Exhibit 7.1
REINSURANCE AGREEMENT
EFFECTIVE FEBRUARY 1, 1999
BETWEEN
CONTINENTAL ASSURANCE COMPANY
AND
GE LIFE AND ANNUITY ASSURANCE
COMPANY
GUARANTEED MINIMUM DEATH BENEFIT
REINSURANCE AGREEMENT
CEDING COMPANY: GE LIFE AND ANNUITY ASSURANCE COMPANY
(hereinafter referred to as the "Ceding Company")
REINSURER: CONTINENTAL ASSURANCE COMPANY OF CHICAGO, ILLINOIS
(hereinafter referred to as "Continental")
EFFECTIVE DATE: February 1, 1999
Commencing on the effective date, the Ceding Company will submit and Continental
agrees to accept, the Ceding Company's Guaranteed Minimum Death Benefit (GMDB)
risks as defined in Schedule B, the Accepted Coverage Schedule, subject to the
provisions of this agreement.
TABLE OF CONTENTS
ARTICLES TITLE PAGE
I Automatic reinsurance 3
II Reinsurance premiums and reporting 3
III Errors and omissions 5
IV Forms 5
V Claims 5
VI Recapture 7
VII Inspection of records 7
VIII Confidentiality 8
IX Insolvency 8
X Termination charge 9
XI Parties to the agreement 10
XII Duration of agreement 10
XIII Arbitration 10
XIV Currency 11
XV Choice of law and forum 11
XVI Dac tax 11
XVII Premium tax 12
XVIII Entire contract 12
SCHEDULES
A Automatic Acceptance Limits 15
B Accepted Coverage 16
C Premium Rates 18
D Quarterly Reporting Format 19
E Sub-Accounts 20
2
ARTICLE I
AUTOMATIC REINSURANCE
1. Beginning with the effective date of this agreement, the Ceding Company
will cede and Continental will accept, subject to the limits and conditions
set forth in this Agreement and the Schedules attached thereto, reinsurance
of the GMDB attached to the Variable Annuity Contracts listed in Schedule
B. The GMDB reinsurance benefit is as described in the rider shown in
Schedule A.
2. This agreement covers only the Ceding Company's liability on claims under
Variable Annuity Contracts. Approved GMDB forms, Variable Annuity
Contracts and Annuity Contract Forms are listed in Schedule B.
3. If the Ceding Company intends to cede to Continental liability with respect
to a new annuity contract, or a revised version of an annuity contract
where such revision effects the GMDB, it must provide Continental written
notice of such intention together with a copy of the proposed annuity
contract, or revision. Continental must approve all such
additions/revisions in writing.
4. The Ceding Company will not change its existing published limits and rules
relating to GMDB as stated in its prospectus in effect as of January 29,
1999. Continental shall have no liability pursuant to revised limits and
rules unless the Ceding Company provides written notice to Continental of
such changes and Continental provides written notice to the Ceding Company
that such revised limits and rules are acceptable.
ARTICLE II
REINSURANCE PREMIUMS AND REPORTING
1. REINSURANCE PREMIUMS
A. Reinsurance premiums will be paid monthly in arrears. Such premiums
will be determined by the application of the rates set forth in
Schedule C to the amount of account value provided for each annuity
insured by the Ceding Company as calculated based on the criteria
defined in Schedule C.
B. Continental's share of the maximum purchase amount issued on the life
of each annuitant shall not exceed $3,000,000 without prior
notification and acceptance. The maximum purchase amount is the sum of
all premium contributions less withdrawals in the Contract. For
purchase amounts in excess of the maximum, where Continental has not
agreed to accept the entire amount, Continental's death benefit
liability will be reduced by the ratio of purchase amounts in excess
of the maximum to the total purchase amounts.
3
2. REINSURANCE REPORTING
A. Within 30 days from the close of the calendar month, the Ceding
Company will forward to Continental a statement or electronic medium
reflecting the premiums due including any adjustments from the prior
month. The Ceding Company will also remit a check for the balance due
or will submit a request for payment of any net amount due from
Continental. No interest is payable on amounts paid within 30 days.
B. If the amounts described in this Article cannot be determined by said
due dates on an exact basis, such payments will be made with a
generally agreed upon formula which will approximate the actual
payments. Adjustments will then be made to reflect actual amounts when
they become available.
3. UNPAID PREMIUMS
A. If any reinsurance premium is not paid within 30 days following the
allotted time, Continental may terminate the reinsurance on unpaid
policies by giving the Ceding Company written notice. The Ceding
Company will be liable for the payment of reinsurance premiums to the
effective date of termination. Failure by Continental to exercise its
right under this paragraph in any specific situation will not be a
waiver of Continental's right to do so at a later date.
B. Continental will reinstate the reinsurance at any time within sixty
(60) days following such termination if the Ceding Company makes
payment, with interest, of all reinsurance premiums due and payable up
to the date of reinstatement and provides full disclosure of all
claims for which it has received notice between dates of termination
and reinstatement. Continental will be liable for reinsurance on only
those claims incurred by the Ceding Company between the dates of
termination and reinstatement if the Ceding Company disclosed at the
time it requested reinstatement of such policies all claims for which
it has received notice. All such claims will be subject to the claims
provisions specified in Article V.
C. Balances remaining unpaid by either party for more than 30 days from
the date due will incur interest retroactive from the due date of the
balance to the date of actual payment. Interest amounts will be
calculated using the 7 year Constant Maturity Treasury rate reported
for the last working day of that calendar month as reported in the
Federal Reserve H15 Report.
4. OFFSET
Continental and the Ceding Company may exercise at any time the right to
offset any undisputed debits or credits, liquidated or unliquidated,
whether on account of premiums or on account of losses or otherwise, due
from either party to the other under this agreement.
4
5. QUARTERLY RESERVE AND VALUATION INFORMATION
The reserve held by Continental for reinsurance of the variable annuity
death benefit will be determined in accordance with the NAIC Actuarial
Guideline XXXIV, but in no event less than the required statutory reserve
in the state of domicile of the Ceding Company or such other state in which
it conducts business.
6. SELF ADMINISTERED REPORTING REQUIREMENTS
The Ceding Company will not change its existing self administered reporting
practices in effect on or after the effective date, unless the Ceding
Company notifies Continental in writing and Continental approves of such
changes. Continental reserves the right to terminate all reinsurance, both
inforce and new business, if the reporting practices of the Ceding Company
deteriorate to the point that Continental cannot properly administer the
risks reinsured under this agreement.
ARTICLE III
ERRORS AND OMISSIONS
This Agreement will not be abrogated by the failure of either the Ceding Company
or Continental to comply with any of the terms of this Agreement if it is shown
that said failure was unintentional and the result of a misunderstanding,
oversight or clerical error on the part of either the Ceding Company or
Continental. Both parties will be returned to the position they would have
occupied had no such oversight, misunderstanding or clerical error occurred.
This provision will cease five years after the termination of the last contract
known to be reinsured under this agreement.
ARTICLE IV
FORMS
The Ceding Company will furnish Continental with any specimen copies of its
applications, forms, and any tables of rates and values which may be required
for the proper administration of the business reinsured under this agreement,
and will keep Continental informed with proper documentation as to any
modifications or new forms under which would be required for the proper
administration of reinsurance under this agreement.
ARTICLE V
CLAIMS
l. The Ceding Company is solely responsible for payment of its claims under
the underlying Annuity Contracts identified in Schedule B.
2. The Ceding Company will determine the Guaranteed Minimum Death Benefit for
each deceased annuitant.
3. Claims are self administered.
4. The amount payable or paid on such claim, will be furnished to Continental
when the claim payment is reported to Continental.
5
5. Continental will be liable to the Ceding Company for the benefits reinsured
hereunder to the same extent as the Ceding Company is liable to the
policyowner for such benefits, and all reinsurance will be subject to the
terms and conditions of the contract under which the Ceding Company will be
liable.
6. Continental will pay its share in a lump sum to the Ceding Company without
regard to the form of claim settlement of the Ceding Company.
7. Continental agrees to pay to the Ceding Company a proportionate share of
any interest paid out to the claimant by the Ceding Company. Continental's
liability to pay interest will be discharged on the date that Continental
issues payment to the Ceding Company.
8. Continental reserves the right to offset any claim payments in accordance
with Article II - 4.
9. Claims remaining unpaid by Continental for more than 30 days after the
receipt of final papers will incur interest calculated from that date using
the 7 year Constant Maturity Treasury Rate as reported for the last working
date of that month in the Federal Reserve H15 Report.
