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Aetna Life Insurance and Annuity Company
Home Office: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
(▇▇▇) ▇▇▇-▇▇▇▇
A Stock Company
Aetna Life Insurance and Annuity Company, herein called Aetna, agrees to pay the
benefits stated in this contract.
Individual Single Premium Immediate Fixed, Variable or Combination Annuity
Contract (Nonparticipating)
Right to Cancel
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THE CONTRACT HOLDER MAY CANCEL THIS CONTRACT WITHIN 10 DAYS OF RECEIVING IT BY
RETURNING THIS CONTRACT, ALONG WITH A WRITTEN NOTICE, TO AETNA AT THE ABOVE
ADDRESS OR TO THE AGENT FROM WHOM IT WAS PURCHASED. WITHIN 7 DAYS AFTER AETNA
RECEIVES THE NOTICE OF CANCELLATION AND THIS CONTRACT AT ITS HOME OFFICE, AETNA
WILL RETURN THE ENTIRE CONSIDERATION PAID LESS ANY PAYMENTS MADE PLUS ANY
INCREASE OR MINUS ANY DECREASE IN THE ACCOUNT VALUE OF ANY FUNDS ALLOCATED TO
THE SEPARATE ACCOUNT.
Signed at the Home Office on the Effective Date.
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President Secretary
This contract sets forth, in detail, all of the rights and obligations of both
the Contract Holder and Aetna. IT IS THEREFORE IMPORTANT THAT YOU READ THIS
CONTRACT CAREFULLY.
This contract and any attached documents constitute the entire legal
relationship between Aetna and the Contract Holder.
ALL PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT.
A050SP99
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A050SP99 Page 2
Table of Contents
Separate Account .................................................... 6
Charges to Separate Account .................................... 6
Variable Annuity Assumed Annual Net Return Rate ................ 6
Transfers ........................................................... 6
I. DEFINITIONS ...................................................... 7
1.01 Annuitant/Joint Annuitant ................................ 7
1.02 Annuity .................................................. 7
1.03 Beneficiary(ies) ......................................... 7
1.04 Contract Holder .......................................... 7
1.05 Fixed Annuity ............................................ 7
1.06 Fund(s) .................................................. 7
1.07 Guaranteed Payment ....................................... 7
1.08 Life Annuity ............................................. 7
1.09 Payee .................................................... 7
1.10 Period Certain Annuity ................................... 7
1.11 Separate Account ......................................... 8
1.12 Survivor ................................................. 8
1.13 Valuation Date ........................................... 8
1.14 Valuation Period ......................................... 8
1.15 Variable Annuity ........................................ 8
II. GENERAL PROVISIONS .............................................. 8
2.01 Premiums ................................................. 8
2.02 Payments ................................................. 8
2.03 Change of Contract ....................................... 8
2.04 Ownership ................................................ 8
2.05 Misstatements and Adjustments ............................ 9
2.06 Incontestability ......................................... 9
2.07 Beneficiary Designation .................................. 9
2.08 Nonparticipating Contract ................................ 9
2.09 State Laws ............................................... 9
III. VARIABLE ANNUITY PROVISIONS .................................... 9
3.01 Fund Annuity Units - Separate Account .................... 9
3.02 Fund Annuity Unit Value .................................. 9
3.03 Fund Annuity Net Return Factors .......................... 9
3.04 Transfer(s) .............................................. 10
3.05 Notice to the Contract Holder ............................ 10
3.06 Change of Fund(s) ........................................ 10
IV. BENEFIT PROVISIONS .............................................. 11
4.01 Death Benefit Provision ................................... 11
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SPECIFICATIONS
Contract Number: [xxxx] Contract Effective Date: [xxxx]
Annuitant: [xxxx] Annuitant Issue Age: [xxxx]
Joint Annuitant: [xxxx] Joint Annuitant Issue Age: [xxxx]
First Payment Date: [xxxx] Payment Frequency: [xxxx]
Single Premium: [xxxx]
Contract Holder: [xxxx]
SCHEDULE OF BENEFITS
Joint and 100% Survivor Annuity with Guaranteed Payments: Annuity payments begin
on the First Payment Date and will continue for the lives of the Annuitant and
Joint Annuitant. At the death of either the Annuitant or Joint Annuitant, the
payment amount will continue to be paid for the life of the survivor. If the
survivor dies prior to the payment of all guaranteed payments, any remaining
payments will be paid to the beneficiary.
