[LOGO] The Guardian(R) The Guardian A Stock Company
Insurance & Annuity Incorporated in the
Company, Inc. State of Delaware
Customer Service Office: Executive Office:
P.O. Box 8833 ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇
▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇
The Guardian Insurance & Annuity Company, Inc. (the Company) will pay the
benefits provided by this contract in accordance with its provisions. All of the
provisions on this and the following pages are part of this contract. This
contract is issued by the Company at its Customer Service Office on the issue
date.
/s/ [ILLEGIBLE] /s/ [ILLEGIBLE]
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Secretary President
Checked by
Under this contract, flexible premium payments may be made following the initial
premium payment. Benefits depend, among other things, on the number and value of
accumulation units and the annuity payout option elected.
ALL VALUES PROVIDED BY THIS CONTRACT WHICH ARE BASED ON THE INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT ARE VARIABLE, MAY INCREASE OR DECREASE, AND ARE
NOT GUARANTEED. SEE THE "ACCUMULATION VALUE" SECTION ON PAGES 6 AND 7 AND THE
"PAYMENT OF CONTRACT PROCEEDS" SECTION ON PAGES 8 AND 9 FOR AN EXPLANATION OF
THE VARIABLE VALUES AND PAYMENTS PROVIDED UNDER THIS CONTRACT.
Flexible Payment Deferred Combination Variable and Fixed Group Annuity
Contract
o Benefits based on the investment experience of a Separate Account are
variable and are not guaranteed
o Non-participating--No dividends payable
Owner :
Issue Date :
Contract Number:
Plan :
[SPECIMEN]
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GUIDE TO CONTRACT PROVISIONS
1. Annuity Benefit
2. Owner
3. Premium Payments
4. Separate Accounts
5. Fixed Rate Option
6. Transfers
7. Accumulation Value
8. Surrenders and Withdrawals
9. Payment of Contract Proceeds
10. General Provisions
Followed by any Endorsements.
An alphabetical index appears on the inside of the back cover.
1. ANNUITY BENEFIT
Under certain conditions, the owner may direct the Company to apply a portion of
this contract's accumulation value to provide monthly annuity payments for a
plan participant. (See page 11 for the definitions of the terms "plan" and
"participant.") Annuity payments for a participant will begin on the annuity
commencement date for such participant as stated by the owner, if:
o this contract is in force on that date; and
o the participant is living and is between the ages of 50 and 85 (unless the
Company agrees otherwise) on that date.
At the time annuity payments begin, the Company will determine the amount of
each monthly annuity payment. This amount will be calculated by applying the
amount applied for a participant as stated by the owner, less any applicable
state premium taxes, under Option V-2 of Variable Annuity Payout Options, unless
another option is elected. The amounts of the payments will vary according to
the annuitant's age. Under Option V-2, payments are guaranteed for a period of
10 years. See the "Payment of Contract Proceeds" section for an explanation of
how annuity payments are determined.
The Company will issue a certificate to the owner for delivery to each
participant when an annuity is provided for such participant. Each such
certificate will set forth the amount and terms of the annuity payments and any
other benefits to which the participant may be entitled under this contract.
2. OWNER
Owner
The owner is named in the application. The owner alone has the right to receive
all benefits and exercise all rights this contract grants or the Company allows.
Nontransferability of Ownership
If this contract is issued in conjunction with a retirement plan qualified under
the Internal Revenue Code, the owner may not:
o change the ownership;
o sell or assign this contract;
o pledge this contract as collateral for a loan or as security for the
performance of an obligation or for any other purpose to any person other
than the Company, unless the owner is:
o the trustee of an employee trust qualified under the Internal
Revenue Code;
o the custodian of a custodial account treated as such; or
o the employer under a qualified nontrusteed pension plan.
Assignment
No assignment will bind the Company unless the original, or a copy in a form
satisfactory to the Company, is filed at the Customer Service Office. Afterward,
the rights of any owner will be subject to the assignment. The entire contract
will be subject to the assignment. The Company will rely solely on the
assignee's statement as to the amount of the assignee's interest. The Company
will not be responsible for the validity of any assignment. Unless otherwise
provided, the assignee may exercise all rights this contract grants except:
o the right to change the beneficiary; and
o the right to elect an annuity payout option.
3. PREMIUM PAYMENTS
Under this contract, the owner may make flexible premium payments to the Company
in accordance with the provisions of the plan. All premium payments are payable
at the Company's Customer Service Office.
The minimum amount of the initial premium payment is $5,000. While this contract
is in force, the Company will accept additional flexible premium payments of at
least $500. Subsequent payments in excess of $100,000 in any one contract year
are acceptable only with the written consent of the Company.
Allocation of Net Premiums
A net premium is equal to the premium paid less any applicable state premium
taxes. Subject to the conditions described below, the Company will allocate the
net premiums to the contract's allocation options, which consist of the Fixed
Rate Option and the following variable investment options:
o the investment divisions of The Guardian Separate Account D (as described
below); and
o The Guardian Real Estate Account (as described below).
Such allocation will be based on the allocation percentages designated in the
application, or as subsequently changed by the owner in a written notice
acceptable to the Company and received by the Company at its Customer Service
Office prior to the date of the allocation. The value of the contract and any
net premiums paid may not be invested in more than four allocation options at
any time; that is, such value or net premiums may not be transferred or
allocated to more than four variable investment options or three variable
investment options and the Fixed Rate Option at any time.
Net premiums will be applied to provide accumulation units (see "Accumulation
Units" provision).
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4. SEPARATE ACCOUNTS
The Guardian Separate Account D and The Guardian Real Estate Account
This contract is funded by two separate investment accounts established by the
Company under the laws of the state of Delaware. These separate accounts are
subject to the laws of the jurisdiction in which this contract is delivered.
These separate accounts are:
o The Guardian Separate Account D (Account D); and
o The Guardian Real Estate Account (the RE Account).
