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Exhibit 4
THE TRAVELERS INSURANCE COMPANY - ONE TOWER SQUARE - HARTFORD CT - 06183
A STOCK COMPANY
WE ARE PLEASED TO PROVIDE YOU THE BENEFITS OF THIS ANNUITY CONTRACT.
PLEASE READ ALL ATTACHED FORMS CAREFULLY.
THE CONTRACT IS SUBJECT TO THE TERMS AND CONDITIONS STATED ON THE ATTACHED
PAGES, ALL OF WHICH ARE A PART OF IT. THE CONTRACT IS ISSUED IN CONSIDERATION
OF THE PURCHASE PAYMENTS.
EXECUTED AT HARTFORD, CONNECTICUT
[SIGNATURE]
PRESIDENT
THIS IS A LEGAL CONTRACT BETWEEN YOU AND US.
PLEASE READ YOUR CONTRACT CAREFULLY.
FLEXIBLE PREMIUM DEFERRED GROUP VARIABLE ANNUITY CONTRACT
TAX QUALIFIED
ELECTIVE OPTIONS NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON
INVESTMENT EXPERIENCE OF THE UNDERLYING FUNDS, ARE VARIABLE AND MAY INCREASE OR
DECREASE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT.
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TABLE OF CONTENTS
Contract Specifications Page 3-4
Definitions Page 5-6
Purchase Payments Page 7
General Contract Provisions Page 7-8
Valuation Information Page 9
Transfers Between Underlying Funds Page 9
Transfers from Underlying Funds to Contracts not Issued by Us Page 10
Transfers from Other Contracts Issued by Us Page 10
Transfers to Other Contracts Issued by Us Page 10
Transfers from Contracts not Issued by Us Page 10
Distributions from the Contract Page 10
Contract Charges Page 10
Contract Discontinuance Provisions Page 11
Settlement Provisions Page 11-14
Variable Xxxxxxx
Xxxxx Xxxxxxx
Xxxxxxx Options
Annuity Tables Page 15-17
Any Riders or Endorsements follow the Life Annuity Tables.
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CONTRACT SPECIFICATIONS
CONTRACT OWNER TRUSTEE OF THE X RETIREMENT PLAN
PLAN NAME THE X RETIREMENT PLAN
CONTRACT NUMBER SPECIMEN
CONTRACT DATE 03/01/96
PURCHASE PAYMENT/TERMINATION AMOUNTS
Minimum Average Purchase Payment Amount: $10,000 per Contract Year
Maximum Purchase Payment Amount: $3,000,000 without prior approval by
Our Office
Termination Amount: $20,000
AMOUNTS DEDUCTED ON SURRENDER:
For the purpose of determining the amounts deducted on Surrender, the
surrender charge is calculated as a percentage of the Cash Value being
surrendered.
CONTRACT YEAR SURRENDER CHARGE
-------------- -----------------
(on amounts not previously surrendered)
---------------------------------------
1 - 2 5%
3 - 4 4%
5 - 6 3%
7 - 8 2%
9 and thereafter 0%
ALLOWABLE DISTRIBUTIONS PRIOR TO CONTRACT DISCONTINUANCE NOT SUBJECT TO AMOUNTS
DEDUCTED ON SURRENDER: Retirement, Separation from Service, loans, hardship
withdrawals (as defined by the Internal Revenue Code), death, disability (as
defined by the Internal Revenue Code section 72 m 7 ), return of Excess
Plan Contributions, certain Plan expenses as mutually agreed upon, transfers to
an employer stock fund, and annuitization under this contract to another
contract issued by Us. Distributions may be in the form of cash payments,
Annuity Options or to a deferred Annuity issued by Us.
For distributions subject to amounts deducted on Surrender, the applicable
portion of the Cash Surrender Value of Your Account will be paid to satisfy the
requested distribution. For allowable distributions not subject to amounts
deducted on Surrender, the applicable portion of the Cash Value of Your Account
will be paid to satisfy the requested distribution
Amounts deducted on Surrender will apply to allowable distributions made to
highly compensated employees until after the fifth Contract Year.
