RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:
Appears in 7 contracts
Samples: Annuity Contract (Talcott Resolution Life & Annuity Insurance Co Separate Account One), Annuity Contract (Talcott Resolution Life & Annuity Insur Co Separate Account Three), Annuity Contract (Talcott Resolution Life & Annuity Insurance Co Separate Account Seven)
RIGHT TO EXAMINE CONTRACT. We want You you to be satisfied with the contract You you have purchased. We urge You you to closely examine its provisions. If for any reason You you are not satisfied with Your purchase, You your purchase you may cancel surrender the contract by returning the contract within ten days after You you receive it. A written request for cancellation must accompany the contract. In such event, We we will pay You to the Contract Owner an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear The Contract Owner bears only the investment risk during the period prior to Our the Company’s receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING Nonparticipating ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 9 AND 7. HL-VA03 1O. HLVA94 Printed in U.S.A. B644R0.FRM P454R0.FRM N454R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Provision 5 Contract Control Provisions 8 6 General Provisions 7 Valuation Provisions 9 Surrenders Termination Provision 10 Death Benefits 11 Settlement Provisions 14 12 Annuity Tables 16 HL-VA03 Page 2 Printed 15 HLVA94 Made in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] 455R0.FRM FUND OPTIONS: THE INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM WILL BE ALLOCATED AS SPECIFIED IN YOUR APPLICATION. THE SAME ALLOCATIONS WILL BE MADE FOR SUBSEQUENT PREMIUM PAYMENTS UNLESS YOU CHANGE THE ALLOCATION OR, AT THE TIME OF A PREMIUM PAYMENT, YOU INSTRUCT US TO ALLOCATE THAT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT DIFFERENTLY. SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY TWO SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY ACCOUNT BASED ON REMAINING GROSS PREMIUMSADVISERS FUND HARTFORD ADVISERS HLS FUND (IA), INC. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE BOND FUND HARTFORD BOND HLS FUND (IA), INC. CAPITAL APPRECIATION FUND HARTFORD CAPITAL APPRECIATION HLS FUND (IA), INC. DIVIDEND AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE GROWTH FUND HARTFORD DIVIDEND AND GROWTH HLS FUND (IA), INC. GROWTH AND INCOME FUND HARTFORD GROWTH AND INCOME HLS FUND (IA), INC. INDEX FUND HARTFORD INDEX HLS FUND (IA), INC. INTERNATIONAL ADVISERS FUND HARTFORD INTERNATIONAL ADVISERS HLS FUND (IA), INC. INTERNATIONAL OPPORTUNITIES FUND HARTFORD INTERNATIONAL OPPORTUNITIES HLS FUND (IA), INC. MIDCAP FUND HARTFORD MIDCAP HLS FUND (IA), INC. MONEY MARKET FUND HARTFORD MONEY MARKET HLS FUND (IA), INC. MORTGAGE SECURITIES FUND HARTFORD MORTGAGE SECURITIES HLS FUND (IA), INC. SMALL COMPANY FUND HARTFORD SMALL COMPANY HLS FUND (IA), INC. STOCK FUND HARTFORD STOCK HLS FUND (IA), INC. OR OTHER FUNDS AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROMAY BE MADE AVAILABLE FROM TIME TO TIME. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPHLVA94-OSHARE-11 3DIR Page 3 (Continued) Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:M537R3.FRM
Appears in 4 contracts
Samples: Talcott Resolution Life & Annuity Insurance Co Separate Account One, Talcott Resolution Life Insurance Co Separate Account Two, Talcott Resolution Life Insurance Co Separate Account Two
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchasedthe right to return this Contract. We urge You may return this Contract to closely examine its provisions. If us for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days, or thirty (30) calendar days if you are replacing another annuity contract or life insurance policy with this Contract, after You you receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal may return it by delivering or mailing it to us with your Written Request at our Service Center or to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) agent who sold it. When we receive your Written Request, we will void the Contract Value as if it had never been in force. Upon receipt of your Written Request, we will refund, within seven (7) calendar days, the Contract Value, plus any fees or charges previously deducted from your Purchase Payments, all determined at the Close of Business on the date of surrenderBusiness Day we receive your Written Request at our Service Center. You bear only This may be more or less than the investment risk during the period prior to Our receipt of request for cancellationPurchase Payment(s). Signed for the Company [ THIS IS A LEGAL CONTRACT BETWEEN YOU AND US READ YOUR CONTRACT CAREFULLY [/s/ Xxx Xxxxxxxx] Premium Payments are flexible as described herein[/s/ Xxxxx X. Xxxxxxxx] [SECRETARY] [PRESIDENT] INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS • THIS CONTRACT IS NON-PARTICIPATING. NONPARTICIPATING ALL PAYMENTS IT DOES NOT PROVIDE FOR THE PAYMENT OF DIVIDENDS. • THIS CONTRACT PROVIDES WAIVER OF CONTINGENT DEFERRED SALES CHARGE BENEFITS, IF APPLICABLE. • CONTRACT VALUES, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFIT PROVIDED BY THIS CONTRACT, WHEN CONTRACT WITH RESPECT TO AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT ARE BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 8 General Provisions ANNUITANT(S) 8 OWNER(S) 8 COLLATERAL ASSIGNMENT OF THE CONTRACT 8 PURCHASE PAYMENT PROVISIONS 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 9 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 9 SEPARATE ACCOUNT SEVEN ] MORTALITY PROVISIONS 9 THE SEPARATE ACCOUNT 9 VALUATION OF ASSETS 10 ACCUMULATION UNITS 10 ACCUMULATION UNIT VALUE 10 CHANGE IN NET ASSET VALUE (NAV) FORMULA 10 ADJUSTMENT OF UNITS AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM VALUES 10 SUSPENSION OF PAYMENTS 11 TRANSFER PROVISIONS 11 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PHASE 11 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE ANNUITY PHASE 11 WITHDRAWAL PROVISIONS 11 WITHDRAWAL 11 CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CHARGES 12 CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL ) 12 ANNUAL CONTRACT MAINTENANCE CHARGE 12 SEPARATE ACCOUNT CHARGES 12 MORTALITY AND EXPENSE RISK CHARGE 12 ADMINISTRATIVE CHARGE 12 DEATH BENEFIT PROVISIONS 12 DEATH OF OWNER DURING THE ACCUMULATION PHASE 12 DEATH OF ANNUITANT DURING THE ACCUMULATION PHASE 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PHASE 13 PAYMENT OF DEATH BENEFIT 14 DEATH OF OWNER DURING THE ANNUITY PHASE 14 DEATH OF ANNUITANT DURING THE ANNUITY PHASE 14 DEATH BENEFIT AND PARTIAL ANNUITIZATIONS 14 BENEFICIARY 15 NON-QUALIFIED BENEFICIARY ANNUITY 15 CHANGE OF BENEFICIARY 15 GENERAL PROVISIONS 15 CONTRACT CHANGES BY THE COMPANY 15 CONTRACT CHANGES BY THE OWNER 16 ENTIRE CONTRACT 16 INCONTESTABILITY 16 MISSTATEMENT OF AGE OR SEX 17 NON-BUSINESS DAYS 17 NON-PARTICIPATING CONTRACT 17 PREMIUM AND OTHER TAXES 17 PROTECTION OF PROCEEDS 17 REGULATORY REQUIREMENTS 17 REPORTS /STATEMENTS 17 ANNUITY PROVISIONS 18 ANNUITY GUIDELINES 18 ANNUITY PAYMENTS 18 FIXED ANNUITY PAYOUT RATE GUARANTEE 18 PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC ANNUITIZATION 18 ANNUITY OPTIONS 19 Single Life Annuity 19 Single Life Annuity with Cash Refund 19 Single Life Annuity with Period Certain 19 Joint and Survivor Life Annuity 19 Joint and Survivor Life Annuity with Period Certain 19 Joint and 2/3 Survivor Life Annuity 20 Joint and 2/3 Survivor Life Annuity with Period Certain 20 Period Certain Annuity 20 INSERT SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:PAGES 4A+ HERE DEFINITIONS
Appears in 2 contracts
Samples: Massachusetts Mutual Variable Annuity Separate Account 4, Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You [ The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company [ at its Annuity Service Center. This may be more or less than the Purchase Payment(s). ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HLTMLS 1 09-VA03 Printed in U.S.A. B644R0.FRM 01 TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUATION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN ACCUMULATION PERIOD 10 TRANSFERS DURING THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY. 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM DEFERRAL OF PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PROVISION 15 TMLS 2 09-01 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE IMMEDIATELY PRECEDING VALUATION DATE; CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:- Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 TMLS 3 09-01 INSERT SCHEDULE PAGES 4A+ HERE
Appears in 2 contracts
Samples: Massachusetts Mutual Variable Annuity Separate Account 4, Qualified Plan Rider (Massachusetts Mutual Variable Annuity Separate Account 4)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchasedthe right to return this Contract. We urge You may return this Contract to closely examine its provisions. If us for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days, or thirty (30) calendar days if you are replacing another annuity contract or life insurance policy with this Contract, after You you receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal may return it by delivering or mailing it to us with your Written Request at our Service Center or to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) agent who sold it. When we receive your Written Request, we will void the Contract Value as if it had never been in force. Upon receipt of your Written Request, we will refund, within seven (7) calendar days, the Contract Value, plus any fees or charges previously deducted from your Purchase Payments, all determined at the Close of Business on the date of surrenderBusiness Day we receive your Written Request at our Service Center. You bear only This may be more or less than the investment risk during the period prior to Our receipt of request for cancellationPurchase Payment(s). Signed for the Company THIS IS A LEGAL CONTRACT BETWEEN YOU AND US READ YOUR CONTRACT CAREFULLY [ /s/ Xxxxxxx Xxxxxxxxx ] Premium Payments are flexible as described herein[ /s/ Xxxxx X. Xxxxxxxx ] [SECRETARY] [PRESIDENT] INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS ● THIS CONTRACT IS NON-PARTICIPATING. NONPARTICIPATING ALL PAYMENTS IT DOES NOT PROVIDE FOR THE PAYMENT OF DIVIDENDS. ● THIS CONTRACT PROVIDES WAIVER OF CONTINGENT DEFERRED SALES CHARGE BENEFITS, IF APPLICABLE. ● CONTRACT VALUES, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFIT PROVIDED BY THIS CONTRACT, WHEN CONTRACT WITH RESPECT TO AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT ARE BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONSTo contact the Insurance Department in the state in which this Contract is issued, PAGES 6 AND 7. HLyou may call: [(XXX) XXX-VA03 Printed in U.S.A. B644R0.FRM XXXX] ICC21-FPVDA 1 [09-21] TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 8 General Provisions ANNUITANT(S) 8 OWNER(S) 8 COLLATERAL ASSIGNMENT OF THE CONTRACT 8 PURCHASE PAYMENT PROVISIONS 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 9 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 9 SEPARATE ACCOUNT SEVEN ] MORTALITY PROVISIONS 9 THE SEPARATE ACCOUNT 9 VALUATION OF ASSETS 10 ACCUMULATION UNITS 10 ACCUMULATION UNIT VALUE 10 CHANGE IN NET ASSET VALUE (NAV) FORMULA 10 ADJUSTMENT OF UNITS AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM VALUES 10 SUSPENSION OF PAYMENTS 11 TRANSFER PROVISIONS 11 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PHASE 11 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE ANNUITY PHASE 11 WITHDRAWAL PROVISIONS 11 WITHDRAWAL 11 CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CHARGES 12 CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. ) 12 ANNUAL CONTRACT MAINTENANCE CHARGE 12 SEPARATE ACCOUNT CHARGES 12 MORTALITY AND EXPENSE RISK CHARGE 12 ADMINISTRATIVE CHARGE 12 DEATH BENEFIT PROVISIONS 12 DEATH OF OWNER DURING THE CDSC IS BASED ACCUMULATION PHASE 12 DEATH OF ANNUITANT DURING THE ACCUMULATION PHASE 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PHASE 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PHASE 13 PAYMENT OF INTEREST ON THE AMOUNT YOU CHOOSE TO SURRENDER DEATH BENEFIT 14 PAYMENT OF DEATH BENEFIT 14 DEATH OF OWNER DURING THE ANNUITY PHASE 14 DEATH OF ANNUITANT DURING THE ANNUITY PHASE 15 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 GENERAL PROVISIONS 16 CONTRACT CHANGES BY THE COMPANY 16 CONTRACT CHANGES BY THE OWNER 16 ENTIRE CONTRACT 17 EVIDENCE OF SURVIVAL 17 INCONTESTABILITY 17 MISSTATEMENT OF AGE OR SEX 17 NON-BUSINESS DAYS 17 NON-PARTICIPATING CONTRACT 17 PREMIUM AND HOW LONG YOUR PREMIUM OTHER TAXES 17 PROTECTION OF PROCEEDS 18 REGULATORY REQUIREMENTS 18 REPORTS /STATEMENTS 18 RESERVATION OF RIGHTS 18 ANNUITY PROVISIONS 18 ANNUITY GUIDELINES 18 ANNUITY PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:19 FIXED ANNUITY PAYOUT RATE GUARANTEE 19 ANNUITY OPTIONS 19 Single Life Annuity 19 Single Life Annuity with Cash Refund 19 Single Life Annuity with Period Certain 20 Joint and Survivor Life Annuity 20 Joint and Survivor Life Annuity with Period Certain 20 Joint and 2/3 Survivor Life Annuity 20 Joint and 2/3 Survivor Life Annuity with Period Certain 20 Period Certain Annuity 21 DEFINITIONS
Appears in 2 contracts
Samples: Massachusetts Mutual Variable Annuity Separate Account 4, Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You [The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company [ at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] Premium Payments are flexible as described herein. NONPARTICIPATING ALL THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HLTMLS 1 [09-VA03 Printed in U.S.A. B644R0.FRM 01] Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUATION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PERIOD 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15 TMLS 2 [09-01] Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A - Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 TMLS 3 [09-01] Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 INSERT SCHEDULE PAGES 4A+ HERE TMLS 4 [09-01] Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 DEFINITIONS ACCUMULATION PERIOD The period during which Purchase Payments may be made. ACCUMULATION UNIT A unit of measure used to determine the value of the Contract Owner’s interest in a Sub-Account of the Separate Account during the Accumulation Period. AGE The age of any Contract Owner or Annuitant on his/her birthday nearest the date for which age is being determined. ANNUITANT The primary person upon whose life Annuity Payments are to be made. On or after the Annuity Date, the Annuitant shall also include any Joint Annuitant. ANNUITY DATE The date on which any Annuity Payments begin. The Annuity Date is shown on the Contract Schedule. ANNUITY PAYMENTS The series of payments that will be made pursuant to any Annuity Option selected. ANNUITY OPTIONS Options available for Annuity Payments. ANNUITY PERIOD The period which begins on the Annuity Date and ends with the last Annuity Payment. ANNUITY SERVICE CENTER The office indicated on the Contract Schedule of this Contract, or other location(s) specified by the Company to which notices, requests and Purchase Payments must be sent. All sums payable by the Company under this Contract are payable only from the Annuity Service Center, or other location(s) specified by the Company. ANNUITY UNIT A unit of measure used to determine the amount of each Variable Annuity Payment after the Annuity Date. BENEFICIARY The person(s) or entity(ies) designated to receive the death benefit provided by this Contract. CONTRACT ANNIVERSARY An anniversary of the Issue Date of this Contract CONTRACT SCHEDULE DATE The effective date of any Contract Schedule. A Contract Schedule bearing the latest Schedule Date will supersede all previous Contract Schedules. CONTRACT OWNER The person(s) or entity(ies) entitled to the ownership rights stated in this Contract. Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 CONTRACT VALUE The sum of the Contract Owner’s interest in the Sub-Accounts of the Separate Account during the Accumulation Period. CONTRACT YEAR The first Contract Year is the annual period which begins on the Issue Date. Subsequent Contract Years begin on each anniversary of the Issue Date. ELIGIBLE INVESTMENT An investment entity shown on the Contract Schedule into which assets of the Separate Account will be invested. FIXED ANNUITY A series of payments made during the Annuity Period which are guaranteed as to dollar amount by the Company. GENERAL ACCOUNT The Company’s general investment account which contains all the assets of the Company with the exception of the Separate Account and other segregated asset accounts. ISSUE DATE The date on which this Contract became effective. NET PURCHASE A Purchase Payment less any Premium Tax assessed by any state or PAYMENT other jurisdiction. PREMIUM TAX A tax imposed by certain states and other jurisdictions when a Purchase Payment is made, when Annuity Payments begin, or when the Contract is surrendered. PURCHASE PAYMENT During the Accumulation Period, a payment made by or on behalf of a Contract Owner with respect to this Contract. RIDER EFFECTIVE The effective date of any Rider as indicated on the Contract Schedule. SEPARATE ACCOUNT DATE The Company’s Separate Account(s) designated on the Contract Schedule. SERIES A segment of an Eligible Investment which constitutes a separate and distinct class of shares into which assets of a Sub-Account will be invested. SUB-ACCOUNT Separate Account assets are divided into Sub-Accounts which are listed on the Contract Schedule. Assets of each Sub-Account will be invested in shares of an Eligible Investment or a Series of an Eligible Investment. VALUATION DATE Each day on which the Company, the New York Stock Exchange (CDSC): WE MAY ASSESS A CDSC WHEN YOU “NYSE”) and the Eligible Investments are open for business. VALUATION PERIOD The period of time beginning at the close of business of the NYSE on each Valuation Date and ending at the close of business for the next succeeding Valuation Date. Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 VARIABLE ANNUITY An annuity with payments which vary as to dollar amount in relation to the investment performance of specified Sub-Accounts of the Separate Account. WRITTEN REQUEST A FULL OR PARTIAL SURRENDERrequest in writing, in a form satisfactory to the Company, which is received by the Annuity Service Center. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM Exhibit 4 2008 Version: Form of Individual Annuity Contract pp1-33 PURCHASE PAYMENT PROVISIONS PURCHASE PAYMENTS HAVE BEEN IN THE CONTRACTThe initial Purchase Payment is due on the Issue Date. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROThe minimum and maximum subsequent and total Purchase Payments are shown on the Contract Schedule. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:The Company reserves the right to reject any Purchase Payment.
Appears in 2 contracts
Samples: Massachusetts Mutual Variable Annuity Separate Account 4, Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days (30 days if this contract is replacing another annuity contract or life insurance policy) after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] /s/ Xxxxx Xxxxxx, Secretary /s/ Lowndes X. Xxxxx, President Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 11 AND 712. HL-VA03 VA99 Printed in U.S.A. B644R0.FRM I316R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Payment Provisions 6 7 Transfers Between Accounts Provisions 7 Dollar Cost Averaging Provisions 8 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Valuation Provisions 11 Surrender Provisions 12 Distribution at Time of Death Benefits 11 Provisions 14 Calculation of the Death Benefit Provisions 14 Settlement Provisions 14 17 Annuity Tables 16 20 HL-VA03 VA99 Page 2 Printed in U.S.A. B645R0.FRM R378R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14[ FEBRUARY 8, 2009 1999 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2029 ] AGE OF ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 1,000 ] SEX OF ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] MINIMUM FIXED ACCOUNT INTEREST RATE 3% DESIGNATED BENEFICIARY [ XXX XXXXX ] (APPLIES TO ACCUMULATION PERIOD ONLY) CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] ANNUAL WITHDRAWAL AMOUNT CONTRACT YEARS 1-7 15% OF PREMIUM PAYMENTS ON A NONCUMULATIVE BASIS AFTER CONTRACT YEAR 7 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL; AND 15% OF PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY. MORTALITY AND EXPENSE RISK CHARGE: [0.501.35%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%[ .15% ] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED OPTIONAL DEATH BENEFIT CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7[ .25% ] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PER ANNUM OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERODAILY SUB-ACCOUNTS VALUE. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPHL-OSHARE-11 VA99-3 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:U.S.A.
Appears in 2 contracts
Samples: Annuity Contract (Talcott Resolution Life & Annuity Insurance Co Separate Account One), Annuity Contract (Hartford Life Insurance Co Separate Account Two)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 7 AND 78. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 5 Premium Payments 6 7 Valuation Provisions 6 7 Transfers Between Accounts 7 8 Contract Control Provisions 8 9 General Provisions 9 10 Surrenders 10 11 Death Benefits 11 13 Settlement Provisions 14 16 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 19 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2008] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 1,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN THREE] ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS [1-7] [10%] OF PREMIUM PAYMENTS MADE PER CONTRACT YEAR ON A NONCUMULATIVE BASIS. AFTER CONTRACT YEAR [7] 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF EACH PREMIUM PAYMENT MADE DURING THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL; AND [10%] OF PREMIUM PAYMENTS MADE DURING EACH OF THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $[30] IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.500.80%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE3 CONTINGENT DEFERRED SALES CHARGES: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED MAY ASSESS A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC "CHARGE") WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC CHARGE IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDCHARGE SCHEDULE. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN THE AMOUNT ASSESSED A CHARGE WILL NOT EXCEED YOUR PREMIUM PAYMENTS. DURING THE FIRST [SEVEN] CONTRACT YEARS ALL SURRENDERS IN EXCESS OF THE AWA ARE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM PREMIUM PAYMENTS, THEN FROM EARNINGS. SURRENDERS FROM PREMIUM PAYMENTS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE SUBJECT TO CDSCA CHARGE. AFTER THE [SEVENTH] CONTRACT YEAR, ALL SURRENDERS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM EARNINGS, THEN FROM PREMIUM PAYMENTS HELD IN YOUR CONTRACT FOR MORE THAN [SEVEN] YEARS AND THEN ONLY FROM PREMIUM PAYMENTS INVESTED FOR LESS THAN [SEVEN] YEARS. ONLY PREMIUM PAYMENTS HELD FOR LESS THAN [SEVEN] YEARS WILL BE SUBJECT TO A CHARGE. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. PERCENTAGE USED TO CALCULATE THE CHARGE IS EQUAL TO: NUMBER OF YEARS FROM CHARGE EACH PREMIUM PAYMENT ------------------------------------------------------------------------- [8% 1 8% 2 8% 3 7% 4 6% 5 5% 6 4% 7 0% 8] AND THEREAFTER NO CDSC CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF IF: - ONLY THE AWA ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR - ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE CDSCCOMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. FOR ANY SURRENDERAll correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, THE P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on each Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME - The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE - The aggregate value of the Accounts on any Valuation Day. CONTRACT YEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. DEFINITION OF WITHDRAWAL BY DIVIDING CERTAIN TERMS (ACONTINUED) BY (B) MULTIPLIED BY (C) WHERE:DEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant, as applicable.
Appears in 2 contracts
Samples: Hartford Life Insurance Co Separate Account Three, Hartford Life & Annuity Insur Co Separate Account Three
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] \s\ Xxxxxx X. Xxxx \s\ Xxxx X. Xxxxxxx Xxxxxx X. Xxxx, Secretary Xxxx X. Xxxxxxx, President Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HLLA-VA03 ASHARE03 Printed in U.S.A. B644R0.FRM B772R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [[ SEPTEMBER 148, 2009 2002 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2032 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 20,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD AND ANNUITY LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED MORTALITY AND EXPENSE RISK CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED [ 0.90% ] PER ANNUM OF THE DAILY SUB- ACCOUNTS VALUE. ADMINISTRATION CHARGE AGAINST [ 0.25% ] PER ANNUM OF THE DAILY SUB-ACCOUNT VALUE. SALES CHARGES: SALES CHARGES ARE A PERCENTAGE OF PREMIUMS PAID AND EQUAL: CHARGE OWNER’S INVESTMENT [ 6.00% ] UP TO $49,999.99 [ 5.50% ] $50,000 TO $99,999.99 [ 5.00% ] $100,000 TO $249,999.99 [ 4.00% ] $250,000 TO $499,999.99 [ 3.00% ] $500,000 TO $999,999.99 [ 2.00% ] $1,000,000 TO $2,499,999.99 [ 1.00% ] $2,500,000 AND OVER THE APPLICABLE SALES CHARGE ON EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROOWNER’S INVESTMENT. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 ASHARE03 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:U.S.A.
