APPLICATION FOR U.S.P.S.-First Class or Express-Mail to: Private Express Mail Carriers-Mail to: VARIABLEANNUITY CONTRACT ITT Hartford 200 Hopmeadow Street Attn: IAO-Director Simsbury, CT 06089 ITT Hartford Life and P.O. Box 2999 Annuity Insurance...
APPLICATION FOR U.S.P.S.-First Class or Express-Mail to: Private Express Mail Carriers-Mail to:
VARIABLEANNUITY CONTRACT ITT Hartford 000 Xxxxxxxxx Xxxxxx
Attn: IAO-Director Simsbury, CT 06089
ITT Hartford Life and P.O. Box 2999
Annuity Insurance Company Hartford, CT 06104-2999
[ITT HARTFORD LOGO]
- ------------------------------------------------------------------------------------------------------------------------------------
1. CONTRACT OWNER Xxxxx Xxxxx
------------------------------------
If no Annuitant is Name
specified in Section 3, --- -- ----
the Contract Owner 0 Xxxx Xxxxxx XX#/XXX 000 00 0000
will be the Annuitant. ------------------------------------ --- -- ----
Street Address -- -- --
Date of Birth 09 10 58
Hartford CT 06106 -- -- --
------------------------------------ month day year
City State Zip /X/ Male / / Female / / Trustee
- ------------------------------------------------------------------------------------------------------------------------------------
2. JOINT CONTRACT ------------------------------------ --- -- ----
OWNER (if any) Name SS#/TIN
--- -- ----
------------------------------------ -- -- --
Relationship to Contract Owner Date of Birth
-- -- --
month day year
/ / Male / / Female
- ------------------------------------------------------------------------------------------------------------------------------------
3. ANNUITANT ------------------------------------ --- -- ----
Name SS#
Complete only if --- -- ----
different from the ------------------------------------ -- -- --
contract owner in Street Address Date of Birth
Section 1. -- -- --
------------------------------------ month day year
City State Zip / / Male / / Female
- ------------------------------------------------------------------------------------------------------------------------------------
4. CONTINGENT ANNUITANT Xxxx Xxxxx Brother
------------------------------------------------------------------------------------------------------
Name Relationship to Owner
- ------------------------------------------------------------------------------------------------------------------------------------
5. BENEFICIARY (IES) Xxx Xxxxx Wife 100%
------------------------------------------------------------------------------------------------------
Designated Name(s) Relationship to Contract Owner Percentage
------------------------------------------------------------------------------------------------------
Contingent Name(s) Relationship to Contract Owner Percentage
- ------------------------------------------------------------------------------------------------------------------------------------
6. TAX QUALIFIED PLANS A. / / Initial / / Transfer / / Rollover
Check the appropriate B. / / IRA / / 403(b) / / 401(k) / / 401(a) / / SEP-IRA / / Other
box(es) in A, B, and C. --------------------
C. / / Individual Accounts / / Unallocated Plan Account
Tax Year for which initial contribution is being made:
-------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
7. FUND SELECTION Please check selected fund(s) and note whole percentage allocations.
The initial premium /X/ Advisers Fund 50 % / / Hartford Dividend and Growth Fund %
will be allocated as ---- ----
selected here. If / / Stock Fund % / / Index Fund %
Dollar Cost Averaging, ---- ----
complete the DCA / / Aggressive Growth Fund % / / GNMA/Mortgage Securities Fund %
enrollment section ---- ----
on the reverse side. / / International Opportunities Fund % / / Bond/Debt Securities Fund %
---- ----
/X/ Fixed Account 50 % / / Money Market Fund %
---- ----
/ / Other %
-------------------- ----
Make checks payable to: ITT Hartford Life Insurance Companies Initial $ 20,000 Total 100 %
--------
Monies remitted via /X/ check / / wire / / 1035 / / Qualified Transfer
- ------------------------------------------------------------------------------------------------------------------------------------
8. SPECIAL REMARKS
- ------------------------------------------------------------------------------------------------------------------------------------
Will the annuity applied for replace one or more existing annuity or life insurance contracts? / / Yes /X/ No (If yes, explain
Have you purchased another ITT Hartford Annuity during the previous 12 months? / / Yes /X/ No in Special
Remarks)
I hereby represent my answers to the above questions to be true and correct to the best of my knowledge and belief. I UNDERSTAND
THAT ANNUITY PAYMENTS OR SURRENDER VALUES, WHEN BASED UPON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND NOT
GUARANTEED AS TO A FIXED DOLLAR AMOUNT.
/X/ RECEIPT OF A VARIABLE ANNUITY AND FUND PROSPECTUS IS HEREBY ACKNOWLEDGED. If not checked, the appropriate prospectus will be
mailed to you.
