|||GOLDEN SINGLE PREMIUM
||||AMERICAN DEFERRED MODIFIED
|||||LIFE INSURANCE GUARANTEED ANNUITY
|||COMPANY GROUP MASTER
CONTRACT
Golden American is a stock company domiciled in Delaware.
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Offices: ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ 19380
CONTRACTHOLDER: Golden Investor Trust, Inc. GROUP CONTRACT NUMBER: G000025-OE
ISSUED IN: Delaware CONTRACT ISSUE DATE: [January 1, 1996]
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In this Contract, we, our and us refer to Golden American Life Insurance
Company.
In consideration of application for this Contract and the payment of premiums,
we agree, subject to the terms and conditions of this Contract, to provide the
benefits described on this and the following pages to the persons eligible,
herein called "Annuitant(s).
If this Contract is in force, we will make income payments to the Certificate
Owner starting on the Annuity Commencement Date shown in each Certificate. If
the Certificate Owner or the Annuitant (if the Owner is other than a natural
person) dies prior to the Annuity Commencement Date shown in each Certificate,
we will pay a death benefit to the Beneficiary. The amounts of such benefits are
subject to the terms of this Contract.
All death proceeds due under this Contract will be paid according to the
Beneficiary designation and the provisions of this Contract. Payment of such
death proceeds by us will completely discharge our liability with respect to the
amounts so paid.
Signed for Golden American Life Insurance Company on the Contract Issue Date.
President: /s/▇▇▇▇▇ ▇▇▇▇▇▇▇▇ Secretary: /s/▇▇▇▇▇ ▇▇▇▇▇▇▇-▇▇▇▇▇▇▇
All payments and values may be subject to a Market Value Adjustment, the
operation of which may cause such payments and values to increase or decrease.
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SINGLE PREMIUM DEFERRED MODIFIED GUARANTEED ANNUITY GROUP MASTER CONTRACT - NO
DIVIDENDS
Annuity Benefit payable at Annuity Commencement Date. Death Benefit payable in
the event of the Certificate Owner's death prior to the Commencement Date. Cash
Surrender Values are based on a Market Value Adjustment formula if the
Certificate is held for a period less than the currently elected Guarantee
Period. Cash Surrender Values may increase or decrease based on the Market Value
Adjustment Formula. Equity Index premium allocation option.
GA-MA-1100 2
TABLE OF CONTENTS
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THE SCHEDULE....................................... 3 CERTIFICATE OWNER BENEFITS..............13
The Separate Account Cash Surrender Value Benefit
Surrender Charges Partial Withdrawal Option
Income Plan Factors Proceeds Payable to the Beneficiary
Premium Taxes
CHOOSING AN INCOME PLAN.................16
IMPORTANT TERMS.................................... 4 ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇
▇▇▇▇▇▇▇ Commencement Date Selection
INTRODUCTION TO THIS CONTRACT...................... 6 Frequency Selection
Eligibility The Annuity Options
The Certificate Owner Payment When Named Person Dies
The Annuitant
The Beneficiary OTHER IMPORTANT INFORMATION.............18
Change of Certificate Owner or Beneficiary Entire Contract
Sending Notice to Us
HOW WE MEASURE A CERTIFICATE'S..................... 8 Reports to Certificate Owners
ACCUMULATION VALUE Assignment - Using a Certificate as
Single Premium Payment Collateral Security
Premium Payment Allocation Changing this Contract
Transfers Contract Changes - Applicable Tax Law
Guarantee Periods Misstatement of Age or Sex
Certificate Accumulation Value Non-Participating
Interest Division Accumulation Value Contestability
Term Indexed Division Accumulation Value Payments We May Defer
Annual Indexed Division Accumulation Value Authority to Make Agreements
Market Value Adjustment Required Note on Our Computations
MVA Index Rate Facility of Payment
Conformity with Law
Records
Certificate Owner's Right to Examine the
Certificate
Copies of any additional Riders and Endorsements are at the
back of this Contract.
THE SCHEDULE
The Schedule gives specific facts about this Contract.
Please refer to the Schedule while reading this Contract.
GA-MA-1100 2
THE SCHEDULE
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THE SEPARATE ACCOUNT
THE SEPARATE ACCOUNT (THE MVA SEPARATE ACCOUNT) IS A NON-UNITIZED SEPARATE
ACCOUNT ESTABLISHED BY US UNDER DELAWARE STATUTES, THAT HOLDS ASSETS FOR
GUARANTEED TERMS. THERE ARE NO DISCRETE UNITS FOR THIS ACCOUNT
Surrender Charges
A Surrender Charge is imposed if a Certificate is surrendered or an Excess
Partial Withdrawal is taken at any time other than during the 30-day period
immediately prior to the Maturity Date of a Guarantee Period. The Surrender
Charge is calculated as a percentage of the Accumulation Value surrendered or
withdrawn, adjusted by the Market Value Adjustment. Surrender Charges vary
according to the duration of the Guarantee Period. The Surrender Charges are 8%
in the first Certificate Year and decrease by 1% per Certificate Year thereafter
until the end of the Guarantee Period as shown in the following table.
Year in Guarantee Period 1 2 3 4 5 6 7 8 9+
-------------------------------------- -------- ------- -------- -------- -------- -------- ------- -------- --------
% 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0
Surrender Charges restart at the beginning of each Guarantee Period for the life
of the Certificate. Surrender is permitted on or before the Annuity Commencement
Date. Surrender Charges are not assessed if the Certificate is surrendered on
the Annuity Commencement Date.
PREMIUM TAXES
We deduct the amount of any premium or other state and local taxes levied by any
state or governmental entity when such taxes are incurred.
We reserve the right to defer collection of Premium Taxes until surrender or
until application of Accumulation Value to an Annuity Option. An Excess Partial
Withdrawal will result in the deduction of any Premium Tax then due us on such
amount. We reserve the right to change the amount deducted for Premium Tax
charges on future Premium Payments to conform with changes in the law or if the
Certificate Owner changes state of residence.
If the charge for Premium Taxes is incurred when premiums are received, we
advance the amount of the charge to the Accumulation Value and deduct it in
equal installments on each Certificate Processing Date. Currently, we will waive
the deduction of the applicable installment on each Certificate Processing Date.
However, we deduct the applicable unrecovered portion of the charge for Premium
Taxes (not including installments which were waived) when determining the Cash
Surrender Value payable if the Certificate is surrendered.
GA-MA-1100 3
THE SCHEDULE (continued)
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INCOME PLAN FACTORS
Values for other payment periods, ages or joint life combinations are available
on request. Monthly payments are shown for each $1,000 applied. The basis for
determining such values is the Annuity 2000 Mortality Table at 3.0% interest. We
may pay a higher rate at our discretion.
Table for Income for a Fixed Period
Fixed Period Monthly Fixed Period Monthly Fixed Period Monthly
of Years Income of Years Income of Years Income
5 17.95 14 7.28 23 5.00
6 15.18 15 6.89 24 4.85
7 13.20 16 6.54 25 4.72
8 11.71 17 6.24 26 4.60
9 10.56 18 5.98 27 4.49
10 9.64 19 5.74 28 4.38
11 8.88 20 5.53 29 4.28
12 8.26 21 5.33 30 4.19
13 7.73 22 5.16
Table for Income for Life
Male/Female Male/Female Male/Female
Age 10 Years Certain 20 Years Certain Refund Certain
50 $4.06/3.83 $3.96/3.77 $3.93/3.75
55 4.43/4.14 4.25/4.05 4.25/4.03
60 4.90/4.56 4.57/4.37 4.66/4.40
65 5.51/5.10 4.90/4.73 5.12/4.83
70 6.26/5.81 5.18/5.07 5.76/5.42
75 7.11/6.70 5.38/5.33 6.58/6.19
80 7.99/7.70 5.48/5.46 7.69/7.21
85 8.72/8.59 5.52/5.51 8.72/8.59
90 9.23/9.18 5.53/5.53 10.63/10.53
GA-MA-1100 3(Cont'd)
IMPORTANT TERMS
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ACCUMULATION VALUE - The amount that a Certificate provides for investment at
any time. Initially, this amount is equal to the premium paid.
ANNUAL INDEXED DIVISION - An investment option available in the Separate
Account.
ANNUITANT - The person designated by a Certificate Owner to be the measuring
life in determining Annuity Payments.
ANNUITY COMMENCEMENT DATE - For each Certificate, the date on which Annuity
Payments begin.
ANNUITY OPTIONS - Options the Certificate Owner selects that determine the form
and amount of Annuity Payments.
ANNUITY PAYMENT - The periodic payment a Certificate Owner receives.
ATTAINED AGE - The age of a Certificate Owner, or that of the Annuitant, on the
Certificate Issue Date plus the number of full years elapsed since the
Certificate Date.
BENEFICIARY - The person designated to receive benefits in the case of the death
of a Certificate Owner.
BUSINESS DAY - Any day the New York Stock Exchange is open for trading,
exclusive of federal holidays, or any day on which the Securities and Exchange
Commission requires that mutual funds, unit investment trusts or other
investment portfolios be valued.
CASH SURRENDER VALUE - The amount a Certificate Owner receives upon surrender of
the Certificate.
CERTIFICATE - A summary of the provisions of, and benefits provided by, this
Contract,
CERTIFICATE ANNIVERSARY - The anniversary of the Certificate Date.
CERTIFICATE DATE - The date we receive the initial premium and upon which we
begin determining the Certificate values. It may not be the same as the
Certificate Issue Date. This date is used to determine Certificate months, years
and anniversaries.
CERTIFICATE ISSUE DATE - The date a Certificate is issued at our Customer
Service Center.
CERTIFICATE OWNER - The person who owns a Certificate and is entitled to
exercise all rights of the Certificate. This person's death also initiates
payment of the Death Benefit.
CERTIFICATE YEAR - The period between Certificate Anniversaries.
CONTINGENT ANNUITANT - The person designated by a Certificate Owner who, upon
the Annuitant's death prior to the Annuity Commencement Date, becomes the
Annuitant.
CONTRACT ISSUE DATE - The date this group Contract is issued at our Customer
Service Center.
CONTRACTHOLDER - The entity to whom this Contract is issued.
GROSS WITHDRAWAL - The total amount of Accumulation Value withdrawn.
GUARANTEE PERIOD - A period for which a Certificate's return is determined by a
declared interest rate (for values in the Interest Division) and the greater of
a Minimum Guaranteed Value or changes to the S&P 500 Index during the period
(for values in the Term and Annual Indexed Divisions).
GA-MA-1100 4
IMPORTANT TERMS (continued)
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INITIAL PREMIUM - The payment amount required to put a Certificate in effect.
INTEREST DIVISION - An investment option available in the Separate Account.
ISSUE AGE - The age of a Certificate Owner, or that of the Annuitant, on the
last birthday on or before the Certificate Date.
MARKET VALUE ADJUSTMENT - A positive or negative adjustment. It may apply if all
or part of the Accumulation Value is withdrawn or applied to an Annuity Option
at any time other than during the 30-day period immediately prior to the end of
a Guarantee Period.
MATURITY DATE - The date on which a Guarantee Period ends. The Maturity Date is
the last day of the last Certificate Year in the Guarantee Period.
NET WITHDRAWAL - The Gross Withdrawal amount, adjusted by any Market Value
Adjustment minus any Surrender Charges.
RIDERS - Riders add provisions or change the terms of this Contract or a
Certificate.
TERM INDEXED DIVISION - An investment option available in the Separate Account.
GA-MA-1100 5
INTRODUCTION TO THIS CONTRACT
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ELIGIBILITY
Eligible persons as stated in the application for this Contract and who have
enrolled and for whom the Initial Premium has been paid are eligible to receive
the benefits under this Contract.
THE CERTIFICATE OWNER
The Certificate Owner is also the Annuitant unless another Annuitant has been
named and is shown in the Certificate. The Certificate Owner has the rights and
options described in this Contract, including but not limited to the right to
receive the Annuity Benefits on the Annuity Commencement Date.
One or more people may own a Certificate. In the case of a sole Certificate
Owner who dies prior to the Annuity Commencement Date, we will pay the
Beneficiary the Death Benefit then due. If the sole Certificate Owner is not an
individual, we will treat the Annuitant as the Certificate Owner for the purpose
of determining when the Certificate Owner dies under the Death Benefit provision
(if there is no Contingent Annuitant). The estate of a sole Certificate Owner
will be the Beneficiary if no Beneficiary designation is in effect, or if the
designated Beneficiary has predeceased the Certificate Owner. In the case of a
Joint Certificate Owner dying prior to the Annuity Commencement Date, the
surviving Certificate Owner(s) will be deemed to be the Beneficiary(ies) and any
other Beneficiary(ies) on record will be treated as the contingent
Beneficiary(ies).
THE ANNUITANT
The Annuitant is the measuring life of the Annuity Benefits provided under a
Certificate. A Certificate Owner may name a Contingent Annuitant. The Annuitant
may not be changed during the Annuitant's lifetime.
If the Annuitant dies before the Annuity Commencement Date, the Contingent
Annuitant becomes the Annuitant. The Certificate Owner will be the Contingent
Annuitant unless the Certificate Owner names someone else. The Annuitant must be
a natural person. If the Annuitant dies and no Contingent Annuitant has been
named, we will allow the Certificate Owner sixty days to designate someone else
as the Annuitant. If all Owners of a Certificate are not individuals and,
through the operation of this provision, a Certificate Owner becomes Annuitant,
we will pay the Death Benefit to the Beneficiary. If there are Joint Certificate
Owners, we will treat the youngest of the Certificate Owners as the Contingent
Annuitant designated, unless we are notified otherwise.
THE BENEFICIARY
The Beneficiary is the person to whom we pay the Death Benefit if a Certificate
Owner dies prior to the Annuity Commencement Date. See "Proceeds Payable to the
Beneficiary" for more information. We pay Death Benefits to the primary
Beneficiary (unless there are Joint Certificate Owners in which case the Death
Benefit is payable to the surviving Certificate Owner). If the primary
Beneficiary dies before the Certificate Owner, the Death Benefit is paid to the
Contingent Beneficiary, if any. If there is no surviving Beneficiary, we pay the
Death Benefit to the Certificate Owner's estate.
Unless otherwise provided, the Death Benefit will be paid as though the
Beneficiary died before the Certificate Owner if:
(1) The Beneficiary dies at the same time as the Certificate Owner; or
(2) The Beneficiary dies within 24 hours of the Certificate Owner's death.
GA-MA-1100 6
INTRODUCTION TO THIS CONTRACT (continued)
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THE BENEFICIARY (CONT'D)
One or more persons may be named as primary Beneficiary or contingent
Beneficiary. In the case of more than one Beneficiary, we will assume any Death
Benefit is to be paid in equal shares to the surviving Beneficiaries. A
Certificate Owner may specify other than equal shares.
A Certificate Owner has the right to change Beneficiaries, unless the primary
Beneficiary is designated as irrevocable. When an irrevocable Beneficiary has
been designated, the Certificate Owner and the irrevocable Beneficiary may have
to act together to exercise the rights and options under a Certificate.
CHANGE OF CERTIFICATE OWNER OR BENEFICIARY
During the Certificate Owner's lifetime and while the Certificate is in effect,
the Certificate Owner may transfer ownership of the Certificate or change the
Beneficiary. To make any of these changes, we require written notice of the
change in a form satisfactory to us. If there are Joint Certificate Owners, both
must agree to the change. The change will take effect as of the day the notice
is signed. The change will not affect any payment made or action taken by us
before recording the change at our Customer Service Center. See "Proceeds
Payable to Beneficiary."
GA-MA-1100 7
HOW WE MEASURE A CERTIFICATE'S ACCUMULATION VALUE
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SINGLE PREMIUM PAYMENT
This is a single premium annuity. However, a Certificate's single premium may be
paid in one lump sum or in installments during the first Certificate Year. Any
such planned installments must be identified at the time the Certificate is
issued and be received by us at our Customer Service Center within 60 days after
the Certificate Date. There is no penalty if a planned installment is not paid.
PREMIUM PAYMENT ALLOCATION
Premium will be allocated among the Divisions of the Separate Account as elected
by the Certificate Owner. Any premium installments will be allocated in the same
manner, unless the Certificate Owner specifies otherwise.
Where to Make Payments Premium Payments are to be remitted to our Customer
Service Center. On request, a receipt signed by our treasurer will be provided.
TRANSFERS
A Certificate Owner may transfer Accumulation Value between Divisions of the
Separate Account only during the 30 day period immediately prior to the expiry
of a Guarantee Period. Such transfers will occur on the Maturity Date of the
ending Guarantee Period. Surrender Charges and Market Value Adjustments will not
apply to such transfers.
GUARANTEE PERIODS
We offer Guarantee Periods of 5, 7 and 10 years. From time to time, we may offer
Guarantee Periods of other durations. We also reserve the right to cease
offering a particular Guarantee Period or Periods.
At the time the Certificate is issued, the Certificate Owner elects an Initial
Guarantee Period from among the durations then being offered by us. The
Guarantee Period elected applies to all Divisions of the Separate Account for a
Certificate. Only one Guarantee Period will be in effect at any one time for any
Certificate.
Upon the expiry of a Guarantee Period (the Guarantee Period Maturity Date), a
subsequent Guarantee Period will begin. Guarantee Period Maturity Dates will
always coincide with a Certificate Anniversary. A Certificate's Initial
Guarantee Period Maturity Date applies to all installment payments received for
that Certificate. Each subsequent Guarantee Period will be the same length as
the previous Guarantee Period, unless: a) the Certificate Owner elects a
different duration from among those then being offered by us; or b) the new
Guarantee Period would extend beyond the Annuity Commencement Date then in
effect. If the period remaining from the expiry of the previous Guarantee Period
to the Annuity Commencement Date is less than the period elected or the period
expiring, the next shortest period then available that will not extend beyond
the Annuity Commencement Date will be offered.
We will notify each Certificate Owner prior to the Guarantee Period Maturity
Date of the options for renewal. In order to elect a different Guarantee Period,
the Certificate Owner must notify us in writing before the Maturity Date of the
Guarantee Period then ending. A Certificate Owner may not select a Guarantee
Period that would extend beyond the Annuity Commencement Date then in effect.
CERTIFICATE ACCUMULATION VALUE
A Certificate's Accumulation Value is the sum of the Accumulation Value in each
of the Separate Account Divisions.
GA-MA-1100 8
HOW WE MEASURE A CERTIFICATE'S ACCUMULATION VALUE (continued)
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INTEREST DIVISION ACCUMULATION VALUE
The Accumulation Value in the Interest Division on the Certificate Date is the
premium allocated to the Division. Thereafter, the Interest Division
Accumulation Value equals the Accumulation Value on the Certificate Date, plus
any premium installments allocated to the Division, plus or minus any transfers,
less Gross Withdrawals, accumulated with interest.
The rate of interest will be as we declare. An Initial Interest Rate will be
declared at the time a Certificate is issued and applies to the Initial
Guarantee Period and, if the premium is paid in installments, to the first
installment only. Different interest rates may apply to each subsequent
Guarantee Period or premium installment as declared by us at the beginning of
the Guarantee Period or at the time the installment payment is received by us.
Interest will be credited daily at a rate to yield the declared annual Interest
Rate.
In case of surrender, withdrawal or transfer, interest will be credited on the
portion of the Accumulation Value surrendered, withdrawn or transferred up to
the date the surrender, withdrawal or transfer is requested. Accumulation Value
at any date within a Certificate Year will be determined by us with allowance
for the time elapsed in the Certificate Year.
TERM INDEXED DIVISION ACCUMULATION VALUE
Accumulation Value at the Beginning of Each Guarantee Period
In the Initial Guarantee Period, the beginning Accumulation Value equals the
premium allocated to the Division. In all subsequent Guarantee Periods, the
beginning Accumulation Value equals the Accumulation Value as of the end of the
prior Guarantee Period, less Gross Withdrawals taken on the Maturity Date of
the prior Guarantee Period, plus or minus any transfers.
Accumulation Value During Each Guarantee Period
During the Initial Guarantee Period, the Accumulation Value equals the sum of
all premium installments allocated to the Division, less Gross Withdrawals.
During subsequent Guarantee Periods, the Accumulation Value equals the
beginning Accumulation Value less Gross Withdrawals
Accumulation Value at the End of Each Guarantee Period
At the end of the Initial Guarantee Period, the Accumulation Value, calculated
on the Maturity Date equals the greater of:
(1) The sum of all premium installments allocated to the Division, less Gross
Withdrawals, multiplied by (1 + the Index Return) calculated separately
for each premium installment; or
(2) he Minimum Guaranteed Value.
At the end of all subsequent Guarantee Periods, the Accumulation Value,
calculated on the Maturity Date, equals the greater of:
(1) The beginning Accumulation Value, less Gross Withdrawals, multiplied
by (1 + the Index Return); or
(2) The Minimum Guaranteed Value.
Amounts surrendered or withdrawn prior to the end of the Guarantee Period do not
participate in the Index Return during that Guarantee Period.
Minimum Guaranteed Value
During the Initial Guarantee Period, the Term Indexed Division Minimum
Guaranteed Value equals:
(1) 90% of the premium allocated to the Division; plus
(2) Accrued interest as declared by us; minus
(3) Net Withdrawals.
For any subsequent Guarantee Period, the Term Indexed Division Minimum
Guaranteed Value equals:
(1) 90% of the Division's beginning Accumulation Value for that Guarantee
Period; plus
(2) Accrued interest as declared by us; minus
(3) Net Withdrawals.
GA-MA-1100 9
HOW WE MEASURE A CERTIFICATE'S ACCUMULATION VALUE (continued)
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TERM INDEXED DIVISION ACCUMULATION VALUE (CONT'D)
The interest rate used in calculating the Term Indexed Division Minimum
Guaranteed Value is declared at the time a Certificate is issued and is
guaranteed for all premium installments and all Guarantee Periods.
Index Return
The Index Return for the Term Indexed Division is equal to (a x b) where:
a is the Division's Index Growth, as described below, but not less than 0; and
b is the Participation Rate for the Guarantee Period elected.
The Participation Rate declared at the time a Certificate is issued applies to
the Initial Guarantee Period and, if the premium is paid in installments, to the
first installment payment only. Different Participation Rates may apply to each
subsequent Guarantee Period or premium installment as declared by us at the
beginning of the Guarantee Period or at the time the installment payment is
received by us.
Index Growth
For the Initial Guarantee Period, the Division's Index Growth is calculated on
the Guarantee Period Maturity Date separately for each premium installment and
equals a minus b divided by b where:
a is the average of the S & P 500 Index Values determined on the same date in
each month of the last Certificate Year in the Guarantee Period as the
Certificate Date; and
b is the S & P 500 Index Value on the date the premium installment is received
by us.
For all subsequent Guarantee Periods, the Division's Index Growth is calculated
on the Guarantee Period Maturity Date and equals a minus b divided by b where:
a is the average of the S & P 500 Index Values determined on the same date in
each month of the last Certificate Year in the Guarantee Period as the
Certificate Date; and
b is the S & P 500 Index Value on first day of the Guarantee Period.
If there is no such corresponding date, the last day of the month is used. If
any date falls on a day the New York Stock Exchange is not open, the S&P 500
Index will be determined as of the next business day.
ANNUAL INDEXED DIVISION ACCUMULATION VALUE
Accumulation Value at the Beginning of Each Certificate Year
In the first Certificate Year, the beginning Accumulation Value equals the
premium allocated to the Division. In all subsequent Certificate Years, the
beginning Accumulation Value equals the Accumulation Value as of the end of
the prior Certificate Year, less Gross Withdrawals as of the Certificate
Anniversary, plus or minus any transfers, if applicable.
(See "Transfers," p. 8.)
Accumulation Value During Each Certificate Year
During the first Certificate Year, the Accumulation Value equals the sum of
all premium installments allocated to the Division, less Gross Withdrawals.
