[LOGO]
THE HARTFORD
HARTFORD LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇
(a stock life insurance company, herein called "We", "Us", "Our")
This Contract is issued to the Contract Owner (herein called "You", "Your") by
Us on the Contract Issue Date, in consideration of receipt of the Premium
Payment by Us. We will provide You with the benefits described in this Contract.
This Contract is subject to the laws of the jurisdiction where it is delivered.
READ THIS CONTRACT CAREFULLY
THIS IS A LEGAL CONTRACT BETWEEN YOU AND US.
RIGHT TO EXAMINE CONTRACT: WE WANT YOU TO BE SATISFIED WITH THE CONTRACT YOU
HAVE PURCHASED. WE URGE YOU TO EXAMINE IT CLOSELY. IF FOR ANY REASON YOU ARE NOT
SATISFIED WITH THIS CONTRACT, YOU MAY CANCEL IT BY RETURNING IT WITHIN TEN (10)
DAYS AFTER YOU RECEIVE IT. IN SUCH AN EVENT, WE WILL PAY YOU AN AMOUNT EQUAL TO
THE CONTRACT VALUE ON THE DATE OF CANCELLATION, MULTIPLIED BY THE MARKET VALUE
ADJUSTMENT.
MARKET VALUE ADJUSTMENT FORMULA
THIS CONTRACT CONTAINS A MARKET VALUE ADJUSTMENT FORMULA. THE FORMULA MAY RESULT
IN EITHER UPWARD OR DOWNWARD ADJUSTMENTS THAT ARE APPLIED TO THE GROSS SURRENDER
VALUE MINUS THE SURRENDER CHARGE. DETAILS OF THE MARKET VALUE ADJUSTMENT ARE
DESCRIBED ON THE CONTRACT SPECIFICATIONS PAGE.
SEPARATE ACCOUNT
THE PREMIUM PAYMENT WILL BE DEPOSITED IN A NON-UNITIZED SEPARATE ACCOUNT. ALL
ASSETS OF HARTFORD LIFE INSURANCE COMPANY ARE AVAILABLE TO MEET THE GUARANTEES
UNDER THE CONTRACT AND ARE AVAILABLE TO MEET THE GENERAL OBLIGATIONS OF HARTFORD
LIFE INSURANCE COMPANY.
SIGNED FOR HARTFORD LIFE INSURANCE COMPANY BY:
[/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇ /s/ ▇▇▇▇ ▇. ▇▇▇▇▇▇▇
------------------------------------ ------------------------------------
▇▇▇▇▇▇ ▇. ▇▇▇▇, SECRETARY ▇▇▇▇ ▇. ▇▇▇▇▇▇▇, PRESIDENT]
NON-PARTICIPATING
INDIVIDUAL SINGLE PREMIUM
MODIFIED GUARANTEED ANNUITY CONTRACT
TABLE OF CONTENTS
PAGE
--------------------------------------------------------------------------------
Contract Specifications 3
Definitions 4
Premium Payment Provisions 6
Contract Control Provisions 6
General Provisions 6
Guarantee Periods and Interest Crediting Provisions 8
Surrender Provisions 9
Death Benefit Provisions 10
Annuity Provisions 13
Annuity Tables 15
2
CONTRACT SPECIFICATIONS
CONTRACT NUMBER [SAMPLE] CONTRACT ISSUE DATE [MARCH 1, 2010]
ANNUITANT [▇▇▇▇▇▇▇ ▇▇▇▇▇] SPECIFICATIONS DATE [MARCH 1, 2010]
ANNUITANT AGE [35] ANNUITY COMMENCEMENT DATE [OCTOBER 1, 2040]
ANNUITANT GENDER [MALE] PREMIUM PAYMENT [$10,000]
CONTRACT OWNER [▇▇▇▇▇▇▇ ▇▇▇▇▇] GUARANTEE PERIOD [5 YEARS]
CONTINGENT ANNUITANT GUARANTEE RATE [7%]
BENEFICIARY [▇▇▇▇▇ ▇▇▇▇▇] MINIMUM INTEREST RATE [1%]
DEFAULT GUARANTEE PERIOD [1YEAR]
RELEVANT INDEX [HMGAa]
SURRENDER CHARGE: This charge is determined by multiplying the applicable rate
specified below by the amount of the Full or Partial Surrender that exceeds the
Annual Free Withdrawal Amount. This charge does not apply to:
- [Transfers from the current Guarantee Period into a new Guarantee
Period or into the Default Guarantee Period made at the end of the
then current Guarantee Period.
- Surrenders during the 30 day period at the beginning of a subsequent
Guarantee Period; or
- Annuitization; or
- The Death Benefit; or
- The Default Guarantee Period.]
This charge varies according to initial and subsequent Guarantee Periods and
equals:
INITIAL GUARANTEE PERIOD EACH SUBSEQUENT GUARANTEE PERIOD
YEAR CHARGE YEAR CHARGE
------------------------------------------------------------------
[1 6% [1 4%
2 6% 2 3%
3 5% 3 2%
4 4% 4 2%
5 3% 5 2%
6 - 10 2%] 6 - 10 2%]
[ANNUAL FREE WITHDRAWAL AMOUNT: The portion of Your Gross Surrender Value which
is not subject to the Surrender Charge and Market Value Adjustment. It equals
any interest credited during the 12 months prior to the Surrender Date that was
not previously withdrawn.]
3
CONTRACT SPECIFICATIONS
MINIMUM AMOUNT: Partial surrenders may only be made if the remaining Contract
Value after the Gross Surrender Value is deducted is at least the Minimum Amount
of [$500] If the partial surrender would reduce the Contract Value to below the
Minimum Amount, Your Contract will be deemed to have been fully surrendered.
ANNUITY PARAMETERS: The Minimum Annuity Payment allowed is: [$100.] The Annuity
Commencement Date will not be deferred beyond the end of the Guarantee Period
immediately following the later of:
a) the Annuitant's [90th] birthday; or
b) the [10th] Contract Year;
unless the Contract Owner elects a later ▇▇▇▇▇▇▇ Commencement Date In Writing,
subject to laws and regulations then in effect and Our approval.
3A
CONTRACT SPECIFICATIONS
MARKET VALUE ADJUSTMENT: The Market Value Adjustment formula which will be used
by Us to determine the Market Value Adjustment is calculated as follows:
[1+I / 1+J] TO THE POWER OF N/12 where:
I = The Relevant Index rate as of three business days prior to the
Guarantee Period effective date (expressed as a decimal, e.g., 1% =
.01), with maturity years equal to the length of the then current
Guarantee Period (This will be interpolated as necessary); and,
J = The Relevant Index rate as of three business days prior to the
date the market value adjustment is applied (expressed as a decimal,
e.g., 1% = .01), with maturity years equal to the remainder of the
then current Guarantee Period (this will be interpolated when
necessary); and
N = the number of months from the Surrender Date to the end of the
then current Guarantee Period.
