EXHIBIT 4 (c)
Form of Group Variable Annuity Policy (11VAN0896GP)
Wilmington, Delaware 19899-0667
A capital stock company
This Group Contract is a contract between AIG Life Insurance Company ("We", "Us"
or "Our") and the Group Contractholder ("You" or "Your") shown on the Group
Contract Schedule.
Subject to the terms of this Group Contract and the Certificates We issue to
each Certificateholder, We will provide the benefits described in this Group
Contract. We do this in return for the application of the Group Contractholder,
and any required individual applications for annuity coverage on the
Annuitant(s) and for the payment of the premiums.
This Group Contract becomes effective at 12:01 A.M. Standard Time on the Group
Contract Effective Date at the address of the Group Contractholder and will
continue in force, in accordance with the applicable provisions, unless
terminated in accordance with its provisions.
This Group Contract is non-participating and is not entitled to share in Our
surplus earnings.
/s/ Xxxxxxxxx X. Xxxx /s X X X'Xxxxxxx
Secretary President
GROUP VARIABLE ANNUITY GROUP CONTRACT
Non-Participating
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INDEX
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Group Contract Sections Page
Group Contract Schedule 3
Group Contract Provisions 4
GROUP CONTRACT SCHEDULE
GROUP CONTRACT NUMBER [00004]
GROUP CONTRACTHOLDER [Direct Consumer's Group Trust Dated April 8, 1996]
GROUP CONTRACT EFFECTIVE DATE [January 15, 1998]
ELIGIBLE PERSONS: [Customers, members or employees of participating
financial institutions]
ANNUITY SERVICE OFFICE: [AIG Life Insurance Company
c/o Delaware Valley Financial Services
000 Xxxxxx Xxxx
P.O. Box 3031
Berwyn, PA 19312-0031
(000) 000-0000]
GROUP CONTRACT PROVISIONS
Eligible Persons. Persons eligible to become Certificateholders under this Group
Contract are those described as Eligible Persons on the Group Contract Schedule.
Certificates. We will issue a Certificate to each Certificateholder describing
the coverage under this Group Contract. The certificate will describe the
benefits of this Group Contract, to whom the benefits will be paid, and the
limitations and conditions that apply.
A certificate may be modified by rider or endorsement issued by Us to be
attached to the certificate. The rider or endorsement will set forth the
modifications to the certificate which affect the Annuitant.
Premiums. All premiums are payable in advance to Us. The initial premium for
each Annuitant is shown on the Contract Schedule of the certificate.
Required Data. The Group Contractholder must give Us all data that We need to
administer this Group Contract.
Examination Of Records. We have the right to examine all records of the Group
Contractholder that pertain to the life insurance provided by this Group
Contract.
Continuation Of This Group Contract. This Group Contract will continue in force,
subject to the Group Contract Termination provision.
Entire Contract. The entire contract consists of this Group Contract, the
certificates, the Group Contractholder's application, each Certificateholder's
application for coverage under this Group Contract, and any attached riders,
endorsements or amendments.
We rely on the Group Contractholder's application to issue this Group Contract
and the individual applications, if any, to issue certificates providing annuity
coverage on each Annuitant. Statements made by the Group Contractholder or any
Annuitant or Certificateholder are deemed to be representations and not
warranties. No such statement will be used to contest this Group Contract, a
certificate or a claim unless a copy of the instrument is furnished to the
person making the statement or to his/her beneficiary.
Changing This Group Contract. This Group Contract may only be changed, in
writing, by one of our executive officers. No other person, including an agent,
has any authority to change or reinstate this Group Contract or extend the time
for paying a premium.
Conformity With State Statutes. Any provision of this Group Contract that, on
the Group Contract Effective Date, conflicts with state laws of the governing
jurisdiction is changed to meet the minimum requirements of those laws.
Group Contract Termination. This Group Contract may only be terminated with
respect to the issuance of new certificates. Either We or the Group
Contractholder may terminate this Group Contract upon giving at least 31 days
written notice to the other. We will not terminate this Group Contract prior to
the end of the first year following the Group Contract Effective Date.
Clerical Error. Clerical error will not void any certificate issued under this
Group Contract which is otherwise validly in force, nor will it keep in force
any certificate that otherwise would end.
Certificate Provisions Made Part Of This Group Contract. The remainder of this
Group Contract consists of provisions that appear in the certificates, riders
and endorsements. A copy of the certificates, riders and endorsements is added
to and made a part of this Group Contract.
AIG LIFE INSURANCE COMPANY
P.O. Box 667
One Alico Plaza
Wilmington, Delaware 19899-0667
GROUP VARIABLE ANNUITY CONTRACT
Non-Participating