Appears in 1 contract
Samples: Individual Flexible (Talcott Resolution Life & Annuity Insurance Co Separate Account Seven)
RIGHT TO EXAMINE CONTRACT. We want You you to be satisfied with the contract You you have purchased. We urge You you to closely examine its provisions. If for any [ILLEGIBLE] reason You you are not satisfied with Your purchase, You your purchase you may cancel surrender the contract by returning the contract within ten days (10) days if this contract is replacing another annuity contract or life insurance policy) after You you receive it. A written request for [ILLEGIBLE] cancellation must accompany the contract. In such event, We we will pay You to the Contract Owner an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear The Contract Owner bears only the investment risk during the period prior to Our the Company's receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein/s/ Bruce D. Gardnxx /s/ Lowndes A. Smith --------------------------------- --------------------------------- BRUCE D. GARDNXX, XXXXXXXXX LOWNDES A. SMITH, PRESXXXXX XURCHASE PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 9 AND 710. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] ITT HARTFORD TABLE OF CONTENTS Page PAGE ------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Provision 5 Contract Control Provisions 8 6 General Provisions 7 Valuation Provisions 9 Surrenders Termination Provisions 10 Death Benefits 11 Settlement Provisions 14 12 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 15 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 14FEBRUARY 8, 2009 1994] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES DXXX XF ISSUE [FEBRUARY 8, 1994] SCOTT] AGE OF XXXXXTANT [35] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2024] SEX OF ANNUITANT AGE [ 35 [MALE] INITIAL PREMIUM PAYMENT [ [$2,000 ] ANNUITANT GENDER [ MALE 20,000] MINIMUM SUBSEQUENT PAYMENT [ $500 ] MINIMUM FIXED ACCOUNT 3% INTEREST RATE CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED DEXXXXXXXX [ANN SCOTT] CXXXXXXX XWNER (IF OTHER [SAME] BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] THAN ANNUITANT) DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNTANNUAL WITHDRAWAL AMOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGECONTRACT YEARS 1-7 10% OF PREMIUM PAYMENTS AFTER CONTRACT YEAR 7 THE GREATER OF: [0.50%] PER ANNUM 100% OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGECONTRACT VALUE REDUCED BY THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL: [0.20%] PER ANNUM OR 10% OF PREMIUM PAYMENTS MADE DURING THE DAILY SUB-ACCOUNTS VALUE7 YEARS PRIOR TO WITHDRAWAL. ANNUAL CONTRACT MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY ANNIVERSARY. MORTALITY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED EXPENSE RISK CHARGE: WE WILL APPLY AN 1.25% PER ANNUM OF THE AVERAGE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: 0%PER ANNUM OF THE AVERAGEDAILY CONTRACT VALUE. 3 CONTINGENT DEFERRED SALES CHARGES: SUBJECT TO THE ANNUAL WITHDRAWAL AMOUNT, SURRENDERS OF CONTRACT VALUES ATTRIBUTABLE TO PREMIUM BASED PAYMENTS MAY BE SUBJECT TO A CONTINGENT DEFERRED SALES CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT("CHARGE"). THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED LENGTH OF TIME FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT RECEIPT OF THE PREMIUM BASED PAYMENT TO THE TIME OF SURRENDER DETERMINES THE CHARGE. DURING THE FIRST SEVEN CONTRACT YEARS, ALL SURRENDERS WILL BE FIRST FROM PREMIUM PAYMENTS AND THEN FROM EARNINGS. IF AN AMOUNT EQUAL TO ALL PREMIUM PAYMENTS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE DEDUCTED FOR ANY PORTION ASSESSED AGAINST THE SURRENDER OF THE REMAINING CONTRACT VALUE. AFTER THE SEVENTH CONTRACT YEAR, ALL SURRENDERS WILL FIRST BE FROM EARNINGS AND THEN FROM PREMIUM PAYMENT THAT IS SUBJECT PAYMENTS. A CHARGE WILL NOT BE ASSESSED AGAINST THE SURRENDER OF EARNINGS. IF AN AMOUNT EQUAL TO THE CHARGEALL EARNINGS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE ASSESSED AGAINST PREMIUM PAYMENTS RECEIVED MORE THAN SEVEN YEARS PRIOR TO SURRENDER, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. WILL BE ASSESSED AGAINST PREMIUM PAYMENTS ARE RECEIVED LESS THAN SEVEN YEARS PRIOR TO SURRENDER. FOR THIS PURPOSE, PREMIUM PAYMENTS WILL BE DEEMED TO BE SURRENDERED IN THE ORDER IN WHICH THEY ARE WERE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment THE CHARGE IS A PERCENTAGE OF THE AMOUNT SURRENDERED (NOT TO EXCEED THE AGGREGATE AMOUNT OF THE PREMIUM BASED PAYMENTS MADE) AND EQUALS: LENGTH OF TIME FROM PREMIUM PAYMENT CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page (NUMBER OF YEARS) ------------------------------------------------------------------- 6% 1 6% 2 5% 3 Printed in U.S.A. CONTRACT SPECIFICATIONS 5% 4 4% 5 3% 6 2% 7 0% 8 AND THEREAFTER NO CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN CHARGES WILL BE ASSESSED IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON EVENT THE CURRENT DEPOSIT PLUS CONTRACT TERMINATES DUE TO THE GREATER OF: A) THE TOTAL BALANCE AS DEATH OF THE IMMEDIATELY PRECEDING VALUATION DATE; ANNUITANT OR BCONTRACT OWNERS (AS APPLICABLE), OR IF CONTRACT VALUES ARE APPLIED TO AN ANNUITY OPTION PROVIDED FOR UNDER THIS CONTRACT (PROVIDED HOWEVER, ANY SURRENDER OUT OF OPTION 4 WILL BE SUBJECT TO CONTINGENT DEFERRED SALES CHARGES, IF APPLICABLE) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROOR UPON THE EXERCISE OF THE ANNUAL WITHDRAWAL AMOUNT. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS 3 (continued) FUND OPTIONS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT INITIAL PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSCBE ALLOCATED AS SPECIFIED IN YOUR APPLICATION. THE PRIOR PREMIUM PAYMENT(S) SAME ALLOCATIONS WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. BE MADE FOR SUBSEQUENT PREMIUM PAYMENTS ARE SURRENDERED IN UNLESS YOU CHANGE THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKENALLOCATION OR, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING A PREMIUM PAYMENT, YOU INSTRUCT US TO ALLOCATE THAT PAYMENT DIFFERENTLY. SEPARATE ACCOUNT: HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT TWO SUB-ACCOUNT BASED ON: ------------------------------------------------------------------------ ADVISERS FUND HVA ADVISERS FUND, INC. STOCK FUND HVA STOCK FUND, INC. AGGRESSIVE GROWTH FUND HVA AGGRESSIVE GROWTH FUND, INC. INTERNATIONAL OPPORTUNITIES FUND HARTFORD INTERNATIONAL OPPORTUNITIES FUND, INC. DIVIDEND AND GROWTH FUND HARTFORD DIVIDEND AND GROWTH FUND, INC. INDEX FUND HARTFORD INDEX FUND, INC. GNMA/MORTGAGE SECURITIES FUND HARTFORD GNMA/MORTGAGE SECURITIES FUND, INC. BOND/DEBT SECURITIES FUND HVA BOND/DEBT SECURITIES FUND, INC. MONEY MARKET FUND HVA MONEY MARKET FUND, INC. OR OTHER FUNDS AS MAY BE MADE AVAILABLE FROM TIME TO TIME. 3 (Acontinued) BY (B) MULTIPLIED BY (C) WHERE:DEFINITION OF CERTAIN TERMS ACCOUNT -- Any of the Sub-Accounts or the Fixed Account. ACCUMULATION UNIT -- An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY -- Currently located at 200 Hopmeadow Xx., Xxxxxxxx, Xx. Xxx xxxxxxxxndence concerning this contract should be sent to our mailing address at P.O. Box 2999. Xxxx: Xxxxxxdual Annuity Operations Hartford, CT 00000-0000. XXXXXX XXXXDRAWAL AMOUNT -- The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT -- The person on whose life this contract is issued. ANNUITY COMMENCEMENT DATE -- The date on which annuity payments are to begin as described under Settlement Provisions in this contract. ANNUITY UNIT -- An accounting unit of measure used to calculate the amount of annuity payments under the variable annuity option. BENEFICIARY -- The person entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMPANY -- The Hartford Life Insurance Company.
Appears in 1 contract
Samples: Reinsurance Agreement (Hartford Life Insurance Co Separate Account Two)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Xalters -------------------------------- -------------------------------- DONALD C. HUNT, SECRETARY XXXX X. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] THE HARTFORD TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 20,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD AND ANNUITY LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.500.90%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: CHARGE [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS ACCOUNT VALUE. SALES CHARGES: SALES CHARGES ARE A PERCENTAGE OF PREMIUMS PAID AND EQUAL: CHARGE OWNER'S INVESTMENT ---------------------------------------------------------------------------------- [6.00%] UP TO $49,999.99 [5.50%] $50,000 TO $99,999.99 [5.00%] $100,000 TO $249,999.99 [4.00%] $250,000 TO $499,999.99 [3.00%] $500,000 TO $999,999.99 [2.00%] $1,000,000 TO $2,499,999.99 [1.00%] $2,500,000 AND OVER THE APPLICABLE SALES CHARGE ON EACH PREMIUM PAYMENT WILL BE BASED ON THE OWNER'S INVESTMENT. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, XX 00000. Xxx xxxxxxxxxxxxxx xxxxxxning this contract should be sent to Our mailing address: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE: $[0] IF THE FEE - An amount which, depending on the amount of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. DEFINITION OF CERTAIN TERMS (CONTINUED) CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE IS [$50,000] OR MORE ON THE - The aggregate value of the Accounts on any Valuation Day. CONTRACT ANNIVERSARYYEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. [$50] IF THE CONTRACT DEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant. DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. NET PREMIUM - Premium payments less the applicable Sales Charges shown on Page 3, less any applicable Premium Tax. OWNER'S INVESTMENT - The sum of all premium payments into this contract plus the value of all eligible investments identified by You and allowed by the Company and owned by You, Your spouse or other immediate family members. PAYEE - The person, designated by You, to whom Annuity payments will be maxx. XXEMIUM TAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. On any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contract from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3 SALES CHARGES - Charges deducted from premium payments at the time they are received by Us. Sales Charges are described on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. DEFINITION OF CERTAIN TERMS (CONTINUED) SURRENDER VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED- The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACTVALUATION DAY - Every day the New York Stock Exchange is open for trading. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSThe value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) on such days. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMSVALUATION PERIOD - The period of time between the close of business on successive Valuation Days. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSWE, BUT NOT LESS THAN ZEROUS, OUR - The Company referred to on the first page of this contract. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTYOU, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARYOUR - The Contract Owner(s). PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVEDPREMIUM PAYMENTS - Premium payments are payable at the Administrative Office of the Company. [7] Year Payments may be made by check or by any other method that We deem acceptable. The initial premium payment is shown on Page 3. This is a flexible premium annuity. We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from you under all deferred variable annuity contracts issued by Us or Our affiliates equals or exceeds 1,000,000. ALLOCATION OF PREMIUM PAYMENTS Net Premium Based Charge payments will apply be allocated to each Account according to Your instructions subject to Our minimum amount(s) then in effect. Any subsequent Net Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed Payments will be allocated to Accounts in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDERaccordance with the most recent premium allocation instructions that We received. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR VALUATION PROVISIONS NET PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT- The Net Premium payment is applied to purchase Accumulation Units with respect to the Sub-Account(s) that You have selected. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROThe number of Accumulation Units credited to each Sub-Account is determined by dividing the Net Premium payment allocated to a Sub-Account by the dollar value of one Accumulation Unit for such Sub-Account. This is computed in compliance with Securities and Exchange Commission regulations. IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSCThe number of Accumulation Units will not be affected by any subsequent change in the value of such Accumulation Units. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDThe Accumulation Unit value in any Sub-Account may increase or decrease from day to day as described below. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERENET INVESTMENT FACTOR The net investment factor for each of the Sub-Accounts is equal to:
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You to This Contract may be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If returned for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract cancellation within ten [10] days after You receive itthe date it is received by the Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be delivered or mailed to the sum of (i) the difference between the premiums paid and the amounts allocated Company or to any Account under agent of the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of Company, along with a written request for cancellation. Signed for This Contract shall then be cancelled and the Company [ shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium) of at least [$10] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS Additional contributions may be made at any time prior to the Annuity Commencement Date, the death of the Annuitant or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. /s/ Xxxxx Xxxxx /s/ Xxxxxx X. Xxxxx ------------------------------- ------------------------------------- Vice President President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY'S GENERAL ACCOUNT AND/OR THE COMPANY'S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7SEPARATE ACCOUNT. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] A DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY THE SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM APPEARS IN THE ACCOUNTS SECTION OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. A DESCRIPTION OF THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE CHARGES DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT AMOUNTS HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND THIS IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROPARTICIPATING CONTRACT. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:THIS PAGE LEFT BLANK INTENTIONALLY
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Xalters -------------------------------- -------------------------------- DONALD C. HUNT, SECRETARY XXXX X. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 2009] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2039] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 2,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN SEVEN] MORTALITY AND EXPENSE RISK CHARGE: [0.500.30%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $[$5030] IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED DISTRIBUTION CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED DISTRIBUTION CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM DISTRIBUTION CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR EIGHT [78] YEARS OR LESS. AN ANNUAL PREMIUM BASED DISTRIBUTION CHARGE SHOWN BELOW OF [0.75%] WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [78] YEAR PREMIUM BASED DISTRIBUTION CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDSCHEDULE. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED DISTRIBUTION CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN MINIMUM AMOUNT RULE: THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT MINIMUM AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. RULE OF THE "PARTIAL SURRENDERS PRIOR TO THE ANNUITY COMMENCEMENT DATE" SECTION OF THE CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS PROVIDES THAT A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN MINIMUM CONTRACT VALUE MUST BE MAINTAINED IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED AS OF THE CONTRACT ISSUE DATE, THE MINIMUM CONTRACT VALUE EQUALS [$2,000]. WE RESERVE THE RIGHT TO INCREASE THE MINIMUM CONTRACT VALUE AT OUR DISCRETION, BUT IN NO EVENT WILL IT EXCEED $10,000. CONTRACT SPECIFICATIONS ANNUAL WITHDRAWAL AMOUNT (AWA): THE AMOUNT THAT CAN BE WITHDRAWN IN ANY CONTRACT YEAR WITHOUT INCURRING A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT CONTINGENT DEFERRED SALES CHARGE. THIS EQUALS 100% OF REMAINING GROSS PREMIUMS MADE MORE THAN [8] YEAR(S) AGO PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY OR (B) MULTIPLIED BY (C) WHERE:
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on and any Premium Taxes as of the date of surrendercancellation. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /x/ Xxxx X. Xxxxxxs -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETXXX XXXX X. XXXXERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Transfer Between Sub-Accounts Provisions 7 Contract Control Provisions 8 General Provisions 9 8 Surrenders 10 Death Benefits 11 Settlement Provisions 14 13 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 10,000] ANNUITANT GENDER [ MALE SEX [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED MORTALITY AND EXPENSE RISK CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM [1.60%] PER ANNUM OF THE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: [0.25%] PER ANNUM OF THE DAILY CONTRACT VALUE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, XX. Xxx xxxxxxxxxxxxxx xxxxxxning this contract should be sent to our mailing address: Attn: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 00000-0000. XXXXXX XXXXXXXXXXX XXX - An amount which, depending on the amount of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT MADE TO THIS CONTRACTFREQUENCY - The frequency with which annuity payments will be made. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSThe frequencies available are monthly, quarterly, semi-annual, and annual. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE ON THE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person that You may designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS- An anniversary of the Contract Issue Date. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: ACONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER - The owner(s) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:or holder of the contract.
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the may cancel this contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchasewithin 10 days of receipt or within any longer period as required by applicable law in the state where this contract was delivered by sending written notice of cancellation to the Company or to an agent of the Company, by phone at {0-000-000-0000} or by return of this contract to the office of the Company. If this contract is replacing another contract, the time period in which You may cancel this contract is 30 days unless another time period is applicable under state law. Upon cancellation, the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We Company will pay You return an amount equal to the sum of Contract Value, (i) unless applicable state law requires the difference between the premiums paid and the amounts allocated return to any Account under the contract and (ii) the Contract Value be based on the date of surrenderPurchase Payments paid or another amount) less any proceeds paid by the Company. You bear only the investment risk during the period prior to Our receipt of request for cancellationTHIS IS A LEGAL CONTRACT - READ THIS CONTRACT CAREFULLY THIS CONTRACT CONTAINS WITHDRAWAL AND SURRENDER CHARGES. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THESE CHARGES MAY BE WAIVED OR NOT APPLICABLE UNDER CERTAIN CONDITIONS SPECIFIED IN THIS CONTRACT MODIFIED SINGLE PREMIUM INDIVIDUAL DEFERRED ANNUITY WITH ONE OR MORE INDEXED STRATEGIES NON-PARTICIPATING THIS CONTRACT, WHEN ’S VALUES MAY BE BASED ON INVESTMENT EXPERIENCE THE PERFORMANCE OF A SUB-ACCOUNT, ARE VARIABLE AND AN EXTERNAL INDEX OR INDICES THAT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONSAND MAY INCREASE OR DECREASE; HOWEVER, PAGES 6 AND 7. HLTHIS CONTRACT DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK OR EQUITY INVESTMENT 22-VA03 Printed in U.S.A. B644R0.FRM D-RILA-BASE 1 05/22 TABLE OF CONTENTS Page Contract Specifications SPECIFICATIONS PAGES SECTION I – DEFINITIONS 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts SECTION II – CONTRACT VALUES AND CHARGES 7 Contract Control Provisions PURCHASE PAYMENTS 7 CONTRACT VALUE 7 OWNERSHIP OF ASSETS 8 General Provisions INTEREST 8 REALLOCATIONS TO AVAILABLE STRATEGIES 8 XXXXXXXXXXX AND SURRENDERS 8 WITHDRAWAL CHARGES 9 Surrenders SURRENDER VALUE 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME SECTION III – PROVISIONS FOLLOWING THE DEATH OF AN OWNER OR ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT 10 DEATH OF AN OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM (DEATH BENEFIT) 10 DEATH OF THE DAILY SUBANNUITANT 11 SECTION IV – SETTLEMENT AND PAYMENT OF PROCEEDS 12 PAYMENTS IN GENERAL 12 PAYMENTS TO MINORS 12 SETTLEMENT OPTIONS 12 ANNUITIZATION UPON MATURITY 13 SECTION V – GENERAL PROVISIONS 14 CONTRACT 14 ANNUAL STATEMENTS 14 DEFERRAL OF PAYMENTS 14 RELIANCE 15 INCONTESTABILITY 15 NON-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM PARTICIPATING 15 MISSTATEMENT OF THE DAILY SUBAGE OR SEX 15 OWNERSHIP 15 ASSIGNMENT INCLUDING OWNERSHIP CHANGE OF THIS CONTRACT 15 CHANGE OF BENEFICIARY 16 MODIFICATION 16 TAXES 16 MINIMUM BENEFITS 16 SPENDTHRIFT PROVISION 16 PROOF OF AGE AND SURVIVAL 16 CONFORMITY WITH LAWS FOR LEGAL ACTIONS 16 22-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPD-OSHARE-11 Page 3 Printed RILA-BASE 2 05/22 SECTION I DEFINITIONS Capitalized terms have specific definitions as detailed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:this contract and outlined below.
Appears in 1 contract
Samples: Gainbridge Life Insurance Co
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on and any Premium Taxes as of the date of surrendercancellation. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 5 Valuation Provisions 6 Transfers Transfer Between Sub-Accounts Provisions 7 Contract Control Provisions 8 General Provisions 9 8 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 17 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 10,000] ANNUITANT GENDER [ MALE SEX [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX OWNEX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED MORTALITY AND EXPENSE RISK CHARGE: WE WILL APPLY AN [1.60%] PER ANNUM OF THE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: [0.25%] PER ANNUM OF THE DAILY CONTRACT VALUE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT. All correspondence concerning this cxxxxxxx xxxxxx xx xxxx xx xxx xailing address: Attn: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT MADE TO THIS CONTRACTFREQUENCY - The frequency with which annuity payments will be made. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSThe frequencies available are monthly, quarterly, semi-annual, and annual. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person that You may designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER - The owner(s) or holder of the contract. CONTRACT VALUE ON THE - The aggregate value of the Sub-Accounts on any Valuation Day. CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMSYEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. EACH DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. DEFINITION OF CERTAIN TERMS (CONTINUED) FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. PAYEE - The person, designated by You, to whom annuity payments will be made. PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: ATAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. On any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contracts from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. SURRENDER VALUE - The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. VALUATION DAY - Every day the New York Stock Exchange is open for trading. The value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING on such days. VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSPERIOD - The period of time between the close of business on successive Valuation Days. WE, BUT NOT LESS THAN ZEROUS, OUR - The company referred to on the first page of this contract. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTYOU, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARYOUR - The Contract Owner(s). PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVEDPREMIUM PAYMENTS Premium payments are payable at the Administrative Office of the Company. [7] Year Payments may be made by check or by any other method that We deem acceptable. The initial premium payment is shown on Page 3. This is a flexible premium annuity. We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from You under all deferred variable annuity contracts issued by Us or Our affiliates then equals or exceeds $1,000,000. 5 PREMIUM PAYMENTS (CONTINUED) ALLOCATION OF PREMIUM PAYMENTS Premium Based Charge payments, minus any applicable Premium Tax We may deduct, will apply be allocated to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPSub-OSHARE-11 Page 3 Printed Account according to Our minimum amount(s) then in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDEReffect. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:Any subsequent premium payments will be allocated to Sub-Accounts in accordance with the most recent premium allocation instructions that We received.
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You [The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company [ at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] Premium Payments are flexible as described herein. NONPARTICIPATING ALL THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY [/s/ Xxxxxxxxx X. Xxxxxxx] [/s/ Xxxxx X. Xxxxxxxx] SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUATION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN ACCUMULATION PERIOD 10 TRANSFERS DURING THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY. 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM DEFERRAL OF PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PROVISION 15 2 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE IMMEDIATELY PRECEDING VALUATION DATE; CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:- Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 3 INSERT SCHEDULE PAGES 4A+ HERE 4
Appears in 1 contract
Samples: Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You The Owner may cancel the this contract by returning it to the contract Company or one of its authorized representatives within ten days after You receive itreceipt. A written request for cancellation must accompany the contract. In such event, We The Company will pay You refund an amount equal to the sum Accumulated Value, after application of any Market Value Adjustment, plus any fees and other charges imposed. This amount may be more or less than gross payment(s) to the contract. If, however, the contract is issued as an Individual Retirement Annuity (iIRA), the Company will refund the greater of the above or gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 440 Lincoln Street, Worcxxxxx, Xxxxxxxxxxxxx 00000 Xxxx xx x xxxxx xxxxract between Allmerica Financial Life Insurance and Annuity Company (the Company) the difference between the premiums paid and the amounts Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to any Variable Sub-Accounts, the Fixed Account under the contract or Guarantee Period Accounts. /s/ Mark A. Hug /s/ Charles F. Cronin Xxxxxxxxx Secretary Flexible Payment Deferred Variable and (ii) the Contract Value Fixed Annuity Annuity Benefit Payments Payable on the date of surrender. You bear only the investment risk during the period Annuity Date Death Benefit Payable if death occurs prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUBAnnuity Date (see Death Benefits section) Non-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM Participating TABLE OF CONTENTS Page SPECIFICATIONS 3 DEFINITIONS 7 OWNER, ANNUITANT AND BENEFICIARY 9 THE ACCUMULATION PHASE PAYMENTS 11 VALUES 11 TRANSFER 13 WITHDRAWAL AND SURRENDER 14 DEATH BENEFIT 16 THE PAYOUT PHASE ANNUITY BENEFIT 18 TRANSFER 20 WITHDRAWAL 20 PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS 22 DEATH OF THE ANNUITANT 22 ANNUITY BENEFIT PAYMENT OPTIONS 22 LIFE ANNUITY GUARANTEE OPTIONS 23 ANNUITY OPTION RATE TABLES 23 GENERAL PROVISIONS 27 SPECIFICATIONS Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGEType: [0.50NQ] Contract Number: [zz00600000] Issue Date: [01/01/02] Annuity Date: [01/01/2035] (Must be at least 30 days after issue date) Owner: [John Doe] Owner Daxx xx Xxrth: [01/01/1950] Joint Owner: [Jack Doe] Joint Owxxx Xxxx of Birth: [01/01/1950] Annuitant: [John Doe] Annuitanx Xxxx xx Xxxxx: [01/01/1950] Joint Annuitant: [Jack Doe] Joint Anxxxxxxx Date of Birth: [01/01/1950] Annuitant Sex: [Male] Beneficiary(ies): Joint Annuitant Sex: [Male] Primary: Surviving Joint Owner, if any 1st Contingent: [Mary Doe] 2nd Contingent: [Sue Doe] Minimum Fixed Account Minimum Additional Payment Guaranteed Interest Rate: [3%] PER ANNUM Amount: [$50.00] Guarantee Period Account Guarantee Period Account Minimum Interest Rate: [3%] Minimum Allocation Amount: [$1,000.00] Minimum Withdrawal Minimum Accumulated Value Amount: [$100.00] After Withdrawal: [$1,000.00] Minimum Annuity Maximum Alternative Annuity Date: [01/01/2049] Benefit Payment: [$100.00] (Must be at least 30 days after issue date) Surrender Charge Table: YEARS FROM SURRENDER CHARGE AS A DATE OF PAYMENT PERCENT OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGEPAYMENTS TO DATE OF WITHDRAWAL WITHDRAWN -------------------------------------------------- [Less Than: 1 7% 2 6% 3 4% Thereafter 0%] Withdrawal Without Surrender Charge Percentage: [0.2010% of Gross Payment Base (reduced by any prior Withdrawal Without Surrender Charge in the same calendar year)] Mortality and Expense Risk Charge: [1.60%] PER ANNUM OF THE DAILY SUBon an annual basis of the daily value of the Sub-ACCOUNTS VALUEAccount assets. ANNUAL MAINTENANCE FEEAdministrative Charge: $[0.15%] IF THE CONTRACT VALUE IS on an annual basis of the daily value of the Sub-Account assets. Contract Fee: [$50,00035, if the Accumulated Value is less than $75,000.00. Waived for 401(k)s.] OR MORE ON THE CONTRACT ANNIVERSARY. Principal Office: 440 Lincoln Street, Worcxxxxx, Xxxxxxxxxxxxx 00000 [(0-000-000-0000)] SPECIFICATIONS (CONTINUED) Owner: [John Doe ] Contract Number: [zzz0000000] Joint Owner: [Jack Doe] Initial Paymexx: [$5000,000.00] IF THE CONTRACT VALUE IS LESS THAN Payment Allocation: (The Initial Payment is allocated in the following manner:) Variable Sub-Accounts: --------------------- [$50,000Select Emerging Markets Fund Fidelity VIP Growth Portfolio Select International Equity Fund Select Growth Fund Oppenheimer Global Securxxxxx Xxxx VA Allmerica Core Equity Fund FT VIP Templeton Foreign Securixxxx Xxxx Allmerica Equity Index Fund MFS New Discovery Series AIM V.I. Blue Chip Fund AIM V.I. Aggressive Growth Fund FT VIP Franklin Large Cap Growth Securities Fund FT VIP Small Cap Fund Alliance Growth & Income Portfolio Select Strategic Growth Fund MFS Total Return Series Alliance Bernstein Small Cap Valux Xxxxxxxio MFS Utilities Series Fidelity VIP Value Strategies Portfolio Oppenheimer Main Street Xxxxxx & Xxcome Fund VA FT VIP Small Cap Value Securities Fund Fidelity VIP Contrafund MFS Mid Cap Growth Series AIM V.I. Basic Value Fund Fidelity VIP III Mid Cap Portfolio Oppenheimer Multiple Strxxxxxxx Xxxd VA AIM V.I. Capital Development Fund Fidelity Equity Income Fund Select Capital Appreciation Fund AllianceBernstein Value Portfolio FT VIP Mutual Shares Securities Fund Select Growth & Income Fund Select Value Opportunity Fund Oppenheimer High Income Xxxx XX Xxxiance Premier Growth Portfolio Select Investment Grade Income Fund Alliance Technology Portfolio Select Strategic Income Fund Oppenheimer Capital Apprxxxxxxxx Xxnd VA Allmerica Government Bond Fund AIM V.I. Premier Equity Fund Allmerica Money Market Fund] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGESelect Aggressive Growth Fund Fixed Account: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM -------------- SPECIFICATIONS (CONTINUED) Owner: [John Doe] Contract Number: [zzz0000000] Joint Owner: [Jack Doe] Xxxxxxxee Period Accounts ------------------------- GUARANTEE INTEREST EXPIRATION PERIOD RATE DATE ------ ---- ---- [ 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years] ------- 100% TOTAL PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:ALLOCATION
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on and any Premium Taxes as of the date of surrendercancellation. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 5 Valuation Provisions 6 Transfers Transfer Between Sub-Accounts Provisions 7 Contract Control Provisions 8 General Provisions 9 8 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 17 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 10,000] ANNUITANT GENDER [ MALE SEX [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX OWNEX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ONE] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED MORTALITY AND EXPENSE RISK CHARGE: WE WILL APPLY AN [1.60%] PER ANNUM OF THE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: [0.25%] PER ANNUM OF THE DAILY CONTRACT VALUE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT. All correspondence concerning this cxxxxxxx xxxxxx xx xxxx xx xxx xailing address: Attn: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT MADE TO THIS CONTRACTFREQUENCY - The frequency with which annuity payments will be made. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSThe frequencies available are monthly, quarterly, semi-annual, and annual. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person that You may designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER - The owner(s) or holder of the contract. CONTRACT VALUE ON THE - The aggregate value of the Sub-Accounts on any Valuation Day. CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMSYEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. EACH DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. DEFINITION OF CERTAIN TERMS (CONTINUED) FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. PAYEE - The person, designated by You, to whom annuity payments will be made. PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: ATAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. On any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contracts from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. SURRENDER VALUE - The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. VALUATION DAY - Every day the New York Stock Exchange is open for trading. The value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING on such days. VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSPERIOD - The period of time between the close of business on successive Valuation Days. WE, BUT NOT LESS THAN ZEROUS, OUR - The company referred to on the first page of this contract. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTYOU, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARYOUR - The Contract Owner(s). PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVEDPREMIUM PAYMENTS Premium payments are payable at the Administrative Office of the Company. [7] Year Payments may be made by check or by any other method that We deem acceptable. The initial premium payment is shown on Page 3. This is a flexible premium annuity. We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from You under all deferred variable annuity contracts issued by Us or Our affiliates then equals or exceeds $1,000,000. 5 PREMIUM PAYMENTS (CONTINUED) ALLOCATION OF PREMIUM PAYMENTS Premium Based Charge payments, minus any applicable Premium Tax We may deduct, will apply be allocated to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPSub-OSHARE-11 Page 3 Printed Account according to Our minimum amount(s) then in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDEReffect. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:Any subsequent premium payments will be allocated to Sub-Accounts in accordance with the most recent premium allocation instructions that We received.
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Xalters -------------------------------- -------------------------------- DONALD C. HUNT, SECRETARY XXXX X. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 20,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.500.90%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: CHARGE [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS ACCOUNT VALUE. ANNUAL MAINTENANCE FEESALES CHARGES: SALES CHARGES ARE A PERCENTAGE OF PREMIUMS PAID AND EQUAL: CHARGE OWNER'S INVESTMENT --------------------------------------------------------------------------------------- [6.00%] UP TO $49,999.99 [05.50%] IF $50,000 TO $99,999.99 [5.00%] $100,000 TO $249,999.99 [4.00%] $250,000 TO $499,999.99 [3.00%] $500,000 TO $999,999.99 [2.00%] $1,000,000 TO $2,499,999.99 [1.00%] $2,500,000 AND OVER THE CONTRACT VALUE IS [$50,000] OR MORE APPLICABLE SALES CHARGE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OWNER'S INVESTMENT. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE IMMEDIATELY PRECEDING COMPANY - Currently located at 200 Hopmeadow St., Simsbury, XX 00000. Xxx xxxxxxxxxxxxxx xxxxxxning this contract should be sent to Our mailing address: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 00000-0000. XXXXXX XXXXXXXXXXX XXX - An amount which, depending on the amount of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. DEFINITION OF CERTAIN TERMS (CONTINUED) CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE - The aggregate value of the Accounts on any Valuation Day. CONTRACT YEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. DEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant. DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. NET PREMIUM - Premium payments less the applicable Sales Charges shown on Page 3, less any applicable Premium Tax. OWNER'S INVESTMENT - The sum of all premium payments into this contract plus the value of all eligible investments identified by You and allowed by the Company and owned by You, Your spouse or other immediate family members. PAYEE - The person, designated by You, to whom Annuity payments will be made. PREMIUM TAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. On any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contract from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3 SALES CHARGES - Charges deducted from premium payments at the time they are received by Us. Sales Charges are described on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. DEFINITION OF CERTAIN TERMS (CONTINUED) SURRENDER VALUE - The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. VALUATION DATE; OR BDAY - Every day the New York Stock Exchange is open for trading. The value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSon such days. VALUATION PERIOD - The period of time between the close of business on successive Valuation Days. WE, BUT NOT LESS THAN ZEROUS, OUR - The Company referred to on the first page of this contract. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTYOU, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARYOUR - The Contract Owner(s). PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVEDPREMIUM PAYMENTS - Premium payments are payable at the Administrative Office of the Company. [7] Year Payments may be made by check or by any other method that We deem acceptable. The initial premium payment is shown on Page 3. This is a flexible premium annuity. We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from you under all deferred variable annuity contracts issued by Us or Our affiliates equals or exceeds 1,000,000. ALLOCATION OF PREMIUM PAYMENTS Net Premium Based Charge payments will apply be allocated to each Account according to Your instructions subject to Our minimum amount(s) then in effect. Any subsequent Net Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed Payments will be allocated to Accounts in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDERaccordance with the most recent premium allocation instructions that We received. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR VALUATION PROVISIONS NET PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT- The Net Premium payment is applied to purchase Accumulation Units with respect to the Sub-Account(s) that You have selected. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROThe number of Accumulation Units credited to each Sub-Account is determined by dividing the Net Premium payment allocated to a Sub-Account by the dollar value of one Accumulation Unit for such Sub-Account. This is computed in compliance with Securities and Exchange Commission regulations. IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSCThe number of Accumulation Units will not be affected by any subsequent change in the value of such Accumulation Units. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDThe Accumulation Unit value in any Sub-Account may increase or decrease from day to day as described below. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERENET INVESTMENT FACTOR The net investment factor for each of the Sub-Accounts is equal to:
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on and any Premium Taxes as of the date of surrendercancellation. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 9 AND 7. 1O. HL-VA03 NCDSC98 Printed in U.S.A. B644R0.FRM P541R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Payment Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 7 General Provisions 8 Valuation Provisions 9 Surrenders 10 Surrender Provisions 11 Distribution at Time of Death Benefits 11 Provisions 12 Settlement Provisions 14 13 Annuity Tables 16 17 HL-VA03 NCDSC98 Page 2 Printed in U.S.A. B645R0.FRM P542R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14[ FEBRUARY 8, 2009 1997 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2027 ] AGE OF ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 20,000 ] SEX OF ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:ANNIVERSARY.
Appears in 1 contract
Samples: Annuity Contract (Hartford Life & Annuity Insurance Co Separate Account One)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters ----------------------------------- ----------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPRXXXXX XXXXXXXX XXX FLEXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 7 AND 78. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 5 Premium Payments 6 Valuation Provisions 6 7 Transfers Between Accounts 7 8 Contract Control Provisions 8 9 General Provisions 9 10 Surrenders 10 11 Death Benefits 11 13 Settlement Provisions 14 16 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 19 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 1,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN THREE] ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS [1-7] [10%] OF PREMIUM PAYMENTS MADE PER CONTRACT YEAR ON A NONCUMULATIVE BASIS. AFTER CONTRACT YEAR [7] 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF EACH PREMIUM PAYMENT MADE DURING THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL; AND [10%] OF PREMIUM PAYMENTS MADE DURING EACH OF THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.501.35%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE3 CONTINGENT DEFERRED SALES CHARGES: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED MAY ASSESS A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC "CHARGE") WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC CHARGE IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDCHARGE SCHEDULE. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN THE AMOUNT ASSESSED A CHARGE WILL NOT EXCEED YOUR PREMIUM PAYMENTS. DURING THE FIRST [SEVEN] CONTRACT YEARS ALL SURRENDERS IN EXCESS OF THE AWA ARE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM PREMIUM PAYMENTS, THEN FROM EARNINGS. SURRENDERS FROM PREMIUM PAYMENTS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE SUBJECT TO CDSCA CHARGE. AFTER THE [SEVENTH] CONTRACT YEAR, ALL SURRENDERS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM EARNINGS, THEN FROM PREMIUM PAYMENTS HELD IN YOUR CONTRACT FOR MORE THEN [SEVEN] YEARS AND THEN ONLY FROM PREMIUM PAYMENTS INVESTED FOR LESS THAN [SEVEN] YEARS. ONLY PREMIUM PAYMENTS HELD FOR LESS THEN [SEVEN] YEARS WILL BE SUBJECT TO A CHARGE. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. PERCENTAGE USED TO CALCULATE THE CHARGE IS EQUAL TO: NUMBER OF YEARS FROM CHARGE EACH PREMIUM PAYMENT ----------------------------------------------- [7% 1 7% 2 7% 3 6% 4 5% 5 4% 6 3% 7 0% 8] AND THEREAFTER NO CDSC CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF IF: - ONLY THE AWA ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR - ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE CDSCCOMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. FOR ANY SURRENDERAll correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, THE P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on each Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME - The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE - The aggregate value of the Accounts on any Valuation Day. CONTRACT YEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. DEFINITION OF WITHDRAWAL BY DIVIDING CERTAIN TERMS (ACONTINUED) BY (B) MULTIPLIED BY (C) WHERE:DEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant, as applicable.
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want [You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If may return this Contract for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive it. A written request for cancellation must accompany You may return it to Us at Our Annuity Service Center or to the contractAgent who sold it. In such event, We will pay void the Contract as if it had never been in force, after You an return it to Us. We will refund the Purchase Payment amount equal allocated to the sum of (i) the difference between the premiums paid General Account and the amounts value of the Purchase Payment amount allocated to the Separate Account, reduced by any Account under amounts withdrawn or Annuity Payments made, within seven days after We receive the contract and (ii) the Contract Value on the date of surrenderContract.] THIS IS A LEGAL CONTRACT BETWEEN YOU AND US PLEASE READ YOUR CONTRACT CAREFULLY [ABCDE] [ABC] [SECRETARY] [PRESIDENT] INDIVIDUAL SINGLE PREMIUM IMMEDIATE FIXED AND VARIABLE ANNUITY CONTRACT Non-Participating ANNUITY PAYMENTS ARE PAYABLE ON THE FIRST ANNUITY PAYMENT DATE. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL ANNUITY PAYMENTS, WITHDRAWAL VALUES AND THE DEATH PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition CONTRACT SCHEDULE 4 DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 Purchase Payment 8 Allocation of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions Purchase Payment 8 GENERAL ACCOUNT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY Account 8 SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUBPROVISIONS 8 Separate Account 8 Valuation of Assets 8 Mortality and Expense Risk Charge 9 Administrative Charge 9 TRANSFER PROVISIONS 9 Transfers 9 ANNUITY PROVISIONS 10 Annuity Payments 10 Fixed Annuity 10 Variable Annuity 10 Variable Annuity Units 10 Variable Annuity Payments 10 Variable Annuity Unit Value 11 DEATH PROVISIONS 12 Death Before the First Annuity Payment Date 12 Death on or after the First Annuity Payment Date 12 Notification and Payment Requirements upon Death 13 Beneficiary 13 Change of Beneficiary 14 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 14 Annuitant 14 Joint Annuitant 14 Owner 14 Joint Owner 14 Assignment of the Contract 14 GENERAL PROVISIONS 15 The Contract 15 Contract Changes by Us 15 Contract Changes by You 15 Contract Termination 15 Evidence of Age and Survival 15 Incontestability 15 Misstatement Of Age or Sex 15 Non-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUBBusiness Days 16 Non-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE Participating Contract 16 Premium and Other Taxes 16 Protection of Proceeds 16 Regulatory Requirements 16 Reports 16 Suspension or Deferral of Payments Provision 16 INSERT SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:PAGES 4A+ HERE
Appears in 1 contract
Samples: Fixed and Variable (Massachusetts Mutual Variable Annuity Separate Account 4)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Walters ----------------------------------- ----------------------------------- DONALD C. HUNT, SECRETARY XXXX C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] THE HARTFORD TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 2009] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2039] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 2,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN SEVEN] MORTALITY AND EXPENSE RISK CHARGE: [0.500.30%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $[$5030] IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED DISTRIBUTION CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED DISTRIBUTION CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM DISTRIBUTION CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR EIGHT [78] YEARS OR LESS. AN ANNUAL PREMIUM BASED DISTRIBUTION CHARGE SHOWN BELOW OF [0.75%] WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [78] YEAR PREMIUM BASED DISTRIBUTION CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDSCHEDULE. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED DISTRIBUTION CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN MINIMUM AMOUNT RULE: THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT MINIMUM AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. RULE OF THE "PARTIAL SURRENDERS PRIOR TO THE ANNUITY COMMENCEMENT DATE" SECTION OF THE CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS PROVIDES THAT A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN MINIMUM CONTRACT VALUE MUST BE MAINTAINED IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED AS OF THE CONTRACT ISSUE DATE, THE MINIMUM CONTRACT VALUE EQUALS [$2,000]. WE RESERVE THE RIGHT TO INCREASE THE MINIMUM CONTRACT VALUE AT OUR DISCRETION, BUT IN NO EVENT WILL IT EXCEED $10,000. CONTRACT SPECIFICATIONS ANNUAL WITHDRAWAL AMOUNT (AWA): THE AMOUNT THAT CAN BE WITHDRAWN IN ANY CONTRACT YEAR WITHOUT INCURRING A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT CONTINGENT DEFERRED SALES CHARGE. THIS EQUALS 100% OF REMAINING GROSS PREMIUMS MADE MORE THAN [8] YEAR(S) AGO PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY OR (B) MULTIPLIED BY (C) WHERE:
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You Within 10 days, or 30 days if a replacement contract, of the date of receipt of this Contract by the Owner, it may be returned by delivering or mailing it to be satisfied with the contract You have Company at its Administrative Office or to the Agent through whom it was purchased. We urge You to closely examine its provisionsWhen the Contract is received by the Company, it will be voided as if it had never been in force. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We The Company will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) refund the Contract Value on computed as of the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for Business Day the Company [ receives the returned contract at its Administrative Office. THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY Secretary President [MONUMENT ADVISOR] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Non-participating INCOME PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments DEFINITIONS 6 Valuation Provisions 6 Transfers Between Accounts PURCHASE PAYMENT PROVISIONS 7 Contract Control Provisions PURCHASE PAYMENTS 7 ALLOCATION OF PURCHASE PAYMENTS 7 SEPARATE ACCOUNT PROVISIONS 7 THE SEPARATE ACCOUNTS 7 VARIABLE ACCOUNT 7 VALUATION OF ASSETS 7 ACCUMULATION UNITS 7 ACCUMULATION UNIT VALUE 7 CONTRACT VALUE 8 General Provisions SUBSCRIPTION FEE 8 DEDUCTION FOR SUBSCRIPTION FEE 8 DEDUCTION FOR TRANSACTION FEE 8 TRANSFERS 8 TRANSFERS DURING THE ACCUMULATION PERIOD 8 WITHDRAWAL PROVISIONS 9 Surrenders WITHDRAWALS 9 PROCEEDS PAYABLE ON DEATH 9 DEATH OF OWNER DURING THE ACCUMULATION PERIOD 9 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 9 DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 9 DEATH OF OWNER DURING THE ANNUITY PERIOD 10 Death Benefits DEATH OF ANNUITANT 10 PAYMENT OF DEATH BENEFIT 10 BENEFICIARY 10 CHANGE OF BENEFICIARY 11 Settlement Provisions SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 11 OWNER, ANNUITANT, XXXXXXXXX, XXXXXXXXXX XXXXXXXXXX 00 OWNER 11 JOINT OWNER 11 ANNUITANT 11 ASSIGNMENT OF A CONTRACT 11 TABLE OF CONTENTS ANNUITY PROVISIONS 11 GENERAL 11 ANNUITY DATE 11 SELECTION OF AN ANNUITY OPTION 12 FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 12 ANNUITY OPTIONS 12 OPTION 1. LIFETIME ONLY ANNUITY: 12 OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 12 OPTION 3. PAYMENT FOR A FIXED PERIOD: 12 OPTION 4. JOINT AND SURVIVOR ANNUITY 12 ANNUITY 12 FIXED ANNUITY 12 MORTALITY TABLES 12 GENERAL PROVISIONS 13 THE CONTRACT 13 MISSTATEMENT OF AGE 13 MISSTATEMENT OF GENDER 13 INCONTESTABILITY 13 MODIFICATION 13 NON-PARTICIPATING 13 EVIDENCE OF SURVIVAL 13 PROOF OF AGE 13 PROTECTION OF PROCEEDS 13 REPORTS 13 TAXES 13 CONFORMITY WITH INTERSTATE INSURANCE PRODUCT REGULATION COMMISSION STANDARDS 14 Annuity Tables 16 HLPAYMENTS TO THIRD PARTIES 14 PAYMENTS FROM THIRD PARTIES 14 ANNUITY OPTION TABLES 15-VA03 Page 2 Printed in U.S.A. B645R0.FRM 17 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN SCHEDULE OWNER: [Xxxx Xxx] CONTRACT ISSUE DATE DATE: [SEPTEMBER 14, 2009 MA] NAME OF JOINT OWNER: [Xxxx Xxx] ANNUITANT: [Xxxx Xxx] ANNUITANT AGE: [ XXXXX XXXXX 0-100 ] ANNUITANT GENDER: [Male/Female] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 DATE: The Annuity Date must be at least two (2) years after the Contract Issue Date CONTRACT NUMBER: [12345678] ANNUITANT AGE [ 35 ] PURCHASE PAYMENTS: INITIAL PREMIUM PAYMENT [ PURCHASE PAYMENT: [$2,000 ] ANNUITANT GENDER [ MALE 25,000.00] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEETOTAL PURCHASE PAYMENT: $[025,000.00] IF THE CONTRACT VALUE IS MAXIMUM TOTAL PURCHASE PAYMENT: $[$50,00010,000,000.00] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHEREwithout prior Company approval ALLOCATION GUIDELINES:
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on and any Premium Taxes as of the date of surrendercancellation. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL[HARTFORD LOGO] LA-VA03 Printed in NCDSC03 PRINTED IN U.S.A. B644R0.FRM B707R0.FRM TABLE OF CONTENTS Page PAGE Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Transfer Between Sub-Accounts Provision 7 Contract Control Provisions 8 General Provisions 9 8 Surrenders 10 Death Benefits 11 Settlement Provisions 14 13 Annuity Tables 16 HLLA-VA03 NCDSC03 Page 2 Printed in PRINTED IN U.S.A. B645R0.FRM B708R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [[ SEPTEMBER 148, 2009 2002 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2032 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 10,000 ] ANNUITANT GENDER SEX [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED MORTALITY AND EXPENSE RISK CHARGE: WE WILL APPLY AN [1.60%] PER ANNUM OF THE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: [0.25%] PER ANNUM OF THE DAILY CONTRACT VALUE. HL-NCDSC03-3 Page 3 PRINTED IN U.S.A. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 000 Xxxxxxxxx Xx., Xxxxxxxx, XX. All correspondence concerning this contract should be sent to our mailing address: Attn: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM MAINTENANCE FEE - An amount which, depending on the amount of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT MADE TO THIS CONTRACTFREQUENCY - The frequency with which annuity payments will be made. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSThe frequencies available are monthly, quarterly, semi-annual, and annual. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person that You may designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER - The owner(s) or holder of the contract. DEFINITION OF CERTAIN TERMS (CONTINUED) CONTRACT VALUE ON THE - The aggregate value of the Sub-Accounts on any Valuation Day. CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMSYEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. EACH DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. PAYEE - The person, designated by You, to whom annuity payments will be made. PREMIUM PAYMENT HAS ITS OWN [7] YEAR TAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. On any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contracts from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. SURRENDER VALUE - The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. VALUATION DAY - Every day the New York Stock Exchange is open for trading. The value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) on such days. VALUATION PERIOD - The period of time between the close of business on successive Valuation Days. WE, US, OUR - The company referred to on the first page of this contract. YOU, YOUR - The Contract Owner(s). NCDSC03-4/5 Page 5 PRINTED IN U.S.A. B682R0.FRM PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PAYMENTS PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROPAYMENTS Premium payments are payable at the Administrative Office of the Company. Payments may be made by check or by any other method that We deem acceptable. IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGEThe initial premium payment is shown on Page 3. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDThis is a flexible premium annuity. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from You under all deferred variable annuity contracts issued by Us or Our affiliates then equals or exceeds $1,000,000. ALLOCATION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGEPAYMENTS Premium payments, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARminus any applicable Premium Tax We may deduct, will be allocated to each Sub-Account according to Our minimum amount(s) then in effect. Any subsequent premium payments will be allocated to Sub-Accounts in accordance with the most recent premium allocation instructions that We received. VALUATION PROVISIONS NET PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVEDThe net premium payment is equal to the premium payment minus any applicable Premium Taxes We may deduct, and is applied to purchase Accumulation Units with respect to the Sub-Account(s) that You have selected. [7] Year Premium Based Charge will apply The number of Accumulation Units credited to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPSub-OSHARE-11 Page 3 Printed Account is determined by dividing the net premium payment allocated to a Sub-Account by the dollar value of one Accumulation Unit for such Sub-Account. This is computed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE compliance with Securities and Exchange Commission regulations. The number of Accumulation Units so determined will not be affected by any subsequent change in the value of such Accumulation Units. The Accumulation Unit value in any Sub-Account may increase or decrease from day to day as described below. NET INVESTMENT FACTOR The net investment factor for each of the Sub-Accounts is equal to: a) the net asset value per share plus applicable distributions per share of the corresponding Fund at the end of the Valuation Period; divided by b) the net asset value per share of the corresponding Fund at the beginning of the Valuation Period; multiplied by c) the daily expense factor for mortality and expense risk charge, any applicable administration charge shown on page 3, and the charge for elected optional riders, if any, adjusted for the number of days in the Valuation Period. ACCUMULATION UNIT VALUE The value of an Accumulation Unit for each Sub-Account of the Separate Account will vary to reflect the investment experience of the applicable Funds. It will be determined by multiplying: (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDERa) the value of the Accumulation Unit for that Sub-Account as of the preceding Valuation Day by (b) the net investment factor for that Sub-Account for the Valuation Day for which the Accumulation Unit value is being calculated. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACTThe value of the Sub-Account as of each Valuation Day is then determined by multiplying: (a) the number of Accumulation Units in that Sub-Account by (b) the Accumulation Unit value as of that Valuation Day. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OFVALUATION PROVISIONS (CONTINUED) ANNUITY UNIT VALUE The value of an Annuity Unit for each Sub-Account of the Separate Account will vary to reflect the investment experience of the applicable Funds. It will be determined by multiplying: Aa) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATEthe value of the Annuity Unit for that Sub-Account as of the preceding Valuation Day; OR Bby b) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSthe net investment factor for that Sub-Account for the Valuation Day for which the Annuity Unit value is being calculated; and by c) the Annuity Unit Factor. ANNUAL MAINTENANCE FEE During each year that this contract is in force prior to the Annuity Commencement Date, BUT NOT LESS THAN ZEROthe Annual Maintenance Fee, if applicable, will be deducted on the Contract Anniversary and upon full surrender of the contract. The fee will be charged against the Contract Value by reducing the number of Accumulation Units from the Sub-Accounts held as of that date. IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTThe fee will be charged on a pro-rate basis with respect to each active Sub-Account. The number of Accumulation Units deducted from each Sub-Account is determined by dividing the pro-rata portion of the Annual Maintenance Fee by the value of an Accumulation Unit for the applicable Sub-Account. TRANSFERS BETWEEN SUB-ACCOUNTS TRANSFER BETWEEN ACCOUNTS You may transfer Contract Values held in the Accounts into other Accounts before and after Xxxxxxx Commencement Date. However, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSCWe may establish, from time to time, restrictions, policies, and procedures relating to transfers between Accounts, which We may modify or terminate at any time. THE PRIOR PREMIUM PAYMENT(SWe may, according to Our then current policies and procedures, restrict or terminate Your transfer privileges if We determine, in Our sole discretion, that You have engaged in a pattern of transfers that is disadvantageous or potentially harmful to other Contract Owners. We may establish, from time to time, restrictions, policies, and procedures, which We may modify or terminate at any time, relating to transfers between Accounts that We determine are competing investment choices. We may, according to Our then current policies and procedures, restrict or terminate Your ability to transfer Contract Values between any Accounts that We determine are competing investment choices. We may also establish time periods during which We may restrict or terminate Your ability to transfer any Contract Values into an Account if, during the time period We establish, Contract Values were transferred out of a competing investment choice of such Account. The right to make transfers between sub-Accounts is subject to modification if We determine, in Our opinion, that exercising that right by one or more Contract Owners is, or would be, to the disadvantage of other Contract Owners. Any modification could be applied to transfers to or from some or all of the Sub-Accounts and could include, but not be limited to: a) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(Sthe requirement of a minimum time period between each transfer; b) WAS PAIDnot accepting transfer requests of an agent acting under a power of attorney or on behalf of more than one Contract Owner, or c) limiting the dollar amount that may be transferred between the Sub-Accounts by a Contract Owner at any one time. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVEDSuch restrictions may be applied in any manner reasonably designed to prevent any use of the transfer right which is considered by Us to be to the disadvantage of other Contract Owners. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:No transfers may be made between Sub-Accounts and the General Account after Xxxxxxx Commencement Date.