For new Guarantee Periods, We may prospectively change the Relevant
Index from time to time; provided, however, the Relevant Index
established at initiation of a Guarantee Period will remain in effect
until maturity of such Guarantee Period.
During a Guarantee Period, if any Relevant Index is no longer
available or the calculation of such index has substantially changed,
We will use a substantially similar index for determining the Market
Value Adjustment. We will notify You of any changes in the
availability of the Relevant Index and the applicable substitute We
will use. Any such change shall be subject to any applicable
regulatory approval that may be required.
ADMINISTRATIVE OFFICE OF THE COMPANY: [Currently located at ▇ ▇▇▇▇▇▇▇ ▇▇▇▇,
▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇. All correspondence concerning this Contract should be
sent to Our mailing address:
Hartford Life Insurance Company, P.O. Box 5085,
Hartford, CT 06102-5085.]
3B
DEFINITIONS
ADMINISTRATIVE OFFICE OF THE COMPANY. Our administrative office is shown on the
Contract Specifications page.
ANNUITANT. The person on whose life this Contract is issued. Also see Contingent
Annuitant and Joint Annuitant.
ANNUITY COMMENCEMENT DATE. It is the date when Annuity payments are scheduled to
begin as described under ▇▇▇▇▇▇▇ Provisions in this Contract.
BENEFICIARY. The person(s) entitled to receive benefits pursuant to the terms of
the Contract in case of the death of the Annuitant, or a Contract Owner(s), as
applicable.
BUSINESS DAY. Any day that We, and for so long as the New York Stock Exchange,
are open for business.
CONTINGENT ANNUITANT. The person You designate who, upon the Annuitant's death
prior to the Annuity Commencement Date, may become the Annuitant.
CONTRACT ANNIVERSARY. The anniversary of the Contract Issue Date. If the
Contract Anniversary falls on a non-Business Day, then the Contract Anniversary
will be the preceding Business Day.
CONTRACT ISSUE DATE. The date Your Contract becomes effective and is shown on
The Contract Specifications page. Contract Years are measured from the Contract
Issue Date.
CONTRACT OWNER(S). The owner(s) or holder(s) of the Contract.
CONTRACT VALUE. The Contract Value on the Contract Issue Date is equal to the
Premium Payment deposited into the Contract less any applicable Premium Taxes.
Thereafter, it is the Premium Payment increased by interest credited, reduced by
any prior surrenders (including applicable Surrender Charges and Premium Taxes)
and adjusted by any Market Value Adjustments previously applied.
CONTRACT YEAR. Any 12-month period between Contract Anniversaries, beginning on
the Contract Issue Date.
DEATH BENEFIT. The amount We will pay upon the death of the Contract Owner(s) or
Annuitant, as applicable.
DEFAULT GUARANTEE PERIOD. The duration that is automatically established by Us
as a default in the event that You do not elect a renewal Guarantee Period upon
the expiration of a Guarantee Period. The maximum Default Guarantee Period is
shown on the Contract Specifications page. The interest rate that We credit for
this duration will not be less than the Minimum Interest Rate.
DUE PROOF OF DEATH. A certified death certificate, an order of a court of
competent jurisdiction, or any other proof acceptable to Us.
GROSS SURRENDER VALUE. The surrender amount requested by You prior to the
deduction of Surrender Charges, Premium Taxes, and the Market Value Adjustment,
as applicable.
GUARANTEE PERIOD. The period offered by Us and elected by You for which either
an initial or renewal interest rate will be credited. The initial Guarantee
Period is shown on the Contract Specifications page and will be amended on each
Specifications Date. A Guarantee Period does not include a Default Guarantee
Period.
IN WRITING. A written form or other method satisfactory to Us and received at
Our Administrative Office as defined.
INTERNAL REVENUE CODE. The Internal Revenue Code of 1986, as amended.
JOINT ANNUITANT. Upon annuitization, a person other than the Annuitant on whose
life, Annuity payments may be made. The Contract will have a Joint Annuitant
only if the Annuity Option selected provides for a survivor.
4
MARKET VALUE ADJUSTMENT. A positive or negative adjustment applied in the
determination of your Gross Surrender Value after the Annual Free Withdrawal
Amount is taken into consideration, if applicable, and after Surrender Charges
are deducted, if applicable. The Market Value Adjustment is calculated by Us and
is shown on the Contract Specifications Page.
NET SURRENDER VALUE. The Gross Surrender Value after the deduction of Surrender
Charges, Premium Taxes, and the Market Value Adjustment, as applicable.
PAYEE. The person, designated by You, to whom Annuity payments will be made.
PREMIUM PAYMENT. 100% of the dollar amount of the money sent to Us to be
invested in Your contract.
PREMIUM TAX. A tax imposed on Us by certain jurisdictions when a Premium Payment
is made or when Annuity Payments are made.
RELEVANT INDEX - The index available as of the beginning of each Guarantee
Period which is a component used to determine the Market Value Adjustment. The
Relevant Index will be determined on the Contract Issue Date and each subsequent
Specifications Date. The Relevant Index is shown on the Contract Specifications
page 3.
SPECIFICATIONS DATE - The effective date of the Contract Specifications page.
The initial Specifications Date is the Contract Issue Date. A new Specifications
Date will be established coinciding with the initiation of each new Guarantee
Period. The Contract Specifications page bearing the latest date supersedes all
prior Contract Specifications pages.
SURRENDER CHARGE. A Surrender Charge may be deducted for a full or partial
surrender. The Surrender Charge schedule is shown on the Contract Specifications
page.
SURRENDER DATE. The date We receive Your request In Writing for a surrender or
the date You request for surrender, if later.
WE, US, OUR. The company referred to on the first page of this Contract.
YOU, YOUR. The Contract Owner(s).
5
PREMIUM PAYMENT PROVISIONS
PREMIUM PAYMENT. The Premium Payment is shown on The Contract Specifications
page. The Premium Payment is payable at Our designated office(s). A Premium
Payment of $1,000,000 or more will be subject to Our prior approval In Writing.
The Premium Payment (less applicable Premium Taxes, if any) will be credited to
the Contract on the Contract Issue Date.
CONTRACT CONTROL PROVISIONS
ANNUITANT, CONTINGENT ANNUITANT, JOINT ANNUITANT, AND CONTRACT OWNER(S).
The Annuitant may not be changed.
The designations of Contract Owner, Joint Annuitant, and Contingent Annuitant
will remain in effect until You change them. The designation of the Contract
Owner may be changed In Writing during the lifetime of the Annuitant. The
designation of Contingent Annuitant may be changed In Writing at any time during
the lifetime of the Annuitant and prior to the Annuity Commencement Date.
