PRUDENTIAL THE PRUDENTIAL
INSURANCE COMPANY
OF AMERICA
agrees to pay the benefits provided under this contract in accordance with and
subject to its terms.
Contract-Holder: Plan:
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Effective Date: Group Annuity Contract No.:
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Eligible Classification:
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Provisions and Schedules Jurisdiction:
attached:
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THE PRUDENTIAL INSURANCE COMPANY
OF AMERICA
By:
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Title: President /s/ Xxxxxx X. Xxxxxx
Date: Secretary /s/ Xxxxxxxx X. Xxxxxxxx
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Attest
---------------------------------
Date:
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Group Annuity Contract providing for contributions on account of Participants.
Annual determination of participation in divisible surplus. All subject to the
provisions of this contract.
NOTICE -- ALL CONTRACTUAL VALUES OR PAYMENTS PROVIDED BY THIS CONTRACT,
WHEN BASED ON THE INVESTMENT RESULTS OF A PRUDENTIAL SEPARATE ACCOUNT
DESCRIBED IN THIS CONTRACT, ARE VARIABLE, SUBJECT TO CHANGE BOTH UP AND
DOWN, AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.
GVA-120-87 (10/11) 19081
TABLE OF CONTENTS
PROVISION Serial Page
I. CONTRIBUTIONS - ACCOUNTS - CHARGES
1.2 Contributions . . . . . . . . . . . . . . . . . . . 100
1.2 Participant's Accounts. . . . . . . . . . . . . . . 100
1.3 Annual Account Charge . . . . . . . . . . . . . . . 110
1.4 Reports . . . . . . . . . . . . . . . . . . . . . . 110
II. INVESTMENT ACCOUNT - UNIT VALUES - COMMITTEE
2.1 The Prudential Variable Contract
Account-10 (VCA-10) . . . . . . . . . . . . . . . 200
2.2 VCA-10 Unit Value . . . . . . . . . . . . . . . . . 200
2.3 VCA-10 Committee. . . . . . . . . . . . . . . . . . 210
III. WITHDRAWALS AND TRANSFERS - DEATH PAYMENTS
3.1 Participant's Withdrawals . . . . . . . . . . . . . 300
3.2 Death Payments. . . . . . . . . . . . . . . . . . . 300
3.3 Transfers between Related Contracts . . . . . . . . 310
3.4 Transfers to Another Financial Institution. . . . . 320
3.5 Transfers Involving a Similar Contract
of Another Employer . . . . . . . . . . . . . . . 330
IV. ANNUITIES
4.1 Annuity Elections . . . . . . . . . . . . . . . . . 400
4.2 Annuity - Single Sum Payment Combination. . . . . . 400
4.3 Small Annuities and Accounts. . . . . . . . . . . . 400
4.4 Terms of Payment of Annuities . . . . . . . . . . . 400
4.5 Payees. . . . . . . . . . . . . . . . . . . . . . . 420
V. CHANGES
5.1 Changes by Prudential . . . . . . . . . . . . . . . 500
5.2 Changes by Agreement. . . . . . . . . . . . . . . . 500
5.3 Changes to Conform to Law . . . . . . . . . . . . . 500
5.4 Persons Empowered to Act for Prudential . . . . . . 500
VI. DISCONTINUANCE - TERMINATION OF CONTRACT
6.1 Discontinuance of Establishing Participants'
Accounts. . . . . . . . . . . . . . . . . . . . . . 600
6.2 Discontinuance of Contributions under
this Contract . . . . . . . . . . . . . . . . . . . 600
6.3 Termination of Contract . . . . . . . . . . . . . . 600
VII. GENERAL TERMS
7.1 Contract-Holder . . . . . . . . . . . . . . . . . . 700
7.2 Communications. . . . . . . . . . . . . . . . . . . 700
7.3 Place of Payment -- Currency . . . . . . . . . . . 700
7.4 Information -- Records . . . . . . . . . . . . . . 710
7.5 Misstatements . . . . . . . . . . . . . . . . . . . 710
7.6 Beneficiary . . . . . . . . . . . . . . . . . . . . 710
GVA-120-87
TC-100 (10)
TABLE OF CONTENTS
(Continued)
Serial Page
Provision
7.7 Plan Changes. . . . . . . . . . . . . . . . . . . . 720
7.8 Divisible Surplus . . . . . . . . . . . . . . . . . 720
7.9 Limit on Assignment . . . . . . . . . . . . . . . . 720
7.10 Certificates. . . . . . . . . . . . . . . . . . . . 730
7.11 Entire Contract -- Construction . . . . . . . . . . 730
SCHEDULES
Schedule A Forms of Annuity Which May Be Purchased . . . A-100
Schedule B Life - Payment Certain Annuity. . . . . . . . S-100
Schedule C Life - Contingent Annuity . . . . . . . . . . S-100
Schedule D Payment Certain Annuity . . . . . . . . . . . S-100
GVA-120-87 (10/11)
TC-110
Provision I. CONTRIBUTIONS - ACCOUNTS - CHARGES:
1.1 CONTRIBUTIONS:
(a) Regular Contributions:
The contributions which are payable under this contract for a
Participant are the payments made for him by his employer pursuant to
a Salary-Annuity Agreement and any amounts contributed for him under
the Plan, if any, and directed by the Participant for payment
hereunder. For each Participant, total contributions (including those
made pursuant to a Salary Annuity Agreement) to this contract and any
companion contract must be made at the rate of at least $200 during
each twelve-month period. Contributions will be transmitted by the
Contract-Holder or the employer.
