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THE TRAVELERS LIFE AND ANNUITY COMPANY - ONE TOWER SQUARE - HARTFORD,
CONNECTICUT - 06183
A STOCK COMPANY
We are pleased to provide You the benefits of this Variable
Annuity Contract. Please read Your Contract and all attached
forms carefully.
RIGHT TO EXAMINE THIS CONTRACT
IF THIS CONTRACT IS ISSUED AS AN INDIVIDUAL RETIREMENT ANNUITY
(IRA), AND THE CONTRACT IS RETURNED TO US AT OUR OFFICE OR TO OUR
AGENT WITHIN 7 DAYS OF ITS DELIVERY TO YOU, WE WILL PAY YOU THE
FULL AMOUNT OF ANY PURCHASE PAYMENT MADE, WITHOUT ADJUSTMENT FOR
ANY PREMIUM TAX OR CONTRACT CHARGES PAID. IF THIS CONTRACT IS
RETURNED DURING THE BALANCE OF THE RIGHT TO EXAMINE PERIOD, WE
WILL PAY YOU THE CONTRACT VALUE AS STATED BELOW. AFTER THE
CONTRACT IS RETURNED, IT WILL BE CONSIDERED AS NEVER IN EFFECT.
IF THIS CONTRACT IS ISSUED AS A NONQUALIFIED CONTRACT OR A
QUALIFIED CONTRACT (OTHER THAN AN IRA) AND RETURNED TO US AT OUR
OFFICE OR TO OUR AGENT TO BE CANCELED WITHIN 10 DAYS AFTER ITS
DELIVERY TO YOU, WE WILL PAY YOU THE CONTRACT VALUE DETERMINED AS
OF THE NEXT VALUATION DATE AFTER WE RECEIVE THE WRITTEN REQUEST
AT OUR OFFICE, PLUS ANY PREMIUM TAX AND CONTRACT CHARGES PAID,
MINUS ANY PURCHASE PAYMENT CREDITS APPLIED. AFTER THE CONTRACT IS
RETURNED, IT WILL BE CONSIDERED AS NEVER IN EFFECT.
This Contract is issued in consideration of the Purchase
Payments. It is subject to the terms and conditions stated on the
attached pages, all of which are parts of it.
Executed at Hartford, Connecticut
/s/ M.A. XXXXXXXXX
President
This is a legal Contract between You and Us. READ YOUR CONTRACT CAREFULLY.
FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE AND ARE
NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
TL-22240 TLAC Ed. 1-99
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TABLE OF CONTENTS
[Right to Examine this Contract Cover Page
Contract Specifications Page 3
Definitions Page 7
Owner, Beneficiary and Annuitant Provisions Page 9
Purchase Payment and Valuation Provisions Page 11
Death Benefit Provisions Page 14
Settlement Provisions Page 15
General Provisions Page 17
Table of Values Page 19
Annuity Tables Page 20]
Any Amendments, Riders or Endorsements follow the Annuity Tables.
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CONTRACT SPECIFICATIONS
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CONTRACT NUMBER [SPECIMEN]
OWNER [XXXX XXX]
[JOINT OWNER] [ ]
ANNUITANT [XXXX XXX]
[CONTINGENT ANNUITANT]
[BENEFICIARY] [XXXXX XXX]
CONTRACT DATE [FEBRUARY 1, 1999]
MATURITY DATE [DECEMBER 31, 2015]
[INITIAL PURCHASE PAYMENT] [$10,000]
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MINIMUM INITIAL PURCHASE PAYMENT: [$5,000]
MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$500]
MAXIMUM PURCHASE PAYMENT WITHOUT OUR APPROVAL: $1,000,000
PURCHASE PAYMENT CREDIT PERCENTAGE: [4.25%]
CONTRACT FEE: $40.00 annually assessed on the [fourth Friday of August.]
This fee will not be assessed under the following situations:
(a) if Your Contract Value is $100,000 or greater on the date the charge is
assessed;
(b) distribution of proceeds due to death; or
(c) after an Annuity payout has begun.
ASSUMED DAILY NET INVESTMENT FACTOR: Upon annuitization, the Assumed Daily Net
Investment Factor is 1.000081 for each Funding Option.
TERMINATION: We reserve the right to terminate this Contract when the Contract
Value is less than $2,000 and no Purchase Payments have been made for two years.
TRANSFERS: You may transfer up to 15% of the Fixed Account value to any of the
Funding Options twice per year during the 30 days following the semi-annual
Contract Date anniversary.
TRANSFER CHARGE: We reserve the right to assess a transfer charge of up to
$10.00 on transfers exceeding 12 per year. We will notify You In Writing at your
last know address at least 31 days prior to the imposition of any such Transfer
Charge.
WITHDRAWAL ALLOWANCE: On an annual basis, after the first Contract Year, You may
take partial surrenders of up to 10% of Your Contract Value less any Purchase
Payment Credits applied within 12 months of the date of the surrender. The
Contract Value is determined as of the first Valuation Date of that Contract
Year without imposition of applicable Contract charge(s) or fee(s). We reserve
the right to not permit a Withdrawal Allowance on a full surrender.
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CONTRACT SPECIFICATIONS
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WITHDRAWAL CHARGES DEDUCTED ON SURRENDER BEFORE THE MATURITY DATE OF THE
CONTRACT:
The withdrawal charge is calculated as a percentage of the Purchase Payments and
associated Purchase Payment Credits withdrawn on a first-in, first-out basis.
For purposes of determining the withdrawal charge, the order of withdrawal will
be deemed to be taken from:
(a) any Purchase Payments and associated Purchase Payment Credits to which
no withdrawal charge applies;
(b) any remaining Withdrawal Allowance (as described above) after the
reduction by the amount of (a);
(c) any remaining Purchase Payments and associated Purchase Payment Credits
to which a withdrawal charge applies; then
(d) any Contract earnings.
YEARS SINCE PURCHASE PERCENT OF PURCHASE PAYMENTS AND
PAYMENT WAS MADE PURCHASE PAYMENT CREDITS
(Not Previously Surrendered)
1-4 8%
5 7%
6 6%
7 5%
8 3%
9 1%
10 + 0%
DISTRIBUTIONS NOT SUBJECT TO A WITHDRAWAL CHARGE:
We will not deduct a withdrawal charge for Purchase Payments attributable to
values under this Contract due to:
(a) death of the Contract Owner or the Annuitant with no Contingent
Annuitant surviving; or
(b) minimum distribution (as defined by the Internal Revenue Code) made
under Our managed distribution program then in effect if elected by
the Owner by a Written Request.
We will not deduct a withdrawal charge for any Purchase Payment Credits
attributable to values under this Contract due to minimum distribution (as
defined by the Internal Revenue Code) made under Our managed distribution
program then in effect if elected by the Owner by a Written Request.
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CONTRACT SPECIFICATIONS
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INVESTMENT OPTIONS:
FIXED ACCOUNT GUARANTEED INTEREST PERIODS: The initial rate for any Purchase
Payment and associated Purchase Payment Credit is guaranteed for one year from
the date they are credited to your account. Subsequent renewal rates will be
guaranteed for the calendar quarter.
FUNDING OPTIONS: [THE TRAVELERS FUND XX XX FOR VARIABLE ANNUITIES
Delaware Group Premium Fund Inc.
REIT Series
Dreyfus Variable Investment Fund
Capital Appreciation Portfolio
Small Cap Portfolio
Greenwich Street Series Fund
Appreciation Portfolio
Diversified Strategic Income Portfolio
Total Return Portfolio
Salomon Brothers Variable Series Funds, Inc.
Salomon Brothers Variable Investors Fund
Diversified Strategic Income Portfolio
The Travelers Series Trust
Convertible Bond Portfolio
Disciplined Mid Cap Stock Portfolio
Disciplined Small Cap Stock Portfolio
Equity Income Portfolio
Federated High Yield Portfolio
Federated Stock Portfolio
Large Cap Portfolio
Lazard International Stock Portfolio
MFS Emerging Growth Portfolio
MFS Mid Cap Growth Portfolio
MFS Research Portfolio
Strategic Stock Portfolio
Travelers Quality Bond Portfolio
Travelers Series Fund Inc.
Alliance Growth Portfolio
MFS Total Return Portfolio
Xxxxxx Diversified Income Portfolio
Warburg Pincus Trust
Emerging Markets Portfolio
Capital Appreciation Fund
Travelers Money Market Portfolio]
FUNDING OPTION DEDUCTIONS:
The Administrative Charge and the Mortality and Expense Risk Charge result in a
daily deduction of [.00003836] per Funding Option. When expressed on an annual
basis, assuming a 365-day year, the deduction equals [1.40%] per Funding Option.
ADMINISTRATIVE CHARGE: .15% on an annual basis
MORTALITY AND EXPENSE RISK CHARGE: [1.25%] on an annual basis
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CONTRACT SPECIFICATIONS
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THIS PAGE LEFT INTENTIONALLY BLANK.
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DEFINITIONS
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ACCUMULATION UNIT - an accounting unit of measure used to calculate the value of
this Contract before Annuity payments begin.
AGE - age last birthday.
ANNUITANT - the person on whose life the Maturity Date and Annuity payments
depend.
ANNUITY UNIT - an accounting unit of measure used to calculate the amount of
Annuity Payments.
CODE - the Internal Revenue Code of 1986, as amended, and all related laws and
regulations, which are in effect during the term of this Contract.
CONTRACT - a Contract that describes the benefits, rights and obligations of the
Owner and Us.
CONTRACT DATE - the date on which the Contract is issued.
CONTRACT YEARS - twelve-month periods beginning with the Contract Date.
DEATH REPORT DATE - the Valuation Date coincident with or next following the day
on which We have received 1) Due Proof of Death and 2) a Written Request for an
election of a single sum payment or an alternate Settlement Option as described
in the Contract.
DUE PROOF OF DEATH - (i) a copy of a certified death certificate; (ii) a copy of
a certified decree of a court of competent jurisdiction as to the finding of
death; (iii) a written statement by a medical doctor who attended the deceased;
or (iv) any other proof satisfactory to Us.
FIXED ACCOUNT - an account that consists of the assets under this Contract other
than those in the Separate Account.
FUNDING OPTIONS - the Underlying Funds available under the Separate Account for
this Contract.
MATURITY DATE - the date on which the Annuity payments are to begin.
NONQUALIFIED CONTRACT - a Contract other than a Qualified Contract.
OUR OFFICE - the Home Office of The Travelers Life and Annuity Company or any
other office which We may designate for the purpose of administering this
Contract.
PREMIUM TAX - the amount of tax, if any, charged by a state or municipality. We
will deduct any applicable Premium Tax from the Contract Value either upon
surrender, annuitization, death, or at the time a Purchase Payment is made, but
no earlier than when We have the liability under state law.
PURCHASE PAYMENTS - payments of premium You make to Us under this Contract.
PURCHASE PAYMENT CREDIT- An amount added to the Accumulation Value of this
Contract at the time a Purchase Payment is made during the first Contract Year.
QUALIFIED CONTRACT - a Contract used in a retirement plan or program whereby the
Purchase Payments and any gains are intended to qualify under Sections 401, 403,
408, 414(d) or 457 of the Code.
RECORDED - a Written Request is Recorded when the information is noted in Our
file for this Contract.
SEPARATE ACCOUNT- the Separate Account indicated in the Contract Specifications
which We established for this class of Contracts and certain other Contracts.
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TERMINATION - discontinuance of this Contract by Us or by Your Written Request.
UNDERLYING FUND - an open-end diversified management investment company or
portfolio thereof, indicated in the Contract Specifications, which serves as a
variable investment option under the Separate Account.
VALUATION DATE -a date on which a Funding Option is valued, which is every day
the New York Stock Exchange is open for trading (except for when trading is
restricted due to an emergency as defined by the Securities and Exchange
Commission.)
VALUATION PERIOD - the period beginning at the close of business of the New York
Stock Exchange on each Valuation Date and ending at the close of business for
the next succeeding Valuation Date. Also referred to as the period between
successive valuations.
WE, US, OUR - The Travelers Life and Annuity Company.
WRITTEN REQUEST - written information including requests for Contract changes
sent to Us in a form and content satisfactory to Us and received at Our Office.
YOU, YOUR - the Owner, including a Joint Owner.
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OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
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OWNER
This Contract belongs to the Owner shown in the Contract Specifications or to
any person subsequently named in a Written Request of Transfer of Ownership as
provided below. As Owner, You have sole power during the Annuitant's lifetime to
exercise any rights and to receive all benefits given in this Contract provided
You have not named an irrevocable Beneficiary and provided the Contract is not
assigned.
You will be the recipient of all payments while the Annuitant is alive unless
You direct them to an alternate recipient under a Recorded payment direction. An
alternate recipient under a payment direction does not become the Owner. A
payment direction is revocable by You at any time by Written Request giving 30
days advance notice.
JOINT OWNER
Joint Owners may be named in a Written Request prior to the Contract Date. Joint
Owners may independently exercise transfers between accounts. All other rights
of ownership must be exercised by Joint action. Joint Owners own equal shares of
any benefits accruing or payments made to them. All rights of a Joint Owner end
at death if another Joint Owner survives. The entire interest of the deceased
Joint Owner in this Contract will pass to the surviving Joint Owner.
If a Joint Owner dies before payment of an Annuity Option begins and is survived
by the Annuitant, any surviving Joint Owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the Beneficiary named in a Written Request.
TRANSFER OF OWNERSHIP
You may transfer ownership by Written Request. You may not revoke any transfer
after the effective date of such transfer. Once the Transfer of Ownership is
Recorded by Us, it will take effect as of the date of Your Request, subject to
any payments made or other actions taken by Us before the recording.
Unless provided otherwise, a Transfer of Ownership does not affect the interest
of any Beneficiary designated prior to the effective date of the transfer.
A Transfer of Ownership may have adverse tax consequences to You as the former
Owner; please consult Your tax advisor.
ASSIGNMENT
You may collaterally assign ownership, of all or a portion of this Contract by
Written Request without the approval of any Beneficiary unless irrevocably
named. You may not exercise any rights of ownership while the assignment remains
in effect without the approval of the collateral assignee. We are not
responsible for the validity of any Assignment. Once the collateral Assignment
is Recorded by Us, it will take effect as of the date of Your Written Request,
subject to any payments made or other actions taken by Us before the Request is
received.
If a claim is made based on an Assignment, We may require proof of interest of
the claimant. A Recorded Assignment takes precedence over any rights of a
Beneficiary. Any amounts due under a Recorded assignment will be paid in a
single sum.
An Assignment may have adverse tax consequences to You; please consult Your tax
advisor.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the Owner or Beneficiary
under this Contract shall be subject to the claims of creditors or any legal
process except as may be provided by an assignment.
BENEFICIARY
The Beneficiary is the party named in a Written Request. The Beneficiary has the
right to receive any remaining Contractual benefits upon the death of the
Annuitant, or under certain circumstances, upon the death of the Owner. If there
is more than one Beneficiary surviving the Annuitant, the Beneficiaries will
share equally in benefits unless different shares are Recorded with Us by
Written Request prior to the death of the Annuitant.
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If a Joint Owner dies before payment of an Annuity Option begins and is survived
by the Annuitant, any surviving Joint Owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the Beneficiary named in a Written Request.
Unless an irrevocable Beneficiary has been named, You have the right to change
any Beneficiary by Written Request during the lifetime of the Annuitant and
while the Contract continues.
Once a change in Beneficiary is Recorded by Us, it will take effect as of the
date of the Written Request, subject to any payments made or other actions taken
by Us before the recording.
If no Beneficiary has been named by You, or if no Beneficiary is living when the
Annuitant dies, the interest of any Beneficiary will pass:
(a) if You are living, to You; or
(b) if You have died and there is a surviving Joint Owner, to the Joint
Owner; or
(c) if You have died and there is not a Joint Owner surviving, to Your
estate.
ANNUITANT
The Annuitant is the individual shown in the Contract Specifications on whose
life Annuity payments are based. The Annuitant may not be changed after the
Contract Date.
CONTINGENT ANNUITANT
You may name one individual as a Contingent Annuitant by Written Request prior
to the Contract Date. A Contingent Annuitant may not be changed, deleted or
added to the Contract after the Contract Date. For purposes of this provision
the Owner cannot be the Annuitant.
If the Annuitant dies prior to the Maturity Date while this Contract is in
effect and while the Contingent Annuitant is living:
(a) the death benefit will not be payable upon the Annuitant's death; and
(b) the Contingent Annuitant becomes the Annuitant; and
(c) all other rights and benefits provided by this Contract will continue in
effect.
When a Contingent Annuitant becomes the Annuitant, the Maturity Date remains the
same as previously in effect, unless otherwise provided.
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PURCHASE PAYMENT AND VALUATION PROVISIONS
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PURCHASE PAYMENT
PURCHASE PAYMENT
A Purchase Payment is any payment You make for this Contract and the benefits it
provides. An initial lump sum Purchase Payment must be made to the Contract and
is due and payable before the Contract becomes effective. Each Purchase Payment
is payable as shown in the Contract Specifications to Us at Our Office or to one
of Our authorized representatives. No Purchase Payment after the initial
Purchase Payment is required to continue this Contract in force, except as
provided in the Termination provision.
Net Purchase Payments are that part of Your Purchase Payments applied to the
Contract Value. A net Purchase Payment is equal to the Purchase Payment less any
applicable Premium Tax.
ALLOCATION OF PURCHASE PAYMENT
We will apply any net Purchase Payment to provide Accumulation Units of selected
Funding Options and/or the Fixed Account of this Contract. The Purchase Payment
will be applied within two business days following its receipt at Our Office.
The net Purchase Payment will be allocated to the Funding Options and/or the
Fixed Account in the proportion specified by You for this Contract. The
available Underlying Funds to which Funding Option assets are allocated are
shown in the Contract Specifications; Underlying Funds may be subsequently added
or deleted.
PURCHASE PAYMENT CREDIT
We will add a Purchase Payment Credit to this Contract with each Purchase
Payment applied during the first Contract Year. The Purchase Payment Credit will
be equal to the Purchase Payment multiplied by the Purchase Payment Credit
Percentage shown in the Contract Specifications. Each Purchase Payment Credit
will be applied on a pro rata basis to the Investment Options in the same ratio
as the applicable Purchase Payment.
Purchase Payment Credits will be deducted from any refund amount under the
following circumstances:
(a) upon return of this Contract during the Right to Examine Period;
(b) due to death of the Owner or Annuitant (with no Contingent Annuitant
surviving) during the 12 months following the application of any
Purchase Payment Credit; or
(c) termination of this Contract during the 12 months following the
application of any Purchase Payment Credit.
Any gains or losses attributable to a Purchase Payment Credit will not be
considered part of any Purchase Payment Credit deducted from any refund amount
or death benefit. Additionally, a withdrawal charge will not be deducted from
any Purchase Payment Credit which is not payable under this Contract.
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FUNDING OPTION VALUATION
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NUMBER OF ACCUMULATION UNITS
The number of Accumulation Units to be credited to each Funding Option once a
Purchase Payment has been received by Us will be determined by dividing the net
Purchase Payment applied to that Funding Option by the then Accumulation Unit
Value of that Funding Option.
ACCUMULATION UNIT VALUE
We determine the value of an Accumulation Unit in each Funding Option on each
Valuation Date by multiplying the value on the preceding Valuation Date by the
net investment factor for that Funding Option for the Valuation Period just
ended.
The value of an Accumulation Unit on any date other than a Valuation Date will
be equal to its value as of the next Valuation Date.
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NET INVESTMENT FACTOR
The net investment factor is a factor applied to measure the investment
performance of a Funding Option from one Valuation Period to the next. The net
investment factor for a Funding Option for any Valuation Period is equal to the
sum of 1.0000 plus the net investment rate.
Each Funding Option's net investment rate for a Valuation Period is equal to the
gross investment rate for that Funding Option, less the applicable Funding
Option deduction for the Valuation Period.
All Funding Option deductions are shown in the Contract Specifications.
The gross investment rate of a Funding Option for a Valuation Period is equal to
(1) divided by (2): where (1) is:
(a) investment income, plus
(b) capital gains and losses, whether realized or unrealized, less
(c) a deduction for any tax levied against the Separate Account and its
Underlying Funds;
and (2) is the amount of the assets at the beginning of the Valuation
Period.
The gross investment rate is based on the net asset value of the
Underlying Fund and may be either positive or negative. Investment income
includes any distribution whose ex-dividend date occurs during the Valuation
Period.
FIXED ACCOUNT VALUATION
NUMBER OF ACCUMULATION UNITS - We will determine the number of Accumulation
Units to be credited to the Fixed Account upon receipt of a Purchase Payment by
dividing the net Purchase Payment applied to the Fixed Account by the then
dollar value of one Accumulation Unit Value of the Fixed Account.
ACCUMULATION UNIT VALUE - We determine the value of an Accumulation Unit in the
Fixed Account on any day by multiplying the value on the immediately preceding
day by the net interest factor for the day on which the value is being
determined.
NET INTEREST FACTOR - The net interest factor for any day is the guaranteed net
interest rate which is equivalent to an effective annual interest rate of 3.00%,
plus 1.0000. The method of crediting additional interest will be at Our
discretion.
Interest is declared in advance. Before Annuity payments begin, We may credit
the Fixed Account with annual interest rates higher than the minimum guaranteed
interest rate of 3.00%. Interest rates may be higher or lower than the initial
interest rates, but not less than the minimum guaranteed interest rate of 3.00%.
Additional amounts may be credited by Us at Our discretion for the guaranteed
interest periods shown in the Contract Specifications.
TRANSFER BETWEEN INVESTMENT OPTIONS
You may transfer all or any part of the Contract Value from one Funding Option
to any other Funding Option at any time up to 30 days before the due date of the
first Annuity payment. Additionally, You may transfer a part of the Fixed
Account value to any of the Funding Options, twice a year during the 30 days
following the semi-annual Contract Date Anniversary in the amount shown in the
Contract Specifications.
Amounts may generally be transferred from the Funding Options to the Fixed
Account at any time, up to 30 days before the due date of the first Annuity
payment. Xxxxxxx previously transferred from the Fixed Account to the Funding
Options may not be transferred back to the Fixed Account for a period of at
least 6 months from the date of transfer. We reserve the right to limit the
number of transfers from one Funding Option to any other Funding Option or to
the Fixed Account. We will not limit these transfers to less than one in any
six-month period.
Transfers between Investment Options will result in the addition or deletion of
Accumulation Units having a total value equal to the dollar amount being
transferred to or from a particular Investment Option. The number of
Accumulation Units will be determined by using the Accumulation Unit Value of
the Investment Options involved as of the next valuation after We receive
notification of request for transfer. Transfers will be subject to any
applicable Transfer charge stated in the Contract Specifications.
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CONTRACT VALUES
CONTRACT VALUE
The Contract Value on any date equals the sum of the accumulated values in the
Funding Options. The accumulated value in a Funding Option equals the number of
outstanding Accumulation Units credited to that Funding Option, multiplied by
the then current Accumulation Unit Value for that Funding Option.
The Guaranteed Value of the Fixed Account equals the accumulated value of the
net Purchase Payments applied to the Fixed Account calculated by using the
guaranteed Net Interest Factor. The Guaranteed Values of the Fixed Account are
shown in the Table of Values.
CONTRACT FEE
A Contract Fee as shown in the Contract Specifications will be deducted to
reimburse Us for administrative expenses relating to the Contract. The Contract
Fee will be deducted by surrendering on a pro rata basis Accumulation Units from
all Funding Options in which You have an interest.
We will deduct the charge on a pro rata basis if the Contract has been in effect
for less than a full period on the date a Contract Fee is deducted. The Contract
Fee will also be prorated upon full surrender or Termination of the Contract.
CASH SURRENDER VALUE
The Cash Surrender Value is equal to the Contract Value less any applicable
charges and fees as shown in the Contract Specifications, less any Purchase
Payment Credit not available for withdrawal less any taxes deducted upon
surrender.
The Guaranteed Cash Surrender Value of the Fixed Account equals the Guaranteed
Value of the Fixed Account less any applicable charges and fees as shown in the
Contract Specifications less any taxes deducted upon surrender. For Guaranteed
Cash Surrender Values of the Fixed Account, refer to the Table of Values.
CASH SURRENDER
You may elect by Written Request to receive the Cash Surrender Value before the
due date of the first Annuity payment and without the consent of any Beneficiary
unless irrevocably named. In the case of a full surrender, this Contract will be
canceled. A partial surrender will reduce Your Contract Value. If You have a
balance in more than one Investment Option, Your Contract Value will be reduced
from all Your Investment Options on a pro rata basis, unless You request
otherwise.
The Cash Surrender Value will be determined as of the next Valuation Date
following receipt of Your Written Request. We may delay payment of the Cash
Surrender Value of the Funding Options for a period of not more than five
business days after We receive Your Written Request. We may delay payment of the
Cash Surrender Value of the Fixed Account for a period of not more than
six-months after We receive Your Written Request.
CONTRACT CONTINUATION
Except as provided in the Termination provision, this Contract does not require
continuing Purchase Payments and will automatically continue as a paid-up
Contract during the lifetime of the Annuitant until the Maturity Date, or until
it is surrendered.
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DEATH BENEFIT PROVISIONS
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DEATH OF ANNUITANT
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a Contingent Annuitant surviving. A
death benefit is also payable under those Settlement Options which provide for
death benefits. We will pay the Beneficiary the death benefit in a single sum as
described below upon receiving Due Proof of Death. A Beneficiary may request
that a death benefit payable under this Contract be applied to a Settlement
Option subject to the provisions of this Contract and the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the Owner is not the Annuitant, and the Owner (including the first of Joint
Owners) dies before the Maturity Date with the Annuitant surviving, We will
recalculate the value of the death benefit under the provisions of Death
Proceeds Prior To The Maturity Date below; by replacing all references to
"Annuitant" with "Owner." The value of the death benefit, as recalculated, will
be paid in a single lump sum or by other election to the party taking proceeds
under the current tax laws. The party must take distributions no later than
under the applicable elections of that provision.
DEATH PROCEEDS PRIOR TO THE MATURITY DATE
Upon the death of the Annuitant, We will pay the Beneficiary the greater of a)
or b) below, less any applicable Premium Tax as of the Death Report Date:
(a) the Contract Value less any Purchase Payment Credits applied within
12 months of death; or
(b) the total Purchase Payments less the total amount of any partial
surrenders (including associated charges, if any) made under this
Contract.
We must be notified of the Annuitant's death no later than six months from the
Annuitant's date of death in order for Us to make payment of death proceeds as
described above. If notification is received more than six months after the
Annuitant's death, We will make payment of death proceeds equal to the Contract
Value on the Death Report Date less any Purchase Payment Credits applied within
12 months of death, less any applicable Premium Tax.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
INTEREST ON DEATH PROCEEDS
Any interest on death proceeds will be paid in accordance with rules in effect
in Your state at the time of death.
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SETTLEMENT PROVISIONS
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MATURITY DATE
The Maturity Date is shown in the Contract Specifications. This is the date on
which We will begin paying to You the first of a series of Annuity payments in
accordance with an Annuity Option elected by You. Annuity payments will begin
under this Contract on the Maturity Date unless the Contract has been fully
surrendered or the proceeds have been paid to the Beneficiary prior to that
date. We may require proof that the Annuitant is alive before Annuity payments
are made. If no Maturity Date is specified, the automatic Maturity Date will be
the greater of when the Annuitant reaches Age 90 or ten years after the Contract
Date.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, You may change the Maturity Date by Written Request to
any time prior to the Annuitant's 90th birthday, or to a later date with Our
consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, We will pay the amount payable
under this Contract to You in one lump sum or in accordance with an Annuity
Option elected by You. While the Annuitant is alive, You may change Your
Settlement Option election by Written Request, but only before the Maturity
Date. We reserve the right to require satisfactory proof of the Age of any
person on whose life Annuity payments are based before making the first payment
under any Annuity Option.
During the Annuitant's lifetime, if no election has been made on the Maturity
Date, We will pay You the first of a series of periodic Annuity payments based
on the life of the Annuitant, in accordance with Annuity Option 2, with 120
monthly payments assured.
Once Annuity payments have commenced, no election changes are allowed.
MINIMUM AMOUNTS
The minimum amount that can be placed under a Settlement Option is $2,000 unless
We consent to a lesser amount. If any periodic payments due are less than $100,
We reserve the right to change the frequency to an interval resulting in a
payment of at least $100 per year. We may make other arrangements that are
equitable to the Annuitant.
ALLOCATION OF ANNUITY
At the time an election of one of the Annuity Options is made, the person
electing the option may elect to have the Cash Surrender Value applied to
provide a Variable Annuity, a Fixed Annuity or a combination of both.
If no election is made to the contrary, the value of a Funding Option will be
applied when Annuity payments start to provide an Annuity which varies with the
investment experience of that same Funding Option and the value of the Fixed
Account will be applied to provide a Fixed Annuity.
You may elect to transfer Contract Value from one Investment Option to another,
as described in the provision Transfer Between Investment Options, in order to
reallocate the basis on which Annuity payments will be determined. Once Annuity
payments start, You may, with Our consent, change the allocation of Your values
in each Funding Option.
VARIABLE ANNUITY
AMOUNT OF FIRST PAYMENT
The Life Annuity Tables are used to determine the first monthly Annuity payment.
They show the dollar amount of the first monthly Annuity payment which can be
purchased with each $1,000 applied. The amount applied to a Variable Annuity
will be the Cash Surrender Value as of 14 days before the date Annuity payments
start. If it would produce a larger first Annuity payment, the Variable Annuity
payment will be determined using the Life Annuity Tables in effect on the
Maturity Date.
TL-22240 TLAC Ed. 1-99
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ANNUITY UNIT VALUE
On any Valuation Date, the Annuity Unit Value for a Funding Option equals the
Funding Option Annuity Unit Value on the preceding Valuation Date, multiplied by
the net investment factor for that Funding Option for the Valuation Period just
ended, divided by the Assumed Daily Net Investment Factor. The Assumed Daily Net
Investment Factor is shown in the Contract Specifications. The Value of an
Annuity Unit on any date other than a Valuation Date will be equal to its value
as of the next Valuation Date.
NUMBER OF ANNUITY UNITS
We determine the number of Annuity Units credited to this Contract in each
Funding Option by dividing the first monthly Annuity payment attributable to
that Funding Option by the Funding Option's Unit Value as of 14 days before the
due date of the first Annuity payment.
AMOUNT OF SECOND AND SUBSEQUENT PAYMENTS
The dollar amount of the second and subsequent payments may change from month to
month. The amount of the Annuity payment for each Funding Option is found by
multiplying the number of Annuity Units credited to the Contract for that
Funding Option by the Annuity Unit Value for that Funding Option. The total
amount of each Annuity Payment will be equal to the sum of the payments in each
Funding Option.
FIXED ANNUITY
A Fixed Annuity is an Annuity with payments which remain fixed as to dollar
amount throughout the payment period. The Life Annuity Tables are used to
determine the monthly Annuity payment. They show the dollar amount of monthly
Annuity payments which can be purchased with each $1,000 applied. The amount
applied to a Fixed Annuity will be the Cash Surrender Value applicable to the
Fixed Annuity as of the day Fixed Annuity payments begin. If it would produce a
larger payment, the Fixed Annuity payment will be determined using the Life
Annuity Tables in effect on the Maturity Date.
================================================================================
ANNUITY OPTIONS
================================================================================
Subject to conditions stated in Elections Of Settlement Options and Minimum
Amounts, all or any part of the Cash Surrender Value of this Contract may be
paid under one or more of the Annuity Options below. We may offer additional
options.
OPTION 1. LIFE ANNUITY - NO REFUND
We will make periodic Annuity payments during the lifetime of the person on
whose life the payments are based, ending with the last payment preceding death.
OPTION 2. LIFE ANNUITY WITH 120, 180 OR 240 MONTHLY PAYMENTS ASSURED
We will make periodic Annuity payments during the lifetime of the person on
whose life the payments are based. If at the death of that person, payments have
been made for less than 120, 180, or 240 months, as elected, We will continue to
make payments to the designated Beneficiary during the remainder of the period.
OPTION 3. JOINT AND LAST SURVIVOR LIFE ANNUITY
We will make periodic Annuity payments during the Joint lifetime of two persons
on whose lives payments are based and during the lifetime of the survivor. No
more payments will be made after the death of the survivor.
OPTION 4. JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE
We will make periodic Annuity payments during the Joint lifetime
of two persons on whose lives payments are based. One of the two persons will be
designated as the primary payee. The other will be designated as the secondary
payee. On the death of the secondary payee, if survived by the primary payee, We
will continue to make periodic Annuity payments to the primary payee in the same
amount that would have been payable during the Joint lifetime of the two
persons. On the death of the primary payee, if survived by the secondary payee,
We will continue to make periodic Annuity payments to the secondary payee in an
amount equal to 50% of the payments which would have been made during the
lifetime of the primary payee. No further payments will be made following the
death of the survivor.
OPTION 5. PAYMENTS FOR A FIXED PERIOD
We will make periodic payments for the period selected.
TL-22240 TLAC Ed. 1-99
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================================================================================
GENERAL PROVISIONS
================================================================================
CONTRACT
The entire Contract between You and Us consists of the Contract, together with
the application, if a copy of such application is attached to the Contract when
issued and any Amendments, Riders or Endorsements.
CONTRACT CHANGES
The only way this Contract may be changed is by a written Amendment, Rider or
Endorsement signed by one of Our officers.
INCONTESTABILITY
We will not contest this Contract from the Contract Date.
MISSTATEMENT
If this Contract is issued as a Nonqualified Contract, and the Annuitant's (or,
if applicable, the Owner's) sex or date of birth was misstated, all benefits of
the Contract are what the Purchase Payment(s) paid would have purchased at the
correct sex and Age. Proof of the Annuitant's and Owner's Age may be filed at
any time at Our Office.
If this Contract is issued as a Qualified Contract and the Annuitant's date of
birth was misstated, all benefits of the Contract are what the Purchase
Payment(s) paid would have purchased at the correct Age. Proof of the
Annuitant's Age may be filed at any time at Our Office.
SUBSTITUTION OF UNDERLYING FUNDS
If it is not possible to continue to offer an Underlying Fund, or in Our
judgment becomes inappropriate for the purposes of this Contract, We may
substitute another Underlying Fund without Your consent. Substitution may be
made with respect to both existing investments and investment of future Purchase
Payments. However, no such substitution will be made without notice to You and
without prior approval of the Securities and Exchange Commission, to the extent
required by law.
TERMINATION
We reserve the right to terminate this Contract on any Valuation Date as stated
in the Contract Specifications. Termination will not occur until 31 days after
We have mailed notice of Termination to You at Your last known address. If this
Contract is terminated, We will pay You the Cash Surrender Value, if any.