GUARANTEED INTEREST PERIODS FOR THE FIXED ACCOUNT (IF APPLICABLE):
The initial interest rate for any Purchase Payment is declared each month and
is guaranteed for twelve months. Each Purchase Payment is placed in a "cell"
for accounting purposes. At the end of the twelve month guarantee period, a
renewal interest rate will be determined that will not be lower than the
minimum interest rate guarantee of 3%. At the end of the initial guarantee
period, the first renewal rate will be guaranteed to the end of that calendar
year. The second and all future renewal rates will be declared each subsequent
January 1 and guaranteed through December 31 of each year.
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CONTRACT SPECIFICATIONS
UNDERLYING FUND TRANSFER CHARGE: $0.00
We reserve the right to limit the number of transfers in an account between
Underlying Funds. The minimum number of transfers allowed would be one in any
six-month period.
THE TRAVELERS SEPARATE ACCOUNT QP FOR VARIABLE
ANNUITIES UNDERLYING FUNDS
Managed Assets Trust Variable Insurance Products Fund
High Yield Bond Trust* Fidelity's High Income Portfolio*
Capital Appreciation Fund Fidelity's Growth Portfolio
American Odysseey Funds, Inc. Fidelity's Equity Income Portfolio
American Odyssey Core Equity Fund Variable Insurance Products Fund II
American Odyssey Emerging Opportunities Fund Fidelity's Asset Manager Portfolio**
American Odyssey International Equity Fund Dreyfus Stock Index Fund, Inc.
American Odyssey Long-Term Bond Fund Xxxxx Xxxxxx/Travelers Series Fund, Inc.
American Odyssey Intermediate Bond Fund Xxxxx Xxxxxx Income & Growth Portfolio
American Odyssey Short-Term Bond Fund Alliance Growth Portfolio
The Travelers Series Trust: Xxxxx Xxxxxx International Equity Portfolio
U.S. Government Securities Portfolio* Xxxxxx Diversified Income Portfolio**
Utilities Portfolio Xxxxx Xxxxxx High Income Portfolio*
Social Awareness Stock Portfolio MFS Total Return Portfolio**
Temploeton Variabe Products Series Fund Xxxxx Xxxxxx Money Market Portfolio*
Xxxxxxxxx Bond Fund*
Xxxxxxxxx Stock Fund
Xxxxxxxxx Asset Allocation Fund**
The annual mortality and expense risk deduction is 1.15% for all funds listed
above. This amounts to a daily deduction of .00003150 per fund.
The Assumed Daily Net Investment Factor is 1.000081 for all Underlying Funds.
The Underlying Funds marked with an asterisk (*) are considered Competing
Funds, and are subject to transfer restrictions as described in the Fixed
Account Rider (if applicable). Those marked with two asterisks (**) are not
currently considered competing, but may be so in the future based on allowable
changes in the fund's investment strategy.
Transfers from the Fixed Account, either to the Underlying Funds or to
contracts not issued by Us, as described in the Fixed Account Rider (if
applicable), may not exceed 20% per Contract Year of the Cash Value in the
Fixed Account valued on each Contract Year anniversary. We reserve the right
to modify the amount available for transfer from the Fixed Account to the
Underlying Funds available in this contract or to other contracts issued by
Us.
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DEFINITIONS
(A) ACCUMULATION UNIT - An accounting unit of measure used to calculate the
value of this contract. An Accumulation Unit exists for each Underlying Fund.
The value of this measure is called the Accumulation Unit Value.
(B) ANNUITANT - The person on whose life the Annuity payments are made.
(C) ANNUITY - Payment of income for a stated period or amount.
(D) ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin.
(E) BENEFICIARY(IES) - The Beneficiary of this contract is the Plan Trustee.
Any Beneficiary designated by the Participant(s) or Annuitant(s) shall be
maintained by You under the provisions of the Plan.
(F) CASH SURRENDER VALUE - The Cash Value less any amounts deducted on
Surrender shown on the Contract Specifications page and any applicable Premium
Tax.
(G) CASH VALUE - The value of the Accumulation Units in Your Account less any
reduction for administrative charges. Sometimes referred to as "Account Value."
