HARTFORD LIFE INSURANCE COMPANY
(A STOCK INSURANCE COMPANY, HEREIN CALLED THE COMPANY)
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
GROUP ANNUITY CONTRACT
INDIVIDUALLY ALLOCATED
CONTRACT OWNER
CONTRACT EFFECTIVE DATE
PLACE OF DELIVERY
CONTRACT NUMBER
THIS CONTRACT IS ISSUED IN CONSIDERATION OF THE APPLICATION OF THE CONTRACT
OWNER, A COPY OF WHICH IS ATTACHED TO AND MADE A PART OF THIS CONTRACT AND THE
PAYMENT OF CONTRIBUTIONS IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THIS
CONTRACT.
THIS CONTRACT IS SUBJECT TO THE LAWS OF THE JURISDICTION WHERE IT IS DELIVERED.
THE CONDITIONS AND PROVISIONS OF THIS AND THE FOLLOWING PAGES ARE PART OF THE
CONTRACT.
THIS CONTRACT MAKES PROVISION FOR THE ACCUMULATION OF CONTRACT VALUES IN THE
GENERAL ACCOUNT OF THE COMPANY TO PROVIDE FIXED ANNUITY ACCUMULATIONS AND
BENEFITS. ACTUAL ANNUITY PAYOUT COMMENCING ON THE ANNUITY COMMENCEMENT DATE
WILL BE ON A FIXED BASIS.
INDIVIDUAL ALLOCATIONS - NONPARTICIPATING
SIGNED FOR THE COMPANY
/s/ Lon A. Smith /s/ Bruce D. Gardner
Lon A. Smith, President Bruce D. Gardner, Secretary
[Logo] ITT HARTFORD
TABLE OF CONTENTS
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Page
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Contract Specifications 3
Definitions 4
Purchase Payment 5
Control Provisions 5
General Provisions 6
Crediting of Interest and Guarantee Periods 7
Premium Taxes 8
Termination Provisions 8
Annuity Options 10
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CONTRACT SPECIFICATIONS
CONTRACT OWNER DOE AND SONS AGENCY CONTRACT NUMBER SPECIMEN
----------------------------- ---------------
MINIMUM PARTICIPANT PURCHASE EFFECTIVE
PAYMENT AMOUNT $5,000 DATE July 1, 1990
----------------------------- ---------------------------
ELIGIBILITY REQUIREMENTS: EMPLOYEES OF THE CONTRACT OWNER AND THEIR DEPENDENTS.
- 3 -
DEFINITIONS
The definitions in this section apply to the following words and phrases
whenever and wherever they appear in this contract.
ACCOUNT VALUE - The sum of the Purchase Payment made by or on behalf of a
Participant and all interest earned to that date.
ANNUITANT - The person on whose life a Certificate is issued. The Participant
must also be the Annuitant.
ANNUITY COMMENCEMENT DATE - The date elected by a Participant which is indicated
on the Certificate.
BENEFICIARY- The person entitled to receive benefits as per the terms of the
contract in case of the death of the Participant.
CERTIFICATE - The individual certificate issued by the Company to the
Participant or to the Contract Owner for delivery to the Participant which
evidences that a Purchase Payment has been made by or on behalf of a Participant
under this contract, and which summarizes the provisions of this contract.
CERTIFICATE DATE - The effective date of participation under this contract and
is the date shown on each Certificate. Certificate Years are measured from the
applicable Certificate Date.
COMPANY - The Hartford Life Insurance Company.
CONTINGENT ANNUITANT - The spouse of the Participant if designated by the
Participant to, upon the Annuitant's death prior to the Annuity Commencement
Date, become the Annuitant and also the Participant.
CONTRACT OWNER - The person or entity specified on page 3.
CURRENT RATE - The applicable effective annual interest rate contained in a
schedule of rates established by the Company from time to time for various
durations.
DEPENDENT - The spouse or child of an Employee eligible to participate in this
contract.
DUE PROOF OF DEATH - A certified copy of the death certificate, an order of a
court of competent jurisdiction, a statement from a physician who attended the
deceased, or any other proof acceptable to the Company.
GROSS SURRENDER VALUE - The Account Value specified by the Participant for a
full surrender.
GUARANTEE PERIOD - The period for which either an Initial or Subsequent
Guarantee Rate will be credited for a Certificate.
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DEFINITIONS(CONTINUED)
INITIAL GUARANTEE PERIOD - The Guarantee Period chosen by the Participant on the
Participant Enrollment Request form as shown on the Certificate.
INITIAL GUARANTEE RATE - The effective annual rate of interest credited to a
Purchase Payment made by or on behalf of a Participant as described in the
Crediting of Interest and Guarantee Periods section. This rate of interest is
specified in each Certificate.
IN WRITING - A written form satisfactory to the Company and filed at their
office in Hartford, Connecticut. All correspondence should be sent to P.O. Box
2999, Hartford, Connecticut 06104-2999.
NET SURRENDER VALUE - The amount payable to the Participant on full surrender
under a Certificate after the application of any Market Value Adjustment. It is
described in the Termination Provisions.
PARTICIPANT - The person(s) eligible to participate pursuant to the eligibility
requirements on page 3 and for whom the Company has received a Purchase Payment.
SUBSEQUENT GUARANTEE RATE - The effective annual rate of interest established by
the Company for the applicable subsequent Guarantee Period.
PURCHASE PAYMENT
No Purchase Payment will be accepted by the Company unless it equals or exceeds
the Minimum Purchase Payment Amount specified on page 3 and is accompanied by a
properly completed Participant Enrollment Request Form. The Company reserves
the right to limit the amount of the Purchase Payment. The amount of the
Purchase Payment will be reflected in the Certificate issued upon receipt of the
payment.
Allocation of Purchase Payments
A Purchase Payment (less applicable premium taxes, if any) will be
allocated to an account established for the Participant's benefit. The value of
a Participant's account will be determined in accordance with the terms of this
contract.
CONTROL PROVISIONS
ANNUITANT, CONTINGENT ANNUITANT AND PARTICIPANT
The Annuitant may not be changed.
Changes in the designation of Contingent Annuitant, who may only be the spouse
of the Participant, may be made at any time prior to the Annuity Commencement
Date by written notice to the Company.
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CONTROL PROVISIONS(CONTINUED)
The Participant has the sole power to exercise all rights, options and
privileges granted by this contract or permitted by the Company and to agree
with the Company to any change in or amendment to the contract. The rights of
the Participant shall be subject to the rights of any assignee of record with
the Company and of any irrevocably designated Beneficiary. No assignment will
be effective against the Company until the assignment has been received In
Writing. The Company assumes no responsibility for the validity of any
assignment.
BENEFICIARY
The Designated Beneficiary will remain in effect until changed by the
Participant. Changes in the Designated Beneficiary may be made during the
lifetime of the Participant by written notice to the Company. If the Designated
Beneficiary has been designated irrevocably, however, such designation cannot be
changed or revoked without such Beneficiary's written consent. Upon receipt of
such notice and written consent, if required, at the offices of the Company, the
new designation will take effect as of the date the notice is signed, whether or
not the Participant is alive at the time of receipt of such notice. The change
will be subject to any payments made or other action taken by the Company before
the receipt of the notice.
In the event of the death of the Participant prior to the Annuity Commencement
Date when there is no surviving Contingent Annuitant, the Beneficiary will be
the Designated Beneficiary then in effect. If there is no Designated
Beneficiary in effect or if the Designated Beneficiary is no longer living, the
Participant's estate will be the Beneficiary.
GENERAL PROVISIONS
ENTIRE CONTRACT
This contract constitutes the entire contract.
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GENERAL PROVISIONS(CONTINUED)
A Certificate is a summary of the Group Annuity Contract. All statements made
by the Participant are deemed to be true and complete to the best of his/her
knowledge and belief.
MODIFICATION OF THE CONTRACT
This contract may be modified at any time by written agreement between the
Contract Owner and the Company. The modification must be signed by the
President, a Vice President, an Assistant Vice President, a Secretary or an
Assistant Secretary of the Company. No modification will affect the amount or
term of any annuities begun prior to the effective date of the modification
unless it is required to conform the contract to, or give the Contract Owner the
benefit of, any Federal or State statutes. No modification of this contract
will affect the method by which any then existing Participant's Account Value
will be determined.
NON-PARTICIPATING
This contract is non-participating. It does not earn dividends.
MISSTATEMENT OF AGE
If the age of a Participant is incorrectly stated, death benefits or annuity
payments will be adjusted to the payment which would have been provided at the
correct age taking into account any overpayments or underpayments which had been
made.