REQUIRED REPORTS
We will furnish a report to the Owner as often as required by law, but at least
once in each Contract Year before the due date of the first Annuity payment. The
report will show the number of Accumulation Units credited to the Contract in
each Funding Option and the corresponding Accumulation Unit Value as of the date
of the report.
VOTING RIGHTS
If required by federal law, You may have the right to vote at the meetings of
the shareholders of the Underlying Funds. If You have voting rights, We will
send a notice to You telling You the time and place of a meeting. The notice
will also explain matters to be voted upon and how many votes You may exercise.
MORTALITY AND EXPENSES
Our actual mortality and expense experience will not affect the amount of any
Annuity payments or any other values under this Contract.
NON-PARTICIPATING
This Contract does not share in Our surplus earnings, so You will receive no
dividends under it.
TAXES BASED UPON PREMIUM OR VALUE
If there is a law or change in law assessing taxes against Us based upon the
premium or value of this Contract, We reserve the right to charge You
proportionately for that tax. This would include, but is not limited to, a tax
based upon Our realized net capital gains in the Funding Options, on which We
are not currently taxed.
TL-22240 TLAC Ed. 1-99
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CONFORMITY WITH STATE AND FEDERAL LAWS
This Contract is governed by the law of the state in which it is delivered. Any
paid-up Annuity, Cash Surrender Value or death benefits that are available under
this Contract are not less than the minimum benefits required by the statutes of
the state in which this Contract is delivered.
Upon receiving appropriate state approval, We may at any time make any changes,
including retroactive changes, in this Contract to the extent that the change is
required to meet the requirements of any law or regulation issued by a
governmental agency to which We or You are subject.
EMERGENCY PROCEDURE
We reserve the right to suspend or postpone the date of any payment of any
benefit or values for any Valuation Period (1) when the New York Stock Exchange
is closed; (2) when trading on the Exchange is restricted; (3) when an emergency
exists as determined by the Securities and Exchange Commission so that disposal
of the securities held in the Funding Options is not reasonably practicable or
it is not reasonably practicable to determine the value of the Funding Option's
net assets, or (4) during any other period when the Securities and Exchange
Commission, by order, so permits for the protection of security holders. Any
provision of this Contract which specifies a Valuation Date will be superseded
by this Emergency Procedure.
RELATION OF THIS CONTRACT TO THE SEPARATE ACCOUNT AND FUNDING OPTIONS
We will have exclusive and absolute ownership and control of the assets of Our
Separate Account and the Funding Options. That portion of the assets of a
Separate Account or Funding Option equal to the reserves and other Contract
liabilities with respect to such Separate Account or Funding Option shall not be
chargeable with liabilities arising out of any other business We conduct. Our
determination of the value of an Accumulation Unit and an Annuity Unit by the
method described in this Contract will be conclusive.
REDUCTION OR ELIMINATION OF CONTRACT CHARGES
All charges and fees under the Contract may be reduced or eliminated when
certain sales or administration of the Contract result in savings or reduction
of expenses, and/or risks.
TRANSFERS TO OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer funds held by You in
this Contract to another Contract issued by Us or one of Our affiliates without
incurring a withdrawal charge as shown in the Contract Specifications. Once the
transfer is complete and We have established a new Contract at Your direction,
NEW WITHDRAWAL CHARGES MAY APPLY TO THE NEW CONTRACT IN ACCORDANCE WITH THE
PROVISIONS OF SUCH CONTRACT.
TL-22240 TLAC Ed. 1-99
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TABLE OF VALUES
GUARANTEED VALUES OF THE FIXED ACCOUNT PER $1,000 OF NET PURCHASE PAYMENT
APPLIED ASSUMING NO PRIOR PARTIAL SURRENDERS
NO. OF NO. OF YEARS
YEARS FROM GUARANTEED FROM DATE GUARANTEED
DATE PAYMENT GUARANTEED CASH SURRENDER PAYMENT IS GUARANTEED CASH SURRENDER
IS APPLIED VALUE VALUE APPLIED VALUE VALUE
1 1030 950 36 2898 2898
2 1060 980 37 2985 2985
3 1092 1012 38 3074 3074
4 1125 1045 39 3167 3167
5 1159 1089 40 3262 3262
6 1194 1134 41 3359 3359
7 1229 1179 42 3460 3460
8 1266 1236 43 3564 3564
9 1304 1294 44 3671 3671
10 1343 1343 45 3781 3781
11 1384 1384 46 3895 3895
12 1425 1425 47 4011 4011
13 1468 1468 48 4132 4132
14 1512 1512 49 4256 4256
15 1557 1557 50 4383 4383
16 1604 1604 51 4515 4515
17 1652 1652 52 4650 4650
18 1702 1702 53 4790 4790
19 1753 1753 54 4934 4934
20 1806 1806 55 5082 5082
21 1860 1860 56 5234 5234
22 1916 1916 57 5391 5391
23 1973 1973 58 5553 5553
24 2032 2032 59 5720 5720
25 2093 2093 60 5891 5891
26 2156 2156 61 6068 6068
27 2221 2221 62 6250 6250
28 2287 2287 63 6437 6437
29 2356 2356 64 6631 6631
30 2427 2427 65 6829 6829
31 2500 2500 66 7034 7034
32 2575 2575 67 7245 7245
33 2652 2652 68 7463 7463
34 2731 2731 69 7687 7687
35 2813 2813 70 7917 7917
TL-22240 TLAC Ed. 1-99
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS
MALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
---------------
ADJUSTED NONE 120 180 240
---------------
AGE
45 3.59 3.57 3.56 3.53
46 3.64 3.62 3.60 3.57
47 3.69 3.67 3.65 3.62
48 3.75 3.73 3.70 3.67
49 3.81 3.78 3.76 3.71
50 3.87 3.84 3.81 3.77
51 3.93 3.90 3.87 3.82
52 4.00 3.97 3.93 3.87
53 4.07 4.04 3.99 3.93
54 4.15 4.11 4.06 3.99
55 4.23 4.19 4.13 4.05
56 4.32 4.27 4.20 4.11
57 4.41 4.35 4.28 4.17
58 4.50 4.44 4.36 4.24
59 4.61 4.53 4.44 4.31
60 4.72 4.63 4.53 4.37
61 4.83 4.74 4.62 4.44
62 4.96 4.85 4.71 4.51
63 5.09 4.97 4.81 4.58
64 5.24 5.09 4.90 4.65
65 5.39 5.22 5.01 4.72
66 5.56 5.36 5.11 4.79
67 5.73 5.50 5.21 4.86
68 5.92 5.64 5.32 4.93
69 6.12 5.80 5.43 4.99
70 6.34 5.96 5.53 5.05
71 6.56 6.12 5.64 5.11
72 6.81 6.29 5.75 5.16
73 7.07 6.46 5.85 5.21
74 7.35 6.64 5.95 5.26
75 7.64 6.82 6.05 5.30
Dollar amounts of the monthly Annuity payments for the first and second
options are based on the Annuity 2000 Table. The above tables assume a
year 2000 issue, and project mortality improvements into the future
using Projection Scale G. These tables assume a net investment rate of
3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
TL-22240 TLAC Ed. 1-99
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS
FEMALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
---------------
ADJUSTED NONE 120 180 240
---------------
AGE
45 3.39 3.39 3.38 3.37
46 3.43 3.43 3.42 3.40
47 3.48 3.47 3.46 3.44
48 3.52 3.52 3.50 3.48
49 3.57 3.56 3.55 3.53
50 3.62 3.61 3.60 3.57
51 3.68 3.66 3.65 3.62
52 3.74 3.72 3.70 3.67
53 3.80 3.78 3.76 3.72
54 3.86 3.84 3.81 3.78
55 3.93 3.90 3.88 3.83
56 4.00 3.97 3.94 3.89
57 4.07 4.05 4.01 3.95
58 4.15 4.12 4.08 4.01
59 4.24 4.20 4.15 4.08
60 4.33 4.29 4.23 4.15
61 4.43 4.38 4.32 4.22
62 4.53 4.48 4.40 4.29
63 4.64 4.58 4.49 4.36
64 4.76 4.69 4.59 4.44
65 4.89 4.80 4.69 4.52
66 5.02 4.92 4.79 4.59
67 5.17 5.05 4.89 4.67
68 5.32 5.19 5.00 4.75
69 5.49 5.33 5.12 4.82
70 5.68 5.48 5.23 4.90
71 5.87 5.64 5.35 4.97
72 6.09 5.81 5.47 5.04
73 6.32 5.99 5.59 5.10
74 6.57 6.18 5.71 5.16
75 6.84 6.37 5.83 5.22
Dollar amounts of the monthly Annuity payments for the first and second
options are based on the Annuity 2000 Table. The above tables assume a
year 2000 issue, and project mortality improvements into the future
using Projection Scale G. These tables assume a net investment rate of
3% per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
TL-22240 TLAC Ed. 1-99
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR QUALIFIED CONTRACTS
UNISEX NUMBER OF MONTHLY PAYMENTS GUARANTEED
----------------
ADJUSTED NONE 120 180 240
----------------
AGE
45 3.49 3.48 3.47 3.45
46 3.54 3.53 3.51 3.49
47 3.59 3.57 3.56 3.53
48 3.64 3.62 3.60 3.58
49 3.69 3.68 3.65 3.62
50 3.75 3.73 3.71 3.67
51 3.81 3.79 3.76 3.72
52 3.87 3.85 3.82 3.77
53 3.94 3.91 3.88 3.83
54 4.01 3.98 3.94 3.88
55 4.08 4.05 4.01 3.94
56 4.16 4.12 4.07 4.00
57 4.24 4.20 4.15 4.07
58 4.33 4.28 4.22 4.13
59 4.42 4.37 4.30 4.20
60 4.52 4.46 4.38 4.27
61 4.63 4.56 4.47 4.34
62 4.75 4.67 4.56 4.41
63 4.87 4.78 4.65 4.48
64 5.00 4.89 4.75 4.55
65 5.14 5.01 4.85 4.62
66 5.29 5.14 4.95 4.70
67 5.45 5.28 5.06 4.77
68 5.62 5.42 5.17 4.84
69 5.81 5.57 5.28 4.91
70 6.00 5.72 5.39 4.98
71 6.22 5.89 5.50 5.04
72 6.44 6.06 5.62 5.10
73 6.69 6.23 5.73 5.16
74 6.95 6.41 5.84 5.21
75 7.24 6.60 5.95 5.26
Dollar amounts of the monthly Annuity payments for the first and second
options are based on the Annuity 2000 Table (blended 50%/50%
female/male). The above tables assume a year 2000 issue, and project
mortality improvements into the future using Projection Scale G. These
tables assume a net investment rate of 3% per Annum, assuming a 365-day
year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
TL-22240 TLAC Ed. 1-99
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
THESE TABLES WILL BE USED FOR NONQUALIFIED CONTRACTS
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.18 3.27 3.35 3.42 3.47 3.51 3.54
50 3.24 3.36 3.47 3.58 3.66 3.73 3.78
55 3.29 3.43 3.59 3.74 3.87 3.99 4.08
60 3.32 3.49 3.69 3.89 4.09 4.28 4.43
65 3.35 3.54 3.76 4.02 4.31 4.59 4.84
70 3.36 3.57 3.82 4.13 4.49 4.89 5.29
75 3.37 3.59 3.86 4.21 4.63 5.14 5.71
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY MALE
AND SECONDARY
FEMALE DOLLAR AMOUNT
45 3.37
50 3.60
55 3.88
60 4.26
65 4.79
70 5.52
75 6.54
Dollar amounts of the monthly Annuity payments for the third and fourth options
are based on the Annuity 2000 Table. The above tables assume a year 2000 issue,
and project mortality improvements into the future using Projection Scale G.