(H) COMPETING FUND - Any investment option under the Plan which, in Our
opinion, consists primarily of fixed income securities and/or money market
instruments. Competing Funds included in this contract are indicated on the
Contract Specifications page.
(I) CONTRACT DATE - The date this contract is issued as shown on the Contract
Specifications page.
(J) CONTRACT DISCONTINUANCE - Termination of this contract by Us or by Your
Written Request.
(K) CONTRACT YEAR - The twelve-month period beginning with the Contract Date or
any anniversary thereof. This may or may not coincide with the Plan year.
(L) 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.
(M) EXCESS PLAN CONTRIBUTIONS - Plan contributions including excess
deferrals, excess contributions, excess aggregate contributions, excess annual
additions, and excess nondeductible contributions that require correction by
the Plan Administrator, excluding reversions upon Plan Termination.
(N) FIXED ANNUITY - An Annuity with payments which remain fixed as to dollar
amount throughout the payment period.
(O) OUR OFFICE - The home office of the Travelers Insurance Company located at
Xxx Xxxxx Xxxxxx, Xxxxxxxx, Xxxxxxxxxxx 00000- 0000. All correspondence
concerning this contract should be sent to the attention of Xxxxxxx Services.
(P) PARTICIPANT- An eligible person who is a member in the Plan.
(Q) PLAN - The Plan designated on the Contract Specifications page. We are not
a party to the Plan. We do not assume the responsibilities of the Plan
Administrator, nor are We bound by the terms of the Plan. All records
pertaining to the Plan will be open for inspection by Us.
(R) PLAN ADMINISTRATOR - The corporation or other entity so specified on the
application or purchase order. If none is specified, the Plan Trustee is the
Plan Administrator.
(S) PLAN TERMINATION - Termination of Your Plan, including partial Plan
Termination., as determined by Us.
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(T) PREMIUM TAX - The amount of tax, if any, charged by the state or
municipality. We will deduct any applicable Premium Tax from the Cash Value
either upon Surrender, annuitization, death, or at the time Purchase Payments
are made, but no earlier than when We have a tax liability under state law.
(U) PURCHASE PAYMENTS - Payments You make to this contract.
(V) SEPARATE ACCOUNT - The Separate Account shown on the Contract
Specifications page which We established under Connecticut Insurance Laws and
which purchases shares of the Underlying Funds for this class of contracts and
certain other contracts.
(W) SEPARATION FROM SERVICE - The termination or permanent severance of the
Participant's employment with the employer for any reason that is a separation
from service within the meaning of the Plan. However, termination of a
Participant's employment with the employer as a result of the sale of all or
part of the employer's business (including divisions or subsidiaries of the
employer) will not be considered Separation from Service unless the Participant
actually loses his/her job or is not immediately included in a pension or
profit sharing plan of the successor employer.
(X) SURRENDER - Funds distributed from the contract for retirement, Separation
from Service, loans, hardship withdrawals, death, disability, return of
Excess Plan Contributions, payment of certain Plan expenses as mutually agreed
upon, Contract Discontinuance, or transfers to other Plan funding vehicles.
Such surrenders may or may not be subject to charges .
(Y) SURRENDER DATE - The date We receive Your Written Request for a Surrender.
(Z) UNDERLYING FUND - An open-ended diversified investment management company
indicated on the Contract Specifications page which is an underlying investment
for the Separate Account.
(AA) VALUATION DATE - The date on which the Separate Account is valued. The
Separate Account is generally valued at the close of business on each day that
the New York Stock Exchange is open for trading.
(BB) VALUATION PERIOD - The period between successive valuations.
(CC) VARIABLE ANNUITY - An Annuity with payments which vary with the net
investment results of the Separate Account.
(DD) WE, OUR, US - The Travelers Insurance Company.
(EE) WRITTEN REQUEST - A written form satisfactory to Us and received at Our
Office.
(FF) YOU, YOUR - The contract owner.
(GG) YOUR ACCOUNT - Accumulation Units credited to You under this contract.
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PURCHASE PAYMENTS
PURCHASE PAYMENT
The Purchase Payments are the payments You make to this contract. 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 to Us
at Our Office. The minimum Purchase Payment is shown on the Contract
Specifications page. We reserve the right to limit the amount of the Purchase
Payment which will be accepted.
Net Purchase Payments are that part of the Purchase Payments applied to the
contract. The net Purchase Payment is equal to the Purchase Payment less any
applicable Premium Tax.
ALLOCATION OF PURCHASE PAYMENTS
The initial net Purchase Payment will be applied within two business days after
it is received in good order at Our office. Any subsequent net Purchase
Payments will be credited to Your Account using the Accumulation Unit Value
determined after We receive those payments at Our Office. Each net Purchase
Payment will be allocated to the Underlying Funds in the proportion specified
by You for this contract. By Written Request, You may change Your choice of
Underlying Funds or allocation percentages. The available Underlying Funds to
which assets may be allocated are shown on the Contract Specifications page;
funds may be subsequently added or deleted.
The net Purchase Payments will be allocated to an account established for You
by Us. At Your direction, We will deposit all net Purchase Payments to Your
Account, satisfy all distribution requests from this account, and provide
periodic reports to You as described in the "Required Reports" provision. You
may contact Us at Our Office for information about this contract or Your
Account. The Plan Administrator will be responsible for maintaining the
individual records for each Participant.
GENERAL CONTRACT PROVISIONS
OWNER
This contract belongs to You. You have sole power while the contract is in
force to exercise any rights given in the contract. 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 Internal Revenue Code.
CREDITOR CLAIMS
No right or benefit to You, the Annuitant or Beneficiary under this contract
shall be subject to the claims of creditors or any legal process other than to
the extent permitted by law.
CONTROL OF THE CONTRACT
All rights in the contract rest with You, and You are entitled to all amounts
held under this contract. You may elect to exercise any options allowed by the
contract with respect to Your Account. Elections made under the contract must
be made by a Written Request, unless another manner is mutually agreed upon.
THE CONTRACT
The entire contract between You and Us consists of the contract and all
attached pages.
CONTRACT CHANGES
The only way this contract may be changed is by a written endorsement signed by
one of Our officers.
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. Substitutions may be
made with respect to both existing investments and investment of future
Purchase Payments subject to applicable law.
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INCONTESTABILITY
We will not contest this contract from its Contract Date.
REQUIRED REPORTS
As often as required by law, but at least once in each Contract Year, We will
furnish a report to You which will show the number of Accumulation Units
credited to this contract in each Underlying Fund and the corresponding
Accumulation Unit Values 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 values or
amounts paid under this contract.
NON-PARTICIPATING
This contract does not share in Our surplus earnings, so You will receive no
dividends under it.
CONTRACT MODIFICATION
We reserve the right to modify this contract to qualify it under all related
laws and regulations which are in effect during the term of this contract. We
will obtain the approval of any regulatory authority needed for the
modifications.
STATE LAWS
This contract is governed by the law of the state in which it is issued for
delivery. 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 any 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 Underlying Funds is not reasonably
practicable or it is not reasonably practicable to determine the value of the
Underlying Fund'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
We will have exclusive and absolute ownership and control of the assets of the
Separate Account. That portion of the assets of the Separate Account equal to
the reserves and other contract liabilities with respect to such Separate
Account 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.
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VALUATION INFORMATION
NUMBER OF ACCUMULATION UNITS
The number of Accumulation Units to be credited for each Underlying Fund once a
Purchase Payment has been received by Us will be determined by dividing the net
Purchase Payment allocated to each Underlying Fund by the corresponding
Accumulation Unit Value of that Underlying Fund.
ACCUMULATION UNIT VALUE
The initial value of an Accumulation Unit for each Underlying Fund is set at
$1.000000. We determine the value of an Accumulation Unit on each Valuation
Date by multiplying the value on the immediately preceding Valuation Date by
the net investment factor for that Underlying Fund for the Valuation Period
just ended.
NET INVESTMENT FACTOR
The net investment factor is a factor applied to measure the investment
performance of an Underlying Fund from one Valuation Period to the next. The
net investment factor for an Underlying Fund for any Valuation Period is equal
to the sum of 1.000000 plus the net investment rate.
Each Underlying Fund's net investment rate for a Valuation Period is equal to
the gross investment rate for that Underlying Fund less the applicable daily
mortality and expense risk deduction. The mortality and expense risk deduction
is shown on the Contract Specifications page.
The gross investment rate of an Underlying Fund 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 expenses levied against the Separate
Account and its Underlying Funds; and
(2) is the amount of the net assets at the beginning of the Valuation
Period.
The gross investment rate for an Underlying Fund may be either positive or
negative. Underlying Fund assets are based on the net assets held in the
Underlying Fund. Investment income includes any distribution whose ex-dividend
date occurs during the Valuation Period.
TRANSFERS BETWEEN UNDERLYING FUNDS
You may transfer all or any part of Your Cash Value, subject to the
restrictions as noted in the Fixed Account Rider (if applicable), from one
Underlying Fund to any other Underlying Fund available under Your Plan.
We reserve the right to limit the number of transfers in an account between
Underlying Funds. The minimum number of transfers allowed would be one in any
six-month period.
Transfers between Underlying Funds 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 Underlying Fund. The Number of
Accumulation Units will be determined by using the Accumulation Unit Value of
the Underlying Funds involved as of the next Valuation Date after We receive
notification of request for transfer. Transfers will be subject to any
applicable Underlying Fund Transfer Charge stated on the Contract
Specifications page.
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TRANSFERS FROM UNDERLYING FUNDS TO CONTRACTS NOT ISSUED BY US
You may transfer all or any part of Your Account's Cash Surrender Value,
subject to the restrictions as noted in the Fixed Account Rider (if
applicable), to any contract not issued by Us. Such transfers may be subject
to amounts deducted on Surrender as shown on the Contract Specifications page.
TRANSFERS FROM OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer funds held by You in
another group Annuity contract issued by Us to this contract without applying
deferred sales charges or Surrender charges to the funds being transferred.
Once the transfer is complete and We have established an account for You at
Your direction, new deferred sales charge or surrender charges may apply to
this contract as shown on the Contract Specifications page.
TRANSFERS TO OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer funds held by You for a
Participant in this contract to another contract issued by Us without incurring
a deferred sales charge or surrender charge as shown on the Contract
Specifications page to the funds being transferred. Once the transfer is
complete and We have established a new account for the Participant at Your
direction, new deferred sales charges or surrender charges may apply to the new
contract in accordance with the provisions of such contract.
TRANSFERS FROM CONTRACTS NOT ISSUED BY US
Under specific conditions, when authorized by state insurance law, We may
credit a Plan up to 4% of the amount transferred to Us from another investment
vehicle as reimbursement to the Plan for any exit penalty assessed by the
other investment vehicle provider. We will recover this credit through reduced
compensation paid to the servicing agent or broker.
DISTRIBUTIONS FROM THE CONTRACT
CASH SURRENDER VALUE
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 in the Underlying Funds for a period of not more than seven
days after We receive the request. The payment of the Cash Surrender Value of
the Fixed Account, may be delayed as described in the Fixed Account Rider.
CONTRACT CHARGES
AMOUNTS DEDUCTED ON SURRENDER
The applicable amounts deducted on Surrender are shown on the Contract
Specifications page. These amounts as well as the mortality and expense risk
deduction may be reduced or eliminated to the extent that We anticipate lower
sales expenses or perform fewer sales services due to:
1. the size of the group participating in the contract;
2. an existing relationship to the contract owner;
3. use of mass enrollment procedures, or;
4. performance of sales functions by a third party, which We
would otherwise perform.
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CONTRACT DISCONTINUANCE PROVISIONS
You may discontinue this contract by Written Request at any time for any
reason.
We reserve the right to discontinue this contract if:
a) the Cash Value of the contract is less than the Termination
Amount shown on the Contract Specifications page; or
b) We determine within Our sole discretion and judgment that
the Plan or administration of the Plan is not in conformity
with applicable law ; or
c) We receive notice that is satisfactory to Us of Plan
Termination.
If We discontinue this contract or We receive Your Written Request to
discontinue the contract, We will, in Our sole discretion and judgment:
a) accept no further payments for this contract; and
b) pay You the Cash Surrender Value of the Underlying Funds; and
c) pay You any Fixed Account Cash Surrender Value , as described
in the Fixed Account Rider .
If this contract is discontinued, We will distribute the Cash Surrender Value
to You at the most current address available on Our records. Discontinuance
of this contract will not affect payments We are making under any Annuity
options which began before the date of discontinuance.
SETTLEMENT PROVISIONS
ELECTION OF SETTLEMENT OPTIONS
Any amount distributed from the contract may be applied to any one of the
Annuity options described below.
Election of any of these options must be made by Written Request to Our Office
at least 30 days prior to the date such election is to become effective.
The form of such Annuity option shall be determined by You. The following
information must be provided with any such request:
a) the Participant's name, address, date of birth, social
security number; and
b) the amount which is to be distributed in the form of an
Annuity option; and
c) the Annuity option which is to be purchased; and
d) the date the Annuity option payments are to begin; and
e) if the form of the Annuity provides a death benefit in the
event of the Participant's death, the name, relationship and
address of the Beneficiary as designated by You; and
f) any other data that We may require.
The Beneficiary, as specified in item (e) above, may be changed by You as long
as We are notified by Written Request while the Annuitant is alive. If the
Beneficiary designation is irrevocable, such designation cannot be changed or
revoked without the consent of the Beneficiary. After We receive the Written
Request and the written consent of the Beneficiary (if required), the new
Beneficiary designation will take effect as of the date the notice is signed.
We have no further responsibility for any payment We made before the Written
Request.
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MINIMUM AMOUNTS
The minimum amount that can be placed under an Annuity 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 make payments at less frequent
intervals.
MISSTATEMENT
If an Xxxxxxxxx's sex or date of birth was misstated, all benefits of this
contract are what the Cash Value would have purchased at the correct sex and
age on the date of issue of the Annuity option elected.
RETIRED LIFE CERTIFICATE
We will issue to each person to whom Annuity benefits are being paid under this
contract, a certificate setting forth the benefits to which such person is
entitled under this contract.
ALLOCATION OF AN ANNUITY
When an Annuity option is elected, You may further elect to have the Cash
Value attributable to a Participant applied to provide a Variable Annuity, a
Fixed Annuity, or a combination of both.
If no election is made to the contrary, the value held in an Underlying Fund
will be applied to provide an Annuity which varies with the investment
experience of that same Underlying Fund. You may elect to transfer all or any
part of the Cash Value from one Underlying Fund to another, as described in the
provision "Transfer Between Underlying Funds," in order to reallocate the basis
on which Annuity payments will be determined. Once Annuity payments have begun,
no further transfers are allowed.
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 an
Annuity will be the Cash Value attributable to a Participant as of 14 days
before the date Annuity payments start. 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 of these options.
ANNUITY UNIT VALUE
The initial value of an Annuity Unit for each Underlying Fund was set at
$1.000000. On any Valuation Date, the Annuity Unit Value for an Underlying
Fund equals the Underlying Fund Annuity Unit Value on the immediately preceding
Valuation Date, multiplied by the net investment factor for that Underlying
Fund for the Valuation Period just ended, divided by the Assumed Daily Net
Investment Factor. The Assumed Daily Net Investment Factor is shown on the
Contract Specifications page.
The value of an Annuity Unit as of 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 the Annuitant's account in
each Underlying Fund by dividing the basic first monthly Annuity payment
attributable to that Underlying Fund by the Underlying Fund's Annuity 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 any or all payments made to an Annuitant after the first
payment may change from month to month based on the net investment results of
the Underlying Fund(s). The total amount of each Annuity payment made to an
Annuitant will be equal to the sum of the payments in each Underlying Fund
allocated to that Annuitant's account.
The actual amount of the payments made to an Annuitant in each Underlying Fund
is found by multiplying the number of Annuity Units credited to the Annuitant's
account in that Underlying Fund by the applicable Annuity Unit Value of the
Underlying Fund as of the date 14 days prior to the date on which the
payment is due.
