STATEMENT OF BENEFIT INFORMATION

Transcription

1 STATEMENT OF BENEFIT INFORMATION CONTRACT SUMMARY Pacific Life Insurance Company P.O. Box 2378 Omaha, NE (800) Contract Owners (800) Registered Representatives/Producers Pacific Mariner Annuity Disclosure Contract Form Series For use in Maryland Pacific Mariner is an individual limited premium deferred annuity contract. It is a fixed annuity which means it earns a specified interest rate during a guaranteed period. This contract is deferred which means annuity payments do not begin until some future date. You can use an annuity to save money for retirement and to receive income for life through an available annuitization option. It is not meant to be used to meet short-term financial goals. Purchase Payments & Interest You can establish this contract with an initial purchase payment of at least $10,000. You decide between 5 or 7 year Initial Guarantee Terms (subject to availability) to allocate your purchase payment. Your purchase payment will earn interest at a rate in effect that is guaranteed for the length of the term you chose. Interest is credited daily. The rate you earn depends on the amount of your purchase payment, the initial guaranteed term you choose and the current interest rate environment. You may receive a higher interest rate for higher purchase payments. The rates will increase according to the following breakpoints: Under $50,000 $50,000- $99,999 $100,000 and above. The total of all expected payments will be used to determine which breakpoint will apply. This rate is guaranteed for the Initial Guarantee Term. All expected payments will be indicated on the Application. At the earlier of the receipt of the last expected payment or 90 days from contract issue, if the actual purchase payments are more or less than the expected purchase payments listed on the application, and do not match the breakpoint determined at issue, the initial interest rate will be adjusted. This adjustment will be based on the breakpoint for the actual purchase payments received. The increase or decrease to the initial interest rate will be retroactive to the contract issue date. Please note that residual payments will not be accepted if they are received outside the designated contractual window. At the end of the Initial Guarantee Term, and on all subsequent contract anniversaries, a new guarantee period begins and the rate is subject to change. Each guarantee period will be for one year terms. A new guaranteed rate is declared for each one year term and the new guaranteed rate depends on the current interest rate environment. The new guaranteed rate will never be less than the interest rate specified in the Contract Specifications and we determine in our discretion interest rates in excess of the stated minimum. Purchase Payment Guarantee: We guarantee that upon a full surrender, you will always get an amount at least equal to Total purchase payments, minus Prior partial withdrawals, minus Surrender charges on those prior partial withdrawals. If you do not take any partial withdrawals prior to the full surrender, you will always get an amount at least equal to the purchase payments you have made. CS1228MD-2-A 1 of 6 9/ A

2 Withdrawals You may make partial or full withdrawals from the contract. Withdrawals may be taken 30 days after the contract effective date and before any annuity payments begin. The minimum amount that may be withdrawn is $500 and the contract value remaining after the withdrawal must not be less than $1,000. If after a withdrawal the value is ever less than $1,000, we may terminate the contract and pay you at least the contract value less any applicable surrender charges. Withdrawal (Surrender) Charges Any withdrawal taken before the end of the Initial Guarantee Term (five or seven contract years, as applicable,) may be subject to a withdrawal charge (also known as a surrender charge). The surrender charge is equal to a percentage of the amount withdrawn based on the contract year of withdrawal. Here is how the charge is calculated: For a seven year Initial Guarantee Term: Contract year Surrender Charge 7% 7% 7% 6% 5% 4% 3% 0% Example: If you withdraw an additional $5,000* from your annuity in the fifth contract year, your surrender charge is $5,000 x 5% = $250. If you take out any amount after the end of the seventh contract year, there is no charge. *The $5,000 does not qualify as a Free Withdrawal as described below. For a five year Initial Guarantee Term: Contract year Surrender Charge 7% 7% 7% 6% 4% 0% Example: If you withdraw an additional $5,000* from your annuity in the fifth contract year, your surrender charge is $5,000 x 4% = $200. If you take out any amount after the end of the fifth contract year, there is no charge. *The $5,000 does not qualify as a Free Withdrawal as described below. Free Withdrawals: You may withdraw a certain amount each contract year without surrender charges. In the first contract year, you may withdraw up to 10% of the total purchase payments, less withdrawals. For each subsequent contract year, you may withdraw up to 10% of the contract value as of the prior contract anniversary. Other Exceptions: Besides free withdrawal situations, there are other cases we may waive the surrender charge. For example, there is no surrender charge on payments made because of your death. Please see Waiver of Withdrawal Charges provision in your contract for further information. Annuitization You may convert your contract value into an income annuity with us at any time after the first contract year. You will then start to get income from your annuity according to the payout option you choose. If you do not choose a date to start income payments, the date will be the younger annuitant s 95 th birthday. The current payout options are: Life Only Guarantees income for as long as the annuitant lives. Life with Period Certain Guarantees income for as long as the annuitant lives. If the annuitant dies during the specified period (usually 5-30 years), it pays income to you (or a beneficiary, if applicable) for the remainder of the specified period. Joint and Survivor Life Guarantees income for as long as the annuitant and secondary annuitant live. Period Certain Only Guarantees income for a specified period (usually years). CS1228MD-2-A 2 of 6 9/ A

