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THE TRAVELERS LIFE AND ANNUITY COMPANY
ONE TOWER SQUARE
HARTFORD, CONNECTICUT 06183
A STOCK COMPANY
We are pleased to provide You the benefits of this Variable Annuity
Contract. Please read Your Contract and all attached forms carefully.
RIGHT TO EXAMINE THIS CONTRACT
IF THIS CONTRACT IS RETURNED TO US AT OUR OFFICE OR OUR AGENT TO
BE CANCELED WITHIN 10 DAYS AFTER ITS DELIVERY TO YOU, WE WILL
PAY YOU THE CONTRACT VALUE DETERMINED AS OF THE NEXT VALUATION
DATE AFTER WE RECEIVE THE WRITTEN REQUEST AT OUR OFFICE, PLUS
ANY PREMIUM TAX CHARGES OR CONTRACT CHARGES PAID. IF THIS
CONTRACT IS ISSUED AS AN INDIVIDUAL RETIREMENT ANNUITY (IRA),
AND IS RETURNED TO US AT OUR OFFICE WITHIN 7 DAYS OF ITS
DELIVERY TO YOU, WE WILL PAY TO YOU THE FULL AMOUNT OF ANY
PREMIUM PAID, WITHOUT ADJUSTMENT FOR ANY PREMIUM TAX CHARGES OR
CONTRACT CHARGES PAID. AFTER THE CONTRACT IS RETURNED, IT WILL
BE CONSIDERED AS NEVER IN EFFECT.
This Contract is issued in consideration of the Purchase Payment. It is
subject to the terms and conditions stated on the attached pages, all of
which are a part of it.
Executed at Hartford, Connecticut
/s/ XXXXXX X. XXXXXXX
President
This is a legal Contract between You and Us.
READ YOUR CONTRACT CAREFULLY.
SINGLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
INCLUDING PRINCIPAL PROTECTION BENEFIT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT.
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TABLE OF CONTENTS
Right to Examine this Contract Cover Page
Contract Specifications Pages 3-4
Definitions Page 5
Owner, Beneficiary and Annuitant Provisions Pages 6-7
Purchase Payment and Valuation Provisions Pages 8-9
Principal Protection Benefit Page 10
Death Benefit Provisions Page 11
Settlement Provisions Pages 12-13
General Provisions Pages 14-15
Annuity Tables Pages 16-21
Any Riders or Endorsements follow the Annuity Tables.
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CONTRACT SPECIFICATIONS
OWNER [XXXX XXX] CONTRACT NUMBER
[JOINT OWNER] [XXXX XXX]
[CONTINGENT ANNUITANT] [XXXX XXX]
ANNUITANT [XXXX XXX]
CONTRACT DATE [01/08/2002]
MATURITY DATE [01/08/2014]
PRINCIPAL PROTECTION EXPIRATION DATE [01/08/2012]
PURCHASE PAYMENT [$20,000]
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MINIMUM PURCHASE PAYMENT: [$10,000]
MAXIMUM PURCHASE PAYMENT WITHOUT OUR APPROVAL: [$1,000,000]
AMOUNTS DEDUCTED ON SURRENDER:
CONTINGENT DEFERRED SALES CHARGE: The contingent deferred sales charge is
calculated as a percentage of the Purchase Payment withdrawn. For the purpose of
determining the contingent deferred sales charge, the order of withdrawal will
be deemed to be taken first from (a) any remaining free withdrawal allowance (as
described below); (b) next from any portion of the Purchase Payment not previous
withdrawn; and then (c) from Contract earnings. After the tenth anniversary of
the Contract, withdrawals will no longer be assessed with a contingent deferred
sales charge.
CONTINGENT DEFERRED
CONTRACT YEAR SALES CHARGE PERCENT
1 [9%
2 9%
3 8%
4 8%
5 7%
6 6%
7 5%
8 4%
9 3%
10 2%
11+ 0%]
FREE WITHDRAWAL ALLOWANCE: On an annual basis, after the first Contract Year,
You may take partial withdrawals of up to [10%] of Your Contract value without
imposition of a contingent deferred sales charge. The Contract value is
determined as of the last Valuation Date of the previous Contract Year. The free
withdrawal allowance applies to any withdrawals [except those transferred
directly to unaffiliated carriers or financial institutions].
ALLOWABLE DISTRIBUTIONS PRIOR TO CONTRACT DISCONTINUANCE NOT SUBJECT TO AMOUNTS
DEDUCTED ON SURRENDER: When a Death Benefit is payable and for minimum
distributions (as defined by the Internal Revenue Code).
CONTRACT FEE: [$30.00] if Contract value is less than [$50,000] on the date the
charge is assessed. Assessed annually on [fourth Friday of August] each year.
TRANSFER CHARGE: [$0.00] We reserve the right to assess a transfer charge of up
to [$10.00] on transfers exceeding [12] per year.
TERMINATION: We reserve the right to terminate this Contract when the Contract
value is less than [$2,000].
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SEPARATE ACCOUNT: [THE TRAVELERS FUND XX XX FOR VARIABLE ANNUITIES]
FUNDING OPTION(S):
UNDERLYING FUND(S): ANNUAL PRINCIPAL PROTECTION FEE
[Greenwich Street Series Fund
Equity Index Portfolio [2.50%]
Travelers Money Market Portfolio* N/A
*AVAILABLE ON OR AFTER THE PRINCIPAL PROTECTION EXPIRATION DATE OR AT TIME OF
ANNUITIZATION. HOWEVER, THE PRINCIPAL PROTECTION BENEFIT IS NOT AVAILABLE FOR
THIS FUNDING OPTION.]
FUNDING OPTIONS DAILY DEDUCTIONS: The annual mortality and expense risk
deduction is [1.25%] and the administration charge is [.15%] for all Funding
Options listed above and is deducted on a pro rata basis from all Funding
Options. This amounts to a daily deduction of [.00003836] per Funding Option. In
addition, the Principal Protection fee(s) corresponding to each Funding Option
will also be deducted from each Funding Option on a daily basis.
ASSUMED DAILY NET INVESTMENT FACTOR, upon annuitization, is [1.000081] for each
Funding Option When expressed on an annual basis, this factor equals [3%].
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DEFINITIONS
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ACCUMULATION UNIT(S) - an accounting unit of measure used to calculate the value
of this Contract before annuity payments begin.
AGE - age last birthday.
ANNUITANT - the person on whose life the Maturity Date and annuity payments
depend.
ANNUITY UNIT(S) - an accounting unit of measure used to calculate the amount of
annuity payments.
CODE - the Internal Revenue Code of 1986, as amended, and all related laws and
regulations, which are in effect during the term of this Contract.
CONTRACT DATE - the date on which the Contract is issued.
CONTRACT - a Contract that describes the benefits, rights, and obligations of
the owner and Us.
CONTRACT DISCONTINUANCE - termination of this Contract by Us or Your Written
Request.
CONTRACT YEAR(S) - twelve-month period(s) beginning with the Contract Date.
DEATH REPORT DATE - the Valuation Date coincident with or next following the day
on which We have received 1) Due Proof of Death and 2) a Written Request for an
election of a single sum payment or an alternate Settlement Option as described
in the Contract.
DUE PROOF OF DEATH - (i) a copy of a certified death certificate; (ii) a copy of
a certified decree of a court of competent jurisdiction as to the finding of
death; (iii) a written statement by a medical doctor who attended the deceased;
or (iv) any other proof satisfactory to Us.
FUNDING OPTION(S) - that portion of the assets of a division or subaccount of a
Separate Account, which is allocated to a particular Underlying Fund.
MATURITY DATE - the date on which the annuity payments are to begin.
OUR OFFICE - the Home Office of The Travelers Life and Annuity Company or any
other office which We may designate for the purpose of administering this
Contract.
PREMIUM TAX - the amount of tax, if any charged by the state or municipality. We
will deduct any applicable Premium Tax from the Contract value either upon
surrender, annuitization, death, or at the time the Purchase Payment is made,
but no earlier than when We have the liability under state law.
PURCHASE PAYMENT- a single payment You make to Us under this Contract.
RECORDED - a Written Request is recorded when the information is noted in Our
file for this Contract.
SEPARATE ACCOUNT(S) - those Separate Accounts indicated in the Contract
Specifications, which We established for this class of Contracts and certain
other Contracts.
SETTLEMENT OPTIONS - an annuity option elected under this Contract.
TAX QUALIFIED CONTRACT - a Contract used in a retirement plan or program that is
intended to qualify under Sections 401, 403,or 408 of the Code.
UNDERLYING FUND(S) - an open-end diversified management investment company or
portfolio thereof, indicated in the Contract Specifications, in which the
Funding Options of the Separate Account invest.
VALUATION DATE - a date on which a Funding Option is valued.
VALUATION PERIOD - the period between successive valuations.
WE, US, OUR - The Travelers Life and Annuity Company.
WRITTEN REQUEST - written information including requests for Contract changes
sent to Us in a form and content satisfactory to Us and received at Our Office.
YOU, YOUR - the owner, including a joint owner.
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OWNER, BENEFICIARY AND ANNUITANT PROVISIONS
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OWNER
This Contract belongs to the owner shown on the Contract Specifications or to
any person subsequently named in a Written Request of transfer of ownership as
provided below. As owner, You have sole power during the Annuitant's lifetime to
exercise any rights and to receive all benefits given in this Contract provided
You have not named an irrevocable beneficiary and provided the Contract is not
assigned.
You will be the recipient of all payments while the Annuitant is alive unless
You direct them to an alternate recipient under a Recorded payment direction. An
alternate recipient under a payment direction does not become the owner. A
payment direction is revocable by You at any time by Written Request giving 30
days advance notice.
JOINT OWNER
Joint owners may be named in a Written Request prior to the Contract Date. Joint
owners may independently exercise transfers between Funding Options. All other
rights of ownership must be exercised by joint action. Joint owners own equal
shares of any benefits accruing or payments made to them. All rights of a joint
owner end at death if another joint owner survives. The entire interest of the
deceased joint owner in this Contract will pass to the surviving joint owner.
If an owner dies and is survived by the Annuitant before payment of an annuity
option begins, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the beneficiary named in a Written Request.
TRANSFER OF OWNERSHIP
You may transfer ownership by Written Request. You may not revoke any transfer
after the effective date. Once the transfer of ownership is Recorded by Us, it
will take effect, subject to any payments made or other actions taken by Us
before the Written Request is Recorded.
Unless provided otherwise, a transfer of ownership does not affect the interest
of any beneficiary designated prior to the effective date of the transfer.
A transfer of ownership may have adverse tax consequences to You as the former
owner.
ASSIGNMENT
You may collaterally assign ownership of all or a portion of this Contract by
Written Request without the approval of any beneficiary unless irrevocably
named. You may not exercise any rights of ownership while the assignment remains
in effect without the approval of the collateral assignee. We are not
responsible for the validity of any assignment. Once the collateral assignment
is Recorded by Us, it will take effect subject to any payments made or other
actions taken by Us before the Written Request is Recorded.
If a claim is made based on an assignment, We may require proof of interest of
the claimant. A Recorded assignment takes precedence over any rights of a
beneficiary. Any amounts due under a Recorded assignment will be paid in a
single sum.
An assignment may have adverse tax consequences to You.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner or beneficiary
under this Contract shall be subject to the claims of creditors or any legal
process except as may be provided by an assignment.
BENEFICIARY
The beneficiary is the party named in a Written Request. The beneficiary has the
right to receive any remaining contractual benefits upon the death of the
Annuitant, or under certain circumstances, upon the death of the owner. If there
is more than one beneficiary surviving the Annuitant, the beneficiaries will
share equally in benefits unless different shares are Recorded with Us by
Written Request prior to the death of the Annuitant.
If a joint owner dies and is survived by the Annuitant before payment of an
annuity option begins, any surviving joint owner is the "designated beneficiary"
referred to in Section 72(s) of the Code, and his or her rights pre-empt those
of the beneficiary named in a Written Request.
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Unless an irrevocable beneficiary has been named, You have the right to change
any beneficiary by Written Request during the lifetime of the Annuitant and
while the Contract is in effect.
Once a change in beneficiary is Recorded by Us, it will take effect, subject to
any payments made or other actions taken by Us before the Written Request is
Recorded.
When an Annuitant dies, if no beneficiary has been named by You, or if no
beneficiary is living, We will pay the death benefit to You or Your estate.
ANNUITANT
The Annuitant is the individual shown on the Contract Specifications on whose
life the first annuity payment is made. The Annuitant may not be changed after
the Contract Date.
CONTINGENT ANNUITANT
You may name one individual as a contingent Annuitant by Written Request prior
to the Contract Date. A contingent Annuitant may not be changed deleted or added
to the Contract after the Contract Date. For purposes of this provision the
owner cannot be the Annuitant.
If the Annuitant dies prior to the Maturity Date while this contract is in
effect and while the contingent Annuitant is living:
a. the death benefit will not be payable upon the Annuitant's
death;
b. the contingent Annuitant becomes the Annuitant; and
c. all other rights and benefits provided by this Contract will
continue in effect.
When a contingent Annuitant becomes the Annuitant, the Maturity Date remains the
same as previously in effect, unless otherwise provided.
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PURCHASE PAYMENT AND VALUATION PROVISIONS
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PURCHASE PAYMENT
PURCHASE PAYMENT
The Purchase Payment is the payment You make for this Contract and the benefits
it provides. The single Purchase Payment must be made to the Contract and is due
and payable before the Contract becomes effective. The Purchase Payment is
payable to Us at Our Office. No additional Purchase Payments may be made to this
Contract.
The net Purchase Payment applied to the Contract value is equal to the Purchase
Payment less any applicable Premium Tax charge.
ALLOCATION OF PURCHASE PAYMENT
We will apply Your net Purchase Payment to provide Accumulation Units of
selected Funding Options of this Contract. The Purchase Payment will be applied
within two business days following its receipt at Our Office if the information
received is satisfactory to Us. The net Purchase Payment will be allocated to
the Funding Options in the proportion specified by You for this Contract. The
available Underlying Funds to which Funding Option assets are allocated are
shown on the Contract Specifications. Underlying Funds and/or Funding Options
may be subsequently added or deleted.
FUNDING OPTION VALUATION
NUMBER OF ACCUMULATION UNITS
The number of Accumulation Units to be credited to each Funding Option once the
Purchase Payment has been received by Us will be determined by dividing the net
Purchase Payment applied to that Funding Option by the then Accumulation Unit
Value of that Funding Option.
ACCUMULATION UNIT VALUE
We determine the value of the an Accumulation Unit in each Funding Option on
each Valuation Date by multiplying the value on the immediately preceding
Valuation Date by the net investment factor for that Funding Option for the
Valuation Period just ended.
The value of an Accumulation Unit on any date other than a Valuation Date will
be equal to its value as of the next Valuation Date.
NET INVESTMENT FACTOR
The net investment factor is a factor applied to measure the investment
performance of a Funding Option from one Valuation Period to the next. The net
investment factor for a Funding Option for any Valuation Period is equal to the
sum of 1.0000 plus the net investment rate.
Each Funding Option's net investment rate for a Valuation Period is equal to the
gross investment rate for that Funding Option, less the applicable Funding
Option deduction for the Valuation Period.
All Funding Option deductions are shown on the Contract Specifications.
The gross investment rate of a Funding Option for a Valuation Period is equal to
(1) divided by (2) where (1) is equal to:
a) investment income, plus
b) capital gains and losses, whether realized or unrealized; less
c) a deduction for any tax levied against the Separate Account and/or the
Underlying Funds; and
(2) is the amount of the assets at the beginning of the Valuation Period.
The gross investment rate for a Funding Option is based on the net asset value
of the Underlying Fund and may be either positive or negative. Investment income
includes any distribution whose ex-dividend date occurs during the Valuation
Period.
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TRANSFER BETWEEN FUNDING OPTIONS
Transfers will not be allowed until the Principal Protection expiration date. On
the Principal Protection expiration date, 100% of Your Contract value will be
transferred to the money market or similar fund, unless You notify Us otherwise
by Written Request.
Transfers between Funding Options will result in the addition or deletion of
Accumulation Units having a total value equal to the dollar amount being
transferred to or from a particular Funding Option. The number of Accumulation
Units will be determined by using the Accumulation Unit value of the Funding
Option involved as of the next valuation after We receive notification of
request for transfer. Transfers will be subject to any applicable transfer
charges stated on the Contract Specifications.
We reserve the right to restrict transfers between Funding Options by any market
timing firm or any other third party authorized to initiate transfers on behalf
of multiple Contract owners. We may not accept, among other things: 1) the
transfer instructions of any agent acting under a power of attorney on behalf of
more than one owner, or 2) the transfer or exchange instructions of individual
owners who have executed pre-authorized transfers forms which are submitted by
market timing firms or other third parties on behalf or more than one owner. We
further reserve the right to limit transfers that We determine will disadvantage
other Contract owners.
CONTRACT VALUES
CONTRACT VALUE
The Contract value of this Contract on any date equals the sum of the
accumulated values in the Funding Options. The accumulated value in a Funding
Option equals the number of outstanding Accumulation Units credited to that
Funding Option, multiplied by the then Accumulation Unit Value for that Funding
Option.
CONTRACT FEE
A Contract fee in the amount and for the period shown on the Contract
Specifications will be deducted from the Contract value to reimburse Us for
administrative expenses relating to the Contract. The Contract fee will be
deducted by surrendering on a pro rata basis Accumulation Units from all Funding
Options in which You have an interest.
We will deduct the charge on a pro rata basis if the Contract has been in effect
for less than a full period on the date a Contract fee is deducted. The Contract
fee will also be prorated upon full surrender or termination of the Contract.
CASH SURRENDER VALUE
The cash surrender value is equal to the Contract value less any amounts
deducted on surrender which are shown on the Contract Specifications and less
any applicable Premium Tax not previously deducted.
CASH SURRENDER
You may elect by Written Request to receive the cash surrender value of this
Contract before the due date of the first annuity payment and without the
consent of any beneficiary unless irrevocably named. You may elect either a full
or partial surrender of the cash surrender value. In the case of a full
surrender, this Contract will be canceled. A partial surrender will result in a
reduction in Your Contract value. If You have a balance in more than one Funding
Option, Your Contract value will be reduced from all Your Funding Options on a
pro rata basis, unless You request otherwise.
The cash surrender value will be determined as of the next valuation following
receipt of Your Written Request. We may delay payment of the cash surrender
value of the Funding Options for a period of not more than five business days
after We receive Your Written Request.
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PRINCIPAL PROTECTION BENEFIT
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PRINCIPAL PROTECTION BENEFIT
The Principal Protection benefit is only available on the Principal Protection
expiration date and provides that the value of each Funding Option, on the
Principal Protection expiration date, will be the greater of:
a) the Contract value attributable to such Funding Option on the Principal
Protection expiration date, or
b) the Principal Protection amount attributable to such Funding Option on
the Principal Protection expiration date.
PRINCIPAL PROTECTION AMOUNT
For each Funding Option, the Principal Protection amount on any date equals the
Purchase Payment allocated to that Funding Option, less all withdrawal
reductions associated with that Funding Option, which were calculated prior to
or on such date. A withdrawal reduction is calculated any time a partial
surrender is withdrawn from the Funding Option and is equal to the Funding
Option's Principal Protection amount immediately prior to the partial surrender
multiplied by the ratio of the amount of the partial surrender, including all
withdrawal charges and fees, to the value of such Funding Option immediately
prior to the partial surrender.
PRINCIPAL PROTECTION FEE(S)
The Principal Protection fee(s) is shown on the Contract Specifications, and is
deducted from the Funding Option(s) on a daily basis. This fee will no longer be
deducted from the Funding Option(s) after the Principal Protection expiration
date.
TRANSFERS
Transfers will not be permitted between Funding Options until the Principal
Protection expiration date. On the Principal Protection expiration date, 100% of
Your Contract value will be transferred to the money market or similar fund,
unless You notify Us otherwise by Written Request.
TERMINATION OF THE PRINCIPAL PROTECTION BENEFIT
If You surrender Your entire Contract value or annuitize Your entire Contract
value prior to the Principal Protection expiration date, the Principal
Protection benefit will be terminated.