Account D is registered as a unit investment trust with the Securities and
Exchange Commission (SEC) under the Investment Company Act of 1940, and its
units are registered under the Securities Act of 1933 (1933 Act). The RE Account
itself is not an investment company, but its interests are registered with the
SEC under the 1933 Act. Each separate account is treated as a division of the
Company. Account D is used to provide values and benefits for variable annuities
only. The Company owns the assets in both separate accounts. The assets in
Account D and the RE Account are kept separate from:
o each other;
o the Company's general investment account; and
o the Company's other separate accounts.
Assets equal to the reserves and liabilities of Account D or the RE Account will
not be charged with liabilities that arise from any other business the Company
may conduct. The Company may transfer assets in excess of the reserves and
liabilities of Account D or the RE Account to the general investment account.
▇▇▇▇▇▇ and realized and unrealized gains and losses from assets in Account D or
the RE Account are credited to or charged against the applicable separate
account without regard to income, gain, or loss in the Company's other
investment accounts.
Investment Divisions
Account D consists of several investment divisions. Each investment division of
Account D invests in shares of a mutual fund. Each mutual fund is managed by an
investment adviser registered under the Investment Advisers Act of 1940.
The investment divisions available on the issue date are listed in the then
current prospectus for Account D as it relates to this contract. Each mutual
fund is more fully described in a separate prospectus for each fund.
Rights Reserved by the Company
The Company reserves the right to take certain actions deemed to be in the
best interest of the owner and when permitted by applicable law. These
actions are:
o to deregister Account D under the Investment Company Act of 1940;
o to operate Account D as a management investment company or any other form
permitted by law;
o to combine any two or more separate accounts or investment divisions
within Account D;
o to transfer assets determined by the Company to be assigned to the class
of contracts to which the contracts belong from Account D or the RE
Account to another separate account by withdrawing the same percentage of
each investment in Account D or the RE Account with appropriate
adjustments to avoid odd lots and fractions;
o to substitute shares of any fund offered under this contract with shares
of another fund offered under this contract if, in the judgment of the
Company, further investment in such shares is no longer appropriate. Such
change may be subject to the approval of the SEC, the Delaware Insurance
Department and other state or federal regulatory authorities;
o to add to, eliminate, or suspend the owner's ability to allocate premium
payments or transfer amounts to any investment division within Account D
and/or the Real Estate Account; and
o to modify this contract as necessary to prevent the owner from being
considered the owner of the assets of Account D, the RE Account, or the
Fixed Rate Option, and thereby subject to federal or state income taxation
on gains under the contract.
Change in Investment Objective or Policy
The Company will notify the owner of any material change in an investment policy
or objective of any mutual fund invested in by an investment division to which
part of this contract's accumulation value is allocated. Details of any such
change will be filed with any regulatory authority where required and will be
subject to any required approval.
5. THE FIXED RATE OPTION
The owner may allocate all or part of any net premiums to the Fixed Rate Option.
The Company will credit interest on the portion of net premiums applied to and
any amounts transferred to the Fixed Rate Option. Interest will accrue daily at
a minimum guaranteed annual rate of 3.5%. At the discretion of the Company, an
interest rate in excess of the minimum guaranteed rate may be credited. The
Company will provide notice of the applicable interest rates in the annual
report to the owner and upon request.
Any portion of a net premium allocated to the Fixed Rate Option on the issue
date will earn interest at the then current rate as set by the Company. This
interest rate will be guaranteed until the next contract anniversary.
After the issue date, any portion of net premiums applied to and any amounts
transferred into the Fixed Rate Option will earn interest at the then current
rate set by the Company. This rate will be guaranteed for the remainder of the
contract year, until the next contract anniversary.
[SPECIMEN]
THE FIXED RATE OPTION--cont'd.
On the contract anniversary, any portion of the accumulation value attributed to
the Fixed Rate Option will earn interest at the then current rate set by the
Company. This rate will be guaranteed until the next contract anniversary.
If, on any contract anniversary the interest rate the Company sets for the Fixed
Rate Option is more than 3 percentage points lower than the rate set for the
immediately preceding contract year, the owner may withdraw all or a portion of
the accumulation value held in the Fixed Rate Option for at least one contract
year without that amount being subject to a contingent deferred sales charge.
The Company must receive proper written request for such withdrawal at its
Customer Service Office within 60 days of such contract anniversary.
6. TRANSFERS
Transfers of Accumulation Value by the Owner
The owner may transfer all or a portion of the accumulation units credited under
this contract among the investment divisions of Account D, the RE Account, and
the Fixed Rate Option, subject to the following conditions:
o Proper written request for transfer must be received by the Company at its
Customer Service Office. Other transfer procedures permitted by the
Company, if any, must be followed as set out in the prospectus for this
contract.
o Accumulation units may not be credited to or transferred into more than
four variable investment options or to three variable investment options
and the Fixed Rate Option at any time.
o The transfer of accumulation units from the RE Account to a subdivision of
Account D or to the Fixed Rate Option may only be made once each year on
or within 30 days after a contract anniversary. The maximum amount that
may be transferred from the RE Account each contract year is the greater
of:
o 33 1/3% of the accumulation value attributable to the RE Account as
of the contract anniversary; or
o $10,000.
o The transfer of accumulation units from the Fixed Rate Option to an
investment division of Account D or to the RE Account may only be made
once each year on or within 30 days after a contract anniversary.
Transfers out of the Fixed Rate Option will be made in the same order as
such amounts were allocated to the Fixed Rate Option. The maximum amount
that may be transferred from the Fixed Rate Option each contract year is
the greater of:
o 33 1/3% of the portion of the accumulation value attributable to the
Fixed Rate Option as of the contract anniversary; or
o $2,500.
The number of additional accumulation units credited under this contract in the
newly elected Fixed Rate Option or variable investment option(s) will be equal
to (a) divided by (b) where:
o (a) is the value of the amount transferred; and
o (b) is the value of an accumulation unit in the newly elected investment
option(s) as of the end of the valuation date on which the proper written
request for transfer is received by the Company at its Customer Service
Office.
The Company reserves the right to limit the frequency of transfers of
accumulation units under the contract to once every 30 days and to charge for
such transfers in the future.