10. The Ceding Company will promptly notify Continental of its intention to
contest benefits reinsured under this agreement or to assert defenses to a
claim for such benefits. If Continental agrees to participate in the
contest or assertion of defenses and the Ceding Company's contest of such
benefits results in the reduction of its liability, Continental will share
in such reduction in proportion to Continental's liability. If Continental
declines to participate in the contest or assertion of defenses,
Continental will discharge all of its liability by payment of the full
amount of the reinsurance to the Ceding Company.
11. Continental will pay its share of the unusual expenses of the contest in
addition to its share of the claim itself. Routine expenses incurred in the
normal settlement of uncontested claims, including interpleader cases, and
the salary of an officer or employee of the Ceding Company, are excluded
from this provision.
12. If Continental participates in the contest, in no event will Continental
participate in punitive or compensatory damages which are awarded against
the Ceding Company as a result of an act, omission or course of conduct
committed solely by the Ceding Company in connection with the benefits
reinsured under this Agreement. Continental will, however, pay its share of
statutory penalties awarded against the Ceding Company in connection with
benefits reinsured under this Agreement if Continental elected to join in
the contest of the coverage in question. The parties recognize that
circumstances may arise in which equity would require Continental, to the
extent permitted by law, to share proportionately in certain assessed
damages. Such circumstances are difficult to define in advance, but
generally would be those situations in which Continental was an active
party and directed, consented to, or ratified the act, omission, or course
of conduct of the Ceding Company which ultimately results in the assessment
of punitive and/or compensatory damages. In such situations, the Ceding
Company and Continental would share such damages so assessed in equitable
proportions. Routine expenses incurred in the normal settlement of
uncontested claims, in the submission of interpleaders and the salary of an
officer or employee of the Ceding Company are excluded from this provision.
6
13. For purposes of this provision, the following definitions will apply:
14. "Punitive Damages" are those damages awarded as a penalty, the amount of
which is not governed nor fixed by statute;
15. "Statutory Penalties" are those amounts which are awarded as a penalty, but
fixed in amount by statute;
16. "Compensatory Damages" are those amounts awarded to compensate for the
actual damages sustained, and are not awarded as penalty, nor fixed in
amount by statute.
ARTICLE VI
RECAPTURE PRIVILEGE
Recapture in not available.
ARTICLE VII
INSPECTION OF RECORDS
Continental will have the right, at any reasonable time, to inspect, at the
office of the Ceding Company, all books, records and documents relating to the
reinsurance under this Agreement.
ARTICLE VIII
CONFIDENTIALITY
Continental and the Ceding Company may come into the possession or knowledge of
Confidential Information of either party in fulfilling their obligations under
this agreement. Continental and the Ceding Company agree to hold such
information in confidence and to take all reasonable steps to ensure that such
Confidential Information is not disclosed in any form by any means by its
employees or third parties of any kind, except by advance written authorization
by an officer of Continental or the Ceding Company; provided however, that
Continental and the Ceding Company will be deemed to have satisfied their
obligations as to the Confidential Information by protecting its confidentiality
in the same manner that they would protect their own proprietary or confidential
information of like kind which will be at least a reasonable manner or, if it is
determined that such disclosure is necessary in order to avoid a violation or
potential violation of legal obligations in accordance with the following:
7
l. If Continental or the Ceding Company, their employees, directors or
advisers are requested or required (by oral questions, interrogatories,
requests for information or documents, subpoena, civil investigative demand
or similar process) to disclose Confidential Information, it will promptly
notify the other party in writing. The party notified will promptly
determine whether to contest such attempted discovery by legal means or to
waive compliance by the notifying party with the terms of this Agreement.
If, in the opinion of its counsel, Continental or the Ceding Company is
subject to contempt, sanction or other penalty for failure to disclose the
requested Confidential Information, it may, without violating the terms of
this Agreement, disclose only that portion of the Confidential Information
that counsel advises is legally required to be disclosed, provided that it
exercises all reasonable efforts to preserve the confidentiality of such
information, including, without limitation, by cooperating with Continental
or the Ceding Company in obtaining a protective order or other reliable
assurance that the Confidential Information will be protected from
redisclosure, provided, however, that all expenses of such efforts (other
than allocated costs of home office employees at such location) shall be
borne by the party whose confidential information is sought to be
disclosed.