Payment Information: Payments will be made on a Fixed basis.
Number of Guaranteed Payments: [xxxx]
Fixed Payment from General Account: [xxxx]
Fixed Annuity Present Value Interest Rate: [xxxx]%
FUNDING ELECTIONS
Number of Fund's
Percent Fund Name Annuity Units Per Payment:
[xxxx] [xxxx] [xxxx]
Variable Annuity Assumed Annual Net Return Rate: [xxxx]%
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Contract Schedule
Separate Account
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Charges to Separate Account
A daily charge at an annual effective rate of 1.25% for mortality
and expense risk and profit (M & E) is deducted from any portion
of the account value allocated to a Variable Annuity. A daily
charge at an annual effective rate of up to 0.25% for
administration is deducted from any portion of the account value
allocated to a Variable Annuity.
Variable Annuity Assumed Annual Net Return Rate
If a Variable Annuity is chosen, an assumed annual net return
rate of 5.0% may be elected. If 5.0% is not elected, Aetna will
use an assumed annual net return rate of 3.5%.
The daily net return rate factor for an assumed annual net return
rate of 3.5% per year is 0.9999058. The daily net return rate
factor for an assumed annual net return rate 5.0% per year is
0.9998663.
If the portion of a Variable Annuity payment for any Fund is not
to decrease, the Annuity return factor under the Separate Account
for that Fund must be:
a) 4.75% on an annual basis plus an annual return of up to
0.25% to offset the administrative charge set at the time
Annuity payments commence if an assumed annual net return
rate of 3.5% is chosen; or
b) 6.25% on an annual basis plus an annual return of up to
0.25% to offset the administrative charge set at the time
Annuity payments commence, if an assumed annual net return
rate of 5% is chosen.
Transfers
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Maximum Number of Allowable Fund Transfers: Twelve per calendar Year
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I. DEFINITIONS
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1.01 Annuitant/Joint Annuitant
An individual named on the Specifications page of this contract
(1) whose death terminates or adjusts the amount of
life-contingent payments, and/or (2) whose death results in the
payment of death benefits; a measured life.
1.02 Annuity
Payment of a specified amount(s) or specified number of units
made:
a) On specified dates or intervals for the lifetime of one or
more Annuitants with or without Guaranteed Payments; or
b) On specified dates or intervals for a specified period of
time.
Annuity benefits payable under this contract are shown in the
Schedule of Benefits on the Specifications page.
1.03 Beneficiary(ies)
The person(s), named by the Contract Holder, entitled to receive
death benefits, if any, under the terms of this contract.
1.04 Contract Holder
The person to whom this contract is issued. Aetna reserves the
right to limit ownership to natural persons.
1.05 Fixed Annuity
An Annuity that is not a Variable Annuity.
1.06 Fund(s)
The open-end registered management investment companies whose
shares are purchased by the Separate Account to fund the
benefits provided by the contract.
1.07 Guaranteed Payment
A payment that is due whether or not the Annuitant, or Joint
Annuitant, if applicable, is alive on the payment due date, as
described in the Schedule of Benefits on the Specifications
page.
1.08 Life Annuity
An Annuity with payments that are based solely on whether or not
the Annuitant, or Joint Annuitant, if applicable, is alive on
the payment due date as described in the Schedule of Benefits on
the Specifications page.
1.09 Payee
A person that receives Annuity payments. The Contract Holder
shall be the Payee unless the Contract Holder designates
otherwise in writing.
1.10 Period Certain Annuity
An Annuity with a specified number of Guaranteed Payments
without a life contingency.
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1.11 Separate Account
An account, established by Aetna under Section 38a-433 of the
Connecticut General Statutes, that buys and holds shares of the
Fund(s) available under this contract. Income, gains or losses,
realized or unrealized are credited or charged to the Separate
Account without regard to other income, gains or losses of
Aetna. Aetna owns the assets held in the Separate Account and is
not a trustee of such amounts. Amounts in the Separate Account
are not generally guaranteed and are held at market value. The
assets of the Separate Account, to the extent of reserves and
other contract liabilities of the Separate Account, cannot be
charged with other Aetna liabilities arising out of any other
Aetna business.
1.12 Survivor
With an Annuity based on the lives of an Annuitant and Joint
Annuitant, the individual who is not the first to die.
