Common use of DECLARATIONS Clause in Contracts

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Pool -- Effective 10/1/2008 Between HLIC and TFLIC EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXX, XXXXXXXX, XX 55125 P.O. BOX 64271, ST. PAUL, MN 55164-0200 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X DateDATE: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X DateDATE: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X DateDATE: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Non-Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC and TFLIC Canada Life xxx XXXXX EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOOXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164XX 00000-0200 0000 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool -- Effective 10/1/2008 Between HLIC ILA and TFLIC Swiss Re EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXX, XXXXXXXX, XX 55125 P.O. BOX 64271, ST. PAUL, MN 55164-0200 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), ) Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC HLAIC and TFLIC Canada Life 102 EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOOXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164-0200 XX 00000 - 0000 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC and TFLIC Canada Life 102 EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOXXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164-0200 55164 - 0271 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSUREDProposed Primary Insured: NAMEName: DATE OF BIRTHDate of Birth: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC and TFLIC Canada Life 102 EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXX, XXXXXXXX, XX 55125 P.O. BOX 64271, STSX. PAULXXXX, MN 55164-0200 XX 00000 - 0000 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSUREDProposed Primary Insured: NAMEName: DATE OF BIRTHDate of Birth: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC HLAIC and TFLIC Canada Life 102 EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOXXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164-0200 55164 - 0271 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X DateDATE: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X DateDATE: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X DateDATE: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Non-Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC Canada Life and TFLIC HLAIC EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOXXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164-0200 0271 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Pool -- Effective 10/1/2008 Between HLIC ILA and TFLIC TLIC EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXX, XXXXXXXX, XX 55125 P.O. BOX 64271, ST. PAUL, MN 55164-55164 0200 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount LIMITED AMOUNT of life insurance coverage, for a limited period LIMITED PERIOD of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC and TFLIC Canada Life 102 EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD HARTFORD LIFE AND ANNUITY INSURANCE COMPANY 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOOXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164-0200 XX 00000 - 0000 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSUREDProposed Primary Insured: NAMEName: DATE OF BIRTHDate of Birth: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions:

DECLARATIONS. Each of the undersigned declares, understands and agrees that: - The answers provided above are complete and true to the best of his/her knowledge and belief. - If the answers to the Health Questions contained in this Agreement or the Application are incorrect, incomplete or untrue, the Company will have the right to deny benefits under this Agreement. X Date: ----------------------------------- ------------------------------ ------------------------------ Proposed Primary Insured Signature X Date: ----------------------------------- ------------------------------ ------------------------------ Proposed Policy Owner Signature (if other than the Proposed Insured) RECEIPT OF PAYMENT A premium payment of $ has been submitted with the Application or Request. Additional premium may be required upon Policy delivery. All premium checks must be made payable to Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company. Do not make check(s) payable to the Agent or leave the payee blank. X Date: ----------------------------------- ------------------------------ ------------------------------ Agent Signature DETACH OWNER'S COPY AT TIME OF APPLICATION HOME OFFICE COPY Allocated Retention. Retention Pool (Non-Excess Risks) -- Effective 10/1/2008 October 1, 2008 Between HLIC and TFLIC Canada Life xxx XXXX EXHIBIT VI CONDITIONAL RECEIPT OR TEMPORARY INSURANCE AGREEMENT EFFECTIVE OCTOBER 1, 2008 [LOGO] HARTFORD LIFE INSURANCE COMPANY THE HARTFORD [LOGO] HARTFORD LIFE AND ANNUITY INSURANCE COMPANY THE HARTFORD 500 BIELENBERG DRXXXDRIVE, XXXXXXXXWOOXXXXX, XX 55125 00000 P.O. BOX 64271, ST. PAUL, MN 55164XX 00000-0200 0000 TEMPORARY INSURANCE AGREEMENT PROPOSED PRIMARY INSURED: NAME: DATE OF BIRTH: Under this Temporary Insurance Agreement ("Agreement"), Hartford Life Insurance Company or Hartford Life and Annuity Insurance Company ("Company") agrees to provide a limited amount of life insurance coverage, for a limited period of time, subject to the terms and conditions set forth below. WHEN COVERAGE BEGINS Temporary life insurance coverage under the Agreement becomes effective on the date this Agreement is signed, subject to ALL all of the following conditions: