Exhibit 4
THE TRAVELERS LIFE AND ANNUITY COMPANY - ONE TOWER SQUARE - HARTFORD,
CONNECTICUT - 06183
A STOCK COMPANY
We are pleased to provide You the benefits of this Variable Annuity Contract.
Please read Your Contract and all attached forms carefully.
RIGHT TO EXAMINE THIS CONTRACT
IF THIS CONTRACT IS ISSUED AS AN INDIVIDUAL RETIREMENT ANNUITY (IRA),
AND THE CONTRACT IS RETURNED TO US AT OUR OFFICE OR TO OUR AGENT WITHIN
7 DAYS OF ITS DELIVERY TO YOU, WE WILL PAY YOU THE FULL AMOUNT OF ANY
PURCHASE PAYMENTS MADE, WITHOUT ADJUSTMENT FOR ANY PREMIUM TAX OR
CONTRACT CHARGES PAID. IF THIS CONTRACT IS RETURNED WITHIN 8-20 DAYS OF
ITS DELIVERY TO YOU, WE WILL PAY YOU THE CONTRACT VALUE AS STATED BELOW.
AFTER THE CONTRACT IS RETURNED, IT WILL BE CONSIDERED AS NEVER IN
EFFECT.
IF THIS CONTRACT IS ISSUED AS A NONQUALIFIED CONTRACT OR A QUALIFIED
CONTRACT (OTHER THAN AN IRA) AND RETURNED TO US AT OUR OFFICE OR TO OUR
AGENT TO BE CANCELED WITHIN 20 DAYS AFTER ITS DELIVERY TO YOU, WE WILL
PAY YOU THE CONTRACT VALUE DETERMINED AS OF THE NEXT VALUATION DATE
AFTER WE RECEIVE THE WRITTEN REQUEST AT OUR OFFICE, PLUS ANY PREMIUM TAX
AND CONTRACT CHARGES PAID. AFTER THE CONTRACT IS RETURNED, IT WILL BE
CONSIDERED AS NEVER IN EFFECT.
This Contract is issued in consideration of the Purchase Payments. It is
subject to the terms and conditions stated on the attached pages, all of
which are parts of it.
Executed at Hartford, Connecticut
/s/ Xxxxxx X Xxxxxxx /s/ Xxxxxx X. Xxxxxx
President Secretary
This is a legal Contract between You and Us. READ YOUR CONTRACT CAREFULLY.
FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT LIFE ANNUITY
COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE AND ARE
NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
TABLE OF CONTENTS
Right to Examine this Contract Cover Page
Contract Specifications Page 3-6
Definitions Page 7-8
Ownership, Beneficiary and Annuitant Provisions Page 9-10
Purchase Payment and Valuation Provisions Page 11-13
Death Benefit Provisions Page 14-15
Settlement Provisions Page 16-17
General Provisions Page 18-19
Table of Values Page 20
Annuity Tables Page 21-26
Any Amendments, Riders or Endorsements follow the Annuity Tables.
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CONTRACT SPECIFICATIONS
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CONTRACT NUMBER [SPECIMEN] [ ] MARKET TYPE
OWNER [XXXX XXX]
[JOINT OWNER] [ ]
ANNUITANT [XXXX XXX]
[CONTINGENT ANNUITANT]
CONTRACT DATE [FEBRUARY 1, 2002]
MATURITY DATE [DECEMBER 31, 2018]
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PURCHASE PAYMENTS:
MINIMUM INITIAL PURCHASE PAYMENT: [$5,000]
MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$100]
MAXIMUM PURCHASE PAYMENT: $1,000,000 unless We consent to a larger amount
TRANSFERS: You may transfer up to[15%] of the Fixed Account value to any of the
variable Funding Options twice a year during the 30 days following the
semi-annual Contract Date anniversary.
TRANSFER CHARGE: We reserve the right to assess a transfer charge of up to
$10.00 on transfers exceeding 12 per year. We will notify You In Writing at Your
last known address at least 31 days prior to the imposition of any such Transfer
Charge.
CONTRACT CHARGE: $30.00 annually. This charge will be assessed annually on
the[fourth Friday of August]. The Contract Charge will be prorated upon full
surrender or Termination of the Contract. No Contract Charge will be deducted
from the Fixed Account.
This charge will not be assessed under the following situations:
(a) if Your Contract Value is [$50,000] or greater on the date the
charge is assessed;
(b) distribution of proceeds due to death; or
(c) after an Annuity payout has begun.
WITHDRAWAL CHARGES DEDUCTED: The Withdrawal Charge is calculated as a percentage
of the Purchase Payments withdrawn on a first-in, first-out basis. For the
purpose of determining the withdrawal charge, the order of withdrawal will be
deemed to be taken from (a) any Purchase Payments that are not subject to the
withdrawal charge; (b) next from any remaining free withdrawal allowance (as
described below) after the reduction by the amount of (a); (c) next from
Purchase Payments still subject to a withdrawal charge (on a first-in, first-out
basis); and then from (d) from Contract earnings. Any free withdrawals taken
will not reduce Purchase Payments still subject to the withdrawal charge.
YEARS SINCE PURCHASE PAYMENT WAS MADE WITHDRAWAL CHARGE
0-1 8%
2 8%
3 7%
4 7%
5 6%
6 5%
7 4%
8 3%
9+ 0%
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CONTRACT SPECIFICATIONS
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DEDUCTIONS NOT SUBJECT TO A WITHDRAWAL CHARGE:
We will not deduct a withdrawal charge for Purchase Payments attributable to
values under this Contract due to:
(a) death of the Contract Owner or the Annuitant with no
Contingent Annuitant surviving;
(b) life annuitization, after the first Contract year; or
(c) minimum distributions (as defined by the Internal Revenue
Code) taken under Our managed distribution program then in
effect if elected by the Owner by a Written Request.
FREE WITHDRAWAL ALLOWANCE: After the first Contract Year, You may withdraw up to
15% of Your Contract value annually as of the first Valuation Date of any given
Contract Year without imposition of the withdrawal charge. (If You have Purchase
Payments no longer subject to the withdrawal charge, the maximum You may
withdraw without the withdrawal charge is the greater of (a) the free withdrawal
allowance or (b) the total amount of Purchase Payments no longer subject to a
withdrawal charge. Note: Any free withdrawal taken will reduce Purchase Payments
no longer subject to a withdrawal charge.) The available amount will be
calculated as of the end of the previous Contract Year. The free withdrawal
allowance applies to any partial withdrawals and to full withdrawals, except
those transferred directly to annuity contracts issued by unaffiliated carriers
and financial institutions. The free withdrawal amount is not cumulative from
year to year. [Provided a minimum initial Purchase Payment of $50,000 has been
received, We will allow the 15% free withdrawal allowance during the first
Contract Year if taken under Our systematic withdrawal program.]
SETTLEMENT OPTION ELECTION: You cannot elect a settlement option during the
first Contract Year.
TERMINATION: We reserve the right to terminate this Contract when the Contract
Value is less than $2,000 and no Purchase Payments have been made for at least
two years.
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CONTRACT SPECIFICATIONS
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[THE TRAVELERS SEPARATE ACCOUNT XX XX FOR VARIABLE ANNUITIES]
FUNDING OPTIONS -
[Travelers Series Fund Inc.
Xxxxx Xxxxxx Aggressive Growth Portfolio
Xxxxx Xxxxxx High Income Portfolio
Xxxxx Xxxxxx International All Cap Growth Portfolio
Xxxxx Xxxxxx Large Cap Value Portfolio
Xxxxx Xxxxxx Large Capitalization Growth Portfolio
Xxxxx Xxxxxx Mid Cap Core Portfolio
Xxxxx Xxxxxx Money Market Portfolio
MFS Total Return Portfolio
Travelers Managed Income Portfolio
The Travelers Series Trust
Convertible Bond Portfolio
MFS Mid Cap Growth Portfolio
MFS Research Portfolio
Social Awareness Stock Portfolio
Greenwich Street Series Fund
Appreciation Portfolio
Fundamental Value Portfolio
Xxxxx Xxxxxx Allocation Series Inc.
Select Balanced Portfolio
Select Growth Portfolio
Select High Growth Portfolio
Xxxxx Xxxxxx Investment Series
Select Government Portfolio
Xxxxx Xxxxxx Growth and Income Portfolio
Xxxxx Xxxxxx Large Cap Core Portfolio
Xxxxx Xxxxxx Premier Selections All Cap Growth Portfolio
Xxx Xxxxxx Life Investment Trust
Xxxxxxxx Portfolio Class II Shares
Emerging Growth Portfolio Class II Shares
Growth and Income Portfolio Class II Shares
Variable Annuity Portfolios
[Xxxxx Xxxxxx Small Cap Growth Opportunities Portfolio]
Alliance Variable Product Series Fund, Inc.]
Premier Growth Portfolio - Class B
Technology Portfolio - Class B
AIM Variable Insurance Funds, Inc.
AIM V.I. Capital Appreciation Fund - Series II Shares
AIM V.I. Value Fund - Series II Shares
Variable Insurance Products Fund (Fidelity)
Growth Portfolio - Service Class 2
Equity Income Portfolio - Service Class 2
Variable Insurance Products Fund III (Fidelity)
Mid Cap Portfolio - Service Class 2
Pioneer Variable Contracts Trust
Pioneer Mid-Cap Value VCT Portfolio - Class II Shares
Pioneer Fund VCT Portfolio - Class II Shares
Xxxxxxxxxxx Variable Account Funds
Xxxxxxxxxxx Capital Appreciation Fund/VA - Service Shares
Xxxxxxxxxxx Main Street Growth & Income Fund/VA - Service Shares
Xxxxxx Variable Trust
Xxxxxx VT International Growth Fund - Class 1B Shares
Xxxxxx VT Small Cap Value Fund - Class IB Shares
Franklin/Xxxxxxxxx Variable Insurance Product Trust
Xxxxxxxxx Growth Securities Fund - Class 2
Franklin Mutual Shares Securities Fund - Class 2]
INFORMATION ABOUT THE SEPARATE ACCOUNT IS PROVIDED IN THE PROSPECTUS FOR [THE
TRAVELERS SEPARATE ACCOUNT XX XX FOR VARIABLE ANNUITIES].
FUNDING OPTIONS DAILY DEDUCTIONS:
The Administrative Charge and the Mortality and Expense Risk Charge result in a
daily deduction of [.0000452] per Funding Option. When expressed on an annual
basis, assuming a 365-day year, the deduction equals [1.65%] per Funding Option.
ADMINISTRATIVE CHARGE: [.15%] ON AN ANNUAL BASIS
MORTALITY AND EXPENSE RISK CHARGE: [1.50%] ON AN ANNUAL BASIS
ASSUMED DAILY NET INVESTMENT FACTOR: Upon annuitization, the Assumed Daily Net
Investment Factor is 1.000081 for each Funding Option. When expressed on an
annual basis this equals 3%, assuming a 365 day year.
FIXED ACCOUNT GUARANTEED INTEREST PERIODS: The initial rate for any Purchase
Payment made to a Fixed Account is guaranteed for one year from date of payment.
Subsequent renewal rates will be guaranteed for a calendar quarter. These
guarantees do not apply to the dollar cost averaging program, if applicable, or
any other administrative program.
This Page Left Blank Intentionally
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DEFINITIONS
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ACCUMULATION UNIT - an accounting unit of measure used to calculate the value of
this Contract before Annuity payments begin.
AGE - age last birthday.
ANNUITANT - the person on whose life the Maturity Date and Annuity payments
depend.
ANNUITY UNIT(S) - an accounting unit of measure used to calculate the value of
Annuity payments.
CODE - the Internal Revenue Code of 1986, as amended, and all related laws and
regulations which are in effect during the term of this Contract.
CONTRACT - a Contract that describes the benefits, rights and obligations of the
Owner and Us.
CONTRACT DATE - the date on which the Contract is issued.
CONTRACT YEARS - twelve-month periods beginning with the Contract Date.
DEATH REPORT DATE - the Valuation Date coincident with or next following the day
on which We have received 1) Due Proof of Death and 2) a Written Request for an
election of a single sum payment or an alternate Settlement Option as described
in the Contract.
DUE PROOF OF DEATH - 1) a copy of a certified death certificate; 2) a copy of a
certified decree of a court of competent jurisdiction as to the finding of
death; 3) a written statement by a medical doctor who attended the deceased; or
4) any other proof satisfactory to Us.
FIXED ACCOUNT(S) - an account that consists of the assets under this Contract
other than those in the Separate Account.
FUNDING OPTION(S) - that portion of the assets of a division of the Separate
Account which is allocated to a particular Underlying Fund; also known as a
Sub-Account.
MATURITY DATE - the date on which the Annuity payments are to begin.
NONQUALIFIED CONTRACT - a Contract other than a Qualified Contract, funded by
after-tax contributions.
OUR OFFICE - the Home Office of The Travelers Life and Annuity Company or any
other office which We may designate for the purpose of administering this
Contract.
PREMIUM TAX - the amount of tax, if any, charged by a state or municipality. We
will deduct any applicable Premium Tax from the Contract Value either upon
surrender, annuitization, death, or at the time a Purchase Payment is made, but
no earlier than when We have the liability under state law.
PURCHASE PAYMENT(S) - payments of premium You make to Us under this Contract.
QUALIFIED CONTRACT - a Contract used in a retirement plan or program whereby the
Purchase Payments and any gains are intended to qualify under sections 401, 403,
408, 414(d) or 457 of the Code.
RECORDED - a Written Request is Recorded when the information is noted in Our
file for this Contract.
SETTLEMENT OPTION(S) - an annuity option elected under this Contract.
SEPARATE ACCOUNT(S) - the Separate Account(s) indicated in the Contract
Specifications which We established for this class of Contracts and certain
other Contracts.
TERMINATION - discontinuance of this Contract by Us or by Your Written Request.
UNDERLYING FUND(S) - an open-end diversified management investment company
indicated in the Contract Specifications, which serves as a variable investment
option under the Separate Account.
VALUATION DATE(S) -a date on which a Funding Option is valued, generally at the
close of business on each day the New York Stock Exchange is open for trading
(except for when trading is restricted due to an emergency as defined by the
Securities and Exchange Commission).
VALUATION PERIOD(S) - the period between successive Valuation Dates.
WE, US, OUR - The Travelers Life and Annuity Company
WRITTEN REQUEST - written information including requests for Contract changes
sent to Us in a form and content satisfactory to Us and received at Our Office.
YOU, YOUR - the owner, including any joint owner.
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OWNERSHIP, BENEFICIARY AND ANNUITANT PROVISIONS
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OWNERSHIP
This Contract belongs to the owner shown in the Contract Specifications or to
any person subsequently named in a Written Request of transfer of ownership as
provided below. As owner, You have sole power during the Annuitant's lifetime to
exercise any rights and to receive all benefits given in this Contract provided
You have not named an irrevocable beneficiary and provided the Contract is not
assigned.
You will be the recipient of all payments while the Annuitant is alive unless
You direct them to an alternate recipient under a Recorded payment direction. An
alternate recipient under a payment direction does not become the owner. A
payment direction is revocable by You at any time by Written Request giving 30
days advance notice.
JOINT OWNERS
Joint owners may be named in a Written Request prior to the Contract Date. Joint
owners may independently exercise transfers between Funding Options. All other
rights of ownership must be exercised by joint action. Joint owners own equal
shares of any benefits accruing or payments made to them. All rights of a joint
owner end at death if another joint owner survives. The entire interest of the
deceased joint owner in this Contract will pass to the surviving joint owner,
unless the deceased joint owner was also the Annuitant.
If a joint owner dies before payment of an annuity option begins and is survived
by the Annuitant, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the beneficiary named in a Written Request. Upon the death of a joint owner
who is the Annuitant, the entire interest will pass to the beneficiary(ies).
TRANSFER OF OWNERSHIP
You may transfer ownership by Written Request. You may not revoke any transfer
after the effective date. Once the transfer of ownership is Recorded by Us, it
will take effect subject to any payments made or other actions taken by Us
before the Written Request is recorded.
Unless a new beneficiary is designated, a transfer of ownership does not affect
the interest of any beneficiary designated prior to the effective date of the
transfer.
A transfer of ownership may have adverse tax consequences to You as the former
owner; please consult Your tax advisor.
NON QUALIFIED ASSIGNMENT
To the extent permitted by law, You may collaterally assign ownership, of all or
a portion of this Contract by Written Request without the approval of any
beneficiary unless irrevocably named. You may not exercise any rights of
ownership while the assignment remains in effect without the approval of the
collateral assignee. We are not responsible for the validity of any assignment.
Once the collateral assignment is Recorded by Us, it will take effect subject to
any payments made or other actions taken by Us before the Written Request is
Recorded.
If a claim is made based on an assignment, We may require proof of interest of
the claimant. A Recorded assignment takes precedence over any rights of a
beneficiary. Any amounts due under a Recorded assignment will be paid in a
single sum.
An assignment may have adverse tax consequences to You; please consult Your tax
advisor.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner or beneficiary
under this Contract shall be subject to the claims of creditors or any legal
process except as may be provided by an assignment.
BENEFICIARY
The beneficiary is the party named in a Written Request. The beneficiary has the
right to receive any remaining contractual benefits upon the death of the
Annuitant, or under certain circumstances, upon the death of the owner. If there
is more than one beneficiary surviving the Annuitant, the beneficiaries will
share equally in benefits unless different shares are Recorded with Us by
Written Request prior to the death of the Annuitant.
If a joint owner dies and is survived by the Annuitant before payment of an
annuity option begins, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the beneficiary named in a Written Request.
Unless an irrevocable beneficiary is Recorded by Us, You have the right to
change any beneficiary by Written Request during the lifetime of the Annuitant
and while the Contract is in effect.
Once a change in beneficiary is Recorded by Us, it will take effect subject to
any payments made or other actions taken by Us before the Written Request is
Recorded.
When an Annuitant dies, if no beneficiary has been named by You, or if no
Beneficiary is living, We will pay the death benefit to You or Your estate.
ANNUITANT
The Annuitant is the individual shown on the Contract Specifications on whose
life Annuity payments are made. The Annuitant may not be changed after the
Contract Date.
NON QUALIFIED CONTINGENT ANNUITANT
You may name one individual as a contingent Annuitant by Written Request prior
to the Contract Date, provided the owner is not a trust. A contingent Annuitant
may not be changed, deleted or added to the Contract after the Contract Date.
For purposes of this provision the owner cannot be the Annuitant.
If the Annuitant dies prior to the Maturity Date while this Contract is in
effect and while the contingent Annuitant is living:
(a) the death benefit will not be payable upon the Annuitant's
death; and
(b) the contingent Annuitant becomes the Annuitant; and
(c) all other rights and benefits provided by this Contract will
continue in effect.
When a contingent Annuitant becomes the Annuitant, the Maturity Date remains the
same as previously in effect, unless otherwise provided.
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PURCHASE PAYMENT AND VALUATION PROVISIONS
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PURCHASE PAYMENT
PURCHASE PAYMENT
A Purchase Payment is any payment You make for this Contract and the benefits it
provides. An initial lump sum Purchase Payment must be made to the Contract and
is due and payable before the Contract becomes effective. Each Purchase Payment
is payable as shown on the Contract Specifications to Us at Our Office or to one
of Our authorized representatives. No additional Purchase Payments after the
initial Purchase is required to continue this Contract in force, except as
provided in the "Termination" provision.
Net Purchase Payments are that part of Your Purchase Payments applied to the
Contract Value. A net Purchase Payment is equal to the Purchase Payment less any
applicable Premium Tax charge.
ALLOCATION OF PURCHASE PAYMENT
We will apply any net Purchase Payment to provide Accumulation Units of selected
Funding Options and/or the Fixed Account of this Contract. The initial net
Purchase Payment will be applied within two business days following its receipt
at Our Office, if the information received is satisfactory to Us. Subsequent net
Purchase Payments will be applied on the same business day if received in good
order at Our Office on or before 4:00 p.m., Eastern Standard Time. The net
Purchase Payment will be allocated to the Funding Options and/or the Fixed
Account in the proportion specified by You for this Contract. The available
Underlying Funds to which Funding Option assets are allocated are shown in the
Contract Specifications Underlying Funds/and or Funding Options may be
subsequently added or deleted.
FUNDING OPTION VALUATION
NUMBER OF ACCUMULATION UNITS
The number of Accumulation Units to be credited to each Funding Option once a
Purchase Payment has been received by Us will be determined by dividing the net
Purchase Payment applied to that Funding Option by the then Accumulation Unit
Value of that Funding Option.
ACCUMULATION UNIT VALUE
We determine the value of an Accumulation Unit in each Funding Option on each
Valuation Date by multiplying the value on the preceding Valuation Date by the
net investment factor for that Funding Option for the Valuation Period just
ended.
The value of an Accumulation Unit on any date other than a Valuation Date will
be equal to its value as of the next Valuation Date.
NET INVESTMENT FACTOR
The net investment factor is a factor applied to measure the investment
performance of a Funding Option from one Valuation Date to the next. The net
investment factor for a Funding Option for any Valuation Period is equal to the
sum of 1.0000 plus the net investment rate.
Each Funding Option's net investment rate for a Valuation Period is equal to the
gross investment rate for that Funding Option, less the applicable Funding
Option deduction for the Valuation Period.
All Funding Option deductions related to this Contract are shown in the Contract
Specifications.
The gross investment rate of a Funding Option for a Valuation Period is equal to
(1) divided by (2), where:
(1) is equal to
a) investment income, plus
b) capital gains and losses, whether realized or unrealized, less
c) a deduction for any tax levied against the Separate Account
and/or the Underlying Funds; and
(2) is the amount of the assets at the beginning of the Valuation Period.
The gross investment rate for a Funding Option is based on the net asset value
of the Underlying Fund and may be either positive or negative. Investment income
includes any distribution whose ex-dividend date occurs during the Valuation
Period.
FIXED ACCOUNT VALUATION
NUMBER OF ACCUMULATION UNITS - We will determine the number of Accumulation
Units to be credited to the Fixed Account upon receipt of a Purchase Payment by
dividing the net Purchase Payment applied to the Fixed Account by the then
dollar value of one Accumulation Unit Value of the Fixed Account.
ACCUMULATION UNIT VALUE - We determine the value of an Accumulation Unit in the
Fixed Account on any day by multiplying the value on the immediately preceding
day by the net interest factor for the day on which the value is being
determined.
NET INTEREST FACTOR - The net interest factor for any day is the guaranteed net
interest rate which is equivalent to an effective annual interest rate of
[3.00%], plus 1.0000. The method of crediting additional interest will be at Our
discretion.
Interest is declared in advance. Before Annuity payments begin, We may credit
the Fixed Account with annual interest rates higher than the minimum guaranteed
interest rate of [3.00%]. Interest rates may be higher or lower than the initial
interest rates, but not less than the minimum guaranteed interest rate of
[3.00%]. Additional amounts may be credited by Us at Our discretion for the
guaranteed interest periods shown in the Contract Specifications.
TRANSFER BETWEEN FUNDING OPTIONS
You may transfer all or any part of the Contract Value from one Funding Option
to any other Funding Option at any time up to 30 days before the Maturity Date.
Additionally, You may transfer a part of the Fixed Account value to any of the
Funding Options twice a year during the 30 days following the semi-annual
Contract Date Anniversary in the amount shown on the Contract Specifications.
Amounts may generally be transferred from the Funding Options to the Fixed
Account at any time up to 30 days before the Maturity Date. Xxxxxxx previously
transferred from the Fixed Account to the Funding Options may not be transferred
back to the Fixed Account for a period of at least 6 months from the date of
transfer. We reserve the right to limit the number of transfers from one Funding
Option to any other Funding Option or to the Fixed Account. We will not limit
these transfers to less than one in any six-month period.
Transfers between Funding Options will result in the addition or deletion of
Accumulation Units having a total value equal to the dollar amount being
transferred to or from a particular Funding Option. The number of Accumulation
Units will be determined by using the Accumulation Unit Value of the Funding
Options involved as of the next valuation after We receive notification of
request for transfer. Transfers will be subject to any applicable Transfer
charge stated on the Contract Specifications.
We reserve the right to restrict transfers between Funding options by any market
timing firm or any other third party authorized to initiate transfers on behalf
of multiple Contract owners. We may not accept, among other things; 1) transfer
instructions of any agent acting under a power of attorney on behalf of more
than one owner, or 2) transfer or exchange instructions of individual owners who
have executed pre-authorized transfer forms which are submitted by market timing
firms or other third parties on behalf of more than one owner. We further
reserve the right to limit transfers by Contract owners, any market timing firm
or any other third party authorized to initiate transfers on behalf of multiple
Contract owners, that We determine, in Our sole discretion, will disadvantage
other Contract owners.
CONTRACT VALUES
CONTRACT VALUE
The Contract Value on any date equals the sum of the accumulated values in the
Funding Options. The accumulated value in a Funding Option equals the number of
outstanding Accumulation Units credited to that Funding Option, multiplied by
the then current Accumulation Unit Value for that Funding Option.
The Guaranteed Value of the Fixed Account equals the accumulated value of the
Fixed Account calculated by using the guaranteed net interest factor. The
Guaranteed Values of the Fixed Account are shown in the Table of Values.
CONTRACT CHARGE
A Contract Charge in the amount and for the period shown on the Contract
Specifications will be deducted from the Contract value to reimburse Us for
administrative expenses relating to the Contract. The Contract Charge will be
deducted by surrendering, on a pro rata basis, Accumulation Units from all
Funding Options in which You have an interest. No Contract Charge will be
deducted from the Fixed Account.
We will deduct the charge on a pro rata basis if the Contract has been in effect
for less than a full period on the date a Contract Charge is deducted. The
Contract Charge will also be prorated upon full surrender or Termination of the
Contract.
CASH SURRENDER VALUE
The cash surrender value is equal to the Contract value less any applicable
withdrawal charges and fees as shown on the Contract Specifications, less any
taxes deducted upon surrender, and any outstanding loan balance.
The guaranteed cash surrender value of the Fixed Account equals the guaranteed
value of the Fixed Account less any applicable charges and fees as shown on the
Contract Specifications, less any taxes deducted upon surrender and less any
outstanding loan balance. For guaranteed cash surrender values of the Fixed
Account, refer to the Table of Values.
CASH SURRENDER
You may elect by Written Request to receive the cash surrender value before the
Maturity Date and without the consent of any beneficiary unless irrevocably
named. You may elect either a full or partial surrender of the cash surrender
value. In the case of a full surrender, this Contract will be canceled. A
partial surrender will result in the reduction of Your Contract value and death
benefit proceeds. If You have a balance in more than one Funding Option, Your
Contract value will be reduced from all Your Funding Options on a pro rata
basis, unless You request otherwise.
The cash surrender value will be determined as of the next Valuation Date
following receipt of Your Written Request. We may delay payment of the cash
surrender value of the Funding Options for a period of not more than five
business days after Your Written Request is recorded. We may delay payment of
the cash surrender value of the Fixed Account for a period of not more than six
months after We receive Your Written Request.
CONTRACT CONTINUATION
Except as provided in the Termination provision, this Contract does not require
continuing Purchase Payments and will automatically continue as a paid-up
Contract during the lifetime of the Annuitant until the Maturity Date, or until
it is surrendered.
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DEATH BENEFIT PROVISIONS
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DEATH OF ANNUITANT
A death benefit is payable to the beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a contingent Annuitant. A death
benefit is also payable under those Settlement Options which provide for death
benefits. We will pay the beneficiary the death benefit, determined as of the
Death Report Date, in a single sum or apply it to a Settlement Option. A
beneficiary may request that a death benefit payable under this Contract be
applied to a Settlement Option subject to the provisions of this Contract and
the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the owner is not the Annuitant, and the owner dies (including the first of
joint owners) before the Maturity Date, We will recalculate the value of the
death benefit proceeds under the provisions of Death Benefit Proceeds Prior To
The Maturity Date below, by replacing all references to "Annuitant" with
"Owner." The value of the death benefit, as recalculated, will be paid in a
single lump sum or by other election to the party taking proceeds under the
current tax laws.
DEATH BENEFIT PROCEEDS PRIOR TO THE MATURITY DATE
If the Annuitant is less than age 75 on the Contract Date and dies before the
Maturity Date, the death benefit payable as of the Death Report Date will be the
greatest of a), b) or c) below less any applicable premium tax and outstanding
loans:
a) the Contract Value on the Death Report Date; or
b) the total Purchase Payments less the total amount of any partial
surrenders made under this contract; or
c) the Step-Up Value (if any, as described below).
Step-Up Value
The Step-Up Value will initially equal the Contract Value on
the first Contract Date anniversary. On each subsequent
Contract Date anniversary that occurs before the Annuitant's
76th birthday and before the Annuitant's death, if the
Contract Value is greater than the Step-Up Value, the Step-Up
Value will be increased to equal the Contract Value on that
date. If the Step-Up Value is greater than the Contract Value,
the Step-Up Value will remain unchanged. Whenever a Purchase
Payment is made, the Step-Up Value will be increased by the
amount of that Purchase Payment. Whenever a partial surrender
is taken, the Step-Up Value will be reduced by a Partial
Surrender Reduction as described below. The only changes made
to the Step-Up Value on or after the Annuitant's 76th birthday
will be those related to additional Purchase Payments or
partial surrenders as described above.
Partial Surrender Reduction
The Partial Surrender Reduction is equal to 1) the Step-Up
Value in effect immediately prior to the reduction for the
partial surrender, multiplied by 2) the amount of the partial
surrender divided by 3) the Contract Value immediately prior
to the partial surrender.
If the Annuitant is age 75-80 on the Contract Date and dies before the Maturity
Date, the death benefit payable as of the Death Report Date will be the greater
of a) or b), less any applicable premium tax and outstanding loans:
a) the Contract Value on the Death Report Date
b) the total Purchase Payments less the total amount of any partial
surrenders made under this contract.
PAYMENT OF DEATH BENEFIT PROCEEDS
We must be notified no later than six months from the date of death in order for
Us to make payment of death benefit proceeds as described above. If notification
is received more than six months after the date of death, the death benefit
payable will be the Contract Value on the Death Report Date, less any applicable
premium tax and outstanding loans.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
INTEREST ON DEATH BENEFIT PROCEEDS
Interest on death benefit proceeds will be paid in accordance with state law at
the time of death.
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SETTLEMENT PROVISIONS
================================================================================
MATURITY DATE
The Maturity Date is shown on the Contract Specifications. Annuity payments will
begin under this Contract on the Maturity Date unless the Contract has been
fully surrendered or the proceeds have been paid to the beneficiary prior to
that date. We may require proof that the Annuitant is alive before Annuity
payments are made. If no Maturity Date is specified, the automatic Maturity Date
will be when the Annuitant reaches age 90.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, You may change the Maturity Date by Written Request to
any time prior to the Annuitant's 90th birthday, or to a later date with Our
consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, We will pay the amount payable
under this Contract to You in one lump sum or in accordance with an Annuity
Option elected by You. While the Annuitant is alive, You may change Your
Settlement Option election by Written Request, but only before the Maturity
Date. We reserve the right to require satisfactory proof of the Age of any
person on whose life Annuity payments are based before making the first payment
under any Annuity Option.
During the Annuitant's lifetime, if no election has been made by the Maturity
Date, We will pay You the first of a series of periodic Annuity payments based
on the life of the Annuitant, in accordance with Annuity Option 2, with 120
monthly payments assured.
Once Annuity payments have commenced, no election changes are allowed.
MINIMUM AMOUNTS
The minimum amount that can be placed under a Settlement Option is $2,000 unless
We consent to a lesser amount. If any periodic payments due are less than $100,
We reserve the right to make payments at less frequent intervals, resulting in a
payment of at least $100 per year.
ALLOCATION OF ANNUITY
At the time an election of one of the annuity options is made, the person
electing the option may elect to have the cash surrender value applied to
provide a variable annuity, a fixed annuity or a combination of both.
Unless You elect otherwise, the cash surrender value of a Funding Option will be
applied to provide an annuity, which varies with the investment experience of
that same Funding Option. The value of the Fixed Account will be applied to
provide a Fixed Annuity.
You may elect to transfer Contract Value from one Investment Option to another,
as described in the provision Transfer Between Investment Options, in order to
reallocate the basis on which Annuity payments will be determined. Once Annuity
payments start, You may, with Our consent, change the allocation of Your values
in each Funding Option.