CHANGE OF ANNUITY COMMENCEMENT DATE
The Participant may change the Annuity Commencement Date provided the
Participant notifies the Company, In Writing, 30 days before the scheduled
Annuity Commencement Date. The Annuity Commencement Date that the Participant
selects must be on or before the later of:
a) the Participant's attained age 90, or
b) the end of the Initial Guarantee Period provided such Initial
Guarantee Period is 10 years or less.
CREDITING OF INTEREST TO A PARTICIPANT'S PURCHASE PAYMENTS AND GUARANTEE PERIODS
Each Purchase Payment (less applicable Premium Taxes, if any), will earn
interest at the Initial Guarantee Rate during the Initial Guarantee Period.
Within 30 days prior to the end of any Guarantee Period, the Company will notify
the Participant of the expiry of the current Guarantee Period, and that a
subsequent Guarantee Period of the same duration will commence, unless the
Company has:
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GENERAL PROVISIONS (CONTINUED)
a) received, In Writing, a request for a full surrender within 30 days
prior to the end of the current Guarantee Period; or
b) received, In Writing, a request for a full surrender within 5 business
days after the end of the current Guarantee Period; or
c) received, In Writing, a request for a Guarantee Period of a different
duration from among those offered by the Company at any time within 30
calendar days prior to the end of the current Guarantee Period; or
d) received, In Writing, a request for a Guarantee Period of a different
duration from among those offered by the Company at any time within 5
business days after the end of the current Guarantee Period.
The Account Value at the beginning of any Subsequent Guarantee Period will be
equal to the Account Value at the end of the Guarantee Period just ending. The
Account Value will earn interest at the Subsequent Guarantee Rate in the
subsequent Guarantee Period. This rate will be at least equal to the Initial
Guarantee Rates being credited to Purchase Payments for new certificates at the
time the Subsequent Guarantee Rate is determined.
PREMIUM TAXES
A deduction is made for premium taxes, if applicable. On any Certificate
subject to premium tax, the tax will be deducted, as provided under applicable
law, from the Purchase Payment when received, or from the Gross Surrender Value
upon surrender, or from the amount applied to effect an annuity at the time
annuity payments commence.
TERMINATION PROVISIONS
GENERAL SURRENDERS
Full surrenders may be made under a Certificate at any time and will terminate
the Certificate. No partial surrenders may be made.
In the case of full surrenders, the Account Value will be reduced by the Gross
Surrender Value on the Surrender Date and the Net Surrender Value will be
payable to the Participant. Except as provided for in the Special Surrenders
Section, the Net Surrender Value is calculated by the Company on a daily basis
as follows:
(A - B) x C, where:
A = the Gross Surrender Value;
B = any unpaid premium taxes;
C = the Market Value Adjustment described below.
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TERMINATION PROVISIONS(CONTINUED)
MARKET VALUE ADJUSTMENT
The formula which will be used to determine the Market Value Adjustment is
calculated by the Company on a daily basis as follows:
1 + I N/12
[---------------]
1 + J
I = Guarantee Rate in effect for the current Guarantee Period (expressed as a
decimal, e.g. 1% = .01).
J = The current Rate plus 0.25% (expressed as a decimal, e.g. 1% = .01) in
effect for durations equal to the number of years remaining in the current
Guarantee Period (years are rounded to the next highest number of years).
If not available, the Company will utilize a rate equal to the most recent
Moody's Corporate Bond Yield Average - Monthly Average Corporates (for the
applicable duration) plus 0.25% as published by Moody's Investors Service,
Inc.
N = The number of complete months from the Surrender Date to the end of the
current Guarantee Period.
SPECIAL SURRENDERS
A Market Value Adjustment will not be applied to a full surrender made at the
end of the Guarantee Period. A request for a surrender at the end of a
Guarantee Period must be received, In Writing, during the 30 day period
preceding the end of such Guarantee Period. A request for a full surrender
received In Writing within five (5) business days of the beginning of a
Subsequent Guarantee Period will be considered a Special Surrender and a Market
Value Adjustment will not be applied.
If the Participant notifies the Company, In Writing within 30 days prior to the
end of a Certificate Year, the Company will send the Participant any interest
credited during the prior Certificate Year. No Market Value Adjustment will be
imposed on such interest payments.
PAYMENT UPON SURRENDER - DEFERRAL OF PAYMENT
The Company may defer payment of any total surrender for the period permitted by
law. In no event will this deferral of payment exceed 6 months from date of
receipt of the election to totally surrender. If the Company defers payment for
more than 30 days, interest of at least 4% per annum on the amount deferred will
be paid. The Company will not, however, defer payment for more than 30 days for
any surrender effective at the end of any Guarantee Period.
