RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company ] B644R0.FRM Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS...
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031-99 TABLE OF CONTENTS SPECIFICATONS DEFINITIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL PROVISIONS Form A3031-99
RIGHT TO EXAMINE CONTRACT. [The Contract Owner has the right to return this Contract. This Contract may be returned to the Company for any reason within ten (10) calendar days after its receipt by the Contract Owner. It may be returned by delivering or mailing it to the Company at its Annuity Service Center. When this Contract is received by the Company it will be voided as if it had never been in force. Upon its return, the Company will refund, within seven days, the Contract Value next computed after receipt of this Contract by the Company at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] ANNUITY PAYMENTS, WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the sum of (1) gross payments, less any amounts allocated to the Variable Account, (2) the Accumulated Value of amounts allocated to the Variable Account on the date the returned contract is received at the Principal Office and (3) any fees or other charges imposed on the amounts allocated to the Variable Account. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the initial payment shown on the Specifications page. Additional payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefits beginning on the Annuity Date or to pay a death benefit to the Beneficiary if an Owner dies prior to the Annuity Date. FLEXIBLE PAYMENT DEFERRED VARIABLE AND FIXED ANNUITY NON-PARTICIPATING 1 TABLE OF CONTENTS SPECIFICATIONS........................................................... 3 DEFINITIONS.............................................................. 5
RIGHT TO EXAMINE CONTRACT. You may return this contract within 90 days after you have received it. It can be mailed or delivered either to us or the representative who sold it. If you return the contract within 10 days after you have received it ("the Free Look Period"), we will refund the Single Purchase Payment less the total amount of all annuity payments made or withdrawals taken. If you return the contract after the expiration of the "Free Look Period" but within 90 days after the Issue Date, we will pay to you the Contract Value on the date the contract is returned to us plus any premium tax deducted on the Issue Date. If the refund is not paid within thirty days from the date the contract is received by the Company or its authorized representative, the amount will be increased by ten percent (10%). ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 Phone Number: 0-000-000-0000 This is a legal contract between you and the Company and is issued in consideration of the Single Purchase Payment shown on the Specifications page. The Net Payment may be allocated to the Fixed Income Option or the Variable Income Option or a combination of both. If you select the Variable Income Option, you can allocate the Net Payment among the Variable Sub-Accounts. Single Payment Immediate Variable and Fixed Annuity Annuity Payments Payable on the Annuity Income Date Death Benefit Payable if an Owner or an Annuitant Dies prior to Annuity Income Date This contract does not participate in the profits or surplus of the Company FORM A3029.WA-99 TABLE OF CONTENTS SPECIFICATIONS............................................................... 3
RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Employer 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 8 Accounts 8 General Account 8 Separate Account 8 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 9 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 10 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continu...
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this Contract for any reason without penalty within 10 days after the date the Owner received it (30 days if this is a replacement Contract). Simply return it to Our Administrative Office or to the financial professional through whom it was purchased. Canceling this Contract will void it from the beginning and upon cancellation, We will refund the Contract Value as of the Valuation Date on which We receive the cancellation Request plus any fees or charges We deducted.
RIGHT TO EXAMINE CONTRACT. Within 10 days of the date of receipt of this Contract by the Owner, it may be returned by delivering or mailing it to the Company at its Administrative Office. When the Contract is received by the Company, it will be voided as if it had never been in force. The Company will refund the Contract Value computed at the end of the Valuation Period during which the Contract is received by the Company at its Administrative Office. THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SIGNED FOR THE COMPANY AT CARMEL, INDIANA, ON THE CONTRACT DATE. ABCDEFGH ABCDEFGH SECRETARY PRESIDENT INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT NON-PARTICIPATING WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE VALUES MAY INCREASE OR DECREASE BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED IN THIS CONTRACT. TABLE OF CONTENTS CONTRACT SCHEDULE.............................................................4 DEFINITIONS...................................................................7
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this Contract for any reason without penalty within 10 days after the date the Owner received it (30 days if this is a replacement Contract). Simply return it to Our Administrative Office or to the financial professional through whom it was purchased. Canceling this Contract will void it from the beginning and upon cancellation, We will refund the Contract Value as of the Valuation Date on which We receive the cancellation Request. Signed for The Lincoln National Life Insurance Company at Our Home Office.
RIGHT TO EXAMINE CONTRACT. You have the right to return this Contract. You may return this Contract to us for any reason within ten (10) calendar days, or thirty (30) calendar days if you are replacing another annuity contract or life insurance policy with this Contract, after you receive it. You may return it by delivering or mailing it to us with your Written Request at our Service Center or to the agent who sold it. When we receive your Written Request, we will void the Contract as if it had never been in force. Upon receipt of your Written Request, we will refund, within seven (7) calendar days, the Contract Value, plus any fees or charges previously deducted from your Purchase Payments, all determined at the Close of Business on the Business Day we receive your Written Request at our Service Center. This may be more or less than the Purchase Payment(s). INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS ● THIS CONTRACT IS NON-PARTICIPATING. IT DOES NOT PROVIDE FOR THE PAYMENT OF DIVIDENDS. ● THIS CONTRACT PROVIDES WAIVER OF CONTINGENT DEFERRED SALES CHARGE BENEFITS, IF APPLICABLE. ● CONTRACT VALUES, WITHDRAWAL VALUES AND THE DEATH BENEFIT PROVIDED BY THIS CONTRACT WITH RESPECT TO AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT ARE BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