Appears in 1 contract
Samples: Individual Flexible (Hartford Life & Annuity Insurance Co Separate Account One)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 7 AND 78. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 5 Premium Payments 6 Valuation Provisions 6 7 Transfers Between Accounts 7 8 Contract Control Provisions 8 9 General Provisions 9 10 Surrenders 10 11 Death Benefits 11 13 Settlement Provisions 14 16 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 19 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 1,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN THREE] ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS [1-4] [10%] OF PREMIUM PAYMENTS MADE PER CONTRACT YEAR ON A NONCUMULATIVE BASIS. AFTER CONTRACT YEAR [4] 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF EACH PREMIUM PAYMENT MADE DURING THE [4] CONTRACT YEARS PRIOR TO WITHDRAWAL; AND [10%] OF PREMIUM PAYMENTS MADE DURING EACH OF THE [4] CONTRACT YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.501.70%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE3 CONTINGENT DEFERRED SALES CHARGES: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED MAY ASSESS A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC "CHARGE") WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC CHARGE IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDCHARGE SCHEDULE. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN THE AMOUNT ASSESSED A CHARGE WILL NOT EXCEED YOUR PREMIUM PAYMENTS. DURING THE FIRST [FOUR] CONTRACT YEARS ALL SURRENDERS IN EXCESS OF THE AWA ARE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM PREMIUM PAYMENTS, THEN FROM EARNINGS. SURRENDERS FROM PREMIUM PAYMENTS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE SUBJECT TO CDSCA CHARGE. AFTER THE [FOURTH] CONTRACT YEAR, ALL SURRENDERS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM EARNINGS, THEN FROM PREMIUM PAYMENTS HELD IN YOUR CONTRACT FOR MORE THEN [FOUR] YEARS AND THEN ONLY FROM PREMIUM PAYMENTS INVESTED FOR LESS THAN [FOUR] YEARS. ONLY PREMIUM PAYMENTS HELD FOR LESS THEN [FOUR] YEARS WILL BE SUBJECT TO A CHARGE. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. PERCENTAGE USED TO CALCULATE THE CHARGE IS EQUAL TO: NUMBER OF YEARS FROM CHARGE EACH PREMIUM PAYMENT -------------------------------------- [7% 1 6% 2 5% 3 4% 4 0% 5] AND THEREAFTER NO CDSC CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF IF: - ONLY THE AWA ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR - ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE CDSCCOMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. FOR ANY SURRENDERAll correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, THE P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on each Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING - The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return (A"AIR") BY when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN (B"AIR") MULTIPLIED BY (C- The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) WHERE:entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant.
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Xalters -------------------------------- -------------------------------- DONALD C. HUNT, SECRETARY XXXX X. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] THE HARTFORD TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 2009] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2039] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 2,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN SEVEN] MORTALITY AND EXPENSE RISK CHARGE: [0.501.15%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $[$5030] IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGEMINIMUM AMOUNT RULE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE THE MINIMUM AMOUNT RULE OF THE "PARTIAL SURRENDERS PRIOR TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM ANNUITY COMMENCEMENT DATE" SECTION OF THE CONTRACT PROVIDES THAT A MINIMUM CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL MUST BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN MAINTAINED IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED AS OF THE CONTRACT ISSUE DATE, THE MINIMUM CONTRACT VALUE EQUALS [$2,000]. WE RESERVE THE RIGHT TO INCREASE THE MINIMUM CONTRACT VALUE AT OUR DISCRETION, BUT IN NO EVENT WILL IT EXCEED $10,000. CONTRACT SPECIFICATIONS ANNUAL WITHDRAWAL AMOUNT (AWA): THE AMOUNT THAT CAN BE WITHDRAWN IN ANY CONTRACT YEAR WITHOUT INCURRING A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT CONTINGENT DEFERRED SALES CHARGE. THIS EQUALS 100% OF REMAINING GROSS PREMIUMS MADE MORE THAN [1] YEAR(S) AGO PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY OR (B) MULTIPLIED BY (C) WHERE:
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL[HARTFORD LOGO] LA-VA03 Printed in U.S.A. B644R0.FRM ASHARE03 PRINTED IN U.S.A.. B772R0.FRM TABLE OF CONTENTS Page PAGE Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HLLA-VA03 ASHARE03 Page 2 Printed in PRINTED IN U.S.A. B645R0.FRM B773R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [[ SEPTEMBER 148, 2009 2002 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2032 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 20,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:.
Appears in 1 contract
Samples: Individual Flexible (Hartford Life & Annuity Insurance Co Separate Account One)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described herein. NONPARTICIPATING PREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX XXXPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 7 AND 78. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 5 Premium Payments 6 Valuation Provisions 6 7 Transfers Between Accounts 7 8 Contract Control Provisions 8 9 General Provisions 9 10 Surrenders 10 11 Death Benefits 11 13 Settlement Provisions 14 16 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 19 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 1,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ONE] ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS [1-4] [10%] OF PREMIUM PAYMENTS MADE PER CONTRACT YEAR ON A NONCUMULATIVE BASIS. AFTER CONTRACT YEAR [4] 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF EACH PREMIUM PAYMENT MADE DURING THE [4] CONTRACT YEARS PRIOR TO WITHDRAWAL; AND [10%] OF PREMIUM PAYMENTS MADE DURING EACH OF THE [4] CONTRACT YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.501.70%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE3 CONTINGENT DEFERRED SALES CHARGES: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED MAY ASSESS A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC "CHARGE") WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC CHARGE IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDCHARGE SCHEDULE. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN THE AMOUNT ASSESSED A CHARGE WILL NOT EXCEED YOUR PREMIUM PAYMENTS. DURING THE FIRST [FOUR] CONTRACT YEARS ALL SURRENDERS IN EXCESS OF THE AWA ARE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM PREMIUM PAYMENTS, THEN FROM EARNINGS. SURRENDERS FROM PREMIUM PAYMENTS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE SUBJECT TO CDSCA CHARGE. AFTER THE [FOURTH] CONTRACT YEAR, ALL SURRENDERS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM EARNINGS, THEN FROM PREMIUM PAYMENTS HELD IN YOUR CONTRACT FOR MORE THEN [FOUR] YEARS AND THEN ONLY FROM PREMIUM PAYMENTS INVESTED FOR LESS THAN [FOUR] YEARS. ONLY PREMIUM PAYMENTS HELD FOR LESS THEN [FOUR] YEARS WILL BE SUBJECT TO A CHARGE. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. PERCENTAGE USED TO CALCULATE THE CHARGE IS EQUAL TO: NUMBER OF YEARS FROM CHARGE EACH PREMIUM PAYMENT ---------------------------------------------------------------- [7% 1 6% 2 5% 3 4% 4 0% 5] AND THEREAFTER NO CDSC CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF IF: - ONLY THE AWA ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR - ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE CDSCCOMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. FOR ANY SURRENDERAll correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, THE P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on each Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING - The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return (A"AIR") BY when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN (B"AIR") MULTIPLIED BY (C- The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) WHERE:entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant.
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You you to be satisfied with the contract You you have purchased. We urge You you to closely examine its provisions. If for any reason You you are not satisfied with Your purchase, You your purchase you may cancel surrender the contract by returning the contract within ten days after You you receive it. A written request for cancellation must accompany the contract. In such event, We we will pay You to the Contract Owner an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear The Contract Owner bears only the investment risk during the period prior to Our the Company's receipt of request for cancellation. Signed for the Company [ ] Premium /s/ Bruce D. Gardnxx /x/ Lowndes A. Smith ------------------------------ ----------------------------------- Bruce D. Gardnxx, XXXXXXXXX Lowndes A. Smith, PRESXXXXX Xremium Payments are flexible as described herein. NONPARTICIPATING Nonparticipating ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 9 AND 710. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] ITT HARTFORD TABLE OF CONTENTS Page PAGE ----------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Provision 5 Contract Control Provisions 8 6 General Provisions 7 Valuation Provisions 9 Surrenders Termination Provisions 10 Death Benefits 11 Settlement Provisions 14 12 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 15 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] 0000000/ CONTRACT ISSUE DATE [SEPTEMBER 14OCTOBER 13, 2009 ] 1994 NAME OF ANNUITANT [ XXXXX XXXXX ] DATE OF ISSUE OCTOBER 13, 1994 AGE OF ANNUITANT 63 ANNUITY COMMENCEMENT DATE [ JANUARY 1FEBRUARY 23, 2039 ] 2003 SEX OF ANNUITANT AGE [ 35 ] MALE INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] 28,218.47 MINIMUM SUBSEQUENT PAYMENT [ $500 ] 500.00 MINIMUM FIXED ACCOUNT INTEREST 3% RATE CONTINGENT ANNUITANT [ XXXX XXXXX ] NONE DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] (IF OTHER THAN ANNUITANT) SAME DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNTANNUAL WITHDRAWAL AMOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGECONTRACT YEARS 1-7 10% OF PREMIUM PAYMENTS AFTER CONTRACT YEAR 7 THE GREATER OF: [0.50%] PER ANNUM 100% OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM CONTRACT VALUE REDUCED BY THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING THE DAILY SUB-ACCOUNTS VALUE7 YEARS PRIOR TO WITHDRAWAL; OR 10% OF PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL. ANNUAL CONTRACT MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY ANNIVERSARY. MORTALITY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED EXPENSE RISK CHARGE: WE WILL APPLY AN 1.25% PER ANNUM OF THE AVERAGE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: 0% PER ANNUM OF THE AVERAGE DAILY CONTRACT VALUE. 3 CONTINGENT DEFERRED SALES CHARGES: SUBJECT TO THE ANNUAL WITHDRAWAL AMOUNT. SURRENDERS OF CONTRACT VALUES ATTRIBUTABLE TO PREMIUM BASED PAYMENTS MAY BE SUBJECT TO A CONTNGENT DEFERRED SALES CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT("CHARGE"). THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED LENGTH OF TIME FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT RECEIPT OF THE PREMIUM BASED PAYMENT TO THE TIME OF SURRENDER DETERMINES THE CHARGE. DURING THE FIRST SEVEN CONTRACT YEARS, ALL SURRENDERS WILL BE FIRST FROM PREMIUM PAYMENTS AND THEN FROM EARNINGS. IF AN AMOUNT EQUAL TO ALL PREMIUM PAYMENTS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE DEDUCTED FOR ANY PORTION ASSESSED AGAINST THE SURRENDER OF THE REMAINING CONTRACT VALUE. AFTER THE SEVENTH CONTRACT YEAR ALL SURRENDERS WILL FIRST BE FROM EARNINGS AND THEN FROM PREMIUM PAYMENT THAT IS SUBJECT PAYMENTS. A CHARGE WILL NOT BE ASSESSED AGAINST THE SURRENDER OF EARNINGS. IF AN AMOUNT EQUAL TO THE CHARGE, BUT IS ALL EARNINGS HAS BEEN SURRENDERED. A CHARGE WILL NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. BE ASSESSED AGAINST PREMIUM PAYMENTS ARE RECEIVED LESS THAN SEVEN YEARS PRIOR TO SURRENDER FOR THIS PURPOSE, PREMIUM PAYMENTS WILL BE DEEMED TO BE SURRENDERED IN THE ORDER IN WHICH THEY ARE WERE RECEIVED. [7] THE CHARGE IS A PERCENTAGE OF THE AMOUNT SURRENDERED (NOT TO EXCEED THE AGGREGATE AMOUNT OF THE PREMIUM PAYMENTS MADE) AND EQUALS: LENGTH OF TIME FROM PREMIUM PAYMENT CHARGE (NUMBER OF YEARS) -------------------------------------------------------------- 6% 1 6% 2 5% 3 5% 4 4% 5 3% 6 2% 7 0% 8 AND THEREAFTER NO CONTINGENT DEERRED SALES CHARGES WILL BE ASSESSED IN THE EVENT THE CONTRACT TERMINATES DUE TO THE DEATH OF THE ANNUITANT OR CONTRACT OWNER (AS APPLICABLE). OR IF CONTRACT VALUES ARE APPLIED TO AN ANNUITY OPTION PROVIDED FOR UNDER THIS CONTRACT (PROVIDED HOWEVER, ANY SURRENDER OUT OF OPTION 4 WILL BE SUBJECT TO CONTINGENT DEFERRED SALES CHARGES, IF APPLICABLE) OR UPON THE EXERCISE OF THE ANNUAL WITHDRAWAL AMOUNT. 3 (Continued) FUND OPTIONS THE INITIAL PREMIUM PAYMENT WILL BE ALLOCATED AS SPECIFIED IN YOUR APPLICATION. THE SAME ALLOCATION WILL BE MADE FOR SUBSEQUENT PREMIUM PAYMENTS UNLESS YOU CHANGE THE ALLOCATION OR, AT THE TIM OF A PREMIXX PAYMENT. YOU INSTRUCT US TO ALLOCATE THAT PAYMENT DIFFERENTLY. SEPARATE ACCOUNT: ITT HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT ONE SUB-ACCOUNT BASED ON: ----------------------------------------------------------------------------- ADVISERS FUND HVA ADVISERS FUND, INC. STOCK FUND HVA STOCK FUND, INC. AGGRESSIVE GROWTH FUND HVA AGGRESSIVE GROWTH FUND, INC. INTERNATIONAL OPPORTUNITIES FUND HARTFORD INTERNATIONAL OPPORTUNITIES FUND, INC. DIVIDEND AND GROWTH FUND HARTFORD DIVIDEND AND GROWTH FUND, INC. INDEX FUND HARTFORD INDEX FUND, INC. GNMA/MORTGAGE SECURITIES FUND HARTFORD GNMA/MORTGAGE SECURITIES FUND, INC. BOND/DEBT SECURITIES FUND HVA BOND/DEBT SECURITIES FUND, INC. MONEY MARKET FUND HVA MONEY MARKET FUND, INC. OR OTHER FUNDS AS MAY BE MADE AVAILABLE FROM TIME TO TIME. 3 (Continued) DEFINITION OF CERTAIN TERMS ACCOUNT -- Any of the Sub-Accounts or the Fixed Account. ACCUMULATION UNIT -- An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY -- Currently located at 200 Hopmeadow Xx. Xxxxxxxx, Xx. Xxx xxxxxxxxndence concerning this contract should be sent to our mailing address at P.O. Box 2999. Xxxx: Xxxxxxdual Annuity Operations, Hartford, CT 00000-0000. XXXXXX XXXXDRAWAL AMOUNT -- The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT -- The person on whose life this contract is issued. ANNUITY COMMENCEMENT DATE -- The date on which annuity payments are to begin as described under Settlement Provisions in this contract. ANNUITY UNIT -- An accounting unit of measure used to calculate the amount of annuity payments under the variable annuity option. BENEFICIARY -- The person entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMPANY -- The ITT Hartford Life and Annuity Insurance Company. CONTINGENT ANNUITANT -- The person so designated by the Contract Owner who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY -- An anniversary of the Contract Date. Similarly, Contract Years are measured from the Contract Date. The Contract Date is shown on Page 3. CONTRACT MAINTENANCE FEE -- An amount which is deducted from the value of the contract at the end of the Contract Year or on the date of surrender of this contract, if earlier. CONTRACT OWNER -- The owner(s) of the contract. CONTRACT VALUE -- The value of the Sub-Accounts plus the value of the Fixed Account on any day. DATE OF ISSUE -- The date on which an Account is established for the Contract Owner by the Company. DOLLAR COST AVERAGING -- Contract Owner initiated systematic transfers from one or more Accounts to any other available Sub-Accounts. DUE PROOF OF DEATH -- A certified copy of the death certificate, an order of a court of competent jurisdiction, a statement from a physician who attended the deceased, or any other proof acceptable to the Company. FIXED ACCOUNT -- Part of the Company's General Account to which all or a portion of the Contract Value may be allocated. DEFINITION OF CERTAIN TERMS (Continued) FUND(S) -- Currently the Funds specified on Page 3 or any other Fund(s) that may be added by the Company. GENERAL ACCOUNT -- All assets of the Company other than those allocated to the Separate Accounts of the Company. MAXIMUM ANNIVERSARY VALUE -- A value used in determining the death benefit. It is based on a series of calculations of Account Values on Contract Anniversaries. premium payments and partial surrenders. As of the date of death, the Company will calculate an Anniversary Value for each Contract Anniversary prior to the deceased's attained age 81. The Anniversary Value is equal to the Account Value on a Contract Anniversary, increased by the dollar amount of any premium payments made since that anniversary and reduced by the dollar amount of any partial surrenders since that anniversary. The Maximum Anniversary Value is equal to the greatest Anniversary Value attained from this series of calculations. PREMIUM TAX -- The amount of tax, if any, charged by a federal, state or municipal entity on premium payments or Contract Values. SEPARATE ACCOUNT -- An Account established by the Company to separate the assets funding the variable benefits for the class of contracts to which this contract belongs from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business the Company may conduct. The Separate Account and the Funds, which are the underlying securities of the Separate Account, are listed on the Contract Specifications on Page 3 of this contract. SUB-ACCOUNT -- The subdivisions of the Separate Account which are used to determine how the Contract Owner's Account is allocated between the Funds. TERMINATION VALUE -- The value of the contract upon termination, as described in the section of the contract captioned "Termination Provisions." VALUATION DAY -- Every day the New York Stock Exchange is open for trading. PREMIUM PAYMENTS PREMIUM PAYMENTS Premium Based Charge payments are payable at the Administrative Office of the Company Payments may be made by check payable to ITT Hartford Life and Annuity Insurance Company or by any other method which the Company deems acceptable. The Initial Premium Payment is shown on Page 3. This is a flexible premium annuity. Additional payments may be accepted by the Company. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. ALLOCATION OF PREMIUM PAYMENTS The Contract Owner shall specify that portion of any premium payments to be allocated to each Account, provided, however, that the minimum allocation to any Account may not be less than the Company's minimum amount then in effect. PREMIUM PAYMENTS (Continued) The Contract Owner may transfer Contract Values held in the Accounts into other Accounts: however, the Company reserves the right to limit the number of transfer to no more frequently than 12 per Contract Year with no two transfers being made on consecutive Valuation Days. Subject to the following two paragraphs, any such limitations will apply to all Contract Owners. The right to reallocate Contract Values between the Accounts is subject to modification if the Company determines, in its sole opinion, that the exercise of that right by one or more Contract Owners is, or would be, to the disadvantage of other Contract Owners. Any modification could be applied to transfers to or from some or all of the Accounts and could include, but not be limited to, the requirement of a minimum time period between each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPtransfer, not accepting transfer requests of an agent acting under a power of attorney on behalf of more than one Contract Owner, or limiting the dollar amount that may be transferred between the Accounts by a Contract Owner at any one time. Such restrictions may be applied in any manner reasonably designed to prevent any use of the transfer right which is considered by the Company to be to the disadvantage of other Contract Owners. The maximum amount transferable from the Fixed Account during any Contract Year is the greater of 30% of the Fixed Account balance as of the last Contract Anniversary or the greatest of any prior transfer from the Fixed Account. This limitation does not apply to Dollar Cost Averaging. However, if any interest rate is renewed at a rate at least one percentage point less than the previous rate, the Contract Owner may elect to transfer up to 100% of the Funds receiving that reduced rate within 60 days of notification of the interest rate decrease. Transfers may not be made from the Sub-OSHARE-11 Page 3 Printed Accounts into the Fixed Account for the six-month period following any transfer from the Fixed Account into the other Sub-Account. The Company reserves the right to defer transfers from the Fixed Account for up to six months from the date of request. CONTRACT CONTROL PROVISIONS ANNUITANT, CONTINGENT ANNUITANT, CONTRACT OWNER The Annuitant may not be changed. The designations of Contract Owner and Contingent Annuitant will remain in U.S.A. effect until changed by the Contract Owner. Changes in the designation of the Contract Owner may be made during the lifetime of the Annuitant by written notice to the Company. Changes in the designation of Contingent Annuitant may be made at any time prior to the Annuity Commencement Dale by writtex xxtice to the Company. Notwithstanding the foregoing, if no Contingent Annuitant has been named and the Contract Owner/Annuitant's spouse is the Beneficiary it will be assumed that the Contract Owner/Annuitant's spouse is the Contingent Annuitant. The Contract Owner has the sole power to exercise all the rights, options and privileges granted by this contract or permitted by the Company and to agree with the Company to any change in or amendment to the contract. The rights of the Contract Owner shall be subject to the rights of any assignee of record with the Company and of any irrevocably designated Beneficiary. In the case of joint Contract Owners, each Contract Owner alone may exercise all rights, options and privileges, except with respect to the Termination and Partial Surrender Annual Withdrawal Amount Provisions and change of ownership. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE CONTROL PROVISIONS (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDERContinued) BENEFICIARY The Designated Beneficiary will remain in effect until changed by the Contract Owner. Changes in the Designated Beneficiary may be made during the lifetime of the Annuitant by written notice to the Administrative Office of the Company. If the Designated Beneficiary has been designated irrevocably, however, such designation cannot be changed or revoked without such Beneficiary's written consent. Upon receipt of such notice and written consent, if required, at the Administrative Office of the Company, the new designation will take effect as of the date the notice is signed, whether or not the Annuitant or Contract Owner is alive at the time of receipt of such notice. The change will be subject to any payments made or other action taken by the Company before the receipt of the notice. In the event of the death of the Annuitant when there is no surviving Contingent Annuitant, the Beneficiary will be as follows. If the death of the Annuitant occurs prior to the Annuity Commencement Date, the Beneficiary shall be the surviving Contract Owner, or joint Contract Owners, if applicable, notwithstanding that the Designated Beneficiary may be different. Otherwise, the Beneficiary will be the Designated Beneficiary then in effect. If the Annuitant is the sole Contract Owner and there is no Designated Beneficiary in effect, the Annuitant's estate will be the Beneficiary. In the event of the death of a Contract Owner prior to the Annuity Commencement Date, the Beneficiary will be as follows. If the owner was the sole Contract Owner, the Beneficiary shall be the Designated Beneficiary then in effect. If no Beneficiary designation is in effect or if the Designated Beneficiary has predeceased the Contract Owner, the Contract Owner's estate shall be the Beneficiary. At the first death of a joint Contract Owner prior to the Annuity Commencement Date, the Beneficiary shall be the surviving Contract Owner notwithstanding that the Designated Beneficiary may be different. GENERAL PROVISIONS THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:CONTRACT This contract constitutes the entire contract.