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TERMINATION PROVISIONS(CONTINUED)
DEATH BENEFIT
If the Participant dies before the Annuity Commencement Date and there is no
designated Contingent Annuitant surviving, the death benefit will be payable to
the Beneficiary as determined under the Contract Control Provisions. If the
death occurs on or prior to the Participant attaining age 65, then the death
benefit equals the higher of the Account Value or the Net Surrender Value as
each is calculated as of the date the Company receives written notification of
Due Proof of Death. If the death occurs after the Participant attains age 65,
then the death benefit equals the Net Surrender Value.
The death benefit will be due and payable within a reasonable period of time
(not to exceed 6 months) after the date the Company receives Due Proof of Death.
The death benefit may be taken in one sum or under any of the annuity options
available under the contract provided however, that, any annuity option selected
must provide that any amount payable as a death benefit will be distributed
within 5 years of the date of death; or, if the annuity option selected provides
for the death benefit to be payable over a period not extending beyond the life
expectancy of the Beneficiary or over the life of the Beneficiary, such
distribution must commence within one year of the date of death.
Notwithstanding the previous sentence, if the Beneficiary is the spouse of the
Participant and is also the Contingent Annuitant, such spouse may elect, in lieu
of receiving the death benefit, to be treated as the Participant.
ANNUITY OPTIONS
ANNUITY BENEFIT
On the Annuity Commencement Date, unless directed otherwise, the Company will
apply the Participant's Account Value multiplied by the Market Value Adjustment,
if any, less applicable premium taxes, if any, to purchase the monthly income
payments according to the Annuity Option elected. If the Annuity Commencement
Date coincides with the end of any Guarantee Period, no Market Value Adjustment
will be applied in the determination of the monthly income payments.
ELECTION OF ANNUITY OPTIONS
A Participant may elect any of the Annuity Options described below, or any other
Annuity Option being offered by the Company at the time of annuitization. In
the absence of such election the Second Option providing a life annuity with 120
monthly payments certain will apply.
Election of any of these options must be made In Writing to the Company at least
30 days prior to the date such election is to become effective.
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ANNUITY OPTIONS(CONTINUED)
DATE OF PAYMENT
The first payment under any option shall be made on the Annuity Commencement
Date. Subsequent payments shall be made on the same day of each month in
accordance with the manner of payment selected.
The Participant, or in the case the Participant shall not have done so, the
Beneficiary after the death of the Participant, as applicable, may elect in
lieu of payment in one sum, that any amount or part thereof due by the Company
under this contract to the Beneficiary shall be applied under any one of the
options stated below. Such election must be made within one year after the
death of the Participant, by written notice to the office of the Company.
DEATH OF PARTICIPANT
In the event of the death of the Participant while receiving annuity payments,
the present values at the current dollar amount on the date of death of any
remaining guaranteed payments, or any then remaining balance of proceeds under
the Fifth Option, will be paid in one sum to the Beneficiary unless other
provisions have been and approved in writing by the Company. Any method of
distribution must provide that any amount payable as a death benefit will be
distributed at least as rapidly as under the method of distribution in effect at
the time of the Participant's death. Calculations of such present value of the
guaranteed payments remaining will be based on the interest rate that is used by
the Company to determine the amount of each certain payment.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE
An annuity effected under a Certificate may not be surrendered after the
commencement of annuity payments.
ANNUITY OPTIONS
FIRST OPTION -- Life Annuity -- An annuity payable monthly during the lifetime
of the Participant, ceasing with the last payment due prior to the death of the
Participant.
SECOND OPTION -- Life Annuity with 120, 180, or 240 Monthly Payments Certain
- -- An annuity providing monthly income to the Participant for a fixed period
of 120 months, 180 months or 240 months (as selected), and for as long
thereafter as the Participant shall live.
THIRD OPTION -- Cash Refund Life Annuity -- An annuity payable monthly during
the lifetime of the Participant, ceasing with the last payment due prior to the
death of the Participant provided that, at the death of the Participant, the
Beneficiary will receive an additional payment equal to the excess, if
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ANNUITY OPTIONS(CONTINUED)
any, of (a) over (b) where (a) is the Account Value applied on the Annuity
Commencement Date under this option and (b) is the dollar amount of annuity
payments already paid.