During subsequent Certificate Years, the Accumulation Value equals the
beginning Accumulation Value, less Gross Withdrawals.
Accumulation Value at the End of Each Certificate Year
At the end of the first Certificate Year, the Accumulation Value, calculated
on the Certificate Anniversary, equals the sum of all premium installments
allocated to the Division, multiplied by (1 + the Index Return), calculated
separately for each premium installment. At the end of all subsequent
Certificate Years, the Accumulation Value calculated on the Certificate
Anniversary, equals the beginning Accumulation Value, less Gross Withdrawals,
multiplied by (1 + the Index Return). However, if on the Guarantee Period
Maturity Date, the Minimum Guaranteed Value exceeds the Accumulation Value,
the ending Accumulation Value for that Certificate Year/Guarantee Period is
set equal to the Minimum Guaranteed Value.
Amounts surrendered or withdrawn prior to the end of each Certificate Year do
not participate in the Index Return during that Certificate Year.
GA-MA-1100 10
HOW WE MEASURE A CERTIFICATE'S ACCUMULATION VALUE (continued)
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ANNUAL INDEXED DIVISION ACCUMULATION VALUE (CONT'D)
Minimum Guaranteed Value
During the Initial Guarantee Period, the Annual Indexed Division Minimum
Guaranteed Value equals:
(1) 90% of the premium allocated to the Division; plus
(2) Accrued interest as declared by us; minus
(3) Net Withdrawals.
For any subsequent Guarantee Period, the Annual Indexed Division Minimum
Guaranteed Value equals:
(1) 90% of the Division's beginning Accumulation Value for that Guarantee
Period; plus
(2) Accrued interest as declared by us; minus
(3) Net Withdrawals.
The interest rate used in calculating the Annual Indexed Division Minimum
Guaranteed Value is declared at the time a Certificate is issued and is
guaranteed for all premium installments and all Guarantee Periods.
Index Return
The Index Return for the Annual Indexed Division is calculated
annually on the Certificate Anniversary and is equal to the lesser of
(a x b) or c where:
a is the Division's Index Growth, as described below, but not less than 0;
b is the Participation Rate for the Certificate Year then ending; and
c is Index Return Maximum for the Certificate Year then ending.
The Participation Rate and the Index Return Maximum declared at the time a
Certificate is issued applies to the first Certificate Year and, if the premium
is paid in installments, to the first installment payment only. Different
Participation Rates and Index Return Maximums may apply to each subsequent
Certificate Year or premium installment as declared by us at the beginning of
the Certificate Year or at the time the installment payment is received by us.
However, the Annual Indexed Division's Participation Rate will never be less
than 50% and the Index Return Maximum will never be less than 8%.
Index Growth
For the first Certificate Year, the Division's Index Growth is calculated
separately for each premium payment, and equals a minus b divided by b where:
a is the average of the S & P 500 Index Values determined on the same date
in each month of the Certificate Year as the Certificate Date; and
b is the S & P 500 Index Value on the date the premium payment is received
by us.
For all subsequent Certificate Years, the Division's Index Growth is calculated
for the Certificate Year and equals a minus b divided by b where:
a is the average of the S & P 500 Index Values determined on the same date
in each month of the Certificate Year as the Certificate Date; and
b is the S & P 500 Index Value on first day of the Certificate Year.
If there is no such corresponding date, the last day of the month is used. If
any date falls on a day the New York Stock Exchange is not open, the S&P 500
Index will be determined as of the next business day.
MARKET VALUE ADJUSTMENT
A Market Value Adjustment (MVA) will be applied to Excess Partial Withdrawals,
Surrenders and Accumulation Value applied to an Income Plan other than on, or
during the 30-day period immediately prior to, a Guarantee Period Maturity Date.
During the Initial Guarantee Period, the MVA applies to, and will be calculated
separately for, each premium installment payment, if any.
GA-MA-1100 11
HOW WE MEASURE A CERTIFICATE'S ACCUMULATION VALUE (continued)
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MARKET VALUE ADJUSTMENT (CONT'D)
Market Value Adjustments will be applied as follows:
(1) The Market Value Adjustment will be applied to the amount withdrawn or
applied before deduction of any applicable Surrender Charge.
(2) For a Partial Withdrawal, or in the case where a portion of an allocation
is applied to an Income Plan, the Market Value Adjustment will be
calculated on the total amount that must be withdrawn or applied to an
Income Plan in order to provide the amount requested.
The Market Value Adjustment is determined by multiplying the amount of the
Accumulation Value withdrawn or applied to an Income Plan by the following
factor:
( 1 + I ) N/365
----------------
( 1 + J + .0050) - 1
Where I is the MVA Index Rate on the first day of the applicable Guarantee
Period, or during the Initial Guarantee Period only, on the date the premium
installment payment, if any, is received by us: J is the Index Rate for
Guarantee Periods equal to the number of years (fractional years rounded up to
the next full year) remaining in the Guarantee Period at the time of
calculation; and N is the remaining number of days in the Guarantee Period at
the time of calculation.
MVA INDEX RATE
The MVA Index Rate is the average of the Ask Yields for the U.S. Treasury Strips
as reported by a national quoting service for the applicable maturity. The
average is based on the period from the 22nd day of the calendar month two
months prior to the calendar month of Index Rate determination to the 21st day
of the calendar month immediately prior to the month of determination. The
applicable maturity date for these U.S. Treasury Strips is on or next following
the last day of the Guarantee Period. If the Ask Yields are no longer available,
the Index Rate will be determined using a suitable replacement method.
We currently set the MVA Index Rate once each calendar month. However, we
reserve the right to set the Index Rate more frequently than monthly, but in no
event will such Index Rate be based on a period less than 28 days.
GA-MA-1100 12
CERTIFICATE OWNER BENEFITS
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While a Certificate is in effect, the Certificate Owner has important rights and
benefits. We discuss these rights and benefits in this section.