A Participant is a person for whom contributions have been paid under
this contract and whose Participant's Account (see section 1.2) has
not been cancelled.
A Salary-Annuity Agreement is an agreement between an employee in an
Eligible Classification and his employer. It is also an agreement
between a Participant who has ceased to be an employee in an Eligible
Classification and his new employer. Under the Agreement, the employer
agrees to pay amounts to purchase an annuity for the employee meeting
the conditions of Section 403(b) of the Federal Internal Revenue Code.
(To save words, male pronouns are used in this contract to refer to
both men and women.)
(b) Rollover Contributions:
An amount which qualifies as a rollover contribution pursuant to the
Federal Internal Revenue Code may be transferred to and paid under
this contract as a contribution for a Participant. Prudential may
require proof that the amount paid so qualifies.
1.2 PARTICIPANT'S ACCOUNT:
Prudential will establish a "Participant's Account" for each person for
whom a contribution is paid under this contract. This Account is expressed
in Units of the separate investment account described in section 2.1.
A number of Units will be added to the Participant's Account on each day a
contribution is received by Prudential for the Participant. This number is
determined by dividing the dollar amount of the contribution by the Unit
Value for the day the contribution is received (see section 2.2 for a
description of the Unit Value). A number of Units will be subtracted from
the Participant's Account on each day on which a withdrawal is made from
his Account. This number is equal to the number requested for
GVA-120-87 (10/11)
Serial 100 1.1-1.2
withdrawal or, if applicable, the number determined by dividing the dollar
amount to be withdrawn by the Unit Value for the day of withdrawal.
A Participant's Account is the sum of the Units added to it, less the sum
of the Units subtracted from it. The dollar value of a Participant's
Account as of any day is the product of the number of Units in his Account
at the close of business on that day and the Unit Value for that day.
A Participant has a non-forfeitable interest in his Account. The Account is
subject to charges described later.
1.3 ANNUAL ACCOUNT CHARGE:
On the last business day (see section 2.2) of each calendar year an amount
will be withdrawn from each Participant's Account equal to the Annual
Account Charge. Also, on any other day on which a Participant's Account is
cancelled, an amount will be withdrawn from his Account equal to the Annual
Account Charge. However, no Charge will be withdrawn if the Participant's
Account is being cancelled on a January 1 to Purchase an annuity for him
under this contract.
The Annual Account Charge is $20.
A Participant may have an Account for Salary-Annuity Agreement payments or
Plan payments, if any, under another group annuity contract issued to the
Contract-Holder by Prudential (a "companion contract"). If so, the total
Annual Account Charge that applies to all his Accounts will not exceed the
amount shown above. This charge will be shared among his Accounts as
Prudential determines. Also, no charge will be withdrawn from his Account
under this contract when it is cancelled unless no amounts remain in an
Account for him under a companion contract.
In addition to the Annual Account Charge, a charge may be made upon a
Participant's withdrawal (see section 3.1).
The Charge may be changed as provided in section 5.1.
1.4 REPORTS:
Prudential will periodically furnish a report with respect to each
Participant's Account which has not been cancelled. The report will show
the status of each Account as of the date of the report.
GVA-120-87 (10/11)
Serial 110 1.3-1.4
Provision II. INVESTMENT ACCOUNT - UNIT VALUES - COMMITTEE:
2.1 THE PRUDENTIAL VARIABLE CONTRACT ACCOUNT - 10 (VCA-10):
VCA-10 is a separate investment account of Prudential established pursuant
to a resolution adopted by its Board of Directors. The resolution provides
that this account is to be used for contracts which state that certain
payments and values under them will vary to reflect the investment results
of this account.
The investments held in VCA-10 are intended to be composed primarily of
common stocks. Prudential will invest and reinvest the assets held in
VCA-10 in accordance with the investment objectives and policies
established for it.
The total market value of the assets held in VCA-10 at all times will be at
least equal to the total reserve liability required by law for all payments
or values which vary in dollar amount to reflect the investment results of
VCA-10. Assets held in VCA-10 equal in market value to that reserve
liability will be held for the sole benefit of all contracts which
participate in VCA-10. The amount, if any, by which the total market value
exceeds the total reserve liability will be subject to the exclusive
control of Prudential. Thus, Prudential may from time to time make
transfers between VCA-10 and its other investment accounts as in its
judgment, experience warrants. A transfer will not affect Prudential's
contractual liabilities under this contract.