Transfers By An Annuitant Following His/Her Annuity Commencement Date
An annuitant receiving annuity payments under a variable annuity payout option
may transfer all or a portion of his/her annuity units (as defined in the
"Annuity Unit Values" provision) among the variable investment options. The
conditions applicable to transfers of accumulation units, as described above,
also apply to transfers made after an annuity commencement date.
However, any transfers after an annuity commencement date can be made only once
each year. Any such transfer will take effect upon the next calculation of
annuity unit values after the Company receives proper transfer instructions at
its Customer Service Office.
For transfers made after an annuity commencement date, the number of additional
annuity units credited under the newly elected variable investment option(s)
will be equal to (a) divided by (b), where:
o (a) is the amount of the monthly variable annuity payment that is to be
transferred as of December 31st of that year; and
o (b) is the value of one annuity unit in the newly elected investment
option(s) as of December 31st of that year.
After an annuity commencement date, the annuitant receiving annuity payments
under a fixed annuity payout option may not transfer into the RE Account or the
investment divisions of Account D.
Dollar Cost Averaging Transfer Option
If part of the contract's accumulation value is allocated to the investment
division investing in The Guardian Cash Fund, the owner may choose to make
monthly transfers under the Dollar Cost Averaging Transfer Option, subject to
the conditions described below.
Under this option, an amount specified by the owner will be automatically
transferred out of The Guardian Cash Fund and into the Fixed Rate Option or the
variable investment option(s)
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TRANSFERS--cont'd.
elected by the owner on a monthly basis. The owner may choose to have monthly
transfers made for durations of 12, 24, or 36 months.
The following conditions apply to the Dollar Cost Averaging Transfer Option:
o An owner may elect this option on the issue date only if the initial
premium is at least:
o $10,000 and the owner chooses to make monthly transfers for a 12
month period; or
o $20,000 and the owner chooses to make monthly transfers for a 24
month or 36 month period.
o An owner may elect this option after the issue date only if the contract
has a minimum accumulation value at the time the option is elected:
o If the owner chooses to make monthly transfers for a 12 month
period, the contract's accumulation value must be at least $10,000.
o If the owner chooses to make monthly transfers for a 24 month or 36
month period, the contract's accumulation value must be at least
$20,000.
o The minimum amount which may be transferred into the Fixed Rate Option
and/or each variable investment option is $100.
o Money may not be transferred into more than three other variable
investment options or two other variable investment options and the Fixed
Rate Option at any time.
The transfer amount(s) selected by the owner multiplied by the duration selected
may not exceed the accumulation value of The Guardian Cash Fund at the time the
option is exercised. Transfers will be made on each monthly anniversary, or on
the next business day if such anniversary is on a weekend or holiday.
The Dollar Cost Averaging Transfer Option will terminate if:
o this contract is surrendered;
o the requested number of transfers has been made;
o the accumulation value in The Guardian Cash Fund is insufficient to make a
monthly transfer; or
o the Company receives proper written request from the owner to cancel the
option. Such request must be received at the Company's Customer Service
Office at least 3 business days before the next monthly anniversary in
order to cancel the transfer scheduled to take effect on such anniversary.
After the issue date, in order to initiate or effect any change under the Dollar
Cost Averaging Transfer Option, or to reinstate such option if it has
terminated, the owner must properly complete an enrollment form and submit it to
the Company's Customer Service Office. Such form must be received by the Company
at least 3 business days before the monthly anniversary on which such first
transfer will be made.
7. ACCUMULATION VALUE
Accumulation Units
An accumulation unit is a measurement used to determine the value of the owner's
interest under this contract while the contract is in force. As each participant
reaches his/her annuity commencement date, the accumulation value under the
contract is reduced by the value of the accumulation units used by the owner to
purchase an annuity for such participant. The number of accumulation units
purchased in each designated variable investment option or the Fixed Rate Option
will be determined by multiplying (a) by (b), then dividing the result by (c),
where:
o (a) is the net premium;
o (b) is the percentage to be allocated to the specified variable investment
option or the Fixed Rate Option; and
o (c) is the value of an accumulation unit for the specified variable
investment option or the Fixed Rate Option as of the valuation period
during which the premium is received at the Company's Customer Service
Office.
The value of each variable accumulation unit will depend on the investment
experience of the variable investment options selected. Thus this value may
increase or decrease and may vary from one valuation period to the next.
Accumulation Unit Value for Account D and the RE Account
The value of a variable accumulation unit for each investment division of
Account D and for the RE Account was established at $10.00 as of the date
operations began for that division or began for the RE Account. The accumulation
unit value for any valuation period thereafter is (a) multiplied by (b), where:
o (a)is the variable accumulation unit value for the immediately preceding
valuation period; and
o (b) is the net investment factor, as described below, for the current
valuation period.
Accumulation Unit Value for the Fixed Rate Option
The value of accumulation units for the Fixed Rate Option was established at
$10.00 as of the date operations began for that option. Thereafter, it will
increase daily at a rate of interest to be determined from time to time by the
Company, but which is guaranteed to be no less than 3.5% annually.
Net Investment Factor
The Company assesses a daily charge of .00003169 of the value of the assets
allocated to each of the investment divisions of Account D and to the RE Account
for its assumption of mortality and expense risks. This mortality and expense
charge is used in determining the net investment factor for each investment
division of Account D and for the RE Account. On an annual basis, the charge is
equal to 1.15% of the value of the assets allocated to these variable investment
options.
[SPECIMEN]
ACCUMULATION VALUE - cont'd.
The net investment factor is used to calculate the value of an accumulation unit
in an investment division of Account D or in the RE Account for a valuation
period. The net investment factor is determined by dividing the sum of (a) and
(b) by (c), and subtracting (d) from the result, where:
o (a) is the net asset value of a fund share held in Account D for the
applicable investment division or any interest held in the RE
Account, determined as of the end of the then current valuation
period;
o (b) is the per share or per interest amount of any dividend and
other distributions made by the fund or the RE Account during the
current valuation period;
o (c) is the net asset value of the particular fund share or interest
in the RE Account determined as of the end of the immediately
preceding valuation period;
o (d) is any applicable state premium taxes and the mortality and
expense charge.