FOURTH OPTION -- Joint and Last Survivor Life Annuity -- An annuity payable
monthly during the joint lifetime of the Participant 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.
FIFTH OPTION -- Payments for a Designated Period -- An amount payable monthly
for the number of years selected which may be from 5 to 30 years.
ANNUITY TABLES
The attached tables of guaranteed annuity purchase rates show the dollar amount
of the monthly payments for each $1,000 applied under the five options. Under
the First, Second, or Third Options, the amount of each payment will depend upon
the age of the Participant at the time the first payment is due. Under the
Fourth Option, the amount of each payment will depend upon the ages of both
payees at the time first payment is due. Actual payments will be based on
annuity rate tables currently in use, if they produce higher payments than the
guaranteed amounts.
DESCRIPTION OF TABLES
The tables for the First, Second, Third and Fourth Options are based on the
1983a Individual Annuity Mortality Table with ages set back one year and a net
investment rate of 4% per annum. The table for the Fifth Option is based on a
net investment rate of 4% per annum.
MINIMUM PAYMENT
The option elected must result in a payment of an amount at least equal to the
minimum payment amount according to Company rules then in effect. If at any
time payments are less than the minimum payment amount, the Company has the
right to change the frequency to an interval resulting in a payment at least
equal to the minimum. If any amount due is less than the minimum per year, the
Company may make other arrangements that are equitable to the Participant.
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HARTFORD LIFE INSURANCE COMPANY
(A STOCK INSURANCE COMPANY, HEREIN CALLED THE COMPANY)
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
GROUP ANNUITY CONTRACT
INDIVIDUALLY ALLOCATED
CONTRACT OWNER
CONTRACT EFFECTIVE DATE
PLACE OF DELIVERY
CONTRACT NUMBER
THIS CONTRACT IS ISSUED IN CONSIDERATION OF THE APPLICATION OF THE CONTRACT
OWNER, A COPY OF WHICH IS ATTACHED TO AND MADE A PART OF THIS CONTRACT AND THE
PAYMENT OF CONTRIBUTIONS IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THIS
CONTRACT.
THIS CONTRACT IS SUBJECT TO THE LAWS OF THE JURISDICTION WHERE IT IS DELIVERED.
THE CONDITIONS AND PROVISIONS OF THIS AND THE FOLLOWING PAGES ARE PART OF THE
CONTRACT.
THIS CONTRACT MAKES PROVISION FOR THE ACCUMULATION OF CONTRACT VALUES IN THE
GENERAL ACCOUNT OF THE COMPANY TO PROVIDE FIXED ANNUITY ACCUMULATIONS AND
BENEFITS. ACTUAL ANNUITY PAYOUT COMMENCING ON THE ANNUITY COMMENCEMENT DATE
WILL BE ON A FIXED BASIS.
INDIVIDUAL ALLOCATIONS - NONPARTICIPATING
SIGNED FOR THE COMPANY
/s/ Lon A. Smith /s/ Bruce D. Gardner
LON A. SMITH, PRESIDENT BRUCE D. GARDNER, SECRETARY
[Logo] ITT HARTFORD
TABLE OF CONTENTS
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Page
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Contract Specifications 3
Definitions 4
Purchase Payment 5
General Provisions 5
Crediting of Interest and Guarantee Periods 6
Premium Taxes 7
Termination Provisions 7
Purchase of Annuity Benefits 9
Annuity Options 10
- 2 -
CONTRACT SPECIFICATIONS
CONTRACT OWNER DOE AND SONS AGENCY CONTRACT NUMBER SPECIMEN
----------------------------- ---------------
MINIMUM PARTICIPANT PURCHASE EFFECTIVE
PAYMENT AMOUNT $5,000 DATE July 1, 1990
----------------------------- ---------------------------
ELIGIBILITY REQUIREMENT: EMPLOYEES OF THE CONTRACT OWNER.
- 3 -
DEFINITIONS
The definitions in this section apply to the following words and phrases
whenever and wherever they appear in this contract.
ACCOUNT - An account established for each Purchase Payment for purposes of
crediting interest, Guarantee Periods and surrenders.
ACCOUNT VALUE - The sum of the Purchase Payment made by or on behalf of a
Participant and all interest earned to that date.
ACCOUNT YEARS - Account Years are measured from the applicable Payment Date.
ANNUITANT - The person on whose life a certificate is issued. The Participant
must also be the Annuitant.
