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EXHIBIT 6.9
FORM OF GROUP VARIABLE ANNUITY CONTRACT
FOR 457 PROGRAMS, FORM VA-10515
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American United Life INSURANCE COMPANY
GROUP FUND B
CONTRACT NO. VA _____________________
CONTRACTHOLDER ______________________
CONTRACT DATE _______________________
American United Life Insurance Company ("Company") will provide all the rights
and benefits of this contract.
This contract is issued in consideration of the application and of the payment
to the Company of Annuity Deposits. This contract provides for investment in
Fund B, and supplements Group Annuity Contract G xx,xxx which shall be referred
to as the "Companion Contract."
Signed for the Company at its Home Office, ___________________________________.
AMERICAN UNITED LIFE INSURANCE COMPANY
By: __________________________________
Attest
GROUP ANNUITY CONTRACT
Equity Fund - Variable Annuities Participating
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT ARE VARIABLE AS HEREIN
PROVIDED AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
VA-10515
TABLE OF CONTENTS
ARTICLE I DEFINITIONS
ARTICLE II ANNUITY DEPOSITS
Section 1 ------- Annuity Deposits
Section 2 ------- Application of Annuity Deposits
Section 3 ------- Credit of Accumulation Units
Section 4 ------- Cessation of Annuity Deposits
ARTICLE III VALUATION
Section 1 ------- Gross Investment Rate and Net Investment Rate
Section 2 ------- Net Investment Factor
Section 3 ------- Accumulation Unit Value
Section 4 ------- Annuity Unit Value
Section 5 ------- Valuation of Assets
ARTICLE IV TRANSFER OPTIONS
Section 1 ------- Transfers from the Companion Contract
Section 2 ------- Transfers to the Companion Contract
ARTICLE V BENEFITS
Section 1 ------- Variable Annuity Benefits
Section 2 ------- Single Sum Benefits
Section 3 ------- Emergency Withdrawals
Section 4 ------- Death Benefits
ARTICLE VI GENERAL PROVISIONS
Section 1 ------- Contract
Section 2 ------- Ownership
Section 3 ------- Beneficiary
Section 4 ------- Dividends
Section 5 ------- Amendments
Section 6 ------- Misstatements
Section 7 ------- Information, Proofs and Determination of Facts
Section 8 ------- Facility of Payment
Section 9 ------- Pronouns
Section 10 ------ Relation of this Contract to Fund B
Section 11 ------ Voting
Section 12 ------ Transfer to Substitute Funding Medium
TABLES
ARTICLE I
DEFINITIONS
CONTRACT ANNIVERSARY means the Contract Date and each subsequent anniversary of
the Plan.
MONTHLY DATE means the Contract Date and the first day of each month thereafter.
CONTRACT YEAR means a period of time beginning on a Contract Anniversary and
ending on the day immediately preceding the next Contract Anniversary.
PLAN means the Deferred Compensation Plan of the Contractholder as it exists on
the Contract Date and any subsequent amendments.
PARTICIPANT means a person on whose behalf funds are on deposit under this
contract.
FUND B is the segregated investment account entitled "American united Life
Fund B" which has been established by the Company to provide the funding for the
variable annuity contracts sold by the Company.
VALUATION PERIOD is a period beginning immediately after a valuation of Fund B
and ending with the next valuation of Fund B. Valuations shall occur as of the
close of trading on the New York Stock Exchange on each day during which the
Exchange is open for trading provided that the Company is open for business.
ANNUITY DEPOSITS means an amount paid on behalf of a Participant by the
Contractholder to the Company at its Home Office.
INDIVIDUAL ACCOUNT is the sum of the accumulation units credited on behalf of a
Participant.
ANNUITY COMMENCEMENT DATE means the Monthly Date on which annuity benefits are
to commence for a Participant, as reported to the Company. The Annuity
Commencement Date must be prior to the Participant's 75th birthday.
VARIABLE ANNUITY is an annuity providing for payments which vary in amount in
accordance with the investment experience of a segregated investment account
such as Fund B.