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DEATH BENEFIT PROVISIONS
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DEATH OF ANNUITANT
A death benefit is payable to the beneficiary upon the death of the Annuitant
before the Maturity Date, unless a contingent Annuitant was named. A death
benefit is also payable under those Settlement Options, which provide for death
benefits. We will pay the beneficiary the death benefit in a single sum as
described below, as of the Death Report Date. A beneficiary may request that a
death benefit payable under this Contract be applied to a Settlement Option
subject to the provisions of this Contract and the current tax laws.
DEATH OF OWNER WITH ANNUITANT SURVIVING
If the owner is not the Annuitant, and the owner dies (including the first of
joint owners) before the Maturity Date and with the Annuitant surviving, We will
recalculate the value of the death benefit under the provisions of Death
Proceeds Prior To The Maturity Date below. The value of the death benefit, as
recalculated, will be paid in a single lump sum or by other election to the
party taking proceeds under the current tax laws. The party must take
distributions no later than under the applicable elections of that provision.
All references to Annuitant in the Death Proceeds Prior to Maturity Date
provision will be replaced with reference to the owner.
DEATH PROCEEDS PRIOR TO THE MATURITY DATE
If the Annuitant dies before the Maturity Date, We will pay the beneficiary the
greater of a) or b) less any applicable Premium Tax as of the Death Report Date:
a) the Contract value on the Death Report Date; or
b) THE RETURN OF PREMIUM DEATH BENEFIT AS OF THE DEATH REPORT DATE. THE
RETURN OF PREMIUM DEATH BENEFIT ON ANY DATE EQUALS THE PURCHASE
PAYMENT LESS ALL PARTIAL SURRENDER REDUCTIONS, WHICH WERE CALCULATED
PRIOR TO OR ON SUCH DATE.
PARTIAL SURRENDER REDUCTION:
A partial surrender reduction will be calculated any time a partial surrender is
withdrawn from the Contract and is equal to:
(1) the amount of the return of premium death benefit immediately prior to
the partial surrender multiplied by
(2) the amount of the partial surrender divided by the Contract value
immediately prior to the partial surrender.
We must be notified no later than six months from the date of death in order for
Us to pay death benefit proceeds as described above. If notification is received
more than six months after the date of death, the death benefit payable will be
the Contract value on the Death Report Date, less any applicable Premium Tax.
DEATH PROCEEDS AFTER THE MATURITY DATE
If the Annuitant dies on or after the Maturity Date, We will pay the beneficiary
a death benefit consisting of any benefit remaining under the Annuity option
then in effect.
INTEREST ON DEATH PROCEEDS
Any interest on death proceeds will be paid in accordance with regulations in
effect in Your state at the time of death.
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SETTLEMENT PROVISIONS
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MATURITY DATE
The Maturity Date is shown on the Contract Specifications. This is the date on
which We will begin paying to You the first of a series of annuity payments in
accordance with the Settlement Option elected by You. Annuity payments will
begin under this Contract on the Maturity Date unless the Contract has been
fully surrendered or the proceeds have been paid to the beneficiary prior to
that date. We may require proof that the Annuitant is alive before annuity
payments are made. If no Maturity Date is specified, the automatic Maturity Date
will be the greater of when the Annuitant reaches age 95 or ten years after the
Contract Date.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, You may change the Maturity Date by Written Request to
any time prior to the Annuitant's 95th birthday or to a later date with Our
consent. The Maturity Date may not be earlier than the first anniversary of the
Contract Date.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, We will pay the amount payable under this Contract to You
in accordance with the Settlement Option elected by You. Once annuity payments
have commenced, no election changes are allowed.
During the Annuitant's lifetime, if no election has been made on the Maturity
Date, We will pay to You the first of a series of monthly annuity payments based
on the life of the Annuitant, in accordance with annuity Option 2, with 120
monthly payments assured.
MINIMUM AMOUNTS
The minimum amount that can be placed under a Settlement Option is $2,000 unless
We consent to a lesser amount. If any periodic payments due are less than $100
We reserve the right to make payments at less frequent intervals, resulting in a
payment of at least $100 per year.
ALLOCATION OF ANNUITY
At the time an election of one of the annuity options is made, the person
electing the option may further elect to have the cash surrender value applied
to provide a variable annuity, a fixed annuity or a combination of both.
Unless You elect otherwise, the cash surrender value of a Funding Option will be
applied when annuity payments start to provide an annuity, which varies with the
investment experience of that same Funding Option.
Once annuity payments start, You may, with Our consent, change the allocation of
Your values in each Funding Option.
VARIABLE ANNUITY
AMOUNT OF FIRST PAYMENT
The Life Annuity Tables are used to determine the first monthly annuity payment.
They show the dollar amount of the first monthly annuity payment, which can be
purchased with each $1,000 applied. The amount applied to a variable annuity
will be the cash surrender value allocated to the variable annuity as of [14]
days prior to the date annuity payments start. We reserve the right to require
satisfactory proof of the Age of any person on whose life annuity payments are
based before making the first payment under any of these options.
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ANNUITY UNIT VALUE
On any Valuation Date, the Annuity Unit value for a Funding Option equals the
Funding Option's Annuity Unit value on the immediately preceding Valuation Date,
multiplied by the net investment factor for that Funding Option for the
Valuation Period just ended, divided by the assumed daily net investment factor.
The assumed daily net investment factor is shown on the Contract Specifications.
The value of an Annuity Unit as of any date other than a Valuation Date will be
equal to its value as of the next succeeding Valuation Date.
NUMBER OF ANNUITY UNITS
We determine the number of Annuity Units credited to this Contract in each
Funding Option by dividing the first monthly Annuity payment attributable to
that Funding Option by the Funding Option's Annuity Unit value as of [14] days
before the due date of the first Annuity payment.
AMOUNT OF SECOND AND SUBSEQUENT PAYMENTS
The dollar amount of the second and subsequent payments may change from month to
month. The amount of the annuity payment for each Funding Option is found by
multiplying the number of Annuity Units for that Funding Option by the Annuity
Unit value for that Funding Option. The total amount of each annuity payment
will be equal to the sum of the payments in each Funding Option.
FIXED ANNUITY
A fixed annuity is an annuity with payments, which remain fixed as to dollar
amount throughout the payment period. The Life Annuity Tables are used to
determine the monthly annuity payment. They show the dollar amount of monthly
annuity payment, which can be purchased with each $1,000 applied. The amount
applied to the fixed annuity will be equal to the cash surrender value allocated
to the fixed annuity determined as of the date fixed annuity payments start. If
it would produce a larger payment, We agree that the fixed annuity payment will
be determined using the Life Annuity Tables in effect on the Maturity Date.
ANNUITY OPTIONS
Subject to conditions stated in Elections Of Settlement Options and Minimum
Amounts, the cash surrender value of this Contract may be paid under one of the
annuity options below if available on the Maturity Date. We may offer additional
options.
OPTION 1. LIFE ANNUITY - NO REFUND
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based, ending with the last monthly payment preceding
death.
OPTION 2. LIFE ANNUITY WITH 120, 180 OR 240 MONTHLY PAYMENTS ASSURED
We will make monthly annuity payments during the lifetime of the person on whose
life the payments are based. If at the death of that person, payments have been
made for less than 120, 180, or 240 months, as elected, We will continue to make
payments to the designated beneficiary during the remainder of the period.
OPTION 3. JOINT AND LAST SURVIVOR LIFE ANNUITY
We will make monthly annuity payments during the joint lifetime of two persons
on whose lives payments are based and during the lifetime of the survivor. No
more payments will be made after the death of the survivor.
OPTION 4. JOINT AND LAST SURVIVOR LIFE ANNUITY - ANNUITY REDUCED ON DEATH OF
PRIMARY PAYEE
We will make monthly annuity payments during the joint lifetime of two persons
on whose lives payments are based. One of the two persons will be designated as
the primary payee. The other will be designated as the secondary payee. On the
death of the secondary payee, if survived by the primary payee, We will continue
to make monthly annuity payments to the primary payee in the same amount that
would have been payable during the joint lifetime of the two persons. On the
death of the primary payee, if survived by the secondary payee, We will continue
to make monthly annuity payments to the secondary payee in an amount equal to
50% of the payments, which would have been made during the lifetime of the
primary payee. No further payments will be made following the death of the
survivor.
OPTION 5. PAYMENTS FOR A FIXED PERIOD
We will make monthly payments for the period selected.
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GENERAL PROVISIONS
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THE CONTRACT
The entire Contract between You and Us consists of the Contract and all attached
pages.
CONTRACT CHANGES
The only way this Contract may be changed is by a written endorsement signed by
one of Our officers.
SUBSTITUTION OF SEPARATE ACCOUNT, FUNDING OPTION(S), OR UNDERLYING FUND(S)
If it is not possible to continue to offer a Separate Account, Funding
Option(s), or Underlying Fund(s), or in Our judgment becomes inappropriate for
the purposes of this Contract, We may substitute another Separate Account,
Funding Option(s), or Underlying Fund(s) without Your consent. Substitution may
be made with respect to existing investments. However, no such substitution will
be made without notice to You and without prior approval of the Securities and
Exchange Commission, to the extent required by law.
MISSTATEMENT
If the Annuitant's (or, if applicable, the owner's) sex or date of birth was
misstated, all benefits of this Contract are what the Purchase Payment paid
would have purchased at the correct sex and Age. Proof of the Annuitant's and
owner's Age may be filed at any time at Our Office.
INCONTESTABILITY
We will not contest this Contract from its Contract Date.
TERMINATION
We reserve the right to terminate this Contract on any Valuation Date if the
Contract value as of the date is less than the termination amount shown on the
Contract Specifications. Termination will not occur until 31 days after We have
mailed notice of termination to You at Your last known address. If this Contract
is terminated, We will pay You the cash surrender value, if any.
REQUIRED REPORTS
We will furnish a report to the owner as often as required by law, but at least
once in each Contract Year before the due date of the first annuity payment. The
report will show the number of Accumulation Units credited to the Contract in
each Funding Option and the corresponding Accumulation Unit value as of the date
of the report.
VOTING RIGHTS
If required by federal law, You may have the right to vote at the meetings of
the Shareholders of the Underlying Funds. If You have voting rights, We will
send a notice to You telling You the time and place of a meeting. The notice
will also explain matters to be voted upon and how many votes You may exercise.
MORTALITY AND EXPENSES
Our actual mortality and expense experience will not affect the amount of any
annuity payments or any other values under this Contract.