1.13 Valuation Date
The date and time on which a Fund Annuity Unit Value is
calculated. Currently, this calculation will be determined at
the close of business of the New York Stock Exchange on any
normal business day, Monday through Friday, that the New York
Stock Exchange is open.
1.14 Valuation Period
The period of time between successive Valuation Dates.
1.15 Variable Annuity
An Annuity with payments that vary with the net investment
results of the Funds available under this contract. Aetna
reserves the right to limit the Fund(s) available with the
Variable Annuity Payment Guarantee, if applicable.
II. GENERAL PROVISIONS
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2.01 Premium
The amount of the premium applied to this contract will be the
premium received minus a deduction for premium taxes, if any.
2.02 Payments
Aetna will pay to the Payee a Fixed or Variable Annuity or a
combination of the two as selected by the Contract Holder and as
shown in the Schedule of Benefits on the Specifications page.
Aetna discharges its obligation to pay when it makes payment by
check or electronic funds transfer to the Payee's address or the
bank that Aetna has on record as of 15 business days before the
payment due date.
We reserve the right to suspend any life-contingent payments to
a Payee if acceptable proof of life of an Annuitant or Joint
Annuitant is not furnished when requested.
2.03 Change of Contract
Only an authorized officer of Aetna may change the terms of this
contract. Aetna reserves the right to modify this contract to
meet the requirements of applicable state and federal laws or
regulations. Aetna will notify the Contract Holder in writing of
any changes.
2.04 Ownership
This is a contract between the Contract Holder and Aetna. The
Contract Holder has title to the contract and, during the
lifetime of the Annuitant, and, if applicable, Joint Annuitant,
all rights to amounts held in the contract. Any choice allowed
under this contract must be made by the Contract Holder in
writing, unless Aetna allows otherwise. Until receipt of such
choices in Aetna's home office, Aetna may rely on any previous
choices made.
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The contract is not subject to the claims of any creditors
except to the extent permitted by law.
Ownership of the contract may be changed to the extent permitted
by law by notifying Aetna in writing in a form acceptable to
Aetna. No such ownership change is binding until such
notification is received and recorded by Aetna at its home
office. Aetna reserves the right not to accept assignment or
transfer to a non natural person.
2.05 Misstatements and Adjustments
If the age, sex, or any relevant fact concerning any Annuitant
is found to be misstated, the correct facts will be used to
adjust payments.
2.06 Incontestability
Aetna will not contest this contract from its effective date.
2.07 Beneficiary Designation
If the contract provides for any Guaranteed Payments following
the death of the Annuitant, and the Joint Annuitant if
applicable, the Contract Holder has the right to name a
Beneficiary(ies).
The Beneficiary designation may be changed by the Contract
Holder during the lifetime of the Annuitant, and, if applicable,
the Joint Annuitant, by sending written notice of the change in
a form acceptable to Aetna to Aetna's home office. Such change
will not be effective until received and recorded by Aetna.
In all cases, Aetna will pay death benefits based on the last
written Beneficiary designation it has on record on the date of
the death.
2.08 Nonparticipating Contract
The Contract Holder or Beneficiaries do not have a right to
share in the earnings of Aetna.
2.09 State Laws
This contract complies with the laws of the state in which it is
delivered. Annuity payments under this contract are equal to or
greater than the minimum required by such laws.
III. VARIABLE ANNUITY PROVISIONS
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3.01 Fund Annuity Units - Separate Account
The initial number of a Fund's Annuity units is stated on the
Specifications page. Each future payment is equal to the sum of
the products of each Fund Annuity unit value multiplied by the
appropriate number of units. The Fund Annuity unit value on the
tenth Valuation Date prior to the due date of the payment is
used.
3.02 Fund Annuity Unit Value
For any Valuation Date, a Fund's Annuity unit value is equal to:
a) The value for the preceding Valuation Date; multiplied by
b) The Annuity net return factor(s) for the Valuation Period;
multiplied by
c) A factor to reflect the assumed annual net return rate.
The factors for the assumed annual net return are shown on the
Contract Schedule.
3.03 Fund Annuity Net Return Factors
The Annuity net return factor(s) are used to compute all
Separate Account Annuity unit values for any Fund. The Annuity
net return factor for each Fund is equal to 1.0000000 plus the
net return rate.
