EXHIBIT 4(a)
----GOLDEN SINGLE PREMIUM
-------AMERICAN DEFERRED MODIFIED
---------LIFE INSURANCE GUARANTEED ANNUITY
-----COMPANY CONTRACT
Golden American is a stock company domiciled in Delaware.
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|Annuitant Owner |
|[XXXXXX X. XXX] [XXXX X. XXX] |
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|Single Premium Paid Annuity Option Annuity Commencement Date |
|[$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] |
|----------------------------------------------------------------------------|
|Separate Account(s) Certificate Number |
|[FIXED ACCOUNT] [123456] |
|----------------------------------------------------------------------------|
This is a legal Contract between its Owner and us. Please read it
carefully. In this Contract you or your refers to the Owner shown
above. We, our or us refers to Golden American Life Insurance
Company.
If this Contract is in force, we will make income payments to you
starting on the Annuity Commencement Date. If the Owner dies prior to
the Annuity Commencement Date, we will pay a death benefit to the
Beneficiary. The amount of such benefits is subject to the terms of
this Contract.
RIGHT TO EXAMINE THIS CONTRACT: YOU MAY RETURN THIS CONTRACT TO US OR
THE AGENT THROUGH WHOM YOU PURCHASED IT WITHIN 10 DAYS AFTER YOU
RECEIVE IT. IF SO RETURNED, WE WILL TREAT THE CONTRACT AS THOUGH IT
WERE NEVER ISSUED. UPON RECEIPT WE WILL PROMPTLY REFUND THE
ACCUMULATION VALUE, ADJUSTED FOR ANY MARKET VALUE ADJUSTMENT.
ALL PAYMENTS AND VALUES PLACED IN THE FIXED ACCOUNT MAY BE SUBJECT TO
A MARKET VALUE ADJUSTMENT, THE OPERATION OF WHICH MAY CAUSE SUCH
PAYMENTS AND VALUES TO INCREASE OR DECREASE.
Signed for Golden American Life Insurance Company on the Contract Date.
Customer Service Center Secretary: /s/ Xxxxx X. Xxxxxxx
0000 Xxxxxxxx Xxxxx ---------------------
Xxxx Xxxxxxx, XX 00000 President:/s/ Xxxxxxx Xxxxxxx
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SINGLE PREMIUM DEFERRED MODIFIED GUARANTEED ANNUITY CONTRACT
Annuity benefit payable at Commencement Date. Death benefit payable
in event of the Owner's death prior to Commencement Date. Benefits
guaranteed if the Contract is held for a period equal to the current
Guarantee Period. The Cash Surrender Values are based on a separate
account Market Value Adjustment formula if the annuity is held for a
shorter period. CASH SURRENDER VALUES MAY INCREASE OR DECREASE BASED
ON THE MARKET VALUE ADJUSTMENT FORMULA. Nonparticipating.
GA-IA-1070 6/00
CONTRACT CONTENTS
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THE SCHEDULE......................3 YOUR CERTIFICATE BENEFITS......10
Charges and Fees................3 Cash Surrender Value Benefit
Income Plan Factors.............3A Partial Withdrawal Option
Proceeds Payable to the
IMPORTANT TERMS...................4 Beneficiary
Exemption of Benefits
INTRODUCTION TO THIS CERTIFICATE..6
CHOOSING AN INCOME PLAN........12
The Certificate
The Owner Annuity Benefits
The Annuitant Annuity Commencement Date Selection
The Beneficiary
Change of Owner or Beneficiary Frequency Selection
The Income Plan
HOW WE MEASURE THE CERTIFICATE'S The Annuity Options
ACCUMULATION VALUE................8 Payment When Named Person Dies
Single Premium Payment OTHER IMPORTANT INFORMATION....14
Accumulation Value
Fixed Account Entire Contract
Guarantee Periods Sending Notice to Us
Market Value Adjustments Reports to Owner
Assignment - Using this Certificate as
Collateral Security
Changing this Certificate
Certificate Changes-Applicable Tax Law
Misstatement of Age or Sex
Non-Participating
Payments We May Defer
Authority to Make Agreements
Required Note on Our Computations
Copies of any additional riders and endorsements are at the back of this
Certificate.
THE SCHEDULE
The Schedule gives specific facts about this Contract and its
coverage. Please refer to the Schedule while reading this
Contract.
GA-IA-1070 2 6/00
THE SCHEDULE
CHARGES AND FEES
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|Annuitant Owner Joint Owner |
|[XXXXXX X. XXX] [XXXX X. XXX] [XXXX X. XXX] |
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|Annuitant's Issue Age Annuitant's Sex Owner's Issue Age |
|[55] [MALE] [35] |
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|Single Premium Paid Annuity Option Annuity Commencement Date |
|[$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] |
|----------------------------------------------------------------------------|
|Certificate Date Issue Date Residence State |
|[JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] |
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|Initial Guarantee Period Initial Guaranteed Certificate Number |
|[10 YEARS] Interest Rate [123456] |
| [6.0%] |
|----------------------------------------------------------------------------|
|Separate Account(s) |
|[FIXED ACCOUNT] |
|----------------------------------------------------------------------------|
Surrender Charges
The Surrender Charge is imposed if the Contract is surrendered or an
excess Partial Withdrawal is taken at any time other than the 30 days
immediately preceding the Maturity Date of a Guarantee Period. The
Surrender Charge is calculated as a percentage of the Accumulation
Value withdrawn or surrendered, adjusted by the Market Value
Adjustment. Surrender Charges vary according to the duration of the
Guarantee Period. The Surrender Charges are 8% in the first year,
then decrease by 1% per year thereafter until the end of the Guarantee
Period as shown in the following schedule:
YEAR IN
GUARANTEE PERIOD 1 2 3 4 5 6 7 8 9 10
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% 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0.0
Surrender Charges restart at the beginning of each Guarantee Period for
the life of the Contract. We currently offer Guarantee Periods of
[1,3, 5, 6, 7, 8, 9, and 10] year(s).
Premium Taxes
We deduct the amount of any Premium or other state and local taxes
levied by any state or governmental entity when such taxes are
incurred.
We reserve the right to defer collection of Premium Taxes until
surrender or until the application of Accumulation Value to an Annuity
Option. An excess Partial Withdrawal will result in the deduction of
any Premium Tax then due us on such amount. No interest will be
credited on Premium Tax deducted. We reserve the right to change the
amount we charge for Premium Tax charges to conform with changes in the
law or if the Owner changes state of residence.
GA-IA-1070 3 6/00
THE SCHEDULE
INCOME PLAN FACTORS
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|----------------------------------------------------------------------------|
|Annuitant Owner |
|[XXXXXX X. XXX] [XXXX X. XXX] |
|----------------------------------------------------------------------------|
|Single Premium Paid Annuity Option Annuity Commencement Date |
|[$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] |
|----------------------------------------------------------------------------|
|Separate Account(s) Certificate Number |
|[FIXED ACCOUNT] [123456] |
|----------------------------------------------------------------------------|
Minimum Monthly Annuity Income Payment: $[20].
Values for other payment periods, ages or joint life combinations are
available on request. Monthly payments are shown for each $1,000
applied with payments starting one month after proceeds have been
applied to the payment plan.
TABLE FOR INCOME FOR A FIXED PERIOD
Fixed Period Monthly Fixed Period Monthly Fixed Period Monthly
of Years Income of Years Income of Years Income
[5 17.95 14 7.28 23 5.00
6 15.18 15 6.89 24 4.85
7 13.20 16 6.54 25 4.72
8 11.71 17 6.24 26 4.60
9 10.56 18 5.98 27 4.49
10 9.64 19 5.74 28 4.38
11 8.88 20 5.53 29 4.28
12 8.26 21 5.33 30 4.19]
13 7.73 22 5.16
TABLE FOR INCOME FOR LIFE
Male/Female Male/Female Male/Female
Age 10 Years Certain 20 Years Certain Refund Certain
[50 $4.06/3.83 $3.96/3.77 $3.93/3.75
55 4.43/4.14 4.25/4.05 4.25/4.03
60 4.90/4.56 4.57/4.37 4.66/4.40
65 5.51/5.10 4.90/4.73 5.12/4.83
70 6.26/5.81 5.18/5.07 5.76/5.42
75 7.11/6.70 5.38/5.33 6.58/6.19
80 7.99/7.70 5.48/5.46 7.69/7.21
85 8.72/8.59 5.52/5.51 8.72/8.59
90 9.23/9.18 5.53/5.53 10.63/10.53]
GA-IA-1070 3A 6/00
IMPORTANT TERMS
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ACCUMULATION VALUE - The Accumulation Value equals the Single Premium
Paid less Partial Withdrawals and any Premium Taxes accumulated with
interest. Interest is calculated from the Contract Date.
ANNUITANT - The person designated by the Owner to be the measuring
life in determining Annuity Payments.
ANNUITY COMMENCEMENT DATE - For each Contract, the date on which
Annuity Payments begin.
ANNUITY OPTIONS - Options the Owner selects that determine the form
and amount of annuity payments.
ANNUITY PAYMENT - The periodic payment an Owner receives. It may be
either a fixed or a variable amount based on the Annuity Option chosen.
BENEFICIARY - The person designated to receive benefits in the case of
the death of the Owner.
CASH SURRENDER VALUE - The amount the Owner receives upon surrender of
the Contract.
CONTINGENT ANNUITANT - The person designated by the Owner who, upon
the Annuitant's death prior to the Annuity Commencement Date, becomes
the Annuitant.
CONTRACT ANNIVERSARY - The anniversary of the Contract Date.
CONTRACT DATE - The date we received the Premium and upon which we
begin determining the Contract values. It may not be the same as the
Contract Issue Date. The Contract Date is the date used to determine
Contract months, processing dates, years, and anniversaries.
CONTRACT ISSUE DATE - The date the Contract is issued at our Customer
Service Center.
CONTRACT YEAR - The period between Contract Anniversaries.
GUARANTEE PERIOD - The period of years a rate of interest is
guaranteed to be credited to the Accumulation Value.
GUARANTEED INTEREST RATE - The effective annual interest rate which we
will credit for a specified Guarantee Period.
ISSUE AGE - The Annuitant's or Owner's age on the last birthday on or
before the Contract Date.
MARKET VALUE ADJUSTMENT - A positive or negative adjustment. It may
apply if all or part of the Cash Surrender Value is withdrawn prior to
the Maturity Date of the Guarantee Period.
MATURITY DATE - The date on which a Guarantee Period matures. The
Maturity Date is the last day of the last Contract Year in the
Guarantee Period.
NONPARTICIPATING - This Contract will not pay dividends. It will not
participate in any of our surplus or earnings.
GA-IA-1070 4 6/00
IMPORTANT TERMS (continued)
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OWNER - The person (persons if there is a joint Owner, or entity if
the Owner is not an individual) who owns the Contract and is entitled
to exercise all rights of the Contract. This person's death also
initiates payment of the death benefit.
PREMIUM - The payment amount required to put each Contract in effect.
PREMIUM TAX - Premium Tax means any tax or fee imposed or levied by
any federal or state government, or political subdivision thereof, on
the Premium of this Contract.
GA-IA-1070 5 6/00
INTRODUCTION TO THIS CONTRACT
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THE CONTRACT
This is a legal Contract between you and us. We provide benefits as
stated in this Contract. In return, you supply us with the Single
Premium Payment required to put this Contract in effect.
This Contract, together with any riders or endorsements, constitutes
the entire Contract. Riders and endorsements add provisions or change
the terms of the basic Contract.
THE OWNER
You are the Owner of this Contract. You are also the Annuitant unless
another Annuitant has been named by you and is shown in the Schedule.
You have the rights and options described in this Contract, including
but not limited to the right to receive the Annuity Benefits on the
Annuity Commencement Date.
One or more people may own this Contract. In the case of a sole Owner
who dies prior to the Annuity Commencement Date, we will pay the
Beneficiary the death benefit then due. If the sole Owner is not an
individual, we will treat the Annuitant as Owner for the purpose of
determining when the Owner dies under the death benefit provision (if
there is no Contingent Annuitant), and the Annuitant's age will
determine the applicable death benefit payable to the Beneficiary.
The sole Owner's estate will be the Beneficiary if no Beneficiary
designation is in effect, or if the designated Beneficiary has
predeceased the Owner. In the case of a joint Owner of the Contract
dying prior to the Annuity Commencement Date, the surviving Owner(s)
will be deemed as the Beneficiary(ies).
THE ANNUITANT
The Annuitant is the measuring life of the Annuity Benefits provided
under this Contract. You may name a Contingent Annuitant. The
Annuitant may not be changed during the Annuitant's lifetime.
If the Annuitant dies before the Annuity Commencement Date, the
Contingent Annuitant becomes the Annuitant. You will be the
Contingent Annuitant unless you name someone else. The Annuitant must
be a natural person. If the Annuitant dies and no Contingent
Annuitant has been named, we will allow you sixty days to designate
someone other than yourself as an Annuitant. If all Owners are not
individuals and, through the operation of this provision, an Owner
becomes Annuitant, we will pay the death proceeds to the Beneficiary.
If there are joint Owners, we will treat the youngest of the Owners as
the Contingent Annuitant designated, unless you elect otherwise.
THE BENEFICIARY
The Beneficiary is the person to whom we pay death proceeds if any
Owner dies prior to the Annuity Commencement Date. See Proceeds
Payable to the Beneficiary for more information. We pay death
proceeds to the primary Beneficiary (unless there are joint Owners in
which case the death benefit proceeds are payable to the surviving
Owner). If the primary Beneficiary dies before the Owner, the death
proceeds are paid to the Contingent Beneficiary, if any. If there is
no surviving Beneficiary, we pay the death proceeds to the Owner's
estate.
Unless otherwise provided, benefits will be paid as though the
Beneficiary died before the Owner if:
(1) the Beneficiary dies at the same time as the Owner; or
(2) within 24 hours of the Owner's death.
GA-IA-1070 6 6/00
INTRODUCTION TO THIS CONTRACT (continued)
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One or more persons may be named as primary Beneficiary or contingent
Beneficiary. In the case of more than one Beneficiary, we will assume
any death proceeds are to be paid in equal shares to the surviving
Beneficiaries. You can specify other than equal shares.
You have the right to change Beneficiaries, unless you designate the
primary Beneficiary irrevocable. When an irrevocable Beneficiary has
been designated, you and the irrevocable Beneficiary may have to act
together to exercise the rights and options under this Contract.
CHANGE OF OWNER OR BENEFICIARY
During your lifetime and while this Contract is in effect you can
transfer ownership of this Contract or change the Beneficiary. To
make any of these changes, you must send us written notice of the
change in a form satisfactory to us. The change will take effect as
of the day the notice is signed. The change will not affect any
payment made or action taken by us before recording the change at our
Customer Service Center. See Proceeds Payable to Beneficiary.
GA-IA-1070 7 6/00
HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE
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SINGLE PREMIUM PAYMENT
The Single Premium Payment is required to put this Contract in effect.
The amount of the Single Premium Payment is shown in the Schedule. If
any check presented as payment of any part of the Premium for this
Contract is not honored, this Contract will be void.
ACCUMULATION VALUE
The Accumulation Value equals the Single Premium Paid less any Partial
Withdrawals and any Premium Taxes accumulated with interest. Interest
is calculated from the Contract Date.
The rates of interest will be as we declare. The Initial Guaranteed
Interest Rate will be credited each Contract Year during the Initial
Guarantee Period. Guaranteed Interest Rates will be determined for
subsequent Guarantee Periods at the beginning of that period and
credited each Contract Year during the current Guarantee Period.
Interest will be credited daily at a rate to yield the declared annual
Guaranteed Interest Rate. The Initial Guaranteed Interest Rate and
any Guaranteed Interest Rates declared for subsequent Guarantee
Periods will not be less than 3%.
In case of a full or Partial Withdrawal, interest will be credited on
the portion of the Accumulation Value surrendered up to the date the
surrender is requested. Accumulation Values at any date within a
Contract Year will be determined by us with allowance for the time
elapsed in the Contract Year. No interest will be credited on any
Premium Tax deducted.
FIXED ACCOUNT
The Fixed Account is a separate account under state insurance law and
is not required to be registered with the Securities and Exchange
Commission under the Investment Company Act of 1940. The Fixed
Account includes your Single Premium Paid which we credit with fixed
rates of interest for the Guarantee Period you select. We reset the
interest rates for subsequent Guarantee Periods based on our sole
discretion.
GUARANTEE PERIODS
The Initial Guarantee Period is selected by you from among the
durations then being offered by the Company and is shown in The
Schedule on page 3. The length of the Initial Guarantee Period will
determine the Initial Guaranteed Interest Rate.
Upon the expiry of a Guarantee Period, a subsequent Guarantee Period
will begin. Each subsequent Guarantee Period will be the same length
as the previous Guarantee Period, unless a) you elect a different
duration from among those then being offered by the Company; or b) the
new Guarantee Period would extend beyond the Annuity Commencement Date
then in effect. If the period remaining from the expiry of the
previous Guarantee Period to the Annuity Commencement Date is less
than the period you have elected or the period expiring, the next
shortest period then available that will not extend beyond the Annuity
Commencement Date will be offered to you.
We will notify you prior to the Maturity Date of your options for
renewal. In order to elect a different Guarantee Period, you must
notify the Company in writing before the end of the 30-day period
immediately preceding the Maturity Date of the current Guarantee
Period. You may not select a Guarantee Period that would extend
beyond the Annuity Commencement Date then in effect.
We reserve the right to offer Guarantee Periods of durations other
than those available on the Contract Date. We also reserve the right
to cease offering a particular Guarantee Period or Periods.
GA-IA-1070 8 6/00
HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
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MARKET VALUE ADJUSTMENTS
A Market Value Adjustment will be applied upon withdrawal or
application to an Income Plan if made more than 30 days prior to the
Maturity Date of the current Guarantee Period, except on free Partial
Withdrawal amounts as described on page 10.
Market Value Adjustments will be applied as follows:
(a) The Market Value Adjustment will be applied to the amount
withdrawn before deduction of any applicable Surrender Charge.
(b) For a Partial Withdrawal, the Market Value Adjustment will be
calculated on the total amount that must be withdrawn, in order to
provide the amount requested.
The Market Value Adjustment is determined by multiplying the amount of
the Accumulation Value withdrawn by the following factor:
(( 1 + I ) N/365
----------------------
( 1 + J + .0050)) -1
Where I is the Index Rate on the first day of the applicable Guarantee
Period; J is the Index Rate for new Guarantee Periods equal to the
number of years (fractional years rounded up to the next full year)
remaining in the Guarantee Period at the time of the calculation; and
N is the remaining number of days in the Guarantee Period at the time
of calculation.
The Index Rate is the average of the Ask Yields for the U.S. Treasury
Strips as reported by a national quoting service for the applicable
maturity. The average is based on the period from the 22nd day of the
calendar month two months prior to the calendar month of Index Rate
determination to the 21st day of the calendar month immediately prior
to the month of determination. The applicable maturity date for these
U.S. Treasury Strips is on or next following the last day of the
Guarantee Period. If the Ask Yields are no longer available, the
Index Rate will be determined using a suitable replacement method.
We currently set the Index Rate once each calendar month. However, we
reserve the right to set the Index Rate more frequently than monthly,
but in no event will such Index Rate be based on a period less than 28
days.
GA-IA-1070 9 6/00
YOUR CONTRACT'S BENEFITS
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While this Contract is in effect, there are important rights and
benefits that are available to you. We discuss these rights and
benefits in this section.
CASH SURRENDER VALUE BENEFIT
Cash Surrender Value
The Cash Surrender Value, while the Annuitant is living and before the
Annuity Commencement Date, is determined as follows:
(1) We take the Contract's Accumulation Value;
(2) We adjust for any applicable Market Value Adjustment;
(3) We deduct any Surrender Charges as shown on the Schedule Page;
(4) We deduct any charges shown in the Schedule that have been
incurred but not yet deducted, including any applicable Premium Tax.
BEGINNING ON THE THIRTIETH DAY IMMEDIATELY PRECEDING THE MATURITY DATE
OF A GUARANTEE PERIOD THERE IS NO SURRENDER CHARGE OR MARKET VALUE
ADJUSTMENT. A WRITTEN REQUEST BY YOU FOR SURRENDER OR TRANSFER TO
ANOTHER GUARANTEE PERIOD MUST BE RECEIVED IN OUR CUSTOMER SERVICE
CENTER BEFORE THE END OF SUCH 30-DAY PERIOD OF THE INITIAL OR
SUBSEQUENT GUARANTEE PERIOD. SURRENDER CHARGES AND THE MARKET VALUE
ADJUSTMENT APPLY TO EACH SUBSEQUENT GUARANTEE PERIOD. SURRENDER
CHARGES FOR EACH SUBSEQUENT GUARANTEE PERIOD START AT 8% FOR THE FIRST
YEAR, THEN DECREASE BY 1% PER YEAR BEGINNING IN YEAR 2 UNTIL THE
MATURITY DATE OF THAT GUARANTEE PERIOD.
Canceling to Receive the Cash Surrender Value
At any time while the Annuitant is living and before the Annuity
Commencement Date, you may surrender this Contract to us. To do this,
you must return this Contract with a signed request for cancellation
to our Customer Service Center.
The Cash Surrender Value will vary daily. We will determine the Cash
Surrender Value as of the date we receive the Contract and your signed
request in our Customer Service Center. All benefits under this
Contract will then end.
We will usually pay the Cash Surrender Value within seven days; but,
we may delay payment as described in the Payments We May Defer
provision.
PARTIAL WITHDRAWAL OPTION
You may make a Partial Withdrawal at any time by giving written notice
to us.
The maximum amount that can be withdrawn each Contract Year without
being considered an excess Partial Withdrawal is described below. We
will collect a Surrender Charge and Market Value Adjustment for excess
Partial Withdrawals and a charge for any unrecovered Premium Taxes.
The minimum Partial Withdrawal amount is $100. After a Partial
Withdrawal, the remaining Cash Surrender Value must be at least $1000
to keep the Contract in force.
The free withdrawal amount for a Contract Year is equal to 12 months
of interest earned and not previously withdrawn in the prior 12
months.
Systematic Partial Withdrawals of interest may be elected to commence
after 28 days from the Contract Issue Date and may be taken on a
monthly, quarterly or annual basis. You select the day withdrawals
will be made, but no later than the 28th date of the month. If you do
not elect a day, the Contract Date will be used. The maximum
withdrawal amount is equal to the interest earned for the prior month,
quarter, or year (depending on the frequency selected).
GA-IA-1070 10 6/00
YOUR CONTRACT BENEFITS (continued)
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For any Contract Year in which the total amount withdrawn exceeds the
free withdrawal amount, a Surrender Charge and Market Value Adjustment
will apply to the excess Partial Withdrawal. If the Contract is
surrendered, the Surrender Charge and Market Value Adjustment will
apply to the total amount withdrawn in that Contract Year, including
any Partial Withdrawals.
NO SURRENDER CHARGE OR MARKET VALUE ADJUSTMENT WILL APPLY TO PARTIAL
WITHDRAWALS OR SURRENDERS DURING THE 30 DAYS IMMEDIATELY PRECEDING THE
MATURITY DATE OF A GUARANTEE PERIOD.
PROCEEDS PAYABLE TO THE BENEFICIARY
Prior to the Annuity Commencement Date
If the sole Owner dies prior to the Annuity Commencement Date, we will
pay the Beneficiary the death benefit. The death benefit is equal to
the Accumulation Value as of the date of death. No Surrender Charge
or Market Value Adjustment will be applied. If there are joint Owners
and any Owner dies, we will pay the surviving Owners the death
benefit. We will pay the amount on receipt of due proof of the
Owner's death at our Customer Service Center. Such amount may be
received in a single lump sum or applied to any of the Annuity Options
(see Choosing an Income Plan). When the Owner (or all Owners where
there are joint Owners) is not an individual, the death benefit will
become payable on the death of the Annuitant prior to the Annuity
Commencement Date (unless a Contingent Annuitant survived the
Annuitant). Only one death benefit is payable under this Contract.
In all events, distributions under the Contract must be made as
required by applicable law.