NON-PARTICIPATING
This Contract does not share in Our surplus earnings, so You will receive no
dividends under it.
TAXES BASED UPON PREMIUM OR VALUE
If there is a law or change in law assessing taxes against Us based upon the
premium or value of this Contract, We reserve the right to charge You
proportionately for that tax. This would include a tax based upon Our realized
net capital gains in the Funding Options.
CONFORMITY WITH STATE AND FEDERAL LAWS
This Contract is governed by the law of the state in which it is delivered. Any
paid-up annuity, cash surrender or death benefits that are available under this
Contract are not less than the minimum benefits required by the statutes of the
state in which this Contract is delivered.
Upon receiving appropriate state approval, We may at any time make any changes,
including retroactive changes, in this Contract to the extent that the change is
required to meet the requirements of any law or regulation issued by an
governmental agency to which We or You are subject.
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EMERGENCY PROCEDURE
We reserve the right to suspend or postpone the date of any payment of any
benefit or values for any Valuation Period (1) when the New York Stock Exchange
is closed; (2) when trading on the Exchange is restricted; (3) when an emergency
exists as determined by the Securities and Exchange Commission so that disposal
of the securities held in the Funding Options is not reasonably practicable or
it is not reasonably practicable to determine the value of the Funding Options'
net assets, or (4) during any other period when the Securities and Exchange
Commission, by order, so permits for the protection of security holders. Any
provision of this Contract, which specifies a Valuation Date, will be superseded
by this Emergency Procedure.
RELATION OF THIS CONTRACT TO THE SEPARATE ACCOUNTS AND FUNDING OPTION(S)
We will have exclusive and absolute ownership and control of the assets of Our
Separate Account and the Funding Options. That portion of the assets of a
Separate Account or Funding Option equal to the reserves and other Contract
liabilities with respect to such Separate Account or Funding Option shall not be
chargeable with liabilities arising out of any other business We conduct. Our
determination of the value of an Accumulation Unit and an Annuity Unit by the
method described in this Contract will be conclusive.
REDUCTION OR ELIMINATION OF CONTRACT CHARGES
All charges and fees under the Contract may be reduced or eliminated when
certain sales or administration of the Contract result in savings or reduction
of expenses, and/or risks.
TRANSFERS TO OTHER CONTRACTS ISSUED BY US
Under specific conditions, We may allow You to transfer Your Contract value to
another Contract issued by Us without incurring contingent deferred sales
charges as shown on the Contract Specifications page. Once the transfer is
complete and We have established a new account at Your direction, new contingent
deferred sales charges or surrender charges may apply to the new Contract in
accordance with the provisions of such Contract.
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS
MALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.59 3.57 3.56 3.53
46 3.64 3.62 3.60 3.57
47 3.69 3.67 3.65 3.62
48 3.75 3.73 3.70 3.67
49 3.81 3.78 3.76 3.71
50 3.87 3.84 3.81 3.77
51 3.93 3.90 3.87 3.82
52 4.00 3.97 3.93 3.87
53 4.07 4.04 3.99 3.93
54 4.15 4.11 4.06 3.99
55 4.23 4.19 4.13 4.05
56 4.32 4.27 4.20 4.11
57 4.41 4.35 4.28 4.17
58 4.50 4.44 4.36 4.24
59 4.61 4.53 4.44 4.31
60 4.72 4.63 4.53 4.37
61 4.83 4.74 4.62 4.44
62 4.96 4.85 4.71 4.51
63 5.09 4.97 4.81 4.58
64 5.24 5.09 4.90 4.65
65 5.39 5.22 5.01 4.72
66 5.56 5.36 5.11 4.79
67 5.73 5.50 5.21 4.86
68 5.92 5.64 5.32 4.93
69 6.12 5.80 5.43 4.99
70 6.34 5.96 5.53 5.05
71 6.56 6.12 5.64 5.11
72 6.81 6.29 5.75 5.16
73 7.07 6.46 5.85 5.21
74 7.35 6.64 5.95 5.26
75 7.64 6.82 6.05 5.30
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES A
YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE WITH MORTALITY
IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS TABLE ASSUMES A NET
INVESTMENT RATE OF 3% PER ANNUM ASSUMING A 365 DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR NONQUALIFIED CONTRACTS
FEMALE NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.39 3.39 3.38 3.37
46 3.43 3.43 3.42 3.40
47 3.48 3.47 3.46 3.44
48 3.52 3.52 3.50 3.48
49 3.57 3.56 3.55 3.53
50 3.62 3.61 3.60 3.57
51 3.68 3.66 3.65 3.62
52 3.74 3.72 3.70 3.67
53 3.80 3.78 3.76 3.72
54 3.86 3.84 3.81 3.78
55 3.93 3.90 3.88 3.83
56 4.00 3.97 3.94 3.89
57 4.07 4.05 4.01 3.95
58 4.15 4.12 4.08 4.01
59 4.24 4.20 4.15 4.08
60 4.33 4.29 4.23 4.15
61 4.43 4.38 4.32 4.22
62 4.53 4.48 4.40 4.29
63 4.64 4.58 4.49 4.36
64 4.76 4.69 4.59 4.44
65 4.89 4.80 4.69 4.52
66 5.02 4.92 4.79 4.59
67 5.17 5.05 4.89 4.67
68 5.32 5.19 5.00 4.75
69 5.49 5.33 5.12 4.82
70 5.68 5.48 5.23 4.90
71 5.87 5.64 5.35 4.97
72 6.09 5.81 5.47 5.04
73 6.32 5.99 5.59 5.10
74 6.57 6.18 5.71 5.16
75 6.84 6.37 5.83 5.22
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES A
YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE WITH MORTALITY
IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS TABLE ASSUMES A NET
INVESTMENT RATE OF 3% PER ANNUM ASSUMING A 365 DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTIONS 1 AND 2- SINGLE LIFE ANNUITIES
THIS TABLE WILL BE USED FOR QUALIFIED CONTRACTS
UNISEX NUMBER OF MONTHLY PAYMENTS GUARANTEED
ADJUSTED NONE 120 180 240
AGE
45 3.49 3.48 3.47 3.45
46 3.54 3.53 3.51 3.49
47 3.59 3.57 3.56 3.53
48 3.64 3.62 3.60 3.58
49 3.69 3.68 3.65 3.62
50 3.75 3.73 3.71 3.67
51 3.81 3.79 3.76 3.72
52 3.87 3.85 3.82 3.77
53 3.94 3.91 3.88 3.83
54 4.01 3.98 3.94 3.88
55 4.08 4.05 4.01 3.94
56 4.16 4.12 4.07 4.00
57 4.24 4.20 4.15 4.07
58 4.33 4.28 4.22 4.13
59 4.42 4.37 4.30 4.20
60 4.52 4.46 4.38 4.27
61 4.63 4.56 4.47 4.34
62 4.75 4.67 4.56 4.41
63 4.87 4.78 4.65 4.48
64 5.00 4.89 4.75 4.55
65 5.14 5.01 4.85 4.62
66 5.29 5.14 4.95 4.70
67 5.45 5.28 5.06 4.77
68 5.62 5.42 5.17 4.84
69 5.81 5.57 5.28 4.91
70 6.00 5.72 5.39 4.98
71 6.22 5.89 5.50 5.04
72 6.44 6.06 5.62 5.10
73 6.69 6.23 5.73 5.16
74 6.95 6.41 5.84 5.21
75 7.24 6.60 5.95 5.26
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES A
YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE (BLENDED 50%/50%
FEMALE/MALE) WITH MORTALITY IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS
TABLE ASSUMES A NET INVESTMENT RATE OF 3% PER ANNUM ASSUMING A 365 DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted age is Actual age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR NONQUALIFIED CONTRACTS
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
MALE
ADJUSTED FEMALE ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.18 3.27 3.35 3.42 3.47 3.51 3.54
50 3.24 3.36 3.47 3.58 3.66 3.73 3.78
55 3.29 3.43 3.59 3.74 3.87 3.99 4.08
60 3.32 3.49 3.69 3.89 4.09 4.28 4.43
65 3.35 3.54 3.76 4.02 4.31 4.59 4.84
70 3.36 3.57 3.82 4.13 4.49 4.89 5.29
75 3.37 3.59 3.86 4.21 4.63 5.14 5.71
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
ADJUSTED AGE OF PRIMARY MALE
AND SECONDARY FEMALE DOLLAR AMOUNT
45 3.37
50 3.60
55 3.88
60 4.26
65 4.79
70 5.52
75 6.54
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES A
YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE WITH MORTALITY
IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS TABLE ASSUMES A NET
INVESTMENT RATE OF 3% PER ANNUM ASSUMING A 365 DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
THESE TABLES WILL BE USED FOR QUALIFIED CONTRACTS
OPTION 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY
UNISEX
ADJUSTED UNISEX ADJUSTED AGE
AGE 45 50 55 60 65 70 75
45 3.19 3.26 3.33 3.38 3.41 3.44 3.46
50 3.26 3.37 3.46 3.54 3.61 3.66 3.69
55 3.33 3.46 3.60 3.72 3.83 3.91 3.98
60 3.38 3.54 3.72 3.90 4.07 4.22 4.33
65 3.41 3.61 3.83 4.07 4.32 4.56 4.75
70 3.44 3.66 3.91 4.22 4.56 4.91 5.23
75 3.46 3.69 3.98 4.33 4.75 5.23 5.74
OPTION 4 - JOINT AND LAST SURVIVOR LIFE ANNUITY
REDUCED BY 50% ON DEATH OF PRIMARY PAYEE
ADJUSTED AGE OF PRIMARY
AND SECONDARY UNISEX DOLLAR AMOUNT
45 3.34
50 3.55
55 3.82
60 4.19
65 4.70
70 5.40
75 6.40
DOLLAR AMOUNTS OF THE MONTHLY ANNUITY PAYMENTS IN THE ABOVE TABLE ASSUMES A
YEAR 2001 ISSUE, AND ARE BASED ON THE ANNUITY 2000 TABLE (BLENDED 50%/50%
FEMALE/MALE) WITH MORTALITY IMPROVEMENTS BASED ON PROJECTION SCALE G. THIS
TABLE ASSUMES A NET INVESTMENT RATE OF 3% PER ANNUM ASSUMING A 365 DAY YEAR.