COMPANION CONTRACT is the group annuity contract issued by the Company to the
Contractholder which provides for fixed dollar annuity payments which are
guaranteed as to dollar amount throughout the payment period.
3
ARTICLE II
ANNUITY DEPOSITS
SECTION 1--ANNUITY DEPOSITS. The Contractholder will direct the Company to
invest all or a portion of the Annuity Deposits made on behalf of a Participant
in Fund B. A Participant's annual Annuity Deposits cannot be less than the
Company's then current established minimum.
SECTION 2--APPLICATION OF ANNUITY DEPOSITS. The Company shall deduct for its
sales and administrative services (provided for by the agreement between the
Company and Fund B) (i) 6% of each Annuity Deposit made for a Participant until
Annuity Deposits under this Contract plus any Annuity Deposits made for the
Participant under any other Fund B contract with the Company total $5,000, and
(ii) 4% of any Annuity Deposits made thereafter for such Participant. The
Company will invest the balance of the Annuity Deposits in Fund B.
SECTION 3--CREDIT OF ACCUMULATION UNITS. The number of accumulation units
credited to an Individual Account will be determined by dividing the balance of
the Annuity Deposit by the dollar value of an accumulation unit immediately
following receipt of the Annuity Deposits by the Company at its Home Office. The
number of accumulation units will not be changed by any subsequent change in the
dollar value of accumulation units.
SECTION 4--CESSATION OF ANNUITY DEPOSITS. Cessation of Annuity Deposits will
occur when the number of Participants on whose behalf Annuity Deposits are being
made is less than 25, if written notice has been given by the Company to the
Contractholder.
Also, cessation of Annuity Deposits will occur if an amendment is made to the
Plan which affects the duties or obligations of the Company; provided that
within 30 days after receiving the amendment, the Company notifies the
Contractholder that the amendment is not acceptable. Unless a mutually
satisfactory agreement is reached within 30 days of the Company's notice,
cessation will occur as of the amendment's effective date.
4
ARTICLE III
VALUATION
SECTION 1--GROSS INVESTMENT RATE AND NET INVESTMENT RATE. The Gross Investment
Rate of Fund B for each Valuation Period is equal to (i) the investment income
and capital gains and losses for the Valuation Period, whether realized or
unrealized, on the assets of Fund B, less a deduction for any applicable taxes
and less expenses of Fund B which are not the contractual liability of the
Company, divided by (ii) the value of the assets of Fund B at the beginning of
the Valuation Period. The Gross Investment Rate may be either positive or
negative. The Net Investment Rate of Fund B for any Valuation Period is equal to
the Gross Investment Rate expressed in decimal form to seven places less a
deduction of .0000328 for each calendar day in the Valuation Period. This
deduction reflects the fee payable to the Company for its mortality risk and
expense guarantees and its investment management services (provided for by the
agreement between the Company and Fund B).
SECTION 2--NET INVESTMENT FACTOR. The net investment factor for each Valuation
Period is the sum of 1.0000000 plus the Net Investment Rate for that Valuation
Period.
SECTION 3--ACCUMULATION UNIT VALUE. The value of an accumulation unit was
established at $1.0000000 on April 3, 1969. The value of an accumulation unit at
the end of any subsequent Valuation Period is determined by multiplying the
value at the end of the previous Valuation Period by the Net Investment Factor
for the specific Valuation Period.
SECTION 4--ANNUITY UNIT VALUE. The value of an annuity unit was established at
$1.0000000 on April 3, 1969. The value of an annuity unit at the end of any
subsequent Valuation Period is determined by multiplying the value of an annuity
unit at the end of the previous Valuation Period by .9999058 for each calendar
day in the specific Valuation Period and by the Net Investment Factor for the
specific Valuation Period.