Appears in 1 contract
Samples: Reinsurance Agreement (Hartford Life & Annuity Insurance Co Separate Account One)
RIGHT TO EXAMINE CONTRACT. We want You [The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company [ at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] Premium Payments are flexible as described herein. NONPARTICIPATING ALL THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HLTMLS 1 [09-VA03 Printed in U.S.A. B644R0.FRM 01] 2008 Version: Form of Individual Annuity Contract pp1-33 TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUATION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PERIOD 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15 TMLS 2 [09-01] 2008 Version: Form of Individual Annuity Contract pp1-33 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A - Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 TMLS 3 [09-01] 2008 Version: Form of Individual Annuity Contract pp1-33 INSERT SCHEDULE PAGES 4A+ HERE TMLS 4 [09-01] 2008 Version: Form of Individual Annuity Contract pp1-33 DEFINITIONS ACCUMULATION PERIOD The period during which Purchase Payments may be made. ACCUMULATION UNIT A unit of measure used to determine the value of the Contract Owner’s interest in a Sub-Account of the Separate Account during the Accumulation Period. AGE The age of any Contract Owner or Annuitant on his/her birthday nearest the date for which age is being determined. ANNUITANT The primary person upon whose life Annuity Payments are to be made. On or after the Annuity Date, the Annuitant shall also include any Joint Annuitant. ANNUITY DATE The date on which any Annuity Payments begin. The Annuity Date is shown on the Contract Schedule. ANNUITY PAYMENTS The series of payments that will be made pursuant to any Annuity Option selected. ANNUITY OPTIONS Options available for Annuity Payments. ANNUITY PERIOD The period which begins on the Annuity Date and ends with the last Annuity Payment. ANNUITY SERVICE CENTER The office indicated on the Contract Schedule of this Contract, or other location(s) specified by the Company to which notices, requests and Purchase Payments must be sent. All sums payable by the Company under this Contract are payable only from the Annuity Service Center, or other location(s) specified by the Company. ANNUITY UNIT A unit of measure used to determine the amount of each Variable Annuity Payment after the Annuity Date. BENEFICIARY The person(s) or entity(ies) designated to receive the death benefit provided by this Contract. CONTRACT ANNIVERSARY An anniversary of the Issue Date of this Contract CONTRACT SCHEDULE DATE The effective date of any Contract Schedule. A Contract Schedule bearing the latest Schedule Date will supersede all previous Contract Schedules. CONTRACT OWNER The person(s) or entity(ies) entitled to the ownership rights stated in this Contract. TMLS 5 [09-01] 2008 Version: Form of Individual Annuity Contract pp1-33 CONTRACT VALUE The sum of the Contract Owner’s interest in the Sub-Accounts of the Separate Account during the Accumulation Period. CONTRACT YEAR The first Contract Year is the annual period which begins on the Issue Date. Subsequent Contract Years begin on each anniversary of the Issue Date. ELIGIBLE INVESTMENT An investment entity shown on the Contract Schedule into which assets of the Separate Account will be invested. FIXED ANNUITY A series of payments made during the Annuity Period which are guaranteed as to dollar amount by the Company. GENERAL ACCOUNT The Company’s general investment account which contains all the assets of the Company with the exception of the Separate Account and other segregated asset accounts. ISSUE DATE The date on which this Contract became effective. NET PURCHASE A Purchase Payment less any Premium Tax assessed by any state or PAYMENT other jurisdiction. PREMIUM TAX A tax imposed by certain states and other jurisdictions when a Purchase Payment is made, when Annuity Payments begin, or when the Contract is surrendered. PURCHASE PAYMENT During the Accumulation Period, a payment made by or on behalf of a Contract Owner with respect to this Contract. RIDER EFFECTIVE The effective date of any Rider as indicated on the Contract Schedule. SEPARATE ACCOUNT DATE The Company’s Separate Account(s) designated on the Contract Schedule. SERIES A segment of an Eligible Investment which constitutes a separate and distinct class of shares into which assets of a Sub-Account will be invested. SUB-ACCOUNT Separate Account assets are divided into Sub-Accounts which are listed on the Contract Schedule. Assets of each Sub-Account will be invested in shares of an Eligible Investment or a Series of an Eligible Investment. VALUATION DATE Each day on which the Company, the New York Stock Exchange (CDSC): WE MAY ASSESS A CDSC WHEN YOU “NYSE”) and the Eligible Investments are open for business. VALUATION PERIOD The period of time beginning at the close of business of the NYSE on each Valuation Date and ending at the close of business for the next succeeding Valuation Date. TMLS 6 [09-01] 2008 Version: Form of Individual Annuity Contract pp1-33 VARIABLE ANNUITY An annuity with payments which vary as to dollar amount in relation to the investment performance of specified Sub-Accounts of the Separate Account. WRITTEN REQUEST A FULL OR PARTIAL SURRENDERrequest in writing, in a form satisfactory to the Company, which is received by the Annuity Service Center. TMLS 7 [09-01] 2008 Version: Form of Individual Annuity Contract pp1-33 PURCHASE PAYMENT PROVISIONS PURCHASE PAYMENTS The initial Purchase Payment is due on the Issue Date. The minimum and maximum subsequent and total Purchase Payments are shown on the Contract Schedule. The Company reserves the right to reject any Purchase Payment. SUBSEQUENT PURCHASE PAYMENTS Subject to the minimum subsequent and maximum total shown on the Contract Schedule, the Contract Owner may make subsequent Purchase Payments. ALLOCATION OF PURCHASE PAYMENTS The allocation of the initial Net Purchase Payment is made in accordance with the selection made by the Contract Owner at the time the Contract is issued. Unless otherwise changed by Written Request by the Contract Owner, subsequent Net Purchase Payment(s) are allocated in the same manner as the initial Net Purchase Payment. Allocation of the Net Purchase Payments is subject to the Allocation Guidelines shown on the Contract Schedule. The Company has reserved the right to allocate initial Purchase Payments to the Money Market Sub-Account until the expiration of the Right to Examine Contract period. SEPARATE ACCOUNT PROVISIONS THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACTSEPARATE ACCOUNT The Separate Account is designated on the Contract Schedule and consists of assets set aside by the Company, which are kept separate from that of the general assets and all other separate account assets of the Company. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OFThe assets of the Separate Account equal to reserves and other liabilities will not be charged with liabilities arising out of any other business the Company may conduct. The Separate Account assets are divided into Sub-Accounts. The Sub-Accounts which are available under this Contract are listed in the Contract Schedule. The assets of the Sub-Accounts are allocated to the Eligible Investment(s) and the Series, if any, within an Eligible Investment shown on the Contract Schedule. The Company may, from time to time, add additional Eligible Investments or Series to those shown on the Contract Schedule. The Contract Owner may be permitted to transfer Contract Values or allocate Net Purchase Payments to the additional Eligible Investments or Series. However, the right to make such transfers or allocations will be limited by the terms and conditions imposed by the Company. Should the shares of any such Eligible Investment(s) or any Series within an Eligible Investment become unavailable for investment by the Separate Account, or the Company deems further investment in these shares inappropriate, the Company may limit further purchase of such shares or may substitute shares of another Eligible Investment or Series for shares already purchased under this Contract. TMLS 8 [09-01] 2008 Version: AForm of Individual Annuity Contract pp1-33 VALUATION OF ASSETS The assets of the Separate Account are valued at their fair market value in accordance with procedures of the Company. ACCUMULATION UNITS During the Accumulation Period, Accumulation Units shall be used to account for all amounts allocated to or withdrawn from the Sub-Accounts of the Separate Account as a result of Purchase Payments, withdrawals, transfers, or fees and charges. The Company will determine the number of Accumulation Units of a Sub-Account purchased or cancelled once it receives the necessary information to completely process the transaction. This will be done by dividing the amount allocated to (or the amount withdrawn from) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:the Sub-Account by the dollar value of one Accumulation Unit of the Sub-Account as of the end of the Valuation Period during which the request for the transaction is received at the Annuity Service Center.
Appears in 1 contract
Samples: Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein/s/ XXXXXXXXX XXXXX XXXXXX /s/ XXXXXX X. XXXXX Xxxxxxxxx Xxxxx Xxxxxx, SECRETARY Xxxxxx X. Xxxxx, PRESIDENT PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL[LOGO] LA-VA03 Printed in PRINTED IN U.S.A. B644R0.FRM B675R0.FRM TABLE OF CONTENTS Page PAGE Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HLLA-VA03 Page 2 Printed in PRINTED IN U.S.A. B645R0.FRM B676R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [[ SEPTEMBER 148, 2009 2002 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2032 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 1,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS [1-7] -------------------- [10%] OF PREMIUM PAYMENTS MADE PER CONTRACT YEAR ON A NONCUMULATIVE BASIS. AFTER CONTRACT YEAR [7] ----------------------- 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF EACH PREMIUM PAYMENT MADE DURING THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL; AND [10%] OF PREMIUM PAYMENTS MADE DURING EACH OF THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.501.35%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGEVA03-3DIR Page 3 PRINTED IN U.S.A. CONTINGENT DEFERRED SALES CHARGES: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED MAY ASSESS A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC "CHARGE") WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC CHARGE IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDCHARGE SCHEDULE. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN THE AMOUNT ASSESSED A CHARGE WILL NOT EXCEED YOUR PREMIUM PAYMENTS. DURING THE FIRST [SEVEN] CONTRACT YEARS ALL SURRENDERS IN EXCESS OF THE AWA ARE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM PREMIUM PAYMENTS, THEN FROM EARNINGS. SURRENDERS FROM PREMIUM PAYMENTS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE SUBJECT TO CDSCA CHARGE. AFTER THE [SEVENTH] CONTRACT YEAR, ALL SURRENDERS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM EARNINGS, THEN FROM PREMIUM PAYMENTS HELD IN YOUR CONTRACT FOR MORE THEN [SEVEN] YEARS AND THEN ONLY FROM PREMIUM PAYMENTS INVESTED FOR LESS THAN [SEVEN] YEARS. ONLY PREMIUM PAYMENTS HELD FOR LESS THEN [SEVEN] YEARS WILL BE SUBJECT TO A CHARGE. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. PERCENTAGE USED TO CALCULATE THE CHARGE IS EQUAL TO: NUMBER OF YEARS FROM CHARGE EACH PREMIUM PAYMENT [ 7% 1 7% 2 7% 3 6% 4 5% 5 4% 6 3% 7 0% 8 ] AND THEREAFTER NO CDSC CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF IF: - ONLY THE AWA ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR - ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE. VA03-3ADIR Page 3A PRINTED IN U.S.A. B647R0.FRM DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE CDSCCOMPANY - Currently located at 000 Xxxxxxxxx Xx., Xxxxxxxx, XX 00000. FOR ANY SURRENDERAll correspondence concerning this contract should be sent to Our mailing address: Hartford Life Investment Product Services, THE P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE - An amount which, depending on the amount of the Contract Value, may be deducted from the value of the contract on each Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME - The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. VA03-4/5 Page 4 PRINTED IN U.S.A. B649R0.FRM DEFINITION OF WITHDRAWAL BY DIVIDING CERTAIN TERMS (ACONTINUED) BY (BCONTRACT OWNER(S) MULTIPLIED BY (C- The owner(s) WHERE:or holder of the contract. CONTRACT VALUE - The aggregate value of the Accounts on any Valuation Day. CONTRACT YEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. DEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant, as applicable.
Appears in 1 contract
Samples: Individual Flexible (Hartford Life & Annuity Insurance Co Separate Account One)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Xalters -------------------------------- -------------------------------- DONALD C. HUNT, SECRETARY XXXX X. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 2009] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT ANNUITX XXXXXXXXXENT DATE [ [JANUARY 1, 2039 2039] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 2,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN SEVEN] MORTALITY AND EXPENSE RISK CHARGE: [0.501.15%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $[$5030] IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGEMINIMUM AMOUNT RULE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE THE MINIMUM AMOUNT RULE OF THE "PARTIAL SURRENDERS PRIOR TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM ANNUITY COMMENCEMENT DATE" SECTION OF THE CONTRACT PROVIDES THAT A MINIMUM CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL MUST BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN MAINTAINED IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED AS OF THE CONTRACT ISSUE DATE, THE MINIMUM CONTRACT VALUE EQUALS [$2,000]. WE RESERVE THE RIGHT TO INCREASE THE MINIMUM CONTRACT VALUE AT OUR DISCRETION, BUT IN NO EVENT WILL IT EXCEED $10,000. CONTRACT SPECIFICATIONS ANNUAL WITHDRAWAL AMOUNT (AWA): THE AMOUNT THAT CAN BE WITHDRAWN IN ANY CONTRACT YEAR WITHOUT INCURRING A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT CONTINGENT DEFERRED SALES CHARGE. THIS EQUALS 100% OF REMAINING GROSS PREMIUMS MADE MORE THAN [1] YEAR(S) AGO PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY OR (B) MULTIPLIED BY (C) WHERE:
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You you to be satisfied with the contract You you have purchased. We urge You you to closely examine its provisions. If for any reason You you are not satisfied with Your purchase, You your purchase you may cancel surrender the contract by returning the contract within ten days after You you receive it. A written request for cancellation must accompany the contract. In such event, We we will pay You to the Contract Owner an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear The Contract Owner bears only the investment risk during the period prior to Our the Company's receipt of request for cancellation. Signed for the Company [ ] /s/ Xxxxx X. Xxxxxxx /s/ Lowndes X. Xxxxx ------------------------------ ----------------------------------- Xxxxx X. Xxxxxxx, SECRETARY Lowndes X. Xxxxx, PRESIDENT Premium Payments are flexible as described herein. NONPARTICIPATING Nonparticipating ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 9 AND 710. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] ITT HARTFORD TABLE OF CONTENTS Page <Table> <Caption> <S> <C> <C> <C> ----------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Provision 5 Contract Control Provisions 8 6 General Provisions 7 Valuation Provisions 9 Surrenders Termination Provisions 10 Death Benefits 11 Settlement Provisions 14 12 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 15 </Table> CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] 0000000/ CONTRACT ISSUE DATE [SEPTEMBER 14OCTOBER 13, 2009 ] 1994 NAME OF ANNUITANT [ XXXXX XXXXX ] DATE OF ISSUE OCTOBER 13, 1994 AGE OF ANNUITANT 63 ANNUITY COMMENCEMENT DATE [ JANUARY 1FEBRUARY 23, 2039 ] 2003 SEX OF ANNUITANT AGE [ 35 ] MALE INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] 28,218.47 MINIMUM SUBSEQUENT PAYMENT [ $500 ] 500.00 MINIMUM FIXED ACCOUNT INTEREST 3% RATE CONTINGENT ANNUITANT [ XXXX XXXXX ] NONE DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] (IF OTHER THAN ANNUITANT) SAME DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNTANNUAL WITHDRAWAL AMOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGECONTRACT YEARS 1-7 10% OF PREMIUM PAYMENTS AFTER CONTRACT YEAR 7 THE GREATER OF: [0.50%] PER ANNUM 100% OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM CONTRACT VALUE REDUCED BY THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING THE DAILY SUB-ACCOUNTS VALUE7 YEARS PRIOR TO WITHDRAWAL; OR 10% OF PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL. ANNUAL CONTRACT MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY ANNIVERSARY. MORTALITY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED EXPENSE RISK CHARGE: WE WILL APPLY AN 1.25% PER ANNUM OF THE AVERAGE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: 0% PER ANNUM OF THE AVERAGE DAILY CONTRACT VALUE. CONTINGENT DEFERRED SALES CHARGES: SUBJECT TO THE ANNUAL WITHDRAWAL AMOUNT. SURRENDERS OF CONTRACT VALUES ATTRIBUTABLE TO PREMIUM BASED PAYMENTS MAY BE SUBJECT TO A CONTNGENT DEFERRED SALES CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT("CHARGE"). THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED LENGTH OF TIME FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT RECEIPT OF THE PREMIUM BASED PAYMENT TO THE TIME OF SURRENDER DETERMINES THE CHARGE. DURING THE FIRST SEVEN CONTRACT YEARS, ALL SURRENDERS WILL BE FIRST FROM PREMIUM PAYMENTS AND THEN FROM EARNINGS. IF AN AMOUNT EQUAL TO ALL PREMIUM PAYMENTS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE DEDUCTED FOR ANY PORTION ASSESSED AGAINST THE SURRENDER OF THE REMAINING CONTRACT VALUE. AFTER THE SEVENTH CONTRACT YEAR ALL SURRENDERS WILL FIRST BE FROM EARNINGS AND THEN FROM PREMIUM PAYMENT THAT IS SUBJECT PAYMENTS. A CHARGE WILL NOT BE ASSESSED AGAINST THE SURRENDER OF EARNINGS. IF AN AMOUNT EQUAL TO THE CHARGE, BUT IS ALL EARNINGS HAS BEEN SURRENDERED. A CHARGE WILL NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. BE ASSESSED AGAINST PREMIUM PAYMENTS ARE RECEIVED LESS THAN SEVEN YEARS PRIOR TO SURRENDER FOR THIS PURPOSE, PREMIUM PAYMENTS WILL BE DEEMED TO BE SURRENDERED IN THE ORDER IN WHICH THEY ARE WERE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment THE CHARGE IS A PERCENTAGE OF THE AMOUNT SURRENDERED (NOT TO EXCEED THE AGGREGATE AMOUNT OF THE PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PAYMENTS MADE) AND EQUALS: <Table> <Caption> LENGTH OF TIME FROM PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES PAYMENT CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: ANUMBER OF YEARS) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (<S> <C) WHERE:> --------------------------------------------------------------
Appears in 1 contract
Samples: Talcott Resolution Life & Annuity Insurance Co Separate Account One
RIGHT TO EXAMINE CONTRACT. We want You you to be satisfied with the contract You you have purchased. We urge You you to closely examine its provisions. If for any reason You you are not satisfied with Your purchase, You your purchase you may cancel surrender the contract by returning the contract within ten days after You you receive it. A written request for cancellation must accompany the contract. In such event, We we will pay You to the Contract Owner an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear The Contract Owner bears only the investment risk during the period prior to Our the Company's receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein/s/ Xxxxx Xxxxxx, SECRETARY /s/ Xxxxxxx X. Smith, PRESIDENT Xxxxx Xxxxxx, SECRETARY Xxxxxxx X. Smith, PRESIDENT PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 9 AND 7. HL1O. VA-VA03 APLINE SAMPLE Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 PAGE Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Provision 5 Contract Control Provisions 8 6 General Provisions 7 Valuation Provisions 9 Surrenders Termination Provisions 10 Death Benefits 11 Settlement Provisions 14 12 Annuity Tables 16 HL15 VA-VA03 Page 2 ALPINE SAMPLE Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 14FEBRUARY 8, 2009 1994] NAME OF ANNUITANT [ [XXXXX XXXXX XXXXX] DATE OF ISSUE [FEBRUARY 8, 1994] AGE OF ANNUITANT [35] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2024] SEX OF ANNUITANT AGE [ 35 [MALE] INITIAL PREMIUM PAYMENT [ [$2,000 20,000] CONTINGENT ANNUITANT GENDER [ MALE [XXXX XXXXX] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ [XXX XXXXX XXXXX] MINIMUM FIXED ACCOUNT INTEREST RATE 3% CONTRACT OWNER [ XXXXX XXXXX [SAME] (IF OTHER THAN ANNUITANT) DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNTANNUAL WITHDRAWAL AMOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGECONTRACT YEARS 1-7 10% OF PREMIUM PAYMENTS. AFTER CONTRACT YEAR 7 THE GREATER OF: [0.50%] PER ANNUM 100% OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM CONTRACT VALUE REDUCED BY THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING THE DAILY SUB-ACCOUNTS VALUE7 YEARS PRIOR TO WITHDRAWAL; AND 10% OF PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL. ANNUAL CONTRACT MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY ANNIVERSARY. MORTALITY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED EXPENSE RISK CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS 1.25% PER ANNUM OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROAVERAGE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: 0% PER ANNUM OF THE AVERAGE DAILY CONTRACT VALUE. IF A SUBSEQUENT PREMIUM PAYMENT BRINGS VA-ALPINE SAMPLE Page 3 PRINTED IN U.S.A. FUND OPTIONS: THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT INITIAL PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGEBE ALLOCATED AS SPECIFIED IN YOUR APPLICATION. THE PRIOR SAME ALLOCATIONS WILL BE MADE FOR SUBSEQUENT PREMIUM PAYMENT(S) WILL MAINTAIN PAYMENTS UNLESS YOU CHANGE THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED ALLOCATION OR, AT THE TIME SUCH OF A PREMIUM PAYMENT(SPAYMENT, YOU INSTRUCT US TO ALLOCATE THAT PAYMENT DIFFERENTLY. SEPARATE ACCOUNT: ALPINE LIFE INSURANCE COMPANY SEPARATE ACCOUNT ONE SUB-ACCOUNT BASED ON ADVISERS FUND HARTFORD ADVISERS HLS FUND (IA), INC. BOND FUND HARTFORD BOND HLS FUND (IA), INC. CAPITAL APPRECIATION FUND HARTFORD CAPITAL APPRECIATION HLS FUND (IA), INC. DIVIDEND AND GROWTH FUND HARTFORD DIVIDEND AND GROWTH HLS FUND (IA), INC. GROWTH AND INCOME FUND HARTFORD GROWTH AND INCOME HLS FUND (IA), INC. INDEX FUND HARTFORD INDEX HLS FUND (IA), INC. INTERNATIONAL ADVISERS FUND HARTFORD INTERNATIONAL ADVISERS HLS FUND (IA), INC. INTERNATIONAL OPPORTUNITIES FUND HARTFORD INTERNATIONAL OPPORTUNITIES HLS FUND (IA), INC. MIDCAP FUND HARTFORD MIDCAP HLS FUND (IA), INC. MONEY MARKET FUND HARTFORD MONEY MARKET HLS FUND (IA), INC. MORTGAGE SECURITIES FUND HARTFORD MORTGAGE SECURITIES HLS FUND (IA), INC. SMALL COMPANY FUND HARTFORD SMALL COMPANY HLS FUND (IA), INC. STOCK FUND HARTFORD STOCK HLS FUND (IA), INC. OR OTHER FUNDS AS MAY BE MADE AVAILABLE FROM TIME TO TIME. VA-ALPINE SAMPLE Page 3 (Continued) WAS PAIDPRINTED IN U.S.A. CONTINGENT DEFERRED SALES CHARGES: SUBJECT TO THE ANNUAL WITHDRAWAL AMOUNT, SURRENDERS OF CONTRACT VALUES ATTRIBUTABLE TO PREMIUM PAYMENTS MAY BE SUBJECT TO A CONTINGENT DEFERRED SALES CHARGE ("CHARGE"). A PROPORTIONATE AMOUNT THE LENGTH OF TIME FROM RECEIPT OF THE PREMIUM BASED PAYMENT TO THE TIME OF SURRENDER DETERMINES THE CHARGE. DURING THE FIRST SEVEN CONTRACT YEARS, ALL SURRENDERS WILL BE FIRST FROM PREMIUM PAYMENTS AND THEN FROM EARNINGS. IF AN AMOUNT EQUAL TO ALL PREMIUM PAYMENTS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE DEDUCTED FOR ANY PORTION ASSESSED AGAINST THE SURRENDER OF THE REMAINING CONTRACT VALUE. AFTER THE SEVENTH CONTRACT YEAR, ALL SURRENDERS WILL BE FIRST FROM EARNINGS AND THEN FROM PREMIUM PAYMENT THAT IS SUBJECT PAYMENTS. A CHARGE WILL NOT BE ASSESSED AGAINST THE SURRENDER OF EARNINGS. IF AN AMOUNT EQUAL TO THE CHARGEALL EARNINGS HAS BEEN SURRENDERED, A CHARGE WILL NOT BE ASSESSED AGAINST PREMIUM PAYMENTS RECEIVED MORE THAN SEVEN YEARS PRIOR TO SURRENDER, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. WILL BE ASSESSED AGAINST PREMIUM PAYMENTS ARE RECEIVED LESS THAN SEVEN YEARS PRIOR TO SURRENDER. FOR THIS PURPOSE, PREMIUM PAYMENTS WILL BE DEEMED TO BE SURRENDERED IN THE ORDER IN WHICH THEY ARE WERE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment THE CHARGE IS A PERCENTAGE OF THE AMOUNT SURRENDERED (NOT TO EXCEED THE AGGREGATE AMOUNT OF THE PREMIUM BASED PAYMENTS MADE) AND EQUALS: LENGTH OF TIME FROM PREMIUM PAYMENT CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page (NUMBER OF YEARS) 6% 1 6% 2 5% 3 Printed in U.S.A. CONTRACT SPECIFICATIONS 5% 4 4% 5 3% 6 2% 7 0% 8 AND THEREAFTER NO CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC CHARGES WILL BE ASSESSED IF ONLY IN THE AWA IS TAKENEVENT THE CONTRACT TERMINATES DUE TO THE DEATH OF THE ANNUITANT OR CONTRACT OWNER (AS APPLICABLE), OR ELIGIBILITY REQUIREMENTS IF CONTRACT VALUES ARE MET APPLIED TO AN ANNUITY OPTION PROVIDED FOR UNDER THIS CONTRACT (PROVIDED HOWEVER, ANY SURRENDER OUT OF OPTION 4 WILL BE SUBJECT TO CONTINGENT DEFERRED SALES CHARGES, IF APPLICABLE), OR IF THE WAIVER CONTRACT IS SURRENDERED ON OR AFTER THE ANNUITANT'S 90TH BIRTHDAY, OR UPON THE EXERCISE OF THE CDSCANNUAL WITHDRAWAL AMOUNT. FOR ANY SURRENDER, THE VA-ALPINE SAMPLE Page 3 (Continued) PRINTED IN U.S.A. DEFINITION OF ACCOUNT - Any of the Sub-Accounts or the Fixed Account. CERTAIN TERMS ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:- The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. ANNUITY COMMENCEMENT DATE - The date on which annuity payments are to begin as described under Settlement Provisions in this contract. ANNUITY UNIT - An accounting unit of measure used to calculate the amount of annuity payments under the variable annuity option.