VARIABLE ANNUITY
ANNUITY UNIT VALUE
On any Valuation Date, the Annuity Unit Value for a Funding Option equals the
Funding Option Annuity Unit Value on the preceding Valuation Date, multiplied by
the net investment factor for that Funding Option for the Valuation Period just
ended, divided by the Assumed Daily Net Investment Factor. The Assumed Daily Net
Investment Factor is shown in the Contract Specifications. The Value of an
Annuity Unit on any date other than a Valuation Date will be equal to its value
as of the next Valuation Date.
NUMBER OF ANNUITY UNITS
We determine the number of Annuity Units credited to this Contract in each
Funding Option by dividing the amount of the first monthly annuity payment
attributable to that Funding Option by the Funding Option's Unit Value as of 14
days before the Maturity Date.
AMOUNT OF FIRST PAYMENT
The Life Annuity Tables are used to determine the first monthly Annuity payment.
They show the dollar amount of the first monthly Annuity payment which can be
purchased with each $1,000 applied. The amount applied to a variable annuity
will be the cash surrender value allocated to the variable annuity as of 14 days
prior to the Maturity Date. The first monthly annuity payment is allocated among
the Funding Options in the same proportion as the cash surrender value is
allocated among the Funding Options. We reserve the right to require the
satisfactory proof of age of any person on whose life Annuity Payments are based
before making the first payment under any of these options.
AMOUNT OF SECOND AND SUBSEQUENT PAYMENTS
The dollar amount of the second and subsequent payments may change from month to
month. The amount of the annuity payment for each Funding Option is found by
multiplying the number of Annuity Units for that Funding Option by the Annuity
Unit Value for that Funding Option. The total amount of each annuity payment
will be equal to the sum of the payments in each Funding Option.
FIXED ANNUITY
A fixed annuity is an annuity with payments which remain fixed as to dollar
amount throughout the payment period. The Life Annuity Tables are used to
determine the monthly annuity payment. They show the dollar amount of monthly
annuity payment which can be purchased with each $1,000 applied. The amount
applied to the fixed annuity will be equal to the cash surrender value allocated
to the fixed annuity determined as of the date fixed annuity payments start. If
it would produce a larger payment, the fixed annuity payment will be determined
using the Life Annuity Tables in effect on the Maturity Date.
ANNUITY OPTIONS
Subject to conditions stated in Elections Of Settlement Options and Minimum
Amounts, all or any part of the Cash Surrender Value of this Contract may be
paid under one or more of the Annuity Options below. We may offer additional
options.
OPTION 1. LIFE ANNUITY - NO REFUND
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based, ending with the last payment preceding death.
OPTION 2. LIFE ANNUITY WITH 120, 180 OR 240 MONTHLY PAYMENTS ASSURED
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based. If at the death of that person, payments have been
made for less than 120, 180, or 240 months, as elected, We will continue to make
payments to the designated beneficiary during the remainder of the period.
OPTION 3. JOINT AND LAST SURVIVOR LIFE ANNUITY
We will make monthly annuity payments during the Joint lifetime of two persons
on whose lives payments are based and during the lifetime of the survivor. No
more payments will be made after the death of the survivor.
OPTION 4. JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE
We will make monthly annuity payments during the Joint lifetime of
two persons on whose lives payments are based. One of the two persons will be
designated as the primary payee. The other will be designated as the secondary
payee. On the death of the secondary payee, if survived by the primary payee, We
will continue to make monthly Annuity payments to the primary payee in the same
amount that would have been payable during the Joint lifetime of the two
persons. On the death of the primary payee, if survived by the secondary payee,
We will continue to make monthly Annuity payments to the secondary payee in an
amount equal to 50% of the payments which would have been made during the
lifetime of the primary payee. No further payments will be made following the
death of the survivor.
OPTION 5. PAYMENTS FOR A FIXED PERIOD
We will make monthly payments for the period selected.
OPTION 6. OTHER ANNUITY OPTIONS
We will make any other arrangements for annuity payments as may be mutually
agreed by You and Us.
================================================================================
GENERAL PROVISIONS
================================================================================
CONTRACT
The entire Contract between You and Us consists of the Contract, and any
attached Amendments, Riders or Endorsements.
CONTRACT CHANGES
The only way this Contract may be changed is by a written amendment, rider or
endorsement signed by one of Our officers.
INCONTESTABILITY
We will not contest this Contract from the Contract Date.
MISSTATEMENT
If this Contract is issued as a Nonqualified Contract, and the Annuitant's (or,
if applicable, the Owner's) sex or date of birth was misstated, all benefits of
the Contract are what the Purchase Payment(s) paid would have purchased at the
correct sex and Age. Proof of the Annuitant's and Owner's Age may be filed at
any time at Our Office.
If this Contract is issued as a Qualified Contract and the Annuitant's date of
birth was misstated, all benefits of the Contract are what the Purchase
Payment(s) paid would have purchased at the correct Age. Proof of the
Annuitant's Age may be filed at any time at Our Office.
SUBSTITUTION OF SEPARATE ACCOUNT OR FUNDING OPTIONS
If it is not possible to continue to offer a Separate Account, Funding Option,
or Underlying Fund or in Our judgment becomes inappropriate for the purposes of
this Contract, We may substitute another Separate Account, Funding Option, or
Underlying Fund without Your consent. Substitution may be made with respect to
both existing investments and investment of future Purchase Payments. However,
no such substitution will be made without notice to You and without prior
approval of the Securities and Exchange Commission, to the extent required by
law.
TERMINATION
We reserve the right to terminate this Contract on any Valuation Date if the
Contract value is less than the Termination amount as stated in the Contract
Specifications and Purchase Payments have not been made to this Contract for at
least two years. Termination will not occur until 31 days after We have mailed
notice of Termination to You at Your last known address. If this Contract is
terminated, We will pay You the cash surrender value, if any.
REQUIRED REPORTS
We will furnish a report to the Contract owner as often as required by law, but
at least once in each Contract Year before the Maturity Date, reporting the
status of the Contract as of a date not more than four months previous to the
date of the mailing. The report will show the number of Accumulation Units
credited to the Contract in each Funding Option and the corresponding
Accumulation Unit Value as of the date of the report.
VOTING RIGHTS
If required by federal law, You may have the right to vote at the meetings of
the shareholders of the Underlying Funds. If You have voting rights, We will
send a notice to You telling You the time and place of a meeting. The notice
will also explain matters to be voted upon and how many votes You may exercise.
MORTALITY AND EXPENSES
Our actual mortality and expense experience will not affect the amount of any
annuity payments or any other values under this Contract.
NON-PARTICIPATING
This Contract does not share in Our surplus earnings, so You will receive no
dividends under it.
CHANGES IN TAXES BASED UPON PREMIUM OR VALUE
If there is a law or change in law assessing taxes against Us based upon the
premium or value of this Contract, We reserve the right to charge You
proportionately for that tax. This would include, but is not limited to, a tax
based upon Our realized net capital gains in the Funding Options and on earnings
in the Fixed Account, on which We are not currently taxed.
CONFORMITY WITH STATE AND FEDERAL LAWS
This Contract is governed by the law of the state in which it is issued. Any
paid-up Annuity, Cash Surrender Value or death benefits that are available under
this Contract will not be less than the minimum benefits required by the
statutes of the state in which this Contract is issued.
Upon receiving appropriate state approval, if necessary, We may at any time make
any changes, including retroactive changes, in this Contract to the extent that
the change is required to meet the requirements of any law or regulation issued
by a governmental agency to which We or You are subject.
EMERGENCY PROCEDURE FOR SUSPENSION OF PAYMENTS
We reserve the right to suspend or postpone the date of any payment of any
benefit or values for any Valuation Period (1) when the New York Stock Exchange
is closed; (2) when trading on the Exchange is restricted; (3) when an emergency
exists as determined by the Securities and Exchange Commission so that disposal
of the securities held in the Funding Options is not reasonably practicable or
it is not reasonably practicable to determine the value of the Funding Option's
net assets, or (4) during any other period when the Securities and Exchange
Commission, by order, so permits for the protection of security holders. Any
provision of this Contract which specifies a Valuation Date will be superseded
by this Emergency Procedure.
RELATION OF THIS CONTRACT TO THE SEPARATE ACCOUNT AND FUNDING OPTIONS
We will have exclusive and absolute ownership and control of the assets of Our
Separate Account and the Funding Options. That portion of the assets of a
Separate Account or Funding Option equal to the reserves and other Contract
liabilities with respect to such Separate Account or Funding Option shall not be
chargeable with liabilities arising out of any other business We conduct. Our
determination of the value of an Accumulation Unit and an Annuity Unit by the
method described in this Contract will be conclusive.
REDUCTION OR ELIMINATION OF CONTRACT CHARGES
All charges and fees under the Contract may be reduced or eliminated when
certain sales or administration of the Contract result in savings or reduction
of expenses and/or risks.
TRANSFERS TO OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer funds held by You to
another Contract issued by Us without incurring charges deducted upon surrender
as shown on the Contract Specifications. Once the transfer is complete and We
have established a new Contract at Your direction, new withdrawal charges or
surrender charges may apply to the new Contract in accordance with the
provisions of such Contract.