The net investment factor may be less than 1.00 since it is related to the
investment experience of a separate account.
Accumulation Value
The value of all the accumulation units credited to this contract is the
accumulation value. The accumulation value within any particular variable
investment option or the Fixed Rate Option is determined by multiplying (a) by
(b), where:
o (a) is the number of accumulation units credited to the contract for
that particular variable investment option or the Fixed Rate Option;
and
o (b) is the applicable current accumulation unit value.
On each participant's annuity commencement date, the accumulation value of this
contract will be reduced by that portion of the accumulation value applied by
the owner to purchase an annuity for the participant.
8. SURRENDERS AND WITHDRAWALS
The owner may withdraw all or part of the accumulation value of this contract.
Surrender of Contract
The owner may surrender this contract for its then current accumulation value;
the contract will then terminate. This contract must be sent to the Company's
Customer Service Office for cancellation.
Partial Withdrawals
Any partial withdrawals first will be taken from the investment divisions of
Account D in proportion to each investment division's accumulation value on the
date of the withdrawal. Partial withdrawals in excess of the amount taken from
the investment divisions of Account D will then be withdrawn from the RE
Account. Any remaining excess will be withdrawn from the Fixed Rate Option.
Amounts withdrawn from any variable investment option or the Fixed Rate Option
will be made in the same order in which such amounts were allocated to that
variable investment option or the Fixed Rate Option.
The total accumulation value remaining after a partial withdrawal must be at
least $1,000. If a partial withdrawal results in the total accumulation value
falling below $1,000, then the balance will be paid to the owner and the
contract will be cancelled.
The following conditions apply for both partial withdrawals and surrenders:
o Written request satisfactory to the Company must be received at its
Customer Service Office prior to any surrender or withdrawal.
o Any withdrawal payment or surrender will be reduced by any
applicable state premium taxes and contingent deferred sales charges
(as described below).
o The amount of any withdrawal payment will be determined as of the
valuation date on or next following the date the Company receives
the owner's proper written request for surrender or withdrawal.
Contingent Deferred Sales Charges
A contingent deferred sales charge may be imposed on partial withdrawals or on
the surrender of the contract. The amount of any contingent deferred sales
charge will be the lesser of:
o 6% of the total premiums paid in the 84 month period preceding the
date of withdrawal or surrender; or
o 6% of the amount withdrawn or surrendered.
However, in any contract year after the first, the owner may make withdrawals,
without incurring any contingent deferred sales charge, of up to 10% of the
greater of:
o the amount of total premiums paid during the 84 months preceding the
date of withdrawal; or
o the accumulation value as of the date of the first withdrawal in
that contract year.
The maximum amount of contingent deferred sales charges applied during the 84
months immediately preceding the date of withdrawal will never exceed 6% of the
total premiums paid during such period.
Administration Fee
On each contract anniversary the Company will deduct an administration fee of
$35 from the accumulation value of this contract. This fee will be deducted from
each investment division of Account D, from the RE Account and from the Fixed
Rate Option in proportion to the percentage of the accumulation value in Account
D, the RE Account, and the Fixed Rate Option on that date. If this contract is
surrendered on a date other than on a contract anniversary, the Company will
deduct the administration fee on the date of surrender.
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9. PAYMENT OF CONTRACT PROCEEDS
Following his/her annuity commencement date, each participant under this
contract will be referred to as an "annuitant".
Payment
When directed by the owner, the Company will make monthly variable annuity
payments to the annuitant under Variable Annuity Payout Option V-2, as stated in
the "Annuity Benefit" provision or, if elected, one of the other annuity payout
options. Payment of any annuity benefit may be made under either a fixed or
variable annuity payout option or a combination of both. If annuity payout
option F-3 or V-3 is chosen, the annuitant must also select a joint annuitant.
o The amount of the first annuity payment will be based on the table for the
annuity payout option elected.
o The amount of any fixed annuity payments will not be less than the
corresponding minimum amount based on the tables for the fixed annuity
payout options, with interest compounded each year at 4%.
o The amount of any variable annuity payments after the first will increase
or decrease according to the value of the variable annuity units, which
reflect the investment experience of the variable investment option(s)
elected. Any such payments will be based on an assumed investment return
of 4% per year.
o All monthly annuity payments are based on:
o the age of the annuitant at the birthday nearest the date payments
are to begin; and
o the annuity payout option elected.
The annuity payout option tables are based on the blended 1983 Individual
Annuity Mortality Table a projected under Scale G factors.
Change of Beneficiary
The annuitant may changes beneficiary designated to receive benefits under
annuity payout options V-2 and F-2. Any request for change must be in a written
form satisfactory to the Company. The change will take effect on the date the
request is signed, whether or not the annuitant is living when the Company
receives the request at its Customer Service Office. However, the change will
not apply to any payments made or actions taken by the Company before the
request is received.
Contingent Beneficiary
A numbered sequence may be used to name contingent beneficiaries for annuity
payout options V-2 and F-2. The beneficiary is the living person(s) designated
by the lowest number in the sequence.
Variable Annuity Payout Options Available
Option V.1 - Life Annuity without Guaranteed Period
The Company will make monthly variable annuity payments for the lifetime of the
annuitant. The amount of the first monthly payment will be based on the Option
V-1 table.
Option V-2 - Life Annuity with 10 Year Guaranteed Period
The Company will make monthly variable annuity payments during the lifetime of
the annuitant. The amount of the first monthly payment will be based on the
Option V2 table.
Payments are guaranteed for a period of 10 years. If the annuitant dies sooner,
payments will be made during the remaining period to the beneficiary designated
by the owner. The beneficiary may elect to be paid the commuted value of the
current dollar amount of the then remaining number of variable annuity payments.
If the beneficiary dies while receiving such payments, the commuted value of the
current dollar amount of the remaining number of variable annuity payments will
be paid in one sum to the beneficiary's estate.
If any designated beneficiary dies before the annuitant, the interest of that
beneficiary shall pass to the designated surviving beneficiary. If more than one
beneficiary survives the annuitant, such interest shall pass to the surviving
beneficiaries in proportion to their respective interest, unless otherwise
previously specified by the owner. If no designated beneficiary survives the
annuitant, and no other designation is provided, the benefit provided under this
annuity payout option shall be paid in one sum to the annuitant's estate.
Option V-3 - Joint and Survivor Annuity
The Company will make monthly variable annuity payments while the annuitant and
the joint annuitant are living. When an annuitant dies, two-thirds of the number
of annuity units in effect while both were living will continue for the lifetime
of the survivor. The amount of the first variable annuity payment will be based
on the Option V-3 table.
Fixed Annuity Payout Options Available
Option F-1 - Life Annuity without Guaranteed Period
The Company will make monthly fixed annuity payments for the lifetime of the
annuitant.
Option F-2 - Life Annuity with 10 Year Guaranteed Annuity Period
The Company will make monthly fixed annuity payments during the lifetime of the
annuitant. Payments are guaranteed for a period of 10 years. If the annuitant
dies sooner, payments will be made during the remaining period to the
beneficiary designated by the owner. The beneficiary may elect to be paid the
present value of the current dollar amount of the then remaining number of fixed
annuity payments. If the beneficiary dies while receiving such payments, the
present value of the current dollar amount of the remaining number of fixed
annuity payments will be paid in one sum to the beneficiary's estate.
PAYMENT OF CONTRACT PROCEEDS - cont'd.
If any designated beneficiary dies before the annuitant, the interest of that
beneficiary shall pass to the designated surviving beneficiary. If more than one
beneficiary survives the annuitant, such interest shall pass to the surviving
beneficiaries in proportion to their respective interest, unless otherwise
previously specified by the owner. If no designated beneficiary survives the
annuitant, and no other designation is provided, the benefit provided under this
annuity payout option shall be paid in one sum to the annuitant's estate.
Option F-3 - Joint and Survivor Annuity
The Company will make monthly fixed payments while the annuitant and the joint
annuitant are living. When an annuitant dies, the Company will continue to pay,
for the lifetime of the survivor, two-thirds of the amount of the payment in
effect while both were living.
Determination of First Annuity Payment
The tables below indicate the dollar amount of the first monthly annuity payment
which can be purchased with each $1,000 of the portion of the accumulation value
applied by the owner to purchase an annuity for a participant. The first annuity
payment is determined by multiplying (a) by (b), where:
o (a) is the amount shown in the applicable table for the annuitant's
age; and
o (b) is the number of thousands of dollars of accumulation value.
The dollar amount of the first monthly annuity payment purchased for ages not
shown in the tables are available upon request.
Annuity Unit Values
For variable annuity payout options, the portion of the accumulation value
stated by the owner will be applied to purchase annuity units. Annuity units are
used to determine the amount of each variable annuity payment after the first.
The value of an annuity unit is determined independently for each investment
division of Account D and for the RE Account The dollar value of variable
annuity units may increase or decrease depending upon the investment experience
of the investment option(s) elected.
The value of an annuity unit in each investment division of Account D and in the
RE Account was established at $1.00 on the date operations began for each such
variable investment option. The value of an annuity unit at the end of any
subsequent valuation period is equal to (a) multiplied by (b), where:
o (a) is the annuity unit value on the immediately preceding valuation
period; and
o (b) is the annuity change factor for the current valuation period.
The annuity change factor is equal to the net investment factor (as described in
the "Net Investment Factor" provision) for the same valuation period adjusted to
recognize the assumed investment return of 4% per year used in determining the
amounts of variable annuity payments.
The valuation of all assets in Account D and the RE Account will be determined
in accordance with all applicable laws and regulations.
Determination of Variable Annuity Payments After the First
The amounts of variable annuity payments made after the first are determined by
multiplying (a) by (b), where:
o (a) is the number of annuity units in each investment division of
Account D and in the RE Account; and
o (b) is the appropriate annuity unit value as of the valuation date
10 days prior to the date the variable annuity payment is due.
The number of annuity units under this contract is determined by dividing (a) by
(b), where:
o (a) is the amount of the first monthly variable annuity payment for
each investment division of Account D and for the RE Account; and
o (b) is the value of the appropriate annuity unit on the date the
first variable annuity payment is made.
The number of annuity units remains fixed during the annuity payment period,
provided no transfers among variable investment options are made.
The Company guarantees that the dollar amount of each variable annuity payment
after the first will not be adversely affected by:
o the actual administration expenses it incurs; or
o variations in mortality experience from the mortality assumptions
upon which the first payment is based.
Annuity Payout Options: General Provisions
o At least $2,000 must be applied under an annuity payout option for
any annuitant. Proceeds of a smaller amount will be paid in one sum.
o If monthly annuity payments are or become $20 or less, the Company
reserves the right to change the frequency of payment.
o While an annuitant is receiving annuity payments and subject to the
Company's consent, the annuitant may change the frequency of the
annuity payments being made. A written request for such change, in a
form satisfactory to the Company, must be received at the Customer
Service Office. The change will take effect upon receipt of the
written request.
o The Company requires satisfactory proof of the age of the annuitant
on the date annuity payments begin.
o Except with the consent of the Company, the annuity payout options
will not be available with respect to any part of the proceeds
payable to an assignee or to other than a natural person entitled to
receive proceeds.
o The annuitant does not have the right to advance or assign payments
made under an annuity payout option.
o The annuitant cannot make any change in the manner of payout, except
as provided in the election.
o To the extent permitted by law, the payments made under an annuity
payout option will not be subject to encumbrance, or to the claims
of creditors or legal process.