SECTION 5--VALUATION OF ASSETS. The value of the assets in Fund B
at the end of any Valuation Period will be the aggregate of the
following:
(a) The face amount of cash; plus
(b) When market quotations are readily available with respect to securities,
the total market value of the securities, valued at the closing prices on
that day for securities traded on national securities exchanges, and at the
bid prices quoted on that day for securities traded over the counter; plus
(c) When market quotations are not readily available, or when restricted
securities or other assets are being valued, the fair value as determined
in good faith by the Fund B Board of Managers; minus
5
(d) An amount for taxes on realized and unrealized capital gains and any other
applicable taxes based on income of, assets in, or the existence of, Fund
B; and minus
(e) Liabilities of Fund B other than contract liabilities.
The determination by the Company of the value of the assets and the accumulation
units and annuity units will be conclusive. Any change in the method of
valuation must be approved by the Board of Managers of Fund B.
6
ARTICLE IV
TRANSFER OPTIONS
SECTION 1--TRANSFERS FROM THE COMPANION CONTRACT. If a Participant is also a
Participant under the Companion Contract, the Contractholder may elect to
transfer all or a portion of the Participant's Withdrawal Value under the
Companion Contract to this contract. The amount so transferred will be
considered an Annuity Deposit on the date of transfer.
The Contractholder may also elect to transfer all or a portion of the
Participant's Annuity Value under the Companion Contract to this contract on his
Annuity Commencement Date to provide the Participant a Variable Annuity. The
amount so transferred will be considered an Annuity Deposit on the date of
transfer.
SECTION 2--TRANSFERS TO THE COMPANION CONTRACT. The Contractholder may, prior to
a Participant's Annuity Commencement Date, by filing written request with the
Company at its Home Office on a form satisfactory to the Company, elect to
transfer all or a portion of the value of the Participant's Individual Account
to the Companion Contract.
The Contractholder may also elect to transfer all or a portion of the value of
the Participant's Individual Account to the Companion Contract on his Annuity
Commencement Date to provide the Participant a fixed dollar annuity settlement
under the Companion Contract.
Transfers to the Companion Contract will be made by the Company at the end of
the Valuation Period in which such written request is received by the Company or
at the end of any later Valuation Period selected by the Contractholder.
7
ARTICLE V
BENEFITS
SECTION 1--VARIABLE ANNUITY BENEFITS. At the Contractholder's request a
Participant's Individual Account will be applied as of his Annuity Commencement
Date to provide a monthly Variable Annuity beginning on that date.
On behalf of the Contractholder, the annuity will be payable to the Participant
under one of the following options as specified in the Contractholder's written
request. If no such written notice has been received by the Company at least 30
days prior to the Participant's 75th birthday, his Annuity Value shall be
automatically applied under Option 2 as a 10 year Certain and Life Annuity.
OPTION 1--LIFE ANNUITY. The monthly annuity will be payable to the
Participant for as long as he lives.
OPTION 2-- CERTAIN AND LIFE ANNUITY. The monthly annuity will be payable to
the Participant for as long as he lives. If the Participant dies before
receiving payments for the certain period (5, 10, or 15 years, as specified
in the election), any remaining payments for the balance of the certain
period will be paid to his beneficiary.
OPTION 3--SURVIVORSHIP ANNUITY. The monthly annuity will be payable to the
Participant for as long as he lives. After the death of the Participant, a
portion (all, 2/3 or 1/2, as specified in the election) of the monthly
annuity will be paid to his contingent annuitant for as long as he lives.
An election of this option will be cancelled automatically if either the
Participant or contingent annuitant dies prior to the Annuity Commencement
Date.
OPTION 4--UNIT REFUND ANNUITY. The monthly annuity will be payable to the
Participant for as long as he lives. At the death of the Participant, his
beneficiary will receive a single sum payment of the then dollar value of
the number of annuity units equal to the excess of (a) the total amount
applied under this option divided by the annuity unit value at the Annuity
Commencement Date over (b) the number of annuity units represented by each
monthly payment multiplied by the number of monthly payments made.
Any other options, including annuities for a fixed period, mutually agreed upon
between the Contractholder and the Company will be made available.
8
In no event will any option elected provide annuity benefits which would extend
for a certain period beyond the life expectancy of a Participant or the joint
life expectancy of a Participant and his contingent annuitant, as determined on
the Annuity Commencement Date.