ANNUITY COMMENCEMENT DATE - The date payment of an annuity is to begin under
this contract. The determination of such date shall be made by the Contract
Owner in accordance with the terms of the plan.
BENEFICIARY - The person entitled to receive benefits as named by the
Participant.
COMPANY - The Hartford Life Insurance Company.
CONTRACT OWNER - The person or entity specified on page 3.
CURRENT RATE - The applicable effective annual interest rate contained in a
schedule of rates established by the Company from time to time for various
durations.
DUE PROOF OF DEATH - A certified copy of the death certificate, an order of a
court of competent jurisdiction, a statement from a physician who attended the
deceased, or any other proof acceptable to the Company.
GROSS SURRENDER VALUE - The Account Value specified by the Participant for a
full surrender.
GUARANTEE PERIOD - The period for which either an Initial or Subsequent
Guarantee Rate will be credited with respect to each Account.
INITIAL GUARANTEE PERIOD - The Guarantee Period chosen by the Participant on the
Participant Enrollment Request Form.
INITIAL GUARANTEE RATE - The rate of interest credited to a Purchase Payment
made by or on behalf of a Participant as described in the Crediting of Interest
and Guarantee Periods section.
IN WRITING - A written form satisfactory to the Company and filed at their
office in Hartford, Connecticut. All correspondence should be sent to P.O. Box
2999, Hartford, Connecticut 06104-2999.
NET SURRENDER VALUE - The amount payable to the Contract Owner on full surrender
from an Account after the application of any Market Value Adjustment. It is
described in the Termination Provisions.
-4-
DEFINITIONS (CONTINUED)
PARTICIPANT - The person(s) covered by the Plan.
PAYMENT CONFIRMATION - The confirmation issued by the Company to the Contract
Owner which evidences that a Purchase Payment has been made under this contract
and which indicates the applicable Payment Date and Initial Guarantee Rate.
PAYMENT DATE - The effective date of each Account under this contract and is the
date shown on each Payment Confirmation.
PLAN - The plan maintained by the Contract Owner which is an eligible state
deferred compensation plan under Section 457 of the Code.
SUBSEQUENT GUARANTEE RATE - The effective annual rate of interest established by
the Company for the applicable subsequent Guarantee Period.
SURRENDER DATE - The date the Company receives the written request for a
surrender.
PURCHASE PAYMENT
No Purchase Payment will be accepted by the Company unless it equals or exceeds
the Minimum Purchase Payment Amount specified on page 3 and is accompanied by a
properly completed Participant Enrollment Request Form. The Company reserves the
right to limit the amount of the Purchase Payment.
ALLOCATION OF PURCHASE PAYMENTS
A Purchase Payment (less applicable premium taxes, if any) will be allocated to
an Account established for the Participant's benefit. The value of a
Participant's Account will be determined in accordance with the terms of this
contract.
GENERAL PROVISIONS
ENTIRE CONTRACT
This contract constitutes the entire contract.
MODIFICATION OF THE CONTRACT
This contract may be modified at any time by written agreement between the
Contract Owner and the Company. The modification must be signed by the
-5-
GENERAL PROVISIONS (CONTINUED)
President, a Vice President, an Assistant Vice President, a Secretary or an
Assistant Secretary of the Company. No modification will affect the amount or
term of any annuities begun prior to the effective date of the modification
unless it is required to conform the contract to, or give the Contract Owner the
benefit of, any Federal or State statutes. No modification of this contract will
affect the method by which any then existing Participant's Account Value will be
determined.
NON-PARTICIPATING
This contract is non-participating. It does not earn dividends.
MISSTATEMENT OF AGE
If the age of a Participant is incorrectly stated, annuity payments will be
adjusted to the payment which would have been provided at the correct age taking
into account any overpayments or underpayments which had been made.
CREDITING OF INTEREST TO A PARTICIPANT'S PURCHASE PAYMENTS AND GUARANTEE PERIODS
Each Purchase Payment (less applicable Premium Taxes, if any) will earn interest
at the Initial Guarantee Rate each Account Year during the Initial Guarantee
Period.