These tables assume a net investment rate of 3% per Annum, assuming a 365-day
year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
TL-22240 TLAC Ed. 1-99
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PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR QUALIFIED CONTRACTS
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
UNISEX
ADJUSTED UNISEX ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.19 3.26 3.33 3.38 3.41 3.44 3.46
50 3.26 3.37 3.46 3.54 3.61 3.66 3.69
55 3.33 3.46 3.60 3.72 3.83 3.91 3.98
60 3.38 3.54 3.72 3.90 4.07 4.22 4.33
65 3.41 3.61 3.83 4.07 4.32 4.56 4.75
70 3.44 3.66 3.91 4.22 4.56 4.91 5.23
75 3.46 3.69 3.98 4.33 4.75 5.23 5.74
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
AGE OF PRIMARY
AND SECONDARY UNISEX DOLLAR AMOUNT
45 3.34
50 3.55
55 3.82
60 4.19
65 4.70
70 5.40
75 6.40
Dollar amounts of the monthly Annuity payments for the third and fourth options
are based on the Annuity 2000 Table (blended 50%/50% female/male). The above
tables assume a year 2000 issue, and project mortality improvements into the
future using Projection Scale G. These tables assume a net investment rate of 3%
per Annum, assuming a 365-day year.
Calendar Year in which 1st payment is due:
Adjusted Age is Actual Age:
1998-2000 2001-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
TL-22240 TLAC Ed. 1-99
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTION 5 - PAYMENTS FOR A FIXED PERIOD
THIS TABLE WILL BE USED WITH QUALIFIED AND NONQUALIFIED CONTRACTS.
MONTHLY MONTHLY
NUMBER OF PAYMENT NUMBER OF PAYMENT
YEARS AMOUNT YEARS AMOUNT
10 9.61 21 5.32
11 8.86 22 5.15
12 8.24 23 4.99
13 7.71 24 4.84
14 7.26 25 4.71
15 6.87 26 4.59
16 6.53 27 4.47
17 6.23 28 4.37
18 5.96 29 4.27
19 5.73 30 4.18
20 5.51
The dollar amounts of the monthly Annuity payments for the fifth option are
based on a net investment rate of 3% per annum, assuming a 365-day year.
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FLEXIBLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
TL-22240 TLAC Ed. 1-99
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WAIVER OF WITHDRAWAL CHARGE FOR NURSING HOME CONFINEMENT
THE EFFECTIVE DATE OF THIS RIDER IS ONE YEAR AFTER THE CONTRACT DATE SHOWN IN
THE CONTRACT SPECIFICATIONS PAGE OF THE CONTRACT.
This rider is made available when the Annuitant is age 70 or under on the
Contract Date and is made part of the Contract to which it is attached.
If after the effective date of this rider, and prior to the Maturity Date of the
Contract, the Annuitant begins confinement in an Eligible Nursing Home, and
remains confined for the Qualifying Period, You may make a total or partial
withdrawal, subject to the Maximum Withdrawal Amount, without incurring a
withdrawal charge. We will waive the withdrawal charge only for withdrawals made
during continued confinement in an Eligible Nursing Home after the Qualifying
Period has been satisfied, or within sixty (60) days after such confinement
ends. We will require proof of confinement in a form satisfactory to Us. Part of
the proof may be certification by a licensed physician that such confinement is
medically necessary.
DEFINITIONS:
An ELIGIBLE NURSING HOME is an institution or special nursing unit of a hospital
which:
(a) Is Medicare approved as a provider of skilled nursing care
services; and
(b) Is not, other than in name only, an acute care hospital, a home
for the aged, a retirement home, a rest home, a community living
center, or a place mainly for the treatment of alcoholism.
OR
Meets all of the following standards:
(a) It is licensed as a Nursing Care Facility by the state in which it
is located;
(b) It is either a freestanding facility or a distinct part of another
facility such as a ward, wing, unit or swing-bed of a hospital or
other facility;
(c) It provides nursing care to individuals who are not able to care
for themselves and who require nursing care;
(d) Its primary function is to provide nursing care and room and
board; and the facility charges for these services. The care must
be performed under the direction of a licensed physician, or
registered nurse (RN), or licensed practical nurse (LPN);
(e) It may include care provided by a licensed physical, respiratory,
occupational or speech therapist; and
(f) It is not, other than in name only, an acute care hospital, a home
for the aged, a retirement home, a rest home, a community living
center, or a place mainly for the treatment of alcoholism.
QUALIFYING PERIOD is confinement in an Eligible Nursing Home for 90 consecutive
days.
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EXCLUSIONS
We will not waive withdrawal charges if confinement is due to one of more of the
following causes:
(a) Mental, nervous, emotional or personality disorder without
demonstrable organic disease, including, but not limited to,
neurosis, psychoneurosis, psychopathy or psychosis;
(b) the voluntary taking or injection for drugs, unless prescribed or
administered by a licenses physician;
(c) the voluntary taking of any drugs prescribed by a licensed
physician and intentionally not taken as prescribed;
(d) sensitivity to drugs voluntarily taken, unless prescribed by a
physician;
(e) drug addiction, unless addiction results from the voluntary taking
of drugs prescribed by a licensed physician, or the involuntary
taking of drugs.
MAXIMUM WITHDRAWAL AMOUNT
The Maximum Withdrawal Amount available without incurring a withdrawal charge is
the Contract Value on the next Valuation Date following written proof of claim,
less any Purchase Payments made within 12 months prior to the date confinement
in an Eligible Nursing Home begins, less any Purchase Payment Credits applied
within 12 months of the date of the withdrawal, less any additional Purchase
Payments made on or after the Annuitant's 71st birthday.
NOTICE OF CLAIM
Written notice of claim must be given to Us following completion of the
Qualifying Period, and either while the Annuitant continues to be confined or
within 60 days after discharge from an Eligible Nursing Home. If notice cannot
be given to Us within 60 days, it must be given as soon as reasonably possible.
PAYMENT OF CLAIMS
Benefits payable under this rider will be paid as soon as We receive proper
written proof of claim. The portion of the Contract Value that is surrendered
will be paid in a lump sum to You.
DENIAL OF WAIVER BENEFIT
If the waiver benefit is denied, the surrender proceeds will not be disbursed
until You are notified of the denial and provided with the opportunity to
reapply for the surrender proceeds or to reject the surrender proceeds.
TAX IMPLICATIONS
Receipt of any portion of the Contract Value may be taxable to You as the Owner,
please consult Your tax advisor.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
PRESIDENT
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DEATH BENEFIT ENDORSEMENT
This endorsement is made part of the Contract as of the date it is attached to
the Contract.
The "DEATH BENEFIT PROVISIONS" section of the Contract is deleted
and replaced with the following:
================================================================================
DEATH BENEFIT PROVISIONS
================================================================================
DEATH OF ANNUITANT
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date, unless there is a Contingent Annuitant surviving. A
death benefit is also payable under those Settlement Options which provide for
death benefits. We will pay the Beneficiary the death benefit in a single sum as
described below upon receiving Due Proof of Death. A Beneficiary may request
that a death benefit payable under this Contract be applied to a Settlement
Option subject to the provisions of this Contract and the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the Owner is not the Annuitant, and the Owner (including the first of Joint
Owners) dies before the Maturity Date with the Annuitant surviving, We will
recalculate the value of the death benefit under the provisions of Death
Proceeds Prior To The Maturity Date below; by replacing all references to
"Annuitant" with "Owner." The value of the death benefit, as recalculated, will
be paid in a single lump sum or by other election to the party taking proceeds
under the current tax laws. The party must take distributions no later than
under the applicable elections of that provision.
DEATH PROCEEDS PRIOR TO THE MATURITY DATE
Upon the death of the Annuitant, the death benefit payable as of the Death
Report Date will be the greatest of (a), (b) or (c) below, less any applicable
Premium Tax:
(a) the Contract Value less any Purchase Payment Credits applied
within 12 months of death;
(b) the total Purchase Payments less the total amount of any partial
surrenders made under this Contract; or
(c) the Step-Up Value (as described below).
We must be notified of the Annuitant's death no later than six months from the
Annuitant's date of death in order for Us to make payment of death proceeds as
described above. If notification is received more than six months after the
Annuitant's death, We will make payment of death proceeds equal to the Contract
Value on the Death Report Date less any Purchase Payment Credits applied within
12 months of death, less any applicable Premium Tax.
STEP-UP VALUE
The Step-Up Value will initially equal the initial Purchase Payment. Whenever an
additional Purchase Payment is made, the Step-Up Value will be increased by the
amount of that Purchase Payment. Whenever a partial surrender is taken, the
Step-Up Value will be reduced by a Partial Surrender Reduction as described
below. On each Contract anniversary that occurs before the Annuitant's 80th
birthday and before the Annuitant's death, if the Contract Value less any
Purchase Payment Credits applied within the last 12 months is greater than the
Step-Up Value, the Step-Up Value will be reset to equal the Contract Value less
any Purchase Payment Credits applied within the last 12 months. The Step-Up
Value will not be reduced on these anniversary recalculations (provided no
surrenders are made on that day). The only changes made to the Step-Up Value on
or after the Annuitant's 80th birthday will be those related to additional
Purchase Payments or partial surrenders as described above.
PARTIAL SURRENDER REDUCTION
The Partial Surrender Reduction is equal to (1) the amount of death benefit
payable immediately prior to the reduction for the partial surrender, multiplied
by (2) the amount of the partial surrender divided by (3) the Contract Value
less any Purchase Payment Credits applied within 12 months of the Annuitant's
death, immediately prior to the partial surrender.
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DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the Beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
INTEREST ON DEATH PROCEEDS
Any interest on death proceeds will be paid in accordance with rules in effect
in Your state at the time of death.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
PRESIDENT
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XXXX INDIVIDUAL RETIREMENT ANNUITY QUALIFICATION RIDER
As requested by you, this Contract is amended as follows to qualify as a Xxxx
Individual Retirement Annuity (IRA) under Section 408A of the Code of 1986, as
amended. Notwithstanding any other specific provisions in the contract to the
contrary, the contract is amended to restrict the rights of the Owner or
Annuitant any Beneficiary, and to limit contributions as follows:
EXCLUSIVE BENEFIT
This Contract is established for the exclusive benefit of the Owner and the
Owner's Beneficiaries.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This Owner may not transfer ownership of the contract, sell the contract, or
assign or pledge the contract as collateral for a loan or as security for the
performance of an obligation or for any other purpose, to any person other than
the Company or a former spouse of the Owner under a divorce decree or under a
written instrument incident to that divorce.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
LIMITATION ON PURCHASE PAYMENTS
The contract will accept contributions only as follows:
Contributions to this Contract must be paid in cash and, except in the case of a
trustee-to-trustee transfer from another Xxxx XXX, or in the case of a qualified
rollover contribution, may not exceed the excess of the Owner's contribution
limit for the taxable year over the aggregate contributions made during the
taxable year to all other Xxxx IRAs and IRAs held by the Owner. Contributions
may be made without respect to the age of the Owner.
The contribution limit for the taxable year is either (1) the lesser of $2,000
or 100% of compensation of the Owner for the taxable year, or (2) where the
Owner files a joint return and receives less compensation for the taxable year
than the Owner's spouse, the lesser of $2,000 or 100% of the compensation of the
Owner and the Owner's spouse for the taxable year less the spouse's contribution
to a Xxxx XXX or IRA for the taxable year, if any.
When the Owner's adjusted gross income (AGI) excess the applicable dollar limit
(ADL; see description below), the annual contribution limit is reduced by the
following amount -
Annual
Contribution Limit x Owner's AGI-ADL
-------
$15,000 ($10,000 if the Owner is married)
For purposes of this section, AGI does not include any amount included in gross
income as a result of a rollover of an IRA to a Xxxx XXX and is reduced by any
deduction under section 219 of the Code.
The ADL is $150,000 for an Owner filing a joint return, $95,000 for an Owner
filing a single return, and $- 0- for a married Owner filing a separate return.