2.2 VCA-10 UNIT VALUE:
The VCA-10 Unit Value for any Business Day is the dollar value of one
VCA-10 Unit for that Business Day. ("Business Day" means a day the New York
Stock Exchange is open for trading.) The initial VCA-10 Unit Value was
$1.00. The VCA-10 Unit Value for any subsequent Business Day is determined
as of the end of that Business Day by multiplying the VCA-10 Unit Change
Factor for that Business Day by the VCA-10 Unit Value for the immediately
preceding Business Day. The VCA-10 Unit Value for any day which is not a
Business Day is equal to the VCA-10 Unit Value for the next Business Day.
The VCA-10 Unit Value will go up or down in accordance with the VCA-10 Unit
Change Factor described below.
To determine the VCA-10 Unit Change Factor for any Business Day, Prudential
will proceed as follows:
(a) Increase $1.00 by the rate of investment results of VCA-10 for that
Business Day, taking into account investment income and market value
changes after provision for any taxes applicable to contracts of this
class arising from the operation of VCA-10.
(b) Subtract from the result found in (a) the VCA-10 Investment Management
Fee per $1.00 at the effective annual rate of 0.25% for the number of
calendar days in the period from the end of the prior Business Day to
the end of the current Business Day. The aggregate amount by which
VCA-10 is reduced in each year by the Investment Management Fee will
be deducted from investment income to the extent possible; any balance
will be deducted from principal.
GVA-120-87 (10)
Serial 200 2.1-2.2
(c) Provide for the Administrative Expense Charge at the effective annual
rate of 0.75%, against the assets of VCA-10. To do so, the result
found in (b) is divided by $1.00 increased at the effective annual
rate of 0.75% for the number of calendar days in the period from
the end of the prior Business Day to the end of the current
Business Day.
The result found in (c) is the VCA-10 Unit Change Factor for that Business
Day.
This section may be changed as provided in section 5.1.
2.3 VCA-10 COMMITTEE:
The operation of VCA-10 will be supervised by The Prudential VCA-10
Committee (the "Committee"). The initial Committee members will be
appointed by Prudential. Thereafter, members will be elected by the
Participants.
GVA-120-87 (10)
Serial 210 2.3
Provision II. INVESTMENT ACCOUNT - UNIT VALUES - COMMITTEE:
2.1 THE PRUDENTIAL VARIABLE CONTRACT ACCOUNT - 11 (VCA-11):
VCA-11 is a separate investment account of Prudential established pursuant
to a resolution adopted by its Board of Directors. The resolution provides
that this account is to be used for contracts which state that certain
payments and values under them will vary to reflect the investment results
of this account.
The investments held in VCA-11 are intended to be composed of high-grade
money market instruments. Prudential will invest and reinvest the assets
held in VCA-10 in accordance with the investment objectives and policies
established for it.
The total market value of the assets held in VCA-11 at all times will be at
least equal to the total reserve liability required by law for all payments
or values which vary in dollar amount to reflect the investment results of
VCA-11. Assets held in VCA-11 equal in value to that reserve liability will
be held for the sole benefit of all contracts which participate in VCA-11.
The amount, if any, by which the total value exceeds the total reserve
liability will be subject to the exclusive control of Prudential. Thus,
Prudential may from time to time make transfers between VCA-11 and its
other investment accounts as, in its judgment, experience warrants. A
transfer will not affect Prudential's contractual liabilities under this
contract.
2.2 VCA-11 UNIT VALUE:
The VCA-11 Unit Value for any Business Day is the dollar value of one
VCA-11 Unit for that Business Day. ("Business Day" means a day the New York
Stock Exchange is open for trading.) The initial VCA-11 Unit Value was
$1.00. The VCA-11 Unit Value for any subsequent Business Day is determined
as of the end of that Business Day by multiplying the VCA-11 Unit Change
Factor for that Business Day by the VCA-11 Unit Value for the immediately
preceding Business Day. The VCA-11 Unit Value for any day which is not a
Business Day is equal to the VCA-11 Unit Value for the next Business Day.
The VCA-11 Unit Value will go up or down in accordance with the VCA-11 Unit
Change Factor described below.
To determine the VCA-11 Unit Change Factor for any Business Day, Prudential
will proceed as follows:
(a) Increase $1.00 by the rate of investment results of VCA-11 for that
Business Day, taking into account investment income and changes in the
value of investments after provision for any taxes applicable to
contracts of this class arising from the operation of VCA-11.
(b) Subtract from the result found in (a) the VCA-11 Investment Management
Fee per $1.00 at the effective annual rate of 0.25% for the number of
calendar days in the period from the end of the prior Business Day to
the end of the current Business Day. The aggregate amount by which
VCA-11 is reduced in each year by the Investment Management Fee will
be deducted from investment income to the extent possible; any balance
will be deducted from principal.
GVA-120-87 (11)
Serial 200 2.1-2.2
(c) Provide for the Administrative Expense Charge at the effective annual
rate of 0.75%, against the assets of VCA-11. To do so, the result
found in (b) is divided by $1.00 increased at the effective annual
rate of 0.75% for the number of calendar days from the end of the
prior Business Day to the end of the current Business Day.