TABLE OF VALUES
GUARANTEED VALUES OF THE FIXED ACCOUNT PER $1,000 OF NET PURCHASE PAYMENT
APPLIED
ASSUMING NO PRIOR PARTIAL SURRENDERS
NO. OF GUARANTEED NO. OF YEARS GUARANTEED
YEARS FROM CASH FROM DATE CASH
DATE PAYMENT GUARANTEED SURRENDER PAYMENT IS GUARANTEED SURRENDER
IS APPLIED VALUE VALUE APPLIED VALUE VALUE
1 1030 950 36 2898 2898
2 1060 980 37 2985 2985
3 1092 1022 38 3074 3074
4 1125 1055 39 3167 3167
5 1159 1099 40 3262 3262
6 1194 1144 41 3359 3359
7 1229 1189 42 3460 3460
8 1266 1236 43 3564 3564
9 1304 1304 44 3671 3671
10 1343 1343 45 3781 3781
11 1384 1384 46 3895 3895
12 1425 1425 47 4011 4011
13 1468 1468 48 4132 4132
14 1512 1512 49 4256 4256
15 1557 1557 50 4383 4383
16 1604 1604 51 4515 4515
17 1652 1652 52 4650 4650
18 1702 1702 53 4790 4790
19 1753 1753 54 4934 4934
20 1806 1806 55 5082 5082
21 1860 1860 56 5234 5234
22 1916 1916 57 5391 5391
23 1973 1973 58 5553 5553
24 2032 2032 59 5720 5720
25 2093 2093 60 5891 5891
26 2156 2156 61 6068 6068
27 2221 2221 62 6250 6250
28 2287 2287 63 6437 6437
29 2356 2356 64 6631 6631
30 2427 2427 65 6829 6829
31 2500 2500 66 7034 7034
32 2575 2575 67 7245 7245
33 2652 2652 68 7463 7463
34 2731 2731 69 7687 7687
35 2813 2813 70 7917 7917
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
MALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.59 3.57 3.56 3.53
46 3.64 3.62 3.60 3.57
47 3.69 3.67 3.65 3.62
48 3.75 3.73 3.70 3.67
49 3.81 3.78 3.76 3.71
50 3.87 3.84 3.81 3.77
51 3.93 3.90 3.87 3.82
52 4.00 3.97 3.93 3.87
53 4.07 4.04 3.99 3.93
54 4.15 4.11 4.06 3.99
55 4.23 4.19 4.13 4.05
56 4.32 4.27 4.20 4.11
57 4.41 4.35 4.28 4.17
58 4.50 4.44 4.36 4.24
59 4.61 4.53 4.44 4.31
60 4.72 4.63 4.53 4.37
61 4.83 4.74 4.62 4.44
62 4.96 4.85 4.71 4.51
63 5.09 4.97 4.81 4.58
64 5.24 5.09 4.90 4.65
65 5.39 5.22 5.01 4.72
66 5.56 5.36 5.11 4.79
67 5.73 5.50 5.21 4.86
68 5.92 5.64 5.32 4.93
69 6.12 5.80 5.43 4.99
70 6.34 5.96 5.53 5.05
71 6.56 6.12 5.64 5.11
72 6.81 6.29 5.75 5.16
73 7.07 6.46 5.85 5.21
74 7.35 6.64 5.95 5.26
75 7.64 6.82 6.05 5.30
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES
A YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE WITH MORTALITY
IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS TABLE ASSUMES A NET
INVESTMENT RATE OF 3% PER ANNUM, ASSUMING A 365-DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
FEMALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.39 3.39 3.38 3.37
46 3.43 3.43 3.42 3.40
47 3.48 3.47 3.46 3.44
48 3.52 3.52 3.50 3.48
49 3.57 3.56 3.55 3.53
50 3.62 3.61 3.60 3.57
51 3.68 3.66 3.65 3.62
52 3.74 3.72 3.70 3.67
53 3.80 3.78 3.76 3.72
54 3.86 3.84 3.81 3.78
55 3.93 3.90 3.88 3.83
56 4.00 3.97 3.94 3.89
57 4.07 4.05 4.01 3.95
58 4.15 4.12 4.08 4.01
59 4.24 4.20 4.15 4.08
60 4.33 4.29 4.23 4.15
61 4.43 4.38 4.32 4.22
62 4.53 4.48 4.40 4.29
63 4.64 4.58 4.49 4.36
64 4.76 4.69 4.59 4.44
65 4.89 4.80 4.69 4.52
66 5.02 4.92 4.79 4.59
67 5.17 5.05 4.89 4.67
68 5.32 5.19 5.00 4.75
69 5.49 5.33 5.12 4.82
70 5.68 5.48 5.23 4.90
71 5.87 5.64 5.35 4.97
72 6.09 5.81 5.47 5.04
73 6.32 5.99 5.59 5.10
74 6.57 6.18 5.71 5.16
75 6.84 6.37 5.83 5.22
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES
A YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE WITH MORTALITY
IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS TABLE ASSUMES A NET
INVESTMENT RATE OF 3% PER ANNUM, ASSUMING A 365-DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR QUALIFIED CONTRACTS.
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
UNISEX NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.49 3.48 3.47 3.45
46 3.54 3.53 3.51 3.49
47 3.59 3.57 3.56 3.53
48 3.64 3.62 3.60 3.58
49 3.69 3.68 3.65 3.62
50 3.75 3.73 3.71 3.67
51 3.81 3.79 3.76 3.72
52 3.87 3.85 3.82 3.77
53 3.94 3.91 3.88 3.83
54 4.01 3.98 3.94 3.88
55 4.08 4.05 4.01 3.94
56 4.16 4.12 4.07 4.00
57 4.24 4.20 4.15 4.07
58 4.33 4.28 4.22 4.13
59 4.42 4.37 4.30 4.20
60 4.52 4.46 4.38 4.27
61 4.63 4.56 4.47 4.34
62 4.75 4.67 4.56 4.41
63 4.87 4.78 4.65 4.48
64 5.00 4.89 4.75 4.55
65 5.14 5.01 4.85 4.62
66 5.29 5.14 4.95 4.70
67 5.45 5.28 5.06 4.77
68 5.62 5.42 5.17 4.84
69 5.81 5.57 5.28 4.91
70 6.00 5.72 5.39 4.98
71 6.22 5.89 5.50 5.04
72 6.44 6.06 5.62 5.10
73 6.69 6.23 5.73 5.16
74 6.95 6.41 5.84 5.21
75 7.24 6.60 5.95 5.26
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES
A YEAR 2001 ISSUE, AND ARE BASED UPON THE ANNUITY 2000 TABLE (BLENDED
50%/50% FEMALE/MALE) WITH MORTALITY IMPROVEMENTS BASED ON PROJECTION SCALE
G. THIS TABLE ASSUMES A NET INVESTMENT RATE OF 3% PER ANNUM, ASSUMING A
365-DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR NONQUALIFIED CONTRACTS.
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.18 3.27 3.35 3.42 3.47 3.51 3.54
50 3.24 3.36 3.47 3.58 3.66 3.73 3.78
55 3.29 3.43 3.59 3.74 3.87 3.99 4.08
60 3.32 3.49 3.69 3.89 4.09 4.28 4.43
65 3.35 3.54 3.76 4.02 4.31 4.59 4.84
70 3.36 3.57 3.82 4.13 4.49 4.89 5.29
75 3.37 3.59 3.86 4.21 4.63 5.14 5.71
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY MALE DOLLAR AMOUNT
AND SECONDARY FEMALE
45 3.37
50 3.60
55 3.88
60 4.26
65 4.79
70 5.52
75 6.54
Dollar amounts of the monthly Annuity payments in the above table and assumes a
year 2001 issue and are based on the Annuity 2000 Table with mortality
improvements based on Projection Scale G. This table assumes a net investment
rate of 3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR QUALIFIED CONTRACTS.
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
UNISEX
ADJUSTED UNISEX ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.19 3.26 3.33 3.38 3.41 3.44 3.46
50 3.26 3.37 3.46 3.54 3.61 3.66 3.69
55 3.33 3.46 3.60 3.72 3.83 3.91 3.98
60 3.38 3.54 3.72 3.90 4.07 4.22 4.33
65 3.41 3.61 3.83 4.07 4.32 4.56 4.75
70 3.44 3.66 3.91 4.22 4.56 4.91 5.23
75 3.46 3.69 3.98 4.33 4.75 5.23 5.74
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY
AND SECONDARY UNISEX DOLLAR AMOUNT
45 3.34
50 3.55
55 3.82
60 4.19
65 4.70
70 5.40
75 6.40
Dollar amounts of the monthly Annuity payments in the above table assumes a year
2001 issue, and are based on the Annuity 2000 Table (blended 50%/50%
female/male) with mortality improvements based on Projection Scale G. This table
assumes a net investment rate of 3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THIS TABLE WILL BE USED FOR NONQUALIFIED AND QUALIFIED CONTRACTS.
OPTION 5 - PAYMENTS FOR A FIXED PERIOD
MONTHLY MONTHLY
NUMBER OF PAYMENT NUMBER OF PAYMENT
YEARS AMOUNT YEARS AMOUNT
5 17.91 18 5.96
6 15.14 19 5.73
7 13.16 20 5.51
8 11.68 21 5.32
9 10.53 22 5.15
10 9.61 23 4.99
11 8.86 24 4.84
12 8.24 25 4.71
13 7.71 26 4.59
14 7.26 27 4.47
15 6.87 28 4.37
16 6.53 29 4.27
17 6.23 30 4.18
The dollar amounts of the monthly Annuity payments for the fifth option are
based on a net investment rate of 3% per annum, assuming a 365-day year.
This Page Left Blank Intentionally
FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
================================================================================
ENHANCED STEPPED-UP PROVISION DEATH BENEFIT RIDER
================================================================================
THIS RIDER IS NOT AVAILABLE WHEN EITHER THE ANNUITANT OR OWNER IS AGE 76 OR
OLDER ON THE RIDER EFFECTIVE DATE.
The Rider Effective Date is the date this rider is attached to and made a part
of the Contract.
The DEATH PROCEEDS PRIOR TO MATURITY DATE section of the Contract or any
attached endorsement/rider is amended by adding the following language to the
end of the section:
The total death benefit payable as of the Death Report Date will equal the death
benefit described in the Contract or any attached endorsement/rider plus the
greater of zero or the following amount:
If the Annuitant is younger than age [70] on the Rider Effective Date:
[40%] of the lesser of
1. [250%] of: the Modified Purchase Payment(s) excluding Purchase
Payment(s) that are both received after the first Rider
Effective Date anniversary and within 12 months of the Death
Report Date, or
2. Your Contract value minus the Modified Purchase Payment(s),
calculated as of the Death Report Date.
If the Annuitant is between the ages of [70 and 75] on the Rider
Effective Date: [25%] of the lesser of
1. [250%] of: the Modified Purchase Payment(s) excluding Purchase
Payment(s) that are both received after the first Rider
Effective Date anniversary and within 12 months of the Death
Report Date, or
2. Your Contract value minus the Modified Purchase Payment(s),
calculated as of the Death Report Date.
Modified Purchase Payment(s)
The initial Modified Purchase Payment is equal to the Contract value as
of the Rider Effective Date. Whenever a Purchase Payment is made after
the Rider Effective Date, the Modified Purchase Payment(s) are
increased by the amount of the Purchase Payment. Whenever a partial
surrender is taken after the Rider Effective Date, the Modified
Purchase Payment(s) are reduced by a Partial Surrender Reduction as
described below.
The Partial Surrender Reduction is equal to 1) the Modified Purchase
Payment(s) in effect immediately prior to the reduction for the partial
surrender, multiplied by 2) the amount of the partial surrender divided
by 3) the Contract value immediately prior to the partial surrender.
The annual Mortality and Expense charge of the Contract is increased by 0.25%
for election of this rider. This increase in the annual Mortality and Expense
charge will result in an increase to the total funding option daily deduction of
.00000685. If election of an Enhanced Stepped-Up Provision Death Benefit Rider
takes place on the Contract Date, these charges will also be shown on the
Contract Specifications page.
This Rider is to be read in conjunction with the Non-Qualified Annuity Spousal
Continuation Rider, if applicable.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/S/ Xxxxxx X Xxxxxxx
PRESIDENT
================================================================================
WAIVER OF WITHDRAWAL CHARGE FOR NURSING HOME CONFINEMENT
================================================================================
WAIVER DOES NOT APPLY WITH RESPECT TO THE NURSING HOME BENEFIT IF THE OWNER IS
CONFINED ON THE CONTRACT DATE, NOR IS THERE COVERAGE UNTIL ONE YEAR AFTER THE
CONTRACT DATE
This rider is made available when the Owner is age 70 or under on the Contract
Date and is made a part of the Contract to which it is attached.
If after the effective date of this rider, and prior to the Maturity Date of the
Contract, the Owner begins confinement in an Eligible Nursing Home, and remains
confined for the Qualifying Period, You may make a total or partial withdrawal,
subject to the Maximum Withdrawal Amount, without incurring a withdrawal charge.