If no Contingent Annuitant has been named, the Contract Owner is the Annuitant,
and the Contract Owner/▇▇▇▇▇▇▇▇▇'s spouse is the Beneficiary, the Contract
Owner/ Annuitant's spouse will be presumed to be the Contingent Annuitant.
In any other situation, if no Contingent Annuitant has been named, the youngest
Contract Owner will be presumed to be the Contingent Annuitant, providing that
the youngest Contract Owner is not the Annuitant. The Contract Owner may waive
this presumption In Writing.
OWNERSHIP. You have the sole power to exercise all rights, options and
privileges granted by this Contract or permitted by Us and to agree with Us to
any change in or amendment to the Contract. Your rights will be subject to the
rights of any assignee of record with Us and of any irrevocably designated
Beneficiary. In the case of joint Contract Owners, each Contract Owner alone may
exercise all rights, options and privileges, except with respect to a full
surrender, partial surrender, selection of an Annuity Option, and/or change of
Ownership or Beneficiary.
BENEFICIARY.The designated Beneficiary will remain in effect until You change
it. The designated Beneficiary may be changed In Writing during the lifetime of
the Annuitant. If the designated Beneficiary has been designated as an
irrevocable Beneficiary, the designation cannot be changed or revoked without
such Beneficiary's written consent. Upon receipt of written notice and Our
consent, if required by Us, the new designation will take effect as of the date
the notice is processed by Us, whether or not the Annuitant or Contract Owner is
alive at the time of receipt. Any payments made or other action taken by Us
before the receipt of the notice will not be subject to the requested change.
GENERAL PROVISIONS
CONTRACT. This Contract and any amendments, endorsements or riders, constitute
the entire Contract.
CONTRACT MODIFICATION. No modification of this Contract will be made without the
signature of Our President, an Executive Vice President, Senior Vice President,
Vice President or Assistant Vice President. No modification will affect the
amount or term(s) of any Annuity Payment begun prior to the modification, unless
it is required to conform the Contract to any federal or state statute. No
modification will affect the method by which Your Contract Value will be
determined.
INCONTESTABILITY. We cannot contest this Contract.
MINIMUM VALUE STATEMENT. Any values available under the Surrender Provisions of
this Contract equal or exceed those required by the state in which the Contract
is issued.
6
MISSTATEMENT OF AGE AND GENDER. Prior to the Annuity Commencement Date, if the
age of the Annuitant has been misstated, the Annuity Commencement Date may
change. Once Annuity payments begin, if the age and/or gender of the Annuitant
have been misstated, the amount of the Annuity payable by Us will be adjusted
based on the correct information. Any underpayments by Us will be made up
immediately and any overpayments will be charged against future amounts becoming
payable. In states which require the crediting of interest in the event of an
underpayment, or the deduction of interest in the event of overpayment, we will
apply an annual effective rate of the greater of 1% or the statutory required
minimum interest rate.
NON-PARTICIPATING. This Contract is nonparticipating. It does not earn
dividends.
REPORTS. You will receive a report once each Contract Year showing the Contract
Value of this Contract and any other information required by the state in which
this Contract was issued.
TAX QUALIFICATION. 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 and maintain such tax qualification,
notwithstanding any other provisions to the contrary. We reserve the right to
amend this Contract to conform to any changes in the tax qualification
requirements under the applicable provision of the Internal Revenue Code.
7
GUARANTEE PERIOD AND INTEREST CREDITING PROVISIONS
GUARANTEE PERIODS. The Company may offer one or more renewal Guarantee Periods
from time to time. We reserve the right to offer new Guarantee Periods or limit
the Guarantee Periods that are offered in the future, or offer certain Guarantee
Periods to certain classes of investors. The duration of a Guarantee Period may
not extend beyond the maximum Annuity Commencement Date as described under the
Annuity Provisions of this Contract.
GUARANTEE PERIOD EXPIRATION, RENEWAL AND DURATION EXCHANGE. Upon expiration
of any Guarantee Period, unless You have elected In Writing to: 1.) renew
into another permissible Guarantee Period duration that We make available
to You at that time that would not extend beyond the maximum Annuity
Commencement Date; or 2.) annuitize Your Contract; or 3.) surrender Your
Contract; or 4.) elect other options made available by Us, the Default
Guarantee Period will automatically commence.
If You have elected to renew into a new Guarantee Period at the expiration
of a previously elected Guarantee Period, during the first 30 days of such
new Guarantee Period, You may elect a duration exchange into a Guarantee
Period of a different permissible duration or into the Default Guarantee
Period without incurring a Surrender Charge or Market Value Adjustment. If
You renew into a new Guarantee Period from the Default Guarantee Period,
such 30 day period does not apply.
You may also elect a duration exchange into a Guarantee Period of a
different permissible duration while Contract Value is held during the
Default Guarantee Period without incurring a Surrender Charge or Market
Value Adjustment. However, You may not renew or transfer the Contract into
any Guarantee Period of a duration that extends beyond the Annuity
Commencement Date as described under the Annuity Provisions of this
Contract.
The Contract Value at the beginning of the new Guarantee Period will equal
the Contract Value at the time of transfer.
Surrender Charges applicable to each subsequent Guarantee Period (excluding the
Default Guarantee Period) are measured from the beginning of each subsequent
Guarantee Period and are shown on the Contract Specifications page as of each
Specifications Date.
CREDITING OF INTEREST. The Premium Payment (less the Gross Surrender Value of
all surrenders previously made), or Contract Value, as applicable, will earn
interest daily at the effective annual Guarantee Rate during the relevant
Guarantee Period. This rate will never be less than the Minimum Interest Rate.
The Guarantee Rate is set by Us for the applicable Guarantee Period on the
effective date of each Guarantee Period. The initial Guarantee Rate that We will
credit is shown on the Contract Specifications page and will be amended for each
succeeding Guarantee Period as of each Specifications Date.
The Contract Value held during the Default Guarantee Period will earn interest
daily at an effective annual rate that will never be less than the Minimum
Interest Rate.
8
MINIMUM INTEREST RATE. The guaranteed Minimum Interest Rate that will be applied
during a Guarantee Period is determined at the beginning of each Guarantee
Period inclusive of the Default Guarantee Period. The Minimum Interest Rate
equals the greater of 1% and an interest rate calculated as follows:
The interest rate will be such that the Contract Value prior to the
application of the Market Value Adjustment will never be less than 87.5% of
the Contract Value at the beginning of the then effective Guarantee Period,
adjusted for prior withdrawals, accumulated at the non-forfeiture interest
rate required by the Standard Non-forfeiture Law for individual fixed
deferred annuities.