The Tables show the dollar amount of the first monthly payment which can be
purchased with $1,000 of value in a Participant's Individual Account, after
deduction of any applicable premium taxes. The value of an Individual Account
will be computed at the valuation which follows the eighteenth day of the month
prior to the Participant's Annuity Commencement Date.
The amount of the first monthly payment shall be divided by the Annuity Unit
Value at the valuation which follows the eighteenth day of the month prior to
the Participant's Annuity Commencement Date to determine the number of annuity
units on which subsequent payments are based. The amount of each monthly
Variable Annuity payment after the first monthly payment will be equal to this
number of annuity units multiplied by the Annuity Unit Value at the valuation
which follows the eighteenth day of the month prior to the month in which the
payment is due.
If the yearly amount of the annuity payable is less than the Company's
established minimum on the Annuity Commencement Date, the Company may pay the
annuity on a less frequent basis.
If the dollar value of a Participant's Individual Account is less than $1,750.00
on his Annuity Commencement Date, or on the date he becomes an Inactive
Participant, the Company may pay the dollar value in cash in full settlement of
all benefits otherwise payable to such Participant.
SECTION 2 -- SINGLE SUM BENEFITS. Upon the Contractholder's written request, the
payment of benefits to a Participant on his Annuity Commencement Date shall be
made in a single sum. The amount paid in a single sum will be equal to the value
of the Participant's Individual Account, determined as of the end of the
Valuation Period in which the request is received, and will be in lieu of the
benefits otherwise provided under this contract for such Participant, his
beneficiary or his contingent annuitant.
SECTION 3--EMERGENCY WITHDRAWALS. If a Participant is faced with an unforseeable
emergency (as defined in the Plan), the Company, upon receipt of the
Contractholder's written request, will pay to the Participant all or a portion
of the value of Participant's Individual Account, determined as of the end of
the Valuation Period in which the request is received. This withdrawal will be
paid in lieu of the benefits otherwise provided under this contract for the
Participant, his beneficiary or his contingent annuitant.
9
SECTION 4--DEATH BENEFITS. If a Participant dies prior to his Annuity
Commencement Date, the Company, upon receipt of due proof of death, will pay a
benefit equal to the value of the Participant's Individual Account determined at
the end of the Valuation Period in which such proof of death is received by the
Company. At the Contractholder's request and on his behalf, the benefit will be
paid to the beneficiary in one sum or as a monthly annuity under one of the
options in Section 1 of this Article. If the Participant has not made an.
election prior to his death, the beneficiary may make such an election.
10
ARTICLE VI
GENERAL PROVISIONS
SECTION 1--CONTRACT. This contract and the application of the Contractholder, a
copy of which is attached to and made a part of the contract, constitute the
entire contract. No agent or other person, except an officer of the Company, can
change this contract or waive any of its conditions.
SECTION 2--OWNERSHIP. The value of all Annuity Deposits received under this
contract and the value of all property and rights purchased with, and all income
attributable to such Annuity Deposits shall remain (until made available to the
Participant or other beneficiary) solely the property and rights of the
Contractholder (without being restricted to the provision of benefits under the
Plan) subject only to the claims of the Contractholder's general creditors.
SECTION 3--BENEFICIARY. Beneficiaries are as designated on the Contractholder's
records in accordance with a Participant's written request.
SECTION 4--DIVIDENDS. This contract's share of the divisible surplus, if any,
will be determined annually by the Company and credited as a dividend on the
Contract Anniversary. Any dividend credited to this contract will be in the form
of an adjustment in the next succeeding year to the deduction from Annuity
Deposits, as provided in Article III, Section 2, or in the form of additional
accumulation units credited to the Participant's Individual Account or in the
form of additional annuity units, as applicable. Any additional units credited
will be considered Annuity Deposits in the year credited for the purpose of
determining the guarantees applicable.
SECTION 5--AMENDMENTS. The Company reserves the right to change any of the
provisions of this contract after the fifth Contract Year. The Company must give
written notice to the Contractholder of its intention to so amend at least 30
days prior to the date the amendment is to take effect. Any such amendment will
not apply to Annuity Deposits made prior to the effective date of the amendment.