We will waive the withdrawal charge only for withdrawals made during continued
confinement in an Eligible Nursing Home after the Qualifying Period has been
satisfied, or within sixty (60) days after such confinement ends. We will
require proof of confinement in a form satisfactory to Us. Part of the proof may
be certification by a licensed physician that such confinement is medically
necessary, as determined by the attending physician.
DEFINITIONS:
An ELIGIBLE NURSING HOME is an institution or special nursing unit of a hospital
which:
(a) Is Medicare approved as a provider of skilled nursing care
services; and
(b) Is not, other than in name only, an acute care hospital, a
home for the aged, a retirement home, a rest home, a community
living center, or a place mainly for the treatment of
alcoholism.
OR
Meets all of the following standards:
(a) It is licensed as a Nursing Care Facility by the state in
which it is located;
(b) It is either a freestanding facility or a distinct part of
another facility such as a ward, wing, unit or swing-bed of a
hospital or other facility;
(c) It provides nursing care to individuals who are not able to
care for themselves and who require nursing care;
(d) Its primary function is to provide nursing care and room and
board; and the facility charges for these services. The care
must be performed under the direction of a licensed physician,
or registered nurse (RN), or licensed practical nurse (LPN);
(e) It may include care provided by a licensed physical,
respiratory, occupational or speech therapist; and
(f) It is not, other than in name only, an acute care hospital, a
home for the aged, a retirement home, a rest home, a community
living center, or a place mainly for the treatment of
alcoholism.
QUALIFYING PERIOD is confinement in an Eligible Nursing Home for 90 consecutive
days.
EXCLUSIONS
We will not waive withdrawal charges if confinement is due to one or more of the
following causes:
(a) Mental, nervous, emotional or personality disorder without
demonstrable organic disease, including, but not limited to,
neurosis, psychoneurosis, psychopathy or psychosis;
(b) The voluntary taking or injection of drugs, unless prescribed
or administered by a licensed physician;
(c) The voluntary taking of any drugs prescribed by a licensed
physician and intentionally not taken as prescribed;
(d) Sensitivity to drugs voluntarily taken, unless prescribed by a
physician;
(e) Drug addition, unless addiction results from the voluntary
taking of drugs prescribed by a licensed physician, or the
involuntary taking of drugs.
MAXIMUM WITHDRAWAL AMOUNT
The Maximum Withdrawal Amount available without incurring a withdrawal charge is
the Contract Value on the next Valuation Date following written proof of claim,
less any Purchase Payments made within 12 months prior to the date confinement
in an Eligible Nursing Home begins, less any additional Purchase Payments made
on or after the Owner's 71st birthday.
NOTICE OF CLAIM
Written notice of claim must be given to Us following completion of the
Qualifying Period, and either while the Owner continues to be confined or within
60 days after discharge from the Eligible Nursing Home. If notice cannot be
given to Us within 60 days, it must be given as soon as reasonably possible.
PAYMENT OF CLAIMS
Benefits payable under this rider will be paid as soon as We receive proper
written proof of claim. The portion of the Contract Value that is withdrawn will
be paid in a lump sum to You.
DENIAL OF WAIVER BENEFIT
If the waiver benefit is denied, the withdrawal proceeds will not be disbursed
until You are notified of the denial and provided with the opportunity to
reapply for the withdrawal proceeds or to reject the withdrawal proceeds.
TAX IMPLICATIONS
Receipt of any portion of the Contract Value may be taxable to You as the Owner.
Please consult with Your tax advisor.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ Xxxxxx X Xxxxxxx
PRESIDENT
INDIVIDUAL RETIREMENT ANNUITY QUALIFICATION RIDER
As requested by you, this Contract is amended as follows to qualify as
an Individual Retirement Annuity (IRA) under Section 408(b) of the Code
of 1986, as amended.
I. EXCLUSIVE BENEFIT
This Contract is established for the exclusive benefit of you or your
Beneficiaries.
II. PROHIBITION OF ASSIGNMENT OR LOAN
This Contract shall not be pledged or otherwise encumbered and it shall
not be sold, assigned or otherwise transferred to any person or entity
other than us. No loans shall be made under this Contract.
III. LIMITATION ON PURCHASE PAYMENTS
Notwithstanding the provisions of the Contract and except in the case
of a rollover contribution (as permitted by Section 402(c), 403(a)(4),
403(b)(8), or 408(d)(3) of the Code) or a contribution made in
accordance with the terms of a Simplified Employee Pension (SEP)
program as described in Section 408(k) of the Code, the total
contributions shall not exceed the lesser of $2,000 or 100% of
compensation for any taxable year. In the case of a spousal IRA, the
maximum contribution shall not exceed the lesser of $2,250 or 100% of
compensation, but no more than $2,000 can be contributed to either
spouse's IRA. In the case of a Simplified Employee Pension Plan
qualifying under Section 408(k), the annual contribution under the
Contract may not exceed the lesser of $30,000 or 15% of compensation.
No contributions will be accepted unless they are in cash.
The amount of purchase payments beyond the minimum purchase payment
under this Contract is not fixed. The minimum purchase payment must be
received as a rollover (see Section X). Payment of purchase payments
beyond the first will not be required to continue this contract.
Purchase payments after the first will not be required to continue this
Contract in force. We reserve the right, however, to terminate this
Contract when no purchase payments have been made for at least two
consecutive years and the Contract Value of the Contract is less than
the termination amount of $1,000 or the paid up Annuity benefit at
maturity would be less than $20 per month. If this Contract is
terminated, we will pay you the Cash Surrender Value, if any.
IV. COMPENSATION
Compensation means wages, salaries, professional fees, or other amounts
derived from or received from personal service actually rendered
(including, but not limited to, commissions) and includes earned income
as defined in Code Section 401(c)(2). Compensation does not include
amounts received as earnings or profits from property or amounts not
includible in gross income. Compensation also does not include any
amount received as a pension or Annuity or as deferred compensation.
The term "compensation" shall include any amount includible in the
individual's gross income under Code Section 71 with respect to a
divorce or separation instrument.
V. DISTRIBUTION OF BENEFITS
Notwithstanding any provision of this contract to the contrary, the
distribution of an individual's interest shall be made in accordance
with the minimum distribution requirements of Section 408(a)(6) or
Section 408(b)(3) of the Code and the regulations thereunder, including
the incidental
death benefit provisions of Section 1.401(a)(9)-2 of the proposed
regulations, all of which are herein incorporated by reference.
Your entire interest in the account must be distributed, or begin to be
distributed, by your required beginning date, which is the April 1
following the calendar year in which you reach age 70 1/2. For each
succeeding year, a distribution must be made on or before December 31.
By the required beginning date you may elect to have the balance in the
account distributed in one of the following forms:
1. a single sum payment;
2. equal or substantially equal payments over your life;
3. equal or substantially equal payments over the lives of you
and your designated Beneficiary;
4. equal or substantially equal payments over a specified period
that may not be longer than your life expectancy;
5. equal or substantially equal payments over a specified period
that may not be longer than the joint life and last survivor
expectancy of you and your designated Beneficiary.
MINIMUM AMOUNTS TO BE DISTRIBUTED
If your interest is to be distributed in other than a lump sum or
substantially equal amounts as discussed above, then the amount to be
distributed each year, commencing at your required beginning date, must
be at least an amount equal to the quotient obtained by dividing your
entire interest by your life expectancy or the joint and survivor
expectancy of you and your designated Beneficiary.
Life expectancy and joint and last survivor expectancy are computed by
use of the return multiples contained in section 1.72-9 of the Income
Tax Regulations. For purposes of this computation, the owner's life
expectancy may be recalculated no more frequently than annually;
however, the life expectancy of a nonspouse Beneficiary may not be
recalculated.
If your designated Beneficiary is not your spouse, then the minimum
amount required to be distributed shall be the greater of the amount
determined above, or the amount determined under the incidental benefit
rules set forth in Treasury Regulation Section 1.401(a)(9)-2.
VI. DEATH
If you die before your entire interest is distributed, the entire
remaining interest will be distributed as follows:
1. If you die on or after distributions have begun under the
DISTRIBUTION OF BENEFITS section, the entire remaining
interest must be distributed at least as rapidly as provided
under the DISTRIBUTION OF BENEFITS section.
2. If you die before distributions have begun under the
DISTRIBUTION OF BENEFITS section, the entire remaining
interest must be distributed as elected by you, or, if you
have not so elected, as elected by the Beneficiary or
Beneficiaries, as follows:
a. by December 31st of the year containing the fifth
anniversary of your death; or
b. in equal or substantially equal payments over the
life or life expectancy of the designated Beneficiary
or Beneficiaries starting by December 31st of the
year following the year of your death. If the
Beneficiary is your surviving spouse and he or she
elects to treat this contract as his or her own, this
distribution may be deferred until December 31st of
the year you would have turned age 70 1/2.
If your surviving spouse dies before distributions begin, the
restrictions in paragraphs 2 (a) and (b) above shall apply.
Unless otherwise elected by you prior to the commencement of
distributions under the DISTRIBUTION OF BENEFITS section, or, if
applicable, by the surviving spouse where you die before distributions
have commenced, life expectancies of you or your spousal Beneficiary
shall be recalculated annually for purposes of distributions under the
DISTRIBUTION OF BENEFITS section and the DEATH section. An election not
to recalculate shall be irrevocable and shall apply to all subsequent
years. The life expectancy of a non-spouse Beneficiary shall not be
recalculated.
VII. ALTERNATIVE CALCULATION METHOD
An individual may satisfy the minimum distribution requirements under
section 408(a)(6) and 408(b)(3) of the Code by receiving a distribution
for one IRA that is equal to the amount required to satisfy the minimum
distribution requirements for two or more IRAs. For this purpose, the
owner of two or more IRAs may use the "alternative method" described in
Notice 88-38, 1988-1 C.B. 524, to satisfy the minimum distribution
requirements described above.
VIII. NONFORFEITABILITY
Your entire interest in this Contract is nonforfeitable.
IX. NONTRANSFERABLE
This Contract is not transferable.
X. ROLLOVERS
A. Subject to subparagraphs (B) and (C) hereof, and the
limitations stated in the Contract, you may transfer to this
Contract your interest in any of the following:
1. the entire amount, or any portion thereof, under any
other individual retirement account or individual
retirement Xxxxxxx qualified under Section 408 of the
Code;
2. the entire amount, or any portion thereof, excluding
nondeductible employee voluntary contributions, under
a trust described in Section 401(a) of the Code which
is exempt from tax under Section 501(a) of the Code
or under a qualified annuity plan described in
Section 403(a) of the Code.
3. the entire amount or any portion thereof, excluding
nondeductible employee voluntary contributions, to
which you are entitled under a tax sheltered annuity
described in Section 403(b) of the Code.