Spousal Continuation upon Death of Owner
If at the Owner's death, the surviving spouse of the deceased Owner is
the Beneficiary, then such surviving spouse may elect to continue the
Contract as their own pursuant to Internal Revenue Code Section 72(s)
or the equivalent provisions of the U.S. Treasury Department rules for
qualified plans.
How to Claim Payments to Beneficiary
We must receive proof of the Owner's (or the Annuitant's) death before
we will make any payments to the Beneficiary. We will calculate the
death benefit as of the date we receive due proof of death. The
Beneficiary should contact our Customer Service Center for
instructions.
EXEMPTION OF BENEFITS
All payments of Benefits under this Contract will be made from our
Customer Service Center. To the extent allowed by law, the Benefits
will be free from creditor's claims or legal process.
GA-IA-1070 11 6/00
CHOOSING AN INCOME PLAN
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ANNUITY BENEFITS
If the Annuitant and Owner are living on the Annuity Commencement
Date, we will begin making payments to the Owner. We will make these
payments under the Annuity Option (or Options) as chosen initially or
as subsequently selected. You may choose or change an Annuity Option
by making a written request at least 30 days prior to the Annuity
Commencement Date. Unless you have chosen otherwise, Option 2 on a 10-
year period certain basis will become effective. The amounts of the
payments will be determined by applying the Accumulation Value
adjusted by a Market Value Adjustment, if applicable, on the Annuity
Commencement Date in accordance with the Annuity Options section below
(see Payments We Defer). Surrender Charges will be waived. A Market
Value Adjustment may apply if the Annuity Commencement Date is more
than 30 days prior to the Maturity Date of the Guarantee Period.
Before we pay any Annuity Benefits, we require the return of this
Contract. If this Contract has been lost, we require the applicable
lost Contract form.
ANNUITY COMMENCEMENT DATE SELECTION
You select the Annuity Commencement Date. You may select any date
following the first Contract Anniversary but before the required date
of Annuity Commencement as shown in the Schedule. If you do not
select a date, the Annuity Commencement Date will be in the month
following the required date of Annuity Commencement.
FREQUENCY SELECTION
You may choose the frequency of the Annuity Payments. They may be
monthly, quarterly, semi-annually or annually. If we do not receive
written notice from you, the payments will be made monthly.
THE INCOME PLAN
While this Contract is in effect and before the Annuity Commencement
Date, you may chose one or more Annuity Options for the payment of
death benefit proceeds. If, at the time of the Owner's death, no
Option has been chosen for paying the death benefit proceeds, the
Beneficiary may choose an Option within one year. You may also elect
an Annuity Option on surrender of the Contract for its Cash Surrender
Value. For each Option we will issue a separate written agreement
putting the Option into effect.
Our approval is needed for any Option where:
(1) the person named to receive payment is other than the Owner
or Beneficiary; or
(2) the person named is not a natural person, such as a
corporation; or
(3) any income payment would be less than the minimum annuity
income payment shown in the Schedule.
THE ANNUITY OPTIONS
There are three Options to choose from. They are:
Option 1. Income for a Fixed Period
Payment is made in equal installments for a fixed number of years.
The payment period cannot be more than 30 years nor less than 5 years.
We guarantee each monthly payment will be at least the Income for
Fixed Period amount shown in the Schedule. Values for annual,
semiannual or quarterly payments are available on request.
GA-IA-1070 12 6/00
CHOOSING AN INCOME PLAN (continued)
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Option 2. Income for Life
Payment is made to the person named in equal monthly installments and
guaranteed for at least a period certain. The period certain can be
10 or 20 years. Other periods certain are available on request. A
refund certain may be chosen instead. Under this arrangement, income
is guaranteed until payments equal the amount applied. If the person
named lives beyond the guaranteed period, payments continue until his
or her death.
We guarantee each payment will be at least the amount shown in the
Schedule. By age, we mean the named person's age on his or her
nearest birthday before the Option's effective date. Amounts for ages
not shown are available on request.
Option 3. Joint Life Income
This Option is available if there are two persons named to receive
payments. At least one of the persons named must be either the Owner
or Beneficiary of this Contract. Monthly payments are guaranteed and
are made as long as at least one of the named persons is living. The
monthly payment amounts are available upon request. Such amounts are
guaranteed and will be calculated on the same basis as the Table for
Income for Life, however, the amounts will be based on two lives.
