG
Insurance Series Fund, and PIMCO
Variable Insurance Trust are registered
with the Securities and Exchange
Commission under the 1940 Investment
Company Act as open-end, diversified
investment management companies. AIM
Variable Insurance Funds, Dreyfus
Investment Portfolios, The ProFunds VP and
Universal Institutional Funds, Inc.]
are registered with the Securities and
Exchange Commission under the 1940
Investment Company Act as open-end
management investment companies.
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PAGE 4A
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3. About This Contract
The following is an overview of some basic
contract provisions to aid your
understanding. The specific provisions of
the Contract are found in the pages
following this overview. In the event of a
discrepancy between this overview and
any specific provisions of this Contract,
the specific Contract provisions will
control.
This is a Flexible Payment Variable Annuity
Contract. This Contract goes into
effect on the Effective Date. This Contract
is a "promise to pay" Annuity
Payments which start on a date chosen by
you called the Annuity Starting Date
(or maturity date). Those payments are made
to a person chosen by you as the
Payee. The Annuitant is the person on whose
life the Contract is based (the
measuring life).
If the Annuitant (or Secondary Annuitant)
is living on the Annuity Starting
Date, we begin to make Annuity Payments. If
the Annuitant dies before the
Annuity Starting Date, the Secondary
Annuitant (if you designated one) takes
over as Annuitant. If the Annuitant and the
Secondary Annuitant both die before
the Annuity Starting Date, the Contract
ends and a death benefit is payable to
the Beneficiary (person who receives the
Death Benefit) chosen by you. The death
benefit is equal to the Fund Value or, if
greater, the Purchase Payments paid by
you less any partial surrenders, plus or
minus any Market Value Adjustment and
less any surrender charge. The Beneficiary
does not have to be the Payee. If the
Owner (and Successor Owner under certain
circumstances) dies before the Annuity
Starting Date, while the Annuitant is
living, the proceeds in this Contract must
be distributed within 5 years after the
date of death (see Death of Owner
section).
Purchase Payments are payments you make to
us. The sum of Purchase Payments made
(less partial surrenders, charges, etc.)
determine the value of the Contract.
There may be a positive or negative Market
Value Adjustment and a surrender
charge on partial surrenders you make or,
if you surrender (cash in) the
Contract in full. The Market Value
Adjustment depends on which Accumulation
Period(s) you selected, how many years are
left in the applicable Period(s) and
how interest rates have changed since those
Periods began. The surrender charge
depends on how long ago you purchased the
Contract.
The value of this Contract is based on
Purchase Payments which you allocate to
either the Variable Account, the Guaranteed
Interest Account or the Dollar Cost
Averaging Plus Account. The Fund Value is
the combined value of the Variable
Account, the Guaranteed Interest Account
and the Dollar Cost Averaging Plus
Account BEFORE any Market Value Adjustment
is applied, any surrender charge and
any Annual Contract Charge, as applicable,
are deducted. The Cash Value, if any,
is the value AFTER any Market Value
Adjustment is applied, any surrender charge
and any Annual Contract Charge, as
applicable are deducted. The Guaranteed
Interest Account and Dollar Cost Averaging
Plus Account are "fixed" accounts and
are part of our General Account. We may
offer one or more choices of Guaranteed
Interest Account Accumulation Periods and
interest rates to apply during those
Periods. The Variable Account is an account
that is separate from our General
Account. The value of the Variable Account
can increase or decrease depending on
investment experience. The Variable Account
is made up of several Sub-accounts
(subdivisions) with different investment
objectives. Each Sub-account invests
only in the shares of its own portfolio of
its fund. The measure of value in a
Sub-account is called a Unit.
The value of Units in a Sub-account can
only change on a Business Day. A
Business Day is any day the New York Stock
Exchange is open for trading or any
other day on which there is enough trading
to change the Unit value of a
Sub-account. Trading refers to the purchase
and sale of securities held by the
portfolio.
When we refer to "I" or "my" in a question,
or to "you" or "your" in an answer,
we mean the Owner. The Owner is the person
who holds the Contract and who has
the rights of ownership. The Owner chooses
any options the Contract offers. When
we refer to "we", "us" and "our" we mean
MONY Life Insurance Company of America.
"Administrative Office" means our office at
1740 Broadway, New York, NY 10019
and also includes our Operations Center at
One MONY Plaza, P.O. Box 4830,
Syracuse, NY 13221.
You can read more about the terms used in
the summary on the following pages.
"Annuity Payments"
(see Section 4)
"Annuity Starting Date"
shown on page 1.
"Beneficiary"
(see Section 11)
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PAGE 5
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"Business Day"
(see Section 3)
"Cash Value"
(see Section 8)
"Effective Date"
shown on page 1.
"Fund Value"
(see Section 6)
"Guaranteed Interest Account" (see Section 15)
"Owner"
(see Section 9)
"Payee"
(see Section 4)
"Purchase Payments"
(see Section 5)
"Secondary Annuitant"
(see Section 12)
"Sub-account"
(see Section 2)
"Variable Account"
(see Section 13)
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4. We Will Pay
What will the Company pay and when will
they pay it?
1. We will pay the Annuity Payments
starting on the Annuity Starting Date to a
person named by you as Payee. You can name
a Payee either in the application or
later (if later, we will send an
endorsement to show the change).
2. We will pay the Death Benefit to the
Beneficiary if the Annuitant dies before
the Annuity Starting Date. But we must
first receive proof that the Annuitant
died before the Annuity Starting Date.
Payment in any case will only be made in
accordance with all the provisions of this
Contract. "Annuitant" includes a
"Secondary Annuitant" if you designated
one.
What are Annuity Payments?
Annuity Payments are Income Payments made
periodically (monthly, quarterly,
semi-annually or annually) over the
lifetime of the Payee or for a selected
period. The income will be purchased by the
Cash Value on the Annuity Starting
Date. The amount of the Cash Value and the
Settlement (payout) Option chosen
will determine the amount of income
payments.
But, if you elect Settlement Option 3 or
3A, the income will be purchas