FORM OF AMENDMENT OF PARTICIPATION AGREEMENT
Exhibit (h)(75)
FORM OF
AMENDMENT
OF
This Amendment dated as of August 28, 2007 is by and among INDIANAPOLIS LIFE INSURANCE COMPANY
(the “Company”), an Indiana corporation, on its own behalf and on behalf of each separate account
of the Company named in Schedule I to Participation Agreement (as defined below), PREMIER VIT, an
open-end diversified management investment company organized under the laws of the State of
Massachusetts (the “Fund”), and ALLIANZ GLOBAL INVESTORS DISTRIBUTORS LLC, a Delaware limited
liability company (“AGI Distributors”).
WHEREAS, the Company, the Fund and AGI Distributors have entered into a Participation
Agreement on September 5, 1995 (the “Participation Agreement”); and
WHEREAS, the Company, the Fund and AGI Distributors desire to amend the Participation
Agreement.
NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties hereto
agree as follows:
1. Anti-Money Laundering, The following provision shall be added to the Participation
Agreement as its last numbered Sub-Section under Section 1 and it shall be numbered accordingly:
Each party to this Agreement hereby agrees to abide by and comply with all applicable
anti-money laundering laws and regulations including the Anti-Money Laundering and Abatement
Act and relevant provisions of the USA Patriot Act of 2001. Each party represents that it
has established an Anti-Money laundering Program that complies with all material aspects of
the USA Patriot Act of 2001 and other applicable anti-money laundering laws and regulations.
Each party also hereby agrees to take action to comply with any new or additional anti-money
laundering regulations. The Company will use best efforts to obtain and verify the requisite
information with respect to each investor on whose behalf the Company is acting with respect
to the Fund and the Company agrees to notify the Underwriter promptly whenever potential
indications of suspicious activity or Office of Foreign Asset Control matches are detected
with respect to any such investor.
2. Continuation. Except as set forth above, the Participation Agreement shall remain
in full force and effect in accordance with its terms.
3. Counterparts. This Amendment may be executed in one or more counterparts, each of
which shall be deemed to be an original.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by a duly
authorized representative as of the day and year first above written.
INDIANAPOLIS LIFE INSURANCE COMPANY
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ALLIANZ GLOBAL INVESTORS DISTRIBUTORS LLC
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