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FIXED ANNUITY
A Fixed Annuity is an Annuity with payments which remain fixed as to dollar
amount throughout the payment period. The dollar amount of the first Fixed
Annuity payment will be calculated as described above in the "Amount of First
Payment" provision. All subsequent payments will be in the same amount and
that amount will be assured throughout the payment period.
BETTERMENT OF RATES
The Cash Value applied to purchase an Annuity option will provide payments at
least equal to those provided if the same amount was applied to purchase a
single premium immediate Annuity offered by Us at that time for the same class
of contracts. If it would produce a larger payment, We agree that the Fixed
Annuity payment will be determined using the Life Annuity Tables in effect on
the Annuity Commencement Date.
ANNUITY OPTIONS
Subject to conditions stated in ELECTION OF SETTLEMENT OPTIONS and MINIMUM
AMOUNTS, all or any part of the Cash Value of this contract may be paid to the
Annuitant under one or more of the options below.
OPTION 1. LIFE ANNUITY - NO REFUND
We will make monthly Annuity payments during the lifetime of the person on
whose life the payments are based, ending with the last monthly payment
preceding death.
OPTION 2. LIFE ANNUITY WITH 120, 180, OR 240 MONTHLY PAYMENTS ASSURED
We will make monthly Annuity payments during the lifetime of the person on
whose life the payments are based and under the conditions stated below.
If at the death of the Annuitant, 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. LIFE ANNUITY-CASH REFUND
We will make monthly Annuity payments during the lifetime of the Annuitant,
ceasing with the last payment due prior to the death of the Annuitant, provided
that, at the death of the Annuitant, the Beneficiary will receive an additional
payment equal to the dollar value of the excess, if any, of (a) over (b)
where, for a Variable Annuity:
(a) is the total amount applied under the option divided by the
Annuity Unit Value on the due date of the first Annuity
payment; and
(b) is
(1) the number of Annuity Units represented by each
payment; times
(2) the number of payments made;
and for a Fixed Annuity:
(a) is the Cash Value applied on the Annuity Commencement Date
under this option; and
(b) is the dollar amount of Annuity
payments already paid.
OPTION 4. JOINT AND LAST SURVIVOR LIFE ANNUITY
We will make monthly Annuity payments during the joint lifetime of the
Annuitant and a secondary payee, and thereafter during the remaining lifetime
of the survivor, ceasing with the last payment prior to the death of the
survivor.
OPTION 5. JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE We will make monthly Annuity payments to the Annuitant during the
joint lifetime of two persons selected. 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 monthly 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 monthly 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.
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ANNUITY OPTIONS
OPTION 6. PAYMENTS FOR A FIXED PERIOD
We will make monthly payments for the period selected. If at the death of the
Annuitant, payments have been made for less than the period selected, We will
continue to make payments to the designated Beneficiary during the remainder of
that period.
OPTION 7. OTHER ANNUITY OPTIONS
We will make other arrangements for Annuity payments as may be mutually agreed
upon by You and Us.