NO SURRENDER CHARGE OR MARKET VALUE ADJUSTMENT IS ASSESSED ON SURRENDERS OR
WITHDRAWALS DURING THE 30-DAY PERIOD IMMEDIATELY PRIOR TO THE MATURITY DATE OF
ANY GUARANTEE PERIOD, PROVIDED WRITTEN NOTICE OF SURRENDER OR WITHDRAWAL IS
RECEIVED IN OUR CUSTOMER SERVICE CENTER BEFORE THE END OF SUCH 30-DAY PERIOD.
SURRENDER CHARGES AND THE MARKET VALUE ADJUSTMENT APPLY TO EACH SUBSEQUENT
GUARANTEE PERIOD. SURRENDER CHARGES FOR EACH SUBSEQUENT GUARANTEE PERIOD START
AT 8% FOR THE FIRST YEAR, THEN DECREASE BY 1% PER YEAR BEGINNING IN YEAR 2 UNTIL
THE MATURITY DATE OF THAT GUARANTEE PERIOD.
CASH SURRENDER VALUE BENEFIT
On or prior to the commencement of Annuity Income Payments if the Annuitant is
living, a Certificate Owner may surrender the Certificate to us. To do this, the
Certificate must be returned with a signed request for cancellation to our
Customer Service Center. We will usually pay the Cash Surrender Value within
seven days; but, we may delay payment as described in the "Payments We May
Defer" provision.
The Cash Surrender Value will vary daily. We will determine the Cash Surrender
Value as of the date we receive the Certificate and the Certificate Owner's
signed request in our Customer Service Center. All benefits under the
Certificate will then end.
A Certificate's Cash Surrender Value, while the Annuitant is living and on or
before the Annuity Commencement Date, is equal to the sum of the Cash Surrender
Value in each of the Divisions of the Separate Account.
In lieu of a lump sum payment, at the time of surrender, a Certificate Owner may
elect to have the Cash Surrender Value paid under an Annuity Option.
Interest Division Cash Surrender Value
The Cash Surrender Value for the Interest Division is equal to the Division's
Accumulation Value, adjusted for any applicable Market Value Adjustment, less
any Surrender Charges or other charges that have been incurred but not yet
deducted, including any applicable Premium Tax.
Term Indexed Division Cash Surrender Value
The Cash Surrender Value for the Term Indexed Division is equal to the greater
of a and b minus c where:
a is the Division's Accumulation Value, adjusted for any applicable Market
Value Adjustment less any Surrender Charges;
b is the Division's Minimum Guaranteed Value, adjusted for any applicable
Market Value Adjustment; and
c is any other charges that have been incurred but not yet deducted, including
any applicable Premium Tax.
Amounts surrendered or withdrawn prior to the end of the Guarantee Period do not
participate in the Index Return during the Guarantee Period.
GA-MA-1100 13
CERTIFICATE OWNER BENEFITS (continued)
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CASH SURRENDER VALUE BENEFIT (CONT'D)
Annual Indexed Division Cash Surrender Value
The Cash Surrender Value for the Annual Indexed Division is equal to the
greater of a and b minus c where:
a is the Division's Accumulation Value, adjusted for any applicable Market
Value Adjustment less any Surrender Charges;
b s the Division's Minimum Guaranteed Value, adjusted for any applicable
Market Value Adjustment; and
c is any other charges that have been incurred but not yet deducted,
including any applicable Premium Tax.
Amounts surrendered or withdrawn prior to the end of each Certificate Year do
not participate in the Index Return during that Certificate Year.
PARTIAL WITHDRAWAL OPTION
A Certificate Owner may make a Partial Withdrawal at any time by giving written
notice to us. Unless otherwise specified, any withdrawals will be taken first
from the Interest Division, then the Annual Interest Division and then the Term
Index Division. The maximum amount that can be withdrawn each Certificate Year
without being considered an Excess Partial Withdrawal is described below. Excess
Partial Withdrawals taken at any time other than during the 30-day period
immediately prior to a Guarantee Period Maturity Date are subject to a Surrender
Charge and Market Value Adjustment, as well as a deduction of any Premium Taxes
not previously paid. The minimum Partial Withdrawal amount is $100. In no event
may a Partial Withdrawal be greater than 90% of the Certificate's Cash Surrender
Value. After a Partial Withdrawal, the remaining Cash Surrender Value must be at
least $1000 to keep the Certificate in force.
To determine the Surrender Charge on Excess Partial Withdrawals, the withdrawals
will occur in the following order:
(1) The Free Amount.
(2) Any remaining Accumulation Value.
The Free Amount
If a Certificate is surrendered at any time other than during
the 30-day period immediately preceding a Guarantee Period Maturity Date, any
withdrawal during the same Certificate Year will be considered an Excess Partial
Withdrawal. Subject to this limitation, during the first Certificate Year,
Systematic Partial Withdrawals of interest earned in the Interest Division may
be taken without being considered an Excess Partial Withdrawal. In each
Certificate Year thereafter, up to 10% of the Certificate's total Accumulation
Value, determined as of the date of withdrawal, may be withdrawn from any one or
any combination of the Divisions without being considered an Excess Partial
Withdrawal.
Systematic Partial Withdrawals
Systematic Partial Withdrawals may be elected to commence after 28 days from
the Certificate Issue Date and may be taken on a monthly, quarterly or annual
basis. The Certificate Owner selects the day withdrawals will be made, but no
later than the 28th day of the month. If a day is not elected, the Certificate
Date will be used.
GA-MA-1100 14
CERTIFICATE OWNER BENEFITS (continued)
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PARTIAL WITHDRAWAL OPTION (CONT'D)
Partial Withdrawals to Meet Minimum Distribution Requirements for Qualified
Plans Partial Withdrawals may be taken from a Certificate issued as a Qualified
Plan to meet Required Minimum Distribution Requirements on a monthly, quarterly
or annual basis. A minimum withdrawal of $100.00 is required. The Certificate
Owner selects the day the withdrawals will be made, but no later than the 28th
day of the month. If a day is not elected, the Certificate Date will be used. No
Surrender Charge will be assessed on Required Minimum Distribution Withdrawals;
however, withdrawals in excess of the Free Amount will be subject to a Market
Value Adjustment.
Systematic Partial Withdrawals and Conventional Partial Withdrawals may not be
taken in the same Certificate Year. Systematic Partial Withdrawals and
Conventional Partial Withdrawals are not allowed when Required Minimum
Distribution Withdrawals are being taken.
PROCEEDS PAYABLE TO THE BENEFICIARY
If a Certificate Owner dies prior to the Annuity Commencement Date, we will pay
the Beneficiary the Death Benefit, calculated as of the date of death. The Death
Benefit varies by Division. The Death Benefit for the Interest Division and the
Annual Indexed Division is equal to the Division Accumulation Value. The Death
Benefit for the Term Indexed Division is equal to the greater of:
(1) The Term Indexed Division's Minimum Guaranteed Value; and
(2) The Term Indexed Division's Accumulation Value calculated using the Index
Return as of the prior certificate Anniversary. For purposes of this
calculation, the S&P 500 Index Value as of the prior Certificate
Anniversary is used as the ending value in determining the Index Growth.
The Certificate Death Benefit is equal to the sum of each Division's Death
Benefit. No Surrender Charge or Market Value Adjustment will be applied. If
there are Joint Certificate Owners and any Certificate Owner dies, we will pay
the surviving Certificate Owner(s) the Death Benefit. We will pay the amount on
receipt of due proof of the Certificate Owner's death at our Customer Service
Center. Such amount may be received in a single lump sum or, while the
Certificate is in effect and before the Annuity Commencement Date, the
Certificate Owner may choose one or more Annuity Options for the payment of
Death Benefit proceeds. If, at the time of the Certificate Owners death, no
Option has been chosen for paying the Death Benefit proceeds, the Beneficiary
may choose an Option within one year.
When the Certificate Owner (or all Certificate Owners where there are Joint
Certificate Owners) is not an individual, the Death Benefit will become payable
on the death of the Annuitant prior to the Annuity Commencement Date (unless a
Contingent Annuitant survived the Annuitant). Only one Death Benefit is payable
under a Certificate. In all events, distributions under the Certificate must be
made as required by applicable law
Spousal Continuation upon Death of Certificate Owner
If at the Certificate Owner's death, the surviving spouse of the deceased
Certificate Owner is the Beneficiary, then such surviving spouse may elect to
continue the Certificate as their own, pursuant to Internal Revenue Code
Section 72(s) or the equivalent provisions of the U.S. Treasury Department
rules for Qualified Plans.
How to Claim Payments to Beneficiary
We must receive proof of a Certificate Owner's (or the Annuitant's) death
before we will make any payments to the Beneficiary. We will calculate the
Death Benefit as of the date we receive due proof of death. The Beneficiary
should contact our Customer Service Center for instructions.
GA-MA-1100 15
CHOOSING AN INCOME PLAN
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ANNUITY BENEFITS
If the Certificate Owner and the Annuitant are living on the Annuity
Commencement Date, we will begin making payments to the Certificate Owner. We
will make these payments under the Annuity Option (or Options) elected by the
Certificate Owner. The Certificate Owner may elect to apply any portion of the
Accumulation Value (minus any applicable premium tax) to any Annuity Option by
making a written request at least 30 days prior to the Annuity Commencement
Date. If, on the Annuity Commencement Date, a Surrender Charge remains, the
elected Annuity Option must include a Period Certain of at least five years
duration. If no Annuity Option has been elected by the Required Annuity
Commencement Date shown in the Schedule, payments will be made under Option 2 on
a 10-year Period Certain basis. The amount of the payments will be determined by
applying the Accumulation Value adjusted by a Market Value Adjustment, if
applicable, on the Annuity Commencement Date in accordance with the Annuity
Options section below (see "Payments We May Defer"). A Market Value Adjustment
may apply if the Annuity Commencement Date is other than on, or during the
30-day period prior to, a Guarantee Period Maturity Date. Any Surrender Charges
otherwise applicable will be waived.
For each Option we will issue a separate written agreement putting the Option
into effect.
Our approval is needed for any Option where:
(1) the person named to receive payment is other than the Certificate Owner
or the Beneficiary; or
(2) the person named is not a natural person, such as a corporation; or
(3) any income payment would be less than the minimum annuity income
payment stated below (See "Frequency Selection").
Before we pay any Annuity Benefits, we require the return of the Certificate.
If the Certificate has been lost, we require the applicable lost Certificate
form.
ANNUITY COMMENCEMENT DATE SELECTION
The Certificate Owner selects the Annuity Commencement Date. Any date following
the first Certificate Anniversary may be elected. Distributions from a
Certificate funding a Qualified Plan must commence no later than April 1st of
the calendar year following the calendar year in which the Certificate Owner
attains age 70 1/2. Otherwise, the Annuity Commencement Date may be no later
than the same date as the Certificate Date in the month following the later of
the Annuitant's 90th birthday or the 10th Certificate Anniversary. In applying
the Accumulation Value, we may first collect any Premium Taxes due us.
On the Annuity Commencement Date, the age of the Annuitant plus the number of
years payments are guaranteed must not exceed 100. If the Certificate Owner does
not select a date, the Annuity Commencement Date will be in the month following
the later of the Annuitant's 90th birthday or the 10th Certificate Anniversary.
FREQUENCY SELECTION
The Certificate Owner may choose the frequency of the Annuity Payments. They may
be monthly, quarterly, semi-annually or annually. If we do not receive written
notice, the payments will be made monthly. However, the minimum monthly annuity
income payment that we will make is $50. The minimum total income payments in
any one year is $250. We have the right to increase these minimums based upon
increases reflected in the Consumer Price Index - Urban (CPI-U) since July 1,
1993. If the Annuity Option or frequency of payments elected do not meet these
minimums, we have the right to make payments at such frequency as necessary to
meet these minimum requirements.
GA-MA-1100 16
CHOOSING AN INCOME PLAN (continued)
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THE ANNUITY OPTIONS
There are four Options to choose from. They are:
Option 1. Income for a Fixed Period
Payment is made in equal installments for a fixed number of years. We guarantee
each monthly payment will be at least the Income for Fixed Period amount shown
in the Schedule. Values for annual, semiannual or quarterly payments are
available on request.