The result found in (c) is the VCA-11 Unit Change Factor for that Business
Day.
Prudential may, upon notice to the Contract-Holder and Participants, change
the basis for determining the Unit Value. The changed basis would be one
designed to maintain a constant Unit Value, with investment results being
reflected through the number of Units in Participants' Accounts.
This section may be changed as provided in section 5.1.
2.3 VCA-11 COMMITTEE:
The operation of VCA-11 will be supervised by The Prudential VCA-11
Committee (the "Committee"). The initial Committee members will be
appointed by Prudential. Thereafter, members will be elected by the
Participants.
GVA-120-87 (11)
Serial 210 2.3
Provision III. WITHDRAWALS AND TRANSFERS - DEATH PAYMENTS:
3.1 PARTICIPANT'S WITHDRAWAL:
A Participant may make withdrawals from his Participant's Account but only
under the conditions permitted by the Plan, if any. The minimum withdrawal
is $500, or the dollar value of his Account if smaller. Payment to the
Participant will normally be made within seven days of Prudential's receipt
of a duly completed request for it. However, it may be paid at a later day
if permitted under the Investment Company Act of 1940.
The amount paid to the Participant will be the dollar amount withdrawn less
the withdrawal charge determined from the following table and the Annual
Account Charge if it applies. The amount payable is also referred to as the
"Withdrawal Value."
TABLE
Withdrawals made in the months
indicated, counting from the day
the Participant's Account was Withdrawal Charge per $1.00
established* being withdrawn.**
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First 24 months $0.07
Next 36 months 0.06
Next 60 months 0.04
Next 60 months 0.03
Thereafter 0.00
*Or, if earlier, the day an Account was established for him under a
companion contract (or under a similar contract if section 3.5 applies).
**No charge is made after the amount withdrawn equals the contributions
made for the Participant. In addition, no charge is made if the withdrawal
is made for reasons of Financial Hardship or Disability Retirement pursuant
to the terms of the Plan, if any.
As of the first day no amounts remain in a Participant's Account or in an
Account for him under a companion contract, his Account is cancelled.
This section may be changed as provided in section 5.1.
3.2 DEATH PAYMENTS:
If a Participant dies before his Participant's Accounts has been cancelled,
the dollar value will be paid to his Beneficiary (see section 7.6). If the
Beneficiary is other than the Participant's spouse, the payment will be
made in one sum within 5 years of the Participant's death unless the
Participant has directed Prudential to purchase an annuity for the
Beneficiary. If the Participant's spouse is the Beneficiary, the payment
will be made in one sum no later than the latest date on which the spouse
is permitted to defer the distribution under law unless the
GVA-120-87 (10/11)
Serial 300 3.1-3.2
Participant has directed Prudential to purchase an annuity for the spouse.
Instead of a one sum payment, the Beneficiary may elect to have the dollar
value of the Participant's Account applied to purchase an annuity. Proof of
the Participant's death must be received by Prudential before any payment
will be made. Any payment made pursuant to this section must be consistent
with the terms of the Plan, if any.
The Beneficiary's annuity election must be made before the Participant's
Account is distributed. The annuity form may be any of those described in
section 4.4. If annuity payments are to start at a future date, the
Participant's Account will be maintained for the Beneficiary in the same
manner as for the Participant. The date for payments to start must be on or
before the latest date on which the Beneficiary is permitted to defer the
distribution under law. No contributions may be made to the Account after
the Participant's death.
If a one sum payment is made to the Beneficiary within one year of the
Participant's death, it will be at least equal to the contributions made
for him under this contract less any withdrawals and transfers.
Any annuity payments to a Beneficiary will be subject to the following:
(a) If an annuity is payable to the Participant's spouse, it must provide
for payment to be made over the life of the spouse (or over a period
not exceeding the life expectancy of the spouse), and
(b) If an annuity is payable to a Beneficiary who is other than the
Participant's spouse, it must provide for payment to be made over the
life of the Beneficiary (or over a period not exceeding the life
expectancy of the Beneficiary).
As of the first day no amounts remain in the Participant's Account or in an
Account with respect to the Participant under a companion contract, the
Participant's Account is cancelled. Section 3.1 does not apply.
3.3 TRANSFERS BETWEEN RELATED CONTRACTS:
A Participant may transfer an amount from his Participant's Account to an
Account maintained for him under a companion contract but only under the
conditions permitted by the Plan, if any. The minimum withdrawal to provide
a transfer is $500, or the dollar value of his Account if smaller. The
transfer will normally be made within seven days of Prudential's receipt of
a duly completed request for it. Section 3.1 does not apply to a withdrawal
for this purpose. Transfers are deemed to be made first from the
contributions paid for the Participant. Investment income is transferred
when there are no longer any contributions in the Participant's Account.
Amounts may be transferred to this contract from a companion contract. An
amount transferred to this contract for a Participant will be treated as
though it were a contribution made for him (see section 1.2). However in
determining any withdrawal charge, any part of the amount transferred which
is investment income will not be considered as a contribution.
GVA-120-87 (10/11)
Serial 310 3.3
Prudential may, upon notice to the Contract-Holder and Participants, limit
the frequency of transfers. This action will take effect on the date of the
notice.
This section may be changed as provided in section 5.1.
3.4 TRANSFERS TO ANOTHER FINANCIAL INSTITUTION:
(a) At the Request of a Participant:
The Withdrawal Value of a Participant's Accounts may be transferred to
another financial institution but only under the conditions permitted
by the Plan, if any. The transfer may be made directly to that
institution or by a payment (or payments) to the Participant who then
makes payment to the institution. The transfer will normally be made
within seven days after Prudential's receipt of a duly completed
transfer request.
The transfer will be a full settlement of Prudential's liability for
the Participant's Account.
(b) At the Contract-Holder's Request:
The Contract-Holder may request Prudential to make transfer payments
to another financial institution named in the request. The transfer
payment will be made on the Transfer Date. The Transfer Date is the
later of the day specified in the request and the 90th day after its
receipt by Prudential.
Prudential will promptly notify each Participant, and each Beneficiary
of a deceased Participant whose Account has not been cancelled, that
the request has been received. Each notified person may elect, within
30 days following his receipt of the notice from Prudential, to have
his Account cancelled and included in the transfer payment to be made
but only under the conditions permitted by the Plan, if any. Each
person who does not make this election will have his Account retained
under this contract pursuant to its terms.
All Accounts of Participants and Beneficiaries who make the election
will be cancelled as of the Transfer Date and an amount equal to the
sum of the Withdrawal Values, expressed in Units of the cancelled
Accounts, times the Unit Value for the day of withdrawal will be
transferred within seven days thereafter.
Instead of making the transfer payment in cash, Prudential may make
all or a part of it in the form of securities representing a uniform
percentage of each holding of the separate investment account
described in section 2.1.
GVA-120-87 (10/11)
Serial 320 3.4
The Contract-Holder may notify Prudential that this section 3.4(b) is
to be inoperative.
This section may be changed as provided in section 5.1.
3.5 TRANSFERS INVOLVING A SIMILAR CONTRACT OF ANOTHER EMPLOYER:
A Participant may cease to be employed by an employer who pays
contributions under this contract. He may become employed by an employer to
whom Prudential has issued a contract similar to this contract. If so, that
Participant may request a transfer to that similar contract from this
contract but only under the conditions permitted by the Plan, if any. The
transfer will normally be made within seven days of receipt of the request.
The dollar value of the Participant's Account will be the amount
transferred. The Account will be cancelled.
Also, this contract will accept a transfer from a contract similar to this
contract for a person covered thereunder who becomes employed by an
employer who pays contributions under this contract. The transferred amount
will be treated as a contribution paid for that person. However, in
determining any withdrawal charge, any part of the transferred amount which
is investment income will not be considered a contribution.
This section may be changed as provided in section 5.1.
GVA-120-87 (10/11)
Serial 330 3.5
Provision IV. ANNUITIES:
4.1 ANNUITY ELECTIONS:
A Participant may, upon notice to Prudential, elect to have his
Participant's Account applied to purchase an annuity for him but only under
the conditions permitted by the Plan, if any. The dollar value of the
Account will be applied.
The schedule of annuity purchase rates that applies is determined from
Schedule A. The monthly amount of any annuity is determined from the
schedule of purchase rates for that annuity.
As of the first day no amounts remain in the Participant's Account or in an
Account for him under a companion contract, his Account is cancelled.
If the Participant's Account has not been cancelled before the month in
which he reaches the latest age at which he is permitted to defer his
distribution under law, a 120 monthly Payment Certain annuity will be
purchased for him at the beginning of that month (see section 4.4).
4.2 ANNUITY - SINGLE SUM PAYMENT COMBINATION;
A Participant may elect that only a portion of his Participant's Accounts
be applied to purchase an annuity with the balance being paid in a single
sum. The portion used to purchase an annuity will be subject to section 4.1
and the balance to section 3.1.
4.3 SMALL ANNUITIES AND ACCOUNTS
If the total monthly amount of annuity which would otherwise be purchased
on behalf of any person under this contract and the companion contracts is
less than $50, Prudential may, in lieu of an annuity under this contract,
make payment in a single sum. The single sum will be equal to the amount
that would otherwise be applied to purchase an annuity as described in
section 4.1.
If no contributions have been made under this contract or any companion
contract for a Participant for a period of 24 months and the dollar value
of his Accounts under all the contracts is $1,000 or less, Prudential may
cancel his Account under this contract. If the Account is cancelled, its
dollar value will be paid to the Participant unless he directs payment to a
named financial institution. The Annual Account Charge will be made only if
no Account remains for him under a companion contract.
4.4 TERMS OF PAYMENT OF ANNUITIES;
Life annuities and Payment Certain annuities are available under this
contract. A Life form of annuity is one payable at least during the
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lifetime of the person (referred to as the "Annuitant") for whom it was
purchased. Depending upon the existence and nature of any payment payable
after the death of the Annuitant, a Life annuity will be one of the
following forms: Life - Payment Certain, Life - Contingent, or Life -
Payment Certain Contingent annuity. A Payment Certain form of annuity may
be payable for a period less than the lifetime of the person for whom the
annuity was purchased. The terms of payment of each form of annuity are
described below.
(a) Life Form of Annuity:
The first monthly payment of a Life - Payment Certain annuity is
payable on the date the annuity is purchased. Monthly payments are
payable on the first day of each month thereafter throughout the
Annuitant's remaining lifetime. If the Annuitant dies before the
number of annuity payments made equals the number of Payments Certain
applicable to him, monthly annuity payments will be continued until
the total number of payments is so equal. These continued annuity
payments will each be in the same amount as was payable to the
Annuitant. The number of Payments Certain is established when the
annuity is purchased and may be 60, 120, 180, 240 or any other number
accepted by Prudential.
The first monthly payment of a Life - Contingent annuity is payable on
the date the annuity is purchased. Monthly payments are payable on the
first day of each month thereafter throughout the Annuitant's
remaining lifetime. If the Annuitant dies before the death of his
Contingent Annuitant, monthly Contingent Annuity payments will become
payable. The first payment of Contingent Annuity will be payable on
the first day of the month following the month in which the
Annuitant's death occurs. Monthly Contingent Annuity payments are
payable on the first day of each month thereafter throughout the
Contingent Annuitant's remaining lifetime. The last monthly payment is
payable for the month in which his death occurs. The amount of each
monthly Contingent Annuity payment will be a percentage of the monthly
annuity payment payable before the Annuitant's death. The percentage
is established when the annuity is purchased and may be 33 1/3%, 50%,
66 2/3% or 100%, or any other percentage accepted by Prudential. Under
a Life - Payment Certain Contingent annuity, a percentage payment will
not take effect until the end of the selected Payment Certain period.
(b) Payment Certain Annuity:
The first monthly payment of a Payment Certain annuity is payable on
the date the annuity is purchased. Monthly payments are payable on the
first day of each month thereafter until the total number of Payments
Certain specified when the annuity was purchased has been paid. The
number of Payments Certain may be 60, 120, 180, 240, or any other
number accepted by Prudential.
GVA-120-87 (10/11)
Serial 410 4.4
Other forms of annuity payments may be provided with the consent of
Prudential.
No form of annuity will be purchased which provides for payments:
(i) to a Beneficiary or a Contingent Annuitant who is not the Annuitant's
spouse if a present value calculation shows that the Annuitant's
expected payments will not be more than 50% of all the expected
annuity payments, or
(ii) to a Contingent Annuitant which are greater in monthly amount than the
payments to the Annuitant.
4.5 PAYEES:
Each annuity payment will be made to the Annuitant, Contingent Annuitant or
Beneficiary entitled to receive it.
GVA-120-87 (10/11)
Serial 420 4.5
Provision V. CHANGES:
5.1 CHANGES BY PRUDENTIAL:
Prudential may make changes in this contract as follows:
(a) The Annual Account Charge and the table of withdrawal charges may be
changed periodically on and after the second anniversary of the
Effective Date.
(b) The effective annual rate of the Administrative Expense Charge and the
terms and amounts (excluding the withdrawal charge table) of
withdrawals and transfers pursuant to Provision III may be changed
periodically on and after the fifth anniversary of the Effective Date.
(c) The schedules of annuity purchase rates may be changed periodically on
and after the tenth anniversary of the Effective Date.
Any change in the table of withdrawal charges and in Schedule D will apply
only to amounts added to Participants' Accounts on and after the date the
change takes effect. Any other change will apply to amounts in
Participants' Accounts whether added before or on and after the date the
change takes effect. Any change in the schedules of annuity purchase rates
will remain in effect for at least ten years.
Any change in accordance with this section will be made by giving notice to
the Contract-Holder at least 90 days before the date on which the change is
to take effect. Notice of changes, other than in the schedules of purchase
rates, will also be given to Participants.
5.2 CHANGES BY AGREEMENTS:
This contract may also be changed in any respect at any time or times by
agreement between the Contract-Holder and Prudential.
5.3 CHANGES TO CONFORM TO LAW:
Prudential may change this contract as, in its discretion, it deems
appropriate to satisfy the requirements of any law or regulation
administered by a governmental agency.
5.4 PERSONS EMPOWERED TO ACT FOR PRUDENTIAL:
No agent or other person except one of the following officers of Prudential
may change this contract or bind Prudential.
Chairman and Chief Executive Officer Associate Actuary
President Secretary
Vice President Assistant Secretary
Actuary
GVA-120-87 (10/11)
Serial 500 5.1-5.4
Provision VI DISCONTINUANCE - TERMINATION OF CONTRACT:
6.1 DISCONTINUANCE OF ESTABLISHING PARTICIPANTS' ACCOUNTS:
Prudential may notify the Contract-Holder that on and after a specified
date no new Participants' Accounts will be established under this contract.
The specified date may not be earlier than 90 days after the date of the
notice. Thereafter, only contributions for persons who are Participants on
the specified date will be accepted hereunder. In all other respects this
contract will continue to operate in accordance with its terms.
6.2 DISCONTINUANCE OF CONTRIBUTIONS UNDER THIS CONTRACT:
Contributions under this contract will be discontinued with respect to all
Participants:
(a) at any time after receipt by Prudential of notice thereof from the
Contract-Holder,
(b) if the Plan, if any, terminates,
(c) as of a date at least 90 days after notice to the Contract-Holder by
Prudential that no further contributions will be accepted hereunder,
or
(d) as of the effective date of any Plan change to which Prudential is
unable or unwilling to give its consent (see section 7.7).
After discontinuance the contract will continue to operate in accordance
with its terms with respect to Participants' Accounts.
6.3 TERMINATION OF CONTRACT:
This contract will terminate when all the following have occurred:
(a) no further contributions may be paid under this contract;
(b) no Participant's Account remains uncancelled; and
(c) no further annuity or transfer payments are payable from this
contract.
GVA-120-87 (10/11)
Serial 600 6.1-6.3
Provision VII. GENERAL TERMS:
7.1 CONTRACT-HOLDER:
Prudential will normally deal only with the Contract-Holder. However,
Prudential and the Contract-Holder may agree to do otherwise. Also, in some
cases the contract calls for dealing with another. Prudential will be
entitled to rely on any action taken or omitted by the Contract-Holder
pursuant to the terms of this contract.
The Contract-Holder may, from time to time, delegate to an agency certain
administrative powers and responsibilities which this contract assigns to
the Contract-Holder. Prudential is not bound to recognize any delegation
until it has received notice of it. The notice must specify those powers
and responsibilities and include evidence of acceptance by the agency. On
and after the date of receipt of the notice, Prudential will deal with the
agency with respect to those powers and responsibilities and will be
entitled to rely on any action taken or omitted by the agency with respect
thereto in the same manner as if dealing with the Contract-Holder. If any
agency fails or refuses to act with respect thereto, then the delegation
will be void for the purposes of this contract. Thereafter, Prudential will
deal only with the Contract-Holder. The Contract-Holder may give notice to
Prudential of delegation to another agency of specified powers and
responsibilities.
7.2 COMMUNICATION:
All communications to the Contract-Holder or to Prudential will be in
writing. They will be addressed to the Contract-Holder at its principal
office, or at such other address as it may communicate to Prudential. They
will be addressed to Prudential, c/o The Prudential Asset Management
Company, Inc., 00 Xxxxxxx Xxxx, Xxxxxxx Xxxx, Xxx Xxxxxx 00000, or at such
other address as it may communicate to the Contract-Holder. All
communications to any other person or organization dealing with Prudential
will be addressed to that person or organization at the last address of
record.
7.3 PLACE OF PAYMENT - CURRENCY:
All payments to Prudential under this contract will he payable at its
office described above or at an address or to a representative as may be
specified by Prudential by notice to the Contract-Holder.
All payments under this contract, whether to or by Prudential, will be in
lawful money of the United States of America. Dollars and cents, as
specified in this contract, means lawful dollars and cents of United States
currency.
GVA-120-87 (10/11)
Serial 700 7.1-7.3
7.4 INFORMATION -- RECORDS:
The Contract-Holder will furnish all information which Prudential may
reasonably require for the administration of this contract. If the
Contract-Holder cannot furnish any required item of information, Prudential
may request the person concerned to furnish the information. Prudential
will not be liable for the fulfillment of any obligations in any way
dependent upon information unless and until it receives the information in
a form satisfactory to it.
Information furnished to Prudential may be corrected for demonstrated
errors in it unless Prudential has already acted to its prejudice by
relying on the information. Except for the corrections, information
furnished to Prudential will be regarded as conclusive. Prudential will
maintain the records necessary for its administration of this contract.
These records will be prepared from the information furnished to Prudential
and will constitute evidence as to the truth of the information in the
records.
7.5 MISSTATEMENTS;
If any relevant fact relating to any person is found to have been
misstated, the following will apply:
(a) The amount of annuity payable by Prudential will be that which would
be provided by the amount allocated to purchase the annuity on the
basis of the correct information, without changing the date of first
payment of the annuity.
Any adjustment by Prudential of the amount or terms of payment made in
accordance with this section will be conclusive upon any other person
affected by it.
(b) The amount of any underpayment by Prudential will be paid in full with
the next payment due. The amount of any overpayment by Prudential will
be deducted to the extent possible from amounts payable thereafter.
7.6 BENEFICIARY:
If, as to any person, this contract provides for the payment of an amount
or amounts after the person dies to a Beneficiary other than the person's
Contingent Annuitant, payment will be made to the Beneficiary the person
named. A person for whom an Account is held or an annuity is being paid
under this contract may name a Beneficiary to replace one previously named.
However, the Participant may instruct Prudential that his Contingent
Annuitant or Beneficiary is not to have this right to name Beneficiary.
A Beneficiary may be named by filing a request with Prudential on a form
acceptable to it. It will become effective when entered on Prudential's
records. It will apply to any amounts payable after the request was
received by Prudential, except any withdrawals and payments made before the
request was entered on Prudential's records. Prudential will acknowledge
the naming of a Beneficiary.
GVA-120-87 (10/11)
Serial 710 7.4-7.6
The interest of any Beneficiary who dies before the Participant ceases upon
that Beneficiary's death. If there is no named Beneficiary when an amount
is payable to one, payment will be made to the estate of the last to die of
the Participant or Annuitant, his Contingent Annuitant, and his
Beneficiary. If a payment would be made to the estate of a Participant or
Annuitant, Prudential may make the payment to any one or jointly to any
number of his surviving relatives: spouse, children, parents, brothers or
sisters.
Prudential, in determining whether a person is a relative of a Participant
or Annuitant or is a Beneficiary entitled to payment, may rely solely on
any evidence it deems acceptable. Each payment Prudential makes in reliance
thereon will be a valid discharge of its obligation under this contract as
to that payment.
If a series of payments becomes payable to a Beneficiary and the first
payment is less than $50, Prudential may choose to make payment in one sum.
Also, if the payee is not a natural person and a series of payments is
payable, Prudential may choose to make a payment in one sum. The one sum
payment will be equal to the value of the series of payments discounted at
interest from each payment due date to the date of the one sum payment. The
discount interest rate will be the interest rate in the schedule of annuity
purchase rates used to establish the series of payments.
7.7 PLAN CHANGES:
If the employer maintains a written Plan of benefits, the name of such Plan
is shown on the first page of this contract. This contract applies to the
terms of the Plan in effect on the Effective Date and to each Plan change
if Prudential consents. The Contract-Holder will furnish Prudential with a
copy of the Plan. While this contract is active, the Contract-Holder will
also furnish a copy of each Plan change.
7.8 DIVISIBLE SURPLUS:
The portion, if any, of the divisible surplus of Prudential accruing upon
this contract will be determined annually by the Board of Directors of
Prudential and credited to Participants' Accounts as determined by the
Board. (It is unlikely any divisible surplus will accrue upon this
contract.)
No annuity under this contract will be taken into account in the
determination of any divisible surplus to be credited to this contract.
7.9 LIMIT ON ASSIGNMENT;
To the extent applicable law requires, the interests in and payments from
this contract are not assignable or subject to the claims of any creditor.
GVA-120-87 (10/11)
Serial 720 7.7-7.9
7.10 CERTIFICATES:
Prudential will issue a certificate for each annuity which is effected
under this contract. If any law requires, Prudential will issue a
certificate to a Participant for whom an annuity has not yet been effected.
A certificate will be descriptive of the Participant's or Annuitant's
rights and duties under the contract.
7.11 ENTIRE CONTRACT -- CONSTRUCTION:
This document constitutes the entire contract.
This contract will be construed according to the laws of the jurisdiction
set forth on the first page.
GVA-120-87 (10/11)
Serial 730 7.10-7.11
SCHEDULE A
FORMS OF ANNUITY WHICH MAY BE PURCHASED
Form of Payment Payable Applicable Schedule
----------------------- -------------------
1. Life - Payment Certain Annuity. 1. Use Schedule B for allocation.
2. Life - Contingent Annuity. 2. Use Schedule C for allocation.
3. Payment Certain Annuity. 3. Use Schedule D for allocation.
Prudential may provide monthly amounts of annuity larger than those shown in the
following schedules for annuities purchased during any period specified by
Prudential. Annuity purchase rates for other forms of annuity consented to by
Prudential will be furnished on request. The following schedules may be changed
as provided in section 5.1.
GVA-120-87 (10/11)
Serial A-100 Schedule A
SCHEDULES
Monthly amount of annuity purchased per $10,000 of a Participant's Account,
after deduction from it of any taxes on annuity considerations that apply.
SCHEDULE B - Life-Payment Certain Annuity (120 Payments Certain)
Monthly Amount
--------------
If date the annuity is purchased is in:
Age
--- ---- ---- ---- ----
60
65
70
SCHEDULE C - Life-Contingent Annuity
Monthly Amount
---------------
If Annuitant and Contingent Annuitant have same date of birth.
If the date the annuity is purchased is in
--------------------------------------------------------------
Age
--- ---- ---- ---- ----
If specified percentage to Contingent Annuitant is 100%:
60
65
70
If specified percentage to Contingent Annuitant is 50%:
60
65
70
SCHEDULE D - Payment Certain Annuity
Monthly Amount
--------------
Number of If date the annuity is purchased is in:
Payments Certain
---------------- ---- ---- ---- ----
60
120
180
* * * *
The rates in these Schedules are to be used without adjustment only when the
facts that apply to the Participant and his annuity are as shown. Rates for
other facts will be furnished upon request.
GVA-120-87 (10/11)
Serial S-100 Schedules B-D