SIGNED AT Hartford, CT ON 2-4-94 /s/ Xxxxx Xxxxx
------------------------ ---------- ------------------------------------------------------------------
City, State Date (Contract Owner's signature)
Do you, as Agent, have reason to believe the contract applied
for will replace existing annuities or insurance? / / Yes /X/ No ------------------------------------------------------------------
(Joint Contract Owner's signature)
LICENSED
AGENT /s/ Xxxx Xxxxx Broker/Dealer Xxxxx Xxxxxx
--------------------------------- ----------------------------------------------------
(signature)
Xxxx Xxxxx Address Financial Plaza, Hartford, CT
--------------------------------- -----------------------------------------------------------
(print)
Telephone # (000) 000-0000
--------------------------------- -------------------------------------------------------
(License I.D. # (Florida Agents Only)
</TABLE>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.(B)(6)(A)
<SEQUENCE>6
<DESCRIPTION>EXHIBIT (B)(6)(A)
<TEXT>
<PAGE>
Exhibit (b)(6)(a)
SECOND AMENDMENT OF RESTATED ARTICLES
ITT LIFE INSURANCE CORPORATION
Amendment of Restated Articles in duplicate are hereby executed by the
undersigned, Xxxxxxx X. Xxxxxxx, President, and L. L. Xxxxxxx, Vice President
and Secretary, of ITT Life Insurance Corporation, a Wisconsin corporation as
follows:
On March 15, 1993, the following amendment to the Restated Articles of
Incorporation of ITT Life Insurance Corporation was duly adopted by the
written consent of all the shareholders and the Company's Board of
Directors:
RESOLVED, that the First and Second Articles of the Company's Restated
Articles of Incorporation be and are hereby amended and restated as
follows. All other Articles of the Restated Articles of Incorporation
are unchanged and continue in full force and effect.
"FIRST: The name of the Corporation is ITT Hartford Life and
Annuity Insurance Company."
"SECOND: The name of the Registered Agent of the Corporation is
CT Corporation Systems and the address of the
Registered Office is 00 Xxxx Xxxxxxxx Xxxxxx, Xxxxxxx,
Wisconsin 53703."
FURTHER RESOLVED, that the directors and officers of the Company be
and they are hereby authorized and directed to take whatever action
may be required by law to give effect to this amendment of the
Restated Articles of Incorporation.
Dated: March 15, 1993 /s/ Xxxxxxx X. Xxxxxxx
- ------------------------------------- ------------------------------------
Xxxxxxx X. Xxxxxxx, President
(Seal)
/s/ L. L. Xxxxxxx
------------------------------------
L. L. Xxxxxxx, Vice President
& Secretary
<PAGE>
STATE OF MINNESOTA)
) SS
COUNTY OF HENNEPIN)
On this 15th day of March, 1993, before me appeared Xxxxxxx X. Xxxxxxx, to me
personally known, who, being by me duly sworn, did say that he is the President
of ITT Life Insurance Corporation, and that the seal affixed to the foregoing
instrument is the corporate seal of the corporation, and that the instrument was
executed in behalf of the corporation by authority of its Board of Directors,
and said Xxxxxxx X. Xxxxxxx acknowledged the instrument to be the free act and
deed of the corporation.
/s/ Xxxx X. Xxxxxxx
[SEAL] ---------------------------------------
Notary Public
My commission expires on
9/10/97
STATE OF MINNESOTA)
) ss
COUNTY OF HENNEPIN)
On this 15th day of March, 1993, before me appeared L. L. Xxxxxxx, who
acknowledged himself to be the Vice President and Secretary of ITT Life
Insurance Corporation, and that he, as such Secretary by authority to do so,
executed the foregoing instrument for the purposes therein contained, by signing
the name of the corporation by himself as Secretary.
/s/ Xxxx X. Xxxxxxx
---------------------------------------
Notary Public
My commission expires on
9/10/97
[SEAL]
<PAGE>
AMENDMENT OF RESTATED ARTICLES
ITT LIFE INSURANCE CORPORATION
Amendment of Restated Articles in duplicate are hereby executed by the
undersigned, Xxxxxx X. XxxXxxxxx, President, and L. L. Xxxxxxx, Vice
President and Secretary, of ITT Life Insurance Corporation, a Wisconsin
corporation, as follows:
On July 27, 1984 the following amendment to the Restated Articles
of Incorporation of ITT Life Insurance Corporation was duly adopted
by the written consent of all the shareholders and the Company's
Board of Directors:
RESOLVED, That the Fourth Article of the corporation's Restated
Articles of Incorporation be and it is hereby amended and
restated as follows. All other Articles of the Restated Articles
of incorporation are unchanged and to continue in full force
and effect.