4. distributions you roll over from retirement plans or
arrangements described in A.2. and A.3. above to this
contract must be completed by means of a direct
transfer or rollover in accordance with Code Section
401(a)(31) in order to avoid mandatory 20% income tax
withholding from the distribution and a possible 10%
additional tax penalty under Code Section 72(t). You
may replace amounts withheld from other sources to
complete the full rollover, but the 10% penalty
may continue to be due, if you do not specify that
the transfer of the distribution be conducted by
direct transfer or rollover.
B. You shall not make a rollover under subparagraph (A)(1) hereof
during the 12 month period commencing on the date you last
made a rollover contribution of the type described in
subparagraph (A)(1).
C. We must receive any amount which qualifies for a rollover
within 60 days after you receive the distribution.
XI. DISTRIBUTIONS PRIOR TO AGE 59 1/2
Except in the event of your death, disability or attainment of age 59
1/2, we shall receive from you a declaration of your intention as to
the disposition of the amounts distributed before making any
distribution from this Contract.
XII. REPORTS
As the issuer of this Contract, we will furnish reports concerning the
status of the Annuity at least annually.
XIII. DISABILITY PAYMENTS
If the Contract contains a Rider for waiver of premium and disability
payment benefits, any disability payments provided for in the CONTRACT
SPECIFICATIONS will be applied as purchase payments under the contract.
XIV. AMENDMENT
This Contract may be amended by us at any time to maintain its
qualified status under Section 408(b) of the Code, following all
regulatory approvals. Any such amendment may be made retroactively
effective if necessary or appropriate to conform to the requirements of
the Code (or any State law granting IRA tax benefits.)
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ R.A.
Chairman
TAX-SHELTERED ANNUITY QUALIFICATION RIDER
This endorsement is made a part of this contract in order to comply with Section
403(b) of the Code. The following conditions, restrictions and limitations
apply.
OWNERSHIP - NON-TRANSFERABLE
You may not sell, assign, or discount this contract or pledge this contract as
collateral for a loan or as security for the performance of an obligation or for
any other purpose, to any person or organization other than to us. This
provision supersedes any provisions of the contract which may be inconsistent
with it.
ELECTIVE DEFERRAL CONTRIBUTION LIMITS
In order to meet the qualification requirements of Code Section 403(b), elective
deferral contributions may not exceed the limitations in effect under Code
Section 402(g).
This rule is an individual limitation that applies to all elective deferral
plans, contracts or arrangements in the aggregate.
WITHDRAWAL RESTRICTIONS
To qualify as a contract which can defer compensation under a Code Section
403(b) plan or arrangement, the withdrawal restrictions under Code Section
403(b)(11) must be met.
Withdrawals attributable to contributions made pursuant to a salary reduction
agreement may be paid only upon or after attainment of age 59 1/2, separation
from service, death, total or permanent disability (as defined in Code Section
72(m)(7)) or in the case of hardship (as defined in the Treasury Regulations).
The hardship exception applies only to the salary reduction contribution and not
to any income attributable to such contribution.
These withdrawal restrictions apply to years beginning after December 31, 1988
but only with respect to assets other than those assets held as of the close of
the last year beginning before January 1, 1989.
If contributions attributable to a custodial account described in Section
403(b)(7) of the Code are transferred to this contract, the following
conditions, restrictions, and limitations apply.
Withdrawals attributable to these transferred contributions may be paid only
upon or after attainment of age 59 1/2, separation from service, death, or total
and permanent disability (as defined in Code Section 72(m)(7)).
Withdrawals on account of hardship may be made only with respect to assets
attributable to a custodial account as of the close of the last year beginning
before January 1, 1989 and amounts contributed thereafter under a salary
reduction agreement but not to any income attributable to such conditions.
ELIGIBLE ROLLOVERS
To the extent you are otherwise eligible for a distribution under this contract,
and provided the distribution is an eligible rollover distribution, you may
elect to have such distribution or a portion of it paid directly to an eligible
retirement plan. You must specify the eligible retirement plan to which such
distribution is to be paid in a form and at such time acceptable to us. Such
distribution shall be made as of a direct transfer to the eligible retirement
plan so specified. Contract surrender penalties may apply to all rollovers.
Previously taxed amounts in this contract are not eligible for rollover. Amounts
that are rolled over are taxed generally until later distributed. An eligible
rollover distribution includes generally any taxable distribution or portion
thereof from this contract except:
a. any distribution which is one of a series of substantially
equal periodic payments made not less frequently than annually
and made to you for life or life expectancy or to you or your
joint life beneficiary for joint lives or life expectancies,
or for a specified period of 10 years or more, or
b. any distribution which is a required distribution as described
above under "MANDATORY DISTRIBUTION REQUIREMENTS."
An eligible retirement plan includes an individual retirement annuity or account
described in Code Section 408. It also includes a tax sheltered annuity plan or
arrangement under Code Section 403(b), provided it accepts eligible rollovers
and is a defined contribution plan.
If you receive a distribution that is eligible for rollover, but you receive the
check directly, then mandatory income tax withholding will be taken from the
distribution. You may roll over the balance to an individual retirement annuity
or account within 60 days of receipt, and may make up the amount withheld from
other sources in the rollover in order to roll over the maximum without possible
early distribution tax penalty on the amount of the tax withholding.
MANDATORY DISTRIBUTION REQUIREMENTS
In order to meet the qualification requirements of Code Section 403(b), all
plans must meet the required mandatory distribution rules in Code Section
401(a)(9).
Code Section 401(a)(9) states that a plan will not be qualified unless the
entire interest of each employee is distributed to such employee not later than
the "required beginning date" or over the life or life expectancy of such
employee or over the lives or joint life expectancy of such employee and a
designated Beneficiary. Generally, the "required beginning date" means April 1
of the calendar year following the calendar year in which the employee attains
age 70 1/2.
If the employee dies after the distribution has begun but before his/her entire
interest has been distributed, the remaining interest must be paid out at least
as rapidly as it was being paid out under the method of payment in effect at the
time of death. If the employee dies before the distribution of his/her entire
interest has begun, the entire interest must be distributed within five years
after the employee's death or an Annuity payable over no longer than life or
life expectancy must be distributed to an electing designated Beneficiary
starting within one year of the employee's death. A spousal designated
Beneficiary may elect to defer distributions until the employee would have
attained the age of 70 1/2.
ADMINISTRATIVE COMPLIANCE
If changes in the Code and related law, regulations and rulings require a
distribution greater than described above in order to keep this Annuity
qualified under the Code, we will administer the contract in accordance with
these laws, regulations and rulings. We will provide you with a revised rider
describing any necessary changes, following all regulatory approvals.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ R.A.
Chairman
TAX LAW QUALIFICATION RIDER
This rider is made a part of this contract as its Contract Date in order to
comply with the tax rules under Section 72(s) of the Code for required
distributions upon the death of any contract owner. The following conditions,
restrictions and limitations must apply to maintain the tax qualified status of
your Annuity.
REQUIRED DISTRIBUTIONS WHERE OWNER AND ANNUITANT DIE SIMULTANEOUSLY
If you are the owner and the Annuitant or you are the owner and you die
simultaneously with the Annuitant before payment of any Annuity or Income Option
begins, an amount equal to the Death Benefit will be distributed within five
years of your death to the contract Beneficiary unless:
a. the Beneficiary elects by Written Request to have the proceeds
distributed over the Beneficiary's life or over a period not
extending beyond life expectancy, and the payments begin
within one year of your death; or
b. the sole Beneficiary is your spouse who elects by Written
Request to continue the contract as the owner and Annuitant.
If you are the owner and the Annuitant or you are the owner and you die
simultaneously with the Annuitant after an Annuity or Income option begins but
before your entire interest has been distributed, the remaining proceeds of the
contract will be distributed at least as rapidly as they were being distributed
under the method of payment in effect at the time of your death.
The death of the first joint owner triggers these distribution requirements.
NON-NATURAL OWNER HOLDING FOR NATURAL PERSONS
The above rules also apply if you are not an individual and the primary
Annuitant dies before payment of an Annuity or Income Option begins. Payments
will be made to the Beneficiary. The primary Annuitant is the first-named
Xxxxxxxxx and the individual who is of primary importance in affecting the
timing or amount of payments under the contract.
If you are not an individual and the primary annuitant dies after payment of an
Annuity or Income option begins, the remaining proceeds of the contract will be
distributed at least as rapidly as they were being distributed under the method
of payment in effect at the time of the primary Annuitant's death.
REQUIRED DISTRIBUTIONS WHERE OWNER AND ANNUITANT DO NOT DIE SIMULTANEOUSLY
If you are the owner but not the Annuitant, and you die before the Annuitant and
before payment of an Annuity or Income Option begins, an amount equal to the
Death Benefit will be distributed within five years of your death to the joint
owner surviving you. In this circumstance, the joint owner is the "designated
beneficiary" referred to in Section 72(s) of the Code, and his or her rights
preempt those of the Beneficiary named in a Written Request. The distribution
may be made over a period that exceeds five years from your death or postponed
by your spouse if:
a. the joint owner elects by Written Request to have the proceeds
distributed over his or her life or over a period not
extending beyond life expectancy, and the payments begin
within one year of your death; or
b. the sole joint owner is your spouse, who elects by Written
Request to continue the contract as owner.
The joint owner is determined by contract designation. If there is no joint
owner or Beneficiary surviving you, ownership of this contract passes to your
estate. The estate or the individual taking the contract benefits through your
estate must take complete distribution within five years of your death.
If you are the owner but not the Annuitant, and you die after payment of an
Annuity or Income Option begins, the remaining proceeds of the contract will be
distributed at least as rapidly as they were being distributed under the method
of payment in effect at the time of your death.
The death of the first joint owner triggers these distribution requirements.
ADMINISTRATIVE COMPLIANCE
If the Code and related law, regulations and rulings require a distribution
other than described above in order to keep this Annuity contract qualified
under the Code, we will administer the contract in accordance with these laws,
regulations, and rulings. We will provide you with a revised rider describing
any necessary changes, following all regulatory approvals
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ R.A.
CHAIRMAN
================================================================================
XXXX INDIVIDUAL RETIREMENT ANNUITY QUALIFICATION RIDER
================================================================================
As requested by you, this contract or certificate (hereinafter collectively
referred to as "contract") is amended as follows to qualify as a Xxxx Individual
Retirement Annuity (IRA) under Section 408A of the Code of 1986, as amended.
Notwithstanding any other specific provisions in the contract to the contrary,
the contract is amended to restrict the rights of the Owner or Annuitant and any
Beneficiary, and to limit contributions as follows:
EXCLUSIVE BENEFIT
This contract is established for the exclusive benefit of the Owner and the
Owner's Beneficiaries.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This Owner may not transfer ownership of the contract, sell the contract, or
assign or pledge the contract as collateral for a loan or as security for the
performance of an obligation or for any other purpose, to any person other than
the Company or a former spouse of the Owner under a divorce decree or under a
written instrument incident to that divorce.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
LIMITATION ON PURCHASE PAYMENTS
The contract will accept contributions only as follows:
Contributions to this contract must be paid in cash and, except in the case of a
trustee-to-trustee transfer from another Xxxx XXX, or in the case of a qualified
rollover contribution, may not exceed the excess of the Owner's contribution
limit for the taxable year over the aggregate contributions made during the
taxable year to all other Xxxx IRAs and IRAs held by the Owner. Contributions
may be made without respect to the age of the Owner.