The nonforfeiture interest rate will be the lesser of three percent or a
rate equal to the average five-year Constant Maturity Treasury Rate
reported by the Federal Reserve for the calendar month two months prior to
the date guaranteed rates updates are made publicly available rounded to
the nearest one-twentieth of one per cent reduced by one hundred
twenty-five basis points; where the resulting interest rate is not less
than one per cent. Guaranteed rates are updated and made publicly available
at least once a month. The nonforfeiture rate will be updated at the
beginning of every guarantee period. It will not change during a Guarantee
Period.
The Minimum Interest Rate will be recalculated at the beginning of every
Guarantee Period and every Default Guarantee Period.
We may credit additional interest at Our sole discretion.
SURRENDER PROVISIONS
SURRENDERS. A full or partial surrender under this Contract may be elected by
You In Writing at any time, subject to any applicable Surrender Charge or Market
Value Adjustment. A request for a surrender at the end of a Guarantee Period
must be received, In Writing, no later than the last Business Day of a Guarantee
Period.
In the event of a full or partial surrender made during a Guarantee Period, no
Surrender Charge or Market Value Adjustment will be imposed on the Annual Free
Withdrawal Amount. A full or partial surrender made on the last Business Day of
a Guarantee Period or at any time during the Default Guarantee Period is not
subject to a Surrender Charge or Market Value Adjustment.
Partial surrenders may only be made if:
a) the Gross Surrender Value surrendered is at least $1,000; and
b) the remaining Contract Value after the Gross Surrender Value has been
deducted is at least equal to the Minimum Amount shown on the
Contract Specifications page.
In the case of any surrender, the Net Surrender Value will be payable to You. In
the event of surrenders in excess of the Annual Free Withdrawal Amount, the Net
Surrender Value is determined by Us as follows:
Assume:
A = the amount you request for a Surrender;
B = Annual Free Withdrawal Amount;
C = the Surrender Charge, plus any unpaid Premium Taxes. The
Surrender Charge equals (A-B) x the applicable Surrender Charge
percentage as shown on the Contract Specifications page.
D = the Market Value Adjustment as calculated by Us, shown on the
Contract Specifications page.
The Net Surrender Value equals (A-C) x D.
9
PAYMENT UPON SURRENDER - DEFERRAL OF PAYMENT. We may defer payment of any
amounts from the Contract for up to six months from the date of the request to
surrender, subject to obtaining any required approval by the Insurance
Commissioner of the state in which this Contract is issued. If We defer payment
for more than 30 days, We will pay interest per annum of at least the statutory
required minimum interest rate then in effect on the amount deferred.
DEATH BENEFIT PROVISIONS
BENEFICIARY DISPOSITION IN THE EVENT OF DEATH BEFORE THE ANNUITY COMMENCEMENT
DATE.
If the Contract Owner dies, and the Annuitant is living, and
a) the joint Contract Owner is living, then the joint Contract Owner
will become the Beneficiary. In this case, the rights of such
designated Beneficiary are voided and the Death Benefit is paid to
the joint Contract Owner.
b) there is no surviving joint Contract Owner, then the designated
Beneficiary will remain the Beneficiary and receives the Death
Benefit.
c) there is no surviving joint Contract Owner, and there is no
Beneficiary designation in effect, or the designated Beneficiary has
predeceased the Contract Owner, then the Contract Owner's estate
shall be the Beneficiary and receives the Death Benefit.
If the Annuitant dies, and
a) the Annuitant is also the sole Contract Owner and there is no named
Contingent Annuitant, the designated Beneficiary will remain the
Beneficiary and receives the Death Benefit.
b) the Contract Owner is a trust or other non-natural person, there may
be no named Contingent Annuitant, the Contract Owner becomes the
Beneficiary and receives the Death Benefit.
c) the Contract Owner is living and there is no Contingent Annuitant or
the Contingent Annuitant is not living, the Contract Owner will be
presumed to be the Contingent Annuitant and the Contract continues.
The Contract Owner may waive this presumption and receive the Death
Benefit. The rights of the designated Beneficiary are automatically
voided.
d) the Contract Owner is living and the Contingent Annuitant is living,
the Contingent Annuitant is designated as the Annuitant and the
Contract continues.
BENEFICIARY DISPOSITION IN THE EVENT OF DEATH ON OR AFTER THE ANNUITY
COMMENCEMENT DATE.
a) If the Contract Owner dies and the joint Contract Owner and Annuitant
are both living, the surviving joint Contract Owner will become the
Contract Owner and the payments will continue as scheduled.
b) If the Contract Owner dies and the joint Contract Owner and all
Annuitants are living, the surviving joint Contract Owner will become
the Beneficiary and receives the Death Benefit.
c) If the Contract Owner dies and there is no surviving Contract Owner
and any Annuitant is living, the designated Beneficiary(ies) becomes
the Contract Owner(s) and payments continue as scheduled.
10
d) If the Contract Owner dies and there is no surviving Contract Owner
or Annuitant, the designated Beneficiary(ies) receive the Death
Benefit.
e) If the Annuitant dies and the surviving Contract Owner and Annuitant
are both living, payments continue to the surviving Contract
Owner(s).
f) If the Annuitant dies and there is a surviving Contract Owner but
all Annuitants are deceased, the surviving Contract Owner(s) receive
the Death Benefit.
g) If the Annuitant dies and there is no surviving Contract Owner and
the Annuitant is living, the designated Beneficiary(ies) becomes the
Contract Owner(s) and payments continue to the surviving Contract
Owner(s).
h) If the Annuitant dies and there is no surviving Contract Owner and
all Annuitants are deceased, the designated Beneficiary(ies) become
the Contract Owner(s) and payments continue to the surviving Contract
Owner(s).
DEATH BENEFIT. The Death Benefit will be calculated as of the date We receive
notification, In Writing, of Due Proof of Death at the Administrative Office of
the Company. If death occurs before the Annuity Commencement Date, the Death
Benefit equals the Contract Value. There is no Surrender Charge or Market Value
Adjustment applied to a single lump sum Death Benefit. However, depending on the
settlement option elected, a Market Value Adjustment may be applied to any
partial surrender(s). If death occurs on or after the Annuity Commencement Date,
any remaining interest in the Contract will be paid at least as rapidly as under
the method of distribution in effect at the time of death.
SETTLEMENT OF THE DEATH BENEFIT. The Death Benefit may be taken in a single lump
sum or under any of the settlement options then being offered by Us subject,
however, to the distribution requirements below. The Beneficiary may elect any
available settlement option, unless the Contract Owner has designated the
settlement option for that Beneficiary. The available settlement options include
any of the annuity options under this Contract or any other options then being
offered or approved by Us. If payment is taken in a single lump sum, an
interest-bearing draft account ("Safe Haven Account") will be offered and if
elected, maintained until the entire balance is withdrawn. The Safe Haven
Account is part of Our General Account assets. The minimum draft writing amount
and remaining balance must be at least equal to the minimum amounts according to
Our rules then in effect. If the remaining balance falls below Our minimum
amount rules, the Safe Haven Account will terminate and We will pay the
remaining balance in a single lump sum.
As of the date of receipt of complete disbursement instructions from the
Beneficiary, the amount to be paid or applied to a selected settlement option
will be computed. When there is more than one Beneficiary, the amount will be
calculated for each Beneficiary's share of the proceeds and paid or applied to a
selected settlement option according to and upon receipt of each Beneficiary's
instructions. If the date of receipt of complete instructions falls on a
non-Business Day, the amount will be computed on the next Business Day.
When payment is taken in a single lump sum, payment will be made within 7
Business Days of Our receipt of complete instructions.
11
DISTRIBUTION REQUIREMENTS. Subject to the Alternative Election or Spouse
Beneficiary provisions below:
a) If any Contract Owner dies before the Annuity Commencement Date, the
entire interest in the Contract will be distributed within five years
after such death; and
b) If any Contract Owner dies on or after the Annuity Commencement Date
and before the entire interest in the Contract has been distributed,
the remaining portion of such interest will be distributed at least
as rapidly as under the method of distribution being used as of the
date of such death.
If the Contract Owner is not an individual, then for purposes of the preceding
paragraph a) or b), the primary Annuitant will be treated as the Contract Owner.
If the Contract Owner is not an individual, then for purposes of the preceding
paragraph a) or b), a change of Annuitant is treated as the death of the
Contract Owner.
During the five year period described above, the amounts otherwise payable as a
Death Benefit will remain in the same Guarantee Period and continue to earn the
same interest rate as at the time of death. If the Guarantee Period ends before
the end of the five year period, the Beneficiary may elect a new Guarantee
Period with a duration closest to, but not to exceed the time remaining in the
period of five years from the date of the Contract Owner's or Annuitant's death.
If a new Guarantee Period is not elected, the Default Guarantee Period will
automatically commence. Full or partial surrenders may be made at any time. In
the event of any surrender, the remaining value will equal the Death Benefit
left with Us, minus any Gross Surrender Values, plus any interest earned. Any
partial surrender(s) made during this five year period will [not] be subject to
a Surrender Charge, however, a Market Value Adjustment [will apply]. No Market
Value Adjustment will be applied to any remaining amount distributed on the last
Business Day of the five year period.
ALTERNATIVE ELECTION TO SATISFY DISTRIBUTION REQUIREMENTS. If any portion of the
interest of a Contract Owner described above is payable to or for the benefit of
a designated Beneficiary, and the Beneficiary elects after the Contract Owner's
death to have the benefit distributed over a period that:
a) does not extend beyond the later of such Beneficiary's life or life
expectancy; and
b) does commence within one year of the date of death;
then for purposes of satisfying the distribution requirements above, the benefit
will be treated as distributed entirely on the date such periodic distributions
begin. During the selected distribution period the amounts otherwise payable as
a Death Benefit will remain in the same Guarantee Period and continue to earn
the same interest rate as at the time of death. If the Guarantee Period ends
before the end of the applicable period, the Beneficiary may elect a new
Guarantee Period with a duration closest to, but not to exceed the time
remaining in the applicable period. If a new Guarantee Period is not elected the
Default Guarantee Period will automatically commence. Full or partial surrenders
may be made at any time. In the event of any surrender, the remaining value will
equal the Death Benefit left with Us, minus any Gross Surrender Values, plus any
interest earned. Any partial surrender(s) made during the applicable period will
not be subject to a Surrender Charge, however, a Market Value Adjustment will
apply. No Market Value Adjustment will be applied to any remaining amount
distributed on the last Business Day of the applicable period.
SPOUSE BENEFICIARY. In the event of the death of a Contract Owner and there is
no joint Contract Owner and the sole Beneficiary is the Contract Owner's spouse
and the Annuitant (Contingent Annuitant, if applicable) is alive, this Contract
will continue with the spouse as the Contract Owner, unless the spouse elects to
be paid a death benefit option. This provision will apply only once with respect
to this Contract. Spousal continuation is only available if the spouse is listed
as 100% Beneficiary.
12
ANNUITY PROVISIONS
ANNUITY COMMENCEMENT DATE. The Annuity Commencement Date is shown on The
Contract Specifications page. You may change the date by notifying Us prior to
the Annuity Commencement Date, subject to the parameters as shown on the
Contract Specifications page and Our approval.
ANNUITY PAYMENT. If the Annuity Commencement Date does not coincide with the end
of a Guarantee Period, We will apply Your Contract Value, less any applicable
Premium Taxes, multiplied by the Market Value Adjustment, if any, to purchase
the modal income payments according to the Annuity Option elected. If the
Annuity Commencement Date coincides with the end of any Guarantee Period or is
elected during the Default Guarantee Period, no Market Value Adjustment will be
applied in the determination of the monthly income payments. No Surrender Charge
will be applied upon annuitization at any time.
ELECTION OF ANNUITY OPTION. You may elect any one of the Annuity Options
described below or any other Annuity Option We offer at the time of
annuitization. In the absence of such election, the Life Annuity with 10 Years
Period Certain will apply. The Annuity Option elected by You may not be changed
on or after the Annuity Commencement Date. Election of any of these options must
be made, In Writing, to Us prior to the Annuity Commencement Date.
Some of the options may not be available if this Contract is issued to qualify
under Section 401, 403, or 408 of the Internal Revenue Code of 1986 as amended.
Life Annuity with Payments for a Period Certain, Joint and Last Survivor Life
Annuity with Payments for a Period Certain, and Payment for a Period Certain, or
any other option with a period certain segment will be available only if the
guaranteed payment period is less than the life expectancy of the Annuitant at
the time the option becomes effective. Such life expectancy will be computed
under the mortality table then in use by Us.
ELECTION OF ANNUITY PAYMENT FREQUENCY. You may elect the Annuity payment
frequency. Available Annuity payment frequencies include: monthly, quarterly,
semi-annual, and annual. In the event that You do not elect a payment frequency,
Annuity payments will be made monthly. Annuity payments will be made according
to the Annuity payment frequency selected. You may elect to change the Annuity
payment frequency of Your payments within 30 days prior to the scheduled Annuity
Commencement Date.
DATE OF PAYMENT. The first Annuity Payment is payable on the Annuity
Commencement Date. The remaining Annuity payments are computed and payable as of
the same day of the month, or the preceding Business Day, if applicable, as the
Annuity Commencement Date, based on the elected Annuity payment frequency.
MINIMUM ANNUITY PAYMENT. The first Annuity Payment must be at least equal to the
Minimum Annuity Payment amount shown in the Annuity Parameters on the Contract
Specifications page. If at any time, payments become less than the minimum
payment amount, We have the right to change the payment frequency to meet the
minimum payment requirements. If any payment amount is less than the minimum
annual payment amount, We may make an alternative arrangement with You.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE. This Contract may not be
surrendered after the commencement of Annuity payments.
PROOF OF SURVIVAL. The payment of any Annuity benefit will be subject to
evidence that the Annuitant is alive on the date such payment is otherwise due,
as approved by Us.
DEATH OF ANNUITANT. In the event of the death of the Annuitant while receiving
Annuity payments, the Beneficiary will continue to receive the remaining
guaranteed payments as scheduled. Alternatively, the Beneficiary may elect to
receive a lump sum payment of the Death Benefit equal to the present value of
any remaining guaranteed payments.
13
ANNUITY OPTIONS
LIFE ANNUITY - An Annuity payable during the lifetime of the Annuitant, ceasing
with the last payment due prior to the death of the Annuitant.
LIFE ANNUITY WITH A CASH REFUND - An Annuity payable during the lifetime of the
Annuitant. At the death of the Annuitant, any remaining value will be paid to
the Beneficiary in a single lump sum. The remaining value equals the Contract
Value applied on the Annuity Commencement Date, minus the dollar amount of
Annuity payments already paid and Premium Taxes.
LIFE ANNUITY WITH PAYMENTS FOR A PERIOD CERTAIN (5 years to 100 years minus
▇▇▇▇▇▇▇▇▇'s age) - An Annuity payable for a fixed number of years and during the
lifetime of the Annuitant. If, at the death of the Annuitant, payments have been
made for less than the period selected, the remaining payments will be made to
the Beneficiary or the Beneficiary can elect to receive the present value of the
remaining payments in a single lump sum. To calculate the present value We will
use an interest rate We determine in Our discretion.
JOINT AND LAST SURVIVOR LIFE ANNUITY - An Annuity payable during the joint
lifetime of the Annuitant and a Joint Annuitant, and thereafter during the
remaining lifetime of the survivor Annuitant. At the time of electing this
option, the Contract Owner may elect reduced payments over the remaining
lifetime of the survivor Annuitant. Payments will cease with the last payment
prior to the death of the survivor.
JOINT AND LAST SURVIVOR LIFE ANNUITY WITH PAYMENTS FOR A PERIOD CERTAIN (5 years
to 100 years-age) - An Annuity payable for a fixed number of years and during
the lifetimes of the Annuitant and the Joint Annuitant and thereafter during the
remaining lifetime of the survivor. At the time of electing this Annuity Option,
the Contract Owner may elect reduced payments over the remaining lifetime of the
survivor. If, at the death of the last surviving Annuitant, payments have been
made for less than the period selected, the remaining payments will be made to
the Beneficiary, or the Beneficiary can elect to receive the present value of
the remaining payments in a single lump sum. To calculate the present value We
will use an interest rate We determine in Our discretion.
PAYMENTS FOR A PERIOD CERTAIN (5 years to 100 years minus Annuitant's age) - An
Annuity payable for a fixed number of years with period of 10 years or greater
available at any time and periods of 5 to 10 years available on or after the
second Contract Year. Payments will be made for the period and frequency
selected. If, at the death of the Annuitant, payments have been made for less
than the period selected, the remaining payments will be made to the Beneficiary
or the Beneficiary can elect to receive the present value of the remaining
payments in a single lump sum. To calculate the present value We will use an
interest rate We determine in Our discretion.
14
ANNUITY TABLES
DESCRIPTION OF TABLES. The attached Annuity Tables show the minimum dollar
amount of the monthly payments for each $1,000 applied under each of the Annuity
Options. Under the Life Annuity, Life Annuity with a Cash Refund, or Life
Annuity with Payments for a Period Certain options, the amount of each payment
will depend upon the age and gender of the Annuitant at the time the first
payment is due. Under the Joint and Last Survivor Annuity and Joint and Last
Survivor Annuity with Payments for a Period Certain options, the amount of each
payment will depend upon the gender of both Annuitants and their ages at the
time the first payment is due. Gender will not be used to determine the amount
of the Annuity payable if this Contract is issued to qualify under certain
sections of the Internal Revenue Code. If gender is used to determine the amount
of Annuity payable, the Annuity Tables at the end of this Contract will provide
rates of payment for male Annuitants and female Annuitants.
The tables for all of the Annuity Options, excluding the Payments for a Period
Certain option, are based on the [Annuity2000 Mortality Table projected forward
using Projection Scale AA], an annuitization year of 2010, and an interest rate
of [1.5%]. The table for the Payments for a Period Certain option is based on an
interest rate of [1.5%] per annum.
The Annuity tables for all of the Annuity Options, excluding the Payments for a
Period Certain option are age dependent. The amount of the first payment will be
based on an age that is a specified number of years younger than the Annuitant's
then-attained age. The revised age is as follows:
DATE OF FIRST PAYMENT REVISED AGE
---------------------------------------------------
[Prior to 2025 2 years
2025 - 2029 3 years
2030 - 2039 4 years
2040 - 2049 5 years
2050 or later 6 years]
15
ANNUITY TABLES FOR FIXED PAYMENTS
BASED ON [1.5%] INTEREST RATE
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed Dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity payment frequency, period
certain, age, or combination of ages not shown will be quoted upon request. The
tables shown below are age dependant and are prior to the application of an age
revision based on the year of annuitization.
