Trust Participation Agreement Sample Contracts

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EXHIBIT 8(r) AMENDMENT TO TRUST PARTICIPATION AGREEMENT
Trust Participation Agreement • July 12th, 2001 • Il Annuity & Insurance Co Separate Account 1
Employer Trust Participation Agreement
Trust Participation Agreement • September 23rd, 2015

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) _ Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription OnlyMedical Plan Selection:$0 Deductible Plan $500 Ded

TRUST PARTICIPATION AGREEMENT Among GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY OF NEW YORK Victory Variable Insurance Funds Victory Capital Management Inc. and Victory Capital Advisers, Inc.
Trust Participation Agreement • April 25th, 2019 • COLI VUL-2 Series Account of Great-West Life & Annuity Insurance Co of New York • Colorado

THIS TRUST PARTICIPATION AGREEMENT (the “Agreement”) is made and entered into as of this 1st day of May, 2018 (the “Effective Date”) by and among GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (hereinafter “GWL&A”), a Colorado life insurance company, on its own behalf and on behalf of its separate account(s) listed on Schedule B attached hereto (the “GWL&A Account(s)”); GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY OF NEW YORK (hereinafter “GWL&ANY”), a New York life insurance company, on its own behalf and on behalf of its separate account(s) listed on Schedule B (the “GWL&ANY Account(s)”); (the GWL&A Account(s) and the GWL&ANY Account(s) may be referred to herein individually, or collectively as the “Accounts”) (GWL&A and GWL&ANY may be referred to herein individually, each as an “Insurance Party,” or collectively as the “Insurance Parties”); Victory Variable Insurance Trusts, a Delaware statutory trust (the “Trust”) on behalf of its series portfolios, individually and not jointly (collec

Employer Trust Participation Agreement
Trust Participation Agreement • October 3rd, 2020

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription Only Medical Plan Selection through Guarantee Trust Life

Employer Trust Participation Agreement
Trust Participation Agreement • September 18th, 2019

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription OnlyMedical Plan Selection:$0 Deductible Plan $500 Deduc

Employer Trust Participation Agreement
Trust Participation Agreement • November 15th, 2010

All Deductibles $0 Deductible Plan $500 Deductible Plan $2000 Deductible Plan $100 Deductible Plan $750 Deductible Plan $2500 Deductible Plan $150 Deductible Plan $1000 Deductible Plan $3000 Deductible Plan $250 Deductible Plan $1500 Deductible Plan $4000 Deductible Plan

Employer Trust Participation Agreement
Trust Participation Agreement • September 18th, 2019

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription OnlyMedical Plan Selection:$0 Deductible Plan $500 Deduc

Employer Trust Participation Agreement
Trust Participation Agreement • October 3rd, 2020

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription Only Medical Plan Selection through Guarantee Trust Life

Employer Trust Participation Agreement
Trust Participation Agreement • June 11th, 2020

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) _ Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription Only Medical Plan Selection through Guarantee Trust Li

Employer Trust Participation Agreement
Trust Participation Agreement • October 23rd, 2018

Entity - Employer Information: Entity Name: Street Address: City, State, Zip: County: Telephone#: ( ) Executive Contact: Email Address: Entity Type: Proprietorship (Schedule C or Occ. Lic.) Corporation (Business License)Government (Letter) Partnership/LLC (Form 1065)Union (Letter) Non-Profit/Religious (Letter) All applying entities must attach the requested letter or document when initially applying for coverage. Seniors Choice Coverage Information: Requested Effective Date (1st day of the month): Total number of full-time and part-time employees: Total number of retirees 65 or over with Medicare Parts A and B: Have you employed 20 or more full-time or part-time employees,20 or more weeks in the current or previous calendar year? Yes No(If yes, active employees eligible for the employer sponsored group health plan are not eligible for Seniors Choice) Seniors Choice Plan Selection: Medical & Prescription Medical Only Prescription OnlyMedical Plan Selection:$0 Deductible Plan $500 Deduc

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