Calendar Year in which 1st payment is due:
Adjusted age is actual age:
2001 2002-2005 2006-2010 2011-2015 2016-2020
minus 0 minus 1 minus 2 minus 3 minus 4
2021-2025 2026-2030 2031-2035 2036 AND LATER
minus 5 minus 6 minus 7 minus 8
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LIFE ANNUITY TABLES
GUARANTEED AMOUNT OF MONTHLY ANNUITY PAYMENTS
PURCHASED WITH EACH $1,000 OF PROCEEDS APPLIED
OPTION 5 - PAYMENTS FOR A FIXED PERIOD
MONTHLY MONTHLY
NUMBER OF PAYMENT NUMBER OF PAYMENT
YEARS AMOUNT YEARS AMOUNT
5 17.91 18 5.96
6 15.14 19 5.73
7 13.16 20 5.51
8 11.68 21 5.32
9 10.53 22 5.15
10 9.61 23 4.99
11 8.86 24 4.84
12 8.24 25 4.71
13 7.71 26 4.59
14 7.26 27 4.47
15 6.87 28 4.37
16 6.53 29 4.27
17 6.23 30 4.18
The dollar amounts of the monthly annuity payments for the fifth option are
based on a net investment rate of 3% per annum assuming a 365 day year.
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SINGLE PREMIUM INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
INCLUDING PRINCIPAL PROTECTION BENEFIT
LIFE ANNUITY COMMENCING AT MATURITY DATE
ELECTIVE OPTIONS NON-PARTICIPATING
ANNUITY PAYMENTS AND OTHER VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT.
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ENDORSEMENT
This endorsement is made a part of this contract in order to comply with
Section 403(b) of the Internal Revenue Code. This endorsement applies to
contributions transferred from a custodial account described in Section
403(b)(7) of the Internal Revenue Code. The following conditions restrictions
and limitations apply.
Withdrawals attributable to these transferred contributions may be paid only
upon or after attainment of age 59 1/2, separation from service, death, or
total and permanent disability (as defined in Internal Revenue Code Section 72
(m) (7)).
Withdrawals on account of hardship may be made only with respect to assets
held in the custodial account as of the close of the last year beginning
before January 1, 1989 and amounts contributed thereafter under a salary
reduction agreement but not to any income attributable to such contributions.
We intend to administer this contract so that it will maintain its
tax-deferred qualification under Internal Revenue Code Section 403 (b). If
temporary or final regulations require a change in the contract language in
order to maintain qualification, we will administer this contract in
accordance with the regulations.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ Xxxxxx X. Xxxxxxx
PRESIDENT
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INDIVIDUAL RETIREMENT ANNUITY QUALIFICATION RIDER
As requested by you, this Contract is amended as follows to qualify as an
Individual Retirement Annuity (IRA) under Section 408(b) of the Code of 1986,
as amended. The provisions of this rider supersede any contrary provisions in
the contract.
EXCLUSIVE BENEFIT
This Contract is established for the exclusive benefit of you or your
Beneficiaries.
OWNER
This contract belongs to the owner shown on the CONTRACT SPECIFICATIONS. As
owner, you have the sole power to exercise rights and receive benefits under
this contract during the Annuitant's lifetime. In order to maintain tax
qualification, this contract may not be sold, assigned, transferred,
discounted or pledged as collateral for a loan or as security for the
performance of an obligation or for any other purpose except as may be
required or permitted under applicable sections of the Code. We will
administer this contract only as an Individual Retirement Annuity.
You will be the recipient of all payments while the Annuitant is alive unless
you direct them to an alternative recipient under a Recorded payment
direction. An alternative recipient under a payment direction does not become
the owner. A payment direction is revocable by you at any time by Written
Request giving 30 days advance notice.
Joint ownership is not permitted under this contract.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This contract shall not be pledged or otherwise encumbered and it shall not be
sold, assigned, or otherwise transferred to any other person or entity other
than us. No loans shall be made under this contract.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
BENEFICIARY
The beneficiary is the party named in a Written Request. The Beneficiary
receives any remaining contractual benefits upon the death of the Annuitant.
You may change or add a Beneficiary by Written Request during the lifetime of
the Annuitant and while this contract continues. Once a change of Beneficiary
is Recorded by us, it will be effect as of the date of the request, subject to
any payments made or other actions taken by us before the recording.
If no Beneficiary has been named by you, or none survives when the Annuitant
dies, the interest of any Beneficiary will pass to the estate of the owner.
ANNUITANT/CONTINGENT ANNUITANT
The Annuitant is the individual shown on the CONTRACT SPECIFICATIONS on whose
life the first Annuity payment is made. The Annuitant may not be changed after
the Contract Date except as may be provided hereunder.
No contingent annuitant is permitted under this contract.
DEATH OF ANNUITANT/DEATH OF OWNER WITH ANNUITANT SURVIVING
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date. A death benefit is also payable under those
Settlement Options which provide for death benefits. We will pay the
Beneficiary the death benefit in a single sum as described below upon
receiving Due Proof of Death. A Beneficiary may request that a death benefit
payable under this contract be applied to a Settlement Option subject to the
provisions of this contract.
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MATURITY DATE
The Maturity Date is shown on the CONTRACT SPECIFICATIONS. This is the date on
which we will begin paying you the first of a series of Annuity or Income
payments in accordance with the Settlement Option elected by you. Annuity or
Income payments will begin under this contract on the Maturity Date unless the
contract has been fully surrendered or the proceeds have been paid to the
Beneficiary prior to that date. We may require proof that the Annuitant is
alive before Annuity payments are made. If no Maturity Date is specified, the
automatic Maturity Date will be the date when the Annuitant reaches age 70.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, you may change the Maturity Date by Written Request to
a later date with our consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, we will pay the amount
payable under this contract in one lump sum or in accordance with the Option
elected by you. While the Annuitant is alive you may change your Settlement
Option election by Written Request, but only before the Maturity Date. Once
Annuity or Income payments have commenced, no further election changes are
allowed.
If no election has been made on the Maturity Date and if the Annuitant is
living and has a spouse, we will pay to you the first of a series of monthly
Annuity payments based on the life of the Annuitant as primary payee and the
Annuitant's spouse as secondary payee in accordance with Annuity Option 4.
During the Annuitant's lifetime, if no election has been made and the
Annuitant has no spouse on the Maturity Date, we will pay to you the first of
a series of monthly Annuity payments based on the life of the Annuitant, in
accordance with Annuity Option 2, with 120 monthly payments assured.
LIMITATION ON PURCHASE PAYMENTS
Notwithstanding the provisions of the Contract and except in the case of a
rollover contribution (as permitted by Section 402(c), 403(a)(4), 403(b)(8),
or 408(d)(3) of the Code) or a contribution made in accordance with the terms
of a Simplified Employee Pension (SEP) program as described in Section 408(k)
of the Code, the total contributions shall not exceed the lesser of $2,000 or
100% of compensation for any taxable year. In the case of a spousal IRA, the
maximum contribution shall not exceed the lesser of $4,000 or 100% of
compensation, but no more than $2,000 can be contributed to either spouse's
IRA. In the case of a Simplified Employee Pension Plan qualifying under
Section 408(k), the annual contribution under the Contract may not exceed the
lesser of $30,000 or 15% of compensation. No contributions will be accepted
unless they are in cash.
The amount of purchase payments beyond the minimum purchase payment under this
Contract is not fixed. The minimum purchase payment must be received as a
rollover (see Section X). Payment of purchase payments beyond the first will
not be required to continue this contract.
Purchase payments after the first will not be required to continue this
Contract in force. We reserve the right, however, to terminate this Contract
when no purchase payments have been made for at least two consecutive years
and the Contract Value of the Contract is less than the termination amount of
$1,000 or the paid up Annuity benefit at maturity would be less than $20 per
month. If this Contract is terminated, we will pay you the Cash Surrender
Value, if any.
COMPENSATION
Compensation means wages, salaries, professional fees, or other amounts
derived from or received from personal service actually rendered (including,
but not limited to, commissions) and includes earned income as defined in Code
Section 401(c)(2). Compensation does not include amounts received as earnings
or profits from property or amounts not includable in gross income.
Compensation also does not include any amount received as a pension or Annuity
or as deferred compensation. The term compensation shall include any amount
includible in the individual's gross income under Code Section 71 with respect
to a divorce or separation instrument.
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DISTRIBUTION OF BENEFITS
Notwithstanding any provision of this contract to the contrary, the
distribution of an individual's interest shall be made in accordance with the
minimum distribution requirements of Section 408(a)(6) or Section 408(b)(3) of
the Code and the regulations thereunder, including the incidental death
benefit provisions of Section 1.401(a)(9)-2 of the proposed regulations, all
of which are herein incorporated by reference.
Your entire interest in the account must be distributed, or begin to be
distributed, by your required beginning date, which is the April 1 following
the calendar year in which you reach age 70 1/2. For each succeeding year, a
distribution must be made on or before December 31. By the required beginning
date you may elect to have the balance in the account distributed in one of
the following forms:
1. a single sum payment;
2. equal or substantially equal payments over your life;
3. equal or substantially equal payments over the lives of you and
your designated Beneficiary;
4. equal or substantially equal payments over a specified period
that may not be longer than your life expectancy;
5. equal or substantially equal payments over a specified period
that may not be longer than the joint life and last survivor
expectancy of you and your designated Beneficiary.
MINIMUM AMOUNTS TO BE DISTRIBUTED
If your interest is to be distributed in other than a lump sum or
substantially equal amounts as discussed above, then the amount to be
distributed each year, commencing at your required beginning date, must be at
least an amount equal to the quotient obtained by dividing your entire
interest by your life expectancy or the joint and survivor expectancy of you
and your designated Beneficiary.
Life expectancy and joint and last survivor expectancy are computed by use of
the return multiples contained in section 1.72-9 of the Income Tax
Regulations. For purposes of this computation, the owner's life expectancy may
be recalculated no more frequently than annually; however, the life expectancy
of a non-spouse Beneficiary may not be recalculated.
If your designated Beneficiary is not your spouse, then the minimum amount
required to be distributed shall be the greater of the amount determined
above, or the amount determined under the incidental benefit rules set forth
in Treasury Regulation Section 1.401(a)(9)-2.
DEATH
If you die before your entire interest is distributed, the entire remaining
interest will be distributed as follows:
1. If you die on or after distributions have begun under the
DISTRIBUTION OF BENEFITS section, the entire remaining interest
must be distributed at least as rapidly as provided under the
DISTRIBUTION OF BENEFITS section.
2. If you die before distributions have begun under the DISTRIBUTION
OF BENEFITS section, the entire remaining interest must be
distributed as elected by you, or, if you have not so elected, as
elected by the Beneficiary or Beneficiaries, as follows:
a) by December 31st of the year containing the fifth
anniversary of your death; or
b) in equal or substantially equal payments over the life or
life expectancy of the designated Beneficiary or
Beneficiaries starting by December 31st of the year
following the year of your death. If the Beneficiary is
your surviving spouse and he or she elects to treat this
contract as his or her own, this distribution may be
deferred until December 31st of the year you would have
turned age 70 1/2.
If your surviving spouse dies before distributions begin, the restrictions in
paragraphs 2 (a) and (b) above shall apply.
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Unless otherwise elected by you prior to the commencement of distributions
under the DISTRIBUTION OF BENEFITS section, or, if applicable, by the
surviving spouse where you die before distributions have commenced, life
expectancies of you or your spousal Beneficiary shall be recalculated annually
for purposes of distributions under the DISTRIBUTION OF BENEFITS section and
the DEATH section. An election not to recalculate shall be irrevocable and
shall apply to all subsequent years. The life expectancy of a non-spouse
Beneficiary shall not be recalculated.
ALTERNATIVE CALCULATION METHOD
An individual may satisfy the minimum distribution requirements under section
408(a)(6) and 408(b)(3) of the Code by receiving a distribution for one IRA
that is equal to the amount required to satisfy the minimum distribution
requirements for two or more IRAs. For this purpose, the owner of two or more
IRAs may use the alternative method described in Notice 88-38, 1988-1 C.B.
524, to satisfy the minimum distribution requirements described above.
NONFORFEITABILITY
Your entire interest in this Contract is nonforfeitable.
ROLLOVERS
A. Subject to subparagraphs (B) and (C) hereof, and the limitations
stated in the Contract, you may transfer to this Contract your
interest in any of the following:
1. the entire amount, or any portion thereof, under any
other individual retirement account or individual
retirement Xxxxxxx qualified under Section 408 of the
Code;
2. the entire amount, or any portion thereof, excluding
nondeductible employee voluntary contributions, under a
trust described in Section 401(a) of the Code which is
exempt from tax under Section 501(a) of the Code or under
a qualified annuity plan described in Section 403(a) of
the Code.
3. the entire amount or any portion thereof, excluding
nondeductible employee voluntary contributions, to which
you are entitled under a tax sheltered annuity described
in Section 403(b) of the Code.
Distributions you roll over from retirement plans or arrangements
described in A.2. and A.3. above to this contract must be completed
by means of a direct transfer or rollover in accordance with Code
Section 401(a)(31) in order to avoid the mandatory 20% income tax
withholding from the distribution and a possible 10% additional tax
penalty under Code Section 72(t). You may replace amounts withheld
from other sources to complete the full rollover, but the 10% penalty
may continue to be due if you do not specify that the transfer of the
distribution be conducted by direct transfer or rollover.
B. You shall not make a rollover under subparagraph (A)(1) hereof
during the 12 month period commencing on the date you last made a
rollover contribution of the type described in subparagraph
(A)(1).
C. We must receive any amount which qualifies for a rollover within
60 days after you receive the distribution.
DISTRIBUTIONS PRIOR TO AGE 59 1/2
Except in the event of your death, disability or attainment of age 59 1/2, we
shall receive from you a declaration of your intention as to the disposition
of the amounts distributed before making any distribution from this Contract.
REPORTS
As the issuer of this Contract, we will furnish reports concerning the status
of the Annuity at least annually.
DISABILITY PAYMENTS
If the Contract contains a Rider for waiver of premium and disability payment
benefits, any disability payments provided for in the CONTRACT SPECIFICATIONS
will be applied as purchase payments under the contract.
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AMENDMENT
This Contract may be amended by us at any time to maintain its qualified
status under Section 408(b) of the Code, following all regulatory approvals.
Any such amendment may be made retroactively effective if necessary or
appropriate to conform to the requirements of the Code (or any State law
granting IRA tax benefits).
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ XXXXXX X XXXXXXX
President
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TAX-SHELTERED ANNUITY QUALIFICATION RIDER
This rider is made a part of this contract in order to comply with Section
403(b) of the Code. The provisions in this contract supersede any contrary
provisions in the contract. The following conditions, restrictions and
limitations apply.
OWNER
This contract belongs to the owner shown on the CONTRACT SPECIFICATIONS. As
owner, you have the sole power to exercise rights and receive benefits under
this contract during the Annuitant's lifetime. In order to maintain tax
qualification, this contract may not be sold, assigned, transferred,
discounted or pledged as collateral for a loan or as security for the
performance of an obligation or for any other purpose except as may be
required or permitted under applicable sections of the Code. We will
administer this contract only as a Tax Qualified Contract under Section 403(b)
of the Code.
You will be the recipient of all payments while the Annuitant is alive unless
you direct them to an alternative recipient under a Recorded payment
direction. An alternative recipient under a payment direction does not become
the owner. A payment direction is revocable by you at any time by Written
Request giving 30 days advance notice.
Joint ownership is not permitted under this contract.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This contract shall not be pledged or otherwise encumbered and it shall not be
sold, assigned, pledged as collateral for a loan, or otherwise transferred to
any other person or entity other than us.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
BENEFICIARY
The beneficiary is the party named in a Written Request. The Beneficiary
receives any remaining contractual benefits upon the death of the Annuitant.
You may change or add a Beneficiary by Written Request during the lifetime of
the Annuitant and while this contract continues, subject to the Annuitant's
provided in this rider. Once a change of Beneficiary is Recorded by us, it
will be effect as of the date of the request, subject to any payments made or
other actions taken by us before the recording.
If no Beneficiary has been named by you, or none survives when the Annuitant
dies, the interest of any Beneficiary will pass:
a) to the estate of the owner; or
b) to the trustee or plan administrator of a trusteed Tax Qualified
plan contract for further distribution in accordance with the
plan.
ANNUITANT/CONTINGENT ANNUITANT
The Annuitant is the individual shown on the CONTRACT SPECIFICATIONS on whose
life the first Annuity payment is made. The Annuitant may not be changed after
the Contract Date except as may be provided hereunder.
No contingent annuitant is permitted under this contract.
DEATH OF ANNUITANT/DEATH OF OWNER WITH ANNUITANT SURVIVING
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date. A death benefit is also payable under those
Settlement Options which provide for death benefits. We will pay the
Beneficiary the death benefit in a single sum as described below upon
receiving Due Proof of Death. A Beneficiary may request that a death benefit
payable under this contract be applied to a Settlement Option subject to the
provisions of this contract.
MATURITY DATE
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The Maturity Date is shown on the CONTRACT SPECIFICATIONS. This is the date on
which we will begin paying you the first of a series of Annuity or Income
payments in accordance with the Settlement Option elected by you. Annuity or
Income payments will begin under this contract on the Maturity Date unless the
contract has been fully surrendered or the proceeds have been paid to the
Beneficiary prior to that date. We may require proof that the Annuitant is
alive before Annuity payments are made. If no Maturity Date is specified, the
automatic Maturity Date will be the date when the Annuitant reaches age 70.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, you may change the Maturity Date by Written Request to
a later date with our consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, we will pay the amount
payable under this contract in one lump sum or in accordance with the Option
elected by you. While the Annuitant is alive you may change your Settlement
Option election by Written Request, but only before the Maturity Date. Once
Annuity or Income payments have commenced, no further election changes are
allowed.
If no election has been made on the Maturity Date and if the Annuitant is
living and has a spouse, we will pay to you the first of a series of monthly
Annuity payments based on the life of the Annuitant as primary payee and the
Annuitant's spouse as secondary payee in accordance with Annuity Option 4.
During the Annuitant's lifetime, if no election has been made and the
Annuitant has no spouse on the Maturity Date, we will pay to you the first of
a series of monthly Annuity payments based on the life of the Annuitant, in
accordance with Annuity Option 2, with 120 monthly payments assured.
ELECTIVE DEFERRAL CONTRIBUTION LIMITS
In order to meet the qualification requirements of Code Section 403(b),
elective deferral contributions may not exceed the limitations in effect under
Code Section 402(g).
This rule is an individual limitation that applies to all elective deferral
plans, contracts or arrangements in the aggregate.
WITHDRAWAL RESTRICTIONS
To qualify as a contract which can defer compensation under a Code Section
403(b) plan or arrangement, the withdrawal restrictions under Code Section
403(b)(11) must be met.
Withdrawals attributable to contributions made pursuant to a salary reduction
agreement may be paid only upon or after attainment of age 59 1/2, separation
from service, death, total or permanent disability (as defined in Code Section
72(m)(7)) or in the case of hardship (as defined in the Treasury Regulations).
The hardship exception applies only to the salary reduction contributions and
not to any income attributable to such contribution.
These withdrawal restrictions apply to years beginning after December 31, 1988
but only with respect to assets other than those assets held as of the close
of the last year beginning before January 1, 1989.
If contributions attributable to a custodial account described in Section
403(b)(7) of the Code are transferred to this contract, the following
conditions, restrictions, and limitations apply:
Withdrawals attributable to these transferred contributions may be
paid only upon or after attainment of age 59 1/2, separation from
service, death, or total and permanent disability (as defined in Code
Section 72(m)(7)).
Withdrawals on account of hardship may be made only with respect to
assets attributable to a custodial account as of the close of the
last year beginning before January 1, 1989 and amounts contributed
thereafter under a salary reduction agreement but not to any income
attributable to such conditions.
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ELIGIBLE ROLLOVERS
To the extent you are otherwise eligible for a distribution under this
contract, and provided the distribution is an eligible rollover distribution,
you may elect to have such distribution or a portion of it paid directly to an
eligible retirement plan. You must specify the eligible retirement plan to
which such distribution is to be paid in a form and at such time acceptable to
us. Such distribution shall be made as of a direct transfer to the eligible
retirement plan so specified. Contract surrender penalties may apply to all
rollovers.
Previously taxed amounts in this contract are not eligible for rollover.
Amounts that are rolled over are taxed generally until later distributed. An
eligible rollover distribution includes generally any taxable distribution or
portion thereof from this contract except:
a. any distribution which is one of a series of substantially
equal periodic payments made not less frequently than
annually and made to you for life or life expectancy or to
you or your joint life beneficiary for joint lives or life
expectancies, or for a specified period of 10 years or more,
or
b. any distribution which is a required distribution as
described below under "MANDATORY DISTRIBUTION REQUIREMENTS."
An eligible retirement plan includes an individual retirement annuity or
account described in Code Section 408. It also includes a tax sheltered
annuity plan or arrangement under Code Section 403(b), provided it accepts
eligible rollovers and is a defined contribution plan.
If you receive a distribution that is eligible for rollover, but you receive
the check directly, then mandatory income tax withholding will be taken from
the distribution. You may roll over the balance to an individual retirement
annuity or account within 60 days of receipt, and may make up the amount
withheld from other sources in the rollover in order to roll over the maximum
without possible early distribution tax penalty on the amount of the tax
withholding.
MANDATORY DISTRIBUTION REQUIREMENTS
In order to meet the qualification requirements of Code Section 403(b), all
plans must meet the required mandatory distribution rules in Code Section
401(a)(9).
Code Section 401(a)(9) states that a plan will not be qualified unless the
entire interest of each employee is distributed to such employee not later
than the "required beginning date" or over the life or life expectancy of such
employee or over the lives or joint life expectancy of such employee and a
designated Beneficiary. Generally, the "required beginning date" means April 1
of the calendar year following the later of (1) the calendar year in which the
employee attains age 70 1/2, or (2) the calendar year in which the employee
retires, except that in the event that the employee is a 5% owner, the
"required beginning date" is April 1 of the calendar year in which the
employee attains age 70 1/2.
If the employee dies after the distribution has begun but before his/her
entire interest has been distributed, the remaining interest must be paid out
at least as rapidly as it was being paid out under the method of payment in
effect at the time of death. If the employee dies before the distribution of
his/her entire interest has begun, the entire interest must be distributed
within five years after the employee's death or an Annuity payable over no
longer than life or life expectancy must be distributed to an electing
designated Beneficiary starting within one year of the employee's death. A
spousal designated Beneficiary may elect to defer distributions until the
employee would have attained the age of 70 1/2.
ADMINISTRATIVE COMPLIANCE
If changes in the Code and related law, regulations and rulings require a
distribution greater than described above in order to keep this Annuity
qualified under the Code, we will administer the contract in accordance with
these laws, regulations and rulings. We will provide you with a revised rider
describing any necessary changes, following all regulatory approvals.
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AMENDMENT
Notwithstanding any provision in this contract or in the 403(b) plan of which
this contract is a part, we reserve the right to amend or modify the contract
or any rider or any endorsement thereto, to the extent necessary to comply
with any law, regulation or other requirement in order to establish or
maintain the qualified status of such plan. Any such amendment or modification
may be made retroactively to conform to the requirements of such law,
regulation or other requirement.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ XXXXXX X XXXXXXX
President
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PENSION/PROFIT SHARING PLAN QUALIFICATION RIDER
If the owner of this contract requested that it be issued to comply with
Section 401(a) of the Code, the following conditions, restrictions and
limitations apply to this contract. The contract shall constitute an asset of
the qualified pension or profit-sharing plan established under Code Section
401(a) and the regulations thereunder and the contract shall be subject to the
provisions, terms and conditions of such qualified plan. The amounts held
under this contract will be used for the exclusive benefit of the employees
and their beneficiaries. The provisions in this rider supersede any contrary
provisions in the contract.
OWNER
This contract belongs to the owner shown on the CONTRACT SPECIFICATIONS. As
owner, you have the sole power to exercise rights and receive benefits under
this contract during the Annuitant's lifetime. In order to maintain tax
qualification, this contract may not be sold, assigned, transferred,
discounted or pledged as collateral for a loan or as security for the
performance of an obligation or for any other purpose except as may be
required or permitted under applicable sections of the Code. We will
administer this contract only as a Tax Qualified Contract.
You will be the recipient of all payments while the Annuitant is alive unless
you direct them to an alternative recipient under a Recorded payment
direction. An alternative recipient under a payment direction does not become
the owner. A payment direction is revocable by you at any time by Written
Request giving 30 days advance notice.
Joint ownership is not permitted under this contract.
TRANSFER OF OWNERSHIP ASSIGNMENT
This contract shall not be pledged or otherwise encumbered and it shall not be
sold, assigned, or otherwise transferred to any other person or entity other
than us.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
BENEFICIARY
The beneficiary is the party named in a Written Request. The Beneficiary
receives any remaining contractual benefits upon the death of the Annuitant.
You may change or add a Beneficiary by Written Request during the lifetime of
the Annuitant and while this contract continues, subject to the limitations
provided in this rider. Once a change of Beneficiary is Recorded by us, it
will be effect as of the date of the request, subject to any payments made or
other actions taken by us before the recording.
If no Beneficiary has been named by you, or none survives when the Annuitant
dies, the interest of any Beneficiary will pass:
a) to the estate of the owner; or
b) to the trustee or plan administrator of a trusteed Tax Qualified plan
contract for further distribution in accordance with the plan.
ANNUITANT/CONTINGENT ANNUITANT
The Annuitant is the individual shown on the CONTRACT SPECIFICATIONS on whose
life the first Annuity payment is made. The Annuitant may not be changed after
the Contract Date except as may be provided hereunder.
No contingent annuitant is permitted under this contract.
DEATH OF ANNUITANT/DEATH OF OWNER WITH ANNUITANT SURVIVING
A death benefit is payable to the Beneficiary upon the death of the Annuitant
before the Maturity Date. A death benefit is also payable under those
Settlement Options which provide for death benefits. We will pay the
Beneficiary the death benefit in a single sum as described below upon
receiving Due Proof of Death. A Beneficiary may request that a death benefit
payable under this contract be applied to a Settlement Option subject to the
provisions of this contract.
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MATURITY DATE
The Maturity Date is shown on the CONTRACT SPECIFICATIONS. This is the date on
which we will begin paying you the first of a series of Annuity or Income
payments in accordance with the Settlement Option elected by you. Annuity or
Income payments will begin under this contract on the Maturity Date unless the
contract has been fully surrendered or the proceeds have been paid to the
Beneficiary prior to that date. We may require proof that the Annuitant is
alive before Annuity payments are made. If no Maturity Date is specified, the
automatic Maturity Date will be the date when the Annuitant reaches age 70.
Additionally, to the extent permitted by law, at least 30 days before the
original Maturity Date, you may change the Maturity Date by Written Request to
a later date with our consent.
ELECTION OF SETTLEMENT OPTIONS
On the Maturity Date, or other agreed upon date, we will pay the amount
payable under this contract in one lump sum or in accordance with the Option
elected by you. While the Annuitant is alive you may change your Settlement
Option election by Written Request, but only before the Maturity Date. Once
Annuity or Income payments have commenced, no further election changes are
allowed.
If no election has been made on the Maturity Date and if the Annuitant is
living and has a spouse, we will pay to you the first of a series of monthly
Annuity payments based on the life of the Annuitant as primary payee and the
Annuitant's spouse as secondary payee in accordance with Annuity Option 4.
During the Annuitant's lifetime, if no election has been made and the
Annuitant has no spouse on the Maturity Date, we will pay to you the first of
a series of monthly Annuity payments based on the life of the Annuitant, in
accordance with Annuity Option 2, with 120 monthly payments assured.
MANDATORY DISTRIBUTION RESTRICTIONS
In order to meet the qualification requirements of Code Section 401(a), all
plans must meet the required mandatory distribution rules in Code Section
401(a)(9).
Code Section 401(a)(9) states that a plan will not be qualified unless the
entire interest of each employee is distributed to such employee not later
than the "required beginning date" or over no longer than the life or life
expectancy of such employee or the lives or joint life expectancy of such
employee and a designated Beneficiary. Generally, the "required beginning
date" means April 1 of the calendar year following the later of (1) the
calendar year in which the employee attains age 70 1/2, or (2) the calendar
year in which the employee retires, except that in the event the employee is a
5% owner, the "required beginning date" is April 1 of the calendar year
following the calendar year in which the employee attains age 70 1/2.
If the employee dies before his/her entire interest has been distributed, the
remaining interest must be paid out at least as rapidly as under the method of
payment in effect at the time of death. If the employee dies before the
distribution of his/her entire interest has begun, the entire interest must be
distributed within five years after the employee's death or an Annuity payable
over no longer than life or life expectancy must be distributed to an electing
designated Beneficiary starting within one year of the employee's death. A
spousal designated Beneficiary may elect to defer distributions until the
employee would have attained the age of 70 1/2.
ANNUITIES DISTRIBUTED UNDER QUALIFIED PLANS
If the applicant for this contract requested that it be issued to comply with
Section 401(a) of the Code, and this contract has subsequently been
transferred to the Annuitant, the following conditions, restrictions and
limitations apply to this contract in addition to the above.
Spousal Consent
Death Benefit - If the Annuitant dies while the contract continues and the
Annuitant has a spouse at the time of the Annuitant's death, we will pay the
death benefit to a person other than the current spouse of the Annuitant only
if proof of spousal consent, which meets the requirements of Section 417 of
the Code, is furnished to us.
If the Beneficiary is not the current spouse and such spousal consent is not
furnished, we will pay 50% of the death benefit to the current spouse. We will
pay the balance of the death benefit to the Beneficiary.
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Cash Surrender - Before the due date of the first Annuity or Income Payment,
1) if you do not have a spouse and without the consent of any Beneficiary; or,
2) if you do have a current spouse then only with the written consent of your
spouse, as required by Section 417 of the Code; we will pay to you all or any
portion of the Cash Surrender Value of the contract upon receipt of your
Written Request for it.
Settlement Option - If the Annuitant is living on the Maturity Date, payment
must be made in accordance with Option 4 under ANNUITY OPTIONS unless you
elect another form of Annuity Option and furnish us a qualified election which
meets the requirements of Section 417 of the Code.