Appears in 1 contract
Samples: Individual Flexible (Alpine Life Insurance Co Seperate Account One)
RIGHT TO EXAMINE CONTRACT. We want You Within 10 days of the date of receipt of this contract, or 60 days if a replacement contract, of the date of receipt of this Contract by the Owner, it may be returned by delivering or mailing it to be satisfied with the contract You have Company at its Administrative Office or to the Registered Representative through whom it was purchased. We urge You to closely examine its provisionsWhen the Contract is received by the Company, it will be voided as if it had never been in force. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We The Company will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) refund the Contract Value on computed as of the date Business Day the Company receives the returned contract at its Administrative Office. This refund amount will be the Contract Value plus the amount of surrenderfees and other charges deducted from gross consideration or imposed under the contract, if applicable. You bear only the investment risk during the period prior to Our The refund will be issued within 10 days of receipt of request policy or contract for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY Secretary President INDIVIDUAL FLEXIBLE PREMIUM DEFERRED SEPARATE ACCOUNT ANNUITY CONTRACT Non-participating INCOME PAYMENTS, WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE VARIABLE ACCOUNT, ARE VARIABLE AND VARIABLE. THE AMOUNTS ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AMOUNTS AND 7. HLWILL INCREASE OR DECREASE IN VALUE BASED UPON INVESTMENT RESULTS JNL-2300-VA03 Printed in U.S.A. B644R0.FRM 1-NY TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts DEFINITIONS 7 Contract Control Provisions PURCHASE PAYMENT PROVISIONS 8 General Provisions PURCHASE PAYMENTS 8 ALLOCATION OF PURCHASE PAYMENTS 8 SEPARATE ACCOUNT PROVISIONS 8 THE SEPARATE ACCOUNTS 8 VARIABLE ACCOUNT 8 VALUATION OF ASSETS 8 ACCUMULATION UNITS 8 ACCUMULATION UNIT VALUE 9 Surrenders CONTRACT VALUE 9 SUBSCRIPTION FEE 9 DEDUCTION FOR SUBSCRIPTION FEE 9 DEDUCTION FOR LOW COST PLATFORM FEE 10 Death Benefits DEDUCTION FOR OPTIONAL ASSET ALLOCATION MODEL FEE TRANSFERS 11 Settlement Provisions TRANSFERS DURING THE ACCUMULATION PERIOD 11 WITHDRAWAL PROVISIONS 11 WITHDRAWALS 11 PROCEEDS PAYABLE ON DEATH 11 DEATH OF OWNER DURING THE ACCUMULATION PERIOD 11 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 11 DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 12 DEATH OF OWNER DURING THE ANNUITY PERIOD 12 DEATH OF ANNUITANT 12 PAYMENT OF DEATH BENEFIT 12 BENEFICIARY 12 CHANGE OF BENEFICIARY 13 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 13 OWNER, ANNUITANT, XXXXXXXXX, XXXXXXXXXX XXXXXXXXXX 00 OWNER 13 JOINT OWNER 13 ANNUITANT 13 ASSIGNMENT OF A CONTRACT 13 TABLE OF CONTENTS ANNUITY PROVISIONS 14 Annuity Tables 16 HLGENERAL 14 ANNUITY DATE 14 SELECTION OF AN ANNUITY OPTION 14 FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 14 ANNUITY OPTIONS 14 OPTION 1. LIFETIME ONLY ANNUITY: 14 OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 14 OPTION 3. PAYMENT FOR A FIXED PERIOD: 14 OPTION 4. JOINT AND SURVIVOR ANNUITY 14 ANNUITY 14 FIXED ANNUITY 14 MORTALITY TABLES 15 GENERAL PROVISIONS 15 THE CONTRACT 15 MISSTATEMENT OF AGE 15 INCONTESTABILITY 15 MODIFICATION 15 NON-VA03 Page 2 Printed in U.S.A. B645R0.FRM PARTICIPATING 15 EVIDENCE OF SURVIVAL 15 PROOF OF AGE 15 PROTECTION OF PROCEEDS 15 REPORTS 15 TAXES 15 REGULATORY REQUIREMENTS 15 ANNUITY OPTION TABLES 16-18 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN SCHEDULE PRIMARY OWNER: [Xxxx Xxx] CONTRACT ISSUE DATE DATE: [SEPTEMBER 14, 2009 1/1/2015] NAME OF JOINT OWNER: [Xxxx Xxx] ANNUITANT: [Xxxx Xxx] ANNUITANT [ XXXXX XXXXX AGE: [35 ] ANNUITANT GENDER: [Male/Female] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 DATE: [1/1/2055] ANNUITANT AGE [ 35 CONTRACT NUMBER: [12345678] PURCHASE PAYMENTS: INITIAL PREMIUM PAYMENT [ PURCHASE PAYMENT: [$2,000 ] ANNUITANT GENDER [ MALE 25,000.00] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGETOTAL PURCHASE PAYMENT: [0.50%$25,000.00] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGEMAXIMUM TOTAL PURCHASE PAYMENT: [0.20%$10,000,000.00] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:without prior Company approval
Appears in 1 contract
Samples: Jefferson National Life of New York Annuity Account 1
RIGHT TO EXAMINE CONTRACT. We want You [The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY [ ABC ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL [ ABC ] [SECRETARY] [PRESIDENT] INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TMLS 1 09/01 TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUTION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PERIOD 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 12 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM DEFERRAL OF PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PROVISION 15 TMLS 2 09/01 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE IMMEDIATELY PRECEDING VALUATION DATE; CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:- Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 TMLS 3 09/01 INSERT SCHEDULE PAGES 4A+ HERE
Appears in 1 contract
Samples: Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You Not later than fifteen days after you receive this Contract, you may return it to be satisfied with us or to the contract You have agent through whom it was purchased. We urge You will cancel it and refund any Contribution you made to closely examine its provisionsus, plus or minus any investment gain or loss which applies to the Variable Investment Options from the date such Contribution was allocated to such Option to the date of cancellation. If for any reason You are not satisfied with Your purchaseAny questions or complaints pertaining to this Contract may be directed to our Processing Office. UNIVERSAL LIFE INSURANCE COMPANY, You may cancel a stock life insurance company. Home Office address: [Metro Office Park Lxx 00 0xx Xxxxx, Xxxxxxxx, Xxxxxx Xxxx] /s/ Jxxx Xxxxxxx Xxxxx /s/ Jxxxxx Xxxx Jxxx Xxxxxxx Xxxxx Jxxxxx Xxxx [President] [Secretary] The amount of the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We Annuity Benefit will pay You an amount be equal to the sum of (i) any Fixed Annuity Benefit. Contract values and benefits based on Separate Account assets are not guaranteed and will decrease or increase with investment experience. Amounts under this Contract are subject to a Withdrawal Charge schedule detailed in the difference between Specification Page There are waivers to the premiums paid Withdrawal Charge schedule which are described in Appendix B. This Contract consists of the cover page, the succeeding Contract pages, the Specification Page, an Endorsement containing provisions applicable to the income tax qualification of your Contract or the provisions specific to Non-Qualified Contracts, and any other Endorsements attached and listed in the amounts allocated to any Account under Specification Page. This is the contract and (ii) the Contract Value on the date of surrenderentire Contract. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications DATA Part I - DEFINITIONS 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts Part II - VARIABLE INVESTMENT OPTIONS 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits Part III - CONTRIBUTIONS AND ALLOCATIONS 11 Settlement Provisions Part IV - TRANSFERS AMONG VARIABLE INVESTMENT OPTIONS 12 Part V - WITHDRAWALS AND TERMINATION 13 Part VI - PAYMENT UPON DEATH 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] Part VII - ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 17 Part VIII - $49,999.99] [0.71%] [$50,000.00 CHARGES 20 Part IX - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:GENERAL PROVISIONS 23
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You Within 10 days of the date of receipt of this Contract by the Owner, it may be returned by delivering or mailing it to be satisfied with the contract You have Company at its Administrative Office or to the Agent through whom it was purchased. We urge You to closely examine its provisionsWhen the Contract is received by the Company, it will be voided as if it had never been in force. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We The Company will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) refund the Contract Value on computed as of the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for Business Day the Company [ receives the returned contract at its Administrative Office. THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY Secretary President [MONUMENT ADVISOR] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Non-participating INCOME PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments DEFINITIONS 6 Valuation Provisions 6 Transfers Between Accounts PURCHASE PAYMENT PROVISIONS 7 Contract Control Provisions PURCHASE PAYMENTS 7 ALLOCATION OF PURCHASE PAYMENTS 7 SEPARATE ACCOUNT PROVISIONS 7 THE SEPARATE ACCOUNTS 7 VARIABLE ACCOUNT 7 VALUATION OF ASSETS 8 General Provisions ACCUMULATION UNITS 8 ACCUMULATION UNIT VALUE 8 CONTRACT VALUE 8 SUBSCRIPTION FEE 8 DEDUCTION FOR SUBSCRIPTION FEE 8 DEDUCTION FOR TRANSACTION FEE 9 Surrenders TRANSFERS 9 TRANSFERS DURING THE ACCUMULATION PERIOD 9 WITHDRAWAL PROVISIONS 9 WITHDRAWALS 9 PROCEEDS PAYABLE ON DEATH 10 Death Benefits DEATH OF OWNER DURING THE ACCUMULATION PERIOD 10 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 10 DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 10 DEATH OF OWNER DURING THE ANNUITY PERIOD 10 DEATH OF ANNUITANT 10 PAYMENT OF DEATH BENEFIT 11 Settlement Provisions BENEFICIARY 11 CHANGE OF BENEFICIARY 11 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 11 OWNER, ANNUITANT, XXXXXXXXX, XXXXXXXXXX XXXXXXXXXX 00 OWNER 11 JOINT OWNER 11 ANNUITANT 11 ASSIGNMENT OF A CONTRACT 12 TABLE OF CONTENTS ANNUITY PROVISIONS 12 GENERAL 12 ANNUITY DATE 12 SELECTION OF AN ANNUITY OPTION 12 FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 12 ANNUITY OPTIONS 12 OPTION 1. LIFETIME ONLY ANNUITY: 12 OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 12 OPTION 3. PAYMENT FOR A FIXED PERIOD: 12 OPTION 4. JOINT AND SURVIVOR ANNUITY 12 ANNUITY 12 FIXED ANNUITY 13 MORTALITY TABLES 13 GENERAL PROVISIONS 13 THE CONTRACT 13 MISSTATEMENT OF AGE 13 INCONTESTABILITY 13 MODIFICATION 13 NON-PARTICIPATING 13 EVIDENCE OF SURVIVAL 13 PROOF OF AGE 13 PROTECTION OF PROCEEDS 13 REPORTS 13 TAXES 13 REGULATORY REQUIREMENTS 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM PAYMENTS TO THIRD PARTIES 14 PAYMENTS FROM THIRD PARTIES 14 ANNUITY OPTION TABLES 15 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] SCHEDULE OWNER: «FIRSTNAM» «LASTNAME» CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] DATE: «COVISS» JOINT OWNER: «JFIRSTNM» «JLASTNAM» ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] DATE: «EXPDAT» CONTRACT NUMBER: «POLNUM» PURCHASE PAYMENTS: INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNTPURCHASE PAYMENT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE«INITPREM» MAXIMUM TOTAL PURCHASE PAYMENT: $[010,000,000.00] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHEREwithout prior Company approval ALLOCATION GUIDELINES:
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value Value, less Payment Enhancements, on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 8 AND 79. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 6 Premium Payments 6 8 Valuation Provisions 6 8 Transfers Between Accounts 7 Provisions 9 Contract Control Provisions 8 10 General Provisions 9 11 Surrenders 10 12 Death Benefits 11 14 Settlement Provisions 14 17 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 20 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 10,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] MORTALITY PAYMENT ENHANCEMENT: PAYMENT ENHANCEMENTS ARE A PERCENTAGE OF PREMIUM PAID AND EXPENSE RISK CHARGEEQUAL: ENHANCEMENT PREMIUM RANGE [0.504.00%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: UP TO $49,999.99 [0.205.00%] PER ANNUM OF $50,000 AND OVER THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY APPLICABLE PAYMENT ENHANCEMENT WILL BE SEPARATELY CALCULATED AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST CREDITED FOR EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT AS RECEIVED BASED ON THE CURRENT DEPOSIT PLUS CUMULATIVE TOTAL AMOUNT OF PREMIUM PAYMENTS. IF AFTER THE GREATER OF: AFIRST PREMIUM PAYMENT IS MADE, ADDITIONAL PREMIUM PAYMENT(S) IS (ARE) RECEIVED WHICH RESULT IN THE TOTAL BALANCE CUMULATIVE PREMIUM PAYMENTS TO REACH A HIGHER PREMIUM RANGE, ALL PRIOR PREMIUM PAYMENTS WILL BE CREDITED WITH AN ADDITIONAL PAYMENT ENHANCEMENT AT A RATE EQUAL TO THE DIFFERENCE BETWEEN THE RATE PREVIOUSLY CREDITED AND THE RATE APPLICABLE TO THE NEWLY REACHED PREMIUM RANGE. SUCH ADDITIONAL PAYMENT ENHANCEMENT WILL BE CREDITED AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT DATE OF RECEIPT OF THE ADDITIONAL PREMIUM BASED CHARGE WILL PAYMENT. UNDER CERTAIN DISBURSEMENTS, PAYMENT ENHANCEMENTS MAY BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE FORFEITED AS DESCRIBED HEREIN. CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:SPECIFICATIONS
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein/s/ Xxxxxxxxx Xxxxx Xxxxxx /s/ Xxxxxx X. Xxxxx Xxxxxxxxx Xxxxx Xxxxxx SECRETARY Xxxxxx X. Xxxxx, PRESIDENT PREMIUM PAYMENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. [HARTFORD LIFE LOGO] HL-VA03 Printed in PRINTED IN U.S.A. B644R0.FRM TABLE OF CONTENTS Page PAGE Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:9
Appears in 1 contract
Samples: Individual Flexible (Hartford Life Insurance Company Separate Account Two)
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on and any Premium Taxes as of the date of surrendercancellation. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Donald C. Hunt /x/ Xxxx X. Xalters -------------------------------- -------------------------------- DONALD C. HUNT, SECRETARY XXXX X. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXENTS ARE FLEXIBLE AS DESCRIBED HEREIN. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] THE HARTFORD TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Transfer Between Sub-Accounts Provisions 7 Contract Control Provisions 8 General Provisions 9 8 Surrenders 10 Death Benefits 11 Settlement Provisions 14 13 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT XXXXXXXXXXXT DATE [ [JANUARY 1, 2039 2032] ANNUITANT AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 10,000] ANNUITANT GENDER [ MALE SEX [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX BENEXXXXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN SEVEN] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] 0 IF THE CONTRACT VALUE IS [$50,000] 50,000 OR MORE ON THE CONTRACT ANNIVERSARY. [$50] 30 IF THE CONTRACT VALUE IS LESS THAN [$50,000] 50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED MORTALITY AND EXPENSE RISK CHARGE: WE WILL APPLY AN [1.60%] PER ANNUM OF THE DAILY CONTRACT VALUE. ADMINISTRATION CHARGE: [0.25%] PER ANNUM OF THE DAILY CONTRACT VALUE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account of this contract before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, XX. Xxx xxxxxxxxxxxxxx xxxxxxning this contract should be sent to our mailing address: Attn: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM MAINTENANCE FEE - An amount which, depending on the amount of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which Annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT MADE TO THIS CONTRACTFREQUENCY - The frequency with which annuity payments will be made. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSThe frequencies available are monthly, quarterly, semi-annual, and annual. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in case of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE ON THE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person that You may designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS- An anniversary of the Contract Issue Date. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: ACONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER - The owner(s) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:or holder of the contract.
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters ----------------------------------- ----------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPRXXXXX XXXXXXXX XXX FLEXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 7 AND 78. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 5 Premium Payments 6 Valuation Provisions 6 7 Transfers Between Accounts 7 8 Contract Control Provisions 8 9 General Provisions 9 10 Surrenders 10 11 Death Benefits 11 13 Settlement Provisions 14 16 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 19 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 1,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ONE] ANNUAL WITHDRAWAL AMOUNT: CONTRACT YEARS [1-7] [10%] OF PREMIUM PAYMENTS MADE PER CONTRACT YEAR ON A NONCUMULATIVE BASIS. AFTER CONTRACT YEAR [7] 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF EACH PREMIUM PAYMENT MADE DURING THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL; AND [10%] OF PREMIUM PAYMENTS MADE DURING EACH OF THE [7] CONTRACT YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.501.35%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE3 CONTINGENT DEFERRED SALES CHARGES: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED MAY ASSESS A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC "CHARGE") WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC CHARGE IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDCHARGE SCHEDULE. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN THE AMOUNT ASSESSED A CHARGE WILL NOT EXCEED YOUR PREMIUM PAYMENTS. DURING THE FIRST [SEVEN] CONTRACT YEARS ALL SURRENDERS IN EXCESS OF THE AWA ARE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM PREMIUM PAYMENTS, THEN FROM EARNINGS. SURRENDERS FROM PREMIUM PAYMENTS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE SUBJECT TO CDSCA CHARGE. AFTER THE [SEVENTH] CONTRACT YEAR, ALL SURRENDERS IN EXCESS OF THE ANNUAL WITHDRAWAL AMOUNT WILL BE TAKEN FIRST FROM EARNINGS, THEN FROM PREMIUM PAYMENTS HELD IN YOUR CONTRACT FOR MORE THEN [SEVEN] YEARS AND THEN ONLY FROM PREMIUM PAYMENTS INVESTED FOR LESS THAN [SEVEN] YEARS. ONLY PREMIUM PAYMENTS HELD FOR LESS THEN [SEVEN] YEARS WILL BE SUBJECT TO A CHARGE. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. PERCENTAGE USED TO CALCULATE THE CHARGE IS EQUAL TO: NUMBER OF YEARS FROM CHARGE EACH PREMIUM PAYMENT ---------------------------------------------------------------- [7% 1 7% 2 7% 3 6% 4 5% 5 4% 6 3% 7 0% 8] AND THEREAFTER NO CDSC CONTINGENT DEFERRED SALES CHARGE WILL BE ASSESSED IF IF: - ONLY THE AWA ANNUAL WITHDRAWAL AMOUNT IS TAKEN, OR - ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF SURRENDER CHARGE. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE CDSCCOMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. FOR ANY SURRENDERAll correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, THE P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on each Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUAL WITHDRAWAL AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME - The amount that can be withdrawn in any Contract Year prior to incurring surrender charges. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE - The aggregate value of the Accounts on any Valuation Day. CONTRACT YEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. DEFINITION OF WITHDRAWAL BY DIVIDING CERTAIN TERMS (ACONTINUED) BY (B) MULTIPLIED BY (C) WHERE:DEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant, as applicable.
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value Value, less Payment Enhancements, on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 8 AND 79. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 6 Premium Payments 6 8 Valuation Provisions 6 8 Transfers Between Accounts 7 Provisions 9 Contract Control Provisions 8 10 General Provisions 9 11 Surrenders 10 12 Death Benefits 11 14 Settlement Provisions 14 17 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 20 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 10,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] MORTALITY PAYMENT ENHANCEMENT: PAYMENT ENHANCEMENTS ARE A PERCENTAGE OF PREMIUM PAID AND EXPENSE RISK CHARGEEQUAL: ENHANCEMENT PREMIUM RANGE -------------------------------------------------------------------------------- [0.504.00%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: UP TO $49,999.99 [0.205.00%] PER ANNUM OF $50,000 AND OVER THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY APPLICABLE PAYMENT ENHANCEMENT WILL BE SEPARATELY CALCULATED AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST CREDITED FOR EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT AS RECEIVED BASED ON THE CURRENT DEPOSIT PLUS CUMULATIVE TOTAL AMOUNT OF PREMIUM PAYMENTS. IF AFTER THE GREATER OF: AFIRST PREMIUM PAYMENT IS MADE, ADDITIONAL PREMIUM PAYMENT(S) IS (ARE) RECEIVED WHICH RESULT IN THE TOTAL BALANCE CUMULATIVE PREMIUM PAYMENTS TO REACH A HIGHER PREMIUM RANGE, ALL PRIOR PREMIUM PAYMENTS WILL BE CREDITED WITH AN ADDITIONAL PAYMENT ENHANCEMENT AT A RATE EQUAL TO THE DIFFERENCE BETWEEN THE RATE PREVIOUSLY CREDITED AND THE RATE APPLICABLE TO THE NEWLY REACHED PREMIUM RANGE. SUCH ADDITIONAL PAYMENT ENHANCEMENT WILL BE CREDITED AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT DATE OF RECEIPT OF THE ADDITIONAL PREMIUM BASED CHARGE WILL PAYMENT. UNDER CERTAIN DISBURSEMENTS, PAYMENT ENHANCEMENTS MAY BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE FORFEITED AS DESCRIBED HEREIN. CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:SPECIFICATIONS
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You The Owner may cancel the this contract by returning it to the contract Company or one of its authorized representatives within ten days after You receive itreceipt. A written request for cancellation must accompany the contract. In such event, We The Company will pay You refund an amount equal to gross payments less any withdrawals taken. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the sum of (iCompany) the difference between the premiums paid and the amounts Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to any Variable Sub-Accounts, the Fixed Account under the contract or Guarantee Period Accounts. President Secretary [ ] [ ] Flexible Payment Deferred Variable and (ii) the Contract Value Fixed Annuity Annuity Benefit Payments Payable on the date of surrender. You bear only the investment risk during the period Annuity Date Death Benefit Payable if death occurs prior to Our receipt Annuity Date (see Death Benefit section) Non-Participating TABLE OF CONTENTS SPECIFICATONS 3 DEFINITIONS 8 OWNER, ANNUITANT AND BENEFICIARY 9 THE ACCUMULATION PHASE PAYMENTS 11 VALUES 11 TRANSFER 13 XXXXXXXXXX AND SURRENDER 14 DEATH BENEFIT 16 THE PAYOUT PHASE ANNUITY BENEFIT 18 TRANSFER 20 WITHDRAWAL 20 PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS 22 DEATH OF THE ANNUITANT 22 ANNUITY BENEFIT PAYMENT OPTIONS 22 LIFE ANNUITY GUARANTEE OPTIONS 23 ANNUITY OPTION RATE TABLES 23 GENERAL PROVISIONS 27 SPECIFICATIONS Contract Type: [NQ] Contract Number: [zz00600000] Issue Date: [01/01/02] Annuity Date: [01/01/2035] (Must be at least 30 days after issue date) Owner: [Xxxx Xxx] Owner Date of request Birth: [01/01/1950] Joint Owner: [Xxxx Xxx] Joint Owner Date of Birth: [01/01/1950] Annuitant: [Xxxx Xxx] Xxxxxxxxx Date of Birth: [01/01/1950] Joint Annuitant: [Xxxx Xxx] Joint Annuitant Date of Birth: [01/01/1950] Annuitant Sex: [Male] Beneficiary(ies): Joint Annuitant Sex: [Male] Primary: Surviving Joint Owner, if any 1st Contingent: [Xxxx Xxx] 2nd Contingent: [Xxx Xxx] Minimum Fixed Account Minimum Additional Payment Guaranteed Interest Rate: [3%] Amount: [$50.00] Guarantee Period Account Guarantee Period Account Minimum Interest Rate: [3%] Minimum Allocation Amount: [$1,000.00] Minimum Withdrawal Minimum Accumulated Value Amount: [$100.00] After Withdrawal: [$1,000.00] Minimum Annuity Maximum Alternative Annuity Date: [01/01/2035] Benefit Payment: [$100.00] (Must be at least 30 days after issue date) Surrender Charge Table: YEARS FROM SURRENDER CHARGE AS A DATE OF PAYMENT PERCENT OF THE PAYMENTS TO DATE OF WITHDRAWAL WITHDRAWN -------------------------------------------------- Less Than: 1 7 % 2 6 % 3 4 % Thereafter 0% Withdrawal Without Surrender Charge Percentage: [10% of Gross Payment Base (reduced by any prior Withdrawal Without Surrender Charge in the same calendar year)] Mortality and Expense Risk Charge: [1.60%] on an annual basis of the daily value of the Sub-Account assets. Administrative Charge: [.15%] on an annual basis of the daily value of the Sub-Account assets. Contract Fee: [$35, if the Accumulated Value is less than $75,000.00. Waived for cancellation. Signed for 401(k)s.] Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 [(0-000-000-0000)] SPECIFICATIONS (CONTINUED) Owner: [Xxxx Xxx ] Contract Number: [zzz0000000] Joint Owner: [Xxxx Xxx] Initial Payment: [$10,000.00] Payment Allocation: (The Initial Payment is allocated in the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A following manner:) VARIABLE SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS ACCOUNTS: [ INSERT NAMES OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE] FIXED ACCOUNT SPECIFICATIONS (CONTINUED) Owner: [0.20%Xxxx Xxx] PER ANNUM OF THE DAILY SUBContract Number: [zzz0000000] Joint Owner: [Xxxx Xxx] GUARANTEE PERIOD ACCOUNTS GUARANTEE INTEREST EXPIRATION PERIOD RATE DATE ------ ---- ---- [ 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years] ------- 100% TOTAL PAYMENT ALLOCATION SPECIFICATIONS (CONTINUED) Owner: [Xxxx Xxx] Contract Number: [zzz0000000] Joint Owner: [Xxxx Xxx] RIDER(S) SELECTED: FOR TX ADD RIDER 3311-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $01 [0] IF THE CONTRACT VALUE IS Annual Step-up with 5% Yield Enhanced Death Benefit Rider:] [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. See Rider for Benefit and Charge:] [$50] IF THE CONTRACT VALUE IS LESS THAN Annual Step-up with 7% Yield Enhanced Death Benefit Rider:] [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR See Rider for Benefit and Charge:] [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN 10% Breakthrough Enhanced Death Benefit Rider:] [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. See Rider for Benefit and Charge:] [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT 15% Breakthrough Enhanced Death Benefit Rider:] [7] YEAR PREMIUM BASED CHARGE See Rider for Benefit and Charge:] [$0 - $49,999.9910% Breakthrough with 5% Yield Enhanced Death Benefit Rider:] [See Rider for Benefit and Charge:] [15% Breakthrough with 5% Yield Enhanced Death Benefit Rider:] [See Rider for Benefit and Charge:] [Discount Rider:] [See Rider for details] [0.71%Enhanced Earnings Rider:] [See Rider for Benefit and Charge:] SPECIFICATIONS (SUPPLEMENT) Contract Type: [Non-qualified] Contract Number: [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:zz00600000]
Appears in 1 contract
Samples: Please Read (Allmerica Fin Life Ins & Ann Co Allmerica Sel Acct)
RIGHT TO EXAMINE CONTRACT. We want You [The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company [ at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] Premium Payments are flexible as described herein. NONPARTICIPATING ALL THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HLTMLS 1 [09-VA03 Printed in U.S.A. B644R0.FRM 01] TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUATION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PERIOD 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15 TMLS 2 [09-01] ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A - Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 TMLS 3 [09-01] INSERT SCHEDULE PAGES 4A+ HERE TMLS 4 [09-01] DEFINITIONS ACCUMULATION PERIOD The period during which Purchase Payments may be made. ACCUMULATION UNIT A unit of measure used to determine the value of the Contract Owner’s interest in a Sub-Account of the Separate Account during the Accumulation Period. AGE The age of any Contract Owner or Annuitant on his/her birthday nearest the date for which age is being determined. ANNUITANT The primary person upon whose life Annuity Payments are to be made. On or after the Annuity Date, the Annuitant shall also include any Joint Annuitant. ANNUITY DATE The date on which any Annuity Payments begin. The Annuity Date is shown on the Contract Schedule. ANNUITY PAYMENTS The series of payments that will be made pursuant to any Annuity Option selected. ANNUITY OPTIONS Options available for Annuity Payments. ANNUITY PERIOD The period which begins on the Annuity Date and ends with the last Annuity Payment. ANNUITY SERVICE CENTER The office indicated on the Contract Schedule of this Contract, or other location(s) specified by the Company to which notices, requests and Purchase Payments must be sent. All sums payable by the Company under this Contract are payable only from the Annuity Service Center, or other location(s) specified by the Company. ANNUITY UNIT A unit of measure used to determine the amount of each Variable Annuity Payment after the Annuity Date. BENEFICIARY The person(s) or entity(ies) designated to receive the death benefit provided by this Contract. CONTRACT ANNIVERSARY An anniversary of the Issue Date of this Contract CONTRACT SCHEDULE DATE The effective date of any Contract Schedule. A Contract Schedule bearing the latest Schedule Date will supersede all previous Contract Schedules. CONTRACT OWNER The person(s) or entity(ies) entitled to the ownership rights stated in this Contract. CONTRACT VALUE The sum of the Contract Owner’s interest in the Sub-Accounts of the Separate Account during the Accumulation Period. CONTRACT YEAR The first Contract Year is the annual period which begins on the Issue Date. Subsequent Contract Years begin on each anniversary of the Issue Date. ELIGIBLE INVESTMENT An investment entity shown on the Contract Schedule into which assets of the Separate Account will be invested. FIXED ANNUITY A series of payments made during the Annuity Period which are guaranteed as to dollar amount by the Company. GENERAL ACCOUNT The Company’s general investment account which contains all the assets of the Company with the exception of the Separate Account and other segregated asset accounts. ISSUE DATE The date on which this Contract became effective. NET PURCHASE A Purchase Payment less any Premium Tax assessed by any state or PAYMENT other jurisdiction. PREMIUM TAX A tax imposed by certain states and other jurisdictions when a Purchase Payment is made, when Annuity Payments begin, or when the Contract is surrendered. PURCHASE PAYMENT During the Accumulation Period, a payment made by or on behalf of a Contract Owner with respect to this Contract. RIDER EFFECTIVE The effective date of any Rider as indicated on the Contract Schedule. SEPARATE ACCOUNT DATE The Company’s Separate Account(s) designated on the Contract Schedule. SERIES A segment of an Eligible Investment which constitutes a separate and distinct class of shares into which assets of a Sub-Account will be invested. SUB-ACCOUNT Separate Account assets are divided into Sub-Accounts which are listed on the Contract Schedule. Assets of each Sub-Account will be invested in shares of an Eligible Investment or a Series of an Eligible Investment. VALUATION DATE Each day on which the Company, the New York Stock Exchange (CDSC): WE MAY ASSESS A CDSC WHEN YOU “NYSE”)and the Eligible Investments are open for business. VALUATION PERIOD The period of time beginning at the close of business of the NYSE on each Valuation Date and ending at the close of business for the next succeeding Valuation Date. VARIABLE ANNUITY An annuity with payments which vary as to dollar amount in relation to the investment performance of specified Sub-Accounts of the Separate Account. WRITTEN REQUEST A FULL OR PARTIAL SURRENDERrequest in writing, in a form satisfactory to the Company, which is received by the Annuity Service Center. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PURCHASE PAYMENT PROVISIONS PURCHASE PAYMENTS HAVE BEEN IN THE CONTRACTThe initial Purchase Payment is due on the Issue Date. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROThe minimum and maximum subsequent and total Purchase Payments are shown on the Contract Schedule. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:The Company reserves the right to reject any Purchase Payment.
Appears in 1 contract
Samples: Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters ----------------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinXXXXXXX XXXXXXXS ARE FLEXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 5 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 17 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 20,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE AND ANNUITY INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ONE] ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.500.90%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: CHARGE [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS ACCOUNT VALUE. SALES CHARGES: SALES CHARGES ARE A PERCENTAGE OF PREMIUMS PAID AND EQUAL: CHARGE OWNER'S INVESTMENT ------------------------------------------------------------------------------------------------ [6.00%] UP TO $49,999.99 [5.50%] $50,000 TO $99,999.99 [5.00%] $100,000 TO $249,999.99 [4.00%] $250,000 TO $499,999.99 [3.00%] $500,000 TO $999,999.99 [2.00%] $1,000,000 TO $2,499,999.99 [1.00%] $2,500,000 AND OVER THE APPLICABLE SALES CHARGE ON EACH PREMIUM PAYMENT WILL BE BASED ON THE OWNER'S INVESTMENT. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. All correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE: $[0] IF THE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE - The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE IS [$50,000] OR MORE ON THE - The aggregate value of the Accounts on any Valuation Day. CONTRACT ANNIVERSARYYEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDEREDDEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant. DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. DEFINITION OF CERTAIN TERMS (CONTINUED) FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. NET PREMIUM - Premium payments less the applicable Sales Charges shown on Page 3, less any applicable Premium Tax. OWNER'S INVESTMENT - The sum of all premium payments into this contract plus the value of all eligible investments identified by You and allowed by the Company and owned by You, Your spouse or other immediate family members. PAYEE - The person, designated by You, to whom Annuity payments will be made. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACTTAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSOn any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contract from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3 SALES CHARGES - Charges deducted from premium payments at the time they are received by Us. Sales Charges are described on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. SURRENDER VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS- The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: AVALUATION DAY - Every day the New York Stock Exchange is open for trading. The value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING on such days. VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSPERIOD - The period of time between the close of business on successive Valuation Days. WE, BUT NOT LESS THAN ZEROUS, OUR - The Company referred to on the first page of this contract. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTYOU, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARYOUR - The Contract Owner(s). PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT- Premium payments are payable at the Administrative Office of the Company. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDPayments may be made by check or by any other method that We deem acceptable. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED(CONTINUED) The initial premium payment is shown on Page 3. AMOUNTS WITHDRAWN IN EXCESS This is a flexible premium annuity. We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from you under all deferred variable annuity contracts issued by Us or Our affiliates equals or exceeds 1,000,000. ALLOCATION OF THE AWA ARE SUBJECT TO CDSCPREMIUM PAYMENTS Net Premium payments will be allocated to each Account according to Your instructions subject to Our minimum amount(s) then in effect. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVEAny subsequent Net Premium Payments will be allocated to Accounts in accordance with the most recent premium allocation instructions that We received. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSCVALUATION PROVISIONS NET PREMIUM PAYMENTS - The Net Premium payment is applied to purchase Accumulation Units with respect to the Sub-Account(s) that You have selected. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHEREThe number of Accumulation Units credited to each Sub-Account is determined by dividing the Net Premium payment allocated to a Sub-Account by the dollar value of one Accumulation Unit for such Sub-Account. This is computed in compliance with Securities and Exchange Commission regulations. The number of Accumulation Units will not be affected by any subsequent change in the value of such Accumulation Units. The Accumulation Unit value in any Sub-Account may increase or decrease from day to day as described below. NET INVESTMENT FACTOR The net investment factor for each of the Sub-Accounts is equal to:
Appears in 1 contract
Samples: Hartford Life & Annuity Insurance Co Separate Account Seven
RIGHT TO EXAMINE CONTRACT. We want You This Contract may be returned to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company at its Annuity Service Center. This may be more or less than the Purchase Payments. THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY [ /s/ Xxx X. Xxxxxx ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL [ /s/ Xxxxx X. Xxxx ] SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [page break] TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUTION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF CHARGE 10 ADMINISTRATIVE CHARGE 10 DISTRIBUTION CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFERS 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PERIOD 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL 13 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM DEFERRAL OF PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PROVISION 15 [page break] ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE IMMEDIATELY PRECEDING VALUATION CONTRACT 16 GENERAL PROVISIONS 16 THE CONTRACT 16 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 INCONTESTABILITY 17 MISSTATEMENT OF AGE OR SEX 17 NON-BUSINESS DAYS 18 NON-PARTICIPATING 18 PROTECTION OF PROCEEDS 18 REGULATORY REQUIREMENTS 18 REPORTS 18 TAXES 18 ANNUITY PROVISIONS 19 ANNUITY GUIDELINES 19 ANNUITY PAYMENTS 19 FIXED ANNUITY 20 VARIABLE ANNUITY 20 ANNUITY UNITS AND PAYMENTS 20 ANNUITY UNIT VALUE 20 ANNUITY OPTIONS 21 Annuity Option A - Life Income 21 Annuity Option B - Life Income with Period Certain 21 Annuity Option C - Joint and Last Survivor Payments 21 Annuity Option D - Joint and 2/3 Survivor Annuity 21 Annuity Option E - Period Certain 21 Annuity Option F - Special Income Settlement Agreement 21 Fixed Annuity Rates 22 Fixed Annuity Rates Table 1 Fixed Annuity Rates Table 2 Fixed Annuity Rates Table 3 Fixed Annuity Rates Table 4 Variable Annuity Rates Variable Annuity Rates Table 5 Variable Annuity Rates Table 6 Variable Annuity Rates Table 7 Variable Annuity Rates Table 8 [page break] [VARIABLE INFORMATION] Panorama Premier CONTRACT SCHEDULE REVISION DATE: August 31, 1994 CONTRACT OWNER: [Xxxx Xxx] AGE AND SEX: [35 Male] ANNUITANT: [Xxxx Xxx] AGE AND SEX: [35 Male] CONTRACT NUMBER: [1234 CML] ISSUE DATE: July 30, 1995 ANNUITY DATE: [August 31, 2024] PURCHASE PAYMENTS: INITIAL PURCHASE PAYMENT: [Non-Qualified: $5,000; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSQualified: $2,000] MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$250, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTor, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKENif the automatic investment option is elected, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:$100.]
Appears in 1 contract
Samples: C M Multi Account A
RIGHT TO EXAMINE CONTRACT. We want You [The Contract Owner has the right to return this Contract. This Contract may be satisfied with returned to the contract You have purchased. We urge You to closely examine its provisions. If Company for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive itits receipt by the Contract Owner. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal It may be returned by delivering or mailing it to the sum of (i) Company at its Annuity Service Center. When this Contract is received by the difference between Company it will be voided as if it had never been in force. Upon its return, the premiums paid and the amounts allocated to any Account under the contract and (ii) Company will refund, within seven days, the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our next computed after receipt of request for cancellation. Signed for this Contract by the Company [ at its Annuity Service Center. This may be more or less than the Purchase Payment(s).] Premium Payments are flexible as described herein. NONPARTICIPATING ALL THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, WITHDRAWAL VALUES AND VALUES THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TMLS 1 09/01 TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms CONTRACT SCHEDULE 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY PURCHASE PAYMENTS 8 SEPARATE ACCOUNT SEVEN ] PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUTION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF ACCUMULATION PERIOD 10 TRANSFERS DURING THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 12 DEATH BENEFIT PAYOUT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15 TMLS 2 09/01 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE CONTRACT 16 GENERAL PROVISIONS 17 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR SEX 18 NON-BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A - Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 TMLS 3 09/01 INSERT SCHEDULE PAGES 4A+ HERE TMLS 4 09/01 DEFINITIONS ACCUMULATION PERIOD The period during which Purchase Payments may be made. ACCUMULATION UNIT A unit of measure used to determine the value of the Contract Owner’s interest in a Sub–Account of the Separate Account during the Accumulation Period. AGE The age of any Contract Owner or Annuitant on his/her birthday nearest the date for which age is being determined. ANNUITANT The primary person upon whose life Annuity Payments are to be made. On or after the Annuity Date, the Annuitant shall also include any Joint Annuitant. ANNUITY DATE The date on which any Annuity Payments begin. The Annuity Date is shown on the Contract Schedule. ANNUITY PAYMENTS The series of payments that will be made pursuant to any Annuity Option selected. ANNUITY OPTIONS Options available for Annuity Payments. ANNUITY PERIOD The period which begins on the Annuity Date and ends with the last Annuity Payment. ANNUITY SERVICE CENTER The office indicated on the Contract Schedule of this Contract, or other location(s) specified by the Company to which notices, requests and Purchase Payments must be sent. All sums payable by the Company under this Contract are payable only from the Annuity Service Center, or other location(s) specified by the Company. ANNUITY UNIT A unit of measure used to determine the amount of each Variable Annuity Payment after the Annuity Date. BENEFICIARY The person(s) or entity(ies) designated to receive the death benefit provided by this Contract. CONTRACT ANNIVERSARY An anniversary of the Issue Date of this Contract. CONTRACT SCHEDULE DATE The effective date of any Contract Schedule. A Contract Schedule bearing the latest Schedule Date will supersede all previous Contract Schedules. CONTRACT OWNER The person(s) or entity(ies) entitled to the ownership rights stated in this Contract. CONTRACT VALUE The sum of the Contract Owner’s interest in the Sub-Accounts of the Separate Account during the Accumulation Period. CONTRACT YEAR The first Contract Year is the annual period which begins on the Issue Date. Subsequent Contract Years begin on each anniversary of the Issue Date. ELIGIBLE INVESTMENT An investment entity shown on the Contract Schedule into which assets of the Separate Account will be invested. FIXED ANNUITY A series of payments made during the Annuity Period which are guaranteed as to dollar amount by the Company. GENERAL ACCOUNT The Company’s general investment account which contains all the assets of the Company with the exception of the Separate Account and other segregated asset accounts. ISSUE DATE The date on which this Contract became effective. NET PURCHASE PAYMENT A Purchase Payment less any Premium Tax assessed by any state or other jurisdiction. PREMIUM TAX A tax imposed by certain states and other jurisdictions when a Purchase Payment is made, when Annuity Payments begin, or when the Contract is surrendered. PURCHASE PAYMENT During the Accumulation Period, a payment made by or on behalf of a Contract Owner with respect to this Contract. RIDER EFFECTIVE DATE The effective date of any Rider as indicated on the Contract Schedule. SEPARATE ACCOUNT The Company’s Separate Account(s) designated on the Contract Schedule. SERIES A segment of an Eligible Investment which constitutes a separate and distinct class of shares into which assets of a Sub-Account will be invested. SUB–ACCOUNT Separate Account assets are divided into Sub-Accounts which are listed on the Contract Schedule. Assets of each Sub-Account will be invested in shares of an Eligible Investment or a Series of an Eligible Investment. VALUATION DATE Each day on which the Company, the New York Stock Exchange (CDSC): WE MAY ASSESS A CDSC WHEN YOU “NYSE”) and the Eligible Investments are open for business. VALUATION PERIOD The period of time beginning at the close of business of the NYSE on each Valuation Date and ending at the close of business for the next succeeding Valuation Date. VARIABLE ANNUITY An annuity with payments which vary as to dollar amount in relation to the investment performance of specified Sub-Accounts of the Separate Account. WRITTEN REQUEST A FULL OR PARTIAL SURRENDERrequest in writing, in a form satisfactory to the Company, which is received by the Annuity Service Center. TMLS 7 09/01 PURCHASE PAYMENT PROVISIONS PURCHASE PAYMENTS The initial Purchase Payment is due on the Issue Date. The minimum and maximum subsequent and total Purchase Payments are shown on the Contract Schedule. The Company reserves the right to reject any Purchase Payment. SUBSEQUENT PURCHASE PAYMENTS Subject to the minimum subsequent and maximum total shown on the Contract Schedule, the Contract Owner may make subsequent Purchase Payments. ALLOCATION OF PURCHASE PAYMENTS The allocation of the initial Net Purchase Payment is made in accordance with the selection made by the Contract Owner at the time the Contract is issued. Unless otherwise changed by Written Request by the Contract Owner, subsequent Net Purchase Payment(s) are allocated in the same manner as the initial Net Purchase Payment. Allocation of the Net Purchase Payments is subject to the Allocation Guidelines shown on the Contract Schedule. The Company has reserved the right to allocate initial Purchase Payments to the Money Market Sub-Account until the expiration of the Right to Examine Contract period. SEPARATE ACCOUNT PROVISIONS THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACTSEPARATE ACCOUNT The Separate Account is designated on the Contract Schedule and consists of assets set aside by the Company, which are kept separate from that of the general assets and all other separate account assets of the Company. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: AThe assets of the Separate Account equal to reserves and other liabilities will not be charged with liabilities arising out of any other business the Company may conduct. The Separate Account assets are divided into Sub-Accounts. The Sub-Accounts which are available under this Contract are listed in the Contract Schedule. The assets of the Sub-Accounts are allocated to the Eligible Investment(s) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR Band the Series, if any, within an Eligible Investment shown on the Contract Schedule. The Company may, from time to time, add additional Eligible Investments or Series to those shown on the Contract Schedule. The Contract Owner may be permitted to transfer Contract Values or allocate Net Purchase Payments to the additional Eligible Investments or Series. However, the right to make such transfers or allocations will be limited by the terms and conditions imposed by the Company. Should the shares of any such Eligible Investment(s) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSor any Series within an Eligible Investment become unavailable for investment by the Separate Account, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTor the Company deems further investment in these shares inappropriate, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:the Company may limit further purchase of such shares or may substitute shares of another Eligible Investment or Series for shares already purchased under this Contract.
Appears in 1 contract
Samples: Massachusetts Mutual Variable Annuity Separate Account 4
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ /s/ Richard G. Costello /s/ John C. Walters -------------------------------- -------------------------------- RICHARD G. COSTELLO, SECRETARY JOHN C. WALTERS, PRESIDENT ] Premium Payments are flexible as described hereinPREMIXX XXXXXXXX XXX XXXXIBLE AS DESCRIXXX XXXXXX. NONPARTICIPATING XXNPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM [LOGO] HARTFORD LIFE TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 5 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM 17 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN [SPECIMEN] CONTRACT ISSUE DATE [SEPTEMBER 148, 2009 2002] NAME OF ANNUITANT [ XXXXX XXXXX [JAMES SCOTT] ANNUITY COMMENCEMENT DATE [ [JANUARY 1, 2039 2032] ANNUITANT XXXXXXXXX AGE [ 35 [35] INITIAL PREMIUM PAYMENT [ [$2,000 20,000] ANNUITANT GENDER [ MALE [MALE] MINIMUM SUBSEQUENT PAYMENT [ [$500 500] CONTINGENT ANNUITANT [ XXXX XXXXX [PAUL SCOTT] DESIGNATED BENEFICIARY [ XXX XXXXX [ANN SCOTT] CONTRACT OWNER [ XXXXX XXXXX OWNEX [JAMES SCOTT] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ [HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO] ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. MORTALITY AND EXPENSE RISK CHARGE: [0.500.90%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: CHARGE [0.200.25%] PER ANNUM OF THE DAILY SUB-ACCOUNTS ACCOUNT VALUE. SALES CHARGES: SALES CHARGES ARE A PERCENTAGE OF PREMIUMS PAID AND EQUAL: CHARGE OWNER'S INVESTMENT ---------------------------------------------------------------------------------------------- [6.00%] UP TO $49,999.99 [5.50%] $50,000 TO $99,999.99 [5.00%] $100,000 TO $249,999.99 [4.00%] $250,000 TO $499,999.99 [3.00%] $500,000 TO $999,999.99 [2.00%] $1,000,000 TO $2,499,999.99 [1.00%] $2,500,000 AND OVER THE APPLICABLE SALES CHARGE ON EACH PREMIUM PAYMENT WILL BE BASED ON THE OWNER'S INVESTMENT. DEFINITION OF CERTAIN TERMS ACCOUNT - Any of the Sub-Accounts. ACCUMULATION UNIT - An accounting unit of measure used to calculate the value of a Sub-Account before annuity payments begin. ADMINISTRATIVE OFFICE OF THE COMPANY - Currently located at 200 Hopmeadow St., Simsbury, CT 06089. All correspondence concerning xxxx xxxxxxxx xxxxxx xx xxxx xx Xxx xailing address: Hartford Life Investment Product Services, P.O. Box 5085, Hartford, CT 06102-5085. ANNUAL MAINTENANCE FEE: $[0] IF THE FEE - An xxxxxx xxxxx, xxxxxxxxx xx xxx xxxxxx of the Contract Value, may be deducted from the value of the contract on the Contract Anniversary and upon full surrender of this contract. The Annual Maintenance Fee is shown on Page 3. ANNUITANT - The person on whose life this contract is issued. The Annuitant may not be changed. Also, see Contingent Annuitant and Joint Annuitant. ANNUITY CALCULATION DATE - The date on which the first annuity payment will be calculated. It will be no more than five Valuation Days prior to the Annuity Commencement Date. ANNUITY COMMENCEMENT DATE - The date on which annuity payments begin as described under Settlement Provisions in this contract. ANNUITY PAYMENT FREQUENCY - The frequency with which annuity payments will be made. The frequencies available are monthly, quarterly, semi-annual, and annual. ANNUITY UNIT - An accounting unit of measure used to calculate the value of annuity payments under a variable annuity option. ANNUITY UNIT FACTOR - A factor that neutralizes the Assumed Investment Return ("AIR") when determining the Annuity Unit Value. When the AIR is 3%, the daily factor is 0.999919. When the AIR is 5%, the daily factor is 0.999866. And when the AIR is 6%, the daily factor is 0.999840. ASSUMED INVESTMENT RETURN ("AIR") - The investment return upon which the variable annuity payments in this contract will be based. The annual rates available are 3%, 5%, and 6%. You may select one of these rates prior to the Annuity Commencement Date. BENEFICIARY - The person(s) entitled to receive benefits as per the terms of the contract in the event of the death of the Contract Owner or Annuitant, as applicable. COMMUTED VALUE -The present value of the remaining guaranteed annuity payments. CONTINGENT ANNUITANT - The person You designate who, upon the Annuitant's death, prior to the Annuity Commencement Date, becomes the Annuitant. CONTRACT ANNIVERSARY - An anniversary of the Contract Issue Date. CONTRACT ISSUE DATE - The date as of which the contract is established for You by Us. The Contract Issue Date is shown on Page 3. CONTRACT OWNER(S) - The owner(s) or holder of the contract. CONTRACT VALUE IS [$50,000] OR MORE ON THE - The aggregate value of the Accounts on any Valuation Day. CONTRACT ANNIVERSARYYEAR - A period of 12 months commencing with the Contract Issue Date or any other anniversary thereafter. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDEREDDEATH BENEFIT - The amount that We will pay upon the death of the Contract Owner or the Annuitant. DUE PROOF OF DEATH - A certified copy of a death certificate, an order of a court of competent jurisdiction, or any other proof acceptable to Us. DEFINITION OF CERTAIN TERMS (CONTINUED) FUNDS - The securities which underlie Your Sub-Accounts. GENERAL ACCOUNT - All of Our assets other than those allocated to the Separate Account. INTERNAL REVENUE CODE - The United States Internal Revenue Code of 1986, as amended or any successor law. INTERNAL REVENUE SERVICE - The United States Internal Revenue Service or any successor agency. JOINT ANNUITANT - Upon annuitization, a person other than the Annuitant on whose continuation of life annuity payments may be made. The contract will have a Joint Annuitant only if the annuity settlement option selected provides for a survivor. The Joint Annuitant may not be changed. NET PREMIUM - Premium payments less the applicable Sales Charges shown on Page 3, less any applicable Premium Tax. OWNER'S INVESTMENT - The sum of all premium payments into this contract plus the value of all eligible investments identified by You and allowed by the Company and owned by You, Your spouse or other immediate family members. PAYEE - The person, designated by You, to whom Annuity payments will be made. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACTTAX - The amount of tax, if any, charged by a federal, state, or other governmental entity on premium payments or Contract Values. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESSOn any contract subject to a Premium Tax, We may deduct the tax at the time We pay the tax to the applicable taxing authorities, at the time the contract is surrendered or on the Annuity Commencement Date. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT If We deduct the tax after Your premium payments have been applied to the Accounts, the tax will be deducted from the Accounts on a pro-rata basis. SEPARATE ACCOUNT - An account that We established to separate the assets funding the variable benefits for this type of contract from the other assets of the Company. The assets in the Separate Account are not chargeable with liabilities arising out of any other business We may conduct. The name of the Separate Account is shown on Page 3 SALES CHARGES - Charges deducted from premium payments at the time they are received by Us. Sales Charges are described on Page 3. SUB-ACCOUNT - The subdivisions of the Separate Account which are used to allocate Your Contract Value among the corresponding Funds. SURRENDER VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS- The Contract Value prior to the Annuity Commencement Date, less any applicable Premium Taxes, and/or Annual Maintenance Fee. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: AVALUATION DAY - Every day the New York Stock Exchange is open for trading. The value of the Separate Account is determined at the close of the New York Stock Exchange (generally 4:00 p.m. Eastern Time) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING on such days. VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSPERIOD - The period of time between the close of business on successive Valuation Days. WE, BUT NOT LESS THAN ZEROUS, OUR - The Company referred to on the first page of this contract. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINTYOU, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEARYOUR - The Contract Owner(s). PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT- Premium payments are payable at the Administrative Office of the Company. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDPayments may be made by check or by any other method that We deem acceptable. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED(CONTINUED) The initial premium payment is shown on Page 3. AMOUNTS WITHDRAWN IN EXCESS This is a flexible premium annuity. We may accept additional payments. The additional payments must be at least equal to the minimum subsequent premium payment shown on Page 3. Our approval is required for any premium payment if the aggregate of all premium payments received from you under all deferred variable annuity contracts issued by Us or Our affiliates equals or exceeds 1,000,000. ALLOCATION OF THE AWA ARE SUBJECT TO CDSCPREMIUM PAYMENTS Net Premium payments will be allocated to each Account according to Your instructions subject to Our minimum amount(s) then in effect. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVEAny subsequent Net Premium Payments will be allocated to Accounts in accordance with the most recent premium allocation instructions that We received. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSCVALUATION PROVISIONS NET PREMIUM PAYMENTS - The Net Premium payment is applied to purchase Accumulation Units with respect to the Sub-Account(s) that You have selected. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHEREThe number of Accumulation Units credited to each Sub-Account is determined by dividing the Net Premium payment allocated to a Sub-Account by the dollar value of one Accumulation Unit for such Sub-Account. This is computed in compliance with Securities and Exchange Commission regulations. The number of Accumulation Units will not be affected by any subsequent change in the value of such Accumulation Units. The Accumulation Unit value in any Sub-Account may increase or decrease from day to day as described below. NET INVESTMENT FACTOR The net investment factor for each of the Sub-Accounts is equal to:
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You The Company wants the Contract Owner to be satisfied with this contract. The Company urges the contract You have purchased. We urge You Contract Owner to closely examine its provisionsit closely. If for any reason You are the Contract Owner is not satisfied with Your purchasethis contract, You the Contract Owner may cancel surrender the contract by returning the contract within ten days after You receive itit was purchased. A written request for cancellation to surrender the contract must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract will be cancelled and (ii) the Contract Value on the date of surrenderany premium paid will be refunded in full. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ [LOGO] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 HARTFORD Form HL-12148 INDIVIDUAL SINGLE PREMIUM Printed in U.S.A. B644R0.FRM DEFERRED ANNUITY CONTRACT TABLE OF CONTENTS Page PAGE -------------------------------------------------------------------------------- Contract Specifications 3 Definition of Certain Terms Definitions 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Purchase Payment 5 Contract Control Provisions 8 5 General Provisions 9 Surrenders 10 Death Benefits 11 6 Crediting of Interest and Guarantee Periods 6 Termination Provisions 7 Settlement Provisions 14 8 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 10 Form HL-12148 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTRACT NUMBER SAMPLE CONTRACT DATE OCTOBER 1, 1987 NAME OF ANNUITANT MATTHEW BROWN DATE OF ISSUE OCTOBER 1, 1987 AXX XX XXXXXXXNT 35 ANNUITANT COMMENCEMENT DATE OCTOBER 1, 2037 SEX OF ANNUITANT MALE PURCHASE PAYMENT $5,000 CONTINGENT ANNUITANT INITIAL GUARANTEE PERIOD 5 YEARS BENEFICIARY KELLY BROWN INITIAL GUARANTEE RATE 8% CONTRACT OWNER MATTHEW BROWN FORM NUMBERS XXXXXXXXXXX OF BENEFITS HL- 12148, 12142, INDIVIDUAL SINGLE PREMIUM DEFERRED SALES ANNUITY CONTRACT 12150, 12151, 12152, 12146, 12129, 12168, 12986, 11613 SURRENDER CHARGE (CDSC): WE MAY ASSESS THIS CHARGE IS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PERCENTAGE OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZEROGROSS SURRENDER VALUE FOR ANY AMOUNT SURRENDERED DURING THE FIRST 7 CONTRACT YEARS. . IF THIS CHARGE EQUALS: CHARGE CONTRACT YEARS ------------------------------------------ 7% 1 6% 2 5% 3 4% 4 3% 5 2% 6 1% 7 0% THEREAFTER FOR A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED SURRENDER MADE AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS END OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. INITIAL GUARANTEE PERIOD, NO CDSC SURRENDER CHARGE WILL BE ASSESSED IF ONLY APPLIED PROVIDED SUCH SURRENDER OCCURS ON OR AFTER THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER END OF THE CDSC3RD CONTRACT YEAR. FOR A SURRENDER MADE AT THE END OF ANY SURRENDEROTHER GUARANTEE PERIOD, THE AMOUNT SUBJECT TO CDSC NO SURRENDER CHARGE WILL BE CALCULATED APPLIED PROVIDED SUCH SURRENDER OCCURS ON OR AFTER THE END OF THE 5TH CONTRACT YEAR. A REQUEST FOR SURRENDER AT THE TIME END OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:THE GUARANTEE PERIOD MUST BE RECEIVED IN WRITING 30 DAYS PRIOR TO THE END OF THE GUARANTEE PERIOD. ANNUAL MAINTENANCE FEE THE ANNUAL CONTRACT MAINTENANCE FEE IS $0 Form HL-12142 Printed in U.S.A.
Appears in 1 contract
RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days (30 days if this contract is replacing another annuity contract or life insurance policy) after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 11 AND 712. HL-VA03 VA99 Printed in U.S.A. B644R0.FRM I316R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Payment Provisions 6 7 Transfers Between Accounts Provisions 7 Dollar Cost Averaging Provisions 8 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Valuation Provisions 11 Surrender Provisions 12 Distribution at Time of Death Benefits 11 Provisions 14 Calculation of the Death Benefit Provisions 14 Settlement Provisions 14 17 Annuity Tables 16 20 HL-VA03 VA99 Page 2 Printed in U.S.A. B645R0.FRM R378R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14[ FEBRUARY 8, 2009 1999 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 2029 ] AGE OF ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 1,000 ] SEX OF ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] MINIMUM FIXED ACCOUNT INTEREST RATE 3% DESIGNATED BENEFICIARY [ XXX XXXXX ] (APPLIES TO ACCUMULATION PERIOD ONLY) CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN TWO ] ANNUAL WITHDRAWAL AMOUNT CONTRACT YEARS 1-7 15% OF PREMIUM PAYMENTS ON A NONCUMULATIVE BASIS AFTER CONTRACT YEAR 7 100% OF THE CONTRACT VALUE REDUCED BY THE TOTAL OF ANY PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL; AND 15% OF PREMIUM PAYMENTS MADE DURING THE 7 YEARS PRIOR TO WITHDRAWAL ON A NONCUMULATIVE BASIS. ANNUAL MAINTENANCE FEE: $0 IF THE CONTRACT VALUE IS $50,000 OR MORE ON THE CONTRACT ANNIVERSARY. $30 IF THE CONTRACT VALUE IS LESS THAN $50,000 ON THE CONTRACT ANNIVERSARY. MORTALITY AND EXPENSE RISK CHARGE: [0.501.35%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%[ .15% ] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED OPTIONAL DEATH BENEFIT CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [7[ .25% ] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS PER ANNUM OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERODAILY SUB-ACCOUNTS VALUE. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGE, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SPHL-OSHARE-11 VA99-3 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:U.S.A.
Appears in 1 contract
Samples: Annuity Contract (Talcott Resolution Life & Annuity Insurance Co Separate Account One)
RIGHT TO EXAMINE CONTRACT. We want [You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If may return this Contract for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten (10) calendar days after You receive it. A written request for cancellation must accompany You may return it to Us at Our Annuity Service Center or to the contractAgent who sold it. In such event, We will pay void the Contract as if it had never been in force, after You an return it to Us. We will refund the Purchase Payment amount equal allocated to the sum of (i) the difference between the premiums paid General Account and the amounts value of the Purchase Payment amount allocated to the Separate Account, reduced by any Account under amounts withdrawn or Annuity Payments made, within seven days after We receive the contract and (ii) the Contract Value on the date of surrenderContract.] THIS IS A LEGAL CONTRACT BETWEEN YOU AND US PLEASE READ YOUR CONTRACT CAREFULLY [ABCDE] [ABC] [SECRETARY] [PRESIDENT] INDIVIDUAL SINGLE PREMIUM IMMEDIATE FIXED AND VARIABLE ANNUITY CONTRACT Non-Participating ANNUITY PAYMENTS ARE PAYABLE ON THE FIRST ANNUITY PAYMENT DATE. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL ANNUITY PAYMENTS, WITHDRAWAL VALUES AND THE DEATH PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SUB-THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition CONTRACT SCHEDULE 4 DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 Purchase Payment 8 Allocation of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions Purchase Payment 8 GENERAL ACCOUNT PROVISIONS 8 General Provisions Account 8 SEPARATE ACCOUNT PROVISIONS 8 Separate Account 8 Valuation of Assets 8 Mortality and Expense Risk Charge 9 Surrenders Administrative Charge 9 TRANSFER PROVISIONS 9 Transfers 9 ANNUITY PROVISIONS 10 Annuity Payments 10 Fixed Annuity 10 Variable Annuity 10 Variable Annuity Units 10 Variable Annuity Payments 10 Variable Annuity Unit Value 11 DEATH PROVISIONS 12 Death Benefits 11 Settlement Provisions Before the First Annuity Payment Date 12 Death on or after the First Annuity Payment Date 12 Notification and Payment Requirements upon Death 13 Beneficiary 13 Change of Beneficiary 14 Annuity Tables ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 14 Annuitant 14 Joint Annuitant 14 Owner 14 Joint Owner 14 Assignment of the Contract 14 GENERAL PROVISIONS 15 The Contract 15 Contract Changes by Us 15 Contract Changes by You 15 Contract Termination 15 Evidence of Age and Survival 15 Incontestability 15 Misstatement Of Age or Sex 15 Non-Business Days 16 HLNon-VA03 Page 2 Printed in U.S.A. B645R0.FRM Participating Contract 16 Premium and Other Taxes 16 Protection of Proceeds 16 Regulatory Requirements 16 Reports 16 Suspension or Deferral of Payments Provision 16 CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN SCHEDULE PRODUCT: [MassMutual RetireEase SelectSM] CONTRACT NUMBER: [1234567] ISSUE DATE DATE: [SEPTEMBER 14, 2009 05/01/2006] NAME OF ANNUITANT [ XXXXX XXXXX CONTRACT SCHEDULE DATE: [05/01/2006] FIRST ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 PAYMENT DATE: 06/01/2006] ANNUITANT OWNER: [Xxxx Xxx] JOINT OWNER: [Xxxx Xxx] ANNUITANT: [Xxxx Xxx] AGE & SEX: [ 35 Male] INITIAL PREMIUM PAYMENT [ $2,000 JOINT ANNUITANT: [Xxxx Xxx] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNTAGE & SEX: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN 35 Female] MORTALITY AND EXPENSE RISK CHARGEPURCHASE PAYMENT Amount applied for Fixed Annuity Payments: [0.50%$30,000.00] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGEAmount applied for Variable Annuity Payments: [0.20%$70,000.00] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEEMinimum and Maximum Purchase Payment: $[0] IF THE CONTRACT VALUE IS The minimum Purchase Payment We will accept is [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY10,000]. The maximum Purchase Payment We will accept is [$501,500,000] IF THE CONTRACT VALUE IS LESS THAN for Annuitant(s) up to and including Age [75] on the Issue Date; the maximum Purchase Payment We will accept is [$50,000500,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR for Annuitant(s) Age [776] YEARS OR LESS. AN ANNUAL PREMIUM BASED CHARGE SHOWN BELOW WILL BE DEDUCTED FROM THE CONTRACT VALUE ON THE CONTRACT ANNIVERSARY BASED ON REMAINING GROSS PREMIUMS. EACH PREMIUM PAYMENT HAS ITS OWN [7] YEAR PREMIUM BASED CHARGE SCHEDULE AND IS ASSIGNED A PREMIUM BASED CHARGE BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALSor older on the Issue Date, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT PREMIUM BASED CHARGE. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT PREMIUM BASED CHARGE APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAIDor for any non-natural Owner. A PROPORTIONATE AMOUNT OF THE PREMIUM BASED CHARGE WILL BE DEDUCTED FOR ANY PORTION OF PREMIUM PAYMENT THAT IS SUBJECT TO THE CHARGEPurchase Payment greater than these amounts must be pre-approved by Us. For Joint Annuitants, BUT IS NOT HELD UNDER THE CONTRACT FOR THE FULL APPLICABLE CONTRACT YEAR. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. [7] Year Premium Based Charge will apply Age refers to each Premium Payment PREMIUM BASED CHARGE BREAKPOINT AMOUNT [7] YEAR PREMIUM BASED CHARGE [$0 - $49,999.99] [0.71%] [$50,000.00 - $99,999.99] [0.64%] [$100,000.00 - $249,999.99] [0.50%] [$250,000.00 - $499,999.99] [0.35%] [$500,000.00 - $999,999.99] [0.28%] [$1,000,000.00+] [0.17%] SP-OSHARE-11 Page 3 Printed in U.S.A. CONTRACT SPECIFICATIONS CONTINGENT DEFERRED SALES CHARGE (CDSC): WE MAY ASSESS A CDSC WHEN YOU REQUEST A FULL OR PARTIAL SURRENDER. THE CDSC IS BASED ON THE AMOUNT YOU CHOOSE TO SURRENDER AND HOW LONG YOUR PREMIUM PAYMENTS HAVE BEEN IN THE CONTRACT. EACH PREMIUM PAYMENT HAS ITS OWN CDSC SCHEDULE AND IS ASSIGNED A CDSC BREAKPOINT AMOUNT BASED ON THE CURRENT DEPOSIT PLUS THE GREATER OF: A) THE TOTAL BALANCE AS OF THE IMMEDIATELY PRECEDING VALUATION DATE; OR B) CUMULATIVE DEPOSITS PREVIOUSLY RECEIVED LESS PRIOR WITHDRAWALS, BUT NOT LESS THAN ZERO. . IF A SUBSEQUENT PREMIUM PAYMENT BRINGS THE CUMULATIVE TOTAL TO A NEW BREAKPOINT, ONLY THAT PREMIUM PAYMENT WILL RECEIVE THE NEW BREAKPOINT CDSC. THE PRIOR PREMIUM PAYMENT(S) WILL MAINTAIN THE ORIGINAL BREAKPOINT CDSC APPLIED AT THE TIME SUCH PREMIUM PAYMENT(S) WAS PAID. PREMIUM PAYMENTS ARE SURRENDERED IN THE ORDER IN WHICH THEY ARE RECEIVED. AMOUNTS WITHDRAWN IN EXCESS OF THE AWA ARE SUBJECT TO CDSC. THE AMOUNT ASSESSED A CDSC WILL NOT EXCEED YOUR REMAINING GROSS PREMIUMS AS DEFINED ABOVE. NO CDSC WILL BE ASSESSED IF ONLY THE AWA IS TAKEN, OR ELIGIBILITY REQUIREMENTS ARE MET FOR THE WAIVER OF THE CDSC. FOR ANY SURRENDER, THE AMOUNT SUBJECT TO CDSC WILL BE CALCULATED AT THE TIME OF WITHDRAWAL BY DIVIDING (A) BY (B) MULTIPLIED BY (C) WHERE:the oldest Joint Annuitant.
Appears in 1 contract
Samples: Massachusetts Mutual Variable Annuity Separate Account 4