LIFE ANNUITY, LIFE ANNUITY WITH A CASH REFUND, AND LIFE ANNUITY WITH PAYMENTS
FOR A PERIOD CERTAIN - SINGLE LIFE ANNUITIES
MALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED
AGE CASH REFUND NONE 120 180 240
----------------------------------------------------------------------------
[35 $2.31 $2.33 $2.33 $2.33 $2.32
40 2.44 2.51 2.51 2.50 2.49
45 2.61 2.74 2.73 2.72 2.70
50 2.83 3.02 3.01 2.99 2.95
51 2.88 3.09 3.07 3.05 3.01
52 2.93 3.16 3.14 3.11 3.07
53 2.99 3.23 3.21 3.18 3.13
54 3.05 3.30 3.28 3.25 3.19
55 3.10 3.39 3.36 3.32 3.26
56 3.17 3.47 3.44 3.40 3.33
57 3.23 3.56 3.53 3.47 3.40
58 3.30 3.66 3.62 3.56 3.47
59 3.37 3.76 3.71 3.64 3.54
60 3.44 3.87 3.81 3.74 3.62
61 3.52 3.98 3.92 3.83 3.69
62 3.60 4.11 4.03 3.93 3.77
63 3.68 4.24 4.15 4.03 3.85
64 3.77 4.38 4.28 4.14 3.92
65 3.86 4.53 4.41 4.24 4.00
66 3.95 4.69 4.55 4.36 4.08
67 4.05 4.86 4.69 4.47 4.15
68 4.16 5.04 4.84 4.58 4.22
69 4.27 5.24 5.00 4.70 4.29
70 4.38 5.45 5.17 4.82 4.36
75 5.05 6.75 6.09 5.37 4.62
80 5.89 8.61 7.07 5.81 4.75
FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED
AGE CASH REFUND NONE 120 180 240
------ --------------------------------------------------------------------
[35 $2.28 $2.29 $2.28 $2.28 $2.28
40 2.40 2.45 2.45 2.44 2.44
45 2.56 2.65 2.65 2.64 2.63
50 2.76 2.90 2.90 2.88 2.86
51 2.81 2.96 2.95 2.94 2.91
52 2.86 3.02 3.01 3.00 2.97
53 2.91 3.09 3.08 3.06 3.02
54 2.96 3.16 3.14 3.12 3.08
55 3.02 3.23 3.21 3.18 3.14
56 3.08 3.30 3.28 3.25 3.21
57 3.14 3.38 3.36 3.33 3.27
58 3.20 3.47 3.44 3.40 3.34
59 3.26 3.55 3.52 3.48 3.41
60 3.33 3.65 3.61 3.56 3.48
61 3.40 3.75 3.71 3.65 3.56
62 3.48 3.85 3.81 3.74 3.63
63 3.56 3.97 3.91 3.84 3.71
64 3.64 4.09 4.03 3.94 3.79
65 3.73 4.22 4.14 4.04 3.87
66 3.82 4.35 4.27 4.15 3.95
67 3.92 4.50 4.40 4.26 4.03
68 4.02 4.66 4.54 4.37 4.11
69 4.13 4.83 4.69 4.49 4.19
70 4.24 5.01 4.85 4.61 4.26
75 4.89 6.17 5.76 5.22 4.57
80 5.73 7.91 7.07 5.81 4.75]
16
ANNUITY TABLES FOR FIXED PAYMENTS
BASED ON [1.5%] INTEREST RATE
(CONTINUED)
JOINT AND LAST SURVIVOR ANNUITY
AGE
OF AGE OF FEMALE
MALE 35 40 45 50 55 60
----------------------------------------------------------------------------------
[35 $2.12 $2.18 $2.23 $2.26 $2.28 $2.30
40 2.17 2.25 2.32 2.38 2.42 2.45
45 2.21 2.31 2.41 2.50 2.57 2.63
50 2.24 2.36 2.49 2.61 2.72 2.82
55 2.25 2.39 2.54 2.70 2.86 3.01
60 2.27 2.41 2.58 2.77 2.98 3.19
65 2.27 2.43 2.61 2.82 3.07 3.34
70 2.28 2.43 2.62 2.85 3.13 3.46
75 2.28 2.44 2.64 2.87 3.17 3.53
80 2.28 2.44 2.64 2.89 3.19 3.58
85 2.28 2.45 2.65 2.89 3.21 3.61
90 2.28 2.45 2.65 2.90 3.22 3.63
AGE
OF AGE OF FEMALE
MALE 65 70 75 80 85 90
---- ------------------------------------------------------------------------
[35 $2.31 $2.32 $2.32 $2.33 $2.33 $2.33
40 2.47 2.49 2.50 2.50 2.51 2.51
45 2.66 2.69 2.71 2.72 2.73 2.73
50 2.89 2.93 2.97 2.99 3.00 3.01
55 3.13 3.22 3.29 3.33 3.35 3.37
60 3.38 3.55 3.67 3.75 3.80 3.83
65 3.62 3.89 4.11 4.28 4.39 4.45
70 3.83 4.22 4.60 4.91 5.14 5.28
75 3.98 4.50 5.06 5.60 6.04 6.34
80 4.08 4.70 5.46 6.28 7.05 7.64
85 4.14 4.84 5.74 6.85 8.03 9.08
90 4.17 4.91 5.93 7.27 8.88 10.50]
JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE
OF AGE OF FEMALE
MALE 35 40 45 50 55 60
----------------------------------------------------------------------------------
[35 $2.12 $2.18 $2.23 $2.26 $2.28 $2.30
40 2.17 2.25 2.32 2.38 2.42 2.45
45 2.21 2.31 2.41 2.50 2.57 2.63
50 2.24 2.36 2.49 2.61 2.72 2.82
55 2.25 2.39 2.54 2.70 2.86 3.01
60 2.27 2.41 2.58 2.77 2.98 3.19
65 2.27 2.43 2.61 2.82 3.07 3.34
70 2.28 2.43 2.62 2.85 3.13 3.45
75 2.28 2.44 2.63 2.87 3.17 3.53
80 2.28 2.44 2.64 2.88 3.19 3.57
85 2.28 2.44 2.64 2.89 3.20 3.60
90 2.28 2.45 2.64 2.89 3.21 3.61
AGE
OF AGE OF FEMALE
MALE 65 70 75 80 85 90
---- -----------------------------------------------------------------------
[35 $2.31 $2.32 $2.32 $2.33 $2.33 $2.33
40 2.47 2.49 2.50 2.50 2.51 2.51
45 2.66 2.69 2.71 2.72 2.73 2.73
50 2.88 2.93 2.97 2.99 3.00 3.00
55 3.13 3.22 3.28 3.32 3.34 3.35
60 3.38 3.54 3.66 3.74 3.78 3.80
65 3.62 3.88 4.10 4.25 4.34 4.38
70 3.82 4.20 4.56 4.85 5.03 5.12
75 3.96 4.47 5.00 5.47 5.80 5.98
80 4.06 4.65 5.34 6.03 6.56 6.87
85 4.11 4.76 5.57 6.43 7.16 7.61
90 4.13 4.82 5.69 6.67 7.54 8.11]
17
ANNUITY TABLES FOR FIXED PAYMENTS
BASED ON [1.5%] INTEREST RATE
(CONTINUED)
PAYMENTS FOR A PERIOD CERTAIN
AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
--------------------------------------------------------------------------------------------------------
[10 $8.96 15 $6.20 20 $4.81
11 8.21 16 5.85 21 4.62
12 7.58 17 5.55 22 4.44
13 7.05 18 5.27 23 4.28
14 6.59 19 5.03 24 4.13
AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS
---- ---------------------------------------------------------------
25 $3.99 30 3.44]
26 3.86
27 3.75
28 3.64
29 3.54
18
ANNUITY TABLES FOR FIXED PAYMENTS
BASED ON [1.5%] INTEREST RATE
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity payment frequency, period
certain, age, or combination of ages not shown will be quoted upon request. The
tables shown below are age dependant and are prior to the application of an age
revision based on the year of annuitization.