The minimum rates for Option 1 are based on 3% interest, compounded
annually. The minimum rates for Options 2 and 3 are based on 3%
interest, compounded annually, and the Annuity 2000 Mortality Table.
We may pay a higher rate at our discretion.
PAYMENT WHEN NAMED PERSON DIES
When the person named to receive payment dies, we will pay any amounts
still due as provided by the Option agreement. The amounts still due
are determined as follows:
(1) For Option 1 or for any remaining guaranteed payments in
Option 2, payments will be continued.
(2) For Option 3, no amounts are payable after both named
persons have died.
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OTHER IMPORTANT INFORMATION
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ENTIRE CONTRACT
This Contract, including any attached rider, endorsement, or amendment
constitutes the entire Contract between you and us. All statements
made by any Owner or any Annuitant will be deemed representations and
not warranties.
SENDING NOTICE TO US
Whenever written notice is required, send it to our Customer Service
Center. The address of our Customer Service Center is shown on the
cover page. Please include your Contract number in all
correspondence.
REPORTS TO OWNER
We will send you a report at least once during each Contract Year.
The report will show the Accumulation Value and the Cash Surrender
Value as of the end of the Contract processing period. The report
will also show the amounts deducted from or added to the Accumulation
Value since the last report. The report will also include any
information that may be currently required by the insurance
supervisory official of the jurisdiction in which the Contract is
delivered.
ASSIGNMENT - USING THIS CONTRACT AS COLLATERAL SECURITY
You can assign this Contract as collateral security for a loan or
other obligation. This does not change the ownership. Your rights
and any Beneficiary's right are subject to the terms of the
assignment. To make or release an assignment, we must receive written
notice satisfactory to us, at our Customer Service Center. We are not
responsible for the validity of any assignment, including any tax
consequences.
CHANGING THIS CONTRACT
This Contract may be changed to another annuity plan according to our
rules at the time of the change.
CONTRACT CHANGES - APPLICABLE TAX LAW
We reserve the right to make changes in this Contract to the extent we
deem it necessary to continue to qualify this Contract as an annuity.
Any such changes will apply uniformly to all Contracts that are
affected. You will be given advance written notice of such changes.
MISSTATEMENT OF AGE OR SEX
If an age or sex has been misstated, the amounts payable or benefits
provided by this Contract will be those that the Premium Payment made
would have bought at the correct age or sex.
NON-PARTICIPATING
This Contract does not participate in the divisible surplus of Golden
American Life Insurance Company.
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OTHER IMPORTANT INFORMATION (continued)
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PAYMENTS WE MAY DEFER
We may, at any time, defer payment of the Cash Surrender Value for up
to six months after we receive a request for it. We will allow
interest of at least 3.00% a year on any Cash Surrender Value payment
derived from requests that we defer 30 days or more. If the applicable
state law requires interest at a greater rate, we will pay the greater
rate.
AUTHORITY TO MAKE AGREEMENTS
All agreements made by us must be signed by one of our officers. No
other person, including an insurance agent or broker, can:
(1) change any of this Contract's terms;
(2) extend the time for Premium Payments; or
(3) make any agreement binding on us.
REQUIRED NOTE ON OUR COMPUTATIONS
We have filed a detailed statement of our computations with the
insurance supervisory official in the jurisdiction where this Contract
is delivered. The values are not less than those required by the law
of that state or jurisdiction.
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SINGLE PREMIUM DEFERRED MODIFIED GUARANTEED ANNUITY CONTRACT
Annuity benefit payable at Commencement Date. Death benefit payable
in event of the Owner's death prior to Commencement Date. Benefits
guaranteed if the Contract is held for a period equal to the current
Guarantee Period. The Cash Surrender Values are based on a separate
account Market Value Adjustment formula if the annuity is held for a
shorter period. CASH SURRENDER VALUES MAY INCREASE OR DECREASE BASED
ON THE MARKET VALUE ADJUSTMENT FORMULA. Nonparticipating.
GA-IA-1070 6/00