Page 9
Page 10
ANNUITY PAYOUT OPTION TABLES
DOLLAR AMOUNT OF THE FIRST MONTHLY ANNUITY PAYMENT PURCHASED
WITH EACH $1,000 OF PROCEEDS APPLIED
----------------------------------------------------------------------------------------------------
Options F-1, F-2, V-1 and V-2 - Life Annuity Options F-3 and V-3 - Joint and Survivor Annuity
----------------------------------------------------------------------------------------------------
Nearest Age of Younger Annuitant
Nearest at Date of First Payment
Nearest Age Options Options Age of --------------------------------
of Annuitant F-1 and V-1 F-2 and V-2 Older Annuitant Age Age
At Date of No Period 10 Years At Date of 10 Years 5 Years Same
First Payment Certain Certain First Payment Less Less Age
----------------------------------------------------------------------------------------------------
40 $4.01 $4.00 40 $3.80 $3.85 $3.92
41 4.04 4.04 41 3.82 3.88 3.95
42 4.08 4.07 42 3.84 3.91 3.98
43 4.12 4.11 43 3.87 3.94 4.02
44 4.16 4.15 44 3.90 3.97 4.05
45 4.20 4.19 45 3.92 4.00 4.09
46 4.24 4.23 46 3.95 4.04 4.13
47 4.29 4.27 47 3.99 4.07 4.17
48 4.34 4.32 48 4.02 4.11 4.21
49 4.39 4.37 49 4.05 4.15 4.26
50 4.44 4.42 50 4.09 4.19 4.30
51 4.50 4.48 51 4.13 4.23 4.35
52 4.56 4.53 52 4.17 4.28 4.41
53 4.62 4.59 53 4.21 4.33 4.46
54 4.69 4.65 54 4.26 4.38 4.52
55 4.76 4.72 55 4.30 4.43 4.58
56 4.83 4.79 56 4.35 4.49 4.65
57 4.91 4.87 57 4.41 4.55 4.72
58 5.00 4.94 58 4.46 4.61 4.79
59 5.08 5.03 59 4.52 4.68 4.87
60 5.18 5.11 60 4.58 4.75 4.95
61 5.28 5.21 61 4.64 4.83 5.04
62 5.39 5.30 62 4.71 4.91 5.14
63 5.50 5.40 63 4.79 4.99 5.24
64 5.63 5.51 64 4.86 5.09 5.34
65 5.76 5.63 65 4.95 5.18 5.46
66 5.90 5.75 66 5.03 5.29 5.58
67 6.05 5.87 67 5.13 5.40 5.71
68 6.21 6.00 68 5.22 5.51 5.85
69 6.39 6.14 69 5.33 5.64 6.00
70 6.57 6.28 70 5.44 5.77 6.16
71 6.76 6.43 71 5.56 5.92 6.33
72 6.97 6.58 72 5.68 6.07 6.51
73 7.19 6.74 73 5.82 6.23 6.70
74 7.43 6.90 74 5.96 6.40 6.91
75 7.69 7.07 75 6.11 6.59 7.13
76 7.96 7.24 76 6.28 6.79 7.37
77 8.25 7.42 77 6.45 7.00 7.62
78 8.56 7.59 78 6.64 7.22 7.89
79 8.90 7.78 79 6.83 7.46 8.18
80 9.26 7.98 80 7.05 7.72 8.50
81 9.65 8.14 81 7.27 8.00 8.84
82 10.07 8.32 82 7.52 8.30 9.20
83 10.53 8.50 83 7.77 8.62 9.60
84 11.02 8.68 84 8.05 8.97 10.02
85 11.55 8.85 85 8.35 9.35 10.49
----------------------------------------------------------------------------------------------------
10. GENERAL PROVISIONS
The Contract
The entire contract consists of this contract, any attached endorsements, and
the attached copy of the application. The Company relied upon the application in
issuing this contract. All statements in the application are assumed to be true
to the best knowledge and belief of the person(s) making them. These statements
are representations and not warranties. No statement will be used to contest
this contract unless contained in the application.
Only the President, a Vice President, or the Secretary of the Company may make
or modify this contract, and then only in writing. No agent is authorized to
change this contract or to waive any of the Company's requirements; no agent may
waive an answer to any question in the application. The Company will not be
bound by any promise or statement made by any agent or other person except as
stated above.
The Company may at any time make any change in this contract to the extent that
such change is required in order to make this contract conform with any law or
any regulation issued by any governmental authority to which the Company is
subject.
Age
If the age of the annuitant has been misstated, any benefit payable under this
contract will be that which the premium(s) would have purchased at the correct
age. Overpayments made by the Company because of such misstatement, with
interest at 6% a year, compounded annually, will be charged against benefits
falling due after the adjustment. If underpayments are made by the Company
because of such misstatement, the Company will pay the balance immediately, with
6% interest, compounded annually.
Plan
The plan is specified on the front cover of this contract. The plan may be
either a pension or profit-sharing plan qualified for special tax treatment
under Section 401(a) of the Internal Revenue Code or other group
employer-sponsored retirement plans.
Participant
A participant is an eligible employee (as defined in the plan) who participates
in the plan. A participant is the annuitant who receives an annuity benefit
under the terms of this contract.
Proof of Age and Survival
The Company has the right to require satisfactory proof:
o of the age of any annuitant or annuitants; and
o that an annuitant is living when a payment is contingent upon the
annuitant's survival.
Issue Date
The issue date is stated on page 3. This is the date this contract is issued at
the Customer Service Office.
Annuity Commencement Date
An annuity commencement date is the date on which monthly annuity payments to a
participant begin, in accordance with the terms of the plan. This date may be
the first day of any calendar month following a participant's 50th birthday, but
may not be later than the participant's 85th birthday, unless the Company agrees
otherwise.
Contract Anniversary
Contract anniversaries are measured from the issue date.
Monthly Anniversary
The monthly anniversary for each contract month is the same day of the month as
the issue date or the last day of that calendar month, if earlier.
Incontestability
This contract will be incontestable after it has been in force during the
annuitant's lifetime for 2 years from its issue date.
Payments by the Company
Any payment by the Company under this contract is payable at its Customer
Service Office. The Company reserves the right to require surrender of this
contract prior to payment of any amounts withdrawn.
Nonparticipating
This contract is not eligible for dividends and will not share in the surplus
earnings of the Company.