Also, this contract may be changed at any time as to any of its provisions by
written agreement between the Contractholder and the Company without the consent
of any Participant, beneficiary and contingent annuitant. Such an amendment will
be binding on each tax Participant, beneficiary and contingent annuitant.
This contract may also be amended or changed at any time by the Company without
the consent of the Contractholder or any Participant, beneficiary or contingent
annuitant if such amendment or change is necessary to permit the contract or the
Plan to meet the requirements of any federal or state statute or rule or
regulation of the U.S. Treasury Department.
11
SECTION 6--MISSTATEMENTS. If the age or sex of any Participant or contingent
annuitant is misstated, the amount of annuity payable by the Company will be
adjusted to the amount the value of the Participant's Individual Account would
have provided on the Annuity Commencement Date using the correct age and sex.
Any overpayments will be deducted from future amounts payable, and any
underpayments will be paid in full with the next payment.
SECTION 7--INFORMATION, PROOFS AND DETERMINATION OF FACTS. The Contractholder
will furnish the Company with any information which, in the opinion of the
Company, is necessary for the administration of this contract.
SECTION 8--FACILITY OF PAYMENT. If any Participant, contingent annuitant or
beneficiary is legally incapable of giving a valid receipt for any payment due
him and no guardian has been appointed, the Company may make such payment to the
person or persons who have assumed the care and principal support of such
Participant, contingent annuitant or beneficiary, except that any payment due a
minor will be paid at a rate not exceeding $100.00 per month. Any payment made
by the Company will fully discharge the Company to the extent of such payment.
SECTION 9--PRONOUNS. Masculine pronouns used in this contract shall include both
masculine and feminine gender unless the context indicates otherwise.
SECTION 10--RELATION OF THIS CONTRACT TO FUND B. The Company shall have absolute
ownership of the assets in Fund B.
SECTION 11--VOTING. The Contractholder shall not be entitled to vote at meetings
of the policyholders of the Company but shall be entitled to vote at meetings of
the participants of Fund B in accordance with the Rules and Regulations of Fund
B.
SECTION 12--TRANSFER TO SUBSTITUTE FUNDING MEDIUM. At the written election of
the Contractholder, the Company will pay to a substitute funding medium an
amount equal to the value of all unapplied accumulation units determined at the
end of the Valuation Period in which the election is received by the Company at
its Home Office.
12
TABLE OF BENEFIT OPTION VALUES
Amounts shown in Table I are based upon the 1951 Group Annuity Table, projected
to 1967 by Scale C, with interest at the rate of 3 1/2% per annum. Amounts shown
in Table I are for exact adjusted ages ant must be interpolated between ages for
each full month of adjusted age in excess of the exact age. For convenience in
interpolation Table II gives the addition to Table I for each month of adjusted
age in excess of that exact age.
The adjusted age is determined by the following process:
MALES
1. Determine the Participant's age in years and full months on the date
retirement payments are to commence, and
2. Deduct one month for each year his calendar year of birth exceeds 1900AD,
or add one month for each year his calendar year of birth precedes 1900AD.
FEMALES
1. Determine the Participant's age in years and full months on the date
retirement payments are to commence, and
2. Deduct five years from such age, and
3. Deduct one month for each year her calendar year of birth exceeds 1900AD,
or add one month for each year her calendar year of birth precedes 1900AD.
All monthly payments will be rounded to the nearest cent with exact one-half
cents rounded up.
Example: A male participant born on June 15, 1903 decides to retire and receive
his first annuity check on January 1, 1968. His exact age on January 1, 1968 is
64 years, 6 months and 16 days. His calendar year of birth exceeds 1900AD by 3
years and therefore his adjusted age is 64 years and 3 months. His annuity
payable for life with 120 payments guaranteed is $6.6296 plus 3 times 0.0142 or
$6.6722 per $1,000 of proceeds applied on January l, 1968.