LIFE ANNUITY, LIFE ANNUITY WITH A CASH REFUND, AND LIFE ANNUITY WITH PAYMENTS
FOR A PERIOD CERTAIN - SINGLE LIFE ANNUITIES
MONTHLY PAYMENTS GUARANTEED
AGE CASH REFUND NONE 120 180 240
-----------------------------------------------------------------------
[35 $2.29 $2.30 $2.30 $2.29 $2.29
40 2.41 2.46 2.46 2.46 2.45
45 2.57 2.67 2.67 2.66 2.65
50 2.78 2.93 2.92 2.91 2.88
51 2.83 2.99 2.98 2.96 2.94
52 2.88 3.05 3.04 3.02 2.99
53 2.93 3.12 3.11 3.08 3.05
54 2.98 3.19 3.17 3.15 3.11
55 3.04 3.26 3.24 3.22 3.17
56 3.10 3.34 3.32 3.29 3.23
57 3.16 3.42 3.40 3.36 3.30
58 3.22 3.51 3.48 3.44 3.37
59 3.29 3.60 3.57 3.52 3.44
60 3.36 3.70 3.66 3.60 3.51
61 3.43 3.80 3.76 3.69 3.59
62 3.50 3.91 3.86 3.78 3.66
63 3.58 4.03 3.97 3.88 3.74
64 3.67 4.15 4.08 3.98 3.82
65 3.76 4.28 4.20 4.08 3.90
66 3.85 4.43 4.33 4.19 3.98
67 3.95 4.58 4.46 4.30 4.06
68 4.05 4.74 4.61 4.42 4.14
69 4.15 4.91 4.76 4.54 4.21
70 4.27 5.10 4.92 4.66 4.28
75 4.92 6.29 5.83 5.26 4.58
80 5.76 8.05 6.87 5.75 4.74]
19
ANNUITY TABLES FOR FIXED PAYMENTS
BASED ON [1.5%] INTEREST RATE
(CONTINUED)
JOINT AND LAST SURVIVOR ANNUITY
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 35 40 45 50 55 60
---------------------------------------------------------------------------------------
[35 $2.12 $2.17 $2.21 $2.24 $2.26 $2.27
40 2.17 2.25 2.31 2.36 2.40 2.42
45 2.21 2.31 2.40 2.48 2.54 2.59
50 2.24 2.36 2.48 2.60 2.70 2.77
55 2.26 2.40 2.54 2.70 2.84 2.97
60 2.27 2.42 2.59 2.77 2.97 3.16
65 2.28 2.44 2.62 2.83 3.07 3.33
70 2.29 2.45 2.64 2.87 3.14 3.46
75 2.29 2.45 2.65 2.89 3.19 3.55
80 2.29 2.46 2.66 2.91 3.22 3.62
85 2.30 2.46 2.67 2.92 3.24 3.65
90 2.30 2.46 2.67 2.93 3.25 3.67
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 65 70 75 80 85 90
--------- -------------------------------------------------------------------------
[35 $2.28 $2.29 $2.29 $2.29 $2.30 $2.30
40 2.44 2.45 2.45 2.46 2.46 2.46
45 2.62 2.64 2.65 2.66 2.67 2.67
50 2.83 2.87 2.89 2.91 2.92 2.93
55 3.07 3.14 3.19 3.22 3.24 3.25
60 3.33 3.46 3.55 3.62 3.65 3.67
65 3.58 3.81 3.99 4.11 4.19 4.23
70 3.81 4.16 4.48 4.72 4.89 4.99
75 3.99 4.48 4.98 5.43 5.78 6.00
80 4.11 4.72 5.43 6.17 6.83 7.32
85 4.19 4.89 5.78 6.83 7.93 8.87
90 4.23 4.99 6.00 7.32 8.87 10.41]
JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 35 40 45 50 55 60
---------------------------------------------------------------------------------------
[35 $2.12 $2.17 $2.21 $2.24 $2.26 $2.27
40 2.17 2.25 2.31 2.36 2.40 2.42
45 2.21 2.31 2.40 2.48 2.54 2.59
50 2.24 2.36 2.48 2.60 2.70 2.77
55 2.26 2.40 2.54 2.70 2.84 2.97
60 2.27 2.42 2.59 2.77 2.97 3.16
65 2.28 2.44 2.62 2.83 3.07 3.33
70 2.29 2.45 2.64 2.87 3.14 3.46
75 2.29 2.45 2.65 2.89 3.19 3.55
80 2.29 2.46 2.66 2.91 3.22 3.61
85 2.29 2.46 2.66 2.92 3.23 3.64
90 2.30 2.46 2.66 2.92 3.24 3.65
AGE OF
FIRST AGE OF SECOND ANNUITANT
ANNUITANT 65 70 75 80 85 90
--------- ------------------------------------------------------------------------
[35 $2.28 $2.29 $2.29 $2.29 $2.29 $2.30
40 2.44 2.45 2.45 2.46 2.46 2.46
45 2.62 2.64 2.65 2.66 2.66 2.66
50 2.83 2.87 2.89 2.91 2.92 2.92
55 3.07 3.14 3.19 3.22 3.23 3.24
60 3.33 3.46 3.55 3.61 3.64 3.65
65 3.58 3.80 3.98 4.09 4.16 4.19
70 3.80 4.15 4.45 4.68 4.81 4.88
75 3.98 4.45 4.93 5.33 5.60 5.74
80 4.09 4.68 5.33 5.96 6.43 6.70
85 4.16 4.81 5.60 6.43 7.11 7.54
90 4.19 4.88 5.74 6.70 7.54 8.08]
20
ANNUITY TABLES FOR FIXED PAYMENTS
BASED ON [1.5%] INTEREST RATE
(CONTINUED)
PAYMENTS FOR A PERIOD CERTAIN
AMOUNT OF AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
--------------------------------------------------------------------------------------------------------
[10 $8.96 15 $6.20 20 $4.81
11 8.21 16 5.85 21 4.62
12 7.58 17 5.55 22 4.44
13 7.05 18 5.27 23 4.28
14 6.59 19 5.03 24 4.13
AMOUNT OF AMOUNT OF
NO. OF MONTHLY NO. OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS
---- ----------------------------------------------------------------
25 $3.99 30 3.44]
26 3.86
27 3.75
28 3.64
29 3.54
21
(THIS PAGE INTENTIONALLY LEFT BLANK)
22
[LOGO]
THE HARTFORD
HARTFORD LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇
NONPARTICIPATING
INDIVIDUAL SINGLE PREMIUM
MODIFIED GUARANTEED ANNUITY CONTRACT