Option 2. Income for Life
Payment is made to the person named in equal monthly installments and
guaranteed for at least a period certain. The period certain can be 10 or
20 years. Other periods certain are available on request. A refund certain may
be chosen instead. Under this arrangement, income is guaranteed until payments
equal the amount applied. If the person named lives beyond the guaranteed
period, payments continue until his or her death.
We guarantee each payment will be at least the amount shown in the Schedule. By
age, we mean the named person's age on his or her nearest birthday before the
Option's effective date. Amounts for ages not shown are available on request.
Option 3. Joint Life Income
This Option is available if there are two persons named to receive payments.
At least one of the persons named must be either the Certificate Owner or
Beneficiary. Monthly payments are guaranteed and are made as long as at least
one of the named persons is living. The monthly payment amounts are available
upon request. Such amounts are guaranteed and will be calculated on the same
basis as the Table for Income for Life, however, the amounts will be based on
two lives.
Option 4. Annuity Plan
Payment may be made under any other method mutually agreed upon by the
Certificate Owner and us.
PAYMENT WHEN NAMED PERSON DIES
When the person named to receive payment dies, we will pay any amounts still due
as provided by the Option agreement. The amounts still due are determined as
follows:
(1) For Option 1 or for any remaining guaranteed payments in Option 2,
payments will be continued.
(2) For Option 3, no amounts are payable after both named persons have died.
GA-MA-1100 17
OTHER IMPORTANT INFORMATION
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ENTIRE CONTRACT
This Contract, including any attached Riders, endorsements, amendments and the
application of the Contractholder, constitute the entire contract between the
Contractholder and us. All statements made by the Contractholder, any
Certificate Owner or any Annuitant will be deemed representations and not
warranties.
SENDING NOTICE TO US
Any written notice or request should be sent to our Customer Service Center.
REPORTS TO CERTIFICATE OWNERS
We will send each Certificate Owner a report at least once during each
Certificate Year. The report will show the Certificate's Accumulation Value and
the Cash Surrender Value as of the Report Date. The report will also show the
allocation of the Accumulation Value as of such date and the amounts deducted
from or added to the Accumulation Value since the last report. The report will
also include any information that may be currently required by the insurance
supervisory official of the jurisdiction in which the Certificate is delivered.
ASSIGNMENT - USING A CERTIFICATE AS COLLATERAL SECURITY
A Certificate Owner may assign the Certificate as collateral security for a loan
or other obligation. This does not change the Certificate's ownership. The
Certificate Owner's rights and any Beneficiary's rights are subject to the terms
of the assignment. The Beneficiary's rights may be subordinate to those of an
assignee unless the Beneficiary was designated as an irrevocable Beneficiary
prior to the assignment. To make or release an assignment, we must receive
written notice satisfactory to us, at our Customer Service Center. We are not
responsible for the validity of any assignment.
CHANGING THIS CONTRACT
This Contract or any additional benefit riders may be changed to another annuity
plan according to our rules at the time of the change.
CONTRACT CHANGES - APPLICABLE TAX LAW
We reserve the right to make changes in this Contract or its Riders to the
extent we deem it necessary to continue to qualify this Contract as an annuity.
Any such changes will apply uniformly to all Certificates that are affected. The
Contractholder and each Certificate Owner will be given advance written notice
of such changes.
MISSTATEMENT OF AGE OR SEX
If an age or sex has been misstated, the amounts payable or benefits provided by
this Contract will be those that the Premium Payment made would have bought at
the correct age or sex.
GA-MA-1100 18
OTHER IMPORTANT INFORMATION (continued)
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NON-PARTICIPATING
Neither this Contract, nor Certificates issued hereunder, participate in our
divisible surplus.
CONTESTABILITY
Certificates issued under this Contract are incontestable from their date of
issue.
PAYMENTS WE MAY DEFER
We may, at any time, defer payment of a Certificate's Cash Surrender Value for
up to six months after we receive a request for it. We will allow interest of at
least 3.00% a year or greater if required by state law, on any Cash Surrender
deferred 30 days or more.
AUTHORITY TO MAKE AGREEMENTS
All agreements made by us must be signed by one of our officers. No other
person, including an insurance agent or broker, has the authority to:
(1) Change any of this Contract's terms;
(2) Extend the time for Premium Payments; or
(3) Make any agreement binding on us.
REQUIRED NOTE ON OUR COMPUTATIONS
We have filed a detailed statement of our computations with the insurance
supervisory official in the appropriate jurisdiction. The values are not less
than those required by the law of that state or jurisdiction. Any benefit
provided by an attached Optional Benefit Rider will not increase these values
unless otherwise stated in that Rider.
FACILITY OF PAYMENT
If no Beneficiary is named, we reserve the right to pay an amount not to exceed
$2,000 to any person we determine to be entitled to such amount by reason of
incurred expenses incident to the last illness or death of a Certificate Owner.
CONFORMITY WITH LAW
If any provision of this Contract is contrary to any law to which it is subject,
such provision is considered amended to conform to such law.
RECORDS
The Contractholder will furnish us information relative to this Contract as we
may require to administer it. Such records, which in our opinion have a bearing
on this Contract, will be open to us for inspection at all reasonable times.
CERTIFICATE OWNER'S RIGHT TO EXAMINE THE CERTIFICATE
A Certificate Owner may return the Certificate to us or the agent through whom
it was purchased within 10 days of receipt (or other period provided by law). If
so returned, we will promptly refund the Accumulation Value, adjusted for any
Market Value Adjustment, plus any charges deducted (or other amount as provided
by law) as of the date the returned Certificate is received by us.
GA-MA-1100 19
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SINGLE PREMIUM DEFERRED MODIFIED GUARANTEED ANNUITY GROUP MASTER CONTRACT - NO
DIVIDENDS
Annuity Benefit payable at Annuity Commencement Date. Death Benefit payable in
the event of the Certificate Owner's death prior to the Commencement Date. Cash
Surrender Values are based on a Market Value Adjustment formula if the
Certificate is held for a period less than the currently elected Guarantee
Period. Cash Surrender Values may increase or decrease based on the Market Value
Adjustment Formula. Equity Index premium allocation option.
GA-MA-1100