2. Confidential Information means any and all information acquired by
Continental or the Ceding Company prior or subsequent to the execution of
this Agreement with the exception of the following:
. Information readily available in the public domain; or
. Information acquired from sources other than the other party.
ARTICLE IX
INSOLVENCY
l. In the event of insolvency of either the Ceding Company or Continental, any
debits or credits due the other party, whether matured or unmatured, under
this agreement or any other agreement, which exists on the date of the
entry of a receivership or liquidation order, shall be deemed mutual debits
or credits as the case may be and shall be offset and only the balance
shall be allowed or paid.
2. In the event of insolvency of the Ceding Company, Continental's liability
for claims will continue to be in accordance with the terms of the
agreement. Payment of reinsurance claims less any reinsurance premiums due
Continental will be made directly to the liquidator, receiver or statutory
successor of the Ceding Company without diminution because of the
insolvency of the Ceding Company.
3. In the event of insolvency of the Ceding Company, the liquidator, receiver
or statutory successor will give Continental written notice of any pending
claim and Continental may, at its own expense, investigate the claim and
interpose any defense which it deems appropriate to the Ceding Company or
its liquidator, receiver or statutory successor. If the Ceding Company
benefits from the defense by Continental, an equitable share of the
expenses incurred by the Continental will be chargeable to the Ceding
Company as part of the expense of liquidation.
4. The Continental's liability will not increase as a result of the insolvency
of the Ceding Company.
8
5. In the event of the insolvency of Continental as determined by the Illinois
Department of Insurance, the liability of Continental shall not terminate
but shall continue with respect to the reinsurance ceded to Continental by
the ceding company prior to the date of such insolvency, and the Ceding
Company shall have a security interest in any and all sums held by or under
deposit in the name of Continental.
6. If the event in paragraph above occurs, Continental shall have the right
within sixty (60) days notice period to transfer all new and existing
reinsurance ceded and all rights and obligations under this Agreement to
another reinsurer, subject to approval of the reinsurer by the Ceding
Company, and upon terms and conditions acceptable to the Ceding Company.
The Ceding Company shall not withhold its approval unreasonably and it is
understood that the terms and conditions of this Agreement shall be
acceptable to the Ceding Company for purposes of such transfer. In the
event that Continental is unable to effect such transfer, upon expiration
of the applicable notice period the Ceding Company shall have the right to
recapture all new and existing reinsurance ceded under this Agreement.
ARTICLE X
TERMINATION CHARGE
If Continental exercises its rights to terminate all new and existing inforce
reinsurance as stipulated in Article II-3 an appropriate charge will be
determined by, and paid to, Continental. Such termination charge will be equal
to one prior year's premium measured from the date of termination.
9
ARTICLE XI
PARTIES TO THE AGREEMENT
This is an Agreement for indemnity reinsurance solely between the Ceding Company
and Continental. The acceptance of reinsurance hereunder will not create any
right or legal relation whatsoever between Continental and any annuitant,
policyowner or any beneficiary under any contracts of the Ceding Company which
may be reinsured hereunder.
ARTICLE XII
DURATION OF AGREEMENT
1. This Agreement will be effective on and after the Effective Date stated on
the cover page. Other than for nonpayment of reinsurance premiums and/or
failure to comply with reporting requirements, the Agreement is unlimited
in duration but may be amended by mutual consent of the Ceding Company and
Continental.
2. This Agreement may be terminated as to new reinsurance by either party's
giving ninety (90) days written notice to the other, effective one year
after date of this agreement.
ARTICLE XIII
ARBITRATION
1. It is the intention of Continental and the Ceding Company that the customs
and practices of the insurance and reinsurance industry will be given full
effect in the operation and interpretation of this Agreement. The parties
agree to act in all things with the highest good faith. If Continental or
the Ceding Company cannot mutually resolve a dispute which arises out of or
relates to this Agreement, however, the dispute will be decided through
arbitration.
2. Disagreements between Continental and the Ceding Company will be submitted
to three arbitrators who must be current or former officers of other life
insurance companies. Within sixty (60) days of the date of notice of the
intent to submit the dispute to arbitration, Continental and the Ceding
Company will each appoint one arbitrator and the third will be selected by
these two arbitrators. If agreement cannot be reached on the selection of
the third arbitrator, each arbitrator will nominate three (3) candidates
within ten (10) days thereafter, two of whom the other will decline, and
the decision will be made by drawing lots.
