TSA. A Tax Sheltered Annuity as described in Section 403(b) of the Code. ------------------------------------------------------------------------------- ================================== The Annuity Contract ================================== What is the entire contract? This contract form is the entire contract between you and us. No one except one of our corporate officers (President, Vice President, Secretary, or Assistant Secretary) can change or waive any of our rights or requirements under the contract. That person must do so in writing. None of our agents or other persons has the authority to change or waive any of our rights or requirements under the contract. Can the contract be modified? We reserve the right to modify the contract to the extent necessary to qualify this contract, if purchased as part of a 401(a) qualified plan or a TSA, to the extent necessary to comply with Section 401, 403 or any other applicable section of the Code, or to comply with the provisions of your 401(a) qualified plan or TSA. We also reserve the right to modify the contract to the extent necessary to qualify the contract, if purchased as part of a deferred compensation plan under Section 457 of the Code, to the extent necessary to comply with Section 457 or any other applicable section of the Code, or to comply with the provisions of your deferred compensation plan. When will this contract become incontestable? This contract is incontestable from its date of issue. What if benefits are based on incorrect data? If the amount of benefits is determined by data as to a person's age that is incorrect, benefits will be recalculated on the basis of the correct data. Any underpayments made by us will be made up immediately. Any overpayments made by us will be subtracted from the future payments under this contract and/or as otherwise legally permissible. What federal and state laws govern this contract? This contract is intended to qualify as an annuity contract for Federal income tax purposes. To that end, the provisions of this contract are to be interpreted to ensure or maintain such tax qualification, despite any other provisions to the contrary. We reserve the right to amend this contract to reflect any clarifications that may be needed or are appropriate to maintain such qualification or to conform this contract to any applicable changes in the tax qualification requirements. We will send you a copy of any such amendments. This contract is governed by the law of the state in which it is delivered. The values and benefits of this contract are at least equal to those required by such state. ------------------------------------------------------------------------------ ================================== Owner ================================== What are your rights as owner of this contract? As long as the annuitant is living and unless otherwise provided in this contract, you may exercise all rights and privileges in this contract or allowed by us. What are your rights as owner if you are a trust or custodial account? If you are a tax-qualified trust or tax-qualified custodial account, then your trustees or custodians (or their successors), properly named by your trust or custodial agreement, may exercise all rights and privileges provided in this contract or allowed by us. Can you change the ownership of this contract? 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 to any person other than as may be required or permitted under Sections 401, 403, 457, or other applicable sections of the Code. However, if you are the trustee of a tax-qualified trust or the custodian of a tax-qualified custodial account, you may transfer ownership of this contract to the annuitant or to a qualified successor trustee or custodian if permitted by the Code. Or, if you are a trust or custodian or an employer as part of a qualified plan under Section 401 or 403 or a deferred compensation plan under Section 457 of the Code, you may transfer ownership of this contract to the annuitant if permitted by the Code. Any permitted transfers must be on a form approved by us. The change must be made while the annuitant is living. Once the change is recorded by us, it will take effect subject to any action taken or payment made by us before the recording. ------------------------------------------------------------------------------- ================================== Beneficiary and Payments To Beneficiary ================================== What death benefits are paid if the annuitant or owner dies before settlement? If the annuitant or owner dies before settlement while this contract is in force, we will pay the beneficiary the accumulation value. The above amount will be payable in a lump sum upon receipt of due proof of death of the annuitant. The beneficiary may elect to receive payment any time within 5 years after the date of death of the annuitant. Instead of a lump sum, payment may be made under an annuity payment plan provided amounts are calculated in accordance with the Code, and:
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TSA. A Tax Tax-Sheltered Annuity as described in Section 403(b) of the Code. ------------------------------------------------------------------------------- 30370C =========================================================================== The Annuity Contract =========================================================================== What is the entire contract? This contract form is and the copy of the application attached to it are the entire contract between you and us. No one except one of our corporate officers (President, Vice President, Secretary, or Assistant Secretary) can change or waive any of our rights or requirements under the contract. That person must do so in writing. None of our agents or other persons has the authority to change or waive any of our rights or requirements under the contract. In issuing this contract, we have relied upon the application. The statements contained in the application are considered representations and not warranties. No statement made in connection with the application will be used by us to void the contract or to deny a claim unless that statement is part of the application. Can the contract be modified? We reserve the right to modify the contract to the extent necessary to qualify this contract, if purchased as part of a 401(a) qualified plan or a TSA, to the extent necessary to comply with Section 401, 403 or any other applicable section of the Code, or to comply with the provisions of your 401(a) qualified plan or TSA. We also reserve the right to modify the contract to the extent necessary to qualify the contract, if purchased as part of a qualified plan under Section 401 or 403 of the Code, or if purchased as part of a deferred compensation plan under Section 457 of the Code, to as part of such plan described in Sections 401, 403 or 457 of the extent necessary to comply with Section 457 Code or under any other applicable section of the Code, or to comply with the provisions of your deferred compensation plan. When will this contract become incontestable? This contract is incontestable from its date of issue. What if benefits are based on incorrect datathe annuitant's birthdate has been misstated? If the amount of benefits is determined by data as to a personannuitant's age that is incorrectbirthdate has been misstated, benefits payments under this contract will be recalculated based on the basis of what would have been provided at the correct databirthdate. Any underpayments made by us will be made up immediately. Any overpayments made by us will be subtracted from the future payments under this contract and/or as otherwise legally permissiblepayments. 30370C What federal and state laws govern this the contract? This contract is intended to qualify as an annuity contract for Federal income tax purposes. To that end, the provisions of this contract are to be interpreted to ensure or maintain such tax qualification, despite any other provisions to the contrary. We reserve the right to amend this contract to reflect any clarifications that may be needed or are appropriate to maintain such qualification or to conform this contract to any applicable changes in the tax qualification requirements. We will send you a copy of any such amendments. This The contract is governed by the law of the state in which it is delivered. The values and benefits of this contract are at least equal to those required by such state. ------------------------------------------------------------------------------ =========================================================================== Owner =========================================================================== What are your rights as owner of this contract? As long as the annuitant is living and unless otherwise provided in this contract, you may exercise all rights and privileges in this contract or allowed by us. What are your rights as owner if you are a trust or custodial account? If you are a tax-qualified trust or tax-qualified custodial account, then your trustees or custodians (or their successors), properly named by your trust or custodial agreement, may exercise all rights and privileges provided in this contract or allowed by us. Can you change the ownership of this contract? 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 to any person other than as may be required or permitted under the applicable Sections 401, 403, 457, or other applicable sections of the Code. However, if you are the trustee of a tax-qualified trust or the custodian of a tax-qualified custodial account, you may transfer ownership of this contract to the annuitant or to a qualified successor trustee or custodian if permitted by the Code. Or, if you are a trust or custodian or an employer as part of a qualified plan under Section 401 or 403 or a deferred compensation plan under Section 457 of the Code, you may transfer ownership of this contract to the annuitant if permitted by the Code. Any permitted transfers transfer must be on a form approved by us. The change must be made while the annuitant is living. Once the change is recorded by us, it will take effect subject to any action taken or payment made by us before the recording. ------------------------------------------------------------------------------- 30370C =========================================================================== Beneficiary and Payments To to Beneficiary =========================================================================== What death benefits are paid if the annuitant or owner dies before settlement? If the annuitant or owner dies before settlement while this contract is in force, we will pay the beneficiary the accumulation value. The accumulation value will be determined as of the date on which due proof of death is received at our home office. The above amount will be payable in a lump sum upon receipt of due proof of death of the annuitant. The beneficiary may elect to receive payment any time within 5 years after the date of death of the annuitant. Instead of a lump sum, payment may be made under an annuity payment plan provided amounts are calculated in accordance with the Code, and:
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