A female participant born on the same date and retiring on the same date would
have an adjusted age of 59 years and 3 months and her annuity on the same option
would be $5.8700 plus 3 times 0.0117 or $5.9051 per $1,000 of proceeds applied
on January l, 1968.
P-9979
13
TABLE I
Dollar Amount of the First Monthly Payment Which is Purchased with Each $1,000
of Proceeds Applied for Each Full Year of Adjusted Exact Age.
Adjusted Options 1, 2 and 4 - Single Life Annuities
Exact Age ----------------------------------------------------------------------------
in Full Period Certain
Years ----------------------------------------------------------------------------- Unit
------- None 5 Years 10 Years 15 Years 20 Years Refund
------- ------- -------- -------- -------- ------
45 $4.5100 $4.5004 $4.4696 $4.4196 $4.3400 $4.3396
46 4.5904 4.5796 4.5404 4.4796 4.3904 4.3804
47 4 6696 4.6600 4.6196 4.5504 4,4504 4.4404
48 4 7596 4.7500 4.7000 4.6200 4.5104 4.5100
49 4.8496 4.8400 4.7804 4.6896 4.5704 4.5796
50 4.9504 4.9300 4.8704 4.7700 4.6304 4.6504
51 5.0500 5.0296 4.9604 4.8504 4.6904 4.7296
52 5.1604 5.1304 5.0600 4.9296 4.7600 4.8004
53 5.2696 5.2396 5.1596 5.0196 4.8200 4.8904
54 5.3896 5.3596 5.2604 5.1000 4.8800 4.9804
55 5.5204 5.4796 5.3696 5.1900 4.9496 5.07C4
56 5.6596 5.6104 5.4896 5.2800 5.0096 5.1604
57 5.8000 5.7496 5.6096 5.3796 5.0804 5.2696
58 5.9500 5.8996 5.7404 5.~804 5.1404 5.3704
59 6.1204 6.0604 5.8700 5.5800 5.2004 5.4904
60 6.2896 6.2200 6.0104 5.6796 5.2604 5.6104
61 6.4~04 6.4000 6.1604 5.7804 5.3204 5.7304
62 6.6904 6.5896 6.3104 5.8800 5.3696 5.8600
63 6 9100 6.7900 6.4700 5.9796 5.4200 6.0000
64 7 1404 7.0096 6.6296 6.0804 5.4704 6.1504
65 7.3900 7.2400 6.8000 6.1800 5.5100 6.3100
66 7.6600 7.4800 6.9800 6.2796 5.5496 6.4696
67 7.9504 7.7404 7.1600 6.3696 5.5904 6.6400
68 8.2600 8.0104 7.3400 6.4596 5.6204 6.8296
69 8.5996 8.2996 7.5200 6.5400 5.6396 7.0204
70 8.9596 8.6104 7.7096 6.6204 5.6696 7.2196
71 9.3496 8.9296 7.3896 6.6~00 5.6804 7.4404
72 9.7804 9.2800 8.0696 6.7596 5.6996 7,6696
73 10,2400 9.6400 8.9496 6.8100 5.7104 7.9C00
74 10.7296 10.0096 8.4200 6.8604 5.7200 8.1496
75 11.2696 10.4104 S.5796 6.9096 5.7296 8.4196
67GA35-0
TABLE I (continued)
OPTION 3 - Survivorship Annuity Sample Values
Adjusted
Exact Age Adjusted Exact Age of the Contingent Annuitant in Full Year
of the 50 55 60 65 70
Annuitant -- -- -- -- --
in Full Years With 100% Payable to Surviving Contingent Annuitant
------------- -------------------------------------------------------------------------
50 4.3032 4.4616 4.5936 4.7088 4.7940
55 4.4616 4.6836 4.8876 5.0784 5.2272
60 4.5936 4.8876 5.1864 5.4828 5.7360
65 4.7088 5.0784 5.4828 5.9160 6.3288
70 4.7940 5.2272 5.7360 6.3288 6.9552
With 66 2/3% Payable to Surviving Contingent Annuitant
-------------------------------------------------------------------------
50 4.4988 4.6128 4.7064 4.7868 4.8456
55 4.7664 4.9332 5.0820 5.2176 5.3208
60 5.0484 5.2812 5.5092 5.7288 5.9112
65 5.3568 5.6700 6.0000 6.3372 6.6480
70 5.6736 6.0696 6.5184 7.0152 7.5156
With 50% Payable to Surviving Contingent-Annuitant
------------------------------------------------------------------------
50 4.6044 4.6932 4.7664 4.8264 4.8720
55 4.9356 5.0688 5.1852 5.2908 5.3700
60 5.3124 5.5020 5.6868 5.8608 6.0036
65 5.7540 6.0216 6.2964 6.5736 6.8196
70 6.2472 6.6036 6.9960 7.4184 7.8336
Values for ages not show. in these Tables will be furnished any Participant upon
request and will be calculated on the same basis as those shown in these Tables.