3. The arbitrators will base their decision on the terms and conditions of
this Agreement plus, as necessary, on the customs and practices of the
insurance and reinsurance industry rather than solely on a strict
interpretation of the applicable law. There will be no appeal from their
decision, and any court having jurisdiction of the subject matter and the
parties may reduce that decision to judgment.
10
4. The arbitration hearing will be held on the date fixed by the arbitrators.
In no event will this date be later than six (6) months after the
appointment of the third arbitrator. As soon as possible, the arbitrators
will establish prearbitration procedures as warranted by the facts and
issues of the particular case. At least ten (10) days prior to the
arbitration hearings, each party will provide the other party and the
arbitrators with a detailed statement of the facts and arguments it will
present at the arbitration hearing. The arbitrators may consider any
relevant evidence; they will give the evidence such weight as they deem it
entitled to after consideration of any objections raised concerning it. The
party initiating the arbitration will have the burden of proving its case
by a preponderance of the evidence. Each party may examine any witnesses
who testify at the arbitration hearing. Within twenty (20) days after the
end of the arbitration hearing, the arbitrators will issue a written
decision. In their decision, the arbitrators will apportion the costs of
arbitration, which will include but not be limited to their own fees and
expenses, as they deem appropriate.
ARTICLE XIV
CURRENCY
All currency will be payable in United States dollars.
ARTICLE XV
CHOICE OF LAW AND FORUM
Illinois law will govern the terms and conditions of the Agreement. In the case
of an arbitration, the arbitration hearing will take place in Chicago, Illinois,
and the Uniform Arbitration Act will control except as provided in Article XIII.
ARTICLE XVI
DAC TAX ELECTION STATEMENT
1. The Ceding Company and Continental hereby agree to the following pursuant
to Section 1.8482(g)(8) of the Income Tax Regulation issued December 1992,
under Section 848 of the Internal Revenue Code of 1986, as amended. This
election will be effective for 1992 and all subsequent taxable years for
which this agreement remains in effect.
2. The term "party" will refer to either the Ceding Company or Continental as
appropriate.
3. The terms used in this article are defined by reference to Regulation
1.848-2 in effect December 1992.
4. The party with net positive consideration for this agreement for each
taxable year will capitalize specified IRS policy acquisition expenses with
respect to this agreement without regard to the general deductions
limitation of Section 848(c)(1).
11
5. Both parties agree to exchange information pertaining to the amount of net
consideration under this agreement each year to ensure consistency or as
otherwise required by the Internal Revenue Service.
6. Continental will submit a schedule to the Ceding Company by February 1 of
each year of its calculation of the net consideration for the preceding
calendar year. This schedule will be accompanied by a statement stating
that Continental will report such net consideration in its tax return for
the preceding calendar year.
7. The Ceding Company may contest such calculation by providing an alternative
calculation to Continental within 30 days of the Ceding Company's receipt
of Continental's calculation. If the Ceding Company does not so notify
Continental, Continental will report the net consideration as determined by
Continental in Continental's tax return for the previous calendar year.
8. If the Ceding Company contests Continental's calculation of the net
consideration, the parties will act in good faith to reach an agreement as
to the correct amount within 30 days of the date the Ceding Company submits
its alternative calculation. If the Ceding Company and Continental reach
agreement on an amount of the net consideration, each party will report
such amount in their respective tax returns for the previous calendar year.
ARTICLE XVII
PREMIUM TAX
Continental will not be responsible for any taxes incurred now or in the future,
directly or indirectly, by the Ceding Company or its affiliated companies.
ARTICLE XVIII
ENTIRE CONTRACT
1. This agreement will constitute the entire agreement between the parties
with respect to the business being reinsured thereunder and that there are
no understandings between the parties other than in the agreement.
2. Any changes or modifications to the agreement will be null and void unless
made by amendment to the agreement and signed by both parties.
