Form of ADDENDUM TO SCHEDULE OF PARTICIPATON AGREEMENT
Form of ADDENDUM TO SCHEDULE OF
PARTICIPATON AGREEMENT
This Addendum (“Addendum”) to the original Schedule of the Participation Agreement executed on December 19, 2003 is entered into by and among ▇▇▇▇▇▇▇, ▇▇▇▇▇ & Co., (the “Distributor”), ▇▇▇▇▇▇▇ Sachs Variable Insurance Trust (the “Trust”), and Protective Life Insurance Company (the “Company”), collectively (the “Parties”).
WHEREAS, the Parties entered into a Participation Agreement dated December 19, 2003 (the “Agreement”). Capitalized terms used herein and not otherwise defined herein shall have the meanings assigned to such terms in the Agreement;
NOW, THEREFORE, in consideration of these premises and the terms and conditions set forth herein, the Parties agree as follows:
1. The following subaccounts and corresponding information are added to Schedule 1 of the Agreement:
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Name of Accounts and Subacounts
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Date Established by the Board of Directors of the Company
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SEC 1940 Act Registration Number
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Type of Product Supported by Account
|
|
07/02/2020
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811-23594
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Variable Annuity Policies
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2. The following classes of Contracts and corresponding information are added to Schedule 2 of the Agreement:
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Policy Marketing Name
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SEC 1933 Act Registration Number
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Contract Form Number
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Annuity or Life
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Schwab Genesis Variable Annuity NY
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333-240193
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[]
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Annuity
|
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Schwab Genesis Advisory Variable Annuity NY
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333-240103
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[]
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Annuity
|
3. The following Trust Classes and Series are added to Schedule 3 of the Agreement:
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Contract Marketing Name
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Trust Classes and Series
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Schwab Genesis Variable Annuity NY
Schwab Genesis Advisory Variable Annuity NY
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Core Fixed Income Fund, Service Class
Global Trends Allocation Fund, Service Class
Growth Opportunities Fund, Service Class
Mid Cap Value Fund, Service Class
Strategic Growth Fund, Service Class
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For the purpose of referring to this Amendment, the date of this Amendment shall be [DATE].
[SIGNATURES ON THE FOLLOWING PAGE]
▇▇▇▇▇▇▇, ▇▇▇▇▇ & Co.
Protective Life and Annuity Insurance Company
Name:
___________________________
Name:
___________________________
Title:
___________________________
Title:
___________________________
Date: ___________________________
Date: ____________________________
Goldman SachsVariable Insurance Trust
By:
___________________________
Name:
___________________________
Title:
___________________________
Date: ___________________________
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