AMENDMENT
Notwithstanding any provision to the contrary in this contract or the
qualified pension or profit-sharing plan of which this contract is a part, we
reserve the right to amend or modify the contract or any rider or endorsement
thereto, to the extent necessary to comply with any law, regulation or other
requirement in order to establish or maintain the qualified status of the
plan. Any such amendment or modification may be made retroactively effective
if necessary or appropriate to conform to the conditions imposed by such law,
regulation or other requirement.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ XXXXXX X XXXXXXX
President
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TAX LAW QUALIFICATION RIDER
This rider is made a part of this contract as its Contract Date in order to
comply with the tax rules under Section 72(s) of the Code for required
distributions upon the death of any contract owner. The provisions in this
rider supersede any contrary provisions in the contract. The following
conditions, restrictions and limitations must apply to maintain the tax
qualified status of your Annuity.
REQUIRED DISTRIBUTIONS WHERE OWNER AND ANNUITANT DIE SIMULTANEOUSLY
If you are the owner and the Annuitant or you are the owner and you die
simultaneously with the Annuitant before payment of any Annuity or Income
Option begins, an amount equal to the Death Benefit will be distributed within
five years of your death to the contract Beneficiary unless:
a. the Beneficiary elects by Written Request to have the
proceeds distributed over the Beneficiary's life or over a
period not extending beyond life expectancy, and the
payments begin within one year of your death; or
b. the sole Beneficiary is your spouse who elects by Written
Request to continue the contract as the owner and Annuitant.
If you are the owner and the Annuitant or you are the owner and you die
simultaneously with the Annuitant after an Annuity or Income option begins but
before your entire interest has been distributed, the remaining proceeds of
the contract will be distributed at least as rapidly as they were being
distributed under the method of payment in effect at the time of your death.
The death of the first joint owner triggers these distribution requirements.
NON-NATURAL OWNER HOLDING FOR NATURAL PERSONS
The above rules also apply if you are not an individual and the primary
Annuitant dies before payment of an Annuity or Income Option begins. Payments
will be made to the Beneficiary. The primary Annuitant is the first-named
Xxxxxxxxx and the individual who is of primary importance in affecting the
timing or amount of payments under the contract.
If you are not an individual and the primary annuitant dies after payment of
an Annuity or Income option begins, the remaining proceeds of the contract
will be distributed at least as rapidly as they were being distributed under
the method of payment in effect at the time of the primary Annuitant's death.
REQUIRED DISTRIBUTIONS WHERE OWNER AND ANNUITANT DO NOT DIE SIMULTANEOUSLY
If you are the owner but not the Annuitant, and you die before the Annuitant
and before payment of an Annuity or Income Option begins, an amount equal to
the Death Benefit will be distributed within five years of your death to the
joint owner surviving you. In this circumstance, the joint owner is the
"designated beneficiary" referred to in Section 72(s) of the Code, and his or
her rights preempt those of the Beneficiary named in a Written Request. The
distribution may be made over a period that exceeds five years from your death
or postponed by your spouse if:
a. the joint owner elects by Written Request to have the
proceeds distributed over his or her life or over a period
not extending beyond life expectancy, and the payments begin
within one year of your death; or
b. the sole joint owner is your spouse, who elects by Written
Request to continue the contract as owner.
The joint owner is determined by contract designation. If there is no joint
owner or Beneficiary surviving you, ownership of this contract passes to your
estate. The estate or the individual taking the contract benefits through your
estate must take complete distribution within five years of your death.
If you are the owner but not the Annuitant, and you die after payment of an
Annuity or Income Option begins, the remaining proceeds of the contract will
be distributed at least as rapidly as they were being distributed under the
method of payment in effect at the time of your death.
The death of the first joint owner triggers these distribution requirements.
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ADMINISTRATIVE COMPLIANCE
If the Code and related law, regulations and rulings require a distribution
other than described above in order to keep this Annuity contract qualified
under the Code, we will administer the contract in accordance with these laws,
regulations, and rulings. We will provide you with a revised rider describing
any necessary changes, following all regulatory approvals.
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ XXXXXX X XXXXXXX
President
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XXXX INDIVIDUAL RETIREMENT ANNUITY QUALIFICATION RIDER
As requested by you, this contract or certificate (hereinafter collectively
referred to as "contract") is amended as follows to qualify as a Xxxx
Individual Retirement Annuity (IRA) under Section 408A of the Code of 1986, as
amended. Notwithstanding any other specific provisions in the contract to the
contrary, the contract is amended to restrict the rights of the Owner or
Annuitant and any Beneficiary, and to limit contributions as follows:
EXCLUSIVE BENEFIT
This contract is established for the exclusive benefit of the Owner and the
Owner's Beneficiaries.
TRANSFER OF OWNERSHIP/ASSIGNMENT
This Owner may not transfer ownership of the contract, sell the contract, or
assign or pledge the contract as collateral for a loan or as security for the
performance of an obligation or for any other purpose, to any person other
than the Company or a former spouse of the Owner under a divorce decree or
under a written instrument incident to that divorce.
CREDITOR CLAIMS
To the extent permitted by law, no right or benefit of the owner, Annuitant or
Beneficiary under this contract shall be subject to the claims or creditors or
any legal process.
LIMITATION ON PURCHASE PAYMENTS
The contract will accept contributions only as follows:
Contributions to this contract must be paid in cash and, except in the case of
a trustee-to-trustee transfer from another Xxxx XXX, or in the case of a
qualified rollover contribution, may not exceed the excess of the Owner's
contribution limit for the taxable year over the aggregate contributions made
during the taxable year to all other Xxxx IRAs and IRAs held by the Owner.
Contributions may be made without respect to the age of the Owner.
The contribution limit for the taxable year is either (1) the lesser of $2,000
or 100% of compensation of the Owner for the taxable year, or (2) where the
Owner files a joint return and receives less compensation for the taxable year
than the Owner's spouse, the lesser of $2,000 or 100% of the compensation of
the Owner and the Owner's spouse for the taxable year less the spouse's
contribution to a Xxxx XXX or IRA for the taxable year, if any.
When the Owner's adjusted gross income (AGI) exceeds the applicable dollar
limit (ADL; see description below), the annual contribution limit is reduced
by the following amount -
Annual
Contribution Limit x Owner's AGI-ADL
----------------
$15,000 ($10,000 if the Owner is married)
For purposes of this section, AGI does not include any amount included in
gross income as a result of a rollover of an IRA to a Xxxx XXX and is reduced
by any deduction under section 219 of the Code.
The ADL is $150,000 for an Owner filing a joint return, $95,000 for an Owner
filing a single return, and $-0- for a married Owner filing a separate return.
ROLLOVER CONTRIBUTION
A qualified rollover contribution described in section 408A(c) can be made
only from (1) another Xxxx XXX or (2) another IRA, which is not a Xxxx XXX,
and can be made from an IRA other than a Xxxx XXX only if the Owner's adjusted
gross income for the taxable year of the rollover does not exceed $100,000.
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COMPENSATION
For purposes of this section, compensation means wages, salaries, professional
fees, or other amounts derived from or received for personal service actually
rendered (including, but not limited to commissions paid salespersons,
compensation for services on the basis of a percentage of profits, commissions
on insurance premiums, tips, and bonuses) and includes earned income, as
defined in the section 401(c)(2) (reduced by the deduction the self-employed
individual takes for contributions made to a self-employed retirement plan).
For purposes of this definition, section 401(c)(2) shall be applied as if the
term trade or business for purposes of section 1402 included service described
in subsection (c)(6). Compensation does not include amounts derived from or
received as earnings or profits from property (including but not limited to,
interest and dividends) or amounts not includible in gross income.
Compensation also does not include any amount received as a pension or annuity
or as deferred compensation. The term "compensation" shall include any amount
includible in the Owner's gross income under section 71 with respect to a
divorce or separation instrument described in subparagraph (A) of section
71(b)(2).
DISTRIBUTION REQUIREMENTS
The Owner's entire interest will be distributed in accordance with one of the
following provisions, as elected:
A. (1) The Owner's entire interest will be paid by December 31 following the
fifth anniversary of the Owner's death.
(2) If any portion of the Owner's interest is payable to a designated
Beneficiary and such Beneficiary has not elected (1) above, then the
entire interest which is payable to the Beneficiary will be
distributed in substantially equal installments over a period not
exceeding the life or life expectancy of the designated Beneficiary,
commencing by December 31 following the first anniversary of the
Owner's death. The designated beneficiary may elect at any time to
receive greater payments if otherwise permitted under the terms of
the contract.
(3) In applying the requirements of A(2) to any portion of the Owner's
interest which is payable to the Owner's surviving spouse, the date
on which the payments must commence is the later of (a) December 31
following the date the deceased Owner would have attained age 70 1/2
or (b) December 31 following the first anniversary of the Owner's
death.
(4) If the designated Beneficiary of the Owner is the Owner's surviving
spouse, the spouse may treat the contract as the spouse's own Xxxx
XXX. This election will be deemed to have been made if the surviving
spouse makes a rollover or other contribution into this contract or
if the surviving spouse has failed to satisfy one or more
requirements described in (1) or (2). If the Owner's surviving spouse
dies before distributions are required to begin under this section,
the Owner's surviving spouse will be treated as having elected to
made the Xxxx XXX his or her own Xxxx XXX.
B. For purposes of this section, life expectancy will be computed by use of
the return of multiples specified in Tables V or VI of Section 1.72-9 of
the Income Tax Regulations based on the attained age of such Beneficiary
during the calendar year in which distributions are required to commence
pursuant to this section. Payments for any subsequent calendar year will be
based on this life expectancy reduced by one for each calendar year which
has elapsed since the calendar year life expectancy was first calculated. A
designated beneficiary of the Owner who is the Owner's surviving spouse may
elect, prior to the time that payments have begun to him or her, to
redetermined life expectancy each year based on the beneficiary's attained
age in each such year.
REPORTS
As the issuer of this contract, we will furnish reports concerning the status
of the Annuity at least annually.
AMENDMENT
This contract may be amended by us at any time to maintain its qualified
status as a Xxxx XXX. Any such amendment may be made retroactively effective
if necessary or appropriate to conform to the requirements of the Code (or any
State law granting IRA tax benefits).
THE TRAVELERS LIFE AND ANNUITY COMPANY
/s/ XXXXXX X XXXXXXX
PRESIDENT
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