12
Signed for Continental: Continental Assurance Company of Chicago, Illinois
By: /s/ Illegible Attest: /s/ Illegible
------------------------------ --------------------------------
Senior Vice President, Assistant Secretary
Life Reinsurance
Date of Signatures: 11/12/1999
Signed for the Ceding Company: GE Life and Annuity Assurance Company
By: /s/ Illegible Attest: /s/ Illegible
------------------------------ --------------------------------
Title: Vice President Title: Vice President
Date of Signatures: 10/22/99
13
SCHEDULES
SCHEDULE A AUTOMATIC ACCEPTANCE LIMITS
SCHEDULE B ACCEPTED COVERAGES
SCHEDULE C PREMIUM RATES
SCHEDULE D QUARTERLY REPORTING FORMAT
SCHEDULE E SUB-ACCOUNTS
14
SCHEDULE A
AUTOMATIC ACCEPTANCE LIMITS
GUARANTEED MINIMUM DEATH BENEFITS (GMDB)
The GMDB reinsured hereunder is provided on all new deferred variable annuity
"Extra Credit" and "Freedom" contracts with the annual ratcheting death benefit.
The GMDB reinsured under the terms of this Agreement is described in the
attached copies of the GMDB rider forms. Such forms are listed in Schedule B of
this agreement. For all new deferred annuity contracts
Extra Credit:
The guaranteed minimum death benefit (GMDB) for death prior to age 80 will be
the greatest of:
1) The purchase payments paid, reduced proportionally by any partial
withdrawals and any applicable surrender charges and less any incurred
taxes;
2) The Account Value on the date of the annuitant death; and
3) The Maximum Anniversary Value, defined as the highest amount based on
the account value at each anniversary adjusted by any subsequent
purchase payments and reduced proportionally for any partial
surrenders and incurred taxes.
The death benefit after attained age 80 and later will equal the death benefit
at attained age 80, adjusted for subsequent purchase payments, partial
surrenders and taxes.
Freedom:
The guaranteed minimum death benefit (GMDB) for death prior to age 80 will be
the greatest of:
1) The purchase payments paid, reduced proportionally by any partial
withdrawals and any applicable surrender charges and less any incurred
taxes;
2) The Account Value on the date of the annuitant death; and
3) The Maximum Anniversary Value, defined as the highest amount based on
the account value at each anniversary adjusted by any subsequent
purchase payments and reduced proportionally for any partial
surrenders and incurred taxes.
The death benefit after attained age 80 and later will equal the death benefit
at attained age 80, adjusted for subsequent purchase payments, partial
surrenders and taxes.
15
For business written at issue ages 81-85:
The guaranteed minimum death benefit (GMDB) for death will be the greatest of:
1) The purchase payments paid, reduced proportionally by surrender
charges and less any incurred taxes;
2) The Contract Value on the date of annuitant death.
In the event of lapse or other policy termination, prior to the annuitant's
death, no benefit will be payable under this coverage.
If the attached GMDB rider forms, Schedule B, differ from the above description
because of state or jurisdiction variations, the rider forms will be taken as
the correct definition of the GMDB.
CAPACITY
$525 million of total account value per calendar year of new policies from both
the "Extra Credit" and "Freedom" policy forms. Additional payments to existing
contracts are cover automatically up to the per contract limit.
16
SCHEDULE B
ACCEPTED COVERAGES
Annuity accounts allocated to the variable annuity policy forms shown below as
governed by the prospectus in effect on January 29, 1999.
The following flexible premium variable annuity policy forms are included in
this agreement:
Extra Credit P1152 1/99
Freedom P1151 1/99
And such other state specific versions as may be required by the states in which
the company conducts business.
17
SCHEDULE C
PREMIUM RATE SCHEDULE
The Adjusted Aggregate Account Value is the sum of the Account Values in all of
the Ceding Company's variable annuities contracts subject to this Agreement
minus Account Values attributable to amounts in excess of the maximum purchase
amounts as described in Article II-1.
For determining the amount at risk, the GMDB and the Account Value are
calculated as month end values for the current month and the end of the prior
month.
The premium is a flat basis point charge applied to Account Value.