Within 30 days prior to the end of any Guarantee Period, the Company will notify
the Participant of the expiry of the current Guarantee Period, and that a
subsequent Guarantee Period of the same duration will commence, unless the
Company has:
a) received, In Writing, a request for a full surrender within 30 days
prior to the end of the current Guarantee Period; or
b) received, In Writing, a request for a full surrender within 5 business
days after the end of the current Guarantee Period; or
c) received, In Writing, a request for a Guarantee Period of a different
duration from among those offered by the Company at any time within 30
calendar days prior to the end of the current Guarantee Period; or
d) received, In Writing, a request for a Guarantee Period of a different
duration from among those offered by the Company at any time within 5
business days after the end of the current Guarantee Period.
The Account Value at the beginning of any subsequent Guarantee Period will be
equal to the Account Value at the end of the Guarantee Period just ending. The
Account Value will earn interest at the Subsequent Guarantee Rate in the
Subsequent Guarantee Period. This rate will be at least equal to the Initial
Guarantee Rates being credited to Purchase Payments for new certificates for the
same duration of Guarantee Period at the time the Subsequent Guarantee Rate is
determined.
-6-
PREMIUM TAXES
A deduction is made for premium taxes, if applicable. On any certificate
subject to a premium tax, the tax will be deducted, as provided under applicable
law, from the Purchase Payment when received, or from the Gross Surrender Value
upon surrender, or from the amount applied to effect an annuity at the time
annuity payments commence.
TERMINATION PROVISIONS
GENERAL SURRENDERS
Full surrenders may be made under this contract at any time. No partial
surrenders may be made.
In the case of full surrenders, the Account Value will be reduced by the Gross
Surrender Value on the Surrender Date and the Net Surrender Value will be
payable to the Contract Owner or applied to purchase an annuity. Except as
provided for in the Special Surrenders Section, the Net Surrender Value is
calculated by the Company on a daily basis as follows:
(A - B) x C, where:
A = the Gross Surrender Value;
B = any unpaid premium taxes;
C = the Market Value Adjustment described below.
MARKET VALUE ADJUSTMENT
The formula which will be used to determine the Market Value Adjustment is
calculated by the Company on a daily basis as follows:
1 + I N/12
[---------------]
1 + J
I = Guarantee Rate in effect for the current Guarantee Period (expressed as a
decimal, e.g. 1% = .01).
J = The Current Rate plus 0.25% (expressed as a decimal, e.g. 1% = .01) in
effect for durations equal to the number of years remaining in the current
Guarantee Period (years are rounded to the next highest number of years).
If not available, the Company will utilize a rate equal to the most recent
Moody's Corporate Bond Yield Average - Monthly Average Corporates (for the
applicable duration) plus 0.25% as published by Moody's Investors Service,
Inc.
N = The number of complete months from the Surrender Date to the end of the
current Guarantee Period.
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TERMINATION PROVISIONS (CONTINUED)
SPECIAL SURRENDERS
A Market Value Adjustment will not be applied to a full surrender made at the
end of the Guarantee Period. A request for a surrender at the end of a
Guarantee Period must be received, In Writing, during the 30 day period
preceding the end of such Guarantee Period. A request for a full surrender
received In Writing within five (5) business days of the beginning of a
Subsequent Guarantee Period will be considered a Special Surrender and a Market
Value Adjustment will not be applied.
PAYMENT UPON SURRENDER - DEFERRAL OF PAYMENT
The Company may defer payment of any total surrender for the period permitted by
law. In no event will this deferral of payment exceed 6 months from date of
receipt of the election to totally surrender. If the Company defers payment for
more than 30 days, interest of at least 4% per annum on the amount deferred will
be paid. The Company will not, however, defer payment for more than 30 days for
any surrender effective at the end of any Guarantee Period.
DEATH BENEFIT
If the Participant dies before the Annuity Commencement date the death benefit
will be payable to the Beneficiary. If the death occurs on or prior to the
Participant attaining age 65, then the death benefit equals the higher of the
Account Value or the Net Surrender Value as each is calculated as of the date
the Company receives written notification of Due Proof of Death. If the death
occurs after the Participant attains age 65, then the death benefit equals the
Net Surrender Value.
The death benefit will be due and payable within a reasonable period of time
(not to exceed 6 months) after the date the Company receives Due Proof of Death.
The death benefit may be taken in one sum or under any of the annuity options
available under the contract provided however, that, any annuity option selected
must provide that any amount payable as a death benefit will be distributed
within 5 years of the date of death; or, if the annuity option selected provides
for the death benefit to be payable over a period not extending beyond the life
expectancy of the Beneficiary or over the life of the Beneficiary, such
distribution must commence within one year of the date of death.