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 APPLIED
OPTIONS 1, 2, AND 3 - SINGLE LIFE ANNUITIES
MALE AND
FEMALE
ADJUSTED NUMBER OF MONTHLY PAYMENTS GUARANTEED CASH
AGE NONE 120 180 240 REFUND
50 4.27 4.24 4.18 4.10 4.06
51 4.37 4.32 4.26 4.17 4.13
52 4.47 4.42 4.34 4.23 4.20
53 4.57 4.51 4.43 4.30 4.27
54 4.68 4.61 4.51 4.37 4.35
55 4.80 4.72 4.60 4.44 4.44
56 4.93 4.83 4.70 4.52 4.52
57 5.07 4.95 4.80 4.59 4.62
58 5.21 5.07 4.90 4.66 4.71
59 5.36 5.20 5.00 4.74 4.81
60 5.53 5.34 5.11 4.81 4.92
61 5.70 5.48 5.21 4.88 5.03
62 5.89 5.62 5.32 4.95 5.15
63 6.08 5.78 5.43 5.01 5.28
64 6.29 5.94 5.54 5.08 5.41
65 6.51 6.10 5.66 5.13 5.54
66 6.75 6.27 5.76 5.19 5.69
67 7.00 6.45 5.87 5.24 5.84
68 7.28 6.63 5.98 5.29 6.00
69 7.57 6.82 6.08 5.33 6.17
70 7.89 7.01 6.18 5.36 6.35
71 8.23 7.20 6.27 5.40 6.54
72 8.60 7.40 6.36 5.42 6.74
73 9.00 7.59 6.44 5.44 6.95
74 9.44 7.78 6.51 5.46 7.18
75 9.91 7.97 6.57 5.47 7.41
Dollar amounts of the life Annuity payments are based on the 1994 Group Annuity
Mortality Table for males projected with mortality improvement scale AA with
ages set back two years and a net investment rate of 3%. The adjusted age of
the person on whose life the Annuity is based is determined from the actual age
last birthday on the due date of the first Annuity payment in the following
manner:
Calendar year in which
first payment is due 1996 - 2000 2001 - 2010 2011 - 2020 2021 - 2030 2031 and later
Adjusted age is actual age minus 0 minus 1 minus 2 minus 3 minus 4
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 APPLIED
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
MALE AND
FEMALE
ADJUSTED
AGES 50 55 60 65 70 75
50 3.75 3.9 4.01 4.11 4.17 4.21
55 3.9 4.11 4.3 4.46 4.59 4.67
60 4.01 4.3 4.59 4.86 5.08 5.25
65 4.11 4.46 4.86 5.26 5.63 5.94
70 4.17 4.59 5.08 5.63 6.2 6.73
75 4.21 4.67 5.25 5.94 6.73 7.56
Dollar amounts of the life Annuity payments are based on the 1994 Group Annuity
Mortality Table for males projected with mortality improvement scale AA with
ages set back two years and a net investment rate of 3%. The adjusted age of
the person on whose life the Annuity is based is determined from the actual age
last birthday on the due date of the first Annuity payment in the following
manner:
Calendar year in which
first payment is due 1996 - 2000 2001 - 2010 2011 - 2020 2021 - 2030 2031 and later
Adjusted age is actual age minus 0 minus 1 minus 2 minus 3 minus 4
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 APPLIED
OPTION 5 - JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE
MALE AND
FEMALE
ADJUSTED
AGES 50 55 60 65 70 75
50 4.27 4.52 4.82 5.16 5.54 5.97
55 4.52 4.80 5.14 5.53 5.97 6.47
60 4.82 5.14 5.53 5.98 6.50 7.10
65 5.16 5.53 5.98 6.51 7.14 7.86
70 5.54 5.97 6.50 7.14 7.89 8.79
75 5.97 6.47 7.10 7.86 8.79 9.91
Dollar amounts of the life Annuity payments are based on the 1994 Group Annuity
Mortality Table for males projected with mortality improvement scale AA with
ages set back two years and a net investment rate of 3%. The adjusted age of
the person on whose life the Annuity is based is determined from the actual age
last birthday on the due date of the first Annuity payment in the following
manner:
Calendar year in which
first payment is due 1996 - 2000 2001 - 2010 2011 - 2020 2021 - 2030 2031 and later
Adjusted age is actual age minus 0 minus 1 minus 2 minus 3 minus 4
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ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 APPLIED
OPTION 6 - PAYMENTS FOR A DESIGNATED PERIOD
MONTHLY MONTHLY
NUMBER PAYMENT NUMBER PAYMENT
OF YEARS AMOUNT OF YEARS AMOUNT
5 17.91 18 5.96
6 15.14 19 5.73
7 13.16 20 5.51
8 11.68 21 5.32
9 10.53 22 5.15
10 9.61 23 4.99
11 8.86 24 4.84
12 8.24 25 4.71
13 7.71 26 4.59
14 7.26 27 4.47
15 6.87 28 4.37
16 6.53 29 4.27
17 6.23 30 4.18
The dollar amounts of the monthly Annuity payments for the Fifth Option are
based on a net investment rate of 3% per annum.
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