3 Death Benefit We will pay the contract value upon your death or the death of the sole surviving annuitant. The contract value is the amount allocated to a guarantee term plus interest credited at the guaranteed rate, less withdrawals (including withdrawal charges) and less any applicable premium taxes. Taxes The annuity contract is tax-deferred which means you do not pay taxes on the interest it earns until the money is paid to you. When you make withdrawals and take other distributions, you pay ordinary income taxes. Federal law may impose an additional 10% tax penalty on certain distributions before the owner attains age 59 ½. Please consult with a tax advisor. Buying an annuity within an IRA or other qualified plan does not give you any extra tax benefits. Choose your annuity based on its other features and benefits as well as its risks and costs, not its tax benefits. You may also be subject to premium tax, depending on your state of residence. The amount of any premium tax imposed on us relating to the contract will be deducted in accordance with our then current practice and any applicable jurisdictional law regarding premium taxes. If premium tax rates change under laws of the jurisdiction in which you reside, the applicable premium tax may also change. If you change the jurisdiction in which you reside, the premium tax may or may not apply. Other Information Once you start to receive your annuity income payments, you cannot surrender your contract. We may change your annuity contract from time to time to follow federal or state laws and regulations. If we do, we will tell you about the changes in writing. Many states have laws that give you a set number of days to look at an annuity contract after you buy it. If you decide during that time that you do not want it, you can return the contract and receive your purchase payments back. Read your contract s Right to Cancel provision on the cover page to learn more about your free look period. We pay the independent producer or the independent producer s third party selling firm for selling the contract to you. This summary is not a contract and is not part of your contract with us. For questions regarding this summary, contact your producer or registered representative. If no producer or registered representative is involved, write to us at Pacific Life Insurance Company, P.O. Box 2378, Omaha, NE or call Pacific Life customer service at (800) CS1228MD-2-A 3 of 6 9/ A

4 Monthly Annuity Payable for Life with Period Certain Illustration 1 The monthly annuity amounts shown below are derived from the assumptions and values described below in the Section titled Individual Limited Premium Fixed Deferred Annuity Illustration 1. The monthly annuity amounts are based on a Life with Guaranteed Period option of the Annuity Options provision, male rates with a period certain of ten (10) years. If Annuity Monthly Annuity Monthly Annuity Starts at: Guaranteed Basis Illustrative Basis* Age 65 $46.81 $46.81 Age Individual Limited Premium Fixed Deferred Annuity Illustration 1 The values shown below assume that the Purchase Payment of $10,000 is paid on the Contract Date and allocated to a Guarantee Term of 5 years with interest accumulated at the initial minimum guaranteed rate of 0.30% per year and a secondary minimum guaranteed rate of 1.00%. The values further assume that no withdrawals have been made, no premium taxes paid and that the Contract Value renews for 1 year periods after the Initial Guarantee Term. The Contract Value for end of Contract Years 1 through 5 reflects the waiver of withdrawal charges on amounts up to the Free Withdrawal amount. The Free Withdrawal amount in Contract Year 1 is 10% of total Purchase Payments less total withdrawals. The Free Withdrawal amount after Contract Year 1 is 10% of the previous Contract Year s ending Contract Value. The full withdrawal value will never be less than total Purchase Payments paid less total withdrawals taken, less prior withdrawal charges. We may credit an annual interest rate during a Guarantee Term that is higher than the Minimum Guaranteed Interest Rate. Guaranteed Values Illustrated Values* End of Full Full Contract Interest Contract Value/ Withdrawal Interest Contract Value/ Withdrawal Year Age Rate Death Benefit Value Rate Death Benefit Value % $10, $10, % $10, $10, % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 13, , % 13, , % 17, , % 17, , End of 10 Years End of 20 Years At age 95 Guaranteed Yield: 0.64% 0.82% 0.94% Illustrative Yield: 0.64% 0.82% 0.94% CS1228MD-2-A 4 of 6 9/ A

5 Monthly Annuity Payable for Life with Period Certain Illustration 2 The monthly annuity amounts shown below are derived from the assumptions and values described below in the Section titled Individual Limited Premium Fixed Deferred Annuity Illustration 2. The monthly annuity amounts are based on a life with guaranteed period of the Annuity Options provision, male rates with a period certain of ten (10) years. If Annuity Monthly Annuity Monthly Annuity Starts at: Guaranteed Basis Illustrative Basis* Age 65 $46.16 $46.16 Age Individual Limited Premium Fixed Deferred Annuity Illustration 2 The values shown below assume that the Purchase Payment of $10,000 is paid on the Contract Date and allocated to a Guarantee Term of 7 years with interest accumulated at the initial minimum guaranteed rate of 0.30% per year and a secondary minimum guaranteed rate of 1.00%. The values further assume that no withdrawals have been made, no premium taxes paid and that the Contract Value renews for 1 year periods after the Initial Guarantee Term. The Contract Value for end of Contract Years 1 through 7 reflects the waiver of withdrawal charges on amounts up to the Free Withdrawal amount. The Free Withdrawal amount in Contract Year 1 is 10% of total Purchase Payments less total withdrawals. The Free Withdrawal amount after Contract Year 1 is 10% of the previous Contract Year s ending Contract Value. The full withdrawal value will never be less than total Purchase Payments paid less total withdrawals taken, less prior withdrawal charges. We may credit an annual interest rate during a Guarantee Term that is higher than the Minimum Guaranteed Interest Rate. Guaranteed Values Illustrated Values* End of Full Full Contract Interest Contract Value/ Withdrawal Interest Contract Value/ Withdrawal Year Age Rate Death Benefit Value Rate Death Benefit Value % $10, $10, % $10, $10, % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 10, , % 11, , % 11, , % 11, % 11, % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 11, , % 12, , % 12, , % 17, , % 17, , End of 10 Years End of 20 Years At age 95 Guaranteed Yield: 0.50% 0.75% 0.91% Illustrative Yield: 0.50% 0.75% 0.91% CS1228MD-2-A 5 of 6 9/ A

6 Registered Representative/Producer Registered Representative/Producer: Please provide your full name, business address, and date below prior to providing this Statement of Benefit Information to the applicant. Registered Representative/Producer s Full Name Date Registered Representative/Producer s Business Address City, State, ZIP CS1228MD-2-A 6 of 6 9/ A