ROLLOVER CONTRIBUTION
A qualified rollover contribution described in section 408A(c) can be made only
from (1) another Xxxx XXX or (2) another IRA, which is not a Xxxx XXX, and can
be made from an IRA other than a Xxxx XXX only if the Owner's adjusted gross
income for the taxable year of the rollover does not exceed $100,000.
COMPENSATION
For purposes of this section, compensation means wages, salaries, professional
fees, or other amounts derived from or received for personal service actually
rendered (including, but not limited to commissions paid salespersons,
compensation for services on the basis of a percentage of profits, commissions
on insurance premiums, tips, and bonuses) and includes earned income, as
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defined in the section 401(c)(2) (reduced by the deduction the self-employed
individual takes for contributions made to a self-employed retirement plan). For
purpose of this definition, section 401(c)(2) shall be applied as if the term
trade or business for purposes of section 1402 included service described in
subsection (c)(6). Compensation does not include amounts derived from or
received as earnings or profits from property (including but not limited to,
interest and dividends) or amounts not includible in gross income. Compensation
also does not include any amount received as a pension or annuity or as deferred
compensation. The term "compensation" shall include any amount includible in the
Owner's gross income under section 71 with respect to a divorce or separation
instrument described in subparagraph (A) of section 71(b)(2).
DISTRIBUTION REQUIREMENTS
The Owner's entire interest will be distributed in accordance with one of the
following provisions, as elected:
A. (1) The Owner's entire interest will be paid by December 31 following the
fifth anniversary of the Owner's death.
(2) If any portion of the Owner's interest is payable to a designated
Beneficiary and such Beneficiary has not elected (1) above, then the
entire interest which is payable to the Beneficiary will be distributed
in substantially equal installments over a period not exceeding the life
or life expectancy of the designated Beneficiary, commencing by December
31 following the first anniversary of the Owner's death. The designated
beneficiary may elect at any time to receive greater payments if
otherwise permitted under the terms of the contract.
(3) In applying the requirements of A92) to any portion of the Owner's
interest which is payable to the Owner's surviving spouse, the date on
which the payments must commence is the later of (a) December 31
following the date the decease Owner would have attained age 70 1/2 or
(b) December 31 following the first anniversary of the Owner's death.
(4) If the designated Beneficiary of the Owner is the Owner's surviving
spouse, the spouse may treat the contract as the spouse's own Xxxx XXX.
This election will be deemed to have been made if the surviving spouse
makes a rollover or other contribution into this contract or if the
surviving spouse has failed to satisfy one or more requirements
described in (1) or (2). If the Owner's surviving spouse dies before
distributions are required to begin under this section, the Owner's
surviving spouse will be treated as having elected to made the Xxxx XXX
his or her own Xxxx XXX.
B. For purposes of this section, life expectancy will be computed by use of the
return of multiples specified in Tables V or VI of Section 1.72-9 of the
Income Tax Regulations based on the attained age of such Beneficiary during
the calendar year in which distributions are required to commence pursuant to
this section. Payments for any subsequent calendar year will be based on this
life expectancy reduced by one for each calendar year which has elapsed since
the calendar year life expectancy was first calculated. A designated
beneficiary of the Owner who is the Owner's surviving spouse may elect, prior
to the time that payments have begun to him or her, to redetermined life
expectancy each year based on the beneficiary's attained age in each such
year.
REPORTS
As the issuer of this Contract, we will furnish reports concerning the status of
the Annuity at least annually.
AMENDMENT
This Contract may be amended by us at any time to maintain its qualified status
as a Xxxx XXX. Any such amendment may be made retroactively effective if
necessary or appropriate to conform to the requirements of the Code (or any
State law granting IRA tax benefits).
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
PRESIDENT
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TAX-SHELTERED ANNUITY QUALIFICATION RIDER
This rider is made a part of this contract in order to comply with Section
403(b) of the Code. The provisions in this contract supersede any contrary
provisions in the contract. The following conditions, restrictions and
limitations apply.
OWNER
This contract belongs to the owner shown on the CONTRACT SPECIFICATIONS. As
owner, you have the sole power to exercise rights and receive benefits under
this contract during the Annuitant's lifetime. In order to maintain tax
qualification, this contract may not be sold, assigned, transferred, discounted
or pledged as collateral for a loan or as security for the performance of an
obligation or for any other purpose except as may be required or permitted under
applicable sections of the Code. We will administer this contract only as a Tax
Qualified Contract under Section 403(b) of the Code.
You will be the recipient of all payments while the Annuitant is alive unless
you direct them to an alternative recipient under a Recorded payment direction.
An alternative recipient under a payment direction does not become the owner. A
payment direction is revocable by you at any time by Written Request giving 30
days advance notice.
Joint ownership is not permitted under this contract.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This contract shall not be pledged or otherwise encumbered and it shall not be
sold, assigned, pledged as collateral for a loan, or otherwise transferred to
any other person or entity other than us.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
BENEFICIARY
The beneficiary is the party named in a Written Request. The Beneficiary
receives any remaining contractual benefits upon the death of the Annuitant. You
may change or add a Beneficiary by Written Request during the lifetime of the
Annuitant and while this contract continues, subject to the Annuitant's provided
in this rider. Once a change of Beneficiary is Recorded by us, it will be effect
as of the date of the request, subject to any payments made or other actions
taken by us before the recording.
If no Beneficiary has been named by you, or none survives when the Annuitant
dies, the interest of any Beneficiary will pass:
a) to the estate of the owner; or
b) to the trustee or plan administrator of a trusteed Tax Qualified plan
contract for further distribution in accordance with the plan.
ANNUITANT/CONTINGENT ANNUITANT
The Annuitant is the individual shown on the CONTRACT SPECIFICATIONS on whose
life the first Annuity payment is made. The Annuitant may not be changed after
the Contract Date except as may be provided hereunder.
No contingent annuitant is permitted under this contract.
DEATH OF ANNUITANT/DEATH OF OWNER WITH ANNUITANT SURVIVING
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date. A death benefit is also payable under those Settlement
Options which provide for death benefits. We will pay the Beneficiary the death
benefit in a single sum as described below upon receiving Due Proof of Death. A
Beneficiary may request that a death benefit payable under this contract be
applied to a Settlement Option subject to the provisions of this contract.
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MATURITY DATE
The Maturity Date is shown on the CONTRACT SPECIFICATIONS. This is the date on
which we will begin paying you the first of a series of Annuity or Income
payments in accordance with the Settlement Option elected by you. Annuity or
Income payments will begin under this contract on the Maturity Date unless the
contract has been fully surrendered or the proceeds have been paid to the
Beneficiary prior to that date. We may require proof that the Annuitant is alive
before Annuity payments are made. If no Maturity Date is specified, the
automatic Maturity Date will be the date when the Annuitant reaches age 70.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, you may change the Maturity Date by Written Request to a
later date with our consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, we will pay the amount payable
under this contract in one lump sum or in accordance with the Option elected by
you. While the Annuitant is alive you may change your Settlement Option election
by Written Request, but only before the Maturity Date. Once Annuity or Income
payments have commenced, no further election changes are allowed.
If no election has been made on the Maturity Date and if the Annuitant is living
and has a spouse, we will pay to you the first of a series of monthly Annuity
payments based on the life of the Annuitant as primary payee and the Annuitant's
spouse as secondary payee in accordance with Annuity Option 4. During the
Annuitant's lifetime, if no election has been made and the Annuitant has no
spouse on the Maturity Date, we will pay to you the first of a series of monthly
Annuity payments based on the life of the Annuitant, in accordance with Annuity
Option 2, with 120 monthly payments assured.
ELECTIVE DEFERRAL CONTRIBUTION LIMITS
In order to meet the qualification requirements of Code Section 403(b), elective
deferral contributions may not exceed the limitations in effect under Code
Section 402(g).
This rule is an individual limitation that applies to all elective deferral
plans, contracts or arrangements in the aggregate.
WITHDRAWAL RESTRICTIONS
To qualify as a contract which can defer compensation under a Code Section
403(b) plan or arrangement, the withdrawal restrictions under Code Section
403(b)(11) must be met.
Withdrawals attributable to contributions made pursuant to a salary reduction
agreement may be paid only upon or after attainment of age 59 1/2, separation
from service, death, total or permanent disability (as defined in Code Section
72(m)(7)) or in the case of hardship (as defined in the Treasury Regulations).
The hardship exception applies only to the salary reduction contributions and
not to any income attributable to such contribution.
These withdrawal restrictions apply to years beginning after December 31, 1988
but only with respect to assets other than those assets held as of the close of
the last year beginning before January 1, 1989.
If contributions attributable to a custodial account described in Section
403(b)(7) of the Code are transferred to this contract, the following
conditions, restrictions, and limitations apply:
Withdrawals attributable to these transferred contributions may be paid
only upon or after attainment of age 59 1/2, separation from service,
death, or total and permanent disability (as defined in Code Section
72(m)(7)).
Withdrawals on account of hardship may be made only with respect to assets
attributable to a custodial account as of the close of the last year
beginning before January 1, 1989 and amounts contributed thereafter under
a salary reduction agreement but not to any income attributable to such
conditions.
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ELIGIBLE ROLLOVERS
To the extent you are otherwise eligible for a distribution under this contract,
and provided the distribution is an eligible rollover distribution, you may
elect to have such distribution or a portion of it paid directly to an eligible
retirement plan. You must specify the eligible retirement plan to which such
distribution is to be paid in a form and at such time acceptable to us. Such
distribution shall be made as of a direct transfer to the eligible retirement
plan so specified. Contract surrender penalties may apply to all rollovers.
Previously taxed amounts in this contract are not eligible for rollover. Amounts
that are rolled over are taxed generally until later distributed. An eligible
rollover distribution includes generally any taxable distribution or portion
thereof from this contract except:
a. any distribution which is one of a series of substantially equal
periodic payments made not less frequently than annually and made to
you for life or life expectancy or to you or your joint life
beneficiary for joint lives or life expectancies, or for a specified
period of 10 years or more, or
b. any distribution which is a required distribution as described below
under "MANDATORY DISTRIBUTION REQUIREMENTS."
An eligible retirement plan includes an individual retirement annuity or account
described in Code Section 408. It also includes a tax sheltered annuity plan or
arrangement under Code Section 403(b), provided it accepts eligible rollovers
and is a defined contribution plan.
If you receive a distribution that is eligible for rollover, but you receive the
check directly, then mandatory income tax withholding will be taken from the
distribution. You may roll over the balance to an individual retirement annuity
or account within 60 days of receipt, and may make up the amount withheld from
other sources in the rollover in order to roll over the maximum without possible
early distribution tax penalty on the amount of the tax withholding.
MANDATORY DISTRIBUTION REQUIREMENTS
In order to meet the qualification requirements of Code Section 403(b), all
plans must meet the required mandatory distribution rules in Code Section
401(a)(9).
Code Section 401(a)(9) states that a plan will not be qualified unless the
entire interest of each employee is distributed to such employee not later than
the "required beginning date" or over the life or life expectancy of such
employee or over the lives or joint life expectancy of such employee and a
designated Beneficiary. Generally, the "required beginning date" means April 1
of the calendar year following the later of (1) the calendar year in which the
employee attains age 70 1/2, or (2) the calendar year in which the employee
retires, except that in the event that the employee is a 5% owner, the "required
beginning date" is April 1 of the calendar year in which the employee attains
age 70 1/2.
If the employee dies after the distribution has begun but before his/her entire
interest has been distributed, the remaining interest must be paid out at least
as rapidly as it was being paid out under the method of payment in effect at the
time of death. If the employee dies before the distribution of his/her entire
interest has begun, the entire interest must be distributed within five years
after the employee's death or an Annuity payable over no longer than life or
life expectancy must be distributed to an electing designated Beneficiary
starting within one year of the employee's death. A spousal designated
Beneficiary may elect to defer distributions until the employee would have
attained the age of 70 1/2.