67GA35-0
TABLE II - Interpolation Factor for Table I
Dollar Amount to be added to Table I for each Full Month of Adjusted Age in
Excess of the Adjusted Exact Age in Full Years.
Table I
Options 1. 2 and 4 - Single Life
Adjusted -----------------------------------------------------------------------------
Exact Age Period Certain
In Full ----------------------------------------------------------------------------- Unit
Years None 5 Years 10 Years 15 Years 20 Years Refund
----- ------- ------- -------- -------- -------- -------
55 $0.0116 $0.0109 $0.0100 $0.0075 $0.0050 $0.0075
56 0.0117 0.0116 0.0100 0.0083 0.0059 0.0091
57 0.0125 0.0125 0.0109 0.0084 0.0050 0.0084
58 0.0142 0.0134 0.0108 0.0083 0.0050 0.0100
59 0.0141 0.0133 0.0117 0.0083 0.0050 0.0100
60 0.0159 0.0150 0.0125 0.0084 0.0050 0.0100
61 0.0175 0.0158 0.0125 0.0083 0.0041 0.0108
62 0.0183 0.0167 0.0133 0.0083 0.0042 0.0177
63 O.Ol92 0.0183 0.0133 0.0084 0.0042 0.0125
64 0.0208 0.0192 0.0142 0.0083 0.0033 0.0133
65 0.0225 0.0200 0.0150 0.0083 0.0033 0.0133
66 0.0242 0.0217 0.0150 0.0075 0.0034 0.0142
67 0.0258 0.0225 0.0150 0.0075 0:0025 0.0158
68 0.0283 0.0241 0.0150 0.0067 0.0016 0.0159
69 0.0300 0.0259 0.0158 0.0067 0.0025 0.0166
70 0.0325 0.0266 0.0150 0.0058 0.0009 0.0184
71 0.0359 0.0292 0.0150 0.0058 0.0016 0.0191
72 0.0383 0.0300 0.0150 0.0042 0.0009 0.0192
73 0.0408 0.0308 0.0142 0.0042 0.0008 0.0208
74 0.0450 0.0334 0.0133 0.0041 0.0008 0.0225
67GA35-0
DESCRIPTION OF
GROUP ANNUITY CONTRACT
Legal Name ________________________________
Address _________________________________________
Contract Effective Date _________________________
(Beginning date must be first day of month desired)
To Provide (check appropriate boxes):
TAX DEFERRED ANNUITIES
__ 403 (b) Account (TSA)
Fixed Plan __ Variable Plan __
__ Individual Retirement Account
Fixed Plan __ Variable Plan __
Deposits to begin_______, 19_____________
IMPORTANT All payments and values provided by the variable part of this contract
since based on the investment experience of a separate account are variable and
are not guaranteed to dollar amount.
QUALIFIED PENSION PLAN
__ Money Purchase Plan
__ Profit Sharing Plan
__ _______________________________
Advance payment of $ _________________ is submitted.
Date ___________________ By:____________________________
________________________ _______________________________
(Agent/Registered Rep.) (Title of Officer)
Accepted By: ________________________________________
American United Life Insurance Company
p-7116 E va-45. XXX