"FOURTH: The aggregate number of shares which the corporation
shall have authority to issue is 3,000 shares consisting of
one class only, designated as Common Shares, of the par value
of $1,250 per share."
FURTHER RESOLVED, That the directors and officers of the corporation
be and they are hereby authorized and directed to take whatever
action may be required by law to give effect to this amendment of
the Restated Articles of Incorporation.
Dated: August 6, 1984 /s/ Xxxxxx X. XxxXxxxxx
----------------------- ------------------------------
Xxxxxx X. XxxXxxxxx, President
/s/ L. L. Xxxxxxx
-------------------------------
L. L. Xxxxxxx, Vice President &
Secretary
[SEAL]
<PAGE>
STATE OF MINNESOTA )
) ss
COUNTY OF HENNEPIN )
On this 6th day of August, 1984, before me appeared Xxxxxx X. XxxXxxxxx,
to me personally known, who, being by me duly sworn, did say that he is
the President of ITT Life Insurance Corporation, and that the seal affixed
to the foregoing instrument is the corporate seal of the corporation, and
that the instrument was executed in behalf of the corporation by authority
of its Board of Directors, and said Xxxxxx X. XxxXxxxxx acknowledged the
instrument to be the free act and deed of the corporation.
/s/ Xxxxxx Xxxx
---------------------
Notary Public
My commission expires on
October 22, 1985 (SEAL)
STATE OF MINNESOTA )
) ss
COUNTY OF HENNEPIN )
On this 6th day of August, 1984, before me appeared L. L. Xxxxxxx, who
acknowledged himself to be the Vice President and Secretary of ITT Life
Insurance Corporation, and that he, as such Secretary by authority to do
so, executed the foregoing instrument for the purposes therein contained,
by signing the name of the corporation by himself as Secretary.
/s/ Xxxxxx Xxxx
---------------------
Notary Public
My commission expires on
October 22, 1985 (SEAL)
<PAGE>
RESTATED ARTICLES OF INCORPORATION
ITT LIFE INSURANCE CORPORATION
These Restated Articles of Incorporation give effect to amendments of the
Articles of Incorporation and otherwise purport merely to restate all those
provisions already in effect. These Restated Articles of Incorporation have
been adopted by the sole shareholder and shall supersede and take the place of
the heretofore existing Articles of Incorporation and amendments thereto.
FIRST: The name of the corporation is ITT Life Insurance Corporation.
SECOND: The address of the Registered Office of the Corporation is Xxxxx
and Xxxxxxxxxxx, 000 Xxxx Xxxxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxx 00000. The
name of the Registered Agent at such address is Xxxxxx X. Xxxxxx.
THIRD: The Corporation may make insurance upon lives, may grant and issue
annuities, either in connection with or separate from contracts of insurance
predicated upon life risks, may issue policies stipulated to be with or without
participation in profits, may issue policies or certificates of insurance
against loss of life or personal injury resulting from any cause, and against
loss resulting from disease or accident, and against any other casualty or risk
which may be subject to life, accident or health insurance. Said Corporation
in addition to the foregoing is authorized generally to do a life, accident
and health insurance business, and is authorized to insure against any and all
hazards against which life, accident and health insurance companies are
authorized to insure by the laws of this state, or of any other state or
territory of the United States or foreign countries in which the company may
be licensed to carry on business. In addition to the foregoing powers, the
purposes of said Corporation are all those permitted by Section 610.21 of
the Wisconsin Statutes.
FOURTH: The aggregate number of shares which the corporation shall have
authority to issue is 2,000 shares consisting of one class only, designated as
Common Shares, of the par value of $1,000 per share.
FIFTH: No shareholder shall, because of his ownership of shares, have a
preemptive or other right to purchase, subscribe for, or take any part of any
shares or any part of the notes, debentures, bonds, or other securities
convertible into or carrying options or warrants to purchase shares of this
corporation issued, optioned, or said by it after its incorporation.
<PAGE>
-2-
SIXTH: Amendments to these Articles of Incorporation may be made at any
special meeting of shareholders duly called for that purpose, or at any annual
meeting of shareholders, provided that a statement of the nature of the proposed
amendment is included in the Notice of Meeting, upon receiving the affirmative
vote of the holders of at least two-thirds of the shares entitled to vote
thereon.
Dated: March 26, 1982 ITT Life Insurance Corporation
By /s/ Xxxxxxx X. Xxxx
---------------------------------
Xxxxxxx X. Xxxx
Chairman of the Board
Attest:
/s/ Xxxxxxx X. XxXxxxx
- -----------------------------------
Xxxxxxx X. XxXxxxx
Secretary
6104D/82D
This document was drafted
by: Xxxxxxx X. XxXxxxx