PURCHASE OF ANNUITY BENEFITS
ELECTION
The Contract Owner may elect to make a surrender of one or more of the Accounts
under this contract and have the Net Surrender Values applied on the Annuity
Commencement Date under any of the Annuity Options described below. Any annuity
benefits payable hereunder are nonassignable.
Election of any of these options must be made In Writing to the Office of the
Company in Hartford, Connecticut at least 30 days prior to the date such
election is to become effective. The form of such annuity shall be determined
by the Contract Owner in accordance with the terms of the Plan. The following
information must be provided with any such request:
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PURCHASE OF ANNUITY PAYMENTS (CONTINUED)
a. the Participant's name, address, date of birth, social security
number; and
b. the amount which is to be distributed to the Participant in the form
of an annuity; and
c. the form of annuity which is to be purchased for the Participant as
determined in accordance with the provision of the Annuity Options and
the date annuity payments are to commence; and
d. if the form of annuity applicable to the Participant provides a death
benefit in the event of his death, the name, relationship and address
of the Beneficiary most recently designated by the Participant in
accordance with the provisions of the Plan; and
e. if the form of annuity applicable to the Participant is the Fourth
Option, the name, address and date of birth of the designated
secondary payee together with the percentage (from those percentages
then being made available by the Company) of the annuity payments
which are to be continued and paid to the surviving payee; and
f. any other data that may reasonably be required by the Company.
DATE OF PAYMENT
The first payment under any option shall be due on the Annuity Commencement
Date. Subsequent payments shall be made on the same day of each month in
accordance with the manner of payment selected.
DEATH OF PARTICIPANT
In the event of the death of the Participant while receiving annuity payments,
the present values at the current dollar amount on the date of death of any
remaining guaranteed payments, or any then remaining balance of proceeds under
the Fifth Option, will be paid in one sum to the Beneficiary unless other
provisions have been requested and approved by the Company. Calculations of
such present value of the guaranteed payments remaining will be based on the
interest rate that is used by the Company to determine the amount of each
certain payment.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE
An annuity effected under this Contract may not be surrendered after the
commencement of annuity payments.
ANNUITY OPTIONS
ANNUITY BENEFIT
FIRST OPTION - Life Annuity - An annuity payable monthly during the lifetime of
Participant, ceasing with the last payment due prior to the death of the
Participant.
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ANNUITY OPTIONS (CONTINUED)
SECOND OPTION - Life Annuity with 120, 180, or 240 Monthly Payments Certain - An
annuity providing monthly income to the Participant for a fixed period of 120
months, 180 months, or 240 months (as selected), and for as long thereafter as
the Participant shall live.
THIRD OPTION - Cash Refund Life Annuity - An annuity payable monthly during the
life time of the Participant, ceasing with the last payment due prior to the
death of the Participant provided that, at the death of the Participant, the
Beneficiary will receive an additional payment equal to the excess, if any, of
(a) over (b) where (a) is the Account Value applied on the Annuity Commencement
Date under this option and (b) is the dollar amount of annuity payments already
paid.
FOURTH OPTION - Joint and Last Survivor Life Annuity - An annuity payable
monthly during the joint lifetime of the Participant 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.
FIFTH OPTION - Payments for a Designated Period - An amount payable monthly for
the number of years selected which may be from 5 to 30 years.
ANNUITY TABLES
The attached tables of guaranteed annuity purchase rates show the dollar amount
of the monthly payments for each $1,000 applied under the five options. Under
the First, Second, or Third Options, the amount of each payment will depend upon
the age of the Participant at the time the first payment is due. Under the
Fourth Option, the amount of each payment will depend upon the age of both
payees at the time first payment is due. Actual payments will be based on
annuity rate tables currently in use, if they produce higher payments than the
guaranteed amounts.
DESCRIPTION OF TABLES
The tables for the First, Second, Third and Fourth Options are based on the
1983a Individual Annuity Mortality Table with ages set back one year and a net
investment rate of 4% per annum. The table for the Fifth Option is based on a
net investment rate of 4% per annum.
MINIMUM PAYMENT
The option elected must result in a payment of an amount at least equal to the
minimum payment amount according to Company rules then in effect. If at any
time payments are less than the minimum payment amount, the Company has the
right to change the frequency to an interval resulting in a payment at least
equal to the minimum. If any amount due is less than the minimum per year, the
Company may make other arrangements that are equitable to the Participant.
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