The contribution limit for the taxable year is either (1) the lesser of $2,000
or 100% of compensation of the Owner for the taxable year, or (2) where the
Owner files a joint return and receives less compensation for the taxable year
than the Owner's spouse, the lesser of $2,000 or 100% of the compensation of the
Owner and the Owner's spouse for the taxable year less the spouse's contribution
to a Xxxx XXX or IRA for the taxable year, if any.
When the Owner's adjusted gross income (AGI) exceeds the applicable dollar limit
(ADL; see description below), the annual contribution limit is reduced by the
following amount -
Annual
Contribution Limit x Owner's AGI-ADL
---------------
$15,000 ($10,000 if the Owner is married)
For purposes of this section, AGI does not include any amount included in gross
income as a result of a rollover of an IRA to a Xxxx XXX and is reduced by any
deduction under section 219 of the Code.
The ADL is $150,000 for an Owner filing a joint return, $95,000 for an Owner
filing a single return, and $-0- for a married Owner filing a separate return.
ROLLOVER CONTRIBUTION
A qualified rollover contribution described in section 408A(c) can be made only
from (1) another Xxxx XXX or (2) another IRA, which is not a Xxxx XXX, and can
be made from an IRA other than a Xxxx XXX only if the Owner's adjusted gross
income for the taxable year of the rollover does not exceed $100,000.
COMPENSATION
For purposes of this section, compensation means wages, salaries, professional
fees, or other amounts derived from or received for personal service actually
rendered (including, but not limited to commissions paid salespersons,
compensation for services on the basis of a percentage of profits, commissions
on insurance premiums, tips, and bonuses) and includes earned income, as defined
in the section 401(c)(2) (reduced by the deduction the self-employed individual
takes for contributions made to a self-employed retirement plan). For purposes
of this definition, section 401(c)(2) shall be applied as if the term trade or
business for purposes of section 1402 included service described in subsection
(c)(6). Compensation does not include amounts derived from or received as
earnings or profits from property (including but not limited to, interest and
dividends) or amounts not includible in gross income. Compensation also does not
include any amount received as a pension or annuity or as deferred compensation.
The term "compensation" shall include any amount includible in the Owner's gross
income under section 71 with respect to a divorce or separation instrument
described in subparagraph (A) of section 71(b)(2).
DISTRIBUTION REQUIREMENTS
The Owner's entire interest will be distributed in accordance with one of the
following provisions, as elected:
A. (1) The Owner's entire interest will be paid by December 31 following the
fifth anniversary of the Owner's death.
(2) If any portion of the Owner's interest is payable to a designated
Beneficiary and such Beneficiary has not elected (1) above, then the entire
interest which is payable to the Beneficiary will be distributed in
substantially equal installments over a period not exceeding the life or life
expectancy of the designated Beneficiary, commencing by December 31 following
the first anniversary of the Owner's death. The designated beneficiary may elect
at any time to receive greater payments if otherwise permitted under the terms
of the contract.
(3) In applying the requirements of A(2) to any portion of the Owner's
interest which is payable to the Owner's surviving spouse, the date on which the
payments must commence is the later of (a) December 31 following the date the
deceased Owner would have attained age 70 1/2 or (b) December 31 following the
first anniversary of the Owner's death.
(4) If the designated Beneficiary of the Owner is the Owner's surviving
spouse, the spouse may treat the contract as the spouse's own Xxxx XXX. This
election will be deemed to have been made if the surviving spouse makes a
rollover or other contribution into this contract or if the surviving spouse has
failed to satisfy one or more requirements described in (1) or (2). If the
Owner's surviving spouse dies before distributions are required to begin under
this section, the Owner's surviving spouse will be treated as having elected to
made the Xxxx XXX his or her own Xxxx XXX.
B. For purposes of this section, life expectancy will be computed by use of the
return of multiples specified in Tables V or VI of Section 1.72-9 of the Income
Tax Regulations based on the attained age of such Beneficiary during the
calendar year in which distributions are required to commence pursuant to this
section. Payments for any subsequent calendar year will be based on this life
expectancy reduced by one for each calendar year which has elapsed since the
calendar year life expectancy was first calculated. A designated beneficiary of
the Owner who is the Owner's surviving spouse may elect, prior to the time that
payments have begun to him or her, to redetermined life expectancy each year
based on the beneficiary's attained age in each such year.
REPORTS
As the issuer of this contract, we will furnish reports concerning the status of
the Annuity at least annually.
AMENDMENT
This contract may be amended by us at any time to maintain its qualified status
as a Xxxx XXX. Any such amendment may be made retroactively effective if
necessary or appropriate to conform to the requirements of the Code (or any
State law granting IRA tax benefits).
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ Xxxxxx X. Xxxxxxx
PRESIDENT
ENDORSEMENT
This endorsement is made a part of this contract in order to comply with Section
403(b) of the Internal Revenue Code. This endorsement applies to contributions
transferred from a custodial account described in Section 403(b)(7) of the
Internal Revenue Code. The following conditions restrictions and limitations
apply.
Withdrawals attributable to these transferred contributions may be paid only
upon or after attainment of age 59 1/2, separation from service, death, or
total and permanent disability (as defined in Internal Revenue Code Section 72
(m)(7)).
Withdrawals on account of hardship may be made only with respect to assets held
in the custodial account as of the close of the last year beginning before
January 1, 1989 and amounts contributed thereafter under a salary reduction
agreement but not to any income attributable to such contributions.
We intend to administer this contract so that it will maintain its tax-deferred
qualification under Internal Revenue Code Section 403(b). If temporary or final
regulations require a change in the contract language in order to maintain
qualification, we will administer this contract in accordance with the
regulations.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ Xxxxxx X. Xxxxxxx
PRESIDENT
CASH LOAN RIDER
This rider is made a part of the contract to which it is attached. The date of
issue of the rider is the date the rider is attached to the contract.
You may request a loan by Written Request as stated below:
1. the loan must be requested before the Maturity Date; and
2. the loan will be made without the consent of any Beneficiary
or other party unless irrevocably named, or unless such
consent is required by law; and
3. the loan cannot exceed the maximum loan amount as stated
below.
We may defer granting a loan for the period permitted by law but not for more
than six months. We will not grant an additional loan until the first loan has
been repaid in full. The minimum and maximum loan amounts are stated below.
A loan may only be taken from the Fixed Account. A transfer of Contract Value
from the Sub-Accounts to the Fixed Account must be made by Written Request prior
to Our granting the loan. The amount transferred to the Fixed Account will be
taken on a pro rata basis from each of the Sub-Accounts which have Contract
Value, unless We are instructed otherwise. An express condition of Us lending
the loan amount is that You will grant Us a security interest in the Contract
Value of the Fixed Account equal to the loan amount.
MINIMUM AND MAXIMUM AMOUNTS
MINIMUM LOAN AMOUNT: [$1,000]
MAXIMUM LOAN AMOUNT: 80% of the Contract Value for contracts with balances up
to $12,500;
$10,000 for contracts with balances between $12,500 and
$20,000;
For contracts with balances over $20,000, the lesser of
$50,000 reduced by the highest total amount of loans
outstanding during the prior 12 month period or 50% of
the Contract Value.
LOAN INTEREST RATE: The maximum loan interest rate is 8% per year. Loan
interest is payable to Us in advance on a quarterly
basis, unless We allow otherwise. The loan interest rate
in effect upon loan origination will remain constant
throughout the term of the loan.
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EFFECT OF A LOAN ON THE CONTRACT VALUE
================================================================================
While a loan remains outstanding, the Contract Value that is equal to the loan
amount will be credited with interest of not less than 3% per year. We will
notify You of the initial rate that will be credited when the loan is granted.
We reserve the right to change the interest rate in the future, but it will
never be less than 3% per year.
The Contract Value may be reduced as stated in the Loan Principal and Interest
Repayments section of this rider.
================================================================================
EFFECT OF A LOAN ON TRANSFERS FROM THE FIXED ACCOUNT TO THE SUB-ACCOUNTS
================================================================================
While a loan remains outstanding, the Cash Surrender Value of the Fixed Account
is the maximum amount that may be transferred from the Fixed Account to any of
the Sub-Accounts, subject to any transfer restrictions of the contract.
================================================================================
LOAN PRINCIPAL AND INTEREST REPAYMENTS
================================================================================
Loan repayment is set forth in the loan agreement. Once a loan is established,
the repayment period may not be changed. The loan may be repaid in full at any
time without penalty. We may send You periodic payment reminders for the loan
principal and interest amount due.
If the entire payment due is not paid by the due date, one of the following
events will occur:
1. If there is Contract Value that is not restricted and is
sufficient to pay the entire payment due or a portion of the
payment amount due, We will surrender the amount due from the
unrestricted Contract Value. Contract Value that is not
restricted consists of any amount that is:
a) not restricted according to the Internal
Revenue Code; and
b) attributable to Purchase Payments made by
You.
When the payment due is surrendered from the Contract Value,
the Contract Value will also be reduced by:
a) any amounts deducted on surrender, if
applicable, which are shown on the Contract
Specifications page; plus
b) any applicable Premium Tax not previously
deducted; plus
c) any applicable Federal or State Income Tax
due in accordance with federal and state tax
regulations in effect on the date of the
surrender.
2. When the entire payment due cannot be paid as described in
item 1 above, We will send You a notice reminding You that the
amount has not been paid. If that payment due is not paid
within 60 days of the date of Our notice, the outstanding loan
plus any accrued interest will be considered a loan in
default. Interest will continue to be charged and credited to
the loan in default while the loan is outstanding. We will not
send you any more periodic payment reminders. Repayment of the
outstanding loan principal and/or accrued interest will be
allowed at any time.
When an event occurs that is recognized under federal tax law
or regulations as one which allows the Contract Value to be
distributed, the Contract Value will be reduced by:
a) the amount of the outstanding loan plus any
accrued interest; plus
b) the amounts deducted on surrender, if
applicable, which are shown on the Contract
Specifications page; plus
c) any applicable Premium Tax not previously
deducted; plus
d) any applicable Federal or State Income Tax
due in accordance with federal and state tax
regulations in effect on the date of the
surrender; and the loan will be considered
as no longer outstanding.
================================================================================
EFFECT ON DEATH BENEFIT ENDORSEMENT FORM TL-12794
================================================================================
If endorsement form, TL-12794 is attached to your contract, the following
sentence is deleted:
"The maximum guaranteed death benefit payable equals 200% of the total
of the purchase payments minus surrenders, minus applicable premium
taxes."
and is replaced with the following:
"The maximum guaranteed death benefit payable equals 200% of the total
of the purchase payments minus surrenders, minus any outstanding loan
amounts, minus applicable premium taxes."
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ R.A.
PRESIDENT