ADMINISTRATIVE COMPLIANCE
If changes in the Code and related law, regulations and rulings require a
distribution greater than described above in order to keep this Annuity
qualified under the Code, we will administer the contract in accordance with
these laws, regulations and rulings. We will provide you with a revised rider
describing any necessary changes, following all regulatory approvals.
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AMENDMENT
Notwithstanding any provision in this contract or in the 403(b) plan of which
this contract is a part, we reserve the right to amend or modify the contract or
any rider or any endorsement thereto, to the extent necessary to comply with any
law, regulation or other requirement in order to establish or maintain the
qualified status of such plan. Any such amendment or modification may be made
retroactively to conform to the requirements of such law, regulation or other
requirement.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
President
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PENSION/PROFIT SHARING PLAN QUALIFICATION RIDER
If the owner of this contract requested that it be issued to comply with Section
401(a) of the Code, the following conditions, restrictions and limitations apply
to this contract. The contract shall constitute an asset of the qualified
pension or profit-sharing plan established under Code Section 401(a) and the
regulations thereunder and the contract shall be subject to the provisions,
terms and conditions of such qualified plan. The amounts held under this
contract will be used for the exclusive benefit of the employees and their
beneficiaries. The provisions in this rider supersede any contrary provisions in
the contract.
OWNER
This contract belongs to the owner shown on the CONTRACT SPECIFICATIONS. As
owner, you have the sole power to exercise rights and receive benefits under
this contract during the Annuitant's lifetime. In order to maintain tax
qualification, this contract may not be sold, assigned, transferred, discounted
or pledged as collateral for a loan or as security for the performance of an
obligation or for any other purpose except as may be required or permitted under
applicable sections of the Code. We will administer this contract only as a Tax
Qualified Contract.
You will be the recipient of all payments while the Annuitant is alive unless
you direct them to an alternative recipient under a Recorded payment direction.
An alternative recipient under a payment direction does not become the owner. A
payment direction is revocable by you at any time by Written Request giving 30
days advance notice.
Joint ownership is not permitted under this contract.
TRANSFER OF OWNERSHIP ASSIGNMENT
This contract shall not be pledged or otherwise encumbered and it shall not be
sold, assigned, or otherwise transferred to any other person or entity other
than us.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
BENEFICIARY
The beneficiary is the party named in a Written Request. The Beneficiary
receives any remaining contractual benefits upon the death of the Annuitant. You
may change or add a Beneficiary by Written Request during the lifetime of the
Annuitant and while this contract continues, subject to the limitations provided
in this rider. Once a change of Beneficiary is Recorded by us, it will be effect
as of the date of the request, subject to any payments made or other actions
taken by us before the recording.
If no Beneficiary has been named by you, or none survives when the Annuitant
dies, the interest of any Beneficiary will pass:
a) to the estate of the owner; or
b) to the trustee or plan administrator of a trusteed Tax Qualified plan
contract for further distribution in accordance with the plan.
ANNUITANT/CONTINGENT ANNUITANT
The Annuitant is the individual shown on the CONTRACT SPECIFICATIONS on whose
life the first Annuity payment is made. The Annuitant may not be changed after
the Contract Date except as may be provided hereunder.
No contingent annuitant is permitted under this contract.
DEATH OF ANNUITANT/DEATH OF OWNER WITH ANNUITANT SURVIVING
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date. A death benefit is also payable under those Settlement
Options which provide for death benefits. We will pay the Beneficiary the death
benefit in a single sum as described below upon receiving Due Proof of Death. A
Beneficiary may request that a death benefit payable under this contract be
applied to a Settlement Option subject to the provisions of this contract.
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MATURITY DATE
The Maturity Date is shown on the CONTRACT SPECIFICATIONS. This is the date on
which we will begin paying you the first of a series of Annuity or Income
payments in accordance with the Settlement Option elected by you. Annuity or
Income payments will begin under this contract on the Maturity Date unless the
contract has been fully surrendered or the proceeds have been paid to the
Beneficiary prior to that date. We may require proof that the Annuitant is alive
before Annuity payments are made. If no Maturity Date is specified, the
automatic Maturity Date will be the date when the Annuitant reaches age 70.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, you may change the Maturity Date by Written Request to a
later date with our consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, we will pay the amount payable
under this contract in one lump sum or in accordance with the Option elected by
you. While the Annuitant is alive you may change your Settlement Option election
by Written Request, but only before the Maturity Date. Once Annuity or Income
payments have commenced, no further election changes are allowed.
If no election has been made on the Maturity Date and if the Annuitant is living
and has a spouse, we will pay to you the first of a series of monthly Annuity
payments based on the life of the Annuitant as primary payee and the Annuitant's
spouse as secondary payee in accordance with Annuity Option 4. During the
Annuitant's lifetime, if no election has been made and the Annuitant has no
spouse on the Maturity Date, we will pay to you the first of a series of monthly
Annuity payments based on the life of the Annuitant, in accordance with Annuity
Option 2, with 120 monthly payments assured.
MANDATORY DISTRIBUTION RESTRICTIONS
In order to meet the qualification requirements of Code Section 401(a), all
plans must meet the required mandatory distribution rules in Code Section
401(a)(9).
Code Section 401(a)(9) states that a plan will not be qualified unless the
entire interest of each employee is distributed to such employee not later than
the "required beginning date" or over no longer than the life or life expectancy
of such employee or the lives or joint life expectancy of such employee and a
designated Beneficiary. Generally, the "required beginning date" means April 1
of the calendar year following the later of (1) the calendar year in which the
employee attains age 70 1/2, or (2) the calendar year in which the employee
retires, except that in the event the employee is a 5% owner, the "required
beginning date" is April 1 of the calendar year following the calendar year in
which the employee attains age 70 1/2.
If the employee dies before his/her entire interest has been distributed, the
remaining interest must be paid out at least as rapidly as under the method of
payment in effect at the time of death. If the employee dies before the
distribution of his/her entire interest has begun, the entire interest must be
distributed within five years after the employee's death or an Annuity payable
over no longer than life or life expectancy must be distributed to an electing
designated Beneficiary starting within one year of the employee's death. A
spousal designated Beneficiary may elect to defer distributions until the
employee would have attained the age of 70 1/2.
ANNUITIES DISTRIBUTED UNDER QUALIFIED PLANS
If the applicant for this contract requested that it be issued to comply with
Section 401(a) of the Code, and this contract has subsequently been transferred
to the Annuitant, the following conditions, restrictions and limitations apply
to this contract in addition to the above.
Spousal Consent
Death Benefit - If the Annuitant dies while the contract continues and the
Annuitant has a spouse at the time of the Annuitant's death, we will pay the
death benefit to a person other than the current spouse of the Annuitant only if
proof of spousal consent, which meets the requirements of Section 417 of the
Code, is furnished to us.
If the Beneficiary is not the current spouse and such spousal consent is not
furnished, we will pay 50% of the death benefit to the current spouse. We will
pay the balance of the death benefit to the Beneficiary.
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Cash Surrender - Before the due date of the first Annuity or Income Payment, 1)
if you do not have a spouse and without the consent of any Beneficiary; or, 2)
if you do have a current spouse then only with the written consent of your
spouse, as required by Section 417 of the Code; we will pay to you all or any
portion of the Cash Surrender Value of the contract upon receipt of your Written
Request for it.
Settlement Option - If the Annuitant is living on the Maturity Date, payment
must be made in accordance with Option 4 under ANNUITY OPTIONS unless you elect
another form of Annuity Option and furnish us a qualified election which meets
the requirements of Section 417 of the Code.
AMENDMENT
Notwithstanding any provision to the contrary in this contract or the qualified
pension or profit-sharing plan of which this contract is a part, we reserve the
right to amend or modify the contract or any rider or endorsement thereto, to
the extent necessary to comply with any law, regulation or other requirement in
order to establish or maintain the qualified status of the plan. Any such
amendment or modification may be made retroactively effective if necessary or
appropriate to conform to the conditions imposed by such law, regulation or
other requirement.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
President
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NONQUALIFIED ANNUITY RIDER - DISTRIBUTION REQUIREMENTS
This rider is made a part of this Contract as its Contract Date in order to
comply with the tax rules under Section 72(s) of the Code for required
distributions upon the death of any Contract Owner. The provisions in this
rider supersede any contrary provisions in the Contract. The following
conditions, restrictions and limitations must apply to maintain the tax
qualified status of Your Annuity.
REQUIRED DISTRIBUTIONS WHERE OWNER AND ANNUITANT DIE SIMULTANEOUSLY
If You are the Owner and the Annuitant or You are the Owner and You die
simultaneously with the Annuitant before payment of any Annuity Option begins,
an amount equal to the Death Benefit will be distributed within five years of
Your death to the Contract Beneficiary unless:
a. the Beneficiary elects by Written Request to have the proceeds
distributed over the Beneficiary's life or over a period not
extending beyond life expectancy, and the payments begin within one
year of Your death; or
b. the sole Beneficiary is Your spouse who elects by Written Request to
continue the Contract as the Owner and Annuitant.
If You are the Owner and the Annuitant or You are the Owner and You die
simultaneously with the Annuitant after an Annuity option begins but before Your
entire interest has been distributed, the remaining proceeds of the Contract
will be distributed at least as rapidly as they were being distributed under the
method of payment in effect at the time of Your death.
The death of the first Joint Owner triggers these distribution requirements.
NON-NATURAL OWNER HOLDING FOR NATURAL PERSONS
The above rules also apply if You are not an individual and the primary
Annuitant dies before payment of an Annuity Option begins. Payments will be made
to the Beneficiary. The primary Annuitant is the first-named Xxxxxxxxx and the
individual who is of primary importance in affecting the timing or amount of
payments under the Contract.
If You are not an individual and the primary annuitant dies after payment of an
Annuity option begins, the remaining proceeds of the Contract will be
distributed at least as rapidly as they were being distributed under the method
of payment in effect at the time of the primary Annuitant's death.
REQUIRED DISTRIBUTIONS WHERE OWNER AND ANNUITANT DO NOT DIE SIMULTANEOUSLY
If You are the Owner but not the Annuitant, and You die before the Annuitant and
before payment of an Annuity Option begins, an amount equal to the Death Benefit
will be distributed within five years of Your death to the Joint Owner surviving
You. In this circumstance, the Joint Owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights preempt those of
the Beneficiary named in a Written Request. The distribution may be made over a
period that exceeds five years from Your death or may be postponed by Your
spouse if:
a. the Joint Owner elects by Written Request to have the proceeds
distributed over his or her life or over a period not extending
beyond life expectancy, and the payments begin within one year of
Your death; or
b. the sole Joint Owner is Your spouse, who elects by Written Request
to continue the Contract as Owner.
The Joint Owner is determined by Contract designation. If there is no Joint
Owner or Beneficiary surviving You, ownership of this Contract passes to Your
estate. The estate or the individual taking the Contract benefits through Your
estate must take complete distribution within five years of Your death.
If You are the Owner but not the Annuitant, and You die after payment of an
Annuity Option begins, the remaining proceeds of the Contract will be
distributed at least as rapidly as they were being distributed under the method
of payment in effect at the time of Your death.
The death of the first Joint Owner triggers these distribution requirements.
ADMINISTRATIVE COMPLIANCE
If the Code and related law, regulations and rulings require a distribution
other than described above in order to keep this Annuity Contract qualified
under the Code, we will administer the Contract in accordance with these laws,
regulations, and rulings. We will provide You with a revised rider describing
any necessary changes, following all regulatory approvals.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
President
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INDIVIDUAL RETIREMENT ANNUITY QUALIFICATION RIDER
As requested by you, this Contract is amended as follows to qualify as an
Individual Retirement Annuity (IRA) under Section 408(b) of the Code of 1986, as
amended. The provisions of this rider supersede any contrary provisions in the
contract.
EXCLUSIVE BENEFIT
This Contract is established for the exclusive benefit of you or your
Beneficiaries.
OWNER
This contract belongs to the owner shown on the CONTRACT SPECIFICATIONS. As
owner, you have the sole power to exercise rights and receive benefits under
this contract during the Annuitant's lifetime. In order to maintain tax
qualification, this contract may not be sold, assigned, transferred, discounted
or pledged as collateral for a loan or as security for the performance of an
obligation or for any other purpose except as may be required or permitted under
applicable sections of the Code. We will administer this contract only as an
Individual Retirement Annuity.
You will be the recipient of all payments while the Annuitant is alive unless
you direct them to an alternative recipient under a Recorded payment direction.
An alternative recipient under a payment direction does not become the owner. A
payment direction is revocable by you at any time by Written Request giving 30
days advance notice.
Joint ownership is not permitted under this contract.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This contract shall not be pledged or otherwise encumbered and it shall not be
sold, assigned, or otherwise transferred to any other person or entity other
than us. No loans shall be made under this contract.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
BENEFICIARY
The beneficiary is the party named in a Written Request. The Beneficiary
receives any remaining contractual benefits upon the death of the Annuitant. You
may change or add a Beneficiary by Written Request during the lifetime of the
Annuitant and while this contract continues. Once a change of Beneficiary is
Recorded by us, it will be effect as of the date of the request, subject to any
payments made or other actions taken by us before the recording.
If no Beneficiary has been named by you, or none survives when the Annuitant
dies, the interest of any Beneficiary will pass to the estate of the owner.
ANNUITANT/CONTINGENT ANNUITANT
The Annuitant is the individual shown on the CONTRACT SPECIFICATIONS on whose
life the first Annuity payment is made. The Annuitant may not be changed after
the Contract Date except as may be provided hereunder.
No contingent annuitant is permitted under this contract.
DEATH OF ANNUITANT/DEATH OF OWNER WITH ANNUITANT SURVIVING
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date. A death benefit is also payable under those Settlement
Options which provide for death benefits. We will pay the Beneficiary the death
benefit in a single sum as described below upon receiving Due Proof of Death. A
Beneficiary may request that a death benefit payable under this contract be
applied to a Settlement Option subject to the provisions of this contract.
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MATURITY DATE
The Maturity Date is shown on the CONTRACT SPECIFICATIONS. This is the date on
which we will begin paying you the first of a series of Annuity or Income
payments in accordance with the Settlement Option elected by you. Annuity or
Income payments will begin under this contract on the Maturity Date unless the
contract has been fully surrendered or the proceeds have been paid to the
Beneficiary prior to that date. We may require proof that the Annuitant is alive
before Annuity payments are made. If no Maturity Date is specified, the
automatic Maturity Date will be the date when the Annuitant reaches age 70.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, you may change the Maturity Date by Written Request to a
later date with our consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, we will pay the amount payable
under this contract in one lump sum or in accordance with the Option elected by
you. While the Annuitant is alive you may change your Settlement Option election
by Written Request, but only before the Maturity Date. Once Annuity or Income
payments have commenced, no further election changes are allowed.
If no election has been made on the Maturity Date and if the Annuitant is living
and has a spouse, we will pay to you the first of a series of monthly Annuity
payments based on the life of the Annuitant as primary payee and the Annuitant's
spouse as secondary payee in accordance with Annuity Option 4. During the
Annuitant's lifetime, if no election has been made and the Annuitant has no
spouse on the Maturity Date, we will pay to you the first of a series of monthly
Annuity payments based on the life of the Annuitant, in accordance with Annuity
Option 2, with 120 monthly payments assured.
LIMITATION ON PURCHASE PAYMENTS
Notwithstanding the provisions of the Contract and except in the case of a
rollover contribution (as permitted by Section 402(c), 403(a)(4), 403(b)(8), or
408(d)(3) of the Code) or a contribution made in accordance with the terms of a
Simplified Employee Pension (SEP) program as described in Section 408(k) of the
Code, the total contributions shall not exceed the lesser of $2,000 or 100% of
compensation for any taxable year. In the case of a spousal IRA, the maximum
contribution shall not exceed the lesser of $4,000 or 100% of compensation, but
no more than $2,000 can be contributed to either spouse's IRA. In the case of a
Simplified Employee Pension Plan qualifying under Section 408(k), the annual
contribution under the Contract may not exceed the lesser of $30,000 or 15% of
compensation. No contributions will be accepted unless they are in cash.
The amount of purchase payments beyond the minimum purchase payment under this
Contract is not fixed. The minimum purchase payment must be received as a
rollover (see Section X). Payment of purchase payments beyond the first will not
be required to continue this contract.
Purchase payments after the first will not be required to continue this Contract
in force. We reserve the right, however, to terminate this Contract when no
purchase payments have been made for at least two consecutive years and the
Contract Value of the Contract is less than the termination amount of $1,000 or
the paid up Annuity benefit at maturity would be less than $20 per month. If
this Contract is terminated, we will pay you the Cash Surrender Value, if any.
COMPENSATION
Compensation means wages, salaries, professional fees, or other amounts derived
from or received from personal service actually rendered (including, but not
limited to, commissions) and includes earned income as defined in Code Section
401(c)(2). Compensation does not include amounts received as earnings or profits
from property or amounts not includable in gross income. Compensation also does
not include any amount received as a pension or Annuity or as deferred
compensation. The term compensation shall include any amount includible in the
individual's gross income under Code Section 71 with respect to a divorce or
separation instrument.
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DISTRIBUTION OF BENEFITS
Notwithstanding any provision of this contract to the contrary, the distribution
of an individual's interest shall be made in accordance with the minimum
distribution requirements of Section 408(a)(6) or Section 408(b)(3) of the Code
and the regulations thereunder, including the incidental death benefit
provisions of Section 1.401(a)(9)-2 of the proposed regulations, all of which
are herein incorporated by reference.
Your entire interest in the account must be distributed, or begin to be
distributed, by your required beginning date, which is the April 1 following the
calendar year in which you reach age 70 1/2. For each succeeding year, a
distribution must be made on or before December 31. By the required beginning
date you may elect to have the balance in the account distributed in one of the
following forms:
1. a single sum payment;
2. equal or substantially equal payments over your life;
3. equal or substantially equal payments over the lives of you and your
designated Beneficiary;
4. equal or substantially equal payments over a specified period that may
not be longer than your life expectancy;
5. equal or substantially equal payments over a specified period that may
not be longer than the joint life and last survivor expectancy of you
and your designated Beneficiary.
MINIMUM AMOUNTS TO BE DISTRIBUTED
If your interest is to be distributed in other than a lump sum or substantially
equal amounts as discussed above, then the amount to be distributed each year,
commencing at your required beginning date, must be at least an amount equal to
the quotient obtained by dividing your entire interest by your life expectancy
or the joint and survivor expectancy of you and your designated Beneficiary.
Life expectancy and joint and last survivor expectancy are computed by use of
the return multiples contained in section 1.72-9 of the Income Tax Regulations.
For purposes of this computation, the owner's life expectancy may be
recalculated no more frequently than annually; however, the life expectancy of a
non-spouse Beneficiary may not be recalculated.
If your designated Beneficiary is not your spouse, then the minimum amount
required to be distributed shall be the greater of the amount determined above,
or the amount determined under the incidental benefit rules set forth in
Treasury Regulation Section 1.401(a)(9)-2.
DEATH
If you die before your entire interest is distributed, the entire remaining
interest will be distributed as follows:
1. If you die on or after distributions have begun under the DISTRIBUTION
OF BENEFITS section, the entire remaining interest must be distributed
at least as rapidly as provided under the DISTRIBUTION OF BENEFITS
section.
2. If you die before distributions have begun under the DISTRIBUTION OF
BENEFITS section, the entire remaining interest must be distributed as
elected by you, or, if you have not so elected, as elected by the
Beneficiary or Beneficiaries, as follows:
a) by December 31st of the year containing the fifth anniversary of
your death; or
b) in equal or substantially equal payments over the life or life
expectancy of the designated Beneficiary or Beneficiaries
starting by December 31st of the year following the year of your
death. If the Beneficiary is your surviving spouse and he or she
elects to treat this contract as his or her own, this
distribution may be deferred until December 31st of the year you
would have turned age 70 1/2.
If your surviving spouse dies before distributions begin, the restrictions in
paragraphs 2 (a) and (b) above shall apply.
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Unless otherwise elected by you prior to the commencement of distributions under
the DISTRIBUTION OF BENEFITS section, or, if applicable, by the surviving spouse
where you die before distributions have commenced, life expectancies of you or
your spousal Beneficiary shall be recalculated annually for purposes of
distributions under the DISTRIBUTION OF BENEFITS section and the DEATH section.
An election not to recalculate shall be irrevocable and shall apply to all
subsequent years. The life expectancy of a non-spouse Beneficiary shall not be
recalculated.
ALTERNATIVE CALCULATION METHOD
An individual may satisfy the minimum distribution requirements under section
408(a)(6) and 408(b)(3) of the Code by receiving a distribution for one IRA that
is equal to the amount required to satisfy the minimum distribution requirements
for two or more IRAs. For this purpose, the owner of two or more IRAs may use
the alternative method described in Notice 88-38, 1988-1 C.B. 524, to satisfy
the minimum distribution requirements described above.
NONFORFEITABILITY
Your entire interest in this Contract is nonforfeitable.
ROLLOVERS
A. Subject to subparagraphs (B) and (C) hereof, and the limitations stated
in the Contract, you may transfer to this Contract your interest in any
of the following:
1. the entire amount, or any portion thereof, under any other
individual retirement account or individual retirement Xxxxxxx
qualified under Section 408 of the Code;
2. the entire amount, or any portion thereof, excluding
nondeductible employee voluntary contributions, under a trust
described in Section 401(a) of the Code which is exempt from tax
under Section 501(a) of the Code or under a qualified annuity plan
described in Section 403(a) of the Code.
3. the entire amount or any portion thereof, excluding nondeductible
employee voluntary contributions, to which you are entitled under a
tax sheltered annuity described in Section 403(b) of the Code.
Distributions you roll over from retirement plans or arrangements
described in A.2. and A.3. above to this contract must be completed by
means of a direct transfer or rollover in accordance with Code Section
401(a)(31) in order to avoid the mandatory 20% income tax withholding from
the distribution and a possible 10% additional tax penalty under Code
Section 72(t). You may replace amounts withheld from other sources to
complete the full rollover, but the 10% penalty may continue to be due if
you do not specify that the transfer of the distribution be conducted by
direct transfer or rollover.
B. You shall not make a rollover under subparagraph (A)(1) hereof during
the 12 month period commencing on the date you last made a rollover
contribution of the type described in subparagraph (A)(1).
C. We must receive any amount which qualifies for a rollover within 60
days after you receive the distribution.
DISTRIBUTIONS PRIOR TO AGE 59 1/2
Except in the event of your death, disability or attainment of age 59 1/2, we
shall receive from you a declaration of your intention as to the disposition of
the amounts distributed before making any distribution from this Contract.
REPORTS
As the issuer of this Contract, we will furnish reports concerning the status of
the Annuity at least annually.
DISABILITY PAYMENTS
If the Contract contains a Rider for waiver of premium and disability payment
benefits, any disability payments provided for in the CONTRACT SPECIFICATIONS
will be applied as purchase payments under the contract.
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AMENDMENT
This Contract may be amended by us at any time to maintain its qualified status
under Section 408(b) of the Code, following all regulatory approvals. Any such
amendment may be made retroactively effective if necessary or appropriate to
conform to the requirements of the Code (or any State law granting IRA tax
benefits).
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ X.X XXXXXXXXX
President
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