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The net return rate is equal to:
a) The value of the shares of the Fund held by the Separate
Account at the end of a Valuation Period; minus
b) The value of the shares of the Fund held by the Separate
Account at the start of the Valuation Period; plus or
minus
c) Taxes (or reserves for taxes) on the Separate Account
(if any); divided by
d) The total value of the Fund Annuity units of the Separate
Account at the start of the Valuation Period; minus
e) A Separate Account charge at an annual effective rate as
shown on the Contract Schedule for Annuity mortality and
expense risks and profit and a daily administrative
charge which will not exceed the amount shown on the
Contract Schedule on an annual basis. The daily
administrative charge will be established on the
Effective Date of this contract.
A net return rate may be more or less than 0%.
The value of a share of the Fund is equal to the net assets of
the Fund divided by the number of shares outstanding.
3.04 Transfer(s)
At the request of a Contract Holder, all or any portion of the
account value may be transferred from any Fund to any other
allowable Fund. Transfers will be processed as of the Valuation
Date next following when a transfer request is received in good
order at Aetna's home office. The maximum number of allowable
transfers in a calendar year is shown on the Contract Schedule.
Aetna reserves the right to increase the number of allowable
transfers.
Transfer requests must be expressed as a percentage of the
allocation among the Funds of the amount upon which the Variable
Annuity will be based. Aetna may establish a minimum transfer
amount.
3.05 Notice to the Contract Holder
Once a year, Aetna will notify the Contract Holder of:
a) The number of Fund(s) Annuity units; and
b) The value of Fund(s) Annuity units.
Such numbers or values will be as of a date no more than 60 days
before the date of the notice.
3.06 Change of Fund(s)
The assets of the Separate Account are segregated by Fund. If
the shares of any Fund are no longer available for investment by
the Separate Account or if in Aetna's judgment further
investment in such shares should become inappropriate in view of
the purpose of the contract, Aetna may cease to make such Fund
shares available for investment under the contract
prospectively, or Aetna may substitute shares of another Fund
for shares already acquired. Aetna may also, from time to time,
add additional Funds. Any elimination, substitution or addition
of Funds will be done in accordance with applicable state and
federal securities laws. Aetna reserves the right to substitute
shares of another Fund for shares already acquired without a
proxy vote.
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IV. BENEFIT PROVISIONS
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4.01 Death Benefit Provision
a) If the Annuitant dies, or under a joint Annuity option the
Survivor dies, any remaining Guaranteed Payments will be paid
to the Beneficiary in the form specified in the Schedule of
Benefits on the Specifications page. Such payments will be
paid at least as rapidly as under the method of distribution
then in effect. Within six months of such death, the
Beneficiary may elect to receive the withdrawal value of any
remaining Guaranteed Payments less any early withdrawal
charge. The rate used to determine the withdrawal value will
be the Fixed Annuity Present Value Interest Rate shown on the
Specifications page. No early withdrawal charge will apply to
the withdrawal value in this situation.
If this contract is issued as a Variable Period Certain
Annuity, the Beneficiary may elect to receive the withdrawal
value of any remaining Guaranteed Payments at any time. No
early withdrawal charge will apply to the withdrawal value in
this situation.
b) If the Contract Holder who is not the Annuitant(s) dies,
payments will be paid to the Payee in the form specified in
the Schedule of Benefits on the Specifications page. If no
Payee designated by the Contract Holder survives the death of
the Contract Holder, payments will be made to the Annuitant.
Such payments will be paid at least as rapidly as under the
method of distribution then in effect.
c) If the Contract Holder dies before the annuity starting date
the entire interest in the contract must be distributed
within five years of the date of death, or payments may be
made over the life or over a period not extending beyond the
life expectancy of the Beneficiary or Payee, as applicable,
provided such payments begin not later than one year after
the date of death. The annuity starting date is generally
defined by the Internal Revenue Code to mean the first day of
the period (month, quarter, half-year, year depending on
whether payments will be made monthly, quarterly,
semi-annually or annually) which ends on the date of the
first annuity payment. This provision will not apply if the
Beneficiary or Payee, as applicable, is the Contract Holder's
spouse.
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Aetna Life Insurance and Annuity Company
Home Office: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
(▇▇▇) ▇▇▇-▇▇▇▇
Individual Single Premium Immediate Fixed, Variable or
Combination Annuity Contract Nonparticipating
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ALL PAYMENTS AND VALUES PROVIDED BY THE CONTRACT, WHEN BASED ON INVESTMENT
EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO
FIXED DOLLAR AMOUNT.
A050SP99