Ownership of Assets
The Company shall have ownership and control of its assets, including all assets
allocated to Account D, the RE Account, and the Fixed Rate Option.
Valuation Date
A valuation date is the date on which the accumulation unit values and the
annuity unit value of the variable investment options are determined. Valuations
are made daily.
Valuation Period
A valuation period is the period between two valuation dates.
Deferment
The Company will ordinarily pay any partial withdrawals or surrender proceeds
within 7 days after the date proper written request for withdrawal or surrender
is received by the Company's Customer Service Office. However, when permitted by
law, the Company may defer payment of any partial withdrawals or surrender
proceeds for up to 6 months after proper written request for such withdrawal or
surrender is received.
The amount payable will be determined as of the date proper written request is
received. Interest at the rate of 3% will be paid on any amount deferred 30 days
or more.
The Company may defer calculation or payment of any partial withdrawals or
surrender proceeds or the transfer of amounts based on separate account
performance if:
o the New York Stock Exchange is closed for trading or trading has
been suspended; or
Page 11
Page 12
GENERAL PROVISIONS - cont'd.
o the Securities and Exchange Commission restricts trading or
determines that a state of emergency exists which may make such
calculation, payment, or transfer impracticable.
The Company may also defer for up to 6 months any calculation, payment or
transfer of amounts attributable to the RE Account if there appears to be
insufficient cash available to meet such payment or transfer requests and prompt
disposition of the RE Account's investments to meet such requests could not be
made on commercially reasonable terms.
Reports to the Owner
The Company will provide a written report to the owner at least once a year
while this contract has an accumulation value. The Company will send the report
to the owner soon after each contract anniversary. The report will show the
accumulation value of this contract, as of a date not more than 2 months prior
to the date of the report.
The Company will also send appropriate statements containing such information as
may be required by applicable laws, rules, and regulations.
ENDORSEMENTS
[SPECIMEN]
Page 13
AMENDMENT OF CONTRACT PROVISIONS
This rider is attached to and made part of the Contract. This rider is subject
to all of the applicable provisions of the Contract.
The Fixed Rate Option
Subject to the conditions stated in this rider, the Owner may allocate all or
part of any net premium(s) to the Fixed Rate Option. If this Contract is a
single premium payment Contract, then any instructions to allocate the net
premium to the Fixed Rate Option must be made on or before the issue date of
this Contract. If any part of a net premium is allocated to the Fixed Rate
Option, the balance may be allocated to no more than three Separate Account
Divisions.
The Fixed Rate Option will not be maintained after the retirement date. Any
portion of the accumulation value in the Fixed Rate Option on the retirement
date will be applied to the annuity payout option elected.
The Company will credit interest on the portion of net premium(s) applied to and
any amounts transferred to the Fixed Rate Option. Interest will accrue daily at
a minimum guaranteed annual rate of 3.5%. At the discretion of the Company an
interest rate in excess of the minimum guaranteed rate may be credited. The
Company will provide notice of the applicable interest rates in the annual
report to the Owner and upon request.
Any portion of a net premium allocated to the Fixed Rate Option on the issue
date will earn interest at the then current rate as set by the Company. This
interest rate will be guaranteed until the next contract anniversary.
After the issue date, any portion of net premium(s) applied to and any amounts
transferred into the Fixed Rate Option will earn interest at the then current
rate set by the Company. This rate will be guaranteed for the remainder of the
contract year, until the next contract anniversary.
On the contract anniversary, any portion of the accumulation value attributed to
the Fixed Rate Option will earn interest at the then current rate set by the
Company. This rate will be guaranteed until the next contract anniversary.
If, on any contract anniversary the interest rate the Company sets for the Fixed
Rate Option is more than 3 percentage points lower than the rate set for the
immediately preceding contract year, the Owner may withdraw all or a portion of
the accumulation value held in the Fixed Rate Option for at least one contract
year without that amount being subject to a surrender charge. The Company must
receive proper written request for such withdrawal at its Customer Service
Office within 60 days of such contract anniversary.
During the period up to 30 days before the retirement date the Owner may
transfer all or a portion of the accumulation units credited under this contract
among the Separate Account Divisions and the Fixed Rate Option, subject to the
following conditions:
o Proper written request for transfer must be received by the Company
at its Customer Service Office. Other transfer procedures permitted
by the Company, if any, must be followed as set out in the
prospectus for this contract.
o Accumulation units may not be credited to or transferred into more
than four Separate Account Divisions or to three Separate Account
Divisions and the Fixed Rate Option at any time.
o The transfer of accumulation units from the Fixed Rate Option to a
Separate Account Division may only be made once each year on or
within 30 days after a contract anniversary. Transfers out of the
Fixed Rate Option will be made in the same order as such amounts
were allocated to the Fixed Rate Option. The maximum amount that may
be transferred from the Fixed Rate Option each contract year is the
greater of:
o 33 1/3% of the portion of the accumulation value attributable to the
Fixed Rate Option as of the contract anniversary; or
o $2,500.
The number of additional accumulation units credited under this contract in the
newly elected Fixed Rate Option will be equal to (a) divided by (b), where:
o (a) is the value of the amount transferred; and
o (b) is the value of an accumulation unit in the Fixed Rate Option as
of the end of the valuation date on which the proper written request
for transfer is received by the Company at its Customer Service
Office.
The Company reserves the right to limit the frequency of transfers of
accumulation units under the contract to once every 30 days and to charge for
such transfers in the future. Transfers into or out of the Fixed Rate Option are
not permitted after the retirement date.
Any partial withdrawals will first be allocated among the Separate Account
Divisions in the same proportion as the accumulation value in each Separate
Account Division bears to the total accumulation value then credited to the
separate account on the date of the withdrawal. Partial withdrawals in excess of
the amount allocated among the Separate Account Divisions will be allocated to
the Fixed Rate Option.
The Company reserves the right to defer the payment of amounts withdrawn from
the Fixed Rate Option for a period not to exceed six months from the date proper
request for such withdrawal is received by the Company. Benefits and values
provided under this rider equal or exceed those required by any state statute
where the contract is delivered.
Attached on the issue date of the Contract.
The Guardian Insurance & Annuity Company, Inc.
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇
Secretary
AMENDMENT OF CONTRACT PROVISIONS
This rider is attached to and made part of the Contract. This rider is subject
to all of the applicable provisions of the Contract.
The Real Estate Option
This rider provides for a Real Estate Option (the RE Option). The RE Option is
supported by a separate investment account established by the Company under the
laws of the state of Delaware. This account is subject to the laws of the
jurisdiction in which this Contract is delivered.
Allocation of Premiums and Transfer of Accumulation or Annuity Units
The owner may allocate all or part of a premium to the RE Option.
The owner may transfer all or a portion of the accumulation units or annuity
units from one or more Separate Account Divisions or from the Fixed Rate Option
to the RE Option and from the RE Option to one or more Separate Account
Divisions, subject to the following conditions:
o if any part of the accumulation value is allocated to the RE Option,
the remaining portion of the accumulation value may be allocated to
no more than three Separate Account Divisions or two Separate
Account Divisions and the Fixed Rate Option at any time.
o Proper written request for transfer must be sent to the Executive
Office. Other transfer procedures permitted by the Company, if any,
must be followed as set out in the prospectus for the Contract.
o Prior to the Retirement Date, the transfer of accumulation units
from the RE Option to a Separate Account Division may only be made
on or within 30 days after a Contract Anniversary. Transfer requests
received within the 30 day period after a Contract Anniversary will
take effect at the end of the business day on which the request is
received.
o Any transfers of annuity units after the Retirement Date can be made
only as of December 31st of any year.
o The maximum amount that may be transferred is the greater of:
o 33 1/3% of the amount invested in the RE Option as of the
Contract Anniversary; or
o $10,000.
Accumulation Value
The Contract's accumulation value will vary daily with the performance of any
amount allocated to the RE Option. The accumulation value at any time will
reflect any transfers between the RE Option and any Separate Account Division or
Fixed Rate Option. On any day, any amount allocated to the RE Option will be
used to compute the Contract's accumulation value, accumulation units, and
annuity units in accordance with the methods set forth in the Contract.
Redemptions (Withdrawals)
Upon receipt of a proper request for partial or total redemption of the
Contract, the Company will cancel accumulation units with an aggregate value
equal to the dollar amount of the requested redemption plus, if applicable, any
Contract charges and withdrawal charges. The Company will cancel all
accumulation units attributable to the Contract's allocation to the Separate
Account Divisions before cancelling any units attributable to any allocation to
the RE Option. In addition, the Company will cancel all accumulation units
attributable to the Contract's allocation to the RE Option before cancelling any
units attributable to any allocation to the Fixed-Rate Option.
Voting Rights
Contract owners have no voting rights with respect to the RE Option.
Deferment
The Company reserves the right to defer payment of any Contract benefits (other
than guaranteed death benefits) funded by the RE Option (such as cash surrenders
and partial withdrawals under the Contracts) and transfers of Contract values
from the RE Option to the Separate Account Divisions for up to 6 months if there
appears to be insufficient cash available to meet such payment or transfer
requests and prompt disposition of the RE Option's investments to meet such
requests could not be made on commercially reasonable terms.
Issue Date
The issue date of this rider is the issue date of the Contractor the date of
attachment if later.
The Guardian Insurance & Annuity Company, Inc.
/s/ ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇
Secretary
Page 14
ALPHABETICAL INDEX
Subject Page
Accumulation Units ........................................................ 6
Accumulation Unit Value for Account D and the RE Account .................. 6
Accumulation Unit Value for the Fixed Rate Option ......................... 6
Accumulation Value ........................................................ 7
Administration Fee ........................................................ 7
Age ....................................................................... 11
Allocation of Net Premiums ................................................ 3
Annuity Benefit ........................................................... 3
Annuity Commencement Date ................................................. 11
Annuity Payout Option Tables .............................................. 10
Annuity Unit Values ....................................................... 9
Assignment ................................................................ 3
Change in Investment Objective or Policy .................................. 4
Change of Beneficiary ..................................................... 8
Contingent Beneficiary .................................................... 8
Contingent Deferred Sales Charges ......................................... 7
Contract Anniversary ...................................................... 11
Contract, The ............................................................. 11
Deferment ................................................................. 11
Determination of First Annuity Payment .................................... 9
Determination of Variable Annuity Payments After the First ................ 9
Dollar Cost Averaging Transfer Option ..................................... 6
Fixed Annuity Payout Options Available .................................... 8
Fixed Rate Option ......................................................... 4
Guardian Separate Account D and the Guardian Real Estate Account .......... 4
Incontestability .......................................................... 11
Investment Divisions ...................................................... 4
Issue Date ................................................................ 11
Monthly Anniversary ....................................................... 11
Net Investment Factor ..................................................... 6
Nonparticipating .......................................................... 11
Nontransferabiity of Ownership ............................................ 3
Owner ..................................................................... 3
Ownership of Assets ....................................................... 11
Partial Withdrawals ....................................................... 7
Participant ............................................................... 11
Payments by the Company ................................................... 11
Payment of Contract Proceeds .............................................. 8
Plan ...................................................................... 11
Premium Payments .......................................................... 3
Proof of Age and Survival ................................................. 11
Reports to Owner .......................................................... 12
Rights Reserved by the Company ............................................ 4
Surrender of Contract ..................................................... 7
Transfers After an Annuity Commencement Date .............................. 5
Valuation Date ............................................................ 11
Valuation Period .......................................................... 11
Variable Annuity Payout Options Available ................................. 8
[SPECIMEN]
Flexible Payment Deferred Combination Variable and Fixed Group Annuity
Contract
o Benefits based on the investment experience of a Separate Account
are variable and are not guaranteed
o Non-participating--No dividends payable
[Logo] The Guardian(R) The Guardian
Insurance & Annuity
Company, Inc.
Customer Service Office: Executive Office:
P.O. Box 8833 ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇
▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