Extra Credit:
Issue Ages Cost of Reinsurance
SCHEDULE D
QUARTERLY REPORTING FORMAT
Within 30 days after the end of each calendar month, the Ceding Company will
furnish Continental an electronic and summarized paper report for the
reinsurance account, valued as of the last day of that month. The report will
indicate for all inforce annuitants the following information:
-------------------------------------------------------------------------------------------------------------
Field # Field Name Description
-------------------------------------------------------------------------------------------------------------
1 Report Date Report date is the last day of the reporting month
(mm/dd/yyyy
-------------------------------------------------------------------------------------------------------------
2 Direct Writing Company Name of your company
-------------------------------------------------------------------------------------------------------------
3 Policy Number Policy or contract number
-------------------------------------------------------------------------------------------------------------
4 Policyholder Name of the policyholder (last name MI first name)
-------------------------------------------------------------------------------------------------------------
5 Issue Age Age of the policyholder when the policy was issued
-------------------------------------------------------------------------------------------------------------
6 Issue Date Date of the policy issued (mm/dd/yyyy)
-------------------------------------------------------------------------------------------------------------
7 Sex Gender of the policyholder (M or F)
-------------------------------------------------------------------------------------------------------------
8 Plan Code Z5400 - GELAAC extra credit business
Z5401 - GELAAC no surrender charge business
Z5402 - GELAAC six-year ratchet, NY business
Z5403 - GELAAC annual ratchet, NY business
-------------------------------------------------------------------------------------------------------------
9 Date of Last Ratchet Last ratchet date, if applicable (mm/dd/yyyy)
-------------------------------------------------------------------------------------------------------------
10 Current Death Benefit Death benefit as of the report date ($xx.xx)
-------------------------------------------------------------------------------------------------------------
11 Current Total Account Value Total account value as of the report date ($xx.xx)
-------------------------------------------------------------------------------------------------------------
12 Current Account Value by Fund Account value by individual fund as of the report date. The
sum of Field 12 should equal Field 11. ($xx.xx)
-------------------------------------------------------------------------------------------------------------
13 Total Death Benefits Paid Total death benefits paid for this reporting month ($xx.xx)
-------------------------------------------------------------------------------------------------------------
14 Death Benefits Paid by CNA Death benefits paid by CNA for this reporting month ($xx.xx)
-------------------------------------------------------------------------------------------------------------
15 Total Death Benefits Due and Unpaid Total death benefits due and unpaid for this reporting month
($xx.xx)
-------------------------------------------------------------------------------------------------------------
16 Death Benefits Due and Unpaid by CNA Death benefits due and unpaid by CNA for this reporting
month ($xx.xx)
-------------------------------------------------------------------------------------------------------------
17 Current First Year Premium First year premium paid for this reporting month. First year
premium is defined as premiums paid during the first 12
months since issue date. ($xx.xx)
-------------------------------------------------------------------------------------------------------------
18 ITD First Year Premium First year premium paid from inception date to report date
($xx.xx)
-------------------------------------------------------------------------------------------------------------
19 Current Renewal Premium Renewal premium paid for this reporting month. Renewal
premium is defined as premiums paid after the 1st
anniversary ($xx.xx)
-------------------------------------------------------------------------------------------------------------
20 ITD Renewal Premium Renewal premium paid from issue date to report date ($xx.xx)
-------------------------------------------------------------------------------------------------------------
19
SCHEDULE E
ELIGIBLE PORTFOLIOS FOR ACCOUNT VALUES
l. Separate Account Sub-Accounts
Xxxxx Small Cap
Xxxxx Growth
Fidelity VIP/Advisor Equity-Inc
Fidelity VIP/Advisor Growth
Fidelity VIP Overseas
Fidelity VIPII Asset Manager
Fidelity VIPII Contra Fund
Fidelity VIP/Advisor Growth & Inc
Fidelity VIP/Advisor Growth Opp
Xxxxxxx Xxxxx Growth & Income
Xxxxxxx Sachs Mid Cap Equity
Federated American Leaders II
Federated High Income Bond II
Federated Utility II
Janus Balanced
Janus Aggressive Growth
Janus Worldwide Growth
Janus Flexible Income
Janus International Growth
Janus Capital Appreciation
Xxxxxxxxxxx High Income
Xxxxxxxxxxx Bond
Xxxxxxxxxxx Aggressive Growth
Xxxxxxxxxxx Growth
Xxxxxxxxxxx Multi Strategies
PBHG Large Cap Growth
PBHG Growth II
Salomon Bros Strategic Xxxx
Xxxxxxx Bros Investors
Salomon Bros Total Return
20
GEI S&P 500 Stock Index
GEI Money Market
GEI Total Return
GEI International Securites
GEI Real Estate Securities
GEI Global Income
GEI Value Equity
GEI Income
GEI US Equity
GEI Premier Growth
2. General